A Cross-Diagnostic Investigation of the Differential Impact of Discrimination on Clinical and Personal Recovery.

OBJECTIVE: Although the negative association between discrimination and recovery has been established, only a few studies have attempted to investigate the underlying mechanism of how perceived discrimination dampens both clinical and personal recovery among people with psychiatric disorders. This study aimed to examine the mediating roles of self-stigma and mental health service engagement in the relationship between perceived discrimination and recovery. METHODS: A total of 374 people (half men and half women; mean±SD age=43.47±12.76) living in Hong Kong and in recovery with a primary diagnosis of a psychotic disorder, mood disorder, or substance use disorder responded to a cross-sectional questionnaire on discrimination, self-stigma, mental health service adherence, recovery orientation of services, clinical recovery, and personal recovery. Multisample structural equation modeling was conducted to examine whether the hypothesized model for perceived discrimination and recovery produced results that could be generalized across people with various psychiatric diagnoses. RESULTS: Findings indicated that respondents perceived discrimination from the general public and from health care professionals, which was positively associated with self-stigmatization and service disengagement and was negatively associated with clinical and personal recovery across three different types of psychiatric disorder. CONCLUSIONS: This study showed that the influence of perceived discrimination on recovery was universal and could be generalized across people with different psychiatric diagnoses. Multipronged stigma reduction interventions targeting the general public, health care professionals, and people in recovery, along with policies that avert discrimination and uphold human rights in health care settings and beyond, should be implemented.

Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials.

Self-help cognitive-behavioral therapy (CBT) is an increasingly popular treatment option for insomnia. The objective of this meta-analysis was to compile an up-to-date evaluation on the efficacy, adherence, acceptability and dropout rate of self-help CBT for insomnia. We systematically searched six key electronic databases up until May 2013. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Twenty randomized controlled trials were included; 10 of which were published after the last review up until January 2007. Meta-analysis of self-help CBT vs. waiting-list, routine care or no treatment was performed. Results showed that self-help CBT improved sleep, sleep-related cognitions and anxiety and depressive symptoms. Effect sizes for sleep-diary-derived sleep efficiency, sleep onset latency, and wake after sleep onset at immediate posttreatment were 0.80, 0.66, and 0.55, respectively. The average dropout rate of self-help CBT at immediate posttreatment was 14.5%, which was not significantly different from the 16.7% in therapist-administered CBT. Subgroup analyses supported the added benefit of telephone consultation. In conclusion, self-help CBT is efficacious and acceptable as an entry level of a stepped care model for insomnia. In places where face-to-face treatments are unavailable or too costly, self-help CBT can be considered as a compromise.

Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis.

BACKGROUND: Computerised cognitive behavioural therapy (CCBT) is an innovative mode of delivering services to patients with psychological disorders. The present paper uses a meta-analysis to systematically review and evaluate the effectiveness of CCBT for insomnia (CCBT-I). METHOD: A comprehensive search was conducted on 7 databases including MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Library, Social Sciences Citation Index and PubMed (up to March 2011). Search terms covered 3 concepts: (1) [internet, web, online, computer-aided, computer-assisted, computer-guided, computerized OR computerised] AND (2) [CBT, cognitive therapy, behavio(u)ral therapy OR behavio(u)r therapy] AND (3) [insomnia, sleep disorders OR sleeping problem]. RESULTS: 533 potentially relevant papers were identified, and 6 randomised controlled trials (RCTs) that met the selection criteria were included in the review and analysis. Two RCTs were done by the same group of investigators (Ritterband and colleagues) using the same internet programmes. Post-treatment mean differences between groups showed that the effects of CCBT-I on sleep quality, sleep efficiency, the number of awakenings, sleep onset latency and the Insomnia Severity Index were significant, ranging from small to large effect sizes. However, effects on wake time after sleep onset, total sleep time and time in bed were non-significant. On average, the number needed to treat was 3.59. The treatment adherence rate for CCBT-I was high (78%). CONCLUSION: The results lend support to CCBT as a mildly to moderately effective self-help therapy in the short run for insomnia. CCBT-I can be an acceptable form of low-intensity treatment in the stepped care model for insomnia.

Adjustment outcomes in Chinese patients following one-month recovery from severe acute respiratory syndrome in Hong Kong.

This study aimed to examine the short-term adjustment outcomes including distress, self-esteem, and quality of life among Chinese patients after 1-month recovery from severe acute respiratory syndrome (SARS) in Hong Kong and to investigate the predictive abilities of a set of selected variables on the outcomes. At 1-month recovery, 100 SARS survivors (mean age = 37; 66 women) and 184 community subjects completed self-administered questionnaires. In the General Health Questionnaire-28, 61% of the SARS survivors were identified as distressed cases under a conservative cutoff score of 6. Compared with the community sample, SARS survivors had significantly more distress and poor quality of life. Being a healthcare worker, severity of SARS symptoms, steroid dosage, and social support accounted for a portion of variances of different measures. Early psychiatric screening and intervention may be beneficial for the adjustment of SARS survivors after short-term recovery. Future research on the long-term impact of SARS is recommended.