Sleep,resilience, and psychological distress in United States military Veterans

Sleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.     

Attitudes toward seeking professional psychological help among Chinese students at a UK university

Aim: In this study we aimed to investigate whether Chinese international and British home students at a university in the United Kingdom differed in their attitudes towards seeking psychological help. Method: The total sample comprised 323 participants. Participants completed measures to assess their attitudes toward seeking professional psychological help (recognition of need for psychological help, stigma tolerance, interpersonal openness, confidence in mental health practitioners). Results: Chinese students reported significantly less interpersonal openness than that reported by British students. Contrary to prediction, however, no significant group differences were found on any of the other mental health attitudes (i.e. recognition of need for psychological help, confidence in mental health practitioners or stigma tolerance). Within‐group contrasts also showed that Chinese students reported lower scores on interpersonal openness than on stigma tolerance and confidence in mental health practitioners. In contrast, British participants reported less confidence in mental health practitioners and recognition of the need for psychological help than reported for stigma tolerance and interpersonal openness. Conclusion: The findings highlight the need for a greater understanding of students' cultural inclinations toward mental health issues and cultural attitudes that may hinder and/or facilitate students' access and engagement with psychological services in higher education institutions.     

“Decoding MH”—A de-stigmatization campaign in the Hong Kong Police Force

Police officers are under high level of stress given the intense and emergent work nature. If left untreated, their mental wellbeing would be at risk and work performance compromised. However, mental health stigma is common among police officers and is perpetuated by factors like police cultures emphasizing toughness and self-reliance. In view of this, since 2016, the Hong Kong Police Force had launched a holistic campaign for Force members which was the first among law enforcement organizations in Hong Kong, aiming to reduce stigma, by enhancing mental health knowledge and decreasing negative attitudes and behaviors towards mental health issues. The programme incorporated standardised trainings of the Mental Health First Aid course with examples modified to the local police context, and psychoeducation via the use of digital medium and sharing by public figures. Positive feedback was received. It was foreseen that the campaign effects would increase Force members' awareness of their mental health, encourage help-seeking and facilitate officers' decision making when encountering crises in the community.     

Managing a stigmatized identity—evidence from a longitudinal analysis about people with mental illness

Previous research about coping with the stigma of mental illness mostly relied on cross‐sectional or qualitative research designs. In the present study, the consequences of ten identity management strategies for mental illness stigma were observed in a longitudinal design. Cross‐lagged analyses were used to describe the influence of the strategies on the frequency of stigma experiences and on mental health in a two‐wave panel of people with mental illness (n = 367, 79% repeated response rate). Selective disclosure and information seeking emerged as adaptive identity management strategies, whereas overcompensation and withdrawal led to lower mental health. Results were mostly unaffected by demographic and psychiatric variables. The results support an empowerment model of stigma resilience that portrays stigmatized people as active constructors of their social world.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.     

A Feasibility Trial of Mental Health First Aid First Nations: Acceptability,Cultural Adaptation,and Preliminary Outcomes

The Mental Health First Aid First Nations course was adapted from Mental Health First Aid Basic to create a community‐based, culturally safe and relevant approach to promoting mental health literacy in First Nations contexts. Over 2.5 days, the course aims to build community capacity by teaching individuals to recognize and respond to mental health crises. This feasibility trial utilized mixed methods to evaluate the acceptability, cultural adaptation, and preliminary effectiveness of MHFAFN. Our approach was grounded in community‐based participatory research principles, emphasizing relationship‐driven procedures to collecting data and choice for how participants shared their voices. Data included participant interviews (n = 89), and surveys (n = 91) from 10 groups in four provinces. Surveys contained open‐ended questions, retrospective pre‐post ratings, and a scenario. We utilized data from nine facilitator interviews and 24 facilitator implementation surveys. The different lines of evidence converged to highlight strong acceptability, mixed reactions to the cultural adaptation, and gains in participants’ knowledge, mental health first aid skill application, awareness, and self‐efficacy, and reductions in stigma beliefs. Beyond promoting individual gains, the course served as a community‐wide prevention approach by situating mental health in a colonial context and highlighting local resources and cultural strengths for promoting mental well‐being.     

Identification Reduces Stigma of Mental Ill‐Health: A Community‐Based Study

The stigma surrounding mental ill‐health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill‐health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill‐health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill‐health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill‐health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well‐being.     

Examining associations among factor-analytically derived components of mental health stigma, distress, and psychological flexibility

Mental health stigma can be detrimental not only for the recipient, but also for the stigmatizer. As mental health stigma is often conceptualized as a multidimensional construct, Study 1 first examined the factor structure of mental health stigma as assessed by the Stigmatizing Attitudes-Believability (SAB; Masuda, Price, Anderson, Schmertz, & Calamaras, 2009). Study 2 investigated differential relations between the factor-analytically derived components of mental health stigma and psychological distress and psychological flexibility. Results of Study 1 revealed that mental health stigma consisted of two related, yet separable components: Exclusion and Course/Origin. The Exclusion component was characterized by negative emotions and cognitions associated with an increased desire for social distance. Course/Origin was marked by pessimistic views toward treatment prognosis and recovery. Results of Study 2 suggested that these two components have differential associations with psychological distress and flexibility. The Course/Origin component of stigma, but not Exclusion, was associated with psychological distress of the stigmatizer. Furthermore, this association was fully mediated by lower levels of psychological flexibility. These findings suggest the importance of conceptualizing mental health stigma multidimensionally.     

Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

Examining the initial usability,acceptability and feasibility of a digital mental health intervention for college students in India

Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the “Mana Maali Digital Anxiety Program.” Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.     

Differential associations of leisure music engagement with resilience: A network analysis

Background/ObjectiveSeveral factors associated with resilience as the maintenance of mental health despite stress exposure can be strengthened through participation in leisure time activities. Since many people listen to or make music in their leisure time, the aim of the present study was to provide insights into the architecture of how resilience relates to passive and active music engagement.Method511 participants regularly listening to and/or making music completed an online survey on resilient outcomes (i.e., mental health and stressor recovery ability), different resilience factors (e.g., optimism, social support), quantitative music engagement (i.e., time spent with music listening/making) and qualitative music engagement (i.e., use of music listening/making for mood regulation).ResultsBivariate correlations showed that subjects spending more time with music making reported better stressor recovery ability and less mental health problems, while partial correlational network analysis revealed no unique associations for quantitative music engagement. Regarding qualitative music engagement, people using music-based mood regulation reported lower mental health, mindfulness, and optimism, but also higher social support. A more heterogeneous pattern emerged for single music-based mood regulation strategies.ConclusionsOur findings highlight the importance of the individual (mal-)adaptive use of music, painting a more nuanced picture of music engagement and resilience.     

Social Media as Social Capital of LGB Individuals in Hong Kong: Its Relations with Group Membership,Stigma, and Mental Well‐Being

Social media are found to facilitate social information exchange among lesbian, gay, and bisexual (LGB) individuals who are subjected to social stigma. This study tested the protective role of LGB‐tailored social media uses and gratifications in promoting LGB group membership, which we hypothesized to reduce LGB stigma and enhance mental health among LGB individuals in Hong Kong. Based on a sample of 233 Chinese LGB individuals in Hong Kong, structural equation modeling showed evidence for our hypotheses, χ_(df=62)² = 88.20, GFI = 0.95, CFI = 0.98, NNFI = 0.98, SRMR = 0.07, RMSEA = 0.04. Community surveillance, identity expression, and emotional support on social media may promote mental health by instilling a sense of group membership and reducing stigma. Social media may build camaraderie and bolster resilience among LGB individuals that may otherwise be difficult in conservative regions.     

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.     

Beyond stigma: Understanding the “inclined abstainers” in military behavioral health-care utilization

ABSTRACT

Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an “inclined abstainer”). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as “inclined abstainers” were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to “inclined actors.” These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.     

Development of the Multicultural Mental Health Awareness Scale

The present study describes the development of an instrument to assess the multicultural competencies of mental health professionals in Australia. The scale was developed to assess the effectiveness of a multicultural mental health training program. Mental health professionals from Queensland, Australia (N = 268) participated in the study by completing a questionnaire battery. Items on the new scale were generated to parallel the Queensland Transcultural Mental Health Centre (QTMHC) training program's objectives. The results describe a 35‐item Multicultural Mental Health Awareness Scale. Factor analysis of the scale indicated three factors of multicultural counselling competencies: Awareness, Knowledge, and Skills. These factors were in line with the Sue et al. (1982) multicultural counselling competencies. The scale has satisfactory internal consistency, test–retest reliability, concurrent validity, and discriminant validity and can be used to evaluate the effectiveness of the multicultural competency training programs in mental health.     

心理弹性对大学生心理应激与心理健康关系的中介作用*

采用梁宝勇、程诚编制的“中国成年人心理弹性量表”、梁宝勇和郝志红编制的“中国大学生心理应激量表”和郑日昌、邓丽芳和张忠华等编制的“中国大学生心理健康量表”,对4所大学620名在校大学生进行测试,探讨心理弹性在大学生心理应激与心理健康关系中的作用。研究结果表明,心理弹性可以缓冲心理应激对大学生心理健康的消极影响,心理弹性部分中介心理应激与心理健康之间关系。     

The Effect of Positive Rumination Training on Mental Health and Attentional Bias

To examine the effect of positive rumination training on mental health and attentional bias, 32 college freshmen with low level of mental health were recruited and assigned to the experimental and waitlist control groups, 16 participants in each group. The experimental group received a 8-session group counseling with 2 h per session. Results showed that positive rumination increased while negative rumination, depression and anxiety decreased significantly for the experimental group. For the waitlist control group, all these indicators did not change significantly. The attention engagement in sad faces of the experimental group decreased significantly while other indicators of attentional bias did not change. The results indicate that group positive rumination training can improve mental health. But further research is needed to examine its effect on attentional bias.

     

Survivor mission: Do those who survive have a drive to thrive at work?

Are helping professionals who have experienced the same types of struggles as their clients more engaged at work? In the current investigation, we examine this question in samples of police detectives (with and without a history of violent victimization) and mental health workers (with and without a history of mental illness). Our results indicate that police detectives who have experienced violent victimization and mental health professionals who have experienced the same mental illness as their clients do indeed exhibit greater work engagement than their colleagues who lack these parallel life experiences. The link between a professional’s firsthand experience of his/her client’s hardships and work engagement appears to be partially explained by higher levels of grit among police detectives and by a greater sense of life-narrative continuity among mental health professionals.     

Mental health protective factors among flourishing Canadian women university student-athletes

Mental health is an important resource for student-athletes. Flourishing (Keyes, 2002) may be a useful concept for examining aspects of mental health. Therefore, the purpose of this study was to investigate mental health protective factors among flourishing Canadian university student-athletes over the course of their sport season. Initially, 36 Canadian student-athletes completed the Mental Health Continuum – Short Form (Keyes, 2009) and Sport Mental Health Continuum – Short Form (Foster & Chow, 2019). Based on the results from the questionnaires, six women athletes who were identified as flourishing at global and sport levels then participated in the study. Data were generated through individual pre- and post-season semi-structured interviews, and in-season weekly written diaries. Analysis followed guidelines outlined by Smith et al. (2009) for interpretative phenomenological analysis. Results are presented over three stages of the seasons (pre-, in-, and post-season). In the pre-season, participants invested in their flourishing by making positive connections and planning their schedule. In-season, participants discussed facing challenges and tried to maintain flourishing by managing their commitments, communicating with coaches, and looking for positives. In the post-season, the participants attempted to re-invest in their flourishing by reflecting on their season and taking a break from sport. It appeared that the athletes were able to identify potential challenges to their flourishing in sport and use global resources to buffer the impact. These results reveal strategies that may help promote and protect mental health among student-athletes.