Alcohol, cannabis, and nicotine use have distinct associations with COVID-19 pandemic-related experiences: An exploratory Bayesian network analysis across two timepoints.

BACKGROUND: Substance use trends during the COVID-19 pandemic have been extensively documented. However, relatively less is known about the associations between pandemic-related experiences and substance use. METHOD: In July 2020 and January 2021, a broad U.S. community sample (N = 1123) completed online assessments of past month alcohol, cannabis, and nicotine use and the 92-item Epidemic-Pandemic Impacts Inventory, a multidimensional measure of pandemic-related experiences. We examined links between substance use frequency, and pandemic impact on emotional, physical, economic, and other key domains, using Bayesian Gaussian graphical networks in which edges represent significant associations between variables (referred to as nodes). Bayesian network comparison approaches were used to assess the evidence of stability (or change) in associations between the two timepoints. RESULTS: After controlling for all other nodes in the network, multiple significant edges connecting substance use nodes and pandemic-experience nodes were observed across both time points, including positive- (r range 0.07-0.23) and negative-associations (r range -0.25 to -0.11). Alcohol was positively associated with social and emotional pandemic impacts and negatively associated with economic impacts. Nicotine was positively associated with economic impact and negatively associated with social impact. Cannabis was positively associated with emotional impact. Network comparison suggested these associations were stable across the two timepoints. CONCLUSION: Alcohol, nicotine, and cannabis use had unique associations to a few specific domains among a broad range of pandemic-related experiences. Given the cross-sectional nature of these analyses with observational data, further investigation is needed to identify potential causal links.

Breaking through social determinants of health: Results from a feasibility study of Imani Breakthrough, a community developed substance use intervention for Black and Latinx people.

Racial and ethnic disparities in substance use intervention design, implementation, and dissemination have been recognized for years, yet few intervention programs have been designed and conducted by and for people who use substances. Imani Breakthrough is a two-phase 22-week intervention developed by the community, run by facilitators with lived experience and church members, that is implemented in Black and Latinx church settings. This community-based participatory research (CBPR) approach is a concept developed in response to a call for action from the State of Connecticut Department of Mental Health and Addiction Services (DMHAS) with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to address rising rates of death due to opioid overdose, and other negative consequences of substance misuse. After nine months of didactic community meetings, the final design involved twelve weeks of education in a group setting related to the recovery process, including the impact of trauma and racism on substance use, and a focus on citizenship and community participation and the 8 dimensions of wellness, followed by ten weeks of mutual support, with intensive wraparound support and life coaching focused on the social determinants of health (SDOH). We found the Imani intervention was feasible and acceptable, with 42 % of participants retained at 12 weeks. In addition, in a subset of participants with complete data, we found a significant increase in both citizenship scores and dimensions of wellness from baseline to week 12, with the greatest improvements in the occupational, intellectual, financial, and personal responsibility dimensions. As drug overdose rates among Black and Latinx people who use substances continue to increase, it is imperative that we address the inequities in the SDOH that contribute to this disparity gap so that we can develop interventions tailored to the specific needs of Black and Latinx people who use drugs. The Imani Breakthrough intervention shows promise as a community-driven approach that can address these disparities and promote health equity.

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.].

Peer Health Navigation Experiences Before and After Prison Release Among People With Opioid Use Disorder.

OBJECTIVE: Recently incarcerated people with opioid use disorder are at high risk of overdose and adverse outcomes as a result of biopsychosocial risk factors. Peer support models aiming to improve these outcomes have expanded in recent years. This qualitative study aimed to document participants' experiences with peer health navigation before and after prison release, examine participants' perspectives on the role of peer health navigators, and understand participants' views on service improvements. METHODS: The authors conducted in-depth, semistructured interviews with 39 recipients of peer health navigation at release, 30 of whom also completed a follow-up interview 3 months later. Interviews were analyzed via cross-case analysis. RESULTS: Interviewees differently valued the various types of support they received. Participants appreciated working with someone with shared lived experience with whom they could establish a trusting relationship. Nevertheless, structural and policy barriers meant that certain key needs-such as housing and employment-could not always be met. CONCLUSIONS: Peer health navigators can connect participants to evidence-based treatment and help them address their psychosocial needs and develop skills to support long-term wellness. Further research is needed to assess the impact of peer health navigation on participant outcomes, such as overdose reduction, treatment engagement, and sustained recovery.

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.

Outcomes of Peer-Provided Individual Placement and Support Services in a Mental Health Peer-Run Vocational Program.

OBJECTIVE: The authors sought to determine whether staff at a peer-run agency could deliver supported employment services with high fidelity to the individual placement and support (IPS) model and whether employment outcomes of peer-delivered IPS plus work-specific health promotion were superior to usual supported employment services. METHODS: Two teams from a vocational program of a large peer-run agency were studied from July 2015 to July 2017. One team received training and supervision in delivering IPS plus employment-focused physical wellness support and mentoring. The other team continued providing usual supported employment services. Study data included vocational outcomes from 348 clients served by the two teams (IPS, N=184; comparison condition, N=164) and the results of IPS fidelity reviews of the IPS team at study baseline, midpoint, and end. The authors modeled the primary outcome of competitive employment with random-effects logistic regression and adjusted propensity scores for age, gender, race, ethnicity, education, and months of service receipt. RESULTS: Following training, the IPS team demonstrated acceptable and increasing fidelity to the IPS model, achieving "good fidelity" by the end of the 25-month observation period. Among IPS recipients, 43% achieved competitive employment versus 21% of comparison recipients (p<0.001). Multivariable analysis indicated that IPS recipients were significantly more likely to achieve competitive employment than individuals in the comparison group (OR=4.06, p<0.001). CONCLUSIONS: Providing training in IPS along with health promotion to the behavioral health peer workforce may help address the severe shortage of IPS services and enhance the competitive employment outcomes of people served by peer-run programs.

Financial Hardship, Hope, and Life Satisfaction Among Un/Underemployed Individuals With Psychiatric Diagnoses: A Mediation Analysis.

Background: Individuals with psychiatric diagnoses who are unemployed or underemployed are likely to disproportionately experience financial hardship and, in turn, lower life satisfaction (LS). Understanding the mechanisms though which financial hardship affects LS is essential to inform effective economic empowerment interventions for this population. Aim: To examine if subjective financial hardship (SFH) mediates the relationship between objective financial hardship (OFH) and LS, and whether hope, and its agency and pathways components, further mediate the effect of SFH on LS among individuals with psychiatric diagnoses seeking employment. Methods: We conducted structured interviews with participants (N = 215) of two peer-run employment programs using indicators of OFH and SFH and standardized scales for hope (overall hope, hope agency, and hope pathways) and LS. Three structural equation models were employed to test measurement models for OFH and SFH, and mediational relationships. Covariates included gender, age, psychiatric diagnosis, race/ethnicity, education, income, employment status, SSI/SSDI receipt, and site. Results: Confirmatory factor analysis (CFA) for items measuring OFH and SFH supported two separate hypothesized factors. OFH had a strong and significant total effect on SFH [standardized beta (B) = 0.68] and LS (B = 0.49), and a weak-to-moderate effect on hope (B = -0.31). SFH alone mediated up to 94% of the effect of OFH on LS (indirect effect B = -0.46, p < 0.01). The effect of SFH on LS through hope was small (indirect effect B = -0.09, p < 0.05), primarily through hope agency (indirect effect B = -0.13, p < 0.01) and not hope pathways. Black and Hispanic ethno-racial identification seemed to buffer the effect of financial hardship on hope and LS. Individuals identifying as Black reported significantly higher overall hope (B = 0.41-0.47) and higher LS (B = 0.29-0.46), net of the effect of OFH and SFH. Conclusion: SFH is a strong mediator of the relationship between OFH and LS in our study of unemployed and underemployed individuals with psychiatric diagnoses. Hope, and particularly its agency component, further mediate a modest but significant proportion of the association between SFH and LS. Economic empowerment interventions for this population should address objective and subjective financial stressors, foster a sense of agency, and consider the diverse effects of financial hardship across ethno-racial groups.

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.].

Improving Black Mental Health: A Collective Call to Action.

A constellation of factors detrimentally affects Black mental health at individual and community levels. Issues such as racism, trauma, and a lack of culturally relevant services prevent access to timely, high-quality mental health treatment. These negative experiences, exacerbated by the current impacts of the COVID-19 pandemic, contribute to the increased prevalence of mental health conditions in Black communities. The authors call for a Wellness First approach to dismantle the status quo and to mobilize collective action among individuals, providers, organizations, funders, and policy makers to create equitable opportunities that promote healing and prevent further trauma in Black communities.

The importance of employment to workers with preexisting behavioral health disorders during the COVID-19 pandemic.

OBJECTIVE: Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. METHOD: Two hundred and seventy two adults with behavioral health conditions, recruited through statewide mental health networks in NJ and NY, completed an online survey in April-May 2020. Multivariable analysis examined the effects of sleep and dietary changes, COVID-19 exposure, anxiety (Generalized Anxiety Disorder-2), and depressive symptoms (Patient Health Questionnaire-2) on employment status and job changes. Respondents' open-ended descriptions of pandemic-related changes in employment were analyzed using the constant comparative method. RESULTS: Two-thirds (65%) were employed, only 4% became unemployed, and 29% reported changes in their jobs as a result of the pandemic. In logistic regression analysis controlling for age, race, education and gender, workers were more likely than nonworkers to report altered eating and sleeping habits, but not greater anxiety or depression. However, those whose jobs changed were more likely to report COVID-19 exposure, altered sleep patterns, clinically significant anxiety symptoms, and both anxiety and depressive symptoms compared to those whose jobs had not changed. Qualitative analysis revealed work's positive impact (pride in job performance, using new skills, feeling safer working from home) and its negative effects (lifestyle disruption, worry about job security, isolation from coworkers). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first study to suggest the important role that work played for people with preexisting behavioral health disorders during the pandemic, with both positive and negative influences, and important implications for services and supports. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.].

Multidimensional wellness for people aging with mental health conditions: A proposed framework.

OBJECTIVE: This project aimed to develop a synthesized framework of multidimensional wellness for people aging with serious mental health conditions (SMHC) using existing frameworks to serve as a guide for policy and interventions to address the unique needs, experiences, and strengths of the population. METHOD: A concept analysis compared a widely used wellness approach (Swarbrick, 1997) for people with SMHC and one for older adults (Fullen, 2019) to synthesize into a practical framework for people aging with SMHC. RESULTS: Nine dimensions were proposed for conceptualizing the wellness of this population including: (a) Developmental, (b) Intellectual/Cognitive, (c) Physical, (d) Emotional, (e) Social, (f) Occupational, (g) Spiritual, (h) Environmental, and (i) Financial. Practical suggestions for implementation are identified. CONCLUSIONS AND IMPLICATION FOR PRACTICE: People aging with SMHC require rehabilitation services that address their unique perspectives, strengths, and challenges. The proposed adapted wellness framework offers a guide to comprehensively address well-being in people aging with SMHC. Placing the model in the context of external factors of resources and supports available, and the impact of societal perspectives about each dimension, further delineates a holistic model of wellness that considers well-being and successful living. This model can offer structure and practical application for services, and consideration of future needs of people aging with SMHC to support psychiatric rehabilitation services, as well as offer strategies to encourage positive aging and recovery. Future work should explore the impact of multidecade experiences of mental health conditions and the mental health system to better support individual recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact of the COVID-19 pandemic on the mental health and daily life of adults with behavioral health disorders.

People with behavioral health disorders may be particularly vulnerable to the impact of the COVID-19 pandemic, yet little is known about how they are faring. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives of adults with mental health and substance use disorders since the pandemic onset. A cross-sectional, online survey was completed by 272 adults in April and May 2020, recruited from statewide networks of community programs in New Jersey and New York. Measures included the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder-2 to screen for depressive and anxiety disorders. Also assessed was the pandemic's impact on sleep and dietary patterns, exposure to COVID-19 infection, and access to health care and medications. Finally, respondents were asked to describe in their own words any changes in their lives since the pandemic began. Over one-third (35.1%) screened positive for generalized anxiety disorder and over one-quarter (29.6%) screened positive for major depressive disorder. The majority reported pandemic-related changes in eating and sleeping patterns and exposure to COVID-19 infection. Multivariable logistic regression analysis found that many changes attributed to the pandemic were positively and significantly associated with screening positive for anxiety and depressive disorders. Qualitative analysis confirmed these findings and identified participants' resilience stemming from social support, emotion management, and self-care. These results can inform the design of services that assist this population to bolster self-management skills and reestablish daily habits to improve their lives during and following the pandemic.

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.].

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.].

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.

Perspectives on trauma and the design of a technology-based trauma-informed intervention for women receiving medications for addiction treatment in community-based settings.

BACKGROUND: Despite national calls to develop gender-specific interventions for women with opioid use disorder (OUD) with co-occurring trauma and post-traumatic stress disorder (PTSD) symptoms, there remains a dearth of research on what modalities or treatment components would be most feasible for this population. This study interviewed women with OUD receiving medication assisted treatment and addiction treatment providers to explore (a) experiences of barriers to receiving trauma treatment, and (b) both the perceptions and desired design of a prospective technology-delivered, trauma-informed treatment for women with OUD. METHODS: Women with lifetime OUD (n = 11) and providers (n = 5) at two community substance use clinics completed semi-structured interviews. Interviews were transcribed, coded, and analyzed in NVivo v11 using a grounded theory approach. Women also completed a demographic form and clinical measures. RESULTS: Clients were primarily women with children reporting histories of multiple trauma exposures, high PTSD symptoms, and polysubstance use. Two themes emerged among clients and one among providers regarding barriers to trauma treatment. Regarding the feasibility and desired attributes of a technology-based intervention, six themes emerged among clients and providers, respectively. CONCLUSIONS: Themes suggest a high interest by clients and providers for a technology-delivered, trauma informed treatment available by smartphone. Utilizing technology as an adjunct to care, without reducing face-to-face therapy, was important to both clients and providers.