It Gets Better: Attenuated Associations Between Latent Classes of Peer Victimization and Longitudinal Psychosocial Outcomes in Four Low-Resource Countries.

Very few studies of peer victimization have been conducted in low-resource countries, where cultural and contextual differences are likely to influence the dynamics of these experiences in ways that may reduce the generalizability of findings of the larger body of literature. Most studies in these settings are also subject to multiple design limitations that restrict our ability to understand the dynamics of peer victimization experiences. Person-centered approaches such as latent class analysis are an improvement on more traditional modeling approaches as they allow exploration of patterns of victimization experiences. The goal of the current study was to examine associations between patterns of peer victimization in adolescence and both concurrent and longitudinal psychosocial adjustment. Data were included for 3536 youth (49.6% female) in Ethiopia, India, Peru, and Vietnam to examine associations between adolescent peer victimization and indicators of poor psychosocial adjustment. Previously derived latent classes of peer victimization based on youth self-report of past-year exposure to nine forms of peer victimization at age 15 were used to predict self-reported emotional difficulties, self-rated health, and subjective wellbeing at ages 15 and 19 while controlling for sex. The findings show that at age 15, victimization was associated with higher emotional difficulties in all settings, lower subjective wellbeing in all except Peru, and lower self-rated health in Vietnam. At follow-up, all associations had attenuated and were largely non-significant. Sensitivity analyses confirmed the robustness of these results. These findings illustrate the multifinality of outcomes of peer victimization, suggesting social and developmental influences for potential pathways of resilience that hold promise for informing interventions and supports in both low and high resource settings.

New ways of seeing: Nursing students' experiences of a pilot service learning program in Australia.

The objective of this paper was to evaluate pre-registration nursing students' experiences of a pilot program that placed them in community based non-government organisations for clinical placement as part of a core mental health subject. Clinical placements that adopt a Service Learning model in primary health care environments are valuable to nursing students but are not commonly available in Australia. In order to enhance student exposure to primary health care models and support experiential learning about the social determinants of health, a pilot Service Learning program was designed to provide clinical placements in non-government organisations. Qualitative data were collected through one focus group with program participants. The focus group was audio-recorded and transcribed verbatim. Thematic analysis of transcribed data was undertaken. The overarching theme identified was 'new ways of seeing'. Three sub-themes - 'learning outside the box', 'confronting the real world' and 'transformative experiences' - were also identified. The authors have concluded that nursing students in community organisations for clinical practicum facilitated valuable learning and generated professional and personal insight leading to increased understanding of the social determinants of health and increased awareness of mental health nursing in the community.

Influence of health beliefs and stigma on choosing internet support groups over formal mental health services.

OBJECTIVE: As the Internet has become a ubiquitous tool for health information, the use of Internet support groups for mental health concerns has grown. Despite the widespread use of these groups, little research has examined the efficacy and effectiveness of online communities for ameliorating mental health symptoms or factors that prompt people to seek online support rather than formal treatment. Our study addresses this gap in the literature by investigating Internet support group use as an alternative to formal mental health services. METHODS: Logistic regression was conducted with data from the 2008 National Survey on Drug Use and Health (NSDUH) to examine relationships among treatment beliefs, practical variables such as time and affordability, stigma, and use of Internet support groups among 2,532 survey participants who reported a need for mental health treatment but were not receiving formal services. RESULTS: Four significant predictors of Internet support group use emerged: fear of being hospitalized or taking medication (adjusted odds ratio [AOR]=8.81, 95% confidence interval [CI]=4.25-18.27), inadequate insurance coverage (AOR=3.22, CI=1.44-7.20), age 26-34 years (AOR=.22, CI=.07-.69), and age 35 or older (AOR=.21, CI=.08-.56). CONCLUSIONS: Fear of coercion and the costs of traditional mental health services were important predictors of Internet support group use. The finding that inadequate insurance coverage prompted people to seek Internet support aligns with a substantial literature regarding lack of financial resources and reduced access to treatment. Individuals' fears of hospitalization and of taking medication suggested that they may view formal treatment as potentially coercive. Further work is needed to decrease public stigma regarding mental health services and the conditions under which involuntary treatment occurs.

Reconceptualizing medication adherence: six phases of dynamic adherence.

Nonadherence is the Achilles' heel of effective psychiatric treatment. It affects the resolution of mental health symptoms and interferes with the assessment of treatment response. The meaning of the term adherence has evolved over time and is now associated with a variety of definitions and measurement methods. The result has been a poorly operationalized and nonstandardized term that is often interpreted differently by providers and patients. Drawing extensively from the literature, this article aims to (1) describe changes in the concept of adherence, drawing from the mental health treatment literature, (2) present a more comprehensive definition of adherence that recognizes the role of patient-provider transactions, (3) introduce dynamic adherence, a six-phase model, which incorporates the role of transactional processes and other factors that influence patients' adherence decisions, and (4) provide recommendations for providers to improve adherence as well as their relationships with patients.