Student mental health: how can psychiatrists better support the work of university medical centres and university counselling services?

Student psychiatric morbidity is rising. Whilst the influence of university counselling services is widely reported, NHS involvement by psychiatrists and general practitioners is not so well described. Counselling and mental health service providers for students at the University of Leeds were approached for numerical data and a university Group on Student Mental Health discussed the findings. The Student Counselling Centre, the University Medical Practice and a dedicated student psychiatric clinic have all seen a rise in referral rates. The University Medical Practice has also seen a rise in the prescribing of psychoactive medication. Collaborative links at the University of Leeds are explored and options for the future discussed. These include self-help over the internet, a research project to assess student mental health needs and the provision of a dedicated NHS psychiatric team for the university.     

Can we Build on Social Movement Theories to Develop and Improve Community‐Based Participatory Research? A Framework Synthesis Review

A long‐standing challenge in community‐based participatory research (CBPR) has been to anchor practice and evaluation in a relevant and comprehensive theoretical framework of community change. This study describes the development of a multidimensional conceptual framework that builds on social movement theories to identify key components of CBPR processes. Framework synthesis was used as a general literature search and analysis strategy. An initial conceptual framework was developed from the theoretical literature on social movement. A literature search performed to identify illustrative CBPR projects yielded 635 potentially relevant documents, from which eight projects (corresponding to 58 publications) were retained after record and full‐text screening. Framework synthesis was used to code and organize data from these projects, ultimately providing a refined framework. The final conceptual framework maps key concepts of CBPR mobilization processes, such as the pivotal role of the partnership; resources and opportunities as necessary components feeding the partnership's development; the importance of framing processes; and a tight alignment between the cause (partnership's goal), the collective action strategy, and the system changes targeted. The revised framework provides a context‐specific model to generate a new, innovative understanding of CBPR mobilization processes, drawing on existing theoretical foundations.     

A Cognitive-Behavioral Model of Persistent Postural-Perceptual Dizziness

Persistent postural-perceptual dizziness (PPPD; previously termed “chronic subjective dizziness”) is a frequently observed disorder in patients who present with dizziness to audiology; ear, nose, and throat; or neurology clinics. The primary symptoms are persistent nonvertiginous dizziness, and hypersensitivity to motion and visual stimuli. These occur either in the absence of any active neuro-otologic illness or, where an episodic vestibular disorder exists, symptoms cannot be fully explained by the disorder alone. Diagnosis is necessarily multidisciplinary and proceeds by identification of primary symptoms and exclusion of other neurological or active medical disorders requiring treatment. Psychological processes are implicated in the development and maintenance of PPPD, with similarities to cognitive models of health anxiety and panic disorder, and there is evidence that cognitive-behavioral therapy is an effective treatment. A cognitive-behavioral model of PPPD is presented along with a case example. It is suggested that dizziness becomes persistent when it is processed as a threat, and that it is maintained by (a) unhelpful appraisals, (b) avoidance and safety behaviors, and (c) attentional strategies including selective attention to body sensations associated with dizziness. Once PPPD is identified techniques for its effective treatment fall within the skills mix of qualified cognitive-behavioral therapists or vestibular clinical scientists who have received additional training in cognitive and behavioral treatment.     

Allocation of effort as a function of payoffs for individual tasks in a multitasking environment

SYNWORK1 software allows the examination of how payoffs affect the allocation of effort by people when they perform four different tasks (memory search, arithmetic, visual monitoring, and auditory monitoring). In a previous study (Wang, Proctor, & Pick, 2007), we showed that participants adopted multitasking strategies allocating relative effort appropriate to payoff differences between the arithmetic and memory tasks, but that they exhibited residual effects of prior payoffs when the payoffs were switched. In the present study, we varied the payoff in two different experiments for only one of these tasks, the memory task in Experiment 1 and the arithmetic task in Experiment 2. Doing this allowed consideration of performance for both the task for which payoff changed explicitly and the other cognitive task, for which the payoff difference was implicit (i.e., relative to the explicit payoff that was manipulated). Although participants adjusted performance on the task for which the payoff explicitly varied, the payoff manipulation had less effect than did the explicit payoff manipulations for both tasks used previously. Also, the change in effort on a task resulting from explicitly increasing its payoff was less than that from decreasing the payoff. SYNWORK1 is a good environment for studying multitasking, but has several limitations that need to be addressed to provide a synthetic work environment that allows investigation of a wider range of theoretically relevant issues.     

Orienting in virtual environments: How are surface features and environmental geometry weighted in an orientation task?

We investigated how human adults orient in enclosed virtual environments, when discrete landmark information is not available and participants have to rely on geometric and featural information on the environmental surfaces. In contrast to earlier studies, where, for women, the featural information from discrete landmarks overshadowed the encoding of the geometric information, Experiment 1 showed that when featural information is conjoined with the environmental surfaces, men and women encoded both types of information. Experiment 2 showed that, although both types of information are encoded, performance in locating a goal position is better if it is close to a geometrically or featurally distinct location. Furthermore, although features are relied upon more strongly than geometry, initial experience with an environment influences the relative weighting of featural and geometric cues. Taken together, these results show that human adults use a flexible strategy for encoding spatial information.     

Suicidality and psychosis: beyond depression and hopelessness

The present study examined recent suicide attempters with and without psychotic disorders in order to understand factors that contribute to suicide ideation during and following the suicide attempt. Patients with psychotic disorders endorsed higher levels of suicide ideation than patients without psychotic disorders. Even when depression, hopelessness, substance abuse, and social problem solving were controlled for, there was a significant association between psychotic disorder and suicide ideation. During the follow-up period, patients with psychotic disorders subsequently attempted suicide at a significantly higher rate than patients without psychotic disorders. The clinical relevance of these findings is discussed.     

Predictors of physical activity,healthy eating and being smoke-free in teens: A theory of planned behaviour approach

This paper elicited context specific underlying beliefs for physical activity, fruit and vegetable consumption and smoke-free behaviour from the Theory of Planned Behaviour (TPB), and then determined whether the TPB explained significant variation in intentions and behaviour over a 1 month period in a sample of grade 7–9 (age 12–16 years) adolescents. Eighteen individual interviews and one focus group were used to elicit student beliefs. Analyses of this data produced behavioural, normative and control beliefs which were put into a TPB questionnaire completed by 183 students at time 1 and time 2. The Path analyses from the main study showed that the attitude/intention relationship was moderately large for fruit and vegetable consumption and small to moderate for being smoke free. Perceived behavioural control had a large effect on being smoke free and a moderately large effect for fruit and vegetable consumption and physical activity. Intention had a large direct effect on all three behaviours. Common (e.g. feel better, more energy) and behaviour-specific (e.g., prevent yellow fingers, control my weight) beliefs emerged across the three health behaviours. These novel findings, to the adolescent population, support the importance of specific attention being given to each of the behaviours in future multi-behavioural interventions.     

Dimensions of perceived control: A factor analysis of three measures and an examination of their relation to activity level and mood in a student and cross-cultural patient sample

Abstract

This study investigated whether measures of three perceived control (PC) concepts tapped independent dimensions, were invariant to population characteristics of health and culture, were differentially sensitive to health outcomes, and were discriminable from self-report disability. The Multidimensional Health Locus of Control, Generalized Self-efficacy, and Perceived Health Competence (PHC) Scales were administered to 106 Scottish students and 145 Scottish, Spanish and Irish patients, who also completed versions of the Sickness Impact Profile. Principal Components analyses revealed five factors reflecting scale constructions for students and six factors for patients, as PHC items fell on two factors. Disability items fell on a separate factor from all PC items. Results suggest: (a) PC is multidimensional regardless of health and culture; (b) adequate assessment requires multiple PC measures; and (c) it is meaningful to consider PC as a possible influence on disability.     

Abstracting Sequences: Reasoning That Is a Key to Academic Achievement

The ability to understand sequences of items may be an important cognitive ability. To test this proposition, 8 first-grade children from each of 36 classes were randomly assigned to four conditions. Some were taught sequences that represented increasing or decreasing values, or were symmetrical, or were rotations of an object through 6 or 8 positions. Control children received equal numbers of sessions on mathematics, reading, or social studies. Instruction was conducted three times weekly in 15-min sessions for seven months. In May, the children taught sequences applied their understanding to novel sequences, and scored as well or better on three standardized reading tests as the control children. They outscored all children on tests of mathematics concepts, and scored better than control children on some mathematics scales. These findings indicate that developing an understanding of sequences is a form of abstraction, probably involving fluid reasoning, that provides a foundation for academic achievement in early education.