Clinical and personal recovery for people with schizophrenia in China: prevalence and predictors.

BACKGROUND: Recovery from schizophrenia is a multidimensional construct that includes two categories: clinical recovery (symptomatic and functional remission) and personal recovery. AIMS: To investigate the overlap between clinical and personal recovery and identify correlates of each. METHODS: A cross-sectional study was conducted with 356 people living with schizophrenia and randomly selected from 12 communities in China. Clinical recovery was assessed using both the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Personal recovery was assessed using the 8-item Recovery Assessment Scale (RAS). Disability and quality of life were assessed using the WHODAS 2.0 and WHOQOL-BREF-2, respectively. RESULTS: Our results showed a recovery proportion of 36.52% for clinical recovery (66.57% for symptomatic remission and 40.73% for functional remission), and 17.42% for personal recovery. Only 8.99% of individuals achieved overall recovery (i.e. they met criteria for both clinical and personal recovery), and there was only a modest correlation (r = 0.26) between these two types of recovery. Overall recovery was only correlated with the quality of life (OR = 1.46, 95% CI: 1.05, 2.03), but there were various correlates for clinical recovery and personal recovery separately. CONCLUSIONS: Recovery from schizophrenia involves both clinical and personal recovery, but when examined in the same sample, personal recovery, and thus overall recovery, is less common, particularly among people with schizophrenia in China.

Depressive symptoms, anxiety symptoms, and their co-occurrence among people living with schizophrenia in China: Prevalence and correlates.

BACKGROUND: The current study examines the prevalence of depressive symptoms, anxiety symptoms, their occurrence, and key socio-demographic and clinical correlates among people living with schizophrenia. METHODS: A cross-sectional study was conducted on 390 schizophrenia individuals. Depressive and anxiety symptoms, patient symptoms, functioning, and disability were assessed using standard assessment tools. RESULTS: People living with schizophrenia had a prevalence of 40.51% for depressive symptoms, 29.74% for anxiety symptoms, and 26.41% for their co-occurrence. More symptoms (odds ratio [OR]: 1.04-1.06, 95% confidence interval [CI]: 1.01-1.10) and higher disability (OR: 1.06, 95% CI: 1.03-1.09) were associated with increased risk of depressive symptoms, anxiety symptoms, and their co-occurrence. In addition, having middle school or high school education (OR: 2.48-2.61, 95% CI: 1.15-5.53), and being unemployed (OR: 4.98-9.08, 95% CI: 1.09-69.87) were associated with increased risk for anxiety symptoms and its co-occurrence with depressive symptoms. CONCLUSIONS: Depressive and anxiety symptoms are relatively common. Interventions should carefully assess these symptoms to distinguish them from schizophrenia to target them in the treatment.

A comparison of psychometric properties of two common measures of caregiving burden: the family burden interview schedule (FBIS-24) and the Zarit caregiver burden interview (ZBI-22).

PURPOSE: The Family Burden Interview Schedule (FBIS-24) and the Zarit Caregiver Burden Interview (ZBI-22) are among the most widely used measures for assessing caregiving burden, but their psychometric performances have not been compared in the same study of caregivers of people living with schizophrenia (PLS). This is important because the measures assess overlapping constructs- the FBIS-24 assesses objective burden (e.g., completion of manual tasks) and the ZBI-22 assesses subjective burden (e.g., perceived distress, stigma). This study seeks to fill this gap by comparing the reliability and validity of the FBIS-24 and the ZBI-22 in a Chinese community sample of caregivers of PLS. METHODS: A Cross-sectional stud was conducted in a community-based mental health service program in Central South part of China. A total of 327 primary family caregivers of PLS completed face-to-face interviews of the FBIS-24, the ZBI-22, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR), and PLS were assessed using the Global Assessment of Function scale (GAF). RESULTS: Our findings show that both the FBIS-24 and ZBI-22 have comparable psychometric performance in terms of the internal consistency, convergent validity and known group's validity. CONCLUSION: Both the FBIS-24 and the ZBI-22 are psychometrically sound measures of caregiving burden but the choice of which measure to use will depend on the research question.

A cross-sectional study on spouse and parent differences in caregiving experiences of people living with schizophrenia in rural China.

BACKGROUND: Conflicting evidence exists on whether parent or spouse caregivers experience better outcomes when caring for family members with schizophrenia. The current study aims to examine relative caregiving experiences and impacts of spouse and parent caregivers for people living with schizophrenia (PLS) in China. METHODS: A cross-sectional study was conducted in a sample of 264 community-dwelling primary family caregivers of PLS. Face-to-face interviews were conducted to collect information on family caregiving activities; negative caregiving impacts including objective and subjective burden, and caregiver psychological distress such as depression and anxiety; positive caregiving impacts including caregiving rewarding feelings, and family functioning for spouse and parent caregivers. RESULTS: Both types of caregivers report engaging in similar caregiving activities and report comparable levels of objective burden. However, parent caregivers report significantly higher subjective burden than spouse caregivers (b = 7.94, 95%CI:2.08, 13.80, P < 0.01), which is also reflected in significantly higher depression (b = 3.88, 95%CI:1.35, 6.41, P < 0.01) and anxiety (b = 2.53, 95%CI: 0.22, 4.84, P < 0.05), and lower family functioning (b = - 1.71, 95%CI: - 2.73, - 0.49, P < 0.01). Despite these differences, both groups of caregivers report comparable rewarding feelings about caregiving. CONCLUSIONS: Our findings have implications for family caregivers globally, but especially for countries that adhere to Confucian cultural values and provide guidance for future family intervention programs. Such programs may do well to incorporate cultural values and beliefs in understanding caregiving and kinship family dynamics so as to support family caregivers, and in particular, the specific vulnerabilities of parent caregivers.

New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China.

BACKGROUND: The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China. OBJECTIVE: This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS. METHODS: We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching. RESULTS: The WeChat use rate was 40.8% in this sample (163/400); 30.7% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8%), professional support (82/163, 50.3%), and peer support (67/163, 41.1%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life. CONCLUSIONS: WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China.

Strengthening the Child- and Youth-Serving Workforce: Surveying the Landscape, Overcoming Challenges.

This special issue addresses a neglected but important topic in our field: strengthening the child- and youth-serving workforce. Investing in this workforce should be a national priority because considerable evidence has shown that investments in early childhood education and development, particularly in low-resource contexts, that are reinforced through skills-based programs in adolescence and adulthood, have beneficial impacts throughout life. Investing in quality child- and youth-serving programs also has the additional benefit of creating a productive and capable future workforce. The editors and authors of the special issue should be commended for producing the first special issue on this topic in our field or in related fields, one that is long overdue. Articles in this issue survey the landscape of an amorphous and complex area of practice and research and describe key challenges for the field. In this commentary, I offer organizing frameworks to characterize the child- and youth-serving workforce, note emerging issues when addressing specific challenges, and identify areas for future research.

Population Health and Trauma-Informed Practice: Implications for Programs, Systems, and Policies.

Population studies indicate that trauma exposure is ubiquitous and has a significant impact on health. Trauma-informed practice seeks to address the health consequences of trauma through integrative responses that incorporate an understanding of the effects of trauma, the multiple pathways to recovery, and the potential for re-traumatization. Current trauma-informed practice considers trauma exposure an individual clinical problem rather than a societal problem with population health consequences. Population health refers to the aggregated health status of individuals who share some characteristic, such as trauma exposure, and includes the study of determinants that shape the distribution of health outcomes in specific populations. In this paper, we describe a population health perspective for trauma-informed practice that complements the current clinical perspective, and then discuss implications of that perspective for programs, systems, and policies. We summarize essential concepts about trauma over the life course and describe principles of population health science relevant to trauma-informed practice. We then discuss implications of these principles by identifying four priorities for trauma-informed practice from a population health perspective: (a) adopting trauma-informed policies to prevent trauma exposure and to foster resilience in the aftermath of trauma; (b) infusing trauma-informed practice into everyday activities so it is a routine part of interpersonal transactions; (c) incorporating trauma-informed practices into existing service systems; and (d) adapting existing treatments to incorporate trauma-informed principles for population health impact.

A Community's Response to Adverse Childhood Experiences: Building a Resilient, Trauma-Informed Community.

Adverse childhood experiences, or ACEs, may be mitigated by trauma-informed social environments-programs, services, systems, communities-that offer responses to trauma that promote healing, recovery, and resilience. However, there is currently little empirical evidence to support the use of specific approaches to do so. Guided by a population health perspective, this paper describes a participatory community change process in response to ACEs that seeks to build a resilient, trauma-informed community in Pottstown, PA. We examine the initial implementation phase of this change process, centered originally on the education sector and the social and behavioral health services sector, and then eventually expanding to 14 community sectors across two years. A variety of data sources and methods are used to track individual and organizational processes, as well as service system network processes. A central feature of this research is the use of data to generate hypotheses rather than test them. Data were also used to guide understanding and decision-making during implementation. The results show that moving forward the community is well-positioned to establish stronger inter-agency and system supports for trauma-informed practice in the service system and in the broader community. We discuss results for their implications for building resilient, trauma-informed communities.

Collective Efficacy as a Key Context in Neighborhood Support for Urban Youth.

Neighborhood context, including the physical and social environment, has been implicated as important contributors to positive youth development. A transactional approach to neighborhood asserts that place and people are mutually constitutive; negative perceptions of place are intrinsically bound with negative portrayals of stigmatized groups, including youth. Adult perceptions of neighborhood youth may contribute to an increased sense of alienation and youth antisocial behavior. This study uses street-intercept interviews with adults (N = 408) to examine the relationship between neighborhood conditions and adult support for neighborhood youth. A path model was used to examine the direct and indirect relationship of neighborhood constructs (safety, aesthetic quality, and walkability) on adult support for neighborhood youth. Neighborhood aesthetic quality and the walking environment were directly associated with adult support for youth, whereas perceived safety was indirectly associated. Collective efficacy partially explained these relationships. Findings support theorized relationships between people and places; improvements to neighborhood physical environment may directly impact resident adults' perceptions of neighborhood young people.

Caseworker assessment of child risk and functioning and their relation to service use in the child welfare system.

Children within the child welfare system are more likely to experience emotional and behavioral problems than children not involved with the system. Many states have adopted standardized risk and assessment measures to inform decision-making on appropriate levels of care related to placement or service intensity for children within the system. This study examined the relationship of caseworker ratings of risk across multiple domains to youth functioning and service use for a sample of children open to the child welfare system. The study identified a stratified random sample of youth who were between the ages of five and 21 and open to the child welfare system (n = 184). Stratification was based on current placement (i.e., in-home, foster home, congregate care, and juvenile justice placements). Administrative data was used to access caseworker ratings of risk across child, parent, and family domains using a standardized risk assessment tool. Children's caseworkers (n = 103) completed a standardized measure of child functioning and reported on youth utilization of services across multiple sectors including specialty mental health, school-based, juvenile justice, and medical settings. Regression analyses using variance-corrected estimation for clustered data (by caseworker) revealed higher levels of child risk were associated with poorer child functioning, which, in turn, were associated with higher rates of multi-sector service use. Recommendations and future directions are discussed.

Time Trends in Smoking Onset by Sex and Race/Ethnicity Among Adolescents and Young Adults: Findings From the 2006-2013 National Survey on Drug Use and Health.

Introduction: During the 2000s the number of adolescents who became new smokers in the United States declined while the number of young adults who did so increased. However, we do not know among which demographic groups these changes occurred. Methods: We analyzed data from the 2006 to 2013 National Survey of Drug Use and Health (n = 180 079). Multivariate linear regression models were used to assess annual trends in smoking onset and log-binomial regression models to assess changes over time in the risk of smoking onset among young adults (18- to 25-years-old) relative adolescents (12- to 17-years-old). Results: From 2006 to 2013, the rate of onset among young adults (6.3%) was greater than among adolescents (1.9%). Time trends demonstrated that annual declines in smoking onset occurred among white young adult males and females. Rates of smoking onset increased among black and Hispanic young adult males with a lower rate of decline among black and Hispanic young adult females. There was a greater risk of smoking onset among young adults relative to adolescents that did not change over time. Conclusions: Smoking onset is becoming more concentrated in the young adult than adolescent years. Despite this trend, there were annual declines in young adult smoking onset but not uniformly across racial/ethnic groups. More effective strategies to prevent young adult smoking onset may contribute to a further decline in adult smoking and a reduction in tobacco-related health disparities. Implications: Smoking onset is becoming more concentrated in the young adult years across sex and racial/ethnic groups. The United States may be experiencing a period of increasing age of smoking onset and must develop tobacco control policies and practices informed by these changes.

Team Science, Justice, and the Co-Production of Knowledge.

Science increasingly consists of interdisciplinary team-based research to address complex social, biomedical, public health, and global challenges through a practice known as team science. In this article, I discuss the added value of team science, including participatory team science, for generating scientific knowledge. Participatory team science involves the inclusion of public stakeholders on science teams as co-producers of knowledge. I also discuss how constructivism offers a common philosophical foundation for both community psychology and team science, and how this foundation aligns well with contemporary developments in science that emphasize the co-production of knowledge. I conclude with a discussion of how the co-production of knowledge in team science can promote justice.

Neighborhood sexual violence moderates women's perceived safety in urban neighborhoods.

Perceptions of neighborhood safety are positively associated with perceptions of neighborhood violence. However, research has yet to examine whether this relationship is moderated by specific types of violence, such as sexual violence, that are more salient for women. Using street-intercept interviews with 343 adults in 9 neighborhoods of a U.S. city with high rates of poverty, unemployment, and crime, we examine the relationship of perceived neighborhood violence to perceived safety in the context of gender while controlling for neighborhood assets that moderate perceptions of neighborhood safety and violence. We hypothesized that gender would moderate the relationship between perceived neighborhood violence and safety, and that women's perceptions of neighborhood safety would be significantly influenced by neighborhood sexual violence, but not other types of violence. Although women and men in these high crime, urban neighborhoods did not differ in their perceptions of neighborhood safety or violence, perceived sexual violence did significantly moderate safety by gender; women's perceptions of neighborhood sexual violence predicted perceived safety in their neighborhood. Importantly, gender did not moderate perceived safety for other types of violence. These results illustrate the importance of taking gender and perceived sexual violence into account to understand neighborhood safety in adults, particularly women.

Reflections on the Future of Community Psychology from the Generations after Swampscott: A Commentary and Introduction to the Special Issue.

This special issue commemorates the 50th anniversary of the founding of U.S. community psychology in Swampscott, Massachusetts in 1965. The issue includes commentaries from a cross-section of community psychologists educated in community psychology training programs established after Swampscott, in the 1970s or later. The contributors, who vary in their involvement in community-engaged research, training, and practice, offer a diverse set of perspectives on the field. Each was asked to reflect on the future of community psychology based on their own training and experiences. After providing some background to the Swampscott Conference and the era in which it took place, I offer a few of my own reflections on community psychology's future growth and development. I then introduce the 15 commentaries that follow.

Reflections on a Community Psychology Setting and the Future of the Field.

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future.

Child and case influences on recidivism in a statewide dissemination of Multisystemic Therapy for juvenile offenders.

Multisystemic Therapy (MST) is an evidence-based treatment for high-risk youth and their families shown to reduce subsequent delinquent activity. This study investigated (1) re-arrest rates of a statewide MST dissemination; and (2) the relation of child, family, and case characteristics to re-arrest rates following receipt of MST. Analyses examined outcomes for 633 youth following referral to MST. Separate models examined predictors of general re-arrest of any type and of more serious misdemeanor or felony arrests. Sixty-five percent of youth experienced a new arrest of any type within 12-months of MST initiation; fewer (53%) experienced a misdemeanor or felony charge in that timeframe. Recipients who were younger, had an externalizing behavior disorder, and had a greater number and severity of pre-MST charges were more likely to recidivate. Findings highlight potential child and case factors that may account for variability in treatment effects when MST is implemented broadly within a system.

Twenty-first century science as a relational process: from eureka! to team science and a place for community psychology.

In this paper we maintain that twenty-first century science is, fundamentally, a relational process in which knowledge is produced (or co-produced) through transactions among researchers or among researchers and public stakeholders. We offer an expanded perspective on the practice of twenty-first century science, the production of scientific knowledge, and what community psychology can contribute to these developments. We argue that: (1) trends in science show that research is increasingly being conducted in teams; (2) scientific teams, such as transdisciplinary teams of researchers or of researchers collaborating with various public stakeholders, are better able to address complex challenges; (3) transdisciplinary scientific teams are part of the larger, twenty-first century transformation in science; (4) the concept of heterarchy is a heuristic for team science aligned with this transformation; (5) a contemporary philosophy of science known as perspectivism provides an essential foundation to advance twenty-first century science; and (6) community psychology, through its core principles and practice competencies, offers theoretical and practical expertise for advancing team science and the transformation in science currently underway. We discuss the implications of these points and illustrate them briefly with two examples of transdisciplinary team science from our own work. We conclude that a new narrative is emerging for science in the twenty-first century that draws on interpersonal transactions in teams, and active engagement by researchers with the public to address critical accountabilities. Because of its core organizing principles and unique blend of expertise on the intersection of research and practice, community psychologists are well-prepared to help advance these developments, and thus have much to offer twenty-first century science.

Relationship of risk assessment to placement characteristics in a statewide child welfare population.

Risk assessments allow child and youth services to identify children who are at risk for maltreatment (e.g., abuse, neglect) and help determine the restrictiveness of placements or need for services among youth entering a child welfare system. Despite the use of instruments by many agencies within the U.S. to determine the appropriate placements for youth, research has shown that placement decisions are often influenced by factors such as gender, age, and severity of social-emotional and behavior problems. This study examined ratings of risk across multiple domains using a structured assessment tool used by caseworkers in the Rhode Island child welfare system. The relationship between ratings of risk and placement restrictiveness was also examined. Risk levels varied across placement settings. Multivariate analyses revealed that lower caseworker ratings of parent risk and higher ratings of youth risk were associated with more restrictive placements for youth. Implications for the child welfare system are discussed.

Effects of Community-Based Wraparound Services on Child and Caregiver Outcomes Following Child Protective Service Involvement.

This study investigated whether statewide delivery of the wraparound service model (WSM) improved child and caregiver outcomes and reduced subsequent child protective service (CPS) contact among families referred to services following a CPS report. Caregivers (n = 247) completed baseline and 6-month interviews to document self-reported engagement in WSM and non-WSM conditions and assess changes in outcomes. Kernel-weighted difference-in-difference (K-DID) models were used to assess program effects, based on reported condition. Child behavior outcomes improved among WSM-engaged families, but differences by condition were non-significant except for internalizing behaviors. Caregiver receipt of WSM was associated with greater retention of behavioral health services, but did not produce statistically significant improvements in their wellbeing. Households in the WSM condition were more likely to be reported to CPS at 6-month follow-up, but this difference was not significant at 12 months and differences in substantiation were not statistically significant. Supplemental analyses compared alternative means of contrasting group effects, highlighting some differences based on method. The WSM produced few significant differential improvements in child or caregiver outcomes and failed to prevent future CPS involvement. Inadequate program fidelity appeared to be a factor in implementation of the WSM, which may have hampered program effectiveness under real-world conditions.

A community's response to suicide through public art: stakeholder perspectives from the Finding the Light Within project.

Suicide is a preventable public health problem and a leading cause of death in the United States. Despite recognized need for community-based strategies for suicide prevention, most suicide prevention programs focus on individual-level change. This article presents seven first person accounts of Finding the Light Within, a community mobilization initiative to reduce the stigma associated with suicide through public arts participation that took place in Philadelphia, Pennsylvania from 2011 through 2012. The stigma associated with suicide is a major challenge to suicide prevention, erecting social barriers to effective prevention and treatment and enhancing risk factors for people struggling with suicidal ideation and recovery after losing a loved one to suicide. This project engaged a large and diverse audience and built a new community around suicide prevention through participatory public art, including community design and production of a large public mural about suicide, storytelling and art workshops, and a storytelling website. We present this project as a model for how arts participation can address suicide on multiple fronts-from raising awareness and reducing stigma, to promoting community recovery, to providing healing for people and communities in need.