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1.
PLoS One ; 19(6): e0304596, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38885226

RESUMEN

The most dominant model of hope is cognitive, in which hope is defined as goal-directed thinking, comprising self-agency and goal route identification. Nonetheless, competing theories about the fundamental nature of hope remain and further exploration of the construct is warranted. Little is known about whether the cognitive model aligns with how higher education students themselves think about hope. Understanding how "lay" populations conceptualise and experience psychological phenomena is as important as applying scientific theory. Personal beliefs impact on how people make sense of their life experiences and on their wellbeing. Research is specifically needed to explore the conceptualisation and experience of hope within diverse student populations. A systematic review was conducted to identify published scientific research and grey literature presenting qualitative accounts of hope from higher education students. A qualitative meta-synthesis of the eight eligible reports was conducted using thematic analysis and synthesis approaches to identify conceptualisations of hope and its associations with mental health and well-being. Nine themes were identified, reflecting that hope is: fundamental; self-construal over time; goal-directed; cognitive-emotional-behavioural; connection; resilience; dynamic and reciprocal; the inverse of depression; positive. These findings were identified as reflecting conclusions in which at least a moderate level of confidence may be placed. These findings clearly align with the cognitive model of hope, but emphasise the additional facets of fundamentality, self-construal, and negative origins. The implications for higher education institutions include to promote growth mindsets, to support students to learn skills for identifying and pursuing goals, and to provide hope-enhancing interventions as part of their student support provision.


Asunto(s)
Esperanza , Estudiantes , Humanos , Estudiantes/psicología , Objetivos , Cognición , Salud Mental , Universidades
2.
PLoS One ; 19(5): e0304470, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38820387

RESUMEN

Young women who are not in education, employment, or training (NEET) experience poorer health and social outcomes compared to non-NEET young women and to NEET young men, especially in deprived areas with intersecting inequalities. The evidence on effective public health approaches is scarce. Interventions that target hope, which NEET young women notably lack, offer a promising theory-driven and intuitive means to prevent mental health problems and improve social outcomes. Hope can be defined as a goal-focused mindset comprising self-agency (motivation and self-belief) and pathways (identifying routes to achieving goals). Hope is implicated in a variety of evidence-based psychosocial interventions for young people, but is not directly targeted by existing prevention programmes for NEET populations. The current study used a phased qualitative research design and participatory methods to model a hope-focused intervention for NEET young women. Phase 1 investigated population needs and intervention parameters through semi-structured interviews with 28 key informants living or working in disadvantaged coastal communities in South-East England. The sample comprised eight NEET young women, four family members, and 16 practitioners from relevant support organisations. Phase 2 refined intervention parameters and outcomes through co-design sessions with four NEET young women, followed by a theory of change workshop with 10 practitioners. The resulting intervention model is articulated as a mentor-supported, in-person psychosocial intervention that builds hope by enhancing positive sense of self and time spent in meaningful activities, before explicitly teaching the skills needed to identify, set, and pursue personally meaningful goals.


Asunto(s)
Esperanza , Humanos , Femenino , Adulto Joven , Inglaterra , Adolescente , Trastornos Mentales/prevención & control , Trastornos Mentales/terapia , Salud Mental , Investigación Cualitativa , Adulto , Empleo , Masculino
3.
Artículo en Inglés | MEDLINE | ID: mdl-38769737

RESUMEN

AIM: It is increasingly recognised that traditional models of mental health (MH) care, with a service transition at age 18 years, may not reflect best practice. The literature supports a move towards youth and young adult focused models of MH care, for young people up to the age of 25, which specifically cater to the unique psychosocial and developmental needs of this population. This service evaluation aimed to explore the facilitators and barriers to the implementation of youth models of MH care across England (UK). METHODS: Six services participated in separate focus groups pertaining to their experience of implementing youth models of MH care. The interview guide for the focus groups was informed by the Consolidated Framework for Implementation Research (CFIR) and explored barriers and facilitators to implementation and sustainment. The focus groups were recorded, transcribed verbatim and analysed thematically. RESULTS: Seven key themes relevant to the implementation of youth models of MH care were identified: a clear rationale for doing things differently, for young people by young people, "building those relationships is key", service identity development, resource and infrastructure, leadership at multiple levels, and valuing and developing staff. CONCLUSIONS: The findings suggest effective communication and leadership, co-production and cross system collaboration contribute to successful implementation of youth models of MH care. The findings will be of interest to those involved in informing and supporting successful implementation and delivery of youth models of mental health care at local and national levels.

4.
Early Interv Psychiatry ; 18(1): 34-41, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37186460

RESUMEN

AIM: Psychosis spectrum disorders continue to rank highly among causes of disability. This has resulted in efforts to expand the range of treatment targets beyond symptom remission to include other recovery markers, including social and occupational function and quality of life. Although the efficacy of psychosocial interventions in early psychosis has been widely reported, the acceptability of these interventions is less well-known. This study explores the participant perspective on a novel, psychosocial intervention combining cognitive remediation and social recovery therapy. METHODS: We employed a qualitative research design, based on semi-structured interviews and reflexive thematic analysis. Six participants with early psychosis were recruited from the intervention arm of a randomized pilot study, three women and three men, aged between 22 and 27 years. RESULTS: Four themes were developed through the analytical process, namely, (1) a solid therapeutic foundation, (2) multi-directional flow of knowledge, (3) a tailored toolset, and (4) an individual pathway to recovery. Participants also provided pragmatic feedback about how to improve the delivery of the therapy assessments and intervention. Both the themes and pragmatic feedback are described. CONCLUSIONS: People with early psychosis described the intervention as acceptable, engaging, helpful and person-centred, suggesting its potential role in a multicomponent therapy model of early intervention in psychosis services. Participants in this study also highlight the importance of an individualized approach to therapy, the vital role of the therapeutic relationship and the ecological validity and value of adopting an assertive outreach delivery, providing therapy outside a conventional clinic setting.


Asunto(s)
Remediación Cognitiva , Trastornos Psicóticos , Masculino , Humanos , Femenino , Adulto Joven , Adulto , Calidad de Vida , Proyectos Piloto , Trastornos Psicóticos/psicología , Investigación Cualitativa
5.
Schizophr Res ; 265: 58-65, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37230912

RESUMEN

BACKGROUND: Research into hallucinatory experiences has focused primarily upon hallucinations within the auditory modality, to the relative neglect of other modalities. Furthermore, the exploration of auditory hallucinations (or 'voices') has focused primarily upon the experiences of people with a diagnosis of psychosis. The presence of multi-modal hallucinations may have implications across diagnoses for levels of distress, formulation and the targeting of psychological interventions. METHODS: This study presents a cross-sectional analysis of observational data from the PREFER survey (N = 335). Linear regression was used to explore the relationships between voice-related distress and the presence, number, type and timing of multi-modal hallucinations. RESULTS: Simple relationships were not found between distress and the presence of hallucinations in visual, tactile, olfactory or gustatory modalities, or in the number of modalities experienced. When considering the degree to which another modality hallucination was experienced simultaneously with voices, there was some evidence that the degree of co-occurrence with visual hallucinations was predictive of distress. CONCLUSIONS: The co-occurrence of voices with visual hallucinations may be associated with relatively greater distress, but not consistently, and the association between multimodal hallucinations and clinical impact appear complex and potentially variable from individual to individual. Further study of associated variables such as perceived voice power may further illuminate these relationships.


Asunto(s)
Trastornos Psicóticos , Voz , Humanos , Estudios Transversales , Alucinaciones/diagnóstico , Alucinaciones/epidemiología , Alucinaciones/etiología , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Encuestas y Cuestionarios , Observación
6.
J Am Coll Health ; : 1-8, 2023 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-37856416

RESUMEN

Objectives: To explore university student peer supporter experiences in the pandemic context and with a specific focus on student mental health. Participants: The sample comprised 13 students from various peer support programs, providing academic, social and/or emotional support at a South-East England university. Methods: A two-phase qualitative design involved individual interviews and focus groups, followed by participant validation with a subset of participants. Results: Peer supporters identified an increased need peri-pandemic for mental health support. The accessibility was aided by students perceiving peer supporters to be approachable, but was undermined by concerns about peers' credibility. Supporter-supportee relationships were characterized by intimacy and mutuality, which were seen as conducive to authenticity, but caused challenges with respect to boundaries. Conclusions: Peer support is a complex activity, characterized by a sense of multiplicity and mutuality. Responsive supervision and dedicated training are necessary to manage these complexities amidst elevated student mental health needs.

7.
PLoS One ; 18(9): e0290641, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37751433

RESUMEN

Limited research has explored the specific impact of voice-hearing experiences upon the social relating of adolescents. This study examined the associations of voice-hearing in youth with social relating, and putative explanatory factors. An observational, cross-sectional design using a clinical comparison group was employed to examine historical and concurrent associations with voice-hearing. Thirty-four young people (age 14-18 years) with voice-hearing experiences and 34 young people who did not hear voices were recruited from NHS mental health services. Participants completed measures about social relating and potential explanatory factors. Analyses of covariance were used to examine between-group differences. Voice-hearers scored higher on negative schematic beliefs (self-beliefs, partial η2 = .163, p = .001; other-beliefs, partial η2 = .152, p =. 002) and depressive and anxiety symptoms (partial η2 = .23 and partial η2 = .24, p-s <. 001 respectively). The two groups did not differ significantly on childhood trauma levels (partial η2 = .02, p = .273), however, the voice-hearing group scored lower on premorbid adjustment (partial η2 = .19, p < .001). Hearing voices in help-seeking youth could be an indicator for social relating issues and holding negative schematic beliefs, and may be an indicator for of increased psychopathological complexity. Although poorer premorbid adjustment might indicate an early vulnerability to social relating difficulties, voice-hearing might be an aggravating factor and one that requires treatment.


Asunto(s)
Experiencias Adversas de la Infancia , Servicios de Salud Mental , Adolescente , Humanos , Estudios Transversales , Audición , Psicopatología
8.
PLoS One ; 18(8): e0288676, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37582069

RESUMEN

BACKGROUND: Calls have been made to rethink the mental health support currently available for young people. This study aims to help re-focus and reduce the inaccessibility of mental health services by offering an adapted version of a theoretically-driven, evidence-based, guided psychosocial intervention known as 'Groups 4 Health' (G4H). To date, the G4H intervention has mainly been trialled in Australia, with promising positive effects on social connection, mental health and well-being. The present study examines the feasibility of running a randomised controlled trial when delivering the G4H intervention for young people in the UK. METHODS: The TOGETHER study is a feasibility randomised controlled trial of an adapted version of the G4H intervention. Participants are aged 16-25, currently experiencing mental health difficulties and recruited from mental health services. The target sample size is 30, with 15 in each trial arm. Participants are randomly allocated to either G4H plus treatment as usual, or treatment as usual alone. The primary outcomes of interest are the feasibility of recruitment, randomisation, data collection and retention to the study at 10 and 14 week follow up, as well as the acceptability, and accessibility of the study protocol and G4H intervention. DISCUSSION: The results of this study will indicate if further optimisation is required to improve the feasibility, acceptability and accessibility of the intervention and study protocol procedures as perceived by end users and practitioners. This offers a significant opportunity to support the local and national demand for accessible, innovative, and effective psychosocial youth mental health support. TRIAL REGISTRATION: ISRCTN registry (ISRCTN12505807). Registration date: 11/04/2022.


Asunto(s)
Salud Mental , Grupo Social , Adolescente , Humanos , Estudios de Factibilidad , Servicio Social , Sistemas de Apoyo Psicosocial , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
BJPsych Open ; 9(4): e130, 2023 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-37466044

RESUMEN

BACKGROUND: There is growing evidence of a beneficial effect of social group processes on well-being and mental health. AIMS: To investigate the role of group membership continuity in reducing mental ill-health among young people who were already vulnerable pre-pandemic, and to understand the social and psychological mechanisms of the benefits of group memberships for vulnerable young people. METHOD: This study takes a cross-sectional design, using survey data from a sample of 105 young people aged 16-35 years, collected approximately 1 year after the global COVID-19 outbreak (January to July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences) and the mediation of these associations by hope and social connectedness (in-person and online). To correct for multiple testing, the Benjamini-Hochberg procedure was implemented for all analyses. Indirect effects were assessed with coverage of 99% confidence intervals. RESULTS: Multiple prior group memberships were associated with preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms. CONCLUSIONS: The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as means of helping to prevent exacerbation of symptoms and promote recovery of mental health problems, particularly during significant life events.

10.
Front Psychol ; 14: 1167869, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37287782

RESUMEN

Introduction: Due to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians' job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth. Method: Nine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention. Results: Compared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician's intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention. Discussion: Clinicians' intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.

11.
J Affect Disord ; 338: 329-340, 2023 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-37348656

RESUMEN

BACKGROUND: Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England. METHODS: A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022. RESULTS: Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not. LIMITATIONS: The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences. CONCLUSION: Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).


Asunto(s)
Trastornos Mentales , Servicios de Salud Mental , Adulto , Humanos , Salud Mental , Trastornos Mentales/terapia , Inglaterra , Investigación Cualitativa , Atención Primaria de Salud
12.
Behav Cogn Psychother ; 51(2): 133-145, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36511079

RESUMEN

BACKGROUND: Many individuals with first-episode psychosis experience severe and persistent social disability despite receiving specialist early intervention. The SUPEREDEN3 trial assessed whether augmenting early intervention in psychosis services with Social Recovery Therapy (SRT) would lead to better social recovery. AIMS: A qualitative process evaluation was conducted to explore implementation and mechanisms of SRT impact from the perspective of SUPEREDEN3 participants. METHOD: A subsample of SUPEREDEN3 trial participants (n = 19) took part in semi-structured interviews, which were transcribed verbatim and analysed thematically. Trial participants were early intervention service users aged 16-35 years with severe and persistent social disability. Both SRT plus early intervention and early intervention alone arm participants were interviewed to facilitate better understanding of the context in which SRT was delivered and to aid identification of mechanisms specific to SRT. RESULTS: The six themes identified were used to generate an explanatory model of SRT's enhancement of social recovery. Participant experiences highlight the importance of the therapist cultivating increased self-understanding and assertively encouraging clients to face feared situations in a way that is perceived as supportive, while managing ongoing symptoms. The sense of achievement generated by reaching targets linked to personally meaningful goals promotes increased self-agency, and generates hope and optimism. CONCLUSIONS: The findings suggest potentially important processes through which social recovery was enhanced in this trial, which will be valuable in ensuring the benefits observed can be replicated. Participant accounts provide hope that, with the right support, even clients who have persistent symptoms and the most severe disability can make a good social recovery.


Asunto(s)
Trastornos Psicóticos , Habilidades Sociales , Humanos , Trastornos Psicóticos/terapia , Trastornos Psicóticos/diagnóstico , Adolescente , Adulto Joven , Adulto , Ensayos Clínicos como Asunto
13.
Curr Psychol ; : 1-14, 2022 Dec 08.
Artículo en Inglés | MEDLINE | ID: mdl-36531191

RESUMEN

High rates of postgraduate researchers (PGRs) terminate their studies early. This attrition can have detrimental personal consequences, and results in a loss of productivity, and research and innovation for the higher education sector and society as a whole. PGRs are vulnerable to the experience of mental health problems; a factor that appears to be increasing attrition amongst students in the UK. However, investigation of the determinants of problems with PGRs' attendance and influencing intention to discontinue their studies is rare. Here, we consider the relative predictive validity of a set of putative predictors (mental health symptoms, demographic, occupational, psychological, social, and relational) of attendance behaviours (absenteeism, presenteeism, mental health-related intermission) and early attrition intention amongst UK PGRs. Depression, anxiety, and suicidality predicted attendance behaviours and greater attrition intention. Individual demographic and occupational factors predicted all outcomes. Psychological, social and relational factors had less predictive validity, although individual variables in these conceptual clusters did significantly predict some outcomes. Our results suggest that interventions to reduce high rates of mental health problems are likely to improve attendance behaviours, and reduce the extent to which PGRs intermit or consider ending their PhD studies for mental health-related reasons. Initiatives designed to improve supervisory relationships and reduce loneliness may also reduce absenteeism, intermission and attrition intention.

14.
BJPsych Open ; 8(5): e174, 2022 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-36156196

RESUMEN

BACKGROUND: Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed. AIMS: The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma. METHOD: We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis. RESULTS: We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive-compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor. CONCLUSIONS: Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions.

15.
PLoS One ; 17(8): e0273254, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35980988

RESUMEN

INTRODUCTION: Mental health stigma causes a range of diverse and serious negative sequelae. Anti-stigma campaigns have largely aligned with medical theories and categorical approaches. Such campaigns have produced some improvements, but mental health stigma is still prevalent. The effect of alternative theoretical perspectives on mental health within anti-stigma campaigns has not been tested. Moreover, we do not know their effect on help-seeking intentions. METHODS: We conducted an online experimental pre-post study comparing the effects of two anti-stigma campaign posters on mental health stigma and help-seeking intentions. One poster adhered to the medical, categorical approach to mental health, whereas the other poster portrayed mental health problems in line with a non-categorical, continuous perspective. RESULTS: After controlling for familiarity with the campaign poster, country of residence and pre-test scores, we found no significant between-group differences in terms of help-seeking intentions and all stigma attitudes except for danger-related beliefs. That is, those who viewed the non-categorical poster reported an increased perception that people with mental health problems are dangerous. DISCUSSION: Our largely null findings may suggest the equivalence of these posters on stigma and help-seeking intentions but may also reflect the brevity of the intervention. Our findings concerning danger beliefs may reflect a Type I error, the complexities of stigma models, or the adverse effects of increased perceived contact. Further research is needed to test the effects of differing mental health paradigms on stigma and help-seeking intentions over a longer duration.


Asunto(s)
Conducta de Búsqueda de Ayuda , Trastornos Mentales , Promoción de la Salud , Humanos , Intención , Trastornos Mentales/psicología , Salud Mental , Aceptación de la Atención de Salud/psicología , Estigma Social
16.
Br J Clin Psychol ; 61(4): 1038-1051, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-35762490

RESUMEN

OBJECTIVES: Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. METHODS: This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137). RESULTS: While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. CONCLUSIONS: While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.


Asunto(s)
Trastornos Paranoides , Trastornos Psicóticos , Adolescente , Cognición , Humanos , Trastornos Paranoides/psicología , Trastornos Psicóticos/psicología , Factores de Riesgo
17.
Psychol Psychother ; 95(4): 939-957, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35773751

RESUMEN

OBJECTIVES: Little is known about the factors that can maintain the distress related to voice-hearing experiences in youth. Building upon understandings developed with adults, this study aimed to explore the associations between negative relating between hearer and voices, persecutory beliefs about voices and voice-related distress in a clinical sample of adolescents. The study also aimed to investigate associations between relating to voices and wider patterns of social relating. DESIGN: This was an observational, cross-sectional, survey study. METHODS: Thirty-four young people (age 14-18 years) who were hearing voices completed measures about voices (characteristics, relating and beliefs) and relating to social others (negative relating styles, social connectedness and belongingness). Participants were patients of NHS mental health services. Bivariate correlations explored associations between relating to voices and distress, beliefs about voices and distress, and between relating to voices and social relating variables. RESULTS: Perceiving the voices as dominant, intrusive, and persecutory and resisting them was significantly associated with distress. Adjusting for loudness and negative content rendered the association between persecutory beliefs and distress non-significant. Fear of separation and of being alone in relation to social others was associated with distancing from voices. Being suspicious, uncommunicative and self-reliant and/or being sadistic and intimidating towards social others was significantly associated with dependence towards the voices. Greater hearer-to-voice dependence was associated with lower perceived social belongingness and connectedness. CONCLUSIONS: Beliefs about voices being persecutory, dominant, intrusive and resisting voices seem to be significant contributors of distress in young people. In terms of proximity and power, relating to voices and social others appears to be contrasting.


Asunto(s)
Alucinaciones , Relaciones Interpersonales , Adulto , Adolescente , Humanos , Estudios Transversales , Audición , Cognición
18.
BJPsych Open ; 8(2): e56, 2022 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-35241211

RESUMEN

BACKGROUND: Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care. AIMS: This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation. METHOD: Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. RESULTS: Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms. CONCLUSIONS: Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.

19.
Br J Psychiatry ; 220(3): 154-162, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35078555

RESUMEN

BACKGROUND: Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention. AIMS: We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone. METHOD: A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation. RESULTS: We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm. CONCLUSIONS: We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.


Asunto(s)
Trastornos Mentales , Adolescente , Análisis Costo-Beneficio , Humanos , Trastornos Mentales/prevención & control , Psicoterapia , Resultado del Tratamiento
20.
Adolesc Res Rev ; 7(2): 235-266, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34250220

RESUMEN

Hopefulness is arguably of central importance to the recovery of youth with major or complex youth depression, yet it is unclear how hopefulness can best be enhanced in treatment. A narrative synthesis of published and grey literature was combined with new insights from a youth lived-experience panel (N = 15), focusing on to what extent and how specific psychological therapies and standard mental health care scaffold hopefulness as applied to depression among 14-25-year-olds. Thirty-one studies of variable quality were included in this review; thirteen were qualitative, thirteen quantitative, and five used mixed methods. Hopefulness is an important active ingredient of psychotherapies and standard mental health care in youth depression. Evidence suggests talking and activity therapies have moderate to large effects on hopefulness and that hopefulness can be enhanced in standard mental health care. However, varying intervention effects suggest a marked degree of uncertainty. Hopefulness is best scaffolded by a positive relational environment in which there is support for identifying and pursuing personally valued goals and engaging in meaningful activity. Animated (https://www.youtube.com/watch?v=o4690PdTGec) and graphical summaries (https://doi.org/10.13140/RG.2.2.27024.84487) are available. Supplementary Information: The online version contains supplementary material available at 10.1007/s40894-021-00167-0.

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