Memory impairment among people who are homeless: A systematic review

Cognitive impairment may interfere with an individual's ability to function independently in the community and may increase the risk of becoming and remaining homeless. The purpose of this study was to systematically review the literature on memory deficits among people who are homeless in order to gain a better understanding of its nature, causes and prevalence. Studies that measured memory functioning as an outcome among a sample of homeless persons were included. Data on sampling, outcome measures, facet of memory explored and prevalence of memory impairment were extracted from all selected research studies. Included studies were evaluated using a critical appraisal process targetted for reviewing prevalance studies. Eleven studies were included in the review. Verbal memory was the most commonly studied facet of memory. Potential contributing factors to memory deficits among persons who are homeless were explored in seven studies. Memory deficits were common among the samples of homeless persons studied. However, there was a great deal of variation in the methodology and quality of the included studies. Conceptualisations of “homelessness” also differed across studies. There is a need for more controlled research using validated neuropsychological tools to evaluate memory impairment among people who are homeless.     

A systematic review of cognitive functioning among young people who have experienced homelessness,foster care,or poverty

Young people who have experienced homelessness, foster care, or poverty are among the most disadvantaged in society. This review examines whether young people who have these experiences differ from their non-disadvantaged peers with respect to their cognitive skills and abilities, and whether cognitive profiles differ between these three groups. Three electronic databases were systematically searched for articles published between 1 January 1995 and 1 February 2015 on cognitive functioning among young people aged 15 to 24 years who have experienced homelessness, foster care, or poverty. Articles were screened using pre-determined inclusion criteria, then the data were extracted, and its quality assessed. A total of 31 studies were included. Compared to non-disadvantaged youth or published norms, cognitive performance was generally found to be impaired in young people who had experienced homelessness, foster care, or poverty. A common area of difficulty across all groups is working memory. General cognitive functioning, attention, and executive function deficits are shared by the homeless and poverty groups. Creativity emerges as a potential strength for homeless young people. The cognitive functioning of young people with experiences of impermanent housing and poverty has been relatively neglected and more research is needed to further establish cognitive profiles and replicate the findings reviewed here. As some aspects of cognitive functioning may show improvement with training, these could represent a target for intervention.     

A systematic review of interventions for adults who stutter

PurposeTo examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter.MethodsFive electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded.ResultsFive RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50–57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don’t stutter. The study on tDCS reduced stuttering frequency by 22–27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions.ConclusionSpeech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.     

Why young people do not kill themselves: the reasons for living inventory for adolescents

Assessed the reliability, validity, and predictive power of a new measure, the Reasons for Living Inventory for Adolescents (RFL-A; Osman et al., 1998). A group of 206 (101 boys and 105 girls) adolescent psychiatric inpatients completed the RFL-A, Minnesota Multiphasic Personality Inventory for Adolescents (Butcher et al., 1992), and a packet of self-report measures. Additional information about the patients including diagnosis and suicide status were obtained from their medical records. It was determined that the RFL-A is a valid and reliable measure of adolescent suicide risk potential. Additionally, the RFL-A possesses better predictive power than the Beck Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). A discussion of the clinical and research utility of the RFL-A is included along with suggestions for future research.     

An exploration of an integrated counselling and coaching approach with distressed young people

This mixed methods study explored the effectiveness and experience of an integrated counselling and coaching approach with young people. An effectiveness study allocated 80 young people aged between 13 and 25 years from four Youth Information Advice and Counselling Services centres in England to two groups: an integrated counselling and coaching group, based on the Personal Consultancy (PC) model, and a humanistic counselling group. Self-report measures of distress were administered at baseline and endpoint. Findings of the quantitative analysis showed that although baseline distress levels between groups were equivalent, post-intervention levels were significantly lower in the integrated group. Interpretative Phenomenological Analysis of qualitative experiences from five young people from the integrated group explored possible reasons for these results. Five master themes emerged: making sense of past, present and/or future, developing a sense of agency, management of affect, enhancing interpersonal relationships and development of self. Findings indicated that young people responded well to the integrated treatment; attending to intra-psychic issues alongside their developmental challenges seemed to have a beneficial effect on their sense of agency in particular. In conclusion, PC may be an effective means of reducing distress in young people.     

Mental health practitioners' attitudes towards transgender people: A systematic review of the literature

Background: A systematic review was conducted to critically evaluate and synthesize literature investigating mental health practitioners' attitudes towards transgender people.

Objective: Three primary objectives were outlined; first, establish whether overall attitudes are positive or negative. Second, explore whether training, education or experience influences attitudes and finally, examine participant demographics in relation to attitude trends.

Method: A systematic electronic search was carried out in March 2017 using Medline, PsycINFO, PsycArticles, CINAHL, ASSIA, and Web of Science electronic databases. Manual citation and ancestral searches were conducted on identified papers. Qualitative, quantitative and mixed method studies were eligible for inclusion. A total of 13 papers of mixed quality were identified.

Results: Existing literature is limited to cross-sectional, quantitative data and fails to investigate differences between implicit and explicit attitudes. Small to moderate convenience samples reduce the generalizability of data. Overall attitudes were positive although negative attitudes were more frequent in male, Caucasian, heterosexual, religious, conservative mental health professionals.

Conclusions: Refined scales are needed to address the unique heterogeneity within transgender populations. Future research should focus on how attitudes impact care provided and employ longitudinal designs to explore the sustainability of targeted attitudinal training.     

Counselling children and young people: A review of the evidence for its effectiveness

This paper summarises and presents the results of a BACP commissioned systematic scoping review on the research evidence on counselling children and young people. The methodology was based on a structured, hierarchical, systematic approach to searching and reviewing the research literature. Inclusion criteria defined the scope of the review in relation to a range of issues in counselling children and young people: behavioural problems and conduct disorders; emotional problems including anxiety, depression and post‐traumatic stress; medical illness; school‐related issues; self‐harming practices and sexual abuse. Four groups of counselling approaches were examined: cognitive‐behavioural; psychoanalytic; humanistic; and creative therapies. The findings indicate that the four therapeutic approaches are effective to a greater or lesser degree in relation to the range of issues. Although the findings show that there is little or no evidence for the effectiveness of some therapies for particular issues, this may not reflect the lived experience of children and young people engaged in counselling in a range of community and institutional settings. Instead, the absence of evidence is likely to reflect a lack of published studies that fit the inclusion criteria for this review.     

A systematic review of interventions for anxiety in people with HIV

People with human immunodeficiency virus (HIV) show elevated anxiety levels compared to the general population. Anxiety can predate HIV infection or be triggered by HIV diagnosis and the many stresses that emerge during the course of HIV disease. Many psychological and pharmacological therapies have been shown to treat anxiety in the general population but a systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review examines all published intervention studies on anxiety and HIV from 1980 to 2009 covered by the databases MedLine (1980-2009) and PsycINFO (1980-2009) for a definitive account of effectiveness of interventions and an indication of prevalence of HIV-related anxiety and measurement within studies. Standard systematic research methods were used to gather quality published papers on HIV and anxiety, searching published data bases according to quality inclusion criteria. From the search, 492 papers were generated and hand searched resulting in 39 studies meeting adequacy inclusion criteria for analysis. Of these, 30 (76.9%) were implemented in North America (the USA and Canada), with little representation from developing countries. Thirty-three (84.6%) studies recruited only men or mostly men. A total of 50 interventions were investigated by the 39 studies; 13 targeted HIV, symptoms or associated outcomes/conditions, 20 directly targeted anxiety and another 17 indirectly targeted anxiety. Twenty-four (48%) interventions were effective in reducing anxiety (including 11 indirect interventions), 16 (32%) were ineffective and 10 (20%) had an unknown effect on anxiety. Sixty-five percent of interventions directly targeting anxiety were effective. Psychological interventions (especially cognitive behavioural stress management interventions and cognitive behavioural therapy) were generally more effective than pharmacological interventions. Only three studies provided prevalence rates - these ranged from 13% to 80%. Anxiety was measured using 16 different instruments. Our detailed data suggest that interventions are both effective and available, although further research into enhancing efficacy would be valuable. Also, the vast majority of studies were Western-based, no studies looked at children or adolescents and few looked specifically at women. An international effort to harmonise measurement of anxiety is also missing. There is a need to routinely log anxiety in those with HIV infection during the course of their disease, to provide specific data on women, young people and those in diverse geographic areas and incorporate management into care protocols.     

Gait variability in people with neurological disorders: A systematic review and meta-analysis

There has been growing evidence showing gait variability provides unique information about gait characteristics in neurological disorders. This study systemically reviewed and quantitatively synthesized (via meta-analysis) existing evidence on gait variability in various neurological diseases, including Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), cerebellar ataxia (CA), Huntington’s disease (HD), multiple sclerosis (MS), and Parkinson’s disease (PD). Keyword search were conducted in PubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Meta-analysis was performed to estimate the pooled effect size for gait variability for each neurological group. Meta-regression was performed to compare gait variability across multiple groups with neurological diseases. Gait variability of 777 patients with AD, ALS, CA, HD, MS, or PD participating in 25 studies was included in meta-analysis. All pathological groups had increased amount of gait variability and loss of fractal structure of gait dynamics compared to healthy controls, and gait variability differentiated distinctive neurological conditions. The HD groups had the highest alterations in gait variability among all pathological groups, whereas the PD, AD and MS groups had the lowest. Interventions that aim to improve gait function in patients with neurological disorders should consider the heterogeneous relationship between gait variability and neurological conditions.     

Treatment-resistant depression: A systematic review of systematic reviews

The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.     

A systematic review of the relationship between religion and attitudes toward transgender and gender-variant people

Background: Prejudice against transgender people is widespread, yet in spite of the prevalence of this negativity relatively little is known about the antecedents and predictors of these attitudes. One factor that is commonly related to prejudice is religion, and this is especially true for prejudice targets that are considered to be “value violating” (as is the case for transgender individuals).

Method: In this paper, we present the findings of our systematic search of the literature on this topic and present the synthesized evidence. Our search strategy was conducted across five databases and yielded 29 studies (across 28 articles).

Results: We found consistent evidence that self-identifying as with either being “religious” or as Christian (and to a lesser extent, being Muslim) was associated with increased transprejudice relative to being nonreligious (and to a lesser extent, being Jewish). Additionally, we found consistent evidence that certain forms of religiosity were also related to transprejudice – specifically religious fundamentalism, church attendance, and interpretations of the bible as literal (transprejudice was unrelated to religious education).

Conclusion: Although this young, but important field of research is growing, more empirical exploration is needed to fully understand that nuances of the religion-transprejudice relationship.     

Secondary prevention interventions for young drug users: a systematic review of the evidence

This paper reviews the international scientific evidence on the effectiveness of secondary prevention interventions for young drug users. The review provides insight into the effectiveness of interventions that have been evaluated using moderately strong research designs. Most of the studies included are from the United States of America. Some interventions are effective in reducing drug use and associated problems while others have no or mixed effect. Those successful in reducing drug use include behavior therapy, Minnesota 12-step programs, residential care, and general drug treatment. Those with either no effect or mixed effect include schools interventions. Involving parents and other agencies may enhance an intervention's effect. There is a lack of good quality studies outside the USA. Future interventions should focus on either low- or high-risk groups of young drug users. Future research should be conducted on a wider range of services for young people and include non-medical outcomes such as communication skills, schooling, employment, family relations, and economic costs.     

The effectiveness of counselling with older people: Results of a systematic review

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand‐searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak.     

Psychological interventions for carers of people with dementia: A systematic review of quantitative and qualitative evidence

Rationale: Carers of people with dementia experience significant levels of stress in their everyday role. The National Dementia Strategy in England identifies the key role that carers play in supporting people with dementia living at home, often to the detriment of their social, emotional and physical health. Aims: To add to the substantive knowledge‐base by combining search criteria used by Pinquart and Sörensen (2006) and Gallagher‐Thompson and Coon (2007) to update the literature on psychological interventions for carers of people with dementia published between 2005 and 2011. Method: Following the study inclusion criteria, comprehensive searches were conducted using the electronic databases Medline, PsycINFO, ERIC, and PubMed. Twenty studies were identified, graded and synthesised into the reported systematic review with both quantitative and qualitative studies included to maximise practice application. Results: Consistent with previous findings, three categories of psychological intervention were identified: (i) psychoeducational‐skill building (n=8); (ii) psychotherapy‐counselling (n=1); (iii) multicomponent (n=6). Our review also identified a fourth intervention category, (iv) technology‐based (n=5). The majority of studies in the updated review examine the constructs of depression, burden, social support and well‐being. The development of focused interventions for carers, whether individually tailored interventions or group interventions around a common issue, was significant for developing practice. Future studies across all categories should continue to embed supervision arrangements within their psychological intervention protocols.