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This chapter discusses why a spiritual assessment is necessary when planning a patient’s mental health care and treatment. It considers the following reasons why psychiatric patients’ spiritual needs should be addressed: (1) the role of spirituality in helping people to stay well, which aligns with the current strengths-based approach to care; (2) patient/carer demand; and (3) increasing research evidence of a positive link between spirituality and mental health. The various approaches to spiritual assessment are described, including the initial brief screening, the spiritual history and the more in-depth assessment that may need to be undertaken by a chaplain or therapist. Tools relevant to each approach are presented before considering what happens after the assessment. Finally, some of the challenges associated with spiritual assessment are discussed, such as documenting/sharing information about spiritual issues, conflict between clinician and patient worldviews, and clinician discomfort/lack of preparedness. Links to educational resources are provided.
This chapter explores the ways in which mental health patients experience spirituality, based on case studies of patients and emerging data from an ongoing study in Birmingham, UK. Psychiatric patients commonly experience spirituality/religion as an awareness of something beyond their physical senses that is of great importance to them. Many turn to spirituality when they become unwell, deriving great strength from it, and for most patients it is closely linked with recovery. However, spirituality does not always have a positive impact, and spiritual struggles can increase mental distress. Spirituality thus has a major influence on mental well-being and recovery. Spiritual care aims to overcome spiritual problems and maximise the benefits of spirituality. It involves finding the right person to help each individual and is very popular with patients. Many patients also want to talk about their spirituality with clinicians and have their spiritual needs addressed as part of clinical treatment.
This paper explores the role that sensitively portrayed literary representations of hallucinations and dissociation may have in counteracting stigma associated with these experiences. In it, we focus on narratives of young people experiencing hallucinatory and dissociative phenomena in two award-winning, young adult novels: How It Feels to Float by Helena Fox and A Monster Calls by Patrick Ness. We identify and discuss three literary devices in these two novels that promote empathy for the characters and their experiences. The narrative accounts in both novels challenge conceptions of hallucinations and dissociation as unknowable and unrelatable experiences with their empathic portrayals of relatable characters that create comprehensible accounts of adolescents grappling with their sense of reality. Importantly, they highlight the potential role that literature can play in stigma reduction by positively shaping young peoples’ understandings of unfamiliar mental health experiences.
This commentary conveys appreciation for a recent review of the rates of complex post-traumatic stress disorder (CPTSD) among refugees, describes the relevance of CPTSD to the refugee experience and discusses implications for assessment and treatment, the effective development of which requires collaboration among researchers, clinicians and individuals with lived experience.
Humans and alcohol share a deep evolutionary history: our capacity to convert alcohol into useable sugars is a trait we share with the African great apes (gorillas and chimpanzees) and is unique to this taxonomic family among the primates. Although the archaeological record only allows us to date the production of alcohol back about 9,000 years (by which time it is already on an industrial scale), a cottage industry of alcohol production must date back a great deal further. With the exception of where its consumption has been prohibited on religious grounds, alcohol use occurs in every culture and society. Notwithstanding its hedonic properties, its real functional benefit is primarily social, playing an important role in rituals and group bonding. I review studies that demonstrate its functional consequences in terms of social bonding, mediated by alcohol’s ability to trigger the brain’s endorphin system. The endorphin system is the central basis for social bonding in primates. The health and other benefits that arise from social bonding are considerable.
For most of human evolutionary history our species lived as hunter-gatherers; hence, much of our cognition and behaviour is adapted to this way of life. Given the magnitude of the sociocultural, economic and lifestyle changes experienced by Homo sapiens over the last 10,000 years, in particular the last several hundred years, aspects of human psychology may be maladapted to modern ways of life. This process of maladaptation following changes in the physical or social environment is referred to as ‘evolutionary mismatch’ and has been hypothesised to contribute to the high prevalence of mental disorders in industrialised societies. However, very few studies have examined the prevalence of these pathologies among contemporary hunter-gatherer populations; thus, empirical support for such diseases of modernity hypotheses is lacking. In this chapter, we review the limited existing research and theorise about the key differences between hunter-gatherer and industrialised societies that are likely to have profound implications for mental health. Specifically, we contrast the strong social support networks, egalitarianism, explorative modes of learning, sensitive child-rearing practices and present orientation of hunter-gatherers with corresponding features of industrialised populations. We argue that mismatches in these domains are partially responsible for of a vast array of mental illnesses, ranging from common mood disorders to behavioural pathologies and psychotic spectrum disorders. We hope that this chapter stimulates the generation and testing of mismatch hypotheses and, eventually, trials of interventions based on mismatch reduction. We end by offering suggestions for methodological approaches to this future research.
The deployment of (Trainee) Associate Psychological Practitioners (T/APPs) to deliver brief psychological interventions focusing on preventing mental health deterioration and promoting emotional wellbeing in General Practice settings is a novel development in the North West of England. As the need and demand for psychological practitioners increases, new workforce supply routes are required to meet this growth.
To evaluate the clinical impact and efficacy of the mental health prevention and promotion service, provided by the T/APPs and the acceptability of the role from the perspective of the workforce and the role to T/APPs, patients and services.
A mixed-methods design was used. To evaluate clinical outcomes, patients completed measures of wellbeing (WEMWBS), depression (PHQ-9), anxiety (GAD-7) and resilience (BRS) at the first session, final session and at a 4–6 week follow-up. Paired-samples t-tests were conducted comparing scores from session 1 and session 4, and session 1 and follow-up for each of the four outcome measures. To evaluate acceptability, questionnaires were sent to General Practice staff, T/APPs and patients to gather qualitative and quantitative feedback on their views of the T/APP role. Quantitative responses were collated and summarised. Qualitative responses were analysed using inductive summative content analysis to identify themes.
T-test analysis revealed clinically and statistically significant reductions in depression and anxiety and elevations in wellbeing and resiliency between session 1 and session 4, and at follow-up. Moderate–large effect sizes were recorded. Acceptability of the T/APP role was established across General Practice staff, T/APPs and patients. Content analysis revealed two main themes: positive feedback and constructive feedback. Positive sub-themes included accessibility of support, type of support, patient benefit and primary care network benefit. Constructive sub-themes included integration of the role and limitations to the support.
The introduction of T/APPs into General Practice settings to deliver brief mental health prevention and promotion interventions is both clinically effective and acceptable to patients, General Practice staff and psychology graduates.
The COVID-19 pandemic may disproportionately affect the mental health of healthcare professionals (HCPs), especially patient-facing HCPs.
To longitudinally examine mental health in HCPs versus non-HCPs, and patient-facing HCPs versus non-patient-facing HCPs.
Online surveys were distributed to a cohort at three phases (baseline, July to September 2020; phase 2, 6 weeks post-baseline; phase 3, 4 months post-baseline). Each survey contained validated assessments for depression, anxiety, insomnia, burnout and well-being. For each outcome, we conducted mixed-effects logistic regression models (adjusted for a priori confounders) comparing the risk in different groups at each phase.
A total of 1574 HCPs and 147 non-HCPs completed the baseline survey. Although there were generally higher rates of various probable mental health issues among HCPs versus non-HCPs at each phase, there was no significant difference, except that HCPs had 2.5-fold increased risk of burnout at phase 2 (emotional exhaustion: odds ratio 2.50, 95% CI 1.15–5.46, P = 0.021), which increased at phase 3 (emotional exhaustion: odds ratio 3.32, 95% CI 1.40–7.87, P = 0.006; depersonalisation: odds ratio 3.29, 95% CI 1.12–9.71, P = 0.031). At baseline, patient-facing HCPs (versus non-patient-facing HCPs) had a five-fold increased risk of depersonalisation (odds ratio 5.02, 95% CI 1.65–15.26, P = 0.004), with no significant difference in the risk for other outcomes. The difference in depersonalisation reduced over time, but patient-facing HCPs still had a 2.7-fold increased risk of emotional exhaustion (odds ratio 2.74, 95% CI 1.28–5.85, P = 0.009) by phase 3.
The COVID-19 pandemic had a huge impact on the mental health and well-being of both HCPs and non-HCPs, but there is disproportionately higher burnout among HCPs, particularly patient-facing HCPs.
Climate change can have various psychopathological manifestations which have been more actively addressed by scientific research only in recent years. Indeed, extreme weather events and environmental changes have been shown to be associated with a range of mental health problems. Following the destruction of ecosystems, biodiversity loss can cause mental distress and emotional responses, including so-called ‘psychoterratic’ syndromes arising from negatively felt and perceived environmental change. Studies investigating relationships between biodiversity and mental health reveal a complex landscape of scientific evidence, calling for a better understanding of this challenging issue.
Given the many complications of drug therapy, it seems reasonable to use non-pharmacological therapies that can improve mental and physical disorders in haemodialysis patients.
This study aims to determine the effectiveness of cognitive behavioural group therapy for insomnia (CBGT-I) in sleep quality, depression, anxiety and general psychological health of haemodialysis patients.
This randomized clinical trial was conducted on 116 haemodialysis patients who were randomly assigned to experimental (n=58) and control (n=58) groups. In the experimental group, CBGT-I was provided during nine weekly sessions. Data collection tools included Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDIII), Beck Anxiety Inventory (BAI), General Health Questionnaire (GHQ-28), Clinical Global Improvement Scale (CGI), Client Satisfaction Questionnaire (CSQ) and Working Alliance Inventory-Short Form (WAI-S). Data were analysed by SPSS-25 and p<.05 was considered significant.
The findings demonstrated that CBGT-I compared with control group was effective in improving sleep quality (p<.001, η2=.790), depression (p<.001, η2=.616), anxiety (p<.001, η2=.682) and general psychological health (p<.001, η2=.871). Participants of CBGT-I showed notable improvements as a result of the treatment, were satisfied with treatment, and had a good therapeutic relationship.
CBGT-I is effective in reducing depression and anxiety in addition to improving sleep quality and general psychological health in haemodialysis patients. Therefore, it is recommended to be used as a complementary treatment for these patients.
While suicide rates have recently declined for White individuals, rates among Black and Hispanic individuals have increased. Yet, little is known about racial/ethnic differences in precursors to suicide, including suicidal ideation (SI) and suicide attempts (SA).
Data from 2009–2020 National Survey of Drug Use and Health (NSDUH) consisted of non-institutionalized US civilians aged ⩾18 (n = 426 008). We compared proportions of White, Black, and Hispanics among adults reporting no past-year suicidal thoughts/behavior, SI, and SA. Multivariable-adjusted analyses were used to evaluate the independence of observed racial/ethnic differences in past-year SI, SA, and mental health service use.
In the entire sample, 20 791 (4.9%) reported past-year SI only and 3661 (0.9%) reported a SA. Compared to White individuals, Black and Hispanic individuals were significantly less likely to report past-year SI [OR 0.73 (95% CI 0.69–0.77); OR 0.75 (95% CI 0.71–0.79), respectively], but more likely to report a past-year SA [OR 1.45 (95% CI 1.28–1.64); OR 1.19 (95% CI 1.04–1.37), respectively] even after multivariable adjustment. Black and Hispanic individuals were significantly less likely to use mental health services, but the lack of significant interactions between race/ethnicity and SI/SA in association with service use suggests differences in service use do not account for differences in SI or SA.
Black and Hispanic individuals are significantly less likely than White individuals to report SI but more likely to report SAs, suggesting differences in suicidal behavior across race/ethnicity that may be impacted by socio-culturally acceptable expressions of distress and structural racism in the healthcare system.
Türkiye hosts 4 million refugees and asylum seekers, with Syrians and Afghans being among the largest refugee groups in country. There are limited comparative data on the conflict- and displacement-related experiences of these groups and the relation with mental health status.
To assess the mental health status of Syrians and Afghans in Türkiye, identify risk factors and explore to what extent differences in mental health conditions are related to potentially traumatic events and post-displacement stressors.
Two parallel online survey studies were conducted between April and June 2021 among 798 Syrians and 785 Afghans in Türkiye. Data were collected on sociodemographic characteristics, traumatic events (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), symptoms of depression and anxiety (Hopkins Symptoms Checklist-25) and post-traumatic stress disorder (PTSD) (Post-Traumatic Stress Disorder Checklist for DSM-5, short form).
For Syrian and Afghan participants respectively, estimated prevalence rates were: 41.1% and 50.3% for depression; 39.6% and 41% for anxiety; and 41.6% and 46.5% for PTSD. In both groups, significant predictors were female gender, exposure to potentially traumatic events, and structural and socioeconomic post-displacement stressors. Additional risk factors were older age for Afghans and higher education for Syrians.
Self-reported symptoms of common mental health problems are highly prevalent among Syrian and Afghan refugees and associated with a wide range of risk factors. After controlling for conflict- and displacement-related experiences, Afghans reported higher anxiety symptoms than Syrians, which is likely related to their legal status in Türkiye.
Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five “pillars” of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.
To investigate whether food insecurity helps explain the association between income and psychological distress and if its role differs by disability status.
Using 2011–2017 National Health Interview Survey cross-sectional data (n 102 543), we conducted linear regression models, fully interacted with disability status, to estimate the association between income-to-poverty ratio (IPR) (<1, 1–<2, 2–<4, ≥4) and psychological distress (Kessler 6 (K6) Scale, range: 0–24). Base models adjusted for socio-demographic factors. We then added food security (secure, low and very low), interacted with disability, and conducted post-estimation adjusted Wald tests.
Nationally representative sample of non-institutionalised adults 18 years and older.
The association between income and psychological distress was stronger for people with disabilities. Compared to those in the highest income category (IPR ≥4), poor individuals (IPR < 1) with and without disabilities scored 2·10 (95 % CI (1·74, 2·46)) and 0·81 (95 % CI (0·69, 0·93)) points higher on the K6 Scale, respectively. Accounting for food insecurity reduced the estimated income disparity in psychological distress significantly more among individuals with disabilities (0·96 points or 46 %) than without disabilities (0·34 points or 42 %), decreasing the difference in the income disparity between those with and without disabilities by 48 % (0·62 points). Further, food insecurity more strongly predicted psychological distress for individuals with disabilities independent of socio-economic disadvantage.
Food insecurity plays a more important role in shaping patterns of psychological distress for people with disabilities, explaining more of the association between income and psychological distress among those with than without disabilities. Improving food security may reduce mental health disparities.
The COVID-19 pandemic poses a major threat to mental health and is associated with an increased risk of suicide. An understanding of suicidal behaviours during the pandemic is necessary for establishing policies to prevent suicides in such social conditions.
We aimed to investigate vulnerable individuals and the characteristics of changes in suicidal behaviour during the COVID-19 pandemic.
We retrospectively reviewed the medical records of patients with suicide attempts who visited the emergency department from February 2019 to January 2021. We analysed the demographic and clinical characteristics, risk factors and rescue factors of patients, and compared the findings between the pre-pandemic and pandemic periods.
In total, 519 patients were included. During the pre-pandemic and pandemic periods, 303 and 270 patients visited the emergency department after a suicide attempt, respectively. The proportion of suicide attempts by women (60.1% v. 69.3%, P = 0.035) and patients with a previous psychiatric illness (63.4% v. 72.9%, P = 0.006) increased during the COVID-19 pandemic. In addition, patients’ rescue scores during the pandemic were lower than those during the pre-pandemic period (12 (interquartile range: 11–13) v. 13 (interquartile range: 12–14), P < 0.001).
Women and people with previous psychiatric illnesses were more vulnerable to suicide attempts during the COVID-19 pandemic. Suicide prevention policies, such as continuous monitoring and staying in touch with vulnerable individuals, are necessary to cope with suicide risk.
Surgery and general anaesthesia are invasive and inherently risky. A rarely discussed reality of perioperative care is that sometimes patients die during anaesthesia and surgery, and many perioperative practitioners are not suitably prepared to handle such an event and its aftermath. Despite the rarity of intraoperative deaths, the experiences of those involved show that there is the potential for a long-lasting impact on individuals and teams. This chapter summarises the incidence of intraoperative death, reviews the potential impact on perioperative practitioners, and explores the different approaches to navigate their aftermath.
Politicians engage in, and the media amplifies, social constructions of welfare recipients as undeserving. Such messaging seeks to influence mass public opinion, but what are the effects on the target population receiving welfare benefits? We test if deservingness messaging affects welfare recipients' mental health. To do so, we exploit a quasi-experiment entailing a dramatic shift in deservingness messaging after a welfare recipient in Denmark became the subject of a national debate, utilizing detailed administrative data on the ensuing consumption of antidepressants by other welfare recipients. We find evidence that welfare recipients experienced worse mental health outcomes after being exposed to deservingness messaging, reflected in a 1.2-percentage-point increase in the use of antidepressants in the weeks following the airing of a critical interview. Deservingness messaging particularly affected more vulnerable groups who had a history of mental health problems.
Violence against women is widely recognised as a violation of human rights and a public health problem. The most common forms of violence against women are domestic abuse and sexual violence, and victimisation is associated with an increased risk of mental disorders. It is reported that a three times increase in the likelihood of depressive disorders, a four times increase in the likelihood of anxiety disorders, and a seven times increase in the likelihood of post-traumatic disorder (PTSD) for women who have experienced domestic violence and abuse. Significant associations between intimate partner violence and symptoms of psychosis, substance misuse, and eating disorders have also been reported. Furthermore, systematic reviews of predominantly cross-sectional studies report consistent relationships between being a victim of domestic violence and abuse and having mental disorders across the diagnostic spectrum for men and women, but since women are more likely to be victims, the population attributable fractions are higher for women. In this presentation, the focus will also be on clinical guidance on the role of mental health professionals in identifying violence against women and responding appropriately, poor identification persists and can lead to non-engagement with services and poor response to treatment. After a literature review, we will present and discuss current data from parental consultation and a survey on violence during the Covid-19 pandemic in Berlin.
It is possible to properly diagnose and treat a person with intellectual disability and mental health problems, but it requires a lot of work on the part of a doctor, nurse, professional medical care, proper rehabilitation and cooperation with a speech therapist, psychiatrist and many others. To improve the functional capacity of this person, it requires the help of a wide variety of professionals to meet their needs. One of the examples of interdisciplinary cooperation in this area is the “Circles of Support” program implemented by the Polish Association for People with Intellectual Disability in Poland. Support circles assume the creation of a group of supporters around a person with a disability, in accordance with their needs, combining formal (family doctor, psychiatrist, psychologist, personal assistant, social worker, therapist, lawyer) and informal support (family, friends, acquaintances, neighbors) , salesperson in your local store). The support is strictly focused on the needs of a person with a disability, and according to their individual preferences, it is fully inclusive. This goal can be achieved by preparing a person with a disability and the environment in a way that enables them to function safely in their local community based on the concept of supportive circles. The only way to build a system of care for of people with intellectual disabilities and their relatives is to rely on networks of connections - people and institutions, on their real commitment and on working out mechanisms supporting the empowerment of people with disabilities - in life, physical, financial matters.