Examining the concept of equity in community psychology with natural language processing.

Large amounts of text-based data, like study abstracts, often go unanalyzed because the task is laborious. Natural language processing (NLP) uses computer-based algorithms not traditionally implemented in community psychology to effectively and efficiently process text. These methods include examining the frequency of words and phrases, the clustering of topics, and the interrelationships of words. This article applied NLP to explore the concept of equity in community psychology. The COVID-19 crisis has made pre-existing health equity gaps even more salient. Community psychology has a specific interest in working with organizations, systems, and communities to address social determinants that perpetuate inequities by refocusing interventions around achieving health and wellness for all. This article examines how community psychology has discussed equity thus far to identify strengths and gaps for future research and practice. The results showed the prominence of community-based participatory research and the diversity of settings researchers work in. However, the total number of abstracts with equity concepts was lower than expected, which suggests there is a need for a continued focus on equity.

The international initiatives of the collaboration between the Aristotle University of Thessaloniki School of Medicine, the Panhellenic Medical Association and the World Psychiatric Association, concerning mental health during the COVID-19 outbreak.

During the coronavirus disease 2019 (COVID-19) pandemic, all European countries were hit, but mortality rates were heterogenous, with some countries being hit very hard, while others including Greece had a much lower death rate during the first wave of spring 2020. The ultra-fast application of measures was probably the reason of this outstanding success. This outbreak is expected to trigger feelings of fear, worry, and stress, as responses to an extreme threat for the community and the individual. In addition, changes in social behavior, as well as in working conditions, daily habits and routine, are expected to impose further stress, especially with the expectation of an upcoming economic crisis and possible unemployment. In Greece, where the lockdown was extremely successful in terms of containing the outbreak, worries concerning the possible adverse effects on mental health were also predominant. A collaboration concerning mental health during the COVID-19 outbreak was established, between the Aristotle University School of Medicine, the Panhellenic Medical Association and the World Psychiatric Association. Two large multinational studies were launched, one concerning the general population and one university students. Students' mental health is an area of special interest, both because of the vulnerability of this age group as well as because any disruption during the time of the studies has profound long-term consequences in the lives of the individuals, and this might trigger feelings of fear, worry, and stress. According the results from the Greek arm of the students' study, during the lockdown, two-thirds of university students reported at least 'much' increase in anxiety, one third in depressive feelings and in 2.59% concerning suicidal thoughts. There was also a worsening of quality of life and deterioration of lifestyle issues. Major depression was present in 12.43% with an additional 13.46% experiencing severe distress. Beliefs in conspiracy theories enjoyed wide acceptance ranging from 20-68%, with students of law, literature, pedagogics, political sciences and related studies manifesting higher acceptance rates. Female sex and depression/dysphoria both independently but also in interaction were related to higher rates of such beliefs. The results of the Greek arm of the general population study suggested that during the lockdown, clinical depression was present in 9.31%, with an additional 8.5% experiencing severe distress. Increased anxious and depressive emotions (including subclinical cases) were present in more than 40% of the population. In persons with a previous history of depression, 23.31% experienced depression vs. 8.96% of cases without previous history, who were experiencing their first depressive episode. Family dynamics suggested that fewer conflicts and better quality of relationships were surprisingly related to higher anxiety and depressive emotions, higher rates of depression and distress, and greater rates of suicidal thoughts. Eventually, spiritual and religious affiliation could protect the individual from the emerging suicidal thoughts. As correlation does not imply causation, the results suggest that conspiracy theories could be either the cause of depression or on the contrary a coping mechanism against depression. After taking into consideration that also in the family environment the expression of anger seemed to be a protective factor, the most likely explanation could be that the beliefs in conspiracy theories are a coping and 'protective' mechanism against the emergence of depression. These studies were among the first published, they went deeper in the data collection and even led to the creation of a model with distinct stages for the development of mental disorders during the lockdown. The analysis of the international data will probably provide further insight into the prevalence of mental disorders and the universal but also culturally specific models and factors pertaining to their development. At the time this editorial was in press, more than 40 countries representing more than two thirds of earth's population were participating with more than 45,000 responses already gathered.

Impact of a community-delivered parenting curriculum on perceived parenting stress and parent-reported outcomes in a low-income diverse population.

INTRODUCTION: There is a need for effective, strengths-based parenting supports for diverse parent populations. We conducted a quasi-experimental study to investigate whether a 12-week parenting program delivered in the community decreases perceived parenting stress and improves parent-reported outcomes. METHOD: Parents in the intervention group participated in Parenting Journey, a curriculum designed to increase resilience and support nurturing family relationships. Parents who were eligible for Parenting Journey but did not enroll were included in the concurrent comparison group. Participants completed the Parenting Stress Index and the Parenting Journey Survey at baseline and follow-up. We conducted bivariate and multivariate analyses to evaluate differences between groups. RESULTS: We enrolled 244 parents, 123 in the intervention group and 121 in the comparison group. The majority of participants in the intervention and comparison groups were female, identified as Black or Latino, and reported an annual household income of less than $20,000. At baseline, intervention participants reported higher total parenting stress than comparison participants (mean percentile 70.7 vs. 55.8, p = .002). At follow-up, intervention participants' mean total parenting stress score decreased by 14.1 points, while comparison participants' score increased by 3.0 points (difference-in-difference p < .0001). Intervention participants were significantly more likely to demonstrate improvement in 4 or more of the 7 constructs measured by the Parenting Journey Survey (adjusted OR = 2.2, 95% CI [1.2, 4.1], p = .01). DISCUSSION: Participation in Parenting Journey is associated with decreased perceived parenting stress and improvement in parent-reported outcomes. Future work should evaluate the longitudinal impact on parental mental health and child socioemotional development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Symposium summary on "Community Psychiatry and DMHP-An update".

This summary provides details of a one-day symposium, titled 'Community Psychiatry and District Mental Health Program (DMHP)- An update' that was organized jointly by the Departments of Psychiatry and Epidemiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru in collaboration with the Department of Health and Family Welfare, Government of Karnataka on September 3rd 2018. This symposium was supported by Dr. Ramachandra N Moorthy, foundation for Mental Health and Neurological Sciences, NIMHANS, Bengaluru.

A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists.

We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.

Conduct problems trajectories and psychosocial outcomes: a systematic review and meta-analysis.

There is increasing evidence that youth who follow the early onset persistent (EOP), adolescent-onset (AO) and childhood-limited (CL) trajectories of conduct problems show varying patterns of health, mental health, educational, and social outcomes in adulthood. However, there has been no systematic review and meta-analysis on outcomes associated with different conduct problems trajectories. We systematically reviewed the literature of longitudinal studies considering outcomes of three conduct problems trajectories: EOP, AO, and CL compared with individuals with low levels of conduct problems (low). We performed a series of meta-analyses comparing each trajectory to the low group for eight different outcomes in early adulthood or later. Thirteen studies met our inclusion criteria. Outcomes were mental health (depression), cannabis use, alcohol use, self-reported aggression, official records of antisocial behaviour, poor general health, poor education, and poor employment. Overall, EOP individuals showed significant higher risk of poor outcome followed by AO individuals, CL individuals, and finally participants in the low group. All conduct problems trajectories showed higher risk of poor psychosocial outcomes compared to the low group, but the magnitude of risk differed across trajectories, with a general trend for the EOP to perform significantly worse, followed by the AO and CL. Early intervention is recommended across domains to maximise likelihood of desistance from antisocial behaviour and improvement on several psychosocial outcomes.

Physical health promotion in patients with functional psychoses receiving community psychiatric services: Results of the PHYSICO-DSM-VR study.

OBJECTIVES: Psychotic patients have poorer health behaviours, including poor diets and sedentary lifestyles increasing their risk for obesity, diabetes, hypertension, and dyslipidaemia, and tend to have a shorter life expectancy as compared to nonpsychiatric populations. Lifestyle intervention programmes that target modifiable risk factors in such patients have produced uneven results. The objective was to evaluate the efficacy of a package of health promotion strategies to improve diet and physical exercise in psychotic patients. Our hypothesis was that a pre- to post-treatment improvement in physical activity and dietary habits would occur in the group receiving intervention. METHOD: This randomised controlled trial was carried out in four psychiatric services. The intervention included psychoeducation sessions on diet and physical activity and regular participation in walking groups (experimental group). The control group received routine treatment. The primary outcome was an improvement of at least one World Health Organization recommendation on diet and exercise. RESULTS: Of a total of 326 subjects recruited, 169 were randomly assigned to the experimental group and 157 to the control group. An improvement in one or more World Health Organization criteria over baseline was observed in 25.4% of experimental group subjects and in 12.2% of control group subjects (odds ratio 2.46, 95% confidence interval 1.22-4.97; p=0.01). CONCLUSIONS: A statistically significant proportion of the sample achieved post-treatment improvement in lifestyle habits, especially as regarded increased physical activity. A post-intervention reduction in lifestyle variability was also noted. Interventions directly addressing dietary habits may be desirable in psychotic patients.

O potencial terapêutico de uma oficina no território: autonomia e noção de pertença / El potencial terapéutico de un taller en el territorio: la autonomía y el sentido de pertinência / The therapeutic potential of a workshop in the territory: autonomy and sense of belonging

Objective: This study describes the therapeutic potential of a workshop in the territory for users of the Psychosocial Care Center and discuss the proposed therapy workshop and user interaction with the territory. Methods: Descriptive and exploratory research. The data resulted from participant observation and interviews as two coordinators. Thematic kind of content analysis was used for data processing. Results: As a result we obtained two thematic categories: Pool and the territory, and Benefits of a Pool Workshop. Conclusion: The workshop held in the territory allows the user to see himself/herself as part of it and also reframe the ways of living in that territory. The notion of belonging, social acceptance and citizenship are keys in building the social subject.

Objetivo: Descrever o potencial terapêutico de uma oficina no território para os usuários de saúde mental e discutir a proposta terapêutica da oficina e a interação dos usuários com o território. Método: Trata-se de estudo descritivo-exploratório. Os dados resultaram da observação participante e das entrevistas com os coordenadores, sendo utilizada a Análise de Conteúdo do tipo Temática para o tratamento dos dados. Resultados: Apresentaram-se duas categorias temáticas: Piscina e o território; e Os benefícios da Oficina de Piscina. Conclusão: A oficina realizada no território permite que o usuário se perceba parte dele e, ainda, ressignificar as formas de viver naquele território, bem como a noção de pertença, de aceitação social e cidadania que são fundamentais na construção do sujeito social.

Objetivo: El presente estudio describe el potencial terapéutico de un taller en el territorio, para los usuarios del Centro de Atención Psicosocial y discutir el taller de terapia propuesta y la interacción del usuario con el territorio. Método: La investigación descriptiva y exploratoria. Los datos de resultado de la observación participante y entrevistas como dos coordinadores. Tipo temático de análisis de contenido fue utilizado para el procesamiento de datos. Resultados: Como resultado se obtuvieron dos categorías temáticas: Piscina y el territorio; y Privilegios taller. El taller realizado en el territorio permite que el usuario se da cuenta parte de ella y también replantear las formas de vivir en ese territorio. Conclusión: La noción de pertenencia, aceptación social y la ciudadanía son clave en la construcción del sujeto social.

Community versus clinical cognitive-behavioral intervention in young-adult Spanish population with generalized social phobia / Intervención cognitivo-conductual comunitaria versus intervención clínica en jóvenes adultos españoles con fobia social generalizada

Ei objetivo del estudio es mejorar los resultados informados por las revisiones sobre el tratamiento de adultos con Fobia social generalizada. La muestra la integraron 91 participantes con Fobia social generalizada (EM: 19.90 años; DT: 1.05) asignados aleatoriamente a tres condiciones experimentales, evaluados antes y después del tratamiento, y a los 6, 12, y 24 meses en los grupos tratados. Los resultados muestran (a) la efectividad de la detección en el contexto comunitario versus la intervención clínica, en el corto y medio plazo, y (b) una mejora significativa de los efectos del tratamiento, frente a los de las revisiones de las intervenciones clínicas ad hoc, tanto en los abandonos como en las tasas de recuperación. Ello permite concluir que esta modalidad de aplicación del tratamiento cognitivo-conductual puede ser una estrategia complementaria a la convencional con la que mejorar los resultados actuales de la intervención psicológica en este trastorno.

The study investigates how to improve the results reported by the reviews on the effects of clinical interventions in adults with Generalized social phobia. The sample was composed of 91 participants (median age = 19.90 years, SD = 1.05) randomly assigned to three experimental conditions. The evaluations were conducted before and after treatment in all three groups and at 6-, 12-, and 24-month follow-up for the treatment groups. The results show (a) the effectiveness of the cognitive-behavioral strategy of detection and intervention, in a community context, versus clinical intervention both for the short and medium term; and (b) a significant improvement over the percentages of dropouts and of rates of complete recovery from the disorder. These findings allow us to conclude that the cognitive-behavioral strategy of detection and intervention, in a community context is shown to be a complementary intervention to the conventional and with high efficiency ratios.

Psychiatrist-determined suitability of patients on long-acting injectable antipsychotics to be discharged from specialist to primary care.

OBJECTIVE: We aim to determine psychiatrists' identified factors associated with suitability of discharging patients on long-acting injectable antipsychotics (LAI) from specialist to primary care. METHOD: We undertook a retrospective observational study utilising case file reviews. A questionnaire was developed specifically for this including sociodemographic information, clinical characteristics of the patients and clinical opinion on suitability of discharge to primary care. RESULTS: In total, 72 case files (51 men, 21 women) were included in the study. The most common diagnosis was schizophrenia (71%) and Risperidone was the most often used LAI (71%). Fourteen (19%) of the patients were deemed suitable for discharge to primary care. A minimum period of 1 year of stability, having good cognitive function and insight, and absence of high-risk history were associated with suitability for discharge. CONCLUSIONS: Treating psychiatrists consider only a minority of patients on long-acting injection antipsychotics as suitable for discharge to primary care.

[Group psychoeducational intervention in relatives of patients suffering from schizophrenia].

The present research paper aims at assessing the effectiveness of a psychoeducational intervention in relatives' groups of patients with schizophrenia or schizoaffective disorder. It examines the possible influence of the intervention on family members as well as on the course of the patient illness. Of a total of 131 relatives, 83 consisted the experimental group and 48 the control group. The relatives of the experimental group were divided into 5 groups and attended 18 psychoeducational sessions. Their patients as well s the patients and the relatives of the control group attended no specific intervention and continued their routine care. The psychoeducational intervention included education about the illness, communication skills training and training in problem-solving. It combined educational and psychotherapeutic techniques. The psychometric tools administered were: The Family Burden Scale, The Family Rituals Scale, The General Health Questionnaire GHQ-28, the Center for Epidemiological studies - Depression Scale (CES-D), the Opinions about Mental Illness Scale OMI, two scales concerning the knowledge about the illness, two questionnaires concerning expectations and feedback about the group process and questionnaires regarding sociodemographic characteristics of the sample and information about the illness. The number of hospitalizations of patients (n=91) during the research year was investigated. An interaction between group and measurement was found. While patient hospitalizations of both research groups did not differ significantly at the year before the study with X2=0.54, p=0.46), they differed when measured a year after the intervention, where patients in the intervention group had statistically significant fewer hospitalizations compared to the patients in the control group (x2=4.58, significant at p=0.032). As to the "compliance" in the medication, two statistical tests were conducted, taking into consideration that "compliance" by patients starting with a "very good" one can't be improved, while by those beginning with poor compliance can't be worsened. In the first investigation, which involved patients with possibility of amelioration or deterioration of "compliance", an improvement of patients (n=12) in the intervention group was recorded. This finding is statistically significant (p=0.0005). The second statistical test included all patients who were giving as an initial reply for the 'compliance' any value below "very good". In the intervention group there were 32 patients, 14 of whom showed improved "compliance" during the research year. This change is statistically significant (p=0.0014). The findings verify that the participation of relatives in psychoeducational groups leads to statistically significant improvement in the course of patient illness, as evident by the reduction in hospitalization rates and the improvement in adherence to pharmacotherapy. The study shows that relatives' psychoeducation constitutes a useful tool in improving the course of illness and empowering the family. The widespread implementation of relatives' psychoeducation in Greece is both necessary and challenging.

Barriers to care and service satisfaction following homicide loss: associations with mental health outcomes.

Homicide survivors are at increased risk for mental health problems, including depression, posttraumatic stress disorder, and complicated grief. Therefore, improving access to community and mental health resources is critical for this population. The atuhors sought to examine barriers to accessing services and service satisfaction among 47 homicide survivors. Over half of the sample met criteria for a mental disorder, with depression being the most prevalent problem. Frequently endorsed barriers to care included financial barriers, inadequate information, and health-related problems. However, participants who engaged in services were generally satisfied with those services. Only depression was uniquely associated with worse overall service satisfaction.

Can small intensive case management teams be as effective as large teams?

In 2007, the Veterans Health Administration (VHA) implemented a program to deliver the full array of Assertive Community Treatment services in areas with low population density using teams with small staffs. VHA administrative data were used to compare treatment and outcomes of veterans who received services from teams with only two or three staff (N=805) and veterans served by teams with ten or more staff (N=861). After adjusting for baseline difference, smaller teams had statistically significantly less symptom improvement and smaller declines in suicidality indices but effect sizes were small and there were no differences on 11 other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small teams.

Care provision to prevent chronic disease by community mental health clinicians.

BACKGROUND: People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. PURPOSE: To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. METHODS: A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. RESULTS: Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. CONCLUSIONS: The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision.

Aproximación diagnóstica de psicopatía mediante instrumento autoinformado / A diagnose approach to psychopathy using a self-report instrument / Aproximação diagnóstica da psicopatia por meio do instrumento autoinformado

Introducción: Dada la relevancia clínica y social que tiene la psicopatía, resulta útil contar con instrumentos autoinformados para la aproximación diagnóstica a la psicopatía. Objetivos: Evaluar la congruencia interna y la validez convergente del Self Report of Psychopathy-Short Form. Material y métodos: Se evaluaron 208 personas condenadas, alojadas en el Centro de Cumplimiento Penal de la Provincia de Los Andes, Chile. Se utilizaron el SRP-III-SF, el PCL-R y la HCR-20. Resultados: La distribución de valores del SRP-III-SF tuvo una media de 61,6 y fue normal. El Coeficiente de Alfa de Cronbach para el total fue 0,8 y para los factores 1, 2, 3 y 4 fue 0,7, 0, 4, 0,7 y 0,5, respectivamente. La correlación del SRP-III-SF con el PCL-R fue 0,4 (p = 0,01) y con HCR 20, 0,5 (p < 0,001). El riesgo de diagnóstico de psicopatía con el PCL-R aumentó en forma lineal para cada cuartil de la distribución del SRP-SF. El área bajo la curva ROC fue 0,66 (p = 0,05; 95% IC 0,5; 0,8).

Introduction: Given the clinical and social relevance of psychopathy, it is desirable to have self-report instruments for a proper diagnostic approach. Objectives: Assess the internal congruence and convergent validity of the Self Report of Psychopathy Scale III-Short Form. Material and Methods: 208 convicts housed at the “Centro de Cumplimiento Penal” detention center in the Province of Los Andes, Chile, were evaluated using the SRP-III-SF, PCL-R, and HCR-20 schemes. Results: the SRP-III-SF distribution was normal, with a mean of 61.6. The Cronbach’s Alpha Coefficient for the total was 0.8, and 0.7, 0.4, 0.7 and 0.5 for the 1, 2, 3, and 4 factors respectively, while the correlations of SRP-III-SF with PCL-R and HCR 20 were, respectively, 0.4 (p = 0.01) and 0.5 (p < 0,001). The scores of the PCL-R diagnosed psychopathy were linearly higher for each quartile of the SRP-SF distribution. The area under the ROC curve was 0.66 (p = 0.05; 95% IC 0.5; 0.8).

Introdução: Dada a relevância clínica e social que tem a psicopatia, é útil contar com instrumentos autoinformados para a aproximação diagnóstica à psicopatia. Objetivos: Avaliar a congruência interna e a validez convergente do Self Report of Psychopathy-Short Form. Material e métodos: Avaliaram-se 208 pessoas condenadas, alojadas no Centro de Cumprimento Penal da Província dos Andes, Chile. SRP-III-SF, PCL-R e HCR-20 foram usados. Resultados: A distribuição dos valores do SRP-III-SF teve uma média de 61.6 e foi normal. O Coeficiente do Alfa de Cronbach para o total foi 0.8 e para os fatores 1, 2, 3 e 4 foi 0.7, 0.4, 0.7 e 0.5, respectivamente. A correlação do SRP-III-SF com PCL-R foi 0.4 (p = 0.01) e com HCR 20, 0.5 (p < 0.001). O risco do diagnóstico de psicopatia com o PCL-R aumentou em forma linear para cada quartil da distribuição do SRP-SF. A área sob a curva ROC foi 0.66 (p = 0.05; 95% IC 0.5; 0.8).

[Social space and support of people with chronic mental illness]. / Sozialraum und Unterstützung für Menschen mit chronisch psychischen Erkrankungen.

This article deals with the conceptional meaning of social space orientation in the field of community psychiatry. The author argues to distinguish between social space sensitivity in professional support and the concept of social space orientation. The purpose of participation and self-determination of the Rehabilitation Act (SGB IX) and the implementation of the Convention on the Rights of Persons with Disabilities require the integration of professional support services development in a local planning process.