Posttraumatic stress disorder symptom trajectories in a 16-month COVID-19 pandemic period.

COVID-19 pandemic presents an unheralded opportunity to better understand trajectories of posttraumatic stress disorder (PTSD) symptoms across a prolonged period of social disruption and stress. We tracked PTSD symptoms among trauma-exposed individuals in the United States and sought to identify population-based variability in PTSD symptom trajectories and understand what, if any, early pandemic experiences predicted membership in one trajectory versus others. As part of a longitudinal study of U.S. residents during the pandemic, participants who reported at least one potentially traumatic experience in their lifetime (N = 1,206) at Wave 1 (April 2020) were included in the current study. PTSD symptoms were assessed using the PCL-5 at four time points extending to July 2021. Latent growth mixture modeling was used to identify heterogeneous symptom trajectories. Trajectory membership was regressed on experiences from the early stage of the pandemic as measured using the Epidemic-Pandemic Impacts Inventory in a model that controlled for variables with documented associations to PTSD trajectories, including age, sex, income, and trauma history. Four trajectories were identified, categorized as resilient (73.0%), recurring (13.3%), recovering (8.3%), and chronic (5.5%). Emotional and physical health problems and positive changes associated with the early phase of the pandemic were each significant predictors of trajectory membership over and above all other variables in the model. Predictors primarily differentiated the resilient trajectory from each of the other three trajectories. Distinct PTSD symptom trajectories during the COVID-19 pandemic suggest a need for targeted efforts to help individuals at most risk for ongoing distress.

Co-Production: Journey to Wellness Guide.

As rates of substance use and mental disorders continue to rise, individuals with mental health and substance use challenges and their supporters could benefit from practical, accessible, cost-effective, wellness-focused tools outlining simple daily strategies to promote long-term recovery. The current article describes such a tool, the Journey to Wellness Guide, based on the Wellness Model, and developed through a co-production process. Co-production refers to a process of research, service design, and educational materials development where people with lived experience of mental health and/or substance use challenges share decision-making power throughout all stages of production, including the sharing of results. The co-production process resulted in a well-received wellness tool and tip guides for personal use, supporting others, and use in a group context. The value of this tool for psychosocial nursing and behavioral health care worker self-care and practice is outlined. [Journal of Psychosocial Nursing and Mental Health Services, 61(9), 24-30.].

Development of a Nurtured Heart Approach® Questionnaire.

A training and coaching team embarked on a training and technical assistance program evaluation project to examine the development of a tool used to determine the impact of training on staff and families serving youth with behavioral health challenges and their families. The training evaluation project centered on the development of a tool to examine the impact of training on trainee attitudes. The current article provides an overview of the development of the Nurtured Heart Approach® (NHA) Questionnaire to help support training and technical assistance implementation efforts by nursing and other trainers interested in best practice approaches to empower youth with behavioral health challenges. The questionnaire was found to be internally consistent and to have relatively stable, empirically derived factors consistent with the NHA model, but differing somewhat from the theoretically derived "Stands," or areas of emphasis. The questionnaire is sensitive to changes in attitude resulting from the NHA training. Therefore, it would a viable, practical instrument to test staff acquisition of NHA-related attitudes. [Journal of Psychosocial Nursing and Mental Health Services, 60(2), 15-19.].

A Welcoming Space to Manage Crisis: The Wellness Respite Program.

The need for behavioral health care prevention, treatment, and recovery supports, including crisis alternatives, has grown and is now receiving federal support through enhanced funding. When a person experiences severe emotional distress, crisis alternatives are a viable option instead of inpatient hospitalization to address the distress and restore balance. Peer respite programs are voluntary, short-term, crisis alternatives for people experiencing mental distress. Models have evolved in response to funding and regulatory requirements, yet research is limited. The current article describes a unique peer-led program, Wellness Respite, in operation for 7 years, including data from recent satisfaction surveys and the role of nurses in the program. Implications of a home-like, short-term crisis alternative and the role of the nurse are emphasized. [Journal of Psychosocial Nursing and Mental Health Services, 60(11), 26-32.].

Caregivers of People With Disabilities: A Program to Enhance Wellness Self-Care.

Caregivers are a source of support for family members with disabilities. However, caregivers are at risk for caregiver burden, which can erode self-care skills and lead to poor physical and mental health outcomes. Caregiver Wellness Self-Care, developed to address that risk, is a 5-week group program in which participants learn about strategies that cultivate their inner resources, while connecting with others for support. Wellness, self-care, mindfulness, and yoga-based information and practices are taught in the sessions and included in participant handouts. Self-reflection and planning activities with facilitated discussions further support awareness and personal transformation. Designed by and for people providing care to an adult family member with a mental health disorder and a developmental/intellectual disability, the program was piloted three times. The current article describes the development of the program through caregiver involvement, participant and facilitator feedback, and implications for future efforts to build caregiver wellness self-care skills. Implications for nurses are highlighted. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 25-32.].

Nudges to Support Health and Wellness for Individuals Served by Behavioral Health Programs.

Individuals served by behavioral health programs experience risk factors that threaten health and longevity. Health behavior changes may be supported through environmental modifications known as nudges. The current review (a) examines the potential value of nudges for helping individuals receiving services from behavioral health programs, and (b) offers physical and social environment strategies to support positive health behaviors. The authors discuss literature related to nudges and environmental influences on health behaviors. The research related to nudges supports the potential value of this framework for nurses in behavioral health settings, who are in a strong position to help address health and wellness concerns disproportionately experienced by individuals in behavioral health programs. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 21-28.].

A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience.

BACKGROUND: An extensive literature exists describing treatment interventions and recovery from eating disorders (EDs); however, this body of knowledge is largely symptom-based and from a clinical perspective and thus limited in capturing perspectives and values of individuals with lived experience of an ED. In this study, we performed a systematic review to coproduce a conceptual framework for personal recovery from an ED based on primary qualitative data available in published literature. METHODS: A systematic review and qualitative meta-synthesis approach was used. Twenty studies focusing on ED recovery from the perspective of individuals with lived experience were included. The studies were searched for themes describing the components of personal recovery. All themes were analyzed and compared to the established connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (CHIME) and Substance Abuse and Mental Health Services Administration (SAMHSA) frameworks of recovery, which are applicable to all mental disorders. Themes were labeled and organized into a framework outlining key components of the ED personal recovery process. RESULTS: Supportive relationships, hope, identity, meaning and purpose, empowerment, and self-compassion emerged as the central components of the recovery process. Symptom recovery and its relationship to the personal recovery process are also significant. DISCUSSION: Individuals with lived experience of EDs noted six essential elements in the personal ED recovery process. This framework is aligned with several of the key components of the CHIME and SAMHSA frameworks of recovery, incorporating person-centered elements of the recovery process. Future research should validate these constructs and develop instruments (or tools) that integrate the lived experiences into a measurement of recovery from an ED.

ANTECEDENTES: Existe una extensa literatura que describe las intervenciones de tratamiento y la recuperación de los trastornos de la conducta alimentaria (TCA); sin embargo, este conjunto de conocimientos se basa en gran medida en los síntomas y además desde una perspectiva clínica y, por lo tanto, es limitado para capturar las perspectivas y los valores de las personas con experiencia vivida de un TCA. En este estudio, realizamos una revisión sistemática para coproducir un marco conceptual para la recuperación personal de un TCA basado en datos cualitativos primarios disponibles en la literatura publicada. MÉTODOS: Se utilizó una revisión sistemática y un enfoque de meta-síntesis cualitativa. Se incluyeron veinte estudios centrados en la recuperación del TCA desde la perspectiva de individuos con experiencia vivida. Se buscaron en los estudios temas que describieran los componentes de la recuperación personal. Todos los temas fueron analizados y comparados con los marcos de recuperación establecidos de CHIME y SAMHSA, que son aplicables a todos los trastornos mentales. Los temas fueron etiquetados y organizados en un marco que describe los componentes clave del proceso de recuperación personal del TCA. RESULTADOS: las relaciones de apoyo, la esperanza, la identidad, el significado y el propósito, el empoderamiento y la autocompasión surgieron como los componentes centrales del proceso de recuperación. La recuperación de los síntomas y su relación con el proceso de recuperación personal también es significativa. CONCLUSIONES: Las personas con experiencia vivida de un TCA destacaron por seis elementos esenciales en el proceso personal de recuperación del TCA. Este marco está alineado con varios de los componentes clave de los marcos de recuperación de CHIME y SAMHSA, incorporando elementos centrados en la persona del proceso de recuperación. La investigación futura debería validar estos constructos y desarrollar instrumentos (o herramientas) que integren las experiencias vividas en una medición de recuperación de un TCA.

Care2Caregivers: A Retrospective Examination of Needs Addressed and Services Provided by a Peer Support Helpline.

Family caregivers of persons with Alzheimer's disease and related dementias (CADRD) provide significant support to their family members but often experience challenges and stress that impact their quality of life. Peer supporters can be an important resource to help alleviate stress associated with caregiving, yet few published studies have examined peer supporters for CADRD. This retrospective cohort study examined data collected from a peer support helpline for CADRD in a middle Atlantic state. Four years of data were reviewed to examine trends across time. Data analysis indicated that the most often reported issues by CADRD callers were related to their own emotional well-being. Results demonstrated that peer supporters have potential to address practical, physical, social, and emotional needs of caregivers who reach out. Nurses are well-positioned to partner with peer support specialists to best address the practical and emotional support needs and self-care challenges faced by CADRD. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 13-16.].

Cancer Screening in Behavioral Health Care Programs.

OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.

"We're All in this Together": Peer-specialist Contributions to a Healthy Lifestyle Intervention for People with Serious Mental Illness.

This qualitative study explored peer specialists' contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists' disclosure of their own experiences making health behaviors changes was critical for building participants' motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.

Effectiveness of Occupational Therapy Services in Mental Health Practice.

National behavioral health care efforts have opened opportunities to reignite occupational therapy mental health practice and research. The profession's person-centered and occupation-based practice fits well with the growing needs of people with serious mental illness (SMI) served in community-based settings. The nine articles in this special issue provide a growing body of evidence to support the effectiveness of occupational therapy interventions for adults with SMI to enhance health management skills and promote independence in living a balanced and satisfying life. However, much more high-level research is required to explicitly investigate the contributions of occupational therapy in all areas of occupation for adults with SMI and to broaden the available evidence base to inform occupational therapy practice.

Strategies to Promote Walking Among Community-Dwelling Individuals With Major Mental Disorders.

Individuals with major mental disorders could benefit from low cost, functional ways to support healthy lifestyles. Walking is a popular, preferred, accessible, and safe physical activity for many people. Walking is free, requiring no specialized equipment or membership fee, and is important to support engagement in other daily living activities. The current study explores the benefits of walking and strategies for promoting walking among community-dwelling individuals with major mental disorders. Key issues include strengthening engagement, tracking progress, and sustaining participation to achieve goals related to walking. The authors propose ways that nurses can support increased walking behavior for improved health and well-being in this population. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 25-32.].

Correlates of Current Smoking Among Adults Served by the Public Mental Health System.

OBJECTIVE: As part of a study of health status among 457 adults with diagnostically heterogeneous serious mental illnesses served by the public mental health system in four U.S. states, we assessed predictors of current cigarette smoking. METHODS: We examined bivariate relationships between smoking status and risks for drug and alcohol use disorders, residential setting, parental status, and employment. Finally, we used multivariable logistic regression to predict current smoking, controlling for significant confounds. RESULTS: Of the total sample, 44% of participants reported that they currently smoked and most (62%) were moderately to severely nicotine-dependent. Those at high risk for drug use disorders were more than three times as likely and those at high risk for alcohol use disorders were more than twice as likely to smoke, compared to their counterparts with little or no drug or alcohol use disorder risk. Controlling for all other model variables including drug and alcohol disorder risk, current smokers were less likely to be parents and more likely to reside in supervised settings than nonsmokers. Younger people and those without a college degree were more likely to smoke, controlling for all other model variables. CONCLUSIONS: Given the high degree of comorbidity of smoking, alcohol disorders, and drug use disorders, the authors highlight the need for integrated interventions that address these issues simultaneously.

Effects of Physical Limitations on Daily Activities Among Adults With Mental Health Disorders: Opportunities for Nursing and Occupational Therapy Interventions.

Individuals living with mental health disorders served by the public mental health system often face comorbid medical conditions that affect their quality of life and lifespan. The effect of physical limitations on the engagement in daily activities among individuals living with mental health disorders has not been extensively researched. Adults attending community wellness centers (N = 53) in a northeastern United State were included in a descriptive study exploring the impact of physical limitations on daily activities. The activities most frequently affected were: walking or moving around, sleeping, and finding a job. The physical limitations affecting these three activities were lack of energy and pain. Health care professionals, including mental health nurses and occupational therapy practitioners, are in an ideal position to collaborate by evaluating and offering treatment interventions that address physical limitations to positively affect occupational functioning and recovery. [Journal of Psychosocial Nursing and Mental Health Services, 55(10), 45-51.].

Consumers of Mental Health Services: Their Knowledge, Attitudes, and Practices About High Energy Drinks and Drugs.

To date, whether individuals with mental illness use high energy drinks (HED) to offset their symptoms, or whether their use began after diagnosis or psychoactive drugs were prescribed is unknown. Their degree of knowledge regarding their symptoms, diagnosis, or what strategies they have used to feel better is also undetermined. A search of the literature yielded no studies about these areas or domains. The current article provides background information on caffeine and HED, with or without alcohol, and the use patterns of consumers of mental health services, as well as their attitudes and knowledge. Participants in the Network for Psychiatric Nursing Researchers, who were consumers, influenced the current study group to expand their thinking about how to address the unknown areas. Their related work and publication are described. [Journal of Psychosocial Nursing and Mental Health Services, 55(4), 37-43.].

Associations Between Gender and Obesity Among Adults with Mental Illnesses in a Community Health Screening Study.

The prevalence of obesity and its associations with gender, clinical factors, and medical co-morbidities were examined among 457 adults attending public mental health programs in 4 U.S. states. BMI was measured directly and other information was gathered by interview. Over half (59%, n = 270) were obese including 18% (n = 83) who were morbidly obese. In hierarchical ordinary least squares regression analysis controlling for demographic, psychiatric, medical, smoking, and health insurance statuses, women were significantly more likely to be obese than men. Obesity also was more likely among those who were younger and not high school graduates, those with diabetes or hypertension, and those who did not smoke tobacco. Interaction effects were found between gender and diabetes, hypertension, tobacco smoking, education, race, and age. The high prevalence of obesity among women, coupled with interactions between gender and other factors, suggest that targeted approaches are needed to promote optimal physical health in this population.

Cancer Screening Among Peer-Led Community Wellness Center Enrollees.

Growing evidence suggests health disparities exist in services for individuals with mental disorders served by the public mental health system. The current study assessed the use of cancer screening services among New Jersey residents in publicly funded mental health programs. Self-administered written surveys were completed by 148 adults using peer-led community wellness centers throughout New Jersey. Information was collected on (a) the use of breast, cervical, and colorectal cancer screening services; (b) barriers to receiving preventive services; and (c) perceptions of overall health. More males than females participated in the study, with equal participation among White and African American individuals. Schizophrenia spectrum disorders were the most common self-reported psychiatric condition. Colorectal cancers had lower screening levels compared to those of the general population. Physicians not advising patients to complete tests emerged as a main cause of low screening rates. Wellness initiatives designed by peers collaborating with health care providers may improve adherence to preventive cancer screening measures.

The Force of Habit: Creating and Sustaining a Wellness Lifestyle.

Regardless of an individual's mental health status, habits are difficult to establish and/or eliminate. Given the importance of good habits to overall health and wellness, nurses and other mental health service providers need to understand the force of habits (positive and negative), factors that make habit change difficult, and approaches that are likely to facilitate building and maintaining good habits. The current article provides a cursory overview of several factors (i.e., motivation, will-power, and rewards) that impact habit formation. Relevant theories and research are presented. Habit formation can be fostered through a careful analysis of current behaviors, specific and measurable short-term goals or objectives, and a detailed action plan.