Journal of the American Psychiatric Nurses Association

Urban, ethnically/racially diverse, impoverished men are predisposed to experience unaddressed depression and anxiety. The overlap of these factors creates significant mental health inequity.

This study sought to capture men’s impressions of the factors that contributed to their experience of depression and anxiety as well as barriers that they experienced in pursuing intervention.

Using community-based participatory research, in the context of long-term partnerships between a department of nursing and three urban, racially/ethnically diverse, and impoverished neighborhoods, the researchers recruited 50 men ages 23–83 years. Data were collected via six homogeneous, Zoom-based focus groups composed of Black, Hispanic, and White men, respectively.

The men identified multiple themes pertaining to modifiable and non-modifiable contributing factors that played a role in their development of depression and anxiety as well as barriers related to stigma, resource issues, and a lack of knowledge of mental illness that they faced when seeking intervention.

Understanding men’s perspectives on the contributing factors and barriers to mental health intervention can provide an evidence base with which to address mental health inequity via tailored care, policy, and research agendas.

Identifying and sharing psychiatric mental health (PMH) research priorities can help identify gaps in the literature, determine training needs for nurses, and assist investigators in locating funding.

The aims for this project included: (1) identify PMH nursing specialty research priorities from large, public funding entities; (2) compare the identified research priorities and scholarly articles published in 2020; and (3) outline future directions for advancing the science of PMH nursing.

Strategic plans of funding entities for PMH research were reviewed for research priorities. Summarized priorities were then compared with publications from peer-reviewed PMH nursing journals. Work conducted in the United States was extracted and categorized as original research, evidence-based practice (EBP), or quality improvement (QI), then design and population.

Priorities from 13 funding entities comprised three domains (education, research, and practice), with nine areas, 30 topics, and subtopics. Eight journals produced 432 articles with 99 (23%) conducted in the United States. Among these journals, publications fitting research priorities ranged from 1 to 33 articles. Of the 99 articles, 85% were original research and 15% were either EBP or QI. Descriptive articles comprised 64% and 23% tested interventions. Populations studied included workforce; adults; infants, children, and adolescents; and parents.

All published articles by the U.S. PMH nurses matched the funding priorities, but not all funding priorities were addressed by 2020 publications. The majority of work was conducted outside of the United States and most published from the United States was descriptive, contrary to many United States funders’ priorities for interventional research.

Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples.

To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020.

Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations.

The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.

Heart rate variability (HRV) is an indicator of autonomic abnormalities. However, little is known about the role of HRV related to substance use behavior and the association between the changes in HRV and signs of relapse in substance use.

The purpose of this study was to review the existing literature on autonomic response to substance use (i.e., opioids, cocaine, and methamphetamine) measured by HRV and its outcomes related to the risk factors of relapse.

A systematic search of the literature was conducted using PubMed, PsychINFO, and Ovid Medline databases. The study includes full-text articles published in English from 2010 to 2020, using measures of HRV in human subjects who use substances.

A total of 14 studies were reviewed. Studies included outpatients with a prescription or nonprescription opioid misuse behavior with a primary diagnosis being chronic pain or substance use disorder (SUD). Significantly decreased resting HRV was found in substance users compared to healthy controls. Lower resting HRV has been significantly associated with stress, craving, and greater symptom severities in individuals with SUD and other substance dependence. HRV indices can be potential measures of homeostatic imbalance and self-regulation flexibility.

HRV may be a useful tool for monitoring early indication of relapse so that relapse prevention measures can be implemented in a timely manner. Future studies in substance use may benefit from examining HRV in relations to substance use and relapse signs and symptoms in a larger population to guide future relapse prevention strategies.

Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed.

The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents.

Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge’s g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators.

The pooled effects on reducing stress were −0.36. The interventions had small effects on decreasing anxiety (g = −0.31) and depression (g = −0.23). Long-term follow-up effects were −0.77 on perceived stress, −0.08 on anxiety, and −0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = −0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (−0.39 vs. −0.26) and depression (−0.36 vs. −0.17).

These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

The quality of mental health treatment has not progressed to the same extent as physical health treatment. Suboptimal mental health outcomes may be attributed to the lack of a systematic approach to tracking and measuring patient progress. In psychiatry, Measurement-Based Care (MBC) offers an objective, systematic approach to monitor clinical progress, evaluate treatment efficacy, and inform clinical decisions, yet remains seldom used in daily practice.

To identify the clinical impact of using MBC in psychiatry.

Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query, “What is the clinical impact of Measurement-Based Care when treating patients with mental illness?”

A total of nine articles met the inclusion criteria for this integrative review. The articles ranged from 2008 to 2021. The following themes were identified from the analysis of these articles: (1) the clinical impact of MBC, (2) provider attitudes about MBC, and (3) barriers to MBC implementation.

MBC, augmenting usual standard care, provides an objective, systematic approach using quantifiable data to monitor symptom severity and treatment effectiveness. This review highlights the clinical benefits of MBC, including increased remission rates, lower risk of relapse, improved medication adherence, and strengthening the therapeutic alliance. Although this review provides an overview of the benefits of MBC in psychiatry, there remains a substantial practice gap warranting further investigation. Strategies must be developed to address barriers at the individual and organizational levels which impede the successful adoption of MBC.

The use of psychotherapy has a long history within psychiatric-mental health nurse practitioner (PMHNP) practice. Underutilization of psychotherapy in practice has potentially led to a reduced emphasis in the PMHNP curriculum. To date, no national survey has solely evaluated how PMHNP programs ensure psychotherapy skill acquisition.

Survey the PMHNP programs within the United States on how psychotherapy skill acquisition is achieved, including (a) psychotherapeutic curricular content; (b) psychotherapy related clinical practicum hours, including simulation and preceptor-delivered hours; and (c) student interest in psychotherapy skills.

Three rounds of e-mail invitations were sent to all PMHNP programs within the United States. Descriptive statistics and reflective thematic analysis were used to examine survey content.

There were 39 (27%) respondents, representing the U.S. regions equally. The most common forms of psychotherapy taught were cognitive–behavioral and motivational interviewing. The content was most often delivered through a hybrid program (65.8%). Psychotherapy clinical hours most often used in psychology and social work were varied (0–720, SD 132.9) and were usually (63.89%) separate from other clinical hours. Qualitative responses focused on increased emphasis on the use of psychotherapy within PMHNP programs and the need to develop competency checklists for psychotherapy skill acquisition to use with simulation.

This survey reported on both similarities and differences in how PMHNP programs ensure student competency in the skill acquisition of psychotherapy. While this article focuses on what skills are needed in psychotherapy education, direction on how programs deliver this content to their students to ensure this skill will be retained in practice is a critical next step.

Parents of children with autism spectrum disorder (ASD) face unique challenges in raising their children, and they are at higher risk for depression compared to parents of children with typical development (TD) and other disabilities.

(1) To compare prevalence of depressive symptoms among mothers of children with ASD (n = 101), Down syndrome (DS, n = 101), and TD (n = 43) and (2) to describe the relationships among depression, self-efficacy, and family functioning, and describe the mediating role of maternal child care self-efficacy between depressive symptoms and child behavior.

In this cross-sectional study, mothers completed the Social Communication Questionnaire, Aberrant Behavior Checklist, Patient Health Questionnaire-9 (PHQ-9), Family Assessment Device General Functioning Scale, and Maternal Self-Efficacy Scale.

Mothers of children with ASD had significantly higher mean PHQ-9 scores (p < .001), higher proportion of positive depression screening (p < .001), and lower family functioning (p < .001). Better family functioning is associated with less depression, better self-efficacy, and less severe ASD symptoms and behaviors. Self-efficacy mediated the relationship between depression and child ASD symptoms, and problematic behavior.

The rates of reported history of depression and low family functioning in mothers of children with ASD are twice the rate in mothers of children with DS and TD. Maternal child care self-efficacy is protective against maternal depression, even in the presence of severe child problematic behaviors and ASD symptoms. Interventions that increase child care self-efficacy and family functioning may be helpful in addressing depression in mothers of children with ASD.

Negative attitudes toward mental disorders are not only an interpersonal issue but also a concern of mental health care. Given that nursing students are future health care providers, it is pivotal to improve their attitudes toward individuals with mental disorders prior to their transition into clinical practice. However, research on nursing students’ attitudes in relation to schizophrenia in Taiwan remains unexplored.

The aim of this article is to examine the correlates of attitudes toward individuals with schizophrenia among Taiwanese undergraduate nursing students.

A descriptive, correlational, and cross-sectional study was adopted. Self-reported questionnaires were conducted with a convenience sample of 306 Taiwanese undergraduate nursing students. Descriptive statistics, independent t tests, one-way analysis of variance, Pearson’s correlations, and a stepwise regression analysis were performed.

Nursing students expressed negative attitudes toward individuals with schizophrenia. Nursing students, who were female, had contact with individuals with mental disorders, and expressed greater empathy and personality traits held more favorable attitudes toward individuals with schizophrenia. The study found that empathy, personality traits, and academic year were the most crucial attributes contributing to attitudes of nursing students toward individuals with schizophrenia.

Findings suggest that nursing education programs with empathy- and personality-tailored modules in mental health are pivotal to provide humanistic approaches with supportive attitudes regarding schizophrenia.

African American women have an elevated risk for experiencing depressive symptoms, and discrimination, stress, and coping contribute to symptoms of depression.

We aimed to examine the associations between discrimination, stress, and coping on symptoms of depression among young African American mothers.

In this retrospective study, we utilized a hierarchical linear regression to explore the effects of perceived racial discrimination, stress, and general and discrimination-related coping responses on depressive symptoms in a sample of African American mothers (N = 250). The data were drawn from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study (InterGEN), a study conducted between 2014 and 2019 and based in Connecticut.

After accounting for maternal age, level of education, and income, greater perceived racial discrimination (p = .03), higher levels of stress (p < .001), greater engagement in avoidance coping (p < .001), and use of passive coping responses to discrimination (p = .04) were uniquely associated with increased depressive symptoms. Other forms of coping, specifically, problem-solving and support seeking, did not appear to influence depressive symptoms in this sample.

The findings highlight the negative impact of discrimination, heightened stress, and maladaptive coping on the emotional health of young African American mothers.

High patient activation is associated with a variety of positive health outcomes. Although increasing patient activation in persons with opioid use disorder (OUD) in intensive outpatient treatment (IOT) programs may increase engagement and improve outcomes, little is known about how patient activation is manifested in these programs.

To describe types of instances in which persons play an active role in their IOT or show self-determination in their recovery generally (patient activation) and types of instances in which they play a passive role in their IOT or have recovery directed by others (patient nonactivation).

A qualitative descriptive study using data from a larger grounded theory study was conducted. Interviews were completed with 14 persons with OUD who attended an IOT program within a large health care system in the Midwest. Content analysis was used to create a typology of instances of patient activation or nonactivation in participants’ IOT experiences.

Six types of instances were identified: (1) making and enacting one’s own treatment decisions, (2) actively collaborating with staff, (3) self-determining one’s disclosure in groups, (4) making a commitment to treatment, (5) taking responsibility for one’s recovery, and (6) taking actions to avoid return to use.

Patient activation is multidimensional and plays a salient role in IOT experiences. IOT staff should engage patients as active participants in their treatment and encourage mutual goal-setting and shared-decision but should be aware that some approaches used too early in treatment may impede recovery.

Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD.

The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST.

In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers.

Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection.

Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.

Psychological well-being of nurses is necessary to protect the overall care of themselves, as well as their patients. This is especially concerning given the effects of the COVID-19 pandemic. There are several research studies on mindfulness for RNs and its impact on psychological health and well-being. There is limited research on how nurses may use mindfulness during patient care.

The purpose of this study was to explore the effects of mindfulness education and practice on helping RNs to develop self-care skills and to apply mindfulness in the clinical setting.

This was an exploratory mixed method design including quantitative (pilot study) and qualitative methods. Upon completion of a 4-week course on mindfulness practices, focus groups were held with the seven participants who completed the program. Open-ended, semi-structured interviews were held 1 week and then 3 months post-intervention. A constant comparative method and thematic analysis were utilized to analyze the data.

Four themes were identified; (1) using mindfulness to calm down one’s emotional response in the clinical setting; (2) awareness; (3) loving yourself; and (4) self-care. Nurses reported increased awareness and were able to use the technique of mindfulness practice during patient care.

The findings of this study validate the benefits of mindfulness for self-care. Nurses were able to utilize mindfulness while caring for patients in different settings and during difficult patient situations, including in Behavioral Health. Further research is needed longitudinally, to explore how mindfulness can be practiced and utilized to improve outcomes in patient care.

The effect of multiple stressors on immigrant young adults’ endocrine functioning and health outcomes has not been comprehensively investigated.

This study tested a theoretical model of cumulative and current stressor effects on the hypothalamic–pituitary–adrenocortical (HPA) axis functioning and health-related quality of life (HRQL) among Arab American young adults.

Using a cross-sectional design, we recruited 160 participants, ages 18 to 24 years, from an urban university in the Midwest. Cumulative stress was assessed by self-report measures of childhood adversity, bullying victimization, and perceived ethnic discrimination. Current perceived stress was measured using the Perceived Stress Scale (PSS) while cortisol levels were measured in participants’ hair. Structural equation modeling tested the effects of cumulative and current stress on cortisol and HRQL.

Cumulative stress was negatively associated with HRQL (standardized path coefficient = −.51, p < .05). Interestingly, however, cumulative stress was inversely associated with hair cortisol level (standardized path coefficient = −.51, p < .05). Current stress was positively associated with cortisol level (standardized path coefficient = .43, p < .05) and negatively associated with the mental HRQL (standardized path coefficient < −.37, p < .05).

Cumulative stress exhibited a different effect on HPA functioning from current perceived stress. Mental health was significantly impaired by both cumulative and current perceived stress. Implications for mental health nursing practice and research among Arab Americans are discussed.

The Beck Anxiety Inventory (BAI) is widely used to measure the severity of anxiety. This tool may additionally allow for an in-depth analysis of symptom typology, as reported symptoms can be placed into four categories (subjective, neurophysiologic, autonomic, and panic-related). Although overall severity ratings in populations may be similar, the type of symptoms reported as severe may differ dependent on characteristics of the populations assessed.

This study examines the variety of anxiety symptoms manifested among U.S. university students and the impact of symptom typology on seeking treatment.

This was an online survey completed by undergraduate students in the United States, responding to questions including the BAI.

A multivariate logistic regression analysis model showed that the likelihood of students seeking treatment increased when they experienced more “subjective” anxiety symptoms, odds ratio (OR) = 2.443, 95% confidence interval (CI) = [1.462, 4.082], p = .001, as compared to symptoms in the other three categories. Students were also asked to report which symptoms were “most bothersome” to them. Many students reported difficulty sleeping and an inability to concentrate. These symptoms are not measured by the BAI.

The results of this study show the potential for the BAI to be used as a symptom categorization tool to be considered independently in identifying target areas for treatment. An understanding of the existence of these gaps may allow providers to better identify students with anxiety who present with symptoms not included in the BAI.

Infertility has increased in recent years. Infertility can cause many mental problems. The place of psychoeducation based on positive psychotherapy (PPT) is important in coping with mental problems.

The aim of this study is to determine the effect of PPT-based training on stigma and self-efficacy in women receiving infertility treatment.

This experimental study with randomized control group was completed with 64 women receiving infertility treatment. While the women in the experimental group received an 8-session PPT-based training, no intervention was applied to those in the control group.

A statistically significant difference was observed (p= .001) between the stigma and self-efficacy levels of the experimental group after the PPT-based training.

It was found that the PPT-based training was effective in decreasing stigma level of the women who received infertility treatment and increasing their self-efficacy level.

Suicidality continues to be the second leading cause of adolescent death. Nurses are in a prime position to address the emotional pain associated with adolescent suicidality but report skepticism and discomfort. Moreover, spirituality is identified as a protective factor against suicidality, yet a gap exists related to exploring spirituality within the context of the emotional pain associated with adolescent suicidality. Building awareness of adolescents’ spirituality and emotional pain associated with suicidality is essential to address nurse skepticism and discomfort.

The purpose of this study was to explore young adults’ experiences of suicide attempt(s) during adolescence in the context of spirituality using a case study application of participant narratives to Minton and Antonen’s B.L.E.S.S. acronym

A multiple-case study design was used to provide an alternative perspective for understanding adolescent suicidality from a spiritual context. Reed’s theory of self-transcendence and the B.L.E.S.S. acronym guided the analysis and interpretation. Convenience online sampling resulted in six adult participants who provided email narratives of their adolescent experiences. Email data collection was guided by Fritz and Vandermause. Analysis of participant narratives followed the protocol of Baxter and Jack.

Participant’s narratives revealed self-transcendence that paralleled the five truths about emotional pain and spirituality inherent in the B.L.E.S.S. acronym.

This case study provides nurses a guide for counteracting the barriers of skepticism and stigma to promote help-seeking behavior associated with adolescent suicidality. Further research is needed for the application of the B.L.E.S.S. acronym with other population samples.

The use of sexual activity to self-injure has been proposed in research literature but remains underexplored. The purpose of this pilot study was to determine the feasibility of identifying sexual activity as self-injury in a U.S. college-based sample and to provide a preliminary examination of sexual activity as self-injury to inform future study on this topic.

A cross-sectional descriptive pilot study was conducted to assess for recognition of and attitudes toward sexual behavior as self-injury and to identify participant-reported experiences of sexual activity to self-injure.

A total of 50 participants completed the online survey. Thirteen (26%) participants reported they had heard of the concept of “sex as self-injury.” Six (12%) participants reported ever having used sexual activity to cause physical or psychological harm to themselves. Participants reported intentions for engaging in sexual activity to self-injure, including causing physical pain, reliving past self-harm or trauma, showing vulnerability, proving self-worth, pleasing or wanting to feel needed by their partner, and suicidal ideation.

Sexual activities have been used by some college students as a means of self-harm. Further research is needed to understand this phenomenon and clinicians should consider screening for this in patients who participate in dangerous sexual behaviors or self-injurious behaviors.

Prior psychiatric simulation experiences required our nursing students to role-play in an unknown area of nursing. Students confidence, clinical satisfaction, and use of clinical skills were negatively impacted leading to unmet course objectives. The aim of this pilot study was to strengthen our baccalaureate senior nursing students’ simulation experience in their psychiatric nursing course with the use of standardized patients (SPs) instead of student role-play and measure the impact of this strategy on students’ learning, satisfaction, and confidence in an unfamiliar area of nursing.

A mixed method explanatory sequential design was used. Participants consisted of a convenience sample of senior nursing students enrolled in their psychiatric nursing course. A quantitative simulation tool and a four-item questionnaire were analyzed after completion of the simulations (n = 47).

Findings of this study identified greater than 80% of students had increased level of learning, confidence, and satisfaction with the SP simulation experience. Nurse faculty were able to overcome simulation barriers, that is, a patient hearing voices, non-verbal signs of depression, and evaluate students meeting course learning outcomes.

Findings from this study highlight students’ positive simulation experiences. Using SPs as an educational strategy can be effective for students to reach competency, achieve higher knowledge, and improve confidence. It is believed the use of SPs as a simulation strategy in psychiatric nursing will assist students with clinical judgment and better prepare them to meet the needs of vulnerable persons with psychiatric conditions.

Behavioral crises are increasingly prevalent in health care settings. Existing programs, however, include procedures that lack adaptability, omit critical components, and deviate from clinical best-practice recommendations. Health care employees also continue to report lacking confidence for safely managing behavioral crises.

We described the development and acceptability of a comprehensive crisis prevention program and its modification for a large pediatric health care system to help remediate the limitations of existing programs.

Chi-square analyses evaluated the acceptability of the crisis prevention program pre- versus post-training and at 3- and 6-month follow-up times. For insignificant outcomes, logistical regressions identify whether responses differed between emergency-department and nonemergency-department employees.

Chi-square analyses were significant for 10 of 15 questions suggesting that employees were more confident in managing and communicating during behavioral crises post-training, and that this confidence was maintained. Logistic regressions found that emergency-department employees differed in some responses to the acceptability questionnaire than nonemergency-department employees over time

The present crisis prevention program is adaptable to various settings and patients, and it is well received overall by employees. The safety of patients and employees is integral to the delivery of quality care and improving patient-provider relations.

Psychiatric hospitalization is an opportunity to provide evidence-based tobacco treatment to optimize cessation efforts among people living with mental illnesses (MI). The purpose of this study was to examine the effectiveness of nurse-driven initiatives to enhance tobacco treatment within an inpatient psychiatric setting.

We assessed the 4-year impact of implementing a nurse-led tobacco treatment service offered to 11,314 inpatients at admissions in a tobacco-free psychiatric facility in Kentucky.

Through a time-series design, we compared the differences in rates of screening for tobacco use and providing treatment from September to December 2015 (prior to implementing the nurse-led tobacco treatment services) to each subsequent year in a 4-year period (2016–2019).

Approximately 60.0% of inpatients were persons using tobacco during the assessment period. Although there were no changes in tobacco use prevalence over the 4-year evaluation duration, there were significant increases in the provision of practical counseling and Food and Drug Administration–approved nicotine replacement therapies for persons using tobacco.

Our findings support the effectiveness of implementing tobacco treatment programs at the organizational level. Psychiatric hospitalizations provide an opportunity to optimize nurse-driven efforts to deliver tobacco treatment to people with MI. Similar models of nurse-led tobacco treatment services can be adopted within inpatient and other mental and behavioral health settings.