The stigma of seeking help for mental health issues: mediating roles of support and coping and the moderating role of symptom profile

A key factor to the prevalence of mental illness might be the disinclination to seek help, perhaps owing to the stigma of mental illness. In two studies, the contribution of severity of depressive symptoms, social support, and unsupport, coping strategies, and salience of psychological versus biological features of depression in relation to perceived self‐ and other‐stigma of help‐seeking for mental health issues were examined. Participants were first year students experiencing a transitional stressor, namely entry to university. Together, the findings point to the contribution of social support and unsupportive interactions, and coping methods to the prediction of perceived stigma of seeking help, but that the framing of mental illness can limit or strengthen these relations.     

The interface of identity distress and psychological problems in students’ adjustment to University

Identity distress, psychological symptoms, and adjustment to university (academic, social, and person-emotional) were examined among students in Spain (N = 241; M_age = 19.0 (1.6), Md = 19; 84% female) and Canada (N = 531; M_age = 19.8 (2.2), Md = 19; 82% female). The expected positive relationships were found between these variables. Similarly, increased identity distress of Spanish students and greater maladjustment at university for those in Canada were associated with contextual differences in the respective environments. Psychological problems mediated the linkages between identity distress with academic, social, and person-emotional functioning at university, respectively. Also, psychological problems and context/country were independent predictors of students’ identity distress. Findings underscore the importance of examining contextual factors that influence student adjustment to university in relation to identity development and mental health and they offer suggestions for further research and counseling services.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

Follow-up of Dropouts From Developmental Programs: A Supplemental Program Evaluation Approach

A potentially useful program-evaluation approach obtains information from program dropouts. This method was applied to university students who dropped out of four developmental programs offered by a student counseling center. Of 44 students telephoned, 29 were successfully reached by student paraprofessionals using a structured interview format. The results contain general implications for developmental programming and provided useful input for three of the programs.     

The impact of psychological distress and university counselling on academic outcomes: Analysis of a routine practice-based dataset

Whole university approaches to student mental health and well-being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE-OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE-OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study.     

Randomized trial testing the integration of the Good Behavior Game and MyTeachingPartner™: The moderating role of distress among new teachers on student outcomes

A growing body of research documents the effectiveness of classroom management programs on a range of student outcomes, yet few early-career teachers receive training on these practices prior to entering the classroom. Moreover, few studies have attended to how variations in teacher distress or level of classroom misbehavior affects training benefits. This study reports findings from a randomized trial of a teacher training program that combined two evidence-based programs (Good Behavior Game [GBG] and MyTeachingPartner™ [MTP]) to determine their impact on novice teachers and their students. In addition, the current study reports findings on moderated impacts by initial teacher distress as well as the overall classroom level of misbehavior. The sample included 188 early-career teachers (grades K-3) in their first three years of teaching from three large, urban school districts. Analyses indicated that intervention had no main effects, but yielded moderated impact depending on the combination of the baseline levels of classroom disruptive behavior and teacher distress; it appears that the program impacts were greatest in the highest risk circumstance (i.e., high teacher stress and elevated challenging student behaviors). For those classrooms, those assigned to intervention evidence improved behavior and student achievement compared to control counterparts by the spring of the training year, relative to the fall baseline (d = 0.18–0.70 depending on outcome). This study is significant in that it highlights effects during a critical window of training and coaching for early career teachers and the need to consider teacher and classroom contextual factors that may moderate professional development efforts.     

Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community Over Five Years

This study evaluated the effectiveness, change mechanisms, and sustainability of a brief mindfulness intervention for people with multiple sclerosis (PwMS) delivered in the community through a frontline service over five years. Participants were 126 PwMS. A single intervention condition design was used with pre-intervention, post-intervention and 2-month follow-up assessments. The primary outcome was distress. Secondary outcomes were perceived stress, quality of life (QoL) and fatigue, and the proposed change mechanisms: mindfulness, self-compassion, psychological inflexibility. Intention-to-treat analyses showed the primary outcome, distress (Cohen’s d = .25), and all secondary outcomes improved: perceived stress (d = .38), mental health QoL (d = .39), physical health QoL (d = .47), fatigue (d = .30), mindfulness (d = .29), self-compassion (d = .37), psychological flexibility (d = .44). Distress, stress and perceived stress continued to improve post-intervention to follow-up. Mindfulness emerged as a temporal mediator of perceived stress (BCa 95% CI). Self-compassion mediated concurrent improvements in distress, perceived stress, fatigue and physical health QoL, while greater psychological flexibility mediated concurrent reductions in distress (BCa 95% CI). Mindfulness home practice was unrelated to improvements on all outcomes except a marginal association with mindfulness. Of the socio-demographic and illness factors, lower disease severity predicted improvements in physical health QoL (p = .046). Improvements in outcomes were supported by qualitative feedback and participant satisfaction ratings. Twenty-one groups were offered with good participant engagement and wide geographical reach, suggesting sustained feasibility of the Mindfulness for MS program over five years. Findings support the delivery of the Mindfulness for MS program through a community-based service in partnership with a local university.

     

Family Support in Children’s Mental Health: A Review and Synthesis

A comprehensive review of structured family support programs in children’s mental health was conducted in collaboration with leadership from key national family organizations. The goals were to identify typologies of family support services for which evaluation data existed and identify research gaps. Over 200 programs were examined; 50 met criteria for inclusion. Programs were categorized by whether they were delivered by peer family members, clinicians, or teams. Five salient components of family support were identified: (a) informational, (b) instructional, (c) emotional, (d) instrumental, and (e) advocacy. Clinician-led programs were heavily represented (n = 33, 66%), followed by family-led (n = 11, 22%), and team-delivered (n = 6, 12%) programs. Key differences between programs delivered by clinicians or by peer family members were found in the degree of emphasis, research methodology, and outcomes. However, the content of the components was similar across all three program types. There are both important differences in emphasis across typologies of family support provided by clinicians, family members, or teams as well as important similarities in content. Family-delivered support may be an important adjunct to existing services for parents, although the research base remains thin. A research agenda to promote more rigorous evaluations of these services especially those delivered by peer family members is critical.     

Effects of Simulated Learning and Facilitated Debriefing on Student Understanding of Mental Illness

Occupational therapy educators have studied various methods regarding student attitudes towards people with disabling conditions. Among the methods that have been studied is simulated learning. This paper describes the effects of a simulated learning exercise and facilitated debriefing on occupational therapy student understanding of mental illness. Results indicate that students had significant change relative to understanding that mental illnesses are brain diseases that respond to treatment (p < .01) on the post-test. Themes derived from qualitative data revealed that students believed that the learning experience increased their understanding, empathy, and insight into daily life with a mental illness.     

Mental imagery increases self-determined motivation to exercise with university enrolled women: A randomized controlled trial using a peer-based intervention

ObjectivesThe purpose of this study was to examine the effects of a peer-based mental imagery intervention on the self-determined motivation and cardio-respiratory fitness of university enrolled women.DesignRandomized controlled trial.Method43 University enrolled women were randomized to peer-mentored or peer-mentored plus mental imagery conditions while 32 completed three meetings with peer-mentors and post-testing (M^age = 19.91; SD = 1.70).ResultsSignificant improvements in cardio-respiratory endurance, ratings of perceived endurance, and self-determined motivation to exercise were observed across both study conditions. Participants assigned to the peer mentored plus mental imagery condition reported significantly greater increases in self-determined motivation to exercise at post-test compared to those in the peer-mentored condition.ConclusionsPeer-based interventions are a viable way to improve fitness and health outcomes while mental imagery appears to be associated with increases in autonomous forms of exercise motivation.     

Stigma by Association Among Family Members of People with a Mental Illness: A Qualitative Analysis

People with mental illness are not the sole recipients of stigmatisation; their immediate family members may be subjected to stigma by association. Through semi‐structured interviews, we investigated experiences of stigma by association among 23 immediate family members of people with mental illness. Participants reported experiencing stigma by association from community members, mental health professionals, and civil servants. Familial relationship, co‐residence, and the gender of participants appeared to play a role in their stigma experiences; parents and spouses reported different manifestations of stigma by association than siblings and children, participants who lived together with their family member with mental illness reported increased experiences of stigma by association, and in contrast to male participants, female participants reported others thinking they are overprotective and as such perpetuated, maintained, or sustained their family members' mental illness. The relevance of these factors points to the need for tailored education and emotional support provision to family members of people with mental illness. Moreover, in‐service training for mental health professionals should include the development of relevant social skills that enable the recognition of familial relationships and roles, and family members' fears, concerns, and problems. Copyright © 2014 John Wiley & Sons, Ltd.     

The influence of a long term exercise program on lower limb movement variability and walking performance in patients with peripheral arterial disease

The purpose of this study was to examine the effects of a 12 month exercise program on lower limb movement variability in patients with peripheral arterial disease (PAD). Participants (n = 21) with an appropriate history of PAD and intermittent claudication (IC) volunteered for this study and were randomly allocated to either a control group (CPAD–IC) (n = 11), which received normal medical therapy and a treatment group (TPAD–IC) (n = 10), which received normal medical therapy treatment and a 12 month supervised exercise program. All participants underwent 2D joint angular kinematic analysis during normal walking to assess lower limb movement variability and walking speed. Between-group differences were analyzed via mixed measures ANOVA. The 12 month supervised exercise program made no significant impact on the lower limb movement variability or walking speed of the TPAD–IC group as determined by either intralimb joint coordination or single joint analysis techniques. Long term supervised exercise programs do not appear to influence the lower limb movement variability of PAD–IC patients.     

The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n?=?16), case management (n?=?9), integrated ‘one-stop-shop’ (n?=?6) and lifestyle (n?=?6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory.

     

The Association Between Strength of Religious Faith and Psychological Functioning

Recently researchers have begun examining the benefit of religious faith on mental and physical health outcomes. This study examined the relationship between religious faith and psychological functioning in 342 university students in diverse educational and geographic settings including a private West Coast Catholic college (sample 1), a Southern public state university (sample 2), and a Southern private Baptist college (sample 3). Participants completed several self-report measures. Strength of religious faith was significantly associated with optimism and experiencing meaning in life among sample 1. Results from sample 2 suggest that strength of religious faith was significantly associated with coping with stress, optimism, experiencing meaning in life, viewing life as a positive challenge, and low anxiety. Strength of religious faith was significantly associated with viewing life as a positive challenge and self-acceptance among sample 3. Although modest correlations surfaced, results suggest that strength of religious faith is associated with several important positive mental health benefits among college students.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

The Effectiveness of Cultural Adjustment and Trauma Services (CATS): Generating Practice-Based Evidence on a Comprehensive, School-Based Mental Health Intervention for Immigrant Youth

A collaborative study of Cultural Adjustment and Trauma Services (CATS), a comprehensive, school-based mental health program for traumatized immigrant children and adolescents, was conducted to generate practice-based evidence on the service delivery model across two school districts. Program effectiveness was assessed by testing whether client functioning and PTSD symptoms improved as a result of 7 separate service elements. An array of clinical services including CBT, supportive therapy, and coordinating services were provided to all students, and an evidence-based intervention for trauma, TF-CBT, was implemented with a subset of students. Greater quantities of CBT and supportive therapy increased functioning, while greater quantities of coordinating services decreased symptoms of PTSD. TF-CBT services were associated with both improved functioning and PTSD symptoms, although TF-CBT was implemented with fidelity to the overall comprehensive service model rather than the structured intervention model. Results suggest the comprehensive school-based model was effective, though different service components affected different student outcomes. Implications of these findings for immigrant mental health interventions and implementing structured evidence-based practices into community mental health programs are discussed. Suggestions are made for future research on existing mental health practices with immigrants.     

Relationships Among Religiousness,Spirituality, and Health for Individuals with Stroke

The current study evaluated the relationships among spiritual beliefs, religious practices, physical health, and mental health for individuals with stroke. A cross-sectional analysis of 63 individuals evaluated in outpatient settings, including 32 individuals with stroke and 31 healthy controls was conducted through administration of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36). For individuals with stroke, the SF-36 General Mental Health scale was significantly correlated with only the BMMRS Religious and Spiritual Coping scale (r = .43; p < .05). No other BMMRS factors were significantly correlated with SF-36 mental or physical health scales. Non-significant trends indicated spiritual factors were primarily related to mental versus physical health. This study suggests spiritual belief that a higher power will assist in coping with illness/disability is associated with better mental health following stroke, but neither religious nor spiritual factors are associated with physical health outcomes. The results are consistent with research that suggests that spiritual beliefs may protect individuals with stroke from experiencing emotional distress.     

Familiarity with and social distance from people with mental illness: Testing the mediating effects of prejudiced attitudes

The purpose of this study was to examine prejudiced attitudes as a factor associated with social distance from people with mental illness. A total of 289 university students from Greece completed written measures assessing social distance from, prejudiced attitudes about, and familiarity with mental illness. A structural equation model with manifest variables was tested. Participants who reported to be more familiar with mental illness held stronger social care and weaker prejudiced beliefs, and consequently expressed a less strong desire for social distance. Implications of the results and suggestions for future research are outlined. Copyright © 2011 John Wiley & Sons, Ltd.     

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness to refugees. Data collected from 290 Afghan, Great Lakes African, Iraqi, and Syrian refugees at four time points over 12 months were used to test the effectiveness of RWP to reduce distress (depression and anxiety symptoms) and increase protective factors (English proficiency, social support, connection to home and American cultures). Intention-to-treat analyses using multilevel modeling revealed significant intervention effects for all hypothesized outcomes. Results provide evidence to support social justice approaches to improving refugee mental health. Findings have implications for refugees worldwide, and for other immigrant and marginalized populations who experience inequities in resources and disproportionate exposure to trauma/stress.