Self-perceived problems in daily activities and strategy building in people with different stages of dementia.

BACKGROUND: People with dementia experience severe problems in their daily lives. However, little is known about self-perceived problems in the course of dementia. The aim of our study was to assess self-perceived problems with daily activities as well as individually developed strategies of older people of different cognitive status. METHODS: Semi-structured interviews were conducted with 25 participants (mean age 67.6 years, 56% female, 24% healthy, 28% mild dementia, 48% severe dementia). Questions addressed problems in daily activities, their occurrence and the behaviour toward them, and their developed strategies. Information was summarized quantitatively and evaluated using the chi-squared and Kruskal-Wallis tests. RESULTS: Self-perceived problems included awareness of physical and cognitive deficits in managing daily life, disturbing factors, and lost autonomy. Increased cognitive impairment was associated with more problems in daily life, even though people with severe dementia seemed not to recognize them. The most frequently reported strategies included orderliness, doing things immediately, and the use of external aids. While healthy people and those with mild dementia developed strategies, those with severe dementia reported only few strategies. CONCLUSION: Our findings indicate that self-perceived problems in daily life and strategy development are strongest in mild dementia, while people with more severe dementia tend to perceive no problems at all while correctly reflecting their current state of dependency. Importantly, despite memory loss during early stages of dementia, strategies are still being developed. Accordingly, strategies for daily living should be taught in early dementia to sustain an independent lifestyle.

Understanding the role of institutions in the multiple streams approach through the recognition of the diaspora as a development agent in Cameroon.

This article examines the potential contribution of the diaspora to development in Cameroon. It illuminates the role of institutional dynamics within the Multiple Streams Approach (MSA). Drawing on the concept of problem compatibility, this research demonstrates that problem recognition does not occur solely as a result of the work of policy entrepreneurs or problem brokers. It also depends on the institutional context within which the problem arises. Data demonstrate that the shock of the economic crisis and its repercussions in Cameroon required innovative sources of development financing, particularly capitalizing on resources from the diaspora, otherwise known as the diaspora option. This led in part to the modification of the "appreciative system" of its network on diaspora policy. Moreover, the heterogeneity of this network has reframed the view of the diaspora, long considered a threat to the stability and security of the country. This analysis, based on interviews with fifteen government officials, experts, and professionals, highlights the institutional processes that drive the problem stream.

Predictors of help-seeking behavior in mothers of preschoolers.

Mental health difficulties in the preschool years require early intervention, but preschool children are underserved in mental healthcare. One explanation might be that parents do not seek services because their problem recognition, or labeling, ability is lacking. While previous research demonstrates that labeling is positively associated with help-seeking, interventions aimed at improving help-seeking by improving labeling are not always successful. Parental perceptions of severity, impairment, and stress also predict help-seeking, but have not been examined alongside labeling. Thus, it is unclear how much they add to the parental help-seeking process. The present study simultaneously examined labeling and parental perceptions of severity, impairment, and stress on help-seeking. Participants (82 adult mothers of children ages 3-5 years) read vignettes describing preschool-aged children with symptoms of depression, anxiety, and ADHD, and answered a series of questions to assess their labeling and likelihood of help-seeking for each of the problems presented. Help-seeking was found to be positively associated with labeling (r = .73; r = .60), severity (r = .66), impairment (r = .31), and stress (r = .25). Furthermore, severity, impairment, and stress predicted endorsements of help-seeking above and beyond what was predicted by labeling alone (R2 change = .12; χ2 (3) = 20.03, p < .01). These results underscore the importance of parental perceptions of children's behavior to the help-seeking process.

Problem drinking recognition among UK military personnel: prevalence and associations.

PURPOSE: Despite the higher prevalence of problem drinking in the UK military compared to the general population, problem recognition appears to be low, and little is known about which groups are more likely to recognise a problem. This study examined prevalence of problem drinking recognition and its associations. METHODS: We analysed data from 6400 regular serving and ex-serving personnel, collected in phase 3 (2014-2016) of the King's Centre for Military Health Research cohort study. MEASUREMENTS: Participants provided sociodemographic, military, health and impairment, life experiences, problem drinking, and problem recognition information. Problem drinking was categorised as scores ≥ 16 in the AUDIT questionnaire. Associations with problem recognition were examined with weighted logistic regressions. FINDINGS: Among personnel meeting criteria for problem drinking, 49% recognised the problem. Recognition was most strongly associated (ORs ≥ 2.50) with experiencing probable PTSD (AOR = 2.86, 95% CI = 1.64-5.07), social impairment due to physical or mental health problems (AOR = 2.69, 95% CI = 1.51-4.79), adverse life events (AOR = 2.84, 95% CI = 1.70-4.75), ever being arrested (AOR = 2.99, CI = 1.43-6.25) and reporting symptoms of alcohol dependence (AOR = 3.68, 95% CI = 2.33-5.82). To a lesser extent, recognition was also statistically significantly associated with experiencing psychosomatic symptoms, feeling less healthy, probable common mental health disorders, and increased scores on the AUDIT. CONCLUSION: Half of UK military personnel experiencing problem drinking does not self-report their drinking behaviour as problematic. Greater problem drinking severity, poorer mental or physical health, and negative life experiences facilitate problem recognition.

Can Sri Lankan Australians Recognise Depression? The Influence of Acculturation, Age and Experiences with Depression on Recognition.

Mental health literacy is an important determinant of mental health help-seeking and is associated with improved mental health. There is evidence that mental health literacy may be lower amongst some migrant communities in Australia. The present study conducted the first cross-sectional survey of mental health literacy in Sri Lankan Australians between April and October 2020. Participants (N = 404) were presented with a culturally-tailored vignette describing an individual with symptoms of major depressive disorder, with correct recognition determined by the coding of an open text response to the question 'what's wrong with Mr Silva?'. Binomial linear regression modelling was conducted to identify predictors of the correct recognition of depression. Approximately 74% of participants recognised the presented symptoms as depression, though multiple other labels were also used by the respondents. The results also suggested that younger age and having a prior diagnosis of depression were significant predictors of recognising depression in the vignette. In the first study of Sri Lankan migrants' mental health literacy in an Australian context, the rates of depression recognition were comparable to those found in the general Australian population. Further research is urgently required to replicate and extend the present findings and ultimately support the development of tailored interventions aimed at improving mental health literacy across the diverse Sri Lankan Australian community.

Prevalence of at-risk drinking recognition: A systematic review and meta-analysis.

BACKGROUND: There is a prominent "treatment gap" in relation to at-risk drinking (ARD), whereby a minority of at-risk drinkers ever access treatment. Research suggests that recognition of problem drinking is a necessary precursor for help-seeking and treatment. OBJECTIVE: This systematic review and meta-analysis aimed to estimate the prevalence of ARD recognition within those meeting criteria for ARD. METHOD: PsycINFO, Web of Science, Scopus, and MEDLINE were searched using the terms: problem* AND (recogni* OR perceive* OR perception OR self-identif*) AND alcohol - to identify studies published in English between 2000 and 2022. Studies reported the frequency (weighted or unweighted) of participants meeting ARD criteria that also directly identified ARD, perceived a need for help, or endorsed a readiness to change. The prevalence of ARD recognition was estimated using a random-effects meta-analysis with 95% confidence intervals (CIs). RESULTS: 17 studies were included which provided data for 33,349 participants with ARD. Most (n = 14) were US studies. ARD was self-identified via a single indicator in 7 studies, whereas recognition was assessed via stages of change in 4 studies and need for help in 6 studies. The pooled prevalence of ARD recognition was 31% (95% CI: 25%-36%), and subgroup analyses indicated alcohol use severity, measure of recognition, and population type to be significant sources of heterogeneity. CONCLUSIONS: Most individuals with ARD fail to recognise their drinking problem so preventive approaches that promote recognition may be helpful. However, we must be cautious of how inconsistency in question framing affects self-reported problem recognition.

The "alcoholic other": Harmful drinkers resist problem recognition to manage identity threat.

OBJECTIVE: Harmful drinkers represent an important Alcohol Use Disorder (AUD) group in public health terms, accounting for significant health and social costs. However, harmful drinkers are characterized by low problem recognition; they tend to construct their drinking identity as positive and problem-free, actively setting themselves apart from the stigmatised 'alcoholic other'. As such, harmful drinkers rarely engage in treatment and represent an important opportunity for lower threshold interventions and self-change. The present study sought to explore AUD problem framing and stigma effects on problem recognition. METHODS: Harmful drinkers without perceived addiction experience recruited online (n = 244, 54% male, 46% female, 96% British) were randomised to one of six conditions comprising beliefs about alcohol problems (control, continuum, binary disease model) and stigma (stigma, non-stigma), and completed measures relating to problem recognition. RESULTS: As predicted, results found that harmful drinkers exposed to binary disease model beliefs and stigmatising language had significantly lower problem recognition than those in other conditions. However, no support was found for the prediction that continuum beliefs would be associated with higher problem recognition. Results suggest that the interaction of binary disease model beliefs and stigma prompted alcoholic label avoidance. CONCLUSION: These findings suggest that problem framing has important consequences for harmful drinkers. Implications for behaviour change amongst harmful drinkers through mechanisms of problem framing and identity are discussed.

Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience.

Low problem recognition may be an important barrier to opportunities for self-change or help-seeking in harmful drinkers. Little is known about how the beliefs harmful drinkers hold about the nature and causes of alcohol problems affect problem recognition and subsequent behaviour change processes. Participants (n = 597) recruited online were randomised to one of two conditions designed to promote beliefs according to (a) a continuum model of alcohol problems or (b) a binary disease model, or (c) a control condition. Participants completed measures of alcohol problem beliefs, problem recognition and other indices including the Alcohol Use Disorder Identification Test (AUDIT), addiction beliefs, addiction experience and demographics. Results showed that harmful drinkers without addiction experience exposed to the continuum condition had significantly higher problem recognition than those in binary disease model or control conditions. Continuum beliefs appear to offer self-evaluative benefits for harmful drinkers with low alcohol problem recognition, thus potentially facilitating help-seeking or self-change regarding alcohol use. Further research to understand the mechanisms by which continuum beliefs may promote more accurate drinking self-evaluation and its potential for behaviour change is warranted. The role of continuum beliefs may have important consequences for alcohol-related messaging and interventions seeking to promote self-change or help-seeking.

"I Don't Feel Like I Have a Problem Because I Can Still Go To Work and Function": Problem Recognition Among Persons With Substance Use Disorders.

Background: Persons with substance use disorders (SUDs) who do not recognize their substance use as problematic are less likely to perceive needing treatment and less motivated to seek help. Factors that contribute to problem recognition among persons with SUDs are poorly understood. Objective: To explore in-depth factors that may explain why those who meet diagnostic criteria for SUDs do not perceive having a substance abuse problem. Methods: We recruited 54 participants with recent (i.e., past-5-year) SUD for qualitative interviews. Participants were recruited via online ads and screened for eligibility through an online survey. Interview questions focused on participants' alcohol and drug use behaviors, adverse consequences stemming from their substance use, past treatment use experiences, and barriers/reasons for not using specialty treatment. Interviews were thematically coded to identify prominent themes that may explain low problem recognition. Results: We identified two prominent themes that contributed to problem recognition: modifying substance use behaviors to avoid adverse consequences and stigma (i.e., "othering"). Participants who (1) reported adjusting their alcohol and drug use in ways that would not interfere with important life responsibilities, especially work-responsibilities; (2) described those with alcohol and drug problems negatively; and (3) associated treatment with personal defeat were less likely to perceive having a SUD. Conclusions/Importance: These findings can be used to inform intervention strategies aimed at increasing problem recognition among persons with SUDs. Such strategies may facilitate motivation (i.e., desire for help and treatment readiness) to use and complete treatment, thereby reducing the unmet treatment gap among persons with SUDs.

Grandiose and vulnerable narcissism: Associations with alcohol use, alcohol problems and problem recognition.

OBJECTIVE: This study fills a gap in the literature by examining the relationship between two types of narcissism, vulnerable and grandiose, and five alcohol-related outcomes (ie, alcohol use, alcohol problems, evaluation and expectancies of problems, and readiness to change). PARTICIPANTS: 345 college students (28% men, 72% women) from a Midwestern university were recruited from undergraduate psychology courses from April 2015 to October 2016. METHODS: Participants completed an online survey with questionnaires measuring the variables of interest. Multiple regression analyses were used to test the hypotheses. RESULTS: Grandiose narcissism was a positive predictor of alcohol consumption and a positive (ie, good) evaluation of alcohol-related problems. Vulnerable narcissism was a positive predictor of alcohol-related problems, problem recognition (ie, readiness to change), and problem expectancies. CONCLUSIONS: The results speak to the effects that different types of narcissism have on alcohol use, alcohol problems and attitudes towards alcohol problems among young adults.

Marijuana consequences in a motivational context: Goal congruence reduces likelihood of taking steps toward change.

This study tested a model of marijuana use, problems, and motivation and barriers to change among a sample of 422 undergraduate students ages 18-25 (M=19.68, SD=1.60) who used marijuana at least once in the past 6 months. We tested a structural equation model (SEM) with use motives (i.e., coping, enhancement, and expansion), perceived use utility, and gender as exogenous variables predicting marijuana use behavior (i.e., use and problems), motivation to change (i.e., problem recognition and perceived costs and benefits of change), and the ultimate outcome, taking steps to reduce marijuana use. Controlling for level of use and problems, expansion motives had a direct effect on increased perceived costs of change and enhancement motives had direct inverse effects on problem recognition and perceived benefits of change. However, the total effect of expansion motives on taking steps was not significant. The perceived role of marijuana in achieving personal strivings (i.e., use utility) was inversely associated with problem recognition, perceived benefits of change, and taking steps toward change. In contrast, coping motives, despite being associated with greater perceived costs of change, were positively associated with taking steps. Problem recognition was positively associated with both increased perceived costs and benefits of reducing marijuana use, reflecting individuals' ambivalence about change. As expected, perceived benefits and costs of reducing use were positively and negatively associated with taking steps toward changing marijuana use, respectively. The results identify individual difference factors that contribute to motivation for change and are consistent with motivational models of change readiness. These results highlight the extent to which integration of marijuana use with personal goal achievement may interfere with taking steps to change use patterns despite associated negative consequences.

Alcohol problem recognition and help seeking in adolescents and young adults at varying genetic and environmental risk.

INTRODUCTION: Alcohol use disorder symptoms frequently occur in adolescents and younger adults who seldom acknowledge a need for help. We identified sociodemographic, clinical, and familial predictors of alcohol problem recognition and help seeking in an offspring of twin sample. METHOD: We analyzed longitudinal data from the Children of Alcoholics and Twins as Parents studies, which are combinable longitudinal data sources due to their equivalent design. We analyzed respondents (n=1073, 56.0% of the total sample) with alcohol use disorder symptoms at the baseline interview. Familial characteristics included perceptions of alcohol problems and help seeking for alcohol problems within the immediate family and a categorical variable indicating genetic and environmental risk. We used logistic regression to examine predictors of alcohol problem recognition and help seeking. RESULTS: Approximately 25.9% recognized their alcohol problems and 26.7% sought help for drinking. In covariate-adjusted analyses, help seeking among family members predicted problem recognition, several clinical characteristics predicted both problem recognition and help seeking, and familial risk predicted help seeking. Alcohol problem recognition mediated the association between alcohol use disorder symptoms and incident help seeking. CONCLUSIONS: Facilitating the self-recognition of alcohol use disorder symptoms, and perhaps the awareness of family members' help seeking for alcohol problems, may be potentially promising methods to facilitate help seeking.

Control and Alcohol-Problem Recognition Among College Students.

OBJECTIVE: This study examined negative control (ie, perceived lack of control over life outcomes) and need for control as predictors of alcohol-problem recognition, evaluations (good/bad), and expectancies (likely/unlikely) among college students. The study also explored the interaction between the need for control and alcohol consumption in alcohol-related outcomes. PARTICIPANTS: Participants were a convenience sample of 500 college students from a rural Midwest university. Data were collected during the 2009-2010 academic year. METHODS: Participants completed a survey assessing control and alcohol-problem recognition, evaluations, and expectancies. RESULTS: Negative control demonstrated a significant positive association with alcohol-problem recognition, evaluations, and expectancies after controlling for gender and alcohol consumption. Need for control did not have a main effect. However, the interaction was significant in that the association between need for control and negative evaluation of alcohol problems was strongest among participants with the highest levels of alcohol consumption. CONCLUSIONS: These results demonstrate that individuals' differences in sense of control are associated with alcohol-problem recognition, evaluations, and expectancies in young adults.

Comorbidity in detoxification: symptom interaction and treatment intentions.

Co-occurring substance use and mental health disorders (CODs) are common. However, very little is known about individuals' recognition of, and perception of the relationship between these disorders. The current study aimed to examine problem recognition, perceived disorder relationships, treatment intentions, and treatment preferences of individuals attending Australian detoxification facilities. Questionnaires were completed by 225 participants, including the Mental Health Screening Form III and the Treatment Preferences Questionnaire. Results indicated that 56.4% of participants screened positive for CODs, with only 4.2% failing to recognise their mental health problems. Participants perceived a functional relationship between disorders, where improvement/deterioration of one disorder leads to the improvement/deterioration of the other. Recognition of mental health problems and perception of a functional relationship between disorders, predict high mental health treatment intentions. These findings have important clinical implications when planning treatment programs and counselling individuals with CODs.

Religiosity as a Predictor of Adolescents' Substance Use Disorder Treatment Outcomes.

BACKGROUND: A growing body of research on adults with substance use disorders (SUDs) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use. METHODS: One hundred twenty-seven outpatient adolescents aged 14 to 19 (Mage=16.7, SD=1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress. RESULTS: On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b=-0.20, t=-2.18, P=.03). However, when problem recognition was added to the model, the impact of religiosity on consequences became nonsignificant, and there was no interaction between religiosity and problem recognition on consequences. CONCLUSIONS: The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery.