Functional recovery in older adults with schizophrenia: A national interRAI study.

BACKGROUND: The concept of recovery for people with schizophrenia (PwS) is still a matter of debate. Growing numbers of PwS living to older age calls for examination of their disease trajectories with a focus on recovery. AIM: To compare two groups of PwS (good wellbeing; poor wellbeing) on several psychosocial variables associated with social wellbeing to identify interventions that support functional recovery. METHOD: Data was drawn from participants from across New Zealand (NZ), who had received a formal diagnosis of Schizophrenia; were living independently in the community, and who had undergone their first International Resident Assessment Instrument (interRAI) assessment from 2012 to 2022. We compared two groups of PwS (good social wellbeing; poor social wellbeing) examining associations with demographic and psychosocial variables. RESULTS: We compared interRAI assessments for: 'poor psychosocial wellbeing' (n = 1,378; 67%; 56% female; 70.5% 65 years and over; 36.1% never married); and 'good psychosocial wellbeing' (n = 693; 33%; 61.1% female; 78.1% 65 years and over; 29.8% never married; n = 549 did not have sufficient social wellbeing data to be included). We found significant associations between social wellbeing and depression, disruptive behaviour, decision making, self-expression, understanding verbal information, activity level, self-reported health and medication adherence. Logistical regression showed depression (ß = .84, p < .001, Wald = 51.01, Exp(B) = 2.31) and mild disruptive behaviour (ß = .63, p = .002, Wald = 9.26, Exp(B) = 0.53) were the only predictors of poor social wellbeing. Those who reported some degree of depressive symptoms were 2.31 (CI [1.84, 2.91]) more likely to be in the poor social wellbeing group. CONCLUSIONS: A significant minority (33.5%) of older PwS enjoy positive social wellbeing. Several psychosocial variables are associated with wellbeing. By addressing the comorbidity of depressive symptoms, we may be able to improve wellbeing for older PwS.

Sexual Assault in Older-Age Adults: Criminal Justice Response in New Zealand.

There is growing recognition that older persons, both male and female, may experience sexual assault. One clearly identified gap in the body of scientific literature is examination of the criminal justice response for older adults who have been sexually assaulted. This retrospective age-group comparative data analysis examines publicly available population and police statistics for 2018 to describe rates (per 100,000) of reported sexual assault across adult age categories (young adult, n = 748; adult, n = 1,478; middle age, n = 290; older adult, n = 58) and compare (using Chi-square bivariate analysis) the criminal justice response to sexual assault for these adult age categories in New Zealand (NZ). Sexual assault was perpetrated against victims across all age and sex groups examined. The rate of reported sexual assault against older adults was significantly lower after the age of 65 years (7.90 per 100,000) compared to younger adults aged 20-64 years (87.57 per 100,000). Across age categories no difference was found in the proportion of cases proceeded to court action. This study raises awareness of the topic of sexual assault perpetrated against older persons and shows that a substantial number of older adults experience sexual assault in cases that do not result in court action. It points to the need for policy-makers to consider the reporting of sexual assaults against older persons to justice services.

Mentoring: A Traditional Cook Island Approach to Support Men.

The present study examines a unique Cook Island approach to the rehabilitation and support of men, particularly those who have been convicted of criminal offending or who are experiencing other mental health or interpersonal difficulties. The culturally appropriate method of enabling change is offered via a community-based 24-hr mentoring system to support men. Run by men, the program is based on traditional Pacific ways of male mentoring in which one man helps another. This study examines the male mentoring program via qualitative analyses of semi-structured interviews. Seven men who had experienced mentoring and six mentors who deliver the program describe the mentoring system and their experiences. The study identifies several perceived benefits or themes in relation to the program. The unique Cook Islands' male mentoring program is viewed as beneficial in that it allows males to be open and supported to make change to be re-absorbed into the community, have healthy functioning, and reduce re-offending via the ongoing supportive care.

Impact, Ramifications and Taking Back Control: A Qualitative Study of Male Survivors of Childhood Sexual Abuse.

There is increasing recognition of the occurrence and frequency of male childhood sexual abuse (MCSA). Quantitative and qualitative research has demonstrated a number of adverse outcomes associated with MCSA in terms of mental health, physical health and difficulties in behavioural, social or interrelationship functioning. The present study gives voice to male survivors of childhood sexual abuse by exploring themes around the impact of MCSA over the course of their life. Interpretative phenomenological analysis (IPA) of semi-structured interviews with nine male survivors of childhood sexual abuse identified a single overarching theme of control and six related superordinate themes of: (i) responsibility, blame and shame; (ii) development of knowledge about sex and abuse; (iii) avoidance of coping with abuse; (iv) effects on relationships as adults; (v) disclosure of abuse to others; and (vi) gaining a sense of meaning of the abuse. The findings showed that being sexually abused defines and controls a person's life, and that despite the difficulties experienced by victims to move past the abuse, some experienced a degree of personal growth. The findings illustrate the way in which individuals can create meaning around their abuse experiences and take back control.

Does Gender Affect Judges' Perceptions of Sexual Assault Cases?

There is growing recognition that females engage in harmful sexual behaviour that is similar in severity and type to males. Existing research, however, suggests that there is a bias towards leniency in judicial systems for female sexual offenders (FSOs) in comparison to male sexual offenders (MSOs). Specifically, FSOs receive shorter sentences than do MSOs and are less likely to be sentenced to prison. The majority of research examining disparity in sentence outcomes for FSOs have been analysed through a quantitative lens. Qualitative methodology is also needed to understand any subjective differences in the way that judges perceive case-relevant factors and whether these perceptions differ as a function of the offender's gender. The present study is a qualitative study that examined judges' perceptions and descriptions of FSO compared to MSO in 10 matched cases of sexual offending. The study found that although there were many similarities in how judges perceived FSO compared to MSO, there were also unique differences that could explain more lenient sentences for FSOs (i.e. the vulnerability, poor mental health and adverse backgrounds of FSOs). Other unique differences found were that judges' perception of FSOs behaviour was described as depraved and cruel, whereas MSOs similar behaviour was not described in such an emotive way. The present study provides additional insight into the reasons for a bias towards leniency for FSOs. In particular, it points towards judicial focus on particular personal circumstances that are seen as relevant in sentencing FSOs but not for MSOs.

Spirituality: A Key Component of the Salvation Army's Bridge Programme Model of Treatment in Aotearoa New Zealand.

Spirituality is vital to The Salvation Army's Bridge model of treatment for alcohol and drug addiction. Spirituality is expressed through Recovery Church, prayer, spirituality lifters, the 12-step programme, and focuses on meaning and purpose. We recruited participants from several regional centers throughout Aotearoa New Zealand and evaluated spirituality using the WHOQol-SRPB and open-ended questions. Most participants held broad understandings of spirituality, only a minority equating it with religion. Participants who completed the Programme had statistically significant increases in spiritual wellbeing at end-of-treatment. These increases were maintained at a 3-month follow-up. Increases in spiritual wellbeing were associated with decreases in severity of alcohol and drug use.

Seeking of help and support after experiencing sexual harm: considerations for cisgender women, cisgender men and gender-diverse people.

AIMS: This study examines the help-seeking behaviours of cisgender women, cisgender men and gender-diverse university students who have experienced sexual harm. METHODS: We examine an existing data set from a cross-sectional survey of experiences of sexual harm among university students. Bivariate analyses were used to analyse the type of sexual harm experienced and subsequent help-seeking behaviours. RESULTS: Although more cisgender women reported experiencing sexual harm, data from this survey demonstrates cisgender men and gender-diverse persons also report experiencing sexual harm. Of those who reported having experienced sexual harm, only a small proportion (27%) reported having told someone about their experience. People who told, most often told family or friends. Additionally, a small proportion of cisgender women told specialised sexual violence services or other services. Cisgender men were less likely to tell someone about their experience compared to cisgender women. CONCLUSIONS: Sexual harm affects students of all genders on campus but there may be differential help-seeking behaviours depending on gender. Cisgender men and gender-diverse persons may be less likely to reach out to formal service providers. Support services need to consider how to accommodate the support needs of all survivors, including cisgender men and gender-diverse persons.

The use and impact of repeated questions in diagnostic child abuse assessment interviews.

There is limited research regarding the use of repeated questions and the subsequent response from children in real-world forensic contexts. We analysed 71 transcripts of diagnostic assessments in which 3- to 6-year-olds were assessed for suspected abuse experiences. On average, 6% of interviewer questions were repeated, and 47% of the repeated questions were abuse-related. The majority (65%) of the repeated questions were directive, but 33% of the repeated questions contained implicit assumptions. Implicit assumption questions were more likely to be abuse-related. Interviewers repeated questions when the child failed to answer due to playing (31%), for no apparent reason (26%) or for clarification purposes (29%). Children most commonly responded to repeat questions by providing new information (64%), not responding at all (19%) or repeating information (12%). We recommend that interviewers avoid the use of suggestive and repeated questions that contain implicit assumptions in relation to assessment of suspected child abuse.

Multisite sentinel surveillance of self-harm in New Zealand: protocol for an observational study.

INTRODUCTION: New Zealand (NZ) has a persistently high rate of suicide, particularly among young people. Hospital presentation for self-harm (SH) is one of the strongest predictors of death by suicide. Improving the monitoring of SH and suicide is a key recommendation for suicide prevention by WHO. This study will establish the first ever sentinel surveillance for SH at several large hospitals and a monthly survey of all practicing paediatricians in NZ. The study will provide robust information about the epidemiology of SH, factors associated with SH and the types of interventions required for those presenting to hospital with SH. METHOD AND ANALYSIS: This observational study will establish SH surveillance in the emergency departments of three public hospitals for the first time in NZ, where study population will include individuals of all ages who present with SH or suicidal ideation. The study methodology is in line with the WHO Best Practice guidelines and international collaborators in Australia and Europe. Electronic triage records will be reviewed manually by the research team to identify potential cases that meet inclusion criteria. For all eligible cases, variables of interest will be extracted from routine clinical records by the research team and recorded on a secure web-based survey application. Additionally, SH surveillance data for the national paediatric population (<15 years) will be obtained via the New Zealand Paediatric Surveillance Unit (NZPSU); paediatricians will report on included cases using the same variables using a secure survey application. A deidentified dataset will be produced for aggregated statistical analysis. ETHICS AND DISSEMINATION: The University of Otago Health Ethics Committee granted ethical approval for this study in addition to local ethics approval at participating hospital sites. The study findings will be disseminated to relevant stakeholders in NZ, in addition to international audiences through publications in peer-reviewed scientific journals and conference presentations.

Strategies to Prevent Elderly Suicide: A Delphi Consensus Study.

OBJECTIVES: In the next decades, many countries will become 'ageing societies'. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide. METHODS: A New Zealand (NZ) 'expert panel' has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults' suicide prevention. RESULTS: A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for 'A suicide prevention strategy for the elderly…' to enhance the national all-ages suicide prevention strategy. CONCLUSION: The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.

Interviews with children about their mental health problems: The congruence and validity of information that children report.

To obtain a child's perspective during a mental health assessment, he or she is usually interviewed. Although researchers and clinicians generally agree that it is beneficial to hear a child's account of his or her presenting issues, there is debate about whether children provide reliable or valid clinical information during these interviews. Here, we examined whether children provide clinically and diagnostically relevant information in a clinical setting. In all, 31 children aged 5-12-years undergoing mental health assessments were asked open-ended questions about their presenting problems during a semi-structured interview. We coded the information that children reported to determine whether it was clinically relevant and could be used to diagnose their problems and to formulate and plan treatment. We also coded children's information to determine whether it was congruent with the children's presenting problems and their eventual clinical diagnoses. Most of the information that children reported was clinically relevant and included information about behaviour, affect, temporal details, thoughts, people, the environment, and the child's physical experiences. The information that children reported was also clinically valid; it was congruent with the problems that were discussed (84%) and also with the eventual diagnosis that the child received after a complete assessment (74%). We conclude that children can contribute relevant, clinically useful, valid information during clinical psychological assessments.

Drawing helps children to talk about their presenting problems during a mental health assessment.

When children require mental health services, clinicians need to conduct assessments that are developmentally sensitive and that include the child's point of view. Drawing is a popular tool that is commonly used in clinical settings. Research on drawing in experimental settings has confirmed that the opportunity to draw while talking increases the amount of verbal information that children report during an interview. The present research examined whether drawing also facilitates children's self reports during a mental health assessment. A total of 33 5-12-year-old children were asked either to draw and tell about their presenting problem or to tell only. Children who drew and told provided twice as much verbal information as children who told only. Further, interviewers in the draw and tell condition used a greater number of minimal responses than did interviewers in the tell only condition. These data have important implications for clinical practice.