A meta-ethnography of shared decision-making in mental health care from the perspective of staff and service users.

BACKGROUND: Human rights, recovery, and value-based approaches are integral to strategic changes and development in mental health care. Successfully integrating such person-centred values in mental health services requires a paradigm shift from traditional biomedical models of care to a more human rights-based approach. An important aspect of this is shared decision making (SDM) between mental health staff and service users. Whilst it is widely acknowledged SDM leads to improved outcomes, there are barriers and challenges to implementing this approach effectively in clinical practice. OBJECTIVES: This systematic review aimed to assess existing empirical research exploring mental health service users and/or staff's attitudes towards and experiences of SDM in adult mental health care settings. METHODS: The review and protocol were registered on PROSPERO (CRD42023369472). Systematic searches were run on four databases. Search terms pertained to studies reporting on mental health staff or service users' experiences of SDM in adult mental health care. Initial searches yielded 721 results. Included studies were analysed using a meta-ethnographic approach. RESULTS: Thirteen articles were included. Data were synthesised using meta ethnographic synthesis, which produced four higher order themes with related subthemes; the role of service user ownership, the influence of fluctuating capacity, the importance of therapeutic alliance and changing clinicians' behaviours and attitudes. IMPLICATIONS: Both staff and service users found SDM to be an important factor in delivering high quality, effective mental health care. Despite this, participants had very little experience of implementing SDM in practice due to several personal, professional, and organisational challenges. This suggests that differences exist between what services strive towards achieving, and the experience of those implementing this in practice. These findings suggest that further research needs to be conducted to fully understand the barriers of implementing SDM in mental health services with training delivered to staff and service users about SDM.

Young Women's Selfhood on Antidepressants: "Not Fully Myself".

The impact of antidepressants on selfhood is well recognized but little is known about what this means for young women who take antidepressants during a key period for identity development. We analyzed interviews with 16 young women to explore the way that antidepressant use might shape selfhood. Thematic analysis was used to identify a range of potential self-related themes in the participants' narratives including a "diagnosed self," "an ill self," "a normal self," "a stigmatized self," "an uncertain self," and a "powerless self." Themes highlighted the complex influence of antidepressants on young women's selfhood. Antidepressants not only offered legitimacy for distress and the opportunity to have a more "normal" self but also left the young women challenged by some of the negative associations with antidepressant use and uncertainty about their identity. Prescribers should be mindful of the impact of antidepressants on young women's developing selfhood.

Siblings of Young People With Cancer in NZ: Experiences That Positively and Negatively Support Well-Being.

Siblings of young people with cancer experience significant distress and these effects often exist long after their sibling's treatment has successfully been completed. In New Zealand, many families must travel several hours to receive treatment, with some having to live away from home for extended periods which can create additional strains. We interviewed 10 siblings of pediatric cancer survivors drawn from a larger quantitative study, to investigate what made siblings' experiences more difficult and to find out what was helpful in supporting their adjustment. The selected participants came from across New Zealand, represented a mix of gender and age, and had a range of depression scores. Our thematic analysis found that experiences that were associated with the most distress included concurrent stressors, and feeling left out, rejected, or isolated. Experiences that were most helpful to their well-being were feeling involved, knowing that they were still important and a priority for their parents, connecting with people through their experiences, and focusing on positive experiences. Our findings suggest that professionals working with these families could help siblings of a child with cancer by promoting hope, acknowledging positive growth, drawing attention to positive events to promote benefit finding, and providing opportunities to have fun. Increasing parental awareness of the impact of differential treatment and improving the public understanding of sibling issues might also be helpful.

How many of 1829 antidepressant users report withdrawal effects or addiction?

More than 10% of adults are prescribed antidepressants annually in some countries. Recent increases in prescribing can be explained more by repeat prescriptions than new patients. This raises the question of whether antidepressants are addictive. A total of 1829 New Zealanders who had been prescribed antidepressants completed an online survey; 44% had been taking antidepressants for more than 3 years and were still taking them. Withdrawal effects when stopping medication were reported by 55%, and addiction by 27%. Paroxetine had particularly high rates of withdrawal symptoms. Only 1% of participants recalled being told about withdrawal effects when prescribed the drugs. Such high rates of withdrawal symptoms suggest that all concerned, including mental health nurses, need to help people considering antidepressants to understand that it can be difficult to withdraw from them. It will also be beneficial to closely monitor people already taking antidepressants and who are at risk of long-term usage.

A trans-theoretical training designed to promote understanding and management of countertransference for trainee therapists.

OBJECTIVE: There is evidence that awareness of countertransference (CT) in combination with a conceptualization of CT facilitates its management. This study examines the impact of a trans-theoretical training designed to make the construct of CT accessible to trainee therapists in programs oriented towards cognitive-behavioral therapy. The training aimed to enhance trainees' awareness, understanding, and management of CT. METHOD: Academics at five New Zealand universities introduced the training into their curriculum. Five academics and 54 clinical psychology trainees evaluated it, responding to open-ended questions on the impact of the training on awareness, understanding, and management of CT. They also rated the training's effectiveness. RESULTS: The majority of trainees reported increased awareness and conceptualization of CT. They rated the training as useful for professional practice and reported increased commitment to monitoring CT. Academics also observed trainees' increased awareness and understanding of CT and openness to discussing it. Trainees and academics were less confident in trainees' abilities to manage CT in clinical practice, although trainees reported gains in this area. CONCLUSIONS: The training appeared to enhance awareness and conceptualization of CT, processes that support its management. However, future research into training models needs to examine the impact on CT management in clinical practice.

Conflict in Men's Experiences With Antidepressants.

While men's experiences of depression and help seeking are known to be shaped by gender, there is little research which examines their experience of using antidepressants to treat this. This study is based on in-depth, narrative-style interviews with 20 New Zealand men who had used antidepressants. The analysis identified a number of areas of conflict in the men's accounts of using this medication. Conflict centered on the way taking antidepressants was seen as undermining personal control while also allowing users to take charge of their problems; facilitating general functioning while undermining sexual functioning; relieving emotional distress while undermining emotional vitality; and the tension participants felt between making autonomous judgments about the value of antidepressants and relying on the "expertise" of others. Participants negotiated these conflicts in a variety of ways. In some cases, antidepressants were positioned as being able to affirm aspects of traditional masculinity, while a smaller number of participants managed these conflicts by redefining aspects of their own masculinity in ways that contrasted with dominant constructions. This research is limited by the sample of older, more privileged men in the context of New Zealand culture which favors macho forms of masculinity. In similar contexts, mental health practitioners should be mindful of the conflicts that men might experience in relation to their antidepressant use. Facilitating men's exploration of these issues may enable them to make better decisions about treatment options or to provide more effective support to those who have opted for antidepressant treatment.

Stressful events and circumstances reported by patients prior to being prescribed antidepressants.

AIMS: This study investigates the extent to which those who receive a prescription for antidepressants perceive psychosocial stressors to be significant in their difficulties. METHODS: This study draws on a survey of adults prescribed antidepressants. It analyses 1,683 responses to an open-ended question that enquired about difficult events and circumstances participants experienced in the time leading up to receiving an antidepressant prescription. RESULTS: Sixty-five percent of respondents described experiencing one or more stressful events or circumstances, with 19 % reporting two and 20% reporting three or more. The most frequently reported stressors identified by participants were categorised as: relationship difficulties (19%), life transitions (19%), losses (18%), work related difficulties (15%) and participants' own or others' health issues (15%). Other less frequently reported stressors included isolation, academic difficulties, abuse and violence and financial difficulties. CONCLUSIONS: Findings are that stressful life events or circumstances are significant for a large number of who are given a prescription for antidepressants. It is important for GPs to be aware of significance of these psychosocial stressors in their patients' lives and make treatment recommendations that address these difficulties. Conclusions need to be interpreted in the light of limitations arising from the sampling method.

Do GPs and psychiatrists recommend alternatives when prescribing anti-depressants?

This study explores whether a partial explanation for high antidepressant prescription rates is the failure of prescribers to recommend alternatives. 1829 New Zealand adults were asked which of six non-pharmacological treatment approaches were recommended when prescribed anti-depressants. The majority (82%) received at least one recommendation and 32% received three or more, most commonly 'Counsellor/Psychologist/Psychotherapist' (74%) and Exercise Schedule (43%). It cannot, therefore, be concluded that failing to consider non-pharmacological treatments is a major cause of high prescribing rates. Being younger and more severely depressed were both positively related to number of recommendations. Psychiatrists made significantly more recommendations than GPs.

Long-term antidepressant use: patient perspectives of benefits and adverse effects.

Long-term antidepressant treatment has increased and there is evidence of adverse effects; however, little is known about patients' experiences and views of this form of treatment. This study used mixed methods to examine patients' views and experiences of long-term antidepressant treatment, including benefits and concerns. Data from 180 patients, who were long-term users of antidepressants (3-15 years), were extracted from an anonymous online survey of patients' experiences of antidepressants in New Zealand. Participants had completed rating scales about the effectiveness of antidepressants, levels of depression before and during antidepressant use, quality of life, and perceived adverse effects. Two open-ended questions allowed participants to comment on personal experiences. The majority (89.4%) reported that antidepressants had improved their depression although 30% reported moderate-to-severe depression on antidepressants. Common adverse effects included withdrawal effects (73.5%), sexual problems (71.8%), and weight gain (65.3%). Adverse emotional effects, such as feeling emotionally numb (64.5%) and addicted (43%), were also common. While the majority of patients were pleased with the benefits of antidepressant treatment, many were concerned about these adverse effects. Some expressed a need for more information about long-term risks and increased information and support to discontinue.

'In my life antidepressants have been ': a qualitative analysis of users' diverse experiences with antidepressants.

BACKGROUND: While mental health professionals have focused on concerns about whether antidepressants work on a neurochemical level it is important to understand the meaning this medication holds in the lives of people who use it. This study explores diversity in the experience of antidepressant users. METHODS: One thousand seven hundred forty-seven New Zealand antidepressant users responded to an open-ended question about their experience of antidepressants. This was analysed using content and thematic analysis. RESULTS: There was considerable diversity in participants' responses including positive (54 %), negative (16 %) and mixed (28 %) experiences with antidepressants. Those with positive experiences saw antidepressants as a necessary treatment for a 'disease', a life saver, a way of meeting social obligations, dealing with difficult circumstances or a stepping stone to further help. Negative themes described antidepressants as being ineffective, having unbearable side effects, undermining emotional authenticity, masking real problems and reducing the experience of control. Mixed experience themes showed how participants weighed up the unpleasant side effects against the benefits, felt calmer but less like themselves, struggled to find the one or dosage and felt stuck with continuing on antidepressants when they wished to stop. CONCLUSIONS: Mental health professions need to recognize that antidepressants are not a 'one size fits all' solution.

Are older people prescribed antidepressants on the basis of fewer symptoms of depression, and for longer periods of time? A survey of 1825 New Zealanders.

AIM: To determine whether older people are prescribed antidepressants at lower levels of depression and with fewer symptoms, and whether they are more likely to engage in chronic usage than younger adults. METHODS: An online survey about experiences with, and opinions about, depression and antidepressants was completed by 1825 New Zealand adults who had been prescribed antidepressants in the preceding five years. RESULTS: Participants over 55 were prescribed antidepressants with significantly fewer symptoms and were significantly less likely to meet DSM criteria for depression. They were also significantly more likely to have used the drugs for three years and still be using them. CONCLUSION: Prescribing physicians and their older patients might benefit from discussing the pros and cons of antidepressants (including the additional risk factors with this age group) and the alternatives. If prescription does occur, careful monitoring to avoid unnecessary, potentially damaging, long-term use is recommended.

Beliefs of people taking antidepressants about the causes of their own depression.

BACKGROUND: The beliefs of people receiving treatment about the causes of their own mental health problems are researched less often than the causal beliefs of the public, but have important implications for relationships with prescribers, treatment choices and recovery. METHOD: An online survey on a range of beliefs about depression, and experiences with antidepressants, was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. RESULTS: Six of 17 beliefs about the causes of their own depression were endorsed by more than half the sample: chemical imbalance, family stress, work stress, heredity, relationship problems and distressing events in childhood. There were some marked differences in content, structure and level of conviction of beliefs about one׳s own depression and the sample׳s previously published beliefs about depression in general. There were also significant differences between the beliefs of demographic groupings. Regression analyses revealed that self-reported effectiveness of the antidepressants was positively associated with bio-genetic causal beliefs. The quality of the relationship with the prescribing doctor was positively related to a belief in chemical imbalance as a cause and negatively related to a belief in unemployment as a cause. LIMITATIONS: The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. CONCLUSIONS: People experiencing depression hold complex, multifactorial and idiosyncratic sets of beliefs about the causes of their own depression, apparently based at least in part on their own life experiences and circumstances. Exploring those beliefs may enhance the doctor-patient relationship and selection of appropriate treatment modality.

Beliefs of people taking antidepressants about causes of depression and reasons for increased prescribing rates.

BACKGROUND: Public beliefs about the causes of mental health problems are related to desire for distance and pessimism about recovery, and are therefore frequently studied. The beliefs of people receiving treatment are researched less often. METHOD: An online survey on causal beliefs about depression and experiences with antidepressants was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. RESULTS: The most frequently endorsed of 17 causal beliefs were family stress, relationship problems, loss of loved one, financial problems, isolation, and abuse or neglect in childhood. Factor analysis produced three factors: 'bio-genetic', 'adulthood stress' and 'childhood adversity'. The most strongly endorsed explanations for increases in antidepressant prescribing invoked improved identification, reduced stigma and drug company marketing. The least strongly endorsed was 'Anti-depressants are the best treatment'. Regression analyses revealed that self-reported efficacy of the antidepressants was positively associated with bio-genetic causal beliefs, negatively associated with childhood adversity beliefs and unrelated to adulthood stress beliefs. The belief that 'People cannot׳ get better by themselves even if they try' was positively associated with bio-genetic beliefs. LIMITATIONS: The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. CONCLUSIONS: Clinicians׳ should consider exploring patients׳ causal beliefs. The public, even when taking antidepressants, continues to hold a multi-factorial causal model of depression with a primary emphasis on psycho-social causes. A three factor model of those beliefs may lead to more sophisticated understandings of relationships with stigma variables.

Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants.

In the context of rapidly increasing antidepressant use internationally, and recent reviews raising concerns about efficacy and adverse effects, this study aimed to survey the largest sample of AD recipients to date. An online questionnaire about experiences with, and beliefs about, antidepressants was completed by 1829 adults who had been prescribed antidepressants in the last five years (53% were first prescribed them between 2000 and 2009, and 52% reported taking them for more than three years). Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself - 52%, Reduction In Positive Feelings - 42%, Caring Less About Others - 39%, Suicidality - 39% and Withdrawal Effects - 55%. Total Adverse Effect scores were related to younger age, lower education and income, and type of antidepressant, but not to level of depression prior to taking antidepressants. The adverse effects of antidepressants may be more frequent than previously reported, and include emotional and interpersonal effects.

Agency in young clients' narratives of counseling: "it's whatever you want to make of it".

Although there is a growing body of research that looks at how adult clients are active agents in their own counseling, there is little similar research that looks at the experiences of young people in counseling. This research explores how client agency is constructed in retrospective accounts of a school counseling experience provided by 22 young people (aged 16-18). The narrative analysis shows how participants constructed their agency as clients in a number of different ways: in asserting their choice over whether to see a counselor; in their evaluations of counselors; in the selection or rejection of aspects of counseling and by portraying themselves as primarily responsible for the benefits obtained from counseling. In these ways, young clients seemed able to shape their construction of counseling to better match their own priorities. But participants also seemed aware of potential threats to their ability to exercise their agency and described how they struggled to express their needs overtly to their counselors. This raises the possibility that young people's assertions of agency may be best understood in the context of their relative powerlessness in counseling situations. Although there is potential to harness young clients' agency in the service of better counseling outcomes, their strong commitment to a view of themselves as agents may result in them experiencing greater accountability without a corresponding access to power in counseling.

The prevalence of voice-hearers in the general population: a literature review.

BACKGROUND: It is increasingly understood that voice-hearing is neither a rare phenomenon experienced only by 'psychiatric patients' nor a meaningless symptom of a 'mental illness'. AIMS: To estimate the prevalence of voice-hearing in the adult general population. METHODS: PsycINFO and relevant literature reviews were searched for studies of the prevalence of verbal auditory hallucinations among adults. RESULTS: Seventeen surveys, from nine countries, were identified. Comparisons across studies were problematic due to differences in definitions, methodologies, and cultural factors. Prevalence ranged from 0.6% to 84%, with an interquartile range (excluding the highest and lowest quartiles) of 3.1%-19.5%, and a median of 13.2%. CONCLUSIONS: Differences in prevalence can be attributed in part to differences in definitions and methodologies, but also to true variations based on gender, ethnicity and environmental context. The findings support the current movement away from pathological models of unusual experiences and towards understanding voice-hearing as occurring on a continuum in the general population, and having meaning in relation to the voice-hearer's life experiences.

Into the unknown: the experiences of individuals living with multiple sclerosis.

This article examines the narratives of 16 individuals diagnosed with multiple sclerosis (MS). Before diagnosis, the participants had experienced disparate and transient symptoms. Diagnosis itself involved numerous tests and health practitioners, varied responses to the diagnosis, an inability to assimilate information about the disease, and a view of MS as being the lesser of two evils. Immediately after diagnosis, participants revealed concerns about the unpredictable progression of the disease. Patient narratives reflected both negative and positive aspects of living with a chronic illness, such as shifting roles, discrimination, reevaluation of priorities, reinvestment in the family, and positive lifestyle changes. All aspects of the narratives revealed fear and anxiety in relation to the unknown.