Does Lockdown Change Health Priorities in the Local Population?

Research Paper Title

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from the AUSL Romagna, Italy.

Background

An observation of the admissions to the emergency room (ER) requiring psychiatric evaluation during the lockdown and investigation of the demographic and clinical variables.

Methods

Retrospective longitudinal observational study of ER accesses for psychiatric evaluation was performed, comparing two periods (09 March to 03 May 2020 vs. 09 March to 03 May 2019). Data (number of admissions, key baseline demographic and clinical variables) were extracted from the ER databases of referral centres in a well-defined geographic area of North-Eastern Italy (Cesena, Ravenna, Forlì, and Rimini).

Results

A 15% reduction of psychiatric referrals was observed, together with a 17% reduction in the total number of patients referring to the ER. This reduction was most evident in the first month of the lockdown period (almost 25% reduction of both referrals and patients). Female gender (OR: 1.52: 95%, CI: 1.12-2.06) and being a local resident (OR: 1.54: 95%CI: 1.02-2.34) were factors associated with the decrease.

Conclusions

Lockdown changed dramatically health priorities in the local population, including people with mental health. The researchers speculate that our observations do not only refer to the confinement due to the lockdown regime but also to fear of contagion and adoption of different coping strategies, especially in women. Key-points During lockdown 15% reduction of psychiatric visits and >17% reduction in the number of psychiatric patients referring to the ER was observed. in the first four weeks of the lockdown almost 25% reduction of both visits and patients was observed Female gender and being a local resident were factors associated with the decrease.

Reference

Beghi, M., Brandolini, R., Casolaro, I., Beghi, E., Cornaggia, C.M., Fraticelli, C., De Paoli, G., Ravani, C., Castelpietra, G. & Ferrari, S. (2020) Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from the AUSL Romagna, Italy. International Journal of Psychiatry in Clinical Practice. doi: 10.1080/13651501.2020.1859120.

Complementary Medicine & Integrative Health Approaches to Trauma Therapy & Recovery

Research Paper Title

Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery.

Abstract

The popularity of complementary and integrative health (also complementary integrated health; CIH) approaches has significantly increased in recent years.

According to the National Centre for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, about 1 in 3 adults and 1 in 9 children used CIH approaches to healing.

Some reports estimate that the use of CIH approaches will continue to increase (Clarke et al., 2015) as these therapies are cost effective and also due to the difficulties in finding trained mental health professionals (Simon et al., 2020).

For the purpose of this special issue, the researchers use the NCCIH’s definition of CIH as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (Barnes et al., 2004, p. v). However, the integration of these therapies into the health system has not followed the same pattern despite the fact that patients report the need to discuss CIH therapies with their doctors or are actually using them (de Jonge et al., 2018; Jou & Johnson, 2016; Stapleton et al., 2015). This inability to keep up with the demand or patients’ preference is possibly due to providers’ lack of understanding and/or knowledge of these therapies, as well as scientific skepticism (Ali & Katz, 2015; Fletcher et al., 2017).

Using data from the 2012 National Health Interview Survey, Jou & Johnson (2016) identified patterns of CIH use in the United States and reasons for patients’ nondisclosure of the use of these therapies. Patients’ fear of disclosure due to perceived scepticism or disapproval from their provider was frequently attributed as a cause of patients’ nondisclosures to providers about the use of these therapies (Eisenberg et al., 2001; Jou & Johnson, 2016; Thomson et al., 2012).

The arrival of patient-centred care models is beginning to shift the ways we understand the patient’s role in treatment engagement. Patient-centred approaches often emphasize the use of preventative and holistic wellness models that go beyond the use of evidence-based treatments. This approach also seeks to be culturally responsive, which is a key factor in addressing health disparities in the United States (American Psychological Association [APA], 2019).

The Institute of Medicine, in its report on CIH therapies, highlighted the importance of engaging patients in their own care, including having a decision about therapeutic options (Bondurant et al., 2005). Likewise, the Race and Ethnicity Guidelines in Psychology (APA, 2019) recommend psychologists engage the patient’s cultural beliefs, or what Kleinman called the “explanatory belief model” (Kleinman, 1978)- for example, by “aim[ing] to understand and encourage indigenous/ ethnocultural sources of healing within professional practice” (APA, 2019, p. 24).

Reference

Mattar, S. & Frewenm P.A. (2020) Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery. Psychological Trauma. 12(8):821-824. doi: 10.1037/tra0000994.

Mental Health in Nursing: One Student’s Perspective

Research Paper Title

Mental health in nursing: A student’s perspective.

Background

A stigma around mental health issues within healthcare and nursing itself has created a culture of perfectionism in the workplace, and nurses struggle to live up to the expectations while pushing aside their feelings, thoughts, and needs.

Inspired by one author’s personal experiences, this article explores mental health issues many nurses confront today.

Reference

Halsted, C. & Hart, V.T. (2020) Mental health in nursing: A student’s perspective. Nursing. 51(1), pp52-55. doi: 10.1097/01.NURSE.0000694764.76416.f9.

3MDR & PTSD: Breaking Through Avoidance & Increasing Engagement

Research Paper Title

Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a mixed methods study.

Background

A novel intervention, Multi-modular motion-assisted memory desensitisation and reconsolidation (3MDR), aims to reduce avoidance and improve engagement for patients with posttraumatic stress disorder (PTSD) who did not sufficiently respond to previous treatments. It has been found to effectively reduce PTSD symptoms for veterans with treatment-resistant PTSD. Symptomatic measures alone might not capture all treatment effects, and addition of qualitative outcomes may provide deeper understanding of treatment processes and treatment-induced changes.

The purpose of this was to study the perspectives of veterans with treatment-resistant PTSD on 3MDR treatment processes and effects and explore the relation of their experiences to PTSD symptom improvement.

Methods

A convergent parallel mixed methods design was applied. For the qualitative part, open-ended question interviews were conducted until data saturation was reached (N = 10). Thematic analysis, rooted in grounded theory, was performed. Quantitative data included pre- to posttreatment responder status based on a structured clinical interview for PTSD.

Results

Treatment processes endorsed by the veterans were engaging, regulating distress, feeling supported, facing traumatic memories, allowing emotions, associating, and disengaging from trauma. In terms of effects, veterans reported positive changes following 3MDR, including openness, new learning, self-understanding, closure, and reintegration. High comparability across themes was observed for responders and non-responders, except for the themes closure and reintegration, which were reported more often or more in depth by responders.

Conclusions

Veterans indicated 3MDR treatment processes that complied with its aims of breaking through avoidance and increasing engagement, thereby facilitating traumatic memory retrieval and processing. However, this did not necessarily translate into PTSD symptom improvement for all veterans. Walking towards trauma-related pictures was highlighted as unique component of 3MDR and connected to specific treatment processes and effects. Positive changes following 3MDR were experienced outside the domain of PTSD symptom improvement, implicating that 3MDR may beneficially impact veterans beyond symptom changes alone.

Reference

van Gelderen, M.J., Nijdam, M.J., Dubbink, G.E., Sleijpen, M. & Vermetten, E. (2020) Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a mixed methods study.

Deployment-Related Stress & Support Needs

Research Paper Title

“This is not your Life…and it becomes your Life”: A Qualitative Exploration of Deployment-related Stress and Support needs in National Guard and Reserve spouses who are Mothers of Young Children.

Background

The adverse effects of deployment-related stress (DRS) on military service members, spouses, and children are well documented.

Findings from a recent Consensus Report on Military Families by the National Academies of Science, Engineering, and Medicine (2019) underscore the priority of gaining a more comprehensive understanding of the diversity of today’s military families and their needs and well-being.

While social support is generally regarded as helpful during times of stress, it has not been studied extensively in National Guard/Reserve spouses who are parents of young children.

Methods

This qualitative study of 30 women examines the unique ways in which DRS affects women who are National Guard/Reserve spouses and mothers of young children, as well as the processes through which they encountered support to manage these stressors.

Salient themes spanned experiences involving deployment cycle phases of separation and reintegration and included both anticipated and unanticipated changes in family-related division of labour, dynamics, and communication patterns.

These were complicated by geographic, social, and cultural isolation and misguided efforts to support spouses initiated by civilians.

Conclusions

Women managed these stressors primarily through seeking, acquiring, and repurposing existing sources of informal social support for themselves and formal supports for their children, with varying degrees of success.

Reference

Ross, A.M., DeVoe, E.R., Steketee, G., Spencer, R. & Richter, M. (2020) “This is not your Life…and it becomes your Life”: A Qualitative Exploration of Deployment-related Stress and Support needs in National Guard and Reserve spouses who are Mothers of Young Children. Family Process. doi: 10.1111/famp.12622. Online ahead of print.

Does VRET & ARET Work as a Treatment for PTSD?

Research Paper Title

Efficacy of immersive PTSD treatments: A systematic review of virtual and augmented reality exposure therapy and a meta-analysis of virtual reality exposure therapy.

Background

Virtual reality exposure therapy (VRET) and augmented reality exposure therapy (ARET) are digitally assisted psychotherapies that potentially enhance posttraumatic stress disorder (PTSD) treatment by increasing a patient’s sense of presence during exposure therapy.

This study aimed to systematically review current evidence regarding the efficacy of VRET and ARET as PTSD treatment.

Methods

A systematic electronic database search, a systematic quality assessment and two meta-analyses were conducted in accordance with PRISMA guidelines.

Results

Eleven studies on the efficacy of VRET for PTSD (n = 438) were found, but no studies on the efficacy of ARET. The majority of VRET studies were of a low quality and had heterogeneous results. Meta-analyses showed VRET outperformed waitlist control (standardised mean difference -0.64 (95% CI -1.05 to -0.22)) while no significant difference was found between VRET and active treatment conditions (standardised mean difference -0.25 (95% CI -0.77 to 0.27)).

Conclusions

VRET was superior to waitlist control groups and as effective as other psychotherapies. However, the results showed considerable heterogeneity due to the low number of studies and variety of VRET methods. VRET may be an effective alternative to current treatments and shows promise for the treatment of PTSD patients that have not responded to previous treatment.

Future research should focus on high quality RCTs, including information on side effects and adverse events, with sufficient numbers of participants.

This study recognises a research gap regarding the efficacy of ARET, while it may have potential for PTSD treatment.

Reference

Eshuis, L.V., van Gelderen, M.J., van Zuidan, M., Nijdam, M.J., Vermetten, E., Olff, M. & Bakker, A. (2020) Efficacy of immersive PTSD treatments: A systematic review of virtual and augmented reality exposure therapy and a meta-analysis of virtual reality exposure therapy. Journal of Psychiatric Research. doi: 10.1016/j.jpsychires.2020.11.030. Online ahead of print.

What are the Correlates of Suicidal Ideation & Behaviours Among Former Military Personnel Not Enrolled in the Veterans Health Administration?

Research Paper Title

Correlates of Suicidal Ideation and Behaviours Among Former Military Personnel Not Enrolled in the Veterans Health Administration.

Background

The current study sought to explore suicidal concomitants, both demographic and psychological, among former military personal.

Methods

The sample included 645 veterans who are at increased risk for suicide but have not yet pursued Veterans Health Administration (VHA) services.

Results

Descriptive statistics revealed that these veterans are primarily young Caucasian males who served in the US Army.

In terms of psychological characteristics, the current sample reported clinically significant levels of depression, post-traumatic stress, and insomnia.

Furthermore, respondents acknowledged use of various substances and high levels of perceived burdensomeness and thwarted belongingness.

Conclusions

The demographic and psychological makeup of the researchers sample was somewhat similar to that of VHA-connected veterans except that their sample was slightly more educated and reported less physical pain.

Reference

Raines, A.M., Allan, N.P., Franklin, C.L., Huet, A. Constans, J.I. & Stecker, T. (2020) Correlates of Suicidal Ideation and Behaviors Among Former Military Personnel Not Enrolled in the Veterans Health Administration. Archives of Suicide Research. 24(4), pp.517-533. doi: 10.1080/13811118.2019.1660286. Epub 2019 Dec 2.

Sleep-Wake Disorders & DSM-5

Research Paper Title

Sleep-wake disorders and DSM-5.

Background

Most individuals with mental disorders complain about the problems they experience with sleeping and waking. It is becoming evident that careful diagnosis of sleep-wake disorders is of great importance for the prevention and treatment of mental disorders. Since the introduction of the DSM-IV, clinical scientific research has provided important new insights in this field.

Therefore the aim of this research was to find out whether the new classification of sleep-wake disorders in DSM-5 is likely to improve the diagnosis of disorders of this type.

Method

The researchers discuss the main changes in the DSM-5 classification of sleep- wake disorders, comparing the new version with the version in DSM-IV.

Results

Because considerable attention is being given to the symptom-orientated and dimensional approach, the classification of sleep-wake disorders in the DSM-5 is closer to current psychiatric practice and it does justice to the current scientific insights into the dimensional nature of psychiatric disorders.

Conclusions

The DSM-5 classification takes recent scientific insights into account and might help to improve the diagnosis of sleep-wake disorders in psychiatry.

Reference

van Bemmel, A.L. & Kerkhof, G.A. (2020) Sleep-wake disorders and DSM-5. Tijdschrift voor Psychiatrie. 56(3), pp.192-195.

Elucidating the Epidemiology of Mental Disorders

Research Paper Title

WHO’s work on the epidemiology of mental disorders.

Background

The WHO programme on epidemiology of mental disorders started in the early 1960’s with a series of reviews of knowledge.

These were followed by activities aiming at four main goals:

  • The standardisation of psychiatric diagnosis, classification and statistics;
  • The development of standardised internationally applicable instruments for the assessment of mental patients and of variables relevant to the assessment of mental illness;
  • The conduct of epidemiological studies of mental disorders; and
  • The training relevant to the above goals.

The paper provides a description of the activities undertaken to achieve these goals and stresses the importance and usefulness of the collaboration of individuals, experts and institutions all over the world in this effort.

Reference

Sartorius, N. (2020) WHO’s work on the epidemiology of mental disorders. Social Psychiatry and Psychiatric Epidemiology. 28(4), pp.147-155. doi: 10.1007/BF00797316.

What is the Impact of Early Manifesting Disorders in the Frame of General Mental Morbidity & of the Effect of Intervention?

Research Paper Title

What happens to children and adolescents with mental disorders? Findings from long-term outcome research.

Background

Research on the long-term outcome of mental disorders originating in childhood and adolescence is an important part of developmental psychopathology.

Methods

After a brief sketch of relevant terms of outcome research, the first part of this review reports findings based on heterotypic cohort studies.

The major second part of this review presents findings based on long-term outcome studies dealing with homotypic diagnostic groups. In particular, the review focuses on the course and prognosis of ADHD, anxiety disorders, depression, conduct disorders, eating disorders, autism spectrum disorders, schizophrenia, and selective mutism.

Results

Findings mainly support the vulnerability hypothesis regarding mental disorders with early manifestation in childhood and adolescence as frequent precursors of mental disorders in adulthood.

Conclusions

The discussion focuses on the impact of early manifesting disorders in the frame of general mental morbidity and of the effect of interventions, which is not yet sufficiently discernible.

Reference

Steinhausen, H-C. (2020) What happens to children and adolescents with mental disorders? Findings from long-term outcome research [German]. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie. 41(6), pp.419-431. doi: 10.1024/1422-4917/a000258.