Evaluation of a Pharmacist-Led Personal Continuous Glucose Monitor Workflow to Improve Glycemic Management in an Internal Medicine Clinic.

The use of personal continuous glucose monitors (CGMs) in patients with diabetes has increased significantly and is expected to continue to increase as CGMs become more affordable and insurance plans improve coverage. The utilization of CGMs has improved diabetes management and reduced hypoglycemic events. A pharmacist-led personal CGM workflow was created to evaluate the impact on glycemic management in patients with diabetes. This was a prospective, investigator-initiated pilot study conducted at an Atrium Health Internal Medicine clinic over 28 weeks. In this pilot, 42 patients were qualifying candidates with diabetes and personal CGM use. Additionally, 30 patients were followed until study completion and included into final analysis. The average baseline A1c was reduced from 8.3% to 7.1% over a 3 - 6 month period. The pharmacist-led CGM workflow revealed a statistically significant reduction in A1c from baseline by an average of 1.2% (95% CI, -0.6 - -1.8; P = 0.0006). On average, patients were enrolled for 19.9 weeks and had an average of 5 visits during this time. During the study duration, 100 medications changes were implemented under the existing Clinical Pharmacist Practitioner (CPP) agreement between the pharmacists and the provider. The implementation of the CGM workflow led to one less diabetes related hospitalization. Overall, 58 CPT 95251 codes were billed yielding $7,052.00 in billed CGM services for the clinic. This project generated 40.6 provider relative value units (RVUs). The utilization of a pharmacist-led personal CGM workflow can improve diabetes outcomes.

Scale Validation and Attributional Analysis of Public Stigma in Early-Pandemic COVID-19.

PURPOSE: To test the validity of a COVID-19 public stigma scale and an attributional model of stigma during the early stages of the pandemic. DESIGN: We administered a cross-sectional survey that included scales related to COVID-19 stigma to U.S. adults. SETTING: We used Amazon MTurk online survey panel to recruit participants in June 2020. SUBJECTS: U.S. adults (N = 170) participated in the study. Participants were average age of 37 and majority were men (61.2%) and White (77.6%). MEASURES: The Stigma Towards Disease Scale (SDS) was adapted to measure public stigma directed towards COVID-19 (SDS-C19). Additional stigma-related measures were adapted for this study. ANALYSIS: Factorial structure of SDS-C19 was assessed using confirmatory factor analysis (CFA). Validity of SDS was examined using Pearson correlations with other stigma measures. We evaluated the attributional model of stigma using structural equation modeling. RESULTS: Internal consistency of SDS-C19 was high and a three-factor model reflecting cognitive, affective, and behavioral factors was supported (χ2 [71, N = 170] =140.954, P = .00, CFI= .946, TLI = .931, RMSEA = .076, SRMR = .087). The SDS-C19 had strong correlations with other stigma-related measures. A blame-mediated attribution model was supported (χ2 [8, N = 170] = 21.793, P = .00, CFI = .976, TLI =.956, RMSEA = .101, SRMR = .058). CONCLUSION: The SDS-C19 is a valid tool for assessing COVID-19 stigma. SDS-C19 and the attribution model can guide public health communication.

Recovery and trauma among urban African Americans with serious mental illness.

OBJECTIVE: Traumatic experiences are prevalent among people with serious mental illness and can significantly worsen outcomes. This study aimed to identify an urban cluster of trauma types, compare continuous distress ratings versus categorical experience of trauma for predicting outcomes such as depression and quality of life, and investigate the mediating role of recovery orientation in the impact of trauma exposure on outcomes. METHOD: Data came from an intervention study on African Americans with serious mental illness living in a large urban area; 212 participants completed baseline self-report measures of past trauma experiences, related distress levels, recovery, depression, and quality of life. Data were assessed using correlations and regressive path modeling. RESULTS: Overall, 56.6% of participants reported experiences with trauma. Analyses suggested an urban cluster of trauma types that was self-reported by over 25% of participants. Distress due to trauma strongly correlated with greater depression as well as reduced quality of life and recovery. Interestingly, the categorical presence of trauma history (yes/no) had no significant relationship with any outcomes. Path analyses revealed that recovery mediated the impact of trauma distress on depression and quality of life, specifically implicating the recovery subfactor of hope. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results suggested that cognitive reframing focused on positive appraisals of overall recovery, and the hope subfactor can have a positive influence on trauma outcomes. The study supported the role of recovery in posttraumatic growth and suggests that hope can be used to help patients process trauma healthily. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A systematic review of community-based participatory research studies involving individuals with mental illness.

OBJECTIVE: This systematic review examined community-based participatory research (CBPR) studies in which people with mental illness (PWMI) directly contributed to research projects. The purpose was to describe study characteristics, team structure and logistics, and level of involvement of in the research process. METHOD: We searched the PsycINFO database from January 2000 to July 2020, identifying 1,395 records and analyzing the 31 that met inclusion criteria. Articles were eligible if they were (a) published in English in a peer-reviewed journal; (b) explicitly stated that at least one adult with mental illness assisted with the study as a CBPR team member; and (c) included a research outcome. RESULTS: Most studies collected qualitative data. Project length, team composition, and frequency of meetings were not specified in about one third of the articles. Twenty-nine studies reported involvement of people with mental illness in research activities such as recruitment, data collection, transcription, and analysis. Nearly half did not specify if they received any training. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Individuals with mental illness were heavily involved in planning and conducting research, demonstrating the feasibility of meaningful involvement. Future research should consider how people with lived experience can assist with quantitative methods, and articles should clearly and explicitly describe characteristics of the partnership (e.g., team composition, frequency of meetings, compensation). The protocol is published in Open Science registry at https://osf.io/mshfb. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Weight Self-Efficacy and Recovery Among African-Americans With Serious Mental Illness and High Body Weight.

ABSTRACT: Many African-Americans with serious mental illness fail to engage in evidence-based programs that positively affect weight management. We examined how having a weight-related physical illness correlated with self-efficacy, recovery, and quality of life by contrasting illnesses with symptoms that are obviously perceived ( e.g. , sleep apnea and pain related to weight) versus those that are not ( e.g. , hypertension). African-Americans with serious mental illness who were overweight (body mass index ≥25) completed the Weight Efficacy Lifestyle Questionnaire, Recovery Assessment Scale, and Quality of Life Scale in this study assessing the impact of a program on weight and health. Silent weight-related physical disorders were not found to correlate with quality of life, recovery, or weight self-efficacy. Differences in recovery were found in people with versus without sleep apnea and weight-related pain. Findings suggest future directions for affirming approaches to promote engagement among African-Americans with serious mental illness in weight management programs.

How African Americans With Severe Mental Illness and Trauma Experience Diet and Exercise.

African Americans have a higher prevalence of obesity and obesity-related diseases than other racial/ethnic groups; among persons with serious mental illness (SMI), African Americans fare worse as well. This qualitative study focused on the perceptions of African Americans with SMI in regard to 1) their experiences with diet and exercise behaviors post trauma and 2) how diet and exercise programming can address trauma. A community-based participatory research (CBPR) team developed the interview guide, research protocols, and conducted three focus groups. The team used thematic analysis to analyze the data. Participant (N = 27) responses on the experience of trauma were coded into the following themes: 1) emotional eating, 2) appetite loss, 3) hesitancy to exercise due to community violence, 4) staying home due to mental health symptoms, and 5) substance use. Themes around how programming can address trauma included: 1) support, 2) communication, 3) strategies to avoid trauma, and 4) engagement in programming. Findings suggest the need for human service professionals to infuse trauma-informed communications and practices throughout programming, incorporate peer-led services and address concerns related to community violence.

Does the peer-led Honest, Open, Proud program reduce stigma's impact for everyone? An individual participant data meta-regression analysis.

PURPOSE: Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up. METHODS: Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up. RESULTS: More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up. CONCLUSION: Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.

Barriers to Meaningful Participatory Mental Health Services Research and Priority Next Steps: Findings From a National Survey.

OBJECTIVE: A growing consensus has emerged regarding the importance of stakeholder involvement in mental health services research. To identify barriers to and the extent of stakeholder involvement in participatory research, the authors undertook a mixed-methods study of researchers and community members who reported participation in such research. METHODS: Eight consultative focus groups were conducted with diverse groups of stakeholders in mental health services research (N=51 unique participants, mostly service users), followed by a survey of service users, family members, community providers, and researchers (N=98) with participatory research experience. Focus groups helped identify facilitators and barriers to meaningful research collaboration, which were operationalized in the national survey. Participants were also asked about high-priority next steps. RESULTS: The barrier most strongly endorsed as a large or very large problem in the field was lack of funding for stakeholder-led mental health services research (76%), followed by lack of researcher training in participatory methods (74%) and insufficiently diverse backgrounds among stakeholders (69%). The two most frequently identified high-priority next steps were ensuring training and continuing education for researchers and stakeholders (33%) and authentically centering lived experience and reducing tokenism in research (26%). CONCLUSIONS: These findings suggest a need for increased attention to and investment in the development, implementation, and sustainment of participatory methods that prioritize collaboration with direct stakeholders, particularly service users, in U.S. mental health services research. The findings also underscore the presence and potentially important role of researchers who dually identify as service users and actively contribute a broader orientation from the service user-survivor movement.

To share or not to share? Evaluation of a strategic disclosure program for suicide attempt survivors.

While suicide attempt survivors often choose to conceal their suicidal thoughts and behaviors to avoid stigma, concealment might also limit the support they receive. This study evaluated a peer-led strategic disclosure intervention for suicide attempt survivors (N = 38) who were randomized to either a 6-hour group disclosure intervention or waitlist control. Results showed a significant group-by-time interaction from baseline to post-intervention on two measures of self-stigma, depression, and self-esteem, but not for other variables. Effect sizes were medium to large. Findings suggest that suicide attempt survivors may benefit from interventions that address self-stigma and disclosure.

Using Multiple Regression Analyses to Uncover Patterns of Correlates of Grief Problems, Depression and Suicidal Ideation Among Suicide Bereaved Individuals.

This analysis of a convenience sample survey of 195 suicide bereaved adults focuses on predictors of three important highly interrelated experiences among the suicide bereaved: grief problems, depression and suicidal thinking. Although each of these three experiences can be explained by a unique set of predictors, they share many commonalities. Several predictors stood out especially in either aggravating or alleviating these experiences: personal (or post-traumatic) growth, perceived social support, feelings of blameworthiness, perceived suicide stigma, years since loss and a respondent's mental health difficulties experienced prior to their suicide loss. We also review the clinical implications of these results.

Peer Navigators for the Health Needs of People of Color With Serious Mental Illness.

People with serious mental illness die up to 20 years younger than others in the same age group, with people of color showing even earlier death. The social disadvantages experienced by this group-for example, poverty, criminal legal involvement, and immigration-are further determinants of this disparity. Peer health navigators (PHNs) are people with experiences of recovery who may share a racial-ethnic background, history of poverty, experience with criminal legal systems, or immigration status with current patients and who assist in practical and timely tasks that help people engage with fragmented health systems. This column describes the PHN practice, including the putative components that define it.

Debate: Stigma implications for diagnosing personality disorders in adolescents.

Diagnosing personality disorders (PDs) in adolescence is a complex and often controversial decision. While early diagnosis provides a pathway to treatment, stigmatizing labels might unintentionally increase prejudice and discrimination for youth and their families, resulting in harm and treatment avoidance. In this paper, we outline stigma-related considerations for diagnosing PDs in adolescence, including types of stigma (public stigma, self-stigma, associative stigma) and moderators of stigma (continuum beliefs, biogenetic attributions, PD sub-diagnosis). Research indicates that PDs are among the most stigmatizing diagnoses in adults, particularly among healthcare providers. Experiences with stigma may differentially impact adolescents, who are undergoing rapid changes in identity development and profound influences from educational systems, peers, and social media. Youth who receive mental health services (especially those embedded in schools) worry about whether and how to talk about a diagnosis. However, adolescents with significant behavioral symptoms are often seen as different from their peers even prior to a formal diagnosis. Systematic efforts are needed to anticipate and mitigate stigma-related impacts on adolescents who might be diagnosed with PDs.

Patient, client, consumer, or service user? An empirical investigation into the impact of labels on stigmatizing attitudes.

OBJECTIVE: Currently there is no universally agreed upon language for those seeking psychiatric treatment, and labels commonly include patient, client, consumer, and service user. Although there is some research regarding preferences for label (Dickens & Picchioni, 2012), little is known about how people perceive an individual differently based on the label used. The current study examined whether specific labels were associated with more stigmatizing attitudes. METHOD: Participants recruited through MTurk (N = 526) were randomized to read a vignette of a man named Harry, described as a patient, client, consumer, or service user with mental illness. After correctly recalling the label from the vignette, participants were assessed for stigmatizing attitudes toward Harry. RESULTS: ANOVAs indicated a no main effects of label on stigmatizing attitudes. A number of variables (e.g., overall stigma, dangerousness, segregation, and distance) revealed a significant interaction between label and prior mental health treatment: For those who have sought prior mental health treatment, the term client may be more stigmatizing than other labels. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study did not find general differences in stigmatizing attitudes associated with mental health treatment label. Although preliminary, these findings suggest treatment labels may not significantly impact stigmatizing attitudes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Anticipated Suicide Stigma, Secrecy, and Suicidality among Suicide Attempt Survivors.

OBJECTIVE: Suicidal behavior is stigmatized, and suicide attempt survivors often keep their experiences secret. Although secrecy can protect from discrimination, research from related fields suggests that both the experience of stigma and secrecy can contribute to suicidality. Although suicide attempt survivors are at high risk for reattempt, research investigating the link between suicide stigma and suicidality among this group is rare. METHOD: A community sample of 159 suicide attempt survivors participated in an online survey in the US. We used multiple linear regression models to test the association between anticipated suicide stigma and current suicidality, as well as a path model to test the mediating effect of secrecy. RESULTS: After controlling for age, sex, number of lifetime suicide attempts, and time since the most recent suicide attempt, anticipated suicide stigma was significantly associated with increased suicidality. In a controlled path model, this link was partially mediated by increased secrecy. CONCLUSION: These results provide initial support that anticipated suicide stigma, and secrecy can contribute to suicidality among suicide attempt survivors. Therefore, programs to support suicide attempt survivors in coping with suicide stigma and secrecy, as well as interventions to reduce harmful aspects of public suicide stigma, could contribute to suicide prevention.

Perceived Social Support and Mental Health After Suicide Loss.

Background: Despite great need, social support is limited after suicide loss, which could contribute to worse mental health outcomes including increased suicidality among suicide loss survivors. Aims: To examine the associations between perceived social support, grief difficulties, depressive symptoms, suicidality, and personal growth among 195 suicide loss survivors. Method: The associations between perceived social support, grief difficulties, depressive symptoms, suicidality, and personal growth were tested using linear regression modeling. Results: In controlled models, more perceived social support was significantly associated with decreased grief difficulties, depressive symptoms, and suicidality, as well as with increased personal growth. Limitations: Participants were mostly Caucasian women who participated in a cross-sectional online survey. Conclusion: Our findings suggest that programs to increase social support after suicide loss may be an important aspect of suicide postvention.

The Self-Stigma of Suicide Attempt Survivors.

Although suicide attempt survivors report feelings of shame and stigmatization, no published scale measures self-stigma experienced by attempt survivors. This article describes the creation and validation the Self-Stigma of Suicide Attempt Scale (SSSAS). In this study, the SSSAS was validated in an online sample (n = 292) of suicide attempt survivors. Results supported the progressive model of self-stigma, wherein a substantial proportion of suicide attempt survivors were aware of stigma, but fewer applied that stigma to themselves or felt harmed by it. Reliabilities of SSSAS subscales were high. Harm subscale scores were correlated with depression, self-esteem, recovery, empowerment, and stigma stress in the expected directions. Future research can seek to further validate the scale and explore relationship between self-stigma and other constructs.

Perceived suicide stigma, secrecy about suicide loss and mental health outcomes.

Perceived suicide stigma and consequent secrecy about suicide loss could contribute to impaired mental health among suicide loss survivors. Using online survey data from 195 suicide loss survivors, higher perceived suicide stigma was associated with more grief difficulties, higher suicidality, and less personal growth. Secrecy partly mediated the association between perceived suicide stigma and grief difficulties as well as suicidality and completely mediated the association between perceived suicide stigma and personal growth. Our findings suggest that supporting suicide loss survivors in coping with perceived suicide stigma could reduce secrecy about suicide loss and by this improve their mental health outcomes.

Strengths and challenges of peer coaches for supported education in colleges and universities.

OBJECTIVE: Peer coaches are an important element in supported education programs. Peers are students with lived experience in recovery. As coaches, they provide on-campus support to assist students with psychiatric disabilities. METHOD: A community-based participatory research (CBPR) team interviewed 44 participants including students with psychiatric disabilities, faculty, and staff about their perceptions of peer coaches. Thematic analysis was used to analyze interview transcripts. RESULTS: Possible strengths included helping navigate services, addressing sense of being alone, and managing school demands. Challenges included finding suited peers, addressing burnout, providing training and supervision, and matching coaches with students. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A list of ingredients for peer coaches within a supported education program was generated. Future research should determine the modifier of these key ingredients. Our findings informed the development of a peer coaching program which is now going through feasibility, fidelity, and impact evaluation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

What's in a word? Clarifying terminology on suicide-related communication.

Efforts to clarify suicide terminology fail to address nuances in suicide-related communication, often relying on poorly-defined terms or implying communication exists primarily as manipulation. In the present paper, we review examples from existing literature and explore how personal suicide-related communication differs from prevention and exposure communication. We also separate definitions for five common types of personal-suicide-related communication: (a) suicide-related disclosure, (b) suicide-related notification, (c) unintended suicide-related communication, (d) coerced suicide-related communication, and (e) conditional suicide-related communication. Finally, we provide specific ways in which standardized definitions can enhance both research and clinical efforts in the future.

Recipients of Suicide-Related Disclosure: The Link between Disclosure and Posttraumatic Growth for Suicide Attempt Survivors.

It is important to explore factors that could help or hinder one's wellbeing following a suicide attempt, which could yield not only negative consequences but also posttraumatic growth (PTG; positive changes following a traumatic event). The present study used a multivariate analysis of covariance (MANCOVA) to test the relationship between disclosure, PTG, and posttraumatic depreciation among suicide attempt survivors when controlling for time since attempt and to test whether these effects remained after controlling for quality of support from family and friends. Suicide attempt survivors (n = 159) completed an online survey about their experiences. Increases in disclosure to family and friends but not to healthcare providers predicted changes in PTG. The effects of family disclosure remained even after controlling for quality of support. Disclosure to healthcare providers demonstrated some statistical effects on PTG, yet in the opposite direction and only after controlling for quality of support. The control variables-time since attempt and quality of support-were the only variables that predicted a change in posttraumatic depreciation. These findings suggest there is value in disclosing one's personal story to family regardless of whether one receives supportive responses and that social support can impact one's PTG.