Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019.

BACKGROUND: Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka. METHODS: In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors. RESULTS: The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV. CONCLUSIONS: IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.

A qualitative evaluation of a co-design process involving young people at risk of suicide.

BACKGROUND: Co-design is becoming common practice in the development of mental health services, however, little is known about the experience of such practices, particularly when young people are involved. OBJECTIVE: The aim of this study was to conduct a process evaluation of the co-design which was undertaken for the development of an intervention for youth and adolescents at risk of suicide. This paper briefly outlines the co-design process undertaken during a COVID-19 lockdown and then focuses on a qualitative evaluation of the experience of taking part in a co-design process. SETTING AND PARTICIPANTS: The evaluation involved young consumers of a public youth mental health service, their carers/parents and service delivery staff who had taken part in the co-design process. METHOD: This study used follow-up semistructured interviews with the co-design participants to explore their experience of the co-design process. Inductive thematic analysis was used to draw out common themes from the qualitative data. RESULTS: It was found that despite the practical efforts of the project team to minimise known issues in co-design, challenges centred around perceptions regarding power imbalance, the need for extensive consultation and time constraints still arose. DISCUSSION: Despite these challenges, the study found that the co-design provided a human-centred, accessible and rewarding process for young people, parents and staff members, leaving them with the feeling that they had made a worthwhile contribution to the design of the new service, as well as contributing to changing practice in service design. CONCLUSION: With sensitivity and adaptation to usual practice, it is possible to include young people with suicidal ideation, their parents/carers and professional staff in a safe and effective co-design process. PATIENT AND PUBLIC CONTRIBUTION: The authors would like to thank and acknowledge the young people with a lived experience and their carers who participated in the co-design process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in this research.

Are codesigned programmes more difficult to implement? A qualitative study of staff perceptions on the implementation of a new youth mental health programme.

BACKGROUND: Codesigned interventions are becoming more common in health services and, in particular, in the design and development of mental health programmes and interventions. However, previous research has established that the transition from codesign to implementation can experience several challenges and that this transition process has received little research attention. OBJECTIVE: The aim of this study was to explore the experience of staff members charged with the implementation of a codesigned intervention for young people and adolescents at risk of suicide. SETTING AND PARTICIPANTS: Five staff members involved in the implementation of the new codesigned programme took part in semi-structured interviews. METHOD: The study involved qualitative evaluation of staff experiences during the implementation of a new child and youth suicide intervention. Interviews were analysed using reflexive thematic analysis. RESULTS: The analysis identified four themes of 'disconnect', 'operational challenges, 'service user' and 'being authentic'. 'Disconnect' captures the difficulties of implementing a codesigned programme which leads to 'operational challenges' in meeting broader expectations while ensuring the feasibility of the programme. The third theme, 'service user', captures the realisation that the young people accessing the new service were different to those involved in the codesign process. The final theme, 'being authentic', highlights how staff needed to be responsive and flexible while remaining true to the principles proposed in the codesign. DISCUSSION: This study yielded some valuable insights into the challenges around the implementation of a codesigned intervention, an under-researched area. The findings suggest that adaption of the design may be necessary, if it is not informed by implementation constraints, making it necessary for the implementation team to be well-briefed on the initial design and given plenty of time to make the necessary adjustments in a coproduction process. Limitations for the generalisation of the results include a small sample of staff and particular challenges that may be unique to this study. CONCLUSION: The present study highlights that for health services undertaking codesign approaches, appropriate time and resources need to be considered for the implementation phase of an initiative, to ensure that there is effective translation from design to implementation and that new codesigned services can be effective within operational constraints. PATIENT AND PUBLIC CONTRIBUTION: The authors would like to thank and acknowledge the young people with a lived-experience and their carers who participated in the codesign process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in the evaluation.

A systematic review and meta-analysis of the relationship between obsessive-compulsive symptoms and symptoms of proposed orthorexia nervosa: The contribution of assessments.

OBJECTIVE: This systematic review and meta-analysis aimed to update the literature on orthorexia nervosa (ON), a proposed diagnosis of pathologically 'healthy' eating, by critically analysing the current evidence for the relationship between ON and obsessive-compulsive (OC) symptoms. Further, this paper aimed to compare the ON/OC relationship significance and strength based on when the ON measurement tool was developed. METHOD: PsycINFO, PubMed and Web of Science databases were queried for quantitative, peer-reviewed studies recruiting adult participants, published in English up to April 2023. Studies not directly comparing ON and OC symptoms were excluded. After full-text review and quality assessment, 40 studies were included in the systematic review and 31 studies in the meta-analysis. RESULTS: ON assessments created prior to the 2016 revised ON diagnostic criteria do not appear to fully capture OC symptoms. Studies using earlier developed ON assessments demonstrated inconsistent ON/OC relationships whereas studies implementing more recent assessments (from 2018 onwards) found consistently significant, larger relationships, highlighting a previously underrated OC component of ON. CONCLUSIONS: Early ON studies, and studies utilising early ON assessments should be interpreted with caution, particularly in relation to OC symptom involvement in ON. Future research should validate novel ON assessments and investigate common underlying factors.

Factors associated with married women's attitude toward intimate partner violence: A study on 20 low-and middle-income countries.

Intimate Partner Violence (IPV) is a global problem and has been reported to be significantly higher for women in Low and Middle-Income Countries (LMICs). The researchers analyzed Demographic and Health Survey (DHS) data of married women in 20 LMICs to examine those most vulnerable to accepting IPV by investigating associated risk factors. The researchers revealed a higher level of acceptance of IPV among illiterate women from poorer households in remote areas. Using these findings, the authors provide insight into ensuring and enhancing the living standards of these vulnerable women by making education more readily accessible.

Perfectionism as a moderator of the relationship between orthorexia nervosa and obsessive-compulsive symptoms.

PURPOSE: Orthorexia nervosa (ON), a proposed disorder describing an obsessive focus on "healthy" eating, is characterised as having overlapping symptoms with obsessive-compulsive disorder. However, ON/obsessive-compulsive (OC) symptom relationships are inconsistently reported. The current study aimed to investigate if the contribution of OC symptoms and beliefs explain variability in ON symptoms and determine if perfectionism, a transdiagnostic factor, moderates the ON/OC symptom relationship. METHODS: The study comprised 190 participants (Mage = 28.63, SDage = 9.88; 80% female) recruited via an undergraduate research programme, social media, advocacy organisations, and a participant registry. Participants completed an online questionnaire assessing ON, OC, and perfectionism symptoms. RESULTS: A linear regression analysis found OC symptoms and beliefs explained 22.9% variability in ON symptoms (p < 0.001, f2 = 0.38) and perfectionism moderated the ON/OC symptom relationship, where higher levels of perfectionism with higher levels of OC symptoms was associated with higher levels of ON symptoms, explaining 2.2% variability (p = .01, f2 = 0.03). CONCLUSION: OC symptoms appear more common in ON than previous studies indicate. However, the interaction between perfectionism and OC symptoms may drive obsessions in ON. Findings help refine our current understanding of ON phenomenology with implications for ON treatment development. Future research should further explore perfectionism in ON phenomenology. LEVEL OF EVIDENCE: Level V (Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees).

Exploring predictors of aggressive intrusive thoughts and aggressive scripts: Similarities and differences in phenomenology.

Experiencing a thought about harming or injuring another person is commonly reported by the general population. Aggressive intrusive thoughts (AITs) and aggressive scripts are two constructs commonly used to define the experience of thinking about harming another person. However, they are generally investigated separately and with two significantly different population groups; respectively, individuals with obsessive-compulsive disorder and people with a history of violent behavior. AITs and aggressive scripts are assumed to have very different implications for violence risk assessment, but conceptual overlap and an absence of empirical research renders this assumption premature. Using a battery of self-report measures, this study aimed to investigate the differential predictors of AITs and aggressive script rehearsal in a nonclinical sample. Additionally, using regression analyses, the predictors of self-reported aggressive behavior were explored in a sample of 412 adults (73% females; Mage = 31.96 years, SD = 11.02). Violence-supportive beliefs and frequency of anger rumination predicted the frequency of aggressive script rehearsal, and aggressive script rehearsal, anger rumination, and violence-supportive beliefs predicted a history of aggressive behavior. In contrast, obsessive beliefs were predictive of AITs, and only AITs were related to ego-dystonicity. Both AITs and aggressive script rehearsal were related to the use of thought control strategies. These findings support the contributions that maladaptive beliefs have in the experience of aggressive scripts and AITs. Beliefs about violence, a history of aggressive behavior, and ego-dystonicity appear to differentiate aggressive scripts from AITs.

Investigating differences in cognitive flexibility, clinical perfectionism, and eating disorder-specific rumination across anorexia nervosa illness states.

INTRODUCTION: Cognitive inflexibility, clinical perfectionism, and eating disorder (ED)-specific rumination are common characteristics reported in anorexia nervosa (AN) and may contribute to the maintenance of the illness. It is suggested that clinical perfectionism and rumination may mediate the relationship between cognitive flexibility and AN pathology; however, research to date has not investigated all these factors together. The aim of the current study was to explore the relationships between these factors and how they may relate to ED symptoms in AN. METHODS: Participants included 15 women with a current diagnosis of AN, 12 women who had a past diagnosis of AN and were currently weight-restored, and 15 healthy controls (HCs). RESULTS: The results revealed that participants with both acute and weight-restored AN self-reported poorer cognitive flexibility than HCs, but the groups did not differ in performance on objective assessments of cognitive flexibility. Participants with AN also reported significantly greater clinical perfectionism and ED-specific rumination than HC. A parallel mediation analysis found that ED-specific rumination mediated the relationship between subjective cognitive flexibility and ED symptoms. Further, subjective cognitive flexibility directly influenced ED symptoms. However, the mediation model was not significant for objective cognitive flexibility. CONCLUSION: The findings of this study have implications for potential treatment barriers and factors which might contribute to the risk of relapse.

Understanding self-report and neurocognitive assessments of cognitive flexibility in people with and without lifetime anorexia nervosa.

Objective: Anorexia nervosa (AN) is a serious eating disorder associated with several cognitive difficulties including poor cognitive flexibility (i.e. difficulties in effectively adapting to changes in the environment and/or changing task demands). AN research has primarily assessed cognitive flexibility using neurocognitive tests, and little is known about the differences or similarities between self-report and neurocognitive assessments of cognitive flexibility. This study investigated the relationship between self-report and neurocognitive assessments of cognitive flexibility in people with no history of an eating disorder (n = 207) and people with a self-reported lifetime diagnosis of AN (n = 19).Methods: Participants completed self-report and neurocognitive assessments of cognitive flexibility through an online study.Results: No significant correlations were found between self-report and neurocognitive assessments of cognitive flexibility for either group of the sample, suggesting that these assessments may evaluate different aspects of cognitive flexibility. Further, negative mood and self-reported eating disorder symptoms were found to significantly relate to self-reported cognitive flexibility, but were not associated with performance on neurocognitive tests of cognitive flexibility.Conclusions: To provide a comprehensive understanding of perceived and objective cognitive flexibility in AN, future research and clinical assessments should include both self-report and neurocognitive assessments.

National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff.

OBJECTIVES: This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff. METHODS: A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. RESULTS: On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. CONCLUSIONS: Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. CLINICAL IMPLICATIONS: This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.