One-year recovery rates for young people with depression and/or anxiety not receiving treatment: a systematic review and meta-analysis.

OBJECTIVES: To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022. ELIGIBILITY CRITERIA: Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10-24 years without specific treatment. DATA EXTRACTION AND SYNTHESIS: Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale. RESULTS: Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63). CONCLUSIONS: The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety. PROSPERO REGISTRATION NUMBER: CRD42021251556.

Living with Psychosis without Mental Health Services: A Narrative Interview Study.

OBJECTIVES: Little research has looked at how people who do not use mental health services experience psychosis. Thus, the present study aimed to explore the experiences and views of people with psychosis who have neither sought nor received support from mental health services for at least 5 years. DESIGN: A narrative interview study. Thematic analysis was used to analyse the data. SETTING: England. PARTICIPANTS: Twenty-eight participants with self-defined psychotic experiences were asked to provide a free narrative about their experiences. RESULTS: Five themes were identified: (1) Perceiving psychosis as positive; (2) Making sense of psychotic experiences as a more active psychological process to find explanations and meaning; (3) Finding sources of strength, mainly in relationships and the environment, but outside of services; (4) Negative past experiences of mental health services, leading to disengagement and (5) Positive past experiences with individual clinicians, as an appreciation of individuals despite negative views of services as a whole. CONCLUSIONS: Perceiving psychosis as something positive, a process of making sense of psychotic experiences and the ability to find external sources of strength all underpin-in addition to negative experiences with services-a choice to live with psychosis outside of services. Future research may explore to what extent these perceptions, psychological processes and abilities can be facilitated and strengthened, in order to support those people with psychosis who do not seek treatment and possibly also some of those who are in treatment.

Experience of neighbourhood violence and mental distress in Brazilian favelas: a cross-sectional household survey.

Background: Living in informal settlements with extensive neighbourhood violence has been shown to be linked with poorer mental health. However, there is little evidence as to whether different levels of personal experiences and fears of neighbourhood violence within such settlements affect mental health. This study assessed such personal experiences and fears of residents in favelas in Brazil. We tested whether variations predict mental health symptoms and quality of life, and whether this is independent of the influence of sociodemographic characteristics and poverty. Methods: In a population-based survey of adults living in a group of favelas in Rio de Janeiro, Brazil, we assessed: sociodemographic characteristics; extent of personal experiences and fear of neighbourhood violence; mental health symptoms on the Brief Symptom Inventory; and quality of life on the Manchester Short Assessment of Quality of Life. Univariate and multivariate regressions were fit to predict mental health symptoms and quality of life. Findings: We interviewed 1,211 residents. Both more experiences of neighbourhood violence and more fear of violence predicted higher levels of mental health symptoms and poorer quality of life. In multivariate regression analyses, the associations remained significant after adjusting for the influence of other factors, in particular female gender, younger age, and marked poverty. Interpretation: Even within a context in which the whole population can be exposed to violence and economic disadvantage, individual variations in the experiences of violence still make a significant difference for mental distress and quality of life. Policies to improve mental health and quality of life of residents in informal settlements need to address risk factors separately, most importantly the personal experiences of violence and poverty. Funding: Economic and Social Research Council and Arts and Humanities Research Council in the United Kingdom. Antecedentes: Viver em assentamentos informais, com ampla violência na vizinhança, parece estar associado a piores condições de saúde mental. No entanto, há poucas evidências de que, nestes locais, os diferentes níveis de experiências pessoais e o medo da violência na vizinhança afetem a saúde mental. Este estudo avaliou experiências pessoais e medos de moradores de favelas no Brasil. Testamos se tais variações predizem sintomas de saúde mental e qualidade de vida, e se isso é independente da influência das características sociodemográficas e da pobreza. Métodos: Com base em um inquérito domiciliar de base populacional, realizado com adultos residentes em um grupo de favelas do Complexo da Maré, Rio de Janeiro, Brasil, foram observadas: características sociodemográficas; a extensão das experiências pessoais de exposição à violência e o medo da violência na vizinhança; sintomas de saúde mental, a partir do Inventário de Sintomas Psicopatológicos (BSI); e qualidade de vida, a partir da escala Manchester Short Assessment of Quality of Life (MANSA). Regressões univariadas e multivariadas foram ajustadas para explicar variações nos sintomas de saúde mental e qualidade de vida. Resultados: Entrevistamos 1.211 pessoa adultas residentes na Maré. Tanto maiores níveis de exposição a experiências de violência na vizinhança quanto mais medo dessa violência estiveram relacionados a piores níveis de saúde mental (maior número e intensidade de sintomas no BSI) e pior qualidade de vida. Nas análises de regressão multivariada, tais associações permaneceram significativas mesmo após controlarmos pela influência de outros fatores, em particular sexo (feminino), idade (mais jovem) e pobreza acentuada. Interpretação: Mesmo em um contexto no qual toda a população pode estar exposta à violência e a desvantagens materiais e econômicas, as variações individuais nas experiências de violência ainda assim fazem diferença significativa nas condições de sofrimento mental e qualidade de vida. Políticas para melhorar a saúde mental e a qualidade de vida dos residentes de assentamentos informais, como as favelas, precisam abordar fatores de risco separadamente focando, principalmente, na redução da exposição a experiências pessoais de violência e da pobreza. Financiamento: Economic and Social Research Council (ESRC) e Arts and Humanities Research Council (AHRC), ambos do Reino Unido.

Evaluation of a positive psychotherapy group intervention for people with psychosis: pilot randomised controlled trial.

AIMS: Third-wave psychological interventions have gained relevance in mental health service provision but their application to people with psychosis is in its infancy and interventions targeting wellbeing in psychosis are scarce. This study tested the feasibility and preliminary effectiveness of positive psychotherapy adapted for people with psychosis (WELLFOCUS PPT) to improve wellbeing. METHODS: WELLFOCUS PPT was tested as an 11-week group intervention in a convenience sample of people with psychosis in a single centre randomised controlled trial (ISRCTN04199273) involving 94 people with psychosis. Patients were individually randomised in blocks to receive either WELLFOCUS PPT in addition to treatment as usual (TAU), or TAU only. Assessments took place before randomisation and after the therapy. The primary outcome was wellbeing (Warwick-Edinburgh Mental Well-Being Scale, WEMWBS). Secondary outcomes included symptoms (Brief Psychiatric Rating Scale), depression (Short Depression-Happiness Scale), self-esteem, empowerment, hope, sense of coherence, savouring beliefs and functioning, as well as two alternative measures of wellbeing (the Positive Psychotherapy Inventory and Quality of Life). Intention-to-treat analysis was performed. This involved calculating crude changes and paired-sample t-tests for all variables, as well as ANCOVA and Complier Average Causal Effect (CACE) Analysis to estimate the main effect of group on all outcomes. RESULTS: The intervention and trial procedures proved feasible and well accepted. Crude changes between baseline and follow-up showed a significant improvement in the intervention group for wellbeing according to all three concepts assessed (i.e., WEMWBS, Positive Psychotherapy Inventory and Quality of Life), as well as for symptoms, depression, hope, self-esteem and sense of coherence. No significant changes were observed in the control group. ANCOVA showed no main effect on wellbeing according to the primary outcome scale (WEMWBS) but significant effects on symptoms (p = 0.006, ES = 0.42), depression (p = 0.03, ES = 0.38) and wellbeing according to the Positive Psychotherapy Inventory (p = 0.02, ES = 0.30). Secondary analysis adapting for therapy group further improved the results for symptom reduction (p = 0.004, ES = 0.43) and depression (p = 0.03, ES = 0.41) but did not lead to any more outcomes falling below the p = 0.05 significance level. CACE analysis showed a non-significant positive association between the intervention and WEMWBS scores at follow-up (b = 0.21, z = 0.9, p = 0.4). CONCLUSIONS: This study provides initial evidence on the feasibility of WELLFOCUS PPT in people with psychosis, positively affecting symptoms and depression. However, more work is needed to optimise its effectiveness. Future research might evaluate positive psychotherapy as a treatment for comorbid depression in psychosis, and consider alternative measurements of wellbeing.

Staff views on wellbeing for themselves and for service users.

BACKGROUND: Wellbeing is an important outcome in the context of recovery from mental illness. The views of mental health professionals on wellbeing may influence their approach to supporting recovery. AIMS: This study aims to explore views held by mental health staff about factors influencing their own wellbeing and that of service users with psychosis. METHODS: Semi-structured interviews were conducted with 14 mental health staff in South London who had worked with people with psychosis. Thematic analysis was used to analyse the data and comparisons were made between staff views of wellbeing for themselves and service users. RESULTS: Staff participants held similar conceptualisations of wellbeing for themselves and for service users. However, they suggested a differential impact on wellbeing for a number of factors, such as balance, goals and achievement, and work. Staff employed a more deficit-based perspective on wellbeing for service users and a more strengths-based view for themselves. CONCLUSIONS: Staff stated a recovery orientation in principle, but struggled to focus on service user strengths in practice. A stronger emphasis in clinical practice on amplifying strengths to foster self-management is indicated, and staff may need support to achieve this emphasis, e.g. through specific interventions and involvement of peer support workers.

Mental health service user experience of positive psychotherapy.

OBJECTIVE: Service user satisfaction with therapy is a key part of the therapeutic process. The aim of this study was to investigate service user experiences of an 11-week group positive psychology intervention for psychosis (WELLFOCUS PPT) in the context of a randomized controlled trial (ISRCTN04199273). METHOD: Participants were 37 individuals (51% male; mean age 45.6 years) receiving the intervention as part of the trial. Semistructured interviews and focus groups were conducted to investigate participants' views of WELLFOCUS PPT. Transcripts were analyzed both deductively and inductively to identify common themes. RESULTS: Feedback about the group experience was positive throughout. Components found helpful included learning to savor experiences, identifying and developing strengths, forgiveness, gratitude, and therapist self-disclosure. CONCLUSION: Findings emphasize the importance of considering service users' perceptions of therapy and can be used to guide clinicians in deciding whether to include one or more of the components of WELLFOCUS PPT in therapy.