Relationships of Family Emotional Support and Negative Family Interactions with the Quality of Life among Chinese People with Mental Illness and the Mediating Effect of Internalized Stigma.

This study aimed to investigate the relationships of family emotional support and negative family interactions with the quality of life among Chinese people with mental illness. Furthermore, it examined the mediating role of internalized stigma in these relationships. One hundred and twenty-five Chinese adults with mental illness were recruited from community mental health service centers in Hong Kong. The results show that both family emotional support and negative family interactions were related to the quality of life. Negative family interactions had a stronger effect on the quality of life compared to family emotional support. Internalized stigma partially mediated the relationship between negative family interactions and the quality of life. These findings suggest that, for Chinese people with mental illness, interventions aimed at promoting quality of life should consider enhancing family emotional support and reducing negative family interactions. In addition, mental health service providers could consider using family approaches to address internalized stigma in the effort of improving the quality of life for their service users.

Parental Factors for Mental Health Service Engagement Among Chinese Young Adults.

Mental health service disengagement can have devastating consequences for people in need of mental health services. This study explored parental factors in mental health service engagement among Chinese young adult mental health service users. Seventy-two Chinese young adults, aged from 18 to 26 years, were recruited from a Hong Kong community mental health service center. Nearly three-fifths (58.3%) of participants were female and over two-fifths (44.2%) attended college. Results of logistic regression analysis showed that Chinese young adult mental health service users with high levels of perceived need for services and low levels of perceived parental involvement in mental health services were more likely to engage in mental health services. However, concerns about the parent-child relationship, perceived parental encouragement and perceived parental demand for mental health service use were not associated with mental health service engagement. The practice implications of these results are discussed in light of the Chinese context.

Building a Working Community: Staff Practices in a Clubhouse for People with Severe Mental Illness.

The trademark of mental health clubhouses is that members and staff work side-by-side in partnership to enhance members' autonomy, competency, and recovery. To explore the intricacies of this unique approach, the author conducted 53 in-depth interviews and 262 h of participant observation in 41 visits over a five-month period in a clubhouse. Findings indicated that staff members built the clubhouse as a "working community" by skillfully integrating three practice domains: social relationships, unit work, and individuals' needs and pursuits. Distinctive skillsets helped to develop genuine relationships with members and facilitate community building, suggesting a model of generalist practice with specific intentionality.

The metabolic syndrome is associated with an increased risk of colorectal polyps independent of plasma homocysteine.

BACKGROUND/AIMS: The links between the metabolic syndrome and homocysteine in relation to the risk of colorectal polyps are not understood. The purpose of this study was to investigate the association between the metabolic syndrome and homocysteine and further analyze the relationship between these two factors and the risk of colorectal polyps. METHODS: This was a case-control study. A total of 135 participants with colorectal polyps (cases) and 110 participants without polyps (controls) were recruited. RESULTS: There were 59 participants with the metabolic syndrome in the case group and 36 participants with the metabolic syndrome in the control group. The metabolic syndrome and its individual components, except for serum triglycerides, and homocysteine were associated with the risk of colorectal polyps. When the association of the metabolic syndrome and homocysteine with the risk of colorectal polyps was simultaneously considered, the association between homocysteine and the risk of colorectal polyps disappeared, but waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, and the metabolic syndrome itself were still significant risk factors for the development of colorectal polyps. CONCLUSION: Although the metabolic syndrome and plasma homocysteine were individually related to the risk of colorectal polyps, the metabolic syndrome was a major contributing factor in relation to the risk of colorectal polyps independent of plasma homocysteine.

Developing community support for homeless people with mental illness in transition.

To facilitate effective transitional services and enhance continuity of care among people with mental illness, this grounded theory study explored the practice of developing community support in critical time intervention (CTI), a time-limited, shortterm psychosocial rehabilitation program designed to facilitate the critical transition from institutional to community settings. Semi-structured, one-on-one interviews with twelve CTI workers were analyzed. Results show that CTI workers self-identified as an "extra support" to develop community ties that will help clients sustain stable housing. Their practice of community support development was represented by a transient triangular relationship model, involving three dyadic relationships (worker-client, worker-primary support, primary support-client) as the building blocks and specific strategies to facilitate the relational transition. Findings also detailed identification of community supports, collaboration and boundary issues in working with primary supports, and engagement with clients in this transitional process. Recommendations were drawn from findings to enhance broad discharge and transitional services.

Influences of attribution and stigma on working relationships with providers practicing Western psychiatry in the Taiwanese context.

This study examined influences of causal attributions of schizophrenia and perceived and internalized mental illness stigma on perceived working alliance with, and informational support received from doctors practicing Western psychiatry in the Taiwanese social-cultural context. This cross-sectional quantitative study used a non-probability, purposive sampling technique to recruit 212 Taiwanese diagnosed with schizophrenia from Taiwanese Alliance of the Mentally Ill, 4 community mental health rehabilitation centres and 2 psychiatric hospitals between July 2012 and March 2013. Linear regression models were used for analysis. The results showed that environmental attributions were positively associated with both perceived working alliance and perceived informational support, while supernatural attributions were negatively associated with perceived working alliance and perceived informational support. Perceived stigma had a negative association with perceived working alliance. The discrimination domain of internalized stigma specifically had a positive association with perceived working alliance, while the withdraw domain had a negative association with perceived informational support. Findings inform the importance of culturally sensitive practices in developing an effective working relationship. Western psychiatric care providers need to explore consumers' casual attributions of mental illness and understand the impact of stigma so that providers may successfully engage consumers in care and provide tailored illness education and information.

Higher plasma homocysteine is associated with increased risk of developing colorectal polyps.

Colorectal adenomas are considered to be precursors of colorectal cancer. B-vitamins (i.e., folate, vitamin B(6) and B(12)) are involved in homocysteine metabolism and play an important role as coenzymes in 1-carbon metabolism, which is thought to have a critical role in the progression of colorectal polyps. The purpose of this study was to examine the effects of B-vitamins and homocysteine on the risk of developing colorectal polyps. Forty-eight participants with colorectal polyps [29 adenomatous polyps (AP), 19 hyperplastic polyps (HP)], and 96 age- and sex-matched healthy controls were recruited. Fasting blood was drawn from each participant to measure hematological parameters, plasma pyridoxal 5'-phosphate (PLP), serum folate and vitamin B(12), and plasma homocysteine. Participants with AP and HP had significantly higher plasma homocysteine levels than did healthy controls. There was no significant difference in serum folate and vitamin B(12) and plasma PLP among the 3 groups. B-vitamins had no significant effect on the risk of colorectal polyps. However, participants with higher plasma homocysteine [odds ratio (OR) = 1.87, 95% confidence interval (CI) = 1.13, 3.08) level exhibited significantly increased risk of colorectal polyps after adjusting for potential confounders. Plasma homocysteine was a strong predictor of the risk of colorectal polyps in participants with adequate B-vitamins status.

Mental illness disclosure in Chinese immigrant communities.

Support from social networks is imperative to mental health recovery of persons with mental illness. However, disclosing mental illness may damage a person's participation in networks due to mental illness stigma, especially in Chinese immigrant communities where social networks (the guanxi network) have specific social-cultural significance. This study focused on mental illness disclosure in Chinese immigrant communities in New York City. Fifty-three Chinese psychiatric patients were recruited consecutively from 2 Chinese bilingual psychiatric inpatient units from 2006 to 2010. Two bilingual psychologists interviewed each participant once in a semistructured interview, including 6 questions on mental illness disclosure. Conventional content analysis was applied to conceptualize the phenomenon. Results showed that participants voluntarily disclosed to a circle of people composed primarily of family and relatives. The decisions and strategies to disclose depended on participants' consideration of 3 critical elements of social relationships. Ganqing, affection associated with relationship building, ultimately determined who had the privilege to know. Renqing, the moral code of reciprocal kindness, further influenced disclosure decisions and what participants anticipated as responses to disclosure. Lastly, concerns over preserving face (lian), a construct representing personal and familial dignity, oftentimes prohibited disclosure. Additionally, in this tight-knit network, involuntary disclosure could happen without participants' permission or knowledge. Participants commonly suffered from stigma after disclosure. However, half of our participants reported situations in which they experienced little discriminatory treatment, and some experienced support and care as a result of cultural dynamics. Recommendations for culturally sensitive practice to facilitate mental illness disclosure among Chinese immigrants were discussed.

A working relationship model that reduces homelessness among people with mental illness.

We applied grounded theory methodology to generate a working relationship model that influences motivation for stable housing among homeless people with serious mental illness, to understand the role of a working relationship in critical service transitions. We focused on practitioners' perspectives and practices in Critical Time Intervention (CTI), a community intervention aimed to reduce homelessness through providing support during the transition from institutional to community living. We found a working relationship that highlighted "nonauthoritative" and "humanistic" features. Workers respected client autonomy and maintained flexibility in the format of client contact and service activities. They used practice strategies including following client leads and informal relating approaches to facilitate the development of client trust. The trusting relationship enhanced client interest in obtaining housing and the commitment to the transformation crucial for retaining housing. We discuss the significance of the relationship and ethical considerations of relationship-building activities in community mental health practices.

Discharge practices in a time-unlimited intervention: the perspectives of practitioners in assertive community treatment.

The Assertive Community Treatment (ACT) model for people with severe mental illness has typically been viewed as a time-unlimited intervention. Without a proscribed service duration, discharge from ACT largely depends on individual clients' situations and practitioners' discretion. We conducted semi-structured focus groups and interviews with practitioners to explore their discharge practices and considerations. Results highlight the heterogeneity of the clientele served in ACT, and therefore the importance of individualized treatment and discharge planning, guidance on assessing the timing of discharge for individual cases, practice strategies that balance independence and social connectedness to promote recovery, and the need for substantial system reform to facilitate transition after discharge.

Family social networks and personal recovery among Chinese people with mental illness in Hong Kong: The mediating effects of self-esteem and self-efficacy.

OBJECTIVE: This study investigated the mediating roles of self-esteem and self-efficacy on the relationship between family social networks and personal recovery among Chinese people with mental illness in Hong Kong. METHODS: One hundred and twenty-five Chinese adults with mental illness from community mental health centers in Hong Kong were recruited for this study. Data were collected using a structured questionnaire. RESULTS: Study results indicated that a large family network size was indirectly related to high levels of personal recovery through high self-efficacy. High perceived family support was directly related to high levels of personal recovery. In addition, high family criticalness was related to low levels of personal recovery directly and indirectly through low self-esteem. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings suggest that using a family approach to enhance individuals' self-esteem and self-efficacy might promote personal recovery among people with mental illness in the Chinese context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assisting adults with severe mental illness in transitioning from parental homes to independent living.

This study explores mental health professionals' practices with adult clients and their parents at the departure of the clients' transition from the parental home to independent living. Using grounded theory methodology, the author interviewed 24 case managers in Assertive Community Treatment programs in Wisconsin and applied dimensional analysis to identify and categorize concepts in verbatim transcripts. Different client-parent relationships were sampled to compare practices on client independent living. Results show that case managers considered client independent living a desirable social norm and a practical approach to addressing long-term care concerns. Based on the status of parental approval of independent living, case managers applied various strategies to foster helpful parental emotional boundaries with clients in order to facilitate client independence. The author discussed implications for practice and suggested future research on clients' and parents' perspectives on independent living and the short-term and long-term effects of the transition on their well-being.

Staff views on member participation in a mental health clubhouse.

The clubhouse model is a community psychiatric rehabilitation program aiming to provide a restorative environment for people with severe mental health problems. These clubhouses provide their members with opportunities for friendship, employment, and education, which help them on their paths towards mental health recovery. Towards that end, the model features clubhouse members and staff working side by side to execute clubhouse activities. That is, unlike most of the community mental health programs where staff provide services to their clients, clubhouse staff are required to partner with members in their work. The aim of this qualitative study was to understand how the clubhouse staff elicited member participation and facilitate recovery. The research was conducted between Year 2013 and Year 2014 at the world's first clubhouse: Fountain House in New York City. The first author conducted 262 hr of active participant observation in 41 visits to Fountain House, and in-depth interviews with 38 staff members who had worked at Fountain House for at least 1 month during the study period. The dimensional analysis procedure was used to analyse the observation notes and interview transcripts. Results showed that participation was a key to rebuilding members' self-confidence, which further encouraged members to seek more opportunities for self-enhancement and personal growth. Specific organisational policies, programming, practical considerations, and other strategies shaped a positive environment for members to exercise autonomy, experience self-efficacy, and model behaviours after others who have succeeded. Findings of this research support the egalitarian staff-member relationships and the maintenance of an open and transparent atmosphere of the clubhouse, as observational learning enables members to move forward with their journeys to recovery. Findings also may inform efforts to shift traditional psychiatric services towards recovery-oriented care.

A fine line to walk: case managers' perspectives on sharing information with families.

In the United States, sharing information with families in health care involves competing demands between clients' rights to confidentiality and families' wishes to know. In this article, I explore how community mental health providers share information with families of clients with severe mental illness. I interviewed 24 case managers in assertive community treatment programs. Results show that case managers share information with families to attain treatment goals rather than to support families in providing care. Case managers respect clients' confidentiality and do not release information without client consent. However, the absence of client consent posts an ethical dilemma when families provide helpful information for clients' treatment. Case managers find themselves walking a fine line between adhering to confidentiality guidelines and working for the clients' best interests. The findings suggest the need to expand confidentiality laws to the exchange of information and to develop guidelines for working with families in community settings.

Working with families in Assertive Community Treatment (ACT): the case manager's perspective.

In response to research findings of insufficient family involvement in mental health services for people with severe mental illness, this grounded theory study examines case managers' interactions with families of clients in Assertive Community Treatment (ACT). Findings suggest that case managers conceptualize families as sources of social connections, rather than sources of care, for clients. This conceptualization is influenced by case managers' goals, which also guide their assessments of families for involvement in treatment in terms of the extent to which families help attain treatment goals. In developing strategies to work with families, case managers engage in ongoing assessments and consider client permission for family involvement in treatment, family availability to clients, and family wishes for involvement in treatment. Three case examples illustrate the relationships among case managers' goals, assessments of families, and selections of work strategies. The potential role of the ACT model in shaping this particular view on families is also discussed.

A comfortable relationship: a patient-derived dimension of ongoing care.

BACKGROUND AND OBJECTIVES: Continuity of care is considered essential to primary care and improves health outcomes. However, it is unclear whether patients and physicians define this concept similarly. This study examined how patients perceive a continuity relationship, from its development through its consequences. METHODS: This was a qualitative study using grounded theory methodology. Researchers selected and interviewed a purposeful sample of 14 primary care patients. Audiotapes of the interviews were transcribed and analyzed using open, axial, and selective coding schemes. RESULTS: Although the majority of patients were not familiar with the phrase continuity of care, all patients in the study identified comfort with their doctor as important to establishing and maintaining an ongoing relationship. Comfort with a physician was developed in several ways. Patients described their level of comfort with a physician as influencing making and keeping appointments, the likelihood that they would discuss concerns about sensitive issues, their perception that medical problems were resolved faster, and their trust in the physician's treatment plan. CONCLUSIONS: For patients, comfort appears to be an important dimension of the physician-patient continuity relationship. Primary care physicians and researchers should further explore how to use patient comfort as an element of care.

FADS Gene Polymorphisms, Fatty Acid Desaturase Activities, and HDL-C in Type 2 Diabetes.

Polyunsaturated fatty acids (PUFA) correlate with risk of dyslipidemia and cardiovascular diseases. Fatty acid desaturase (FADS) single nucleotide polymorphisms (SNPs) modulate circulating PUFA concentrations. This study examined influence of FADS1 and FADS2 genetic variants on desaturase activities and blood lipid concentrations in type 2 diabetes patients, and further assessed their interrelationships. Selected SNPs (FADS1: rs174547, rs174548, rs174550; FADS2: rs174575, rs174576, rs174583, rs498793 and rs2727270) were genotyped in 820 type 2 diabetes patients and compared with those reported in the HapMap. Patient subgroups (n = 176) without taking lipid-lowering medicine were studied to assess influence of tag SNPs including rs174547, rs174575, rs498793 and rs2727270 on delta-5 desaturase (D5D: 20:4 (n-6)/20:3 (n-6)) and delta-6 desaturase (D6D:18:3 (n-6)/18:2 (n-6)) activities, and blood lipids. FADS1 rs174547 TT/TC/CC and FADS2 rs2727270 CC/CT/TT were significantly (p for trend < 0.05) associated with reduced HDL-C, D5D and D6D activities. Upon adjustment for confounders, D5D (p = 0.006) correlated significantly and D6D marginally (p = 0.07) correlated with increased HDL-C levels, whereas rs174547 and rs2727270 polymorphisms were not associated. D6D andD5D activities may play a role in modulating HDL-C levels in type 2 diabetes. Future studies with larger sample sizes are needed to investigate how FADS genetic variations interact with desaturase activities or PUFAs in the metabolism of lipoproteins in diabetic patients.

Sociocultural Factors Associated with Caregiver-Psychiatrist Relationship in Taiwan.

OBJECTIVE: Research on sociocultural factors associated caregiver-provider relationship is needed to enhance family involvement in psychiatric care. This study examines from the caregiver's perspective the associations of schizophrenia attributions, stigmatization, and caregiving experiences with caregiver-psychiatrist working relationship in Taiwan. METHODS: This cross-sectional study used a convenience sample of 152 Taiwanese family caregivers of persons diagnosed with schizophrenia, recruited from a grassroots organization, 4 community mental health rehabilitation centers and 2 psychiatric hospitals between July 2012 and March 2013. Multiple linear regression models were used for analysis. RESULTS: Biological attribution was positively associated with perceived family collaboration, and so was environmental attribution with perceived informational support. Internalized stigma was negatively associated with perceived family collaboration. Caregiving rewards were positively related to both perceived family collaboration and informational support, and so was experience of problems with services to perceived family collaboration. CONCLUSION: The examination of family perceptions informs Western psychiatric care providers of the importance of culturally sensitive practices in developing an effective working relationship with family caregivers, particularly in regards to caregivers' casual attributions, impact of stigma, and caregiving experiences.

Characterizing Factors of Employment Status in Persons With Major Depressive Disorder.

Employment is fundamental to mental health recovery. The aim of this study is to construct a parsimonious profile indicating employment potential of people with major depressive disorder (MDD) to facilitate clinical assessment on employment participation. Data were drawn from Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. We included participants who had MDD at Wave 1 and were interviewed in both waves (N = 2,864). We conducted Classification and Regression Tree (CART) analysis to identify key characterizing factors of Wave 2 employment among 32 Wave 1 risk and protective factors. The results show that 82.1% of those employed at Wave 1 were likely to be employed at Wave 2. Among those unemployed at Wave 1, 51% of those motivated to work, measured by work-seeking behavior in the prior year, were likely to be employed at Wave 2. Among those unemployed and motivated to work, better functional mental health was associated with employment (>25.3 vs. ≤25.3). Results highlight the importance of motivation to work, shown in active work seeking, in facilitating employment despite clinical conditions.

Pathway model of parental help seeking for adolescents experiencing first-episode psychosis.

AIM: Parents and caregivers are confronted with many challenges when caring for adolescents experiencing first-episode psychosis (FEP). Understanding and support for parental help-seeking process is essential for adolescents' timely access to treatment. The study aimed to develop a pathway model of parental help seeking for adolescents experiencing FEP and identify crucial time points for intervention. METHODS: Directed content analysis was conducted on semi-structured qualitative interviews of 16 parents whose children had experienced FEP and focused on parents' experiences prior to and during FEP until first hospitalization. RESULTS: The resultant parental help seeking for FEP model included two stages and six phases. The contemplation stage is composed of phases of initial awareness, recognizing severity and considering options. The action stage entailed help-seeking intention, securing help and service appraisal. All parents promptly began help seeking after recognizing severe symptoms and sought advice from professional and community supports, although parents' lack of initial awareness was common. Further analysis on individual parents' help-seeking trajectories showed that among the 50% parents who reported pre-existing childhood conditions, 87.5% did not report initial awareness of psychotic symptoms. CONCLUSIONS: Findings recommend intervention at three specific periods of help seeking. First, psychoeducation is needed when parents first engage with health care for their children's disabling conditions. Professionals treating childhood conditions need training to vigilantly monitor the overall mental health of the children over time. Second, it is important to enhance the roles of formal and informal community resources in facilitating parental help seeking. Finally, family-focused interventions are essential in supporting the family for securing needed treatment.