Mental Health Research – Page 5 – Mental Health Matters

Can We Link Personality Pathology with Smoking & Traits?

Published on 03/16/2021 by Andrew MarshallLeave a comment

Research Paper Title

Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology.

Background

Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviours such as smoking.

Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence.

Methods

The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e. current, former, never).

Results

Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers.

Conclusions

Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system.

Reference

Halberstadt, A.L., Skrzynski, C.J., Wright, A.G.C. & Creswell, K.G. (2021) Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology. Personality Disorders. doi: 10.1037/per0000487. Online ahead of print.

What are the Factors Associated with Suicide in Chinese Adults?

Published on 03/15/2021 by Andrew MarshallLeave a comment

Research Paper Title

Factors associated with suicide risk among Chinese adults: A prospective cohort study of 0.5 million individuals.

Background

Suicide is a leading cause of death in China and accounts for about one-sixth of all suicides worldwide. The objective of this study was to examine the recent distribution of suicide and risk factors for death by suicide. Identifying underlying risk factors could benefit development of evidence-based prevention and intervention programmes.

Methods

The researchers conducted a prospective study, the China Kadoorie Biobank, of 512,715 individuals (41% men, mean age 52 years) from 10 (5 urban, 5 rural) areas which are diverse across China in geographic locations, social economic developmental stages, and prevalence of disease patterns. After the baseline measurements of risk factors during 2004 to 2008, participants were followed up for suicide outcomes including suicide and possible suicide deaths. Risk factors, such as sociodemographic factors and physical and mental health status, were assessed by semi-structured interviews and self-report questionnaires.

Suicide and possible suicide deaths were identified through linkage to the local death registries using ICD-10 codes. The researchers conducted Cox regression to calculate hazard ratios (HRs) for suicide and for possible suicide in sensitivity analyses.

Results

During an average follow-up period of 9.9 years, 520 (101 per 100,000) people died from suicide (51.3% male), and 79.8% of them lived in rural areas. Sociodemographic factors associated with increased suicide risk were male gender (adjusted hazard ratios [aHR] = 1.6 [95% CI 1.4 to 2.0], p < 0.001), older age (1.3 [1.2 to 1.5] by each 10-yr increase, p < 0.001), rural residence (2.6 [2.1 to 3.3], p < 0.001), and single status (1.7 [1.4 to 2.2], p < 0.001). Increased hazards were found for family-related stressful life events (aHR = 1.8 [1.2 to 1.9], p < 0.001) and for major physical illnesses (1.5 [1.3 to 1.9], p < 0.001). There were strong associations of suicide with a history of lifetime mental disorders (aHR = 9.6 [5.9 to 15.6], p < 0.001) and lifetime schizophrenia-spectrum disorders (11.0 [7.1 to 17.0], p < 0.001). Links between suicide risk and depressive disorders (aHR = 2.6 [1.4 to 4.8], p = 0.002) and generalized anxiety disorders (2.6 [1.0 to 7.1], p = 0.056) in the last 12 months, and sleep disorders (1.4 [1.2 to 1.7], p < 0.001) in the past month were also found.

All HRs were adjusted for sociodemographic factors including gender, age, residence, single status, education, and income. The associations with possible suicide deaths were mostly similar to those with suicide deaths, although there was no clear link between possible suicide deaths and psychiatric factors such as depression and generalised anxiety disorders. A limitation of the study is that there is likely underreporting of mental disorders due to the use of self-report information for some diagnostic categories.

Conclusions

In this study, the researchers observed that a range of sociodemographic, lifestyle, stressful life events, physical, and mental health factors were associated with suicide in China. High-risk groups identified were elderly men in rural settings and individuals with mental disorders. These findings could form the basis of targeted approaches to reduce suicide mortality in China.

Reference

Yu, R., Chen, Y., Li, L., Chen, J., Guo, Y., Bian, Z., Lv., Yu, C., Xie., Huang, D., Chen, Z. & Fazel, S. (2021) Factors associated with suicide risk among Chinese adults: A prospective cohort study of 0.5 million individuals. PLoS Med. doi: 10.1371/journal.pmed.1003545. eCollection 2021 Mar.

Updating the Development of Mobile Computing Technology & the Delivery of Psychological Interventions

Published on 03/12/2021 by Andrew MarshallLeave a comment

Research Paper Title

Ecological momentary interventions for mental health: A scoping review.

Background

The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these “ecological momentary interventions” were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed.

Therefore the aim of this study was to provide an overview of the definitions given for “ecological momentary interventions” in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions.

Methods

A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardised extraction worksheet. Selected articles were then thematically categorised.

Results

The search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states.

Conclusions

With the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.

Reference

Balaskas, A., Schueller, S.M., Cox, A.L. & Doherty, G. (2021) Ecological momentary interventions for mental health: A scoping review. PLoS One. doi: 10.1371/journal.pone.0248152. eCollection 2021.

Examining the Ethnic & Migration-Related Differences in the Use of IAPT-Based Psychological Treatment

Published on 03/11/2021 by Andrew MarshallLeave a comment

Research Paper Title

The association of migration and ethnicity with use of the Improving Access to Psychological Treatment (IAPT) programme: a general population cohort study.

Background

Common mental disorders (CMD), such as depression and anxiety, are an important cause of morbidity, economic burden and public mental health need. The UK Improving Access to Psychological Therapies (IAPT) programme is a national effort to reduce the burden and impact of CMD, available since 2008.

Therefore, the aim of this study was to examine ethnic and migration-related differences in use of IAPT-based psychological treatment using a novel epidemiological dataset with linkage to de-identified IAPT records.

Methods

Data from a psychiatric morbidity survey of two South East London boroughs (2008-2010) were individually-linked to data on IAPT services serving those boroughs. The researchers used Poisson regression to estimate association between ethnicity and migration status (including years of UK residence), with rate of subsequent use of psychological treatment.

Results

The rate of psychological treatment use was 14.4 cases per thousand person years [cases/1000 pyrs, 95% confidence intervals (95% CI) 12.4, 16.7]. There was strong statistical evidence that compared to non-migrants, migrants residing in the UK for less than 10 years were less likely to use psychological treatment after adjustment for probable sociodemographic predictors of need, life adversity, and physical/psychiatric morbidity at baseline [rate ratio (RR) 0.4 (95% CI 0.20, 0.75]. This difference was not explained by migration for asylum/political reasons, or English language proficiency, and was evident for both self- and GP referrals.

Conclusions

Lower use of IAPT among recent migrants is unexplained by sociodemographics, adversity, and baseline morbidity. Further research should focus on other individual-level and societal barriers to psychological treatment use among recent migrants to the UK, including in categories of intersecting migration and ethnicity.

Reference

Bhavsar, V., Jannesari, S., McGuire, P., MacCabe, J.H., Das-Munshi, J., Bhugra, D., Dorrington, S., Brown, J.S.L., Hotopf, M.H. & Hatch, S.L. (2021) The association of migration and ethnicity with use of the Improving Access to Psychological Treatment (IAPT) programme: a general population cohort study. Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-021-02035-7. Online ahead of print.

What is the Incidence of Mental Health in New York?

Published on 03/10/2021 by Andrew MarshallLeave a comment

Research Paper Title

Rising Mental Health Incidence Among Adolescents in Westchester, NY.

Background

Many governments have publicly released healthcare data, which can be mined for insights about disease conditions, and their impact on society.

Methods

The researchers present a big-data analytics approach to investigate data in the New York Statewide Planning and Research Cooperative System (SPARCS) consisting of 20 million patient records.

Results

Whereas the age group 30-48 years exhibited an 18% decline in mental health (MH) disorders from 2009 to 2016, the age group 0-17 years showed a 5.4% increase. MH issues amongst the age group 0-17 years comprise a significant expenditure in New York State. Within this age group, we find a higher prevalence of MH disorders in females and minority populations. Westchester County has seen a 32% increase in incidences and a 41% increase in costs.

Conclusions

The approach is scalable to data from multiple government agencies and provides an independent perspective on health care issues, which can prove valuable to policy and decision-makers.

Reference

Rao, A.R., Rao, S. & Chhabra, R. (2021) Rising Mental Health Incidence Among Adolescents in Westchester, NY. Community Mental health Journal. doi: 10.1007/s10597-021-00788-8. Online ahead of print.

The Body Cathexis Scale & Body Satisfaction in Women

Published on 03/09/2021 by Andrew MarshallLeave a comment

Research Paper Title

Measuring body satisfaction in women with eating disorders and healthy women: appearance-related and functional components in the Body Cathexis Scale (Dutch version).

Background

Differentiating the concept of body satisfaction, especially the functional component, is important in clinical and research context. The aim of the present study is to contribute to further refinement of the concept by evaluating the psychometric properties of the Dutch version of the Body Cathexis Scale (BCS). Differences in body satisfaction between clinical and non-clinical respondents are also explored.

Methods

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate whether functional body satisfaction can be distinguished as a separate factor, using data from 238 adult female patients from a clinical sample and 1060 women from two non-clinical samples in the Netherlands. Univariate tests were used to identify differences between non-clinical and clinical samples.

Results

EFA identified functionality as one of three factors, which was confirmed by CFA. CFA showed the best fit for a three-factor model, where functionality, non-weight, and weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes.

Conclusions

The three factors of the BCS may be used as subscales, enabling researchers and practitioners to use one scale to measure different aspects of body satisfaction, including body functionality. Use of the BCS may help to achieve a more complete understanding of how people evaluate body satisfaction and contribute to further research on the effectiveness of interventions focussing on body functionality.

Reference

Rekkers, M.E., Scheffers, M., van Busschbach, J.T & van Elburg, A.A. (2021) Measuring body satisfaction in women with eating disorders and healthy women: appearance-related and functional components in the Body Cathexis Scale (Dutch version). Eating and Weight Disorders. doi: 10.1007/s40519-021-01120-9. Online ahead of print.

New Insights on Suicide Care from a Nursing Perspective

Published on 03/05/2021 by Andrew MarshallLeave a comment

Research Paper Title

Suicide care from the nursing perspective: A meta-synthesis of qualitative studies.

Background

To explore nurses’ experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. A qualitative meta-synthesis.

Methods

Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019.

The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso’s method.

Results

Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: ‘Understanding suicidal behaviour as a consequence of suffering’, ‘Nurses’ personal distress in suicide care’, ‘The presence of the nurse as the axis of suicide care’ and, ‘Improving nurses’ relational competences for a better therapeutic environment’.

Conclusions

Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care.

Impact

This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

Reference

Clua-Garcia, R., Casanova-Garrigos, G. & Moreno-Poyato, A.R. (2021) Suicide care from the nursing perspective: A meta-synthesis of qualitative studies. Journal of Advanced Nursing. doi: 10.1111/jan.14789. Online ahead of print.

Interventions for Preventing Type 2 Diabetes in Adults with Mental Disorders in Low- & Middle-Income Countries

Published on 03/04/2021 by Andrew MarshallLeave a comment

Research Paper Title

Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries.

Background

The prevalence of type 2 diabetes is increased in individuals with mental disorders. Much of the burden of disease falls on the populations of low- and middle-income countries (LMICs).

Therefore the aim of this study was to assess the effects of pharmacological, behaviour change, and organisational interventions versus active and non-active comparators in the prevention or delay of type 2 diabetes among people with mental illness in LMICs.

Methods

The researchers searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase and six other databases, as well as three international trials registries. They also searched conference proceedings and checked the reference lists of relevant systematic reviews. Searches are current up to 20 February 2020.

A randomised controlled trials (RCTs) of pharmacological, behavioural or organisational interventions targeting the prevention or delay of type 2 diabetes in adults with mental disorders in LMICs.

Pairs of review authors working independently performed data extraction and risk of bias assessments. They conducted meta-analyses using random-effects models.

Results

One hospital-based RCT with 150 participants (99 participants with schizophrenia) addressed our review’s primary outcome of prevention or delay of type 2 diabetes onset. Low-certainty evidence from this study did not show a difference between atypical and typical antipsychotics in the development of diabetes at six weeks (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.03 to 7.05) (among a total 99 participants with schizophrenia, 68 were in atypical and 31 were in typical antipsychotic groups; 55 participants without mental illness were not considered in the analysis). An additional 29 RCTs with 2481 participants assessed one or more of the review’s secondary outcomes. All studies were conducted in hospital settings and reported on pharmacological interventions.

One study, which the researchers could not include in our meta-analysis, included an intervention with pharmacological and behaviour change components. They identified no studies of organisational interventions. Low- to moderate-certainty evidence suggests there may be no difference between the use of atypical and typical antipsychotics for the outcomes of drop-outs from care (RR 1.31, 95% CI 0.63 to 2.69; two studies with 144 participants), and fasting blood glucose levels (mean difference (MD) 0.05 lower, 95% CI 0.10 to 0.00; two studies with 211 participants). Participants who receive typical antipsychotics may have a lower body mass index (BMI) at follow-up than participants who receive atypical antipsychotics (MD 0.57, 95% CI 0.33 to 0.81; two studies with 141 participants; moderate certainty of evidence), and may have lower total cholesterol levels eight weeks after starting treatment (MD 0.35, 95% CI 0.27 to 0.43; one study with 112 participants). There was moderate certainty evidence suggesting no difference between the use of metformin and placebo for the outcomes of drop-outs from care (RR 1.22, 95% CI 0.09 to 16.35; three studies with 158 participants).

There was moderate-to-high certainty evidence of no difference between metformin and placebo for fasting blood glucose levels (endpoint data: MD -0.35, 95% CI -0.60 to -0.11; change from baseline data: MD 0.01, 95% CI -0.21 to 0.22; five studies with 264 participants). There was high certainty evidence that BMI was lower for participants receiving metformin compared with those receiving a placebo (MD -1.37, 95% CI -2.04 to -0.70; five studies with 264 participants; high certainty of evidence). There was no difference between metformin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Low-certainty evidence from one study (48 participants) suggests there may be no difference between the use of melatonin and placebo for the outcome of drop-outs from care (RR 1.00, 95% CI 0.38 to 2.66). Fasting blood glucose is probably reduced more in participants treated with melatonin compared with placebo (endpoint data: MD -0.17, 95% CI -0.35 to 0.01; change from baseline data: MD -0.24, 95% CI -0.39 to -0.09; three studies with 202 participants, moderate-certainty evidence).

There was no difference between melatonin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Very low-certainty evidence from one study (25 participants) suggests that drop-outs may be higher in participants treated with a tricyclic antidepressant (TCA) compared with those receiving a selective serotonin reuptake inhibitor (SSRI) (RR 0.34, 95% CI 0.11 to 1.01). It is uncertain if there is no difference in fasting blood glucose levels between these groups (MD -0.39, 95% CI -0.88 to 0.10; three studies with 141 participants, moderate-certainty evidence). It is uncertain if there is no difference in BMI and depression between the TCA and SSRI antidepressant groups.

Conclusions

Only one study reported data on the primary outcome of interest, providing low-certainty evidence that there may be no difference in risk between atypical and typical antipsychotics for the outcome of developing type 2 diabetes. The researchers are therefore not able to draw conclusions on the prevention of type 2 diabetes in people with mental disorders in LMICs. For studies reporting on secondary outcomes, there was evidence of risk of bias in the results. There is a need for further studies with participants from LMICs with mental disorders, particularly on behaviour change and on organisational interventions targeting prevention of type 2 diabetes in these populations.

Reference

Mishu, M.P., Uphoff, E., Aslam, F., Philip, S., Wright, J., Tirbhowan, N., Ajjan, R.A., Azdi, Z.A., Stubbs, B., Chhurchill, R. & Siddiqi, N. (2021) Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD013281.pub2.

Psychiatric Rehabilitation & Young Adults with Serious Mental Health Conditions

Published on 03/03/2021 by Andrew MarshallLeave a comment

Research Paper Title

Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions.

Background

This study can inform psychiatric rehabilitation practice by describing the patterns of education, training, and employment activities among young adults with serious mental health conditions and identify potentially malleable factors that hinder or facilitate their ability to continuously pursue these activities.

Methods

One-time, in-person interviews were conducted with 55 young adults, ages 25-30, with serious mental health conditions in Massachusetts. The life story interview script asked participants about key life and mental health experiences and details about their education, training, and employment experiences.

Results

Young adult paths’ through post-secondary school, training, and work were often non-linear and included multiple starts and stops. Many young adults reported unsteady and inconsistent patterns of school and work engagement and only half were meaningfully engaged in education, employment, or training at the time of the interview. Employment often included service industry jobs with short tenures and most who had attempted post-secondary college had not obtained a degree. Barriers to continuous pursuit of school, training, or work included stress-induced anxiety or panic, increased symptomatology related to their mental health condition, and interpersonal conflicts. Flexible school, training, and work environments with supportive supervisors helped facilitate the continuous pursuit of these activities.

Conclusions

Psychiatric rehabilitation professionals need to help young adults with serious mental health conditions manage stress and anxiety and periods of increased symptomatology, navigate interpersonal challenges, and advocate for flexible and supportive accommodations. Early and blended education and employment supports would also be beneficial.

Reference

Sabella, K. (2021) Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions. Psychiatric Rehabilitation Journal. doi: 10.1037/prj0000470. Online ahead of print.