A Qualitative Study Into the Relative Stigmatization of Mental Illness by Mental Health Professionals.

Mental health professionals stigmatize mental illness, which has significant ramifications for public health and policy. Within this domain, there is a lack of comprehensive research on relative stigma, emotions, and behaviors and an absence of literature that can guide research on these topics. The current study sought to address these limitations. Unstructured interviews were conducted with 22 mental health professionals, and data were analyzed using a grounded theory approach. The current study identified a collection of mental disorders (e.g., borderline personality disorder), stereotypes (e.g., dangerousness), emotion-related responses (e.g., fear), and behaviors (e.g., helping) as being key to the relative stigmatization of mental illness by mental health professionals. The results also suggested that professional context and familiarity with mental illness decrease the stigmatization of mental illness by mental health professionals. These variables and constructs were combined to form a grounded theory of mental health professionals stigmatizing mental illness. The current study has implications for the direction of future research on the stigmatization of mental illness by mental health professionals and interventions that strive to mitigate this type of stigmatization.

Impairments in Physiological Reactivity to Emotive Stimuli After Traumatic Brain Injury: A Systematic Review of Skin Conductance and Heart Rate Variability Evidence.

OBJECTIVE: To examine evidence of impairments in physiological reactivity to emotive stimuli following traumatic brain injury (TBI). METHODS: A search of PsychINFO, CINAHL (Cumulative Index to Allied Health Literature), Web of Science, EMBASE (Excerpta Medica dataBASE), and Scopus databases was conducted from 1991 to June 24, 2021, for studies comparing changes in skin conductance or heart rate variability to emotive stimuli between adults with TBI and controls. Two reviewers independently assessed eligibility and rated methodological quality. RESULTS: Twelve eligible studies examined physiological reactivity to laboratory-based emotive stimuli, which included nonpersonal pictures/videos, posed emotion, stressful events, and personal event recall. Overall, 9 reported evidence that individuals with TBI experience lower physiological reactivity to emotive stimuli compared with healthy controls, although the findings varied according to the type and valence of emotional stimuli and physiological parameter. Most studies using nonpersonal pictures or videos found evidence of lower physiological reactivity in TBI participants compared with controls. CONCLUSIONS: Based on laboratory-based studies, individuals with TBI may experience lower physiological reactivity to emotive stimuli. Further research is needed to investigate physiological responses to personally relevant emotional stimuli in real-world settings and to understand the interplay between physiological reactivity, subjective experiences, and behavior.

Telehealth use by mental health professionals during COVID-19.

OBJECTIVE: To examine and describe telehealth use and attitudes among mental health professionals in Australia and New Zealand during the initial stages of the COVID-19 pandemic. METHODS: Participants completed a brief online survey between May and July 2020. Participants were recruited via peak and professional organisations and through psychology-focused social media groups and networks. The survey examined frequency of telehealth use, reasons for non-use, telehealth modalities, prior use, attitudes towards use, plans for future use, and training, information or resource needs. RESULTS: A total of 528 professionals (85.2% female) participated in the survey, of which 98.9% reported using telehealth and 32.2% reported using telehealth exclusively. Respondents were less likely to use telehealth if they worked with clients experiencing complex issues (e.g. trauma), had more hours of weekly client contact, had a choice about whether to use telehealth or felt less positive about using technology. Respondents were more likely to hold positive views towards telehealth if they were female, had used online programmes with clients previously, were frequent telehealth users and were comfortable using technology. Participants expressed mixed views on client safety and the impact of telehealth on therapeutic process and effectiveness. CONCLUSION: Telehealth has a clear and ongoing role within mental healthcare and there is a need for strong guidance for professionals on how to manage client risk, privacy, security and adapt therapy for delivery via telehealth. In particular, there is a need for individual-, organisational-, professional- and policy-level responses to ensure that telehealth remains a viable and effective healthcare medium into the future.

Understanding client engagement in digital mental health interventions: An investigation of the eTherapy Attitudes and Process Questionnaire.

AIMS: Digital mental health services may increase the accessibility and affordability of mental health treatments. However, client dropout a low use is often reported. The purpose of the current study was to investigate the structural validity of the e-Therapy Attitudes and Process (eTAP) questionnaire, as a theoretically based (theory of planned behavior) tool for understanding ongoing client engagement intentions with digital mental health treatments. The possible role of eHealth literacy in predicting behavioral intentions to use digital mental health treatments was also examined. METHODS: Participants were 244 Australian-based adults aged between 18 and 56 years, who were currently using a digital mental health tool. Data were collected via online survey. RESULTS: Confirmatory Factor Analysis was conducted, with good model fit obtained following two theoretically supported modifications. Moderated hierarchical regression supported the utility of the theory of planned behavior in predicting behavioral intentions, with attitudes emerging as a strong and consistent individual predictor. No support was found for the moderating role or individual significance of eHealth literacy. CONCLUSIONS: These findings support the clinical and research use of the eTAP as a theory-based measure to understand client engagement in digital mental health interventions. The study also highlights the need for interventions to target attitudes to improve clients' ongoing engagement in digital mental health.

Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals.

Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusions: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.

Development of a measure of stigma towards occupational stress for mental health professionals.

PURPOSE: Stigma is a common barrier to mental health professionals (MHPs) seeking help for occupational stress and burnout, although there is a lack of psychometrically sound tools to measure this construct. The current study aimed to develop and validate a scale (the Mental Health Professional Stigma Scale; MHPSS) for this purpose. METHODS: The MHPSS and related measures were completed by 221 Australian MHPs via online survey, with a subsample completing the MHPSS again 2 weeks after initial completion. RESULTS: Exploratory factor analysis revealed a four-factor solution, comprising of 13 items and accounting for 50.16% of variance. Factors were Perceived Other Stigma, Perceived Structural Stigma, Personal Stigma, and Self stigma. The internal consistency, test-retest reliability, and validity of the scale were supported. CONCLUSIONS: The MHPSS has utility to capture stigmatising attitudes and beliefs related to occupational stress and burnout among MHPs. It may be used to assist in the development and evaluation of initiatives to reduce stigma and increase help-seeking among MHPs.

Stressors and protective factors among regional and metropolitan Australian medical doctors: A mixed methods investigation.

OBJECTIVE: This study aimed to compare stress, burnout, stressors, and protective factors among regional- and metropolitan-based Australian medical doctors. METHOD: A mixed methods design was utilized with 252 Australian medical doctors completing an online questionnaire package. A subsample also completed qualitative interviews. RESULTS: Stress was significantly higher among doctors compared with population norms. Over half of doctors reported burnout on one or more dimensions. The strongest unique predictors were being female, working late, and work-family conflict. Qualitatively, 12 stressors (e.g., training and competition, workload, and time management) and 9 protective subthemes (e.g., being well resourced, clinical interest) emerged across system-level, clinical environment-level, and individual factor and personal response themes. CONCLUSIONS: Stress and burnout among doctors are alarmingly high and both system/organization-level (e.g., communication systems, workload, flexible work arrangements) and individual-level (e.g., fostering resilience/coping strategies) predictors are implicated by our results. These may be useful targets for future interventions.

Exploring scale validity and measurement invariance of the Toronto Mindfulness Scale across levels of meditation experience and proficiency.

OBJECTIVES: The Toronto Mindfulness Scale (TMS) is a widely used instrument of state mindfulness. Research suggests the interpretation and functioning of mindfulness scale items may differ as a function of meditation experience, and thus, establishing invariance across experience levels is essential. METHODS: Five hundred and five meditation practitioners (32.7% male, 33.3% female, and 34.1% unspecified) with an average age of 42.37 years (SD = 12.70) completed the TMS online. RESULTS: Results support at least partial invariance across subgroups based on years of mindfulness meditation experience and self-reported proficiency. Construct validity of the Decentering subscale was also supported; however, the Curiosity subscale did not meet validity expectations, as it required additional model modifications to yield good fit, and means were not sensitive to differences in group experience or proficiency. CONCLUSIONS: Our findings suggest further review of the TMS Curiosity items may be warranted to determine its suitability for use within mindfulness assessment.

What prevents doctors from seeking help for stress and burnout? A mixed-methods investigation among metropolitan and regional-based australian doctors.

OBJECTIVE: Despite the increased risk of experiencing mental health concerns, particularly related to stress and burnout, psychological help-seeking among medical doctors is typically low. This study examined the barriers to treatment experienced by doctors for stress and burnout-related difficulties. METHODS: A mixed-methods design was adopted. The quantitative sample comprised 274 Australian-based medical doctors. Qualitative interviews were conducted with a subsample of 20 (11 regional and 9 metropolitans) doctors. For triangulation, five stakeholder interviews were also conducted with representatives of the profession. RESULTS: Time was the greatest barrier to treatment. Qualitatively, doctors identified barriers such as stigma and fear of professional consequences, and particularly among regional doctors, access to services and professional culture. CONCLUSIONS: There is a need for tailored strategies to address barriers to psychological treatment among doctors for improving service access and mental health.

Not quite city and not quite rural: Active lifestyle beliefs in peri-urban Australians.

ISSUE ADDRESSED: Residents of peri-urban Australia face health inequalities compared to city dwellers. Active lifestyles provide many benefits that could improve the health of this population; however, peri-urban Australians are more likely to be inactive and sedentary. The aim of this study was to identify the physical activity and sedentary behaviour-related beliefs of peri-urban Australians. METHODS: Semi-structured interviews were undertaken with adult residents of peri-urban, southern Queensland. Participants (N = 8) were recruited from a related study, purposefully selected to ensure diversity. Data were analysed by thematic analysis. Interviews were conducted until data and inductive-thematic saturation were reached. RESULTS: Three themes were identified, representing beliefs about intrapersonal, interpersonal/socio-cultural and physical environmental factors relevant to active lifestyles among peri-urban Australians. Active lifestyle behaviours were perceived as beneficial for health. Social interaction was described as an important outcome of physical activity. Features of the physical environment negatively impacted the perceived difficulty of performing physical activity and avoiding sedentary behaviour. CONCLUSIONS: Active lifestyle strategies that support social interaction through physical activity and participation in sports may be particularly useful in peri-urban environments where opportunities for social interaction are limited. Such strategies should also take into account contextual factors that negatively impact active lifestyle control beliefs (eg, distance). SO WHAT?: This study provides insight into factors that may influence the active lifestyles of peri-urban Australians. This information can be used to develop contextually relevant strategies designed to encourage physical activity, discourage sedentary behaviour and assist to relieve health disparities faced by this population.