Disruptions in the management and care of university students with preexisting mental health conditions during the COVID-19 pandemic.

Students with preexisting mental health conditions or disabilities may fair worse due to virus mitigation strategies during the COVID-19 pandemic. This study was conducted to understand the experiences of students with preexisting mental health conditions or disabilities at a public university during COVID-19. We examined disruptions in the management of preexisting mental health conditions or disabilities and its impact on psychological well-being. Students were surveyed about their health care experiences during the COVID-19 pandemic between June and September 2020. Linear regressions and mediation analyses were conducted to examine the relationships between disruption to care, mental health self-efficacy, and four psychological well-being outcomes (stress, anxiety, depression, and overall distress). Of the total (N = 1,082) study participants, 258 (24%) reported having a preexisting mental health condition(s) or disabilities (81% female; Mage = 23.47). Of those, 155 (61%) reported that COVID-19 disrupted health care delivery and management of their conditions or disabilities. Of those who reported this disruption, 51% (n = 109) of participants reported a disruption in their ability to see a health care professional and 58% (n = 69) reported either that they lost care or that the quality of the new telemedicine care was not sufficient. A series of linear regressions revealed significant relationships between disruption to care and the four psychological outcomes. Mediation analyses revealed that depression, stress, anxiety, and overall distress were mediated by self-efficacy in managing mental health. University administrators and health care providers should evaluate the scope of mental health care and telemedicine services for students to help long-term psychological effects of COVID-19.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Heterogeneous mental health consequences of COVID-19: Costs and benefits.

In this commentary, I argue that the mental health impact of COVID-19 will show substantial variation across individuals, contexts, and time. Further, one key contributor to this variation will be the proximal and long-term impact of COVID-19 on the social environment. In addition to the mental health costs of the pandemic, it is likely that a subset of people will experience improved social and mental health functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Is poverty on young minds? Stereotype endorsement, disadvantage awareness, and social-emotional challenges in socioeconomically disadvantaged children.

Socioeconomic disadvantage is associated with social-emotional difficulties, including internalizing and externalizing problems, as early as toddlerhood. The aim of the current study was to understand whether economically disadvantaged children's beliefs about the consequences and correlates of poverty (poverty stereotypes) and their beliefs about their personal economic disadvantage contribute to their social-emotional functioning. Interviews were conducted with 94 socioeconomically diverse 4- to 9-year-old children, whose parents reported on their social-emotional functioning and family socioeconomic disadvantage. As hypothesized, among relatively socioeconomically disadvantaged children, perceived disadvantage was associated with social-emotional functioning. The same relation was not found for relatively socioeconomically advantaged children. Socioeconomically disadvantaged children who endorsed higher levels of personal disadvantage had more attention problems and more anxious-depressive symptoms than socioeconomically disadvantaged children who endorsed lower levels of personal disadvantage. In addition, only among socioeconomically disadvantaged children (and not among relatively advantaged children) was negative stereotyping associated with attention problems. Socioeconomically disadvantaged children who endorsed more negative stereotypes had higher levels of attention problems. There was no evidence of an association between negative stereotyping and anxious-depressive symptoms and no moderation of this relation by socioeconomic status. Implications and directions for future research are discussed in light of several relevant theoretical frameworks, including stigma consciousness, status anxiety, and critical consciousness. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Coping, mental health, and subjective well-being among mental health staff working in secure forensic psychiatric settings: Results from a workplace health assessment.

Given raised rates of patient suicide and violence in secure psychiatric facilities, staff in such settings are arguably at increased risk for burnout and reduced mental health. The present article responds to the recent U.K. National Institute for Health and Care Excellence (NICE) call to assess workforce well-being. This article held the following aims: (1) to quantify existing levels of mental health (i.e., depression, anxiety, distress, and posttraumatic stress) and subjective well-being (i.e., job satisfaction, life satisfaction, and four domains of burnout) and (2) to evaluate Coping Self-Efficacy (CSE) and Need for Affect (NFA) as factors associated with staff mental health and subjective well-being. We conducted a voluntary cross-sectional health needs assessment of forensic mental health staff (N = 170) between 2017 and 2018 from one National Health Service (NHS) Trust. Descriptive findings suggest staff possessed nonclinical average ranges of mental health symptoms. Subjective well-being findings showed burnout was relatively low, whereas job and life satisfaction were modest. Regression models demonstrated that (a) thought/emotion stopping beliefs were negatively associated with psychological exhaustion; (b) social support beliefs were positively associated with life satisfaction and job enthusiasm; (c) NFA Avoidance was linked with poor mental health and burnout, and; (d) NFA Approach was positively associated with two health subjective well-being indicators. Overall, assessment results suggest NHS forensic mental health staff reported relatively good health. Cognitive- and emotion-focused coping beliefs demonstrate promise as content for prevention programming. Using Emotional Labor Theory, we offer psychological services-based recommendations for future prevention programming and research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A predictive model of resilience among family caregivers supporting relatives with traumatic brain injury (TBI): A structural equation modelling approach.

Constructs from positive psychology were employed to create an explicit model of caregiver resilience. Predictive and mediating relationships among resilience and related variables (personality, coping, self-efficacy, hope, social support) were then tested for their association with burden and psychological adjustment among family members caring for relatives with severe TBI. Family participants (n = 131) from six rehabilitation units from New South Wales and Queensland completed assessments which elicited explanatory (Eysenck Personality Questionnaire, Ways of Coping Questionnaire), mediating (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey), and caregiver outcome (Caregiver Burden Scale, Mental Health sub-Scale-SF36, General Health Questionnaire, and Positive and Negative Affect Scale) variables. Structural Equation Modeling (SEM) showed that resilience had a direct effect on positive affect in caregivers. Resilience also played a protective role in relation to two variables associated with caregiver vulnerability: an indirect association with caregiver burden mediated through social support; a direct effect on hope, which, in turn, was associated with positive mental health. Positive mental health then played a buffering role in relation to psychological distress and negative affect. Resilience, in combination with other psychological attributes, was associated with reduced morbidity among family caregivers after severe TBI.

High-achieving schools connote risks for adolescents: Problems documented, processes implicated, and directions for interventions.

Excessive pressures to excel, generally in affluent contexts, are now listed among the top 4 "high risk" factors for adolescents' mental health, along with exposure to poverty, trauma, and discrimination. Multiple studies of high-achieving school (HAS) cohorts have shown elevated rates of serious symptoms relative to norms, with corroborating evidence from other research using diverse designs. Grounded in theories on resilience and ecological influences in development, a conceptual model is presented here on major risk and protective processes implicated in unrelenting achievement pressures facing HAS youth. These include forces at the macrolevel, including economic and technological changes that have led to the "middle class squeeze," and proximal influences involving the family, peers, schools, and communities. Also considered are potential directions for future interventions, with precautions about some practices that are currently widespread in HAS contexts. In the years ahead, any meaningful reductions in the high distress of HAS youth will require collaborations among all stakeholders, with parents and educators targeting the specific areas that must be prioritized in their own communities. Leaders in higher education and social policy could also help in beginning to curtail this problem, which is truly becoming an epidemic among today's youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parenting styles and socio-demographic dynamics associated with mental health of in-school adolescents in Ibadan, south-west Nigeria.

Background: Positive parenting and enabling socio-demography, engenders good conduct in adolescence. Balanced parental demandingness and emotional responsiveness, deployed by authoritative parents, supports adolescents' mental health. Parental emotional responsiveness deters peer-pressured risky behaviours; while parental negligence, permissiveness, or demandingness encourages mental health problems. This is especially in the context of unfavourable socio-demographic setting. Aim: We aimed to evaluate parenting styles and socio-demographic factors associated with adolescents' mental health. Method: A cross-sectional multistage study was conducted with 286 in-school adolescents in Ibadan, Nigeria. Data were collected with questionnaires. The questionnaires evaluated socio-demography, mental health, and perceived parenting styles using the Strength and Difficulty Questionnaire (SDQ) and Scale of Parenting Styles (SPS) questionnaires. Data analysis was conducted using SPSS 21. Results: Some of the adolescents in this study, experienced peer problems (4.9%), conduct problems (9.4%), hyperactivity problems (0.7%), emotional problems (14.3%), and they lacked pro-social behaviours (11.1%). In comparison to adolescents who perceived fathers as authoritative, adolescents who perceived fathers as less demanding experienced emotional (p = 0.01) and peer (p = 0.02) problems. Perceived maternal negligence and authoritarian parenting was associated with more peer problems (1.5±2.3 and 1.3±2.2) in comparison to perceived maternal authoritative style (0.6±1.5). Most adolescents from lower social class experienced conduct (88.8%; p = 0.07) and emotional problems (73.2%; p = 0.20). Conclusion: Competent parenting style and socio-economic resources supports resilience to mental health problems in adolescents.

Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses.

INTRODUCTION: The purpose of this study was to examine mental health status by gender identity among undergraduate and graduate students. METHODS: Data came from the 2015-2017 Healthy Minds Study, a mobile survey of randomly selected students (N=65,213 at 71 U.S. campuses, including 1,237 gender minority [GM] students); data were analyzed in 2018. Outcomes were symptoms of depression, anxiety, eating disorders, self-injury, and suicidality based on widely used, clinically validated screening instruments. Bivariable and multivariable analyses explored differences between GM and cisgender (non-GM) students as well as by assigned sex at birth. RESULTS: Across mental health measures, a significantly higher prevalence of symptoms was observed in GM students than cisgender students. Compared with 45% of cisgender students, 78% of GM students met the criteria for 1 or more of the aforementioned mental health outcomes. GM status was associated with 4.3 times higher odds of having at least 1 mental health problem (95% CI=3.61, 5.12). CONCLUSIONS: Findings from this largest campus-based study of its kind using representative data with both gender identity and mental health measures underscore the importance of recognizing and addressing GM mental health burdens, such as by screening for mental health and providing gender-affirming services. There is broad urgency to identify protective factors and reduce mental health inequities for this vulnerable population.

Perception of Benefits and Risks of Neurocognitive Disorders Diagnosis: A French National Survey.

BACKGROUND: Neurocognitive disorders (NCD) are underdiagnosed in primary care, mainly because of the misunderstanding of benefits associated with timely diagnosis. OBJECTIVE: The aim of this study was to explore the benefits and risks of diagnosis in a population of general practitioners (GPs), specialized physicians (SPs), other healthcare professionals (HPs), and informal caregivers (ICs). METHODS: A questionnaire was submitted to GPs, SPs, HPs. and ICs. It aimed at evaluating benefits and risks related to NCD diagnosis associated with four prototypical clinical cases at different stages: isolated cognitive complaint/mild NCD, major NCD at mild/moderate stage, moderate stage with behavioral and psychotic symptoms, and severe stage. The concepts of early, timely, and personalized diagnosis were evaluated. RESULTS: A total of 719 completed surveys were collected from 183 GPs, 176 SPs, 281 HPs, and 79 ICs. More than 90% of the participants considered initiating a diagnosis as relevant except at the severe stage. Benefits were superior to risks for all groups and all four cases alike (p < 0.001). Benefits were lower according to GPs and higher for SPs than the other groups at the first two stages (p < 0.001). At the moderate stage, there were few differences between groups. At the severe stage, GPs and SPs claimed it was less relevant to carry out a diagnosis than the other groups (p < 0.001). Risks were higher for ICs and lower for SPs (p < 0.001). The best diagnosis concept was the personalized diagnosis. CONCLUSION: Benefits appeared more relevant than risks with differences according to the stage of the disease and type of respondents.

Evaluating Patient Brain and Behavior Pathways to Caregiver Health in Neurodegenerative Diseases.

BACKGROUND: Caregivers of patients with neurodegenerative diseases are at heightened risk for serious health problems, but health differences between individual caregivers abound. AIMS: To determine whether atrophy in patient brains could be used to identify caregivers at heightened risk for health problems and which patient variables mediate this relationship. METHODS: In 162 patient-caregiver dyads, we assessed patient atrophy using structural MRI, caregiver health, and patient behavior and cognitive symptoms. RESULTS: Patient atrophy in the right insula and medial frontal gyrus was associated with worse caregiver health; this relationship was partially mediated by patient neuropsychiatric symptoms, and assessing atrophy in these regions improved predictions of poor caregiver health above and beyond patient behavioral symptoms. CONCLUSIONS: This study shows the value of patients' brain data in identifying caregivers at risk for becoming sick themselves.

The other side of the coin in renal replacement therapies: the burden on caregivers.

PURPOSE: Living with end-stage renal disease may be burdensome, not only for patients, but also for caregivers. In this study, we aim to compare caregiver burden, psychological symptoms in caregivers of peritoneal dialysis (PD), hemodialysis (HD), and transplantation (TX), and find out associated factors. METHODS: A total of 43 PD, 42 HD, 42 TX patients and a total of 127 caregivers that were actively involved with the care of their patients' dialysis were enrolled. Patients had been on renal replacement therapy at least for 6 months and caregivers had given care at least for 6 months. The World Health Organization Quality of Life short version and hospital anxiety and depression scale (HAD) were applied to the patients. Symptom Checklist-90-Revised and Zarit caregiver burden scale were applied to the caregivers. RESULTS: Zarit caregiver burden score was found highest in HD group, which was significantly higher than PD and TX. All three groups had similar HAD anxiety scores, whereas the HAD depression score was highest in HD group, lower in PD, and lowest in TX. Quality of life was lowest in HD group. Zarit caregiver burden score was found higher in caregivers with symptoms like somatization, anxiety, obsessive-compulsive, depression, interpersonal sensitivity, psychoticism, paranoid ideation, hostility, and additional psychological symptoms than the ones who did not have these symptoms. Psychological symptoms were similar in PD, HD, and TX groups. CONCLUSION: Caregiver burden was found highest in HD group. Educational, social, and psychological support interventions may be considered for caregivers.

An intervention programme for caregivers of dementia patients with frontal behavioural changes: an explorative study with controlled effect on sense of competence.

AIM: Caregivers of dementia patients experience high levels of burden; this is especially true of caregivers of dementia patients with behavioural problems. As intervention studies for these caregivers are still lacking, we conducted an explorative pilot study into the efficacy of a support programme. METHODS: Participants were caregivers of dementia patients affected by apathy, disinhibition, and/or stereotypical behaviour. All patients had a Frontal Behavioural Inventory score of 11 or higher. Caregivers were randomized to the intervention group or control group (both n = 15). The intervention was a 6-month programme that consisted of psychoeducation, social support, and behavioural cognitive therapy. Quantitative and qualitative data were collected at baseline and after the intervention. RESULTS: An increased sense of competence was found in the intervention group. Burden, perceived stress, and depressive symptoms decreased, although the difference between the intervention and control groups was not significant. CONCLUSIONS: Caregivers' sense of competence improved as a result of the support programme, and caregivers revealed its comprehensive supportive effects. Further research into the efficacy of the programme on a larger scale is recommended.

Alternate versions of a fixed-choice, delay-discounting assessment for repeated-measures designs.

Delay discounting, reflected in the tendency to prefer immediate rewards over delayed rewards, is associated with most forms of problematic substance use. When assessed multiple times to examine within-individual changes, for example, following acute drug administration or an intervention, shifts in delay discounting simply because of repeated assessment is a concern, particularly when the assessment task is identical. This may be true for the Monetary Choice Questionnaire (MCQ), a widely used, fixed-item assessment of delay discounting. The present research examined possible within-individual difference/equivalence of MCQ indices at test/retest. This was contrasted with within-individual difference/equivalence when using an alternate version of the MCQ at retest, specifically developed to maintain the assessment structure and scoring of the original MCQ but with different choice items. Eighty-four participants completed delay discounting at test and retest with a 1-week interval; participants were randomized to complete the MCQ at both test and retest (MCQ/MCQ; n = 43) or complete the MCQ at test and an alternate version of the MCQ at retest (MCQ/MCQ-A; n = 41). Conventional hypothesis testing indicated no significant changes in delay discounting in the MCQ/MCQ condition or MCQ/MCQ-A condition. However, equivalence analysis, which is able to established whether scores are statistically equivalent, indicated that test/retest scores were not equivalent in some cases. Specifically, only 1 magnitude in the MCQ/MCQ condition was equivalent at test/retest, whereas 2 magnitudes in the MCQ/MCQ-A condition were equivalent at test/retest. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Income within context: relative income matters for adolescent social satisfaction and mental health.

BACKGROUND: Previous research has shown that a mismatch between one's own socioeconomic status (SES) and the SES of the surrounding context can lead to maladaptive outcomes, such as increased social stigma and low levels of belongingness (Johnson, Richeson, & Finkel, Journal of Personality and Social Psychology, 100, 2011, 838; Ostrove, The Journal of Social Issues, 59, 2003, 771). This study examines an adolescent population, as contextual comparisons should be especially salient at this time. METHODS: Participants included over 900 adolescents at age 15 involved in a multisite longitudinal study. RESULTS: Results showed that lower relative income status predicted increased social dissatisfaction, internalizing and externalizing problems, after controlling for family SES. Moreover, the effect of relative income was indirectly related to these problems through social dissatisfaction. Exploratory multigroup analyses by gender suggested that the adolescent girls may be driving the effects of relative income. CONCLUSIONS: Findings are discussed in regard to adolescent socioemotional functioning, as well as the implications for gender differences related to relative income status.

Which behaviours? Identifying the most common and burdensome behaviour changes in amyotrophic lateral sclerosis.

Behaviour change is increasingly recognised as a common feature of amyotrophic lateral sclerosis (ALS), and may be similar to that seen in frontotemporal dementia (FTD). The behaviours most disturbed in ALS, and those that relate most significantly to caregiver burden, however, have not been well established. Forty ALS participants and their caregivers, and 27 age- and gender-matched healthy controls and their relatives, participated in this study. ALS participants were assessed on a disease rating scale, and caregivers and control informants completed the revised version of the Cambridge Behaviour Inventory and a measure of burden. ALS caregivers reported significantly more disturbance than healthy control informants on the functional domains of everyday skills, self-care, and sleep, and in the behavioural domains of mood and motivation. There were no differences between groups in frequency of memory and orientation difficulties, or behaviours characteristic of FTD, such as changes to eating habits or stereotypic and motor behaviour, indicating that the behavioural profile in ALS may differ from FTD. In the ALS group, the domains with the strongest relationship to caregiver burden were everyday skills, motivation and memory, likely because poor motivation, memory dysfunction and difficulties completing activities of daily living require more carer support via direct supervision, prompting or hands on care. Services to support ALS patients and caregivers need to provide targeted interventions for those functional and behavioural changes which are most burdensome in the disease.

Neuropsychiatric symptoms in dementia may predict caregiver burden: a Sicilian exploratory study.

BACKGROUND: Behavioural and psychological symptoms of dementia are very common. They represent a main cause of burden and distress in caregivers and can lead to early institutionalization of patients. We aimed to find the most specific behavioural and psychological symptoms of dementia that can strongly affect the caregivers' burden. METHODS: Twenty-seven patients and their caregivers were enrolled in this study. All of the patients were affected by Alzheimer's, vascular, or frontotemporal dementia and were evaluated with the Neuropsychiatric Inventory and Mini-Mental State Examination. Caregivers were administered the Caregiver Burden Inventory. RESULTS: Apathy, depression, anxiety, and agitation were the most common symptoms and were found in up to 90% of the patients. We detected strong correlations between patient neuropsychiatric symptoms, (i.e. irritability, hallucinations, aberrant motor behavioural, depression, and agitation) and Caregiver Burden Inventory scores. Multiple regression analysis found hallucinations, irritability, and depression to be significant predictors of caregiver burden. Moreover, the Neuropsychiatric Inventory score was more closely related to caregiver burden than the Mini-Mental State Examination score. CONCLUSION: Our results revealed that demented patients' behavioural problems are related to the level of caregiver burden and distress. Further investigations are needed to differentiate the present findings among dementia subtypes and to better evaluate the effect of caregivers' personal characteristics on their own burden.

Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers.

INTRODUCTION: Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers. METHOD: The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patient's frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD. RESULTS: We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers' distress. CONCLUSIONS: The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems ­ both disruptive and depressive ­ and the distress they cause in caregivers.

The SAD PERSONS scale for suicide risk assessment: a systematic review.

The SAD PERSONS scale (SPS) is widely used for suicide risk assessment in clinical and educational settings. The study objective was to systematically review the SPS performance in clinical situations. A systematic search of electronic databases was conducted. Relevant descriptive, quality, and outcome data were reviewed. In the search, 149 studies were identified and 9 met inclusion criteria. Included studies were highly variable across outcome measures, populations, and assessment methods. Only 3 studies examined SPS performance in predicting suicide outcomes; none showed the scale accurately predicted suicidal behavior. Available literature is of limited quality and quantity. Insufficient evidence exists to support SPS use in assessment or prediction of suicidal behavior. Well-designed studies that address the observed limitations are required.