The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18‐month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3‐year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma‐informed, are discussed.     

A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: Results of the Pleasant Events Program (PEP)

Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.     

The role of primary prevention in mental health services: A review and critique

Community psychology in the West has had a growing impact on mental health service provision. One facet of this development has been the advocacy of an increased focus on the primary prevention of mental illness. This paper reviews both theoretical and practical work in this area in order to assess the current role and relevance of primary preventive interventions. There is a discussion of primary prevention's historical and theoretical contexts, of its conceptualisations and definitions, of criticisms of its relevance and efficacy, and of examples of its practice. It is argued that primary prevention is inappropriately marginalised in current service provision and that there is a need to engage in the long-term planning and evaluation of primary preventive interventions in order to facilitate their fuller incorporation into national and local policies on mental health.     

Religiosity,spirituality, mental health,and mental health treatment outcomes in Australia: a systematic literature review

The relationship between religiosity and mental health is a relatively well-researched field within North America, covering numerous domains of religiosity, including: religion, spirituality, prayer, church attendance, church affiliation and belief in God or a higher power. Considering the Australian literature, there are few papers that explore these dimensions of religiosity and their relationship with health, and in particular, very little research into the field of religiosity and mental health. Using systematic literature review methods, this study explores the Australian research into relationships between religiosity, mental health, and treatment outcomes for psychiatric illness and suicidal behaviour.     

System-Level Change in Cultural and Linguistic Competence (CLC): How Changes in CLC are Related to Service Experience Outcomes in Systems of Care

As US demographic trends shift toward more diversity, it becomes increasingly necessary to address differential needs of diverse groups of youth in mental health service systems. Cultural and linguistic competence (CLC) is essential to providing the most appropriate mental health services to youth and their families. The successful implementation of CLC often begins at the system level. Though various factors may affect change and system-level factors set the tone for broad acceptance of CLC within systems, there is limited empirical evidence linking culturally competent practices to outcomes. The purpose of the present study was to examine system-level CLC changes over time within systems of care and their associations with service experiences among youth and their families. Participants were 4,512 youth and their families enrolled in the national evaluation of the Children’s Mental Health Initiative (CMHI). Results suggest that implementation of CLC at the system level improves over time in funded systems of care. Further, variation exists in specific system-level components of CLC. In addition, the changes in CLC at the system level are related to family/caregiver participation in treatment. Implications for supporting positive changes in CLC among systems of care communities, and specific strategies for community psychologists, are discussed.     

Barriers to evidence-based treatment: developmental psychopathology and the interdisciplinary disconnect in school mental health practice

Reframing the role of school psychologists and related school professionals in a public health and primary prevention model represents a proactive antidote to their more traditional reactive stance to mental health problems. Two additional concepts, developmental psychopathology and complex comorbidity, are suggested as critical to complete this transition, and illustrations of these concepts for more effective school mental health services are provided.     

Sacrificing parents on the altar of children's rights: Intergenerational struggles and rights in deportability

State actors arguing for the rights of undocumented children often attempt to strengthen children's deservingness by portraying their parents as bad parents who put their children at risk. Through ethnographic observations in Malmö, Sweden and Birmingham, UK, this article shows how such demonization of the parents by the state is not reflected in the everyday life experiences of undocumented families themselves. While the state views the parents as putting their children at risk by ‘hiding’ them, the parents view the state as putting their children at risk by trying to deport them. The article discusses how parents act as ‘humanitarian agents’ responsible for caring for the children when state support to the deserving, rights-bearing child is limited by the notion of the deportable migrant child. These parental practices of unrecognized emotional labour are analysed as motherwork. The interdependent character of family life in deportability is highlighted through how children take on parental responsibilities as well and how stress and knowledge about their irregular situation is shared across generations. To conclude, the article argues that if one neglects the intergenerational context of undocumented children's rights, one risks marginalising the human rights of both children as well as adults.     

School-Based Mental Health Programs and Services: Overview and Introduction to the Special Issue

School-based mental health (SBMH) programs and services have grown progressively in the United States in the past two decades, related in part to increased recognition of their advantages and heightened federal support. However, SBMH is an emerging field, with many issues needing attention. This introductory article provides a context for the special issue by highlighting the importance of increased conceptual clarity about SBMH, enhanced mental health—education systems integration, and advancement of the SBMH research base. Key elements for success of SBMH programs and services are discussed, as underscored recently by the report of the New Freedom Commission on Mental Health (2003) and other important initiatives. These elements include (a) school–family–community agency partnerships, (b) commitment to a full continuum of mental health education, mental health promotion, assessment, problem prevention, early intervention, and treatment, and (c) services for all youth, including those in general and special education. A synopsis of the articles in the special issue is provided, emphasizing their conceptual and empirical contributions to delivery and sustainability of effective mental health practices in schools.     

Making the grade: a pilot investigation of an e-intervention to increase mental health literacy and help-seeking intentions among international university students

ABSTRACT

International students may have less understanding and awareness of mental health issues and appear unlikely to seek help. The purpose of the current study was to construct and evaluate a brief online educational intervention designed to increase mental health literacy (MHL) and help-seeking among international tertiary students studying in Australia. The intervention was tested among 45 international tertiary students (undergraduate and postgraduate), who were randomly allocated to control and intervention conditions. The intervention led to significant improvements in help-seeking attitudes, particularly in stigmatising attitudes. No significant effects were found for MHL or help-seeking intentions. A brief educational intervention can improve help-seeking attitudes among international tertiary students. Future research may focus on establishing optimal intervention dosage.     

An internet survey of emotional health,treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score?=?23.96; SD?=?9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.     

A new theory on children's drawings: Analyzing the role of emotion and movement in graphical development

The aim of this paper is to develop a new understanding of children's drawings and to provide ideas for future research in early childhood. Starting from classic theories on child graphical development, we proceed to analyze them and provide our own views on the subject. We will also recount a number of relevant empirical studies that appear to validate our theory. Our belief is that emotion and self-expression through movement play a key role in the development of child art, and that this may be already visible during the scribbling stage of drawing.     

The emotional relations of children's participation rights in diverse social and spatial contexts: Advancing the field

Children's participation rights, enshrined in the UN Convention on the Rights of the Child (1989), have been a popular area of research, policy and practice for decades. Despite a great deal of interest and activity, participation rights have posed a particular challenge to implement. In response, researchers have consistently called for more in-depth and nuanced analyses of the way participatory rights are actually lived and experienced by children and young people, within the complexity of interdependent relationships. However, there has been surprisingly little focus on the emotional relations of children's participation rights. The analytical links between emotions and participation rights are rarely the focus and, where emotions are discussed, they are rarely discussed as a central concern in their own right. This article provides a review of the field and identifies three ways in which making emotions a central concern can help to advance debates on children's participation rights: by helping to unsettle ‘traditional’ constructions of the child-adult binary, by increasing sensitivity to ethical and safeguarding issues, and by making visible and challenging intersectional power relations.     

Predicting positive mental health in internally displaced persons in Indonesia: the roles of economic improvement and exposure to violent conflict

Positive mental health, rather than just the absence of mental illness, is rarely investigated among the internally displaced persons (IDPs) affected by violent conflict in low-income countries. The purpose of this study was to investigate a model that could explain the interrelationship between factors contributing to positive mental health in displaced populations. In a longitudinal study we examine poverty, exposure to traumatic events and the change of material well-being after one year. We collected data in two consecutive years (2005 and 2006) from a community-based sample of IDPs in Ambon, Indonesia, through face-to-face structured interviews with consenting adults. Participants of this study were IDPs lived in Ambon during the violent conflict period. We interviewed 471 IDPs in the first year and reinterviewed 399 (85%) of the same subjects in the second year. The IDPs possessed good sense of coherence and subjective well-being. Our final model, which was generated by the use of structural equation modeling, fits the data well (χ² = 52.51, df = 45, p = .21, CFI = .99, RMSEA = .019). Exposure to violent conflict had a negative impact on IDPs’ mental health initially and better economic conditions improved it (r = ?.30 and .29 respectively). Mental health status one year previously was a strong predictor of future mental health, followed by individual economic growth in the past year (r = .43 and .29 respectively). On a group level the IDPs were resilient and adaptive to survive in adverse living conditions after devastating violent conflict, and the economic improvement contributed to it.     

Chinese students in Japan: The mediator and the moderator between their personality and mental health

To clarify the influence of personality traits on the psychological acculturation of Chinese international students in Japan, the present study used three structuring questions: (a) What personality trait makes the students vulnerable to psychological distress? (b) What mediates between personality and psychological distress? (c) What buffers personality from psychological distress? The study examined personality traits (Harm‐Avoidance, HA; and Self‐Directedness, SD; two dimensions of the Temperament and Character Inventory), acculturation attitudes (integration, assimilation, separation, and marginalization), and the mental health (General Health Questionnaire (GHQ)‐30) of 253 Chinese students in Japan (17–30 years of age) using self‐report questionnaires. The hypotheses are: For the Chinese international students in Japan, (a) the individuals with high HA or low SD are more vulnerable to psychological distress; (b) the acculturation strategy mediates between personality (HA/SD) and mental health (GHQ); (c) social support can moderate the effect of personality on acculturation adaptation. The results show that the Chinese international students in Japan had higher GHQ scores compared to normative standards, and marginalization (a less adaptive strategy) was their second most preferred acculturation strategy, next to integration. Individuals with high HA or low SD were more likely to have a marginalization attitude and suffer from more psychological distress. The mediation effect of marginalization and the moderation effect of social support in life (SSL) between HA/SD and GHQ were confirmed. Most of the hypotheses were supported by the results. Explanations of these findings and their implication for acculturation adaptation are discussed.     

Repentance and seeking forgiveness: the effects of spiritual therapy based on Islamic tenets to improve mental health

For years, spirituality has been utilised by many as an asset to improve mental and physical health. This study creates a valid argument that Islamic teachings specifically can have a notable effect on students’ overall health. This particular therapy originates from the Islamic concept of soul purification/cleansing (otherwise known as: tazkiyah al-nafs). The reason behind this was to evaluate the impact of tawba (meaning repentance) and istighfar (forgiveness) therapy for improving mental health in a selected group of Muslim college students. Participants were expected to attend eight consecutive sessions exploring both tawba and istighfar therapy. Both before they trialled the treatment and once they had completed it, all participants were also required to complete the ‘Social Emotional Health Survey-Higher Education’ (SEHS-HE). We concluded that in general this programme was in fact successful in improving the overall mental and even physical health in our select group of Islam practising students.     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.     

Exploring the mental health of Mexican migrant farm workers in the Midwest: psychosocial predictors of psychological distress and suggestions for prevention and treatment

The purposes of the present study were threefold: (a) to assess the prevalence levels of anxiety and depression in a sample of Mexican migrant farm workers in the midwestern United States; (b) to explore the relationships among acculturative stress, anxiety, and depression; and (c) to examine the variables that best predict anxiety and depression. The overall sample revealed elevated levels of anxiety and depression. Migrant farm workers with heightened levels of acculturative stress were more likely to report high levels of anxiety and depression. Family dysfunction, ineffective social support, low self-esteem, lack of agreement with the decision to migrate, high education levels, high levels of acculturative stress, and high levels of anxiety were significantly associated with high depression levels. The overall findings suggest that migrant farm workers who experience elevated levels of acculturative stress may be at risk for experiencing high levels of anxiety and depression. The findings highlight the importance of establishing prevention and treatment services for migrant farm workers that aim to increase levels of emotional support, self-esteem, and coping skills.     

Experiences in difference: An exploration of the usefulness and relevance of psychoanalytic theory to transcultural mental health work

Abstract

This paper presents accounts of work with mental health service users in a multicultural residential setting and, explores some of the difficulties involved in working from a psychodynamic perspective in such a setting. It argues that a psychoanalytic understanding of the role of phantasy in the experience of difference, upon which ideas of culture and identity are constructed, can be helpful to practitioners concerned with addressing the consequences of their clients' experience of racism and other forms of discrimination. Particular reference is made to Winnicott's writings on play, transitional space and the location of cultural experience.