International Journal of Social Psychiatry

Emotional distress among caregivers of people with mental illness is common, changes overtime and requires appropriate coping strategies to prevent long-term disability. Explanatory models, which underpin understanding of disease and illness, are crucial to coping.

To study the association of explanatory models and distress among caregivers of people with acute psychotic illness.

A total of 60 consecutive patients and their primary caregivers who presented to the Department of Psychiatry, Christian Medical College, Vellore, were recruited for the study. Positive and Negative Syndrome Scale (PANSS), Short Explanatory Model Interview (SEMI) and the General Health Questionnaire-12 (GHQ-12) were used to assess severity of psychosis, explanatory models of illness and emotional distress. Standard bivariate and multivariable statistics were employed.

Majority of the caregivers simultaneously held multiple models of illness, which included medical and non-medical perspectives. The GHQ-12 score were significantly lower in people who held multiple explanatory models of illness when compared to the caregivers who believed single explanations.

Explanatory models affect coping in caregivers of patients with acute psychotic presentations. There is a need to have a broad-based approach to recovery and care.

Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential.

To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression.

In-depth interviews (n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal’s illness representational model.

Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs; Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression.

Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For example, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones.

Excess mortality among people with severe mental illness (SMI) is largely attributed to co-morbid physical illness. Improving the physical health of this population is critically important; however, physical health monitoring among people with SMI is often inadequate.

This study aimed to facilitate an enhanced understanding of barriers to successfully attend to clients’ physical health in mental health settings, through exploring care coordinators’ views and experiences regarding their ability to monitor physical health in clients with SMI (specifically, psychosis).

Semi-structured interviews were conducted with seven care coordinators from a South East London (UK) community mental health team. Data were analysed using thematic analysis principles.

Three themes were identified in these data, capturing (1) how care coordinators viewed the professional roles of other clinical staff and themselves, (2) views on barriers to the provision of physical healthcare and (3) factors that motivated care coordinators to attend to clients’ physical health.

Our findings can inform efforts to implement physical healthcare interventions within mental health settings. Such insights are timely, as academic literature and guidelines regarding clinical practice increasingly promote the value of integrated provision of mental and physical healthcare.

Refugees are at risk of psychiatric morbidity because of forced migration, traumatic events and resettlement in unfamiliar environments. Many live in low- and middle-income countries (LAMIC) under stressful conditions contributing to increased suicide risk.

This study assessed the feasibility of regular contact and use of safety planning cards (CASP) by community volunteers (CVs) in reducing suicidal behaviour among Sri Lankan refugees residing in camps in Tamil Nadu, South India.

A household survey was carried out on consenting adults in two refugee camps – one intervention and one control – randomly selected using lottery method. The primary outcome was reduction in suicidal behaviour. Experience of trauma during war and migration, depression, post-traumatic stress and alcohol use were documented. Individuals scoring >16 on Centre for Epidemiological Studies Depression (CESD) or >30 on Post-traumatic Stress Disorder (PTSD) or with active/passive suicidal ideation or a history of previous suicidal attempts were considered as high risk. CVs were trained to deliver CASP intervention to high-risk individuals. Change from baseline to follow-up was computed for intervention and control groups, and the difference between changes in suicide rates was compared using proportion test.

In total, 639 refugees from intervention and 664 from control camps participated. Of the 288 high-risk refugees in intervention camp, 139 completed the intervention. In the control camp, 187 were categorised as high risk. Prevalence of suicide attempts was 6.1%. Following intervention, differences between sites in changes in combined suicide (attempted suicides and suicides) rates per 100,000 per year were 519 (95% confidence interval (CI): 136–902; p < .01).

CASP, an intervention involving contact by CVs and use of safety planning cards, is feasible to implement and can reduce suicidal behaviour among refugees. Its replication in more settings will enhance validity.

Despite evidence identifying adjustment difficulties among retiring athletes, research investigating factors that contribute to post-retirement complications is limited. Athletic identity may be an important determinant of adverse adaptation to sport retirement.

The purpose of this study was to address the influence of athletic identity on post-retirement depression and anxiety symptoms among varsity athletes.

An anonymous, online survey regarding athletic identity and psychiatric symptoms was completed by 72 self-identified varsity athletes during their final season of competition and 3 months after retiring from sport.

After controlling for the effects of pre-retirement anxiety symptoms, endorsement of an athletic identity significantly predicted anxiety symptoms in the post-retirement period. A similar, but non-significant, pattern was observed for depressive symptoms.

The findings of this study suggest that athletes’ degree of athletic identity may be a risk factor for the emergence of psychiatric distress in the months following their retirement from sport. Identity-focused screening or intervention during athletes’ sport careers could potentially mitigate some of the psychological difficulties associated with sport retirement.

Few longitudinal studies have investigated the functional outcomes of individuals with recent-onset psychotic illness in low- and middle-income countries.

To investigate short-term functional remission and its predictors in a central Vietnamese sample.

A naturalistic 6-month prospective cohort study recruited 79 patients of public health facilities who had experienced a first episode of schizophrenia or related illness in the past 18 months. Individuals and their family members were interviewed using standardised assessments of community functioning, symptoms, treatment, demographics and various psychosocial variables. Rates of functional remission (i.e. no or minimal impairment) were calculated based on rigorous, culturally appropriate criteria. Generalised estimating equations were used to explore predictors of remission.

Rates of global functional remission were 28% at baseline and 53% at follow-up. In individual functional domains, remission was least common for occupational activities, intermediate for relationships and relatively common for daily living activities. Global functional remission was significantly associated with absence of negative and cognitive symptoms, average or better household economic status and unimpaired premorbid functioning.

Remission rates appeared similar to those seen in many international intervention studies. However, individuals from poor households had markedly unfavourable outcomes, suggesting the need for community-based interventions targeting low-socioeconomic status (SES) groups.

Although effective treatment is available for a variety of mental disorders, the treatment and help-seeking gap remains high. One of the main obstacles to help-seeking behaviour is prevailing stigmatizing attitudes.

To examine attitudes within the general population towards seeking professional help in times of mental distress.

A representative general population survey (N = 594) was conducted in Slovenia by means of an Internet-based questionnaire, covering data on demographic variables and attitudes towards help-seeking behaviour.

More stigmatizing attitudes towards help-seeking behaviour were found in men, single persons, those of a younger age and lower educational achievement and in respondents coming from regions with a high suicide rate. Furthermore, 52.50% of the total sample have had an experience with psychological problems, yet only 41.50% of those have sought professional help. Experience with help-seeking behaviour in the past was associated with less stigmatizing attitudes.

Knowledge and understanding of mental health problems are necessary prerequisites to seeking help, but not the only ones. To improve help-seeking behaviour, it is also important to combat stigmatizing attitudes. Additionally, destigmatizing campaigns should also focus on social norms.

Although several studies have analyzed the risk factors of antenatal and post-partum depression, evidence on the prevalence and the risk profile for antenatal depressive symptoms (ADS) between native-born and different groups of non-native born women living in the same country is scant. The aim of this article is to compare the prevalence and the risk profile for ADS across geographical areas in women recruited from two large hospitals of North-western Italy.

The presence of ADS was defined as an Edinburgh Post-natal Depression Scale (EPDS) score ≥12 or a Beck Depression Inventory, Short Form (BDI-SF) score ≥9 or the presence of suicidal ideation/behavior. Crude and adjusted odds ratios (ORs) of ADS were calculated using logistic regression models.

The prevalence of ADS was 12.4% among Italian women and ranged from 11.4% in other European to 44.7% in North-African women. Crude ORs of ADS were OR = 3.3 (95% confidence interval (CI), 1.2–8.8) for Asian, 3.3 (95% CI, 1.9–5.6) for South-American and 5.7 (95% CI, 3.4–9.6) for North-African women. Marital problems, at-risk pregnancy, past psychiatric history, pharmacological treatment, psychological treatment, financial problems, change in residence and number of children were significantly associated with ADS in multivariate analyses, regardless of women’s origin. After adjusting for these variables, the OR of ADS remained significant for South-American and North-African women.

Our results demonstrate that the risk of ADS varies across geographical areas of origin and is highest among North-African women. The risk factors identified should be assessed in routine obstetric care to inform decisions about interventions to prevent post-partum depression and its consequences on the mothers and the newborns.

Persons with serious mental illnesses (SMI) can lead productive lives, and the majority want to work. Mental health providers can play an important role in helping their clients gain and maintain employment.

The Provider Survey was developed to shed additional light on providers’ views toward employment and recovery, and the utilization of Individual Placement and Support (IPS) supported employment (SE) services for people with SMI.

A total of 1,306 providers of the State of Connecticut participated in the survey. Four main questions were addressed in the survey: what do providers do, what do they view as most important regarding employment, what are their views when it comes to what promotes recovery and what barriers do providers face in attempting to refer their clients to IPS services.

Referring clients to additional supports was rated as the most important aspect of what providers do; encouragement was rated as the most important component to enable clients in gaining and maintaining employment; agency, belonging and medical care were rated as most important in promoting recovery; and expectations that clients would be discriminated against at work was the most important barrier to referring clients for SE. Also, employment and finances were seen as the least important factors in promoting the recovery of people with SMI.

This survey suggests that one reason that more clients may not be referred to IPS programs is that clinicians do not view employment or financial self-sufficiency as important factors in recovery, further compounding the historical view that these persons are unable to, and uninterested in, working. Such findings call for a provider education and training campaign to highlight the fact that most persons with SMI – like most persons in general – do want to work and, with supports, most are capable of doing so.

Gender differences are one of the most important and crucial subjects in evaluating the nursing care as well as mental health care system for psychiatric patients especially patients with schizophrenia.

We aimed to identify differences in needs of male and female patients with schizophrenia in psychiatric hospitals in Baghdad city and its relationship with some variables.

A descriptive, analytical design that was carried out by using Camberwell needs assessment, short appraisal schedule, self-report version (CANSAS-P) after translating to Arabic.

Results indicated that there were a lot of unmet needs of male and female patients with schizophrenia, according to the entire CANSAS-P domains especially psychological symptoms. Differences were found in types of needs as the majority of men have more social needs while females was found to be more occupied with their fears and need safety.

there were differences in types of need between male and female patients with schizophrenia; needs were affected by some variables such as educational level, first 10 days of admission and family visiting.

Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population.

To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy.

Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000–2015). Statistics performed by means of linear regression models.

Increased smokers (β = 1.68, p = .03), heavy smokers, that is, people smoking 11–20 cigarettes per day (β = 2.18, p = .04) or more than 20 cigarettes per day (β = 1.04, p < .01) and mean number of smoked cigarettes per day (β = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (β = 0.91, p = .04), while the Italian families’ expenditure for alcoholic beverages decreased (β = –812.80, p = .01). Alcohol consumption decreased (β = –0.60, p < .01), especially in men (β = –0.95, p < .01); binge drinking increased in years 2009–2010. No change was noticeable in the diet indicators collected.

The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

Social support is an important facilitator of the quality of life for people with schizophrenia. This study examines what is perceived as helpful and unhelpful support from the members of the natural social networks by 32 Turkish people with schizophrenia.

Semi-structured interviews and thematic analysis were used to examine what is perceived as helpful and unhelpful support.

The findings suggested that instrumental, emotional and socialization supports were the general categories that capture the perceptions of support. Intrusion and belittling/rejection appeared as unhelpful. It is important to take these perceptions into account in providing psychoeducation to families and in designing psychosocial intervention programs.