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Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.
Epidemiology is the study of disease and its determinants in populations. Epidemiological studies investigate what the patterns of diseases are and why they develop in particular populations. Epidemiology is important in improving our understanding of what causes disease. Similarly, understanding epidemiology and how to interpret observational data is crucial to avoid inaccurate causal inferences. Unfortunately, critically evaluating all of the data on mental health problems in old age was outside the scope of this chapter, but we try to highlight some important limitations and gaps in the literature. There are exciting developments in epidemiology that will guide our knowledge about the determinants of psychiatric disease. For example, genome-wide association studies (GWAS) are increasing our understanding of genetic associations with psychiatric diseases.
This paper offers a perspective on nursing and lived experience responses to the COVID-19 pandemic. It charts health systems and mental health impacts with a particular focus on children and adolescents, older people and people availing of mental health services. Issues of moral distress and the nursing reaction are considered alongside psychological and social concerns which continue to rapidly evolve. The perspective of a person attending adult community mental health services and the experience of engaging with a mental health service remotely is provided. Matters of note for acute inpatient mental health nursing are highlighted and informed by the lived experience of a mental health nurse. The need for integrated health systems responses across nursing disciplines and the wider interdisciplinary team is elucidated.
The COVID-19 pandemic has and will have a huge impact on mental health, especially in countries that have been significantly affected, such as Spain.
Aims
Here we aim to provide the perspectives of a group of psychiatrists from Barcelona, one of the epicentres of the pandemic so far, to highlight the potential fatality of a virus that caught us unaware and unprepared, and hopefully this article will be of aid to countries about to face the pandemic.
Results
The unprecedented situations that we have been faced with so far have included reconfiguring hospitals and the redeployment of healthcare professionals, with flexibility and adaptability key to managing the overload in demand. This has led to healthcare professionals being exposed to extremely stressful situations and they have had impossible decisions to make that may have mental health consequences, some of which may be severe and long lasting.
Conclusions
A rebound effect on mental health problems is to be expected in the medium and long term, especially for healthcare professionals and psychiatric patients, necessitating a strengthening of preventive approaches and policies for mental health along with a prompt reopening of mental health services. Ways to provide psychiatric healthcare in the immediate future need to be re-evaluated, and the development of telepsychiatry services is probably to be expected.
Psychological inflexibility and emotional dysregulation are a hallmark of psychopathology, being intrinsically embedded in emotional and personality disorders. However, the transdiagnostic mechanisms of psychological inflexibility and emotional dysregulation domains are still a matter of discussion.
Aims:
The present study aims to explore the relationships between cognitive fusion (as a measure of psychological inflexibility), emotion regulation strategies, such as cognitive reappraisal and emotional suppression and emotional dysregulation domains in two different samples.
Method:
In a cross-sectional design, 297 individuals were assessed with self-report measures and divided into non-clinical (n = 231) and clinical samples (n = 66), according to diagnosis.
Results:
Results showed that the degree of cognitive fusion was higher in the clinical sample. However, significant correlations between cognitive fusion, emotional regulation strategies and emotional dysregulation domains were found in the two samples. Cognitive reappraisal and emotional dysregulation domains predicted cognitive fusion and mediated the relationship between cognitive fusion and symptomatology in the two samples.
Conclusions:
Relationships between cognitive fusion and emotional dysregulation domains were found independent of diagnosis. The implementation of emotion regulation strategies may be related to individual differences. However, cognitive fusion, reappraisal and lack of strategies may be core transdiagnostic features in psychological inflexibility and emotion dysregulation.
Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective.
Aims
This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269).
Method
A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10–24 years) in LMICs.
Results
Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver–adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only.
Conclusions
Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.
Mental illness is common among forced migrant populations, and ongoing mental illness can hinder refugees’ ability to negotiate the asylum process. This editorial rehearses the challenges of undertaking research among forced migrant populations, exploring how they could be addressed in future research, and outlines differences between forced migrant groups. It points to the growing body of evidence that can be called on in advocating for systemic change in government policy and mental health services, with significant support for a sensitive and objective inquisitorial approach to gathering evidence in support of asylum claims.
Imagine a society comprising individuals who realize their maximal potential in every facet of their lives. In this society, people work together to better their communities and the lives of others. Individually, the citizens are free of disease, physically fit, well-educated masters of their craft, and they engage in a life of recreation and interconnectedness with family, neighbors, and friends while living with purpose and passion. Is this utopia too good to be true? The voice of reason may say life is not perfect; there are too many ever-changing variables. We are familiar with the physical law of entropy stating that randomness, or disorder, increases with time. However, why not aim toward a society as described above? We can strive to be the best version of ourselves, both on the micro, individual level and on the macro, societal level.
Personality disorders (PDs) were not always considered to be mental illnesses. Even today, there is resistance to this point of view. So how did people with these problems come to be seen as meriting a psychiatric diagnosis? The problem has always concerned how to draw a line between normality and pathology.
The impact of food insecurity on mental health has not yet been examined in graduate students, a population widely considered at elevated risk for financial strain and negative mental health outcomes. This study aimed to derive initial prevalence estimates of food insecurity in a sample of current graduate students at a large state university and to elucidate the relationship between food insecurity and depression, anxiety and stress in this sample.
Design:
Cross-sectional online survey including the US Household Food Security Survey Module: Six-Item Short Form and the Depression, Anxiety, and Stress Scales (DASS-21).
Setting:
University in the northeastern region of the USA.
Participants:
Two hundred sixty-three graduate students.
Results:
In the present sample, 59·7 % of participants reported high/marginal food security, 18·5 % reported low food security and 21·8 % reported very low food security. Graduate students with very low food security reported significantly greater depression (η2 = 0·09), anxiety (η2 = 0·10) and stress (η2 = 0·10), compared with those with low food security and high food security (all P’s < 0·001).
Conclusions:
Food insecurity occurred in nearly half of the graduate students surveyed, and very low food security was associated with elevated levels of depression, anxiety and stress. Findings highlight the need to address food insecurity and associated elevated mental health problems present among graduate students.
Downloading a mobile health (m-health) app on your smartphone does not mean you will ever use it. Telling another person about an app does not mean you like it. Using an online intervention does not mean it has had an impact on your well-being. Yet we consistently rely on downloads, clicks, ‘likes’ and other usage and popularity metrics to measure m-health app engagement. Doing so misses the complexity of how people perceive and use m-health apps in everyday life to manage mental health conditions. This article questions commonly used behavioural metrics of engagement in mental health research and care, and proposes a more comprehensive approach to measuring in-app engagement.
In this editorial we define ‘productivity’ and ‘efficiency’ in a mental health service context, outlining the key challenges to measuring these in practice. We attempt to bring clarity of thought to this often debated, but rarely researched area.
It is important to understand the differential impact of individual difference characteristics on psychopathology. Sex and gender constructs are individual difference variables that are crucial in fully understanding mental illnesses. In this chapter, we consider international perspectives on sex and gender in psychopathology. Unfortunately, our knowledge of sex and gender in psychopathology is limited by several factors, including conflated terminology, sex- and gender-neutral research, and various biases; all of which are discussed herein. Furthermore, our knowledge related to the intersection of nationality and sex and gender on psychopathology is limited. Nonetheless, we discuss what is known and what remains unknown about sex and gender in five major psychopathology categories: Autism Spectrum Disorder, ADHD, Eating Disorders, Major Depressive Disorder, and Substance Use Disorders.
The role of appetitive needs in the etiology of addiction is described in this chapter, including consideration of typologies of needs, how appetitive need-satiation cycles may cross over into addiction, and factors that may facilitate dysregulation of appetitive effects. An overview of an Associational Memory-Appetitive System Relations Model (AMASR) is presented. The constituents of this model are described and include neurobiological vulnerability, lifestyle pushes (stresses) and pulls (seductions), associative learning of relations among addiction-related cues with subjective perception of appetitive needs fulfillment, and associative memory for alternative behaviors, all which interact and lead to addictive or nonaddictive behavior.
FB is a 53-year-old Caucasian male living in the USA. He had played professional football in the NFL until his thirties and in retirement had worked as a coach. He has two grown up children who have now left home. He is not currently working and lives with his wife of 28 years. He was initially reviewed by his family doctor in response to his wife’s concerns. Although his participation in this initial consultation was minimal it was noted that his personality seemed to have coarsened and there were significant changes in his behaviour. As a result he was referred to a psychiatrist for a more detailed assessment. He only agreed to attend this assessment after much encouragement from his family and friends although he had admitted privately to a friend that ‘something was not quite right’. The report from this psychiatric assessment is set out below.
Refugees experience adversities and changes in their lives that profoundly impact family life. Family values and relationships may influence how those events are experienced and the ability of family members to cope with them. The frequent consequences of violence exposure and war events, displacement and resettlement include significant losses and disruptions to relationships and family and community life. Such experiences are associated with a higher prevalence of psychiatric disorders, especially PTSD and depression. The stressors may strain family relations and result in insecure infant-parent attachment and family conflict. The process of migration and resettlement may also provide opportunities for assimilation into a safer and more affluent society and enable changes in family relationships, with opportunities for new, rewarding roles for some family members but for others occupational and status decline and low morale. Over time, refugees’ mental health and social adaptation improves. Refugees show significant resilience - most cope well even when faced with harrowing adversities - but this is more likely in the presence of confiding and supportive family relationships.
Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations.
Methods:
PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: “COVID-19”, “SARS-CoV-2”, “pandemic”, “neuro-COVID”, “stroke-COVID”, “epilepsy-COVID”, “COVID-encephalopathy”, “SARS-CoV-2-encephalitis”, “SARS-CoV-2-rhabdomyolysis”, “COVID-demyelinating disease”, “neurological manifestations”, “psychosocial manifestations”, “treatment recommendations”, “COVID-19 and therapeutic changes”, “psychiatry”, “marginalised”, “telemedicine”, “mental health”, “quarantine”, “infodemic” and “social media”. A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context.
Results:
Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes.
Conclusion:
Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.
Posttraumatic stress disorder (PTSD) is often complicated by the after-effects of mild traumatic brain injury (mTBI). The mixture of brain conditions results in abnormal affective and cognitive functioning, as well as maladaptive behavior. To better understand how brain activity explains cognitive and emotional processes in these conditions, we used an emotional N-back task and functional magnetic resonance imaging (fMRI) to study neural responses in US military veterans after deployments to Iraq and Afghanistan. Additionally, we sought to examine whether hierarchical dimensional models of maladaptive personality could account for the relationship between combat-related brain conditions and fMRI responses under cognitive and affective challenge. FMRI data, measures of PTSD symptomatology (PTSS), blast-induced mTBI (bmTBI) severity, and maladaptive personality (MMPI-2-RF) were gathered from 93 veterans. Brain regions central to emotion regulation were selected for analysis, and consisted of bilateral amygdala, bilateral dorsolateral prefrontal (dlPFC), and ventromedial prefrontal/subgenual anterior cingulate (vmPFC-sgACC). Cognitive load increased activity in dlPFC and reduced activity in emotional responding brain regions. However, individuals with greater PTSS showed blunted deactivations in bilateral amygdala and vmPFC-sgACC, and weaker responses in right dlPFC. Additionally, we found that elevated emotional/internalizing dysfunction (EID), specifically low positive emotionality (RC2), accounted for PTSS-related changes in bilateral amygdala under increased cognitive load. Findings suggest that PTSS might result in amygdala and vmPFC-sgACC activity resistant to moderation by cognitive demands, reflecting emotion dysregulation despite a need to marshal cognitive resources. Anhedonia may be an important target for interventions that improve the affective and cognitive functioning of individuals with PTSD.
The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal.
Aims
To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP.
Method
A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers.
Results
The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma. Involvement of Ministry of Health, procurement of new psychotropic medicines through PRIME, motivation of health workers and the development of a new supervision system were key facilitating factors.
Conclusions
Effective implementation of mental health services in primary care settings require interventions to increase demand for services and to ensure there is clinical supervision for health workers, private rooms for consultations, a separate cadre of psychosocial workers and a regular supply of psychotropic medicines.
Social problems in many domains, including health, education, social relationships, and the workplace, have their origins in human behavior. The documented links between behavior and social problems have sparked interest in governments and organizations to develop effective interventions to promote behavior change. The Handbook of Behavior Change provides comprehensive coverage of contemporary theory, research, and practice on behavior change. The handbook incorporates theory- and evidence-based approaches to behavior change with chapters from leading theorists, researchers, and practitioners from multiple disciplines, including psychology, sociology, behavioral science, economics, and implementation science. Chapters are organized into three parts: (1) Theory and Behavior Change; (2) Methods and Processes of Behavior Change: Intervention Development, Application, and Translation; and (3) Behavior Change Interventions: Practical Guides to Behavior Change. This chapter provides an overview of the theory- and evidence-based approaches of the handbook, introduces the content of the handbook, and provides suggestions on how the handbook may be used by different readers. The handbook aims to provide all interested in behavior change, including researchers and students, practitioners, and policy makers, with up-to-date knowledge on behavior change and guidance on how to develop effective interventions to change behavior in different populations and contexts.