Canadian Undergraduate Perspectives on Medical Assistance in Dying for Mental Illness: Does Psychiatric Illness Type, Age, and Exposure to Information Influence Acceptance of MAiD?

BACKGROUND AND OBJECTIVES: In 2027, Canadians whose only medical condition is an untreatable mental illness and who otherwise meet all eligibility criteria will be able to request Medical Assistance in Dying (MAiD). This study investigates the attitudes of undergraduate students towards widening the scope of MAiD for physical illness for certain psychiatric conditions. We were interested in understanding if age, information, and type of mental illness influenced undergraduates' acceptance or rejection of MAiD for mental illness (MAiD-MI). METHOD: 413 undergraduate students participated in this study which examined the factors that correlate with the acceptance or rejection of MAiD-MI. Four scenarios were presented in which age (older or younger) and illness type (depression or schizophrenia) were manipulated. Demographic questions and measures assessing personality, religion, and attitudes towards euthanasia were administered. Questions assessing participants' general understanding of MAiD and their life experiences with death and suicide were also asked. RESULTS: Most of the participants accepted MAiD-MI for both depression and schizophrenia. As hypothesized, support for MAiD-MI was higher for patients with schizophrenia than for depression. Also as hypothesized, support was higher for older patients than for younger patients. Variables such as religion, personality and political affiliation were also associated with acceptance or rejection of MAiD-MI. Finally, consistent with our hypotheses, participants' understanding of MAiD and experiences with death and suicide was predictive of support for MAiD-MI.

Canadian Undergraduates' Perspectives on Medical Assistance in Dying (MAiD): A Quantitative Study.

Background and Objectives: In 2016, Medical Assistance in Dying (MAiD) became legal in Canada for those suffering a grievous and untreatable medical condition. Currently, it is not available to minors or to those with an untreatable mental illness, although it is likely the scope of MAiD will be widened to include persons with severe and untreatable mental illnesses. However, little is known about the factors predicting acceptance or rejection of MAiD for persons with either a grievous medical condition or an untreatable mental illness. Methods: A survey was administered to 438 undergraduate students to examine factors associated with their acceptance or rejection of MAiD. The survey included four different scenarios: a young or old person with an untreatable medical condition, and a young or old person with an untreatable mental illness. Demographic questions (age, sex, religion, etc), personality measures, and an attitude towards euthanasia scale were also administered, as well as questions assessing participants' general understanding of MAiD and their life experiences with death and suicide. Results/Conclusion: Overall, most of the Canadian undergraduate participants accepted MAiD for both terminally ill and mentally ill patients; however, different variables, such as age, religion, and ethnicity, predicted the acceptance or rejection of MAiD for each scenario.

Prisoner exposure to nature: Benefits for wellbeing and citizenship.

The direct or indirect experience of crime can cause individuals to feel vengeful against the perpetrator(s). The prison system reflects this sentiment by creating austere environments that are dehumanizing, punitive, and hopeless. Prisons are, therefore, environments in which retribution and punishment take priority over rehabilitation. Frequently, prisoners are believed to be untreatable because of their antisocial orientation. However, several factors influence an antisocial orientation such as socioeconomic status, family of origin, and mental health. The ubiquitous nothing works misbelief has resulted in prisoner marginalization and increased recidivism because of insufficient treatment. In 2015, 10 million individuals were incarcerated worldwide with around 30 million circulating through prisons each year. The prison environment decreases prisoner life expectancy and overall health. Sadly, prisoner benefits from treatment post-incarceration dissipate after 3-6 months and many prisoners die by suicide or drug overdose. Prison overpopulation, as well as poor outcome post-incarceration, requires more effective treatment. We hypothesize that Prisoner Exposure to Nature (PEN) can transform prisons into environments that are conducive to maintaining and improving physical and mental health. In prior work we proposed the continuum Nature Exposure Sufficiency (NES) versus Nature Exposure Insufficiency (NEI). Prisons are impoverished environments that limit Nature Exposure (NE) which results in NEI. Individuals experience fluctuations in mental and physical health as a result of NEI. Numerous studies have shown that direct and indirect NE can improve mood, physical health, and facilitate connectivity with self and society. It is necessary to consider ways in which we can incorporate NE for prisoner wellbeing. Additionally, it is crucial that prison personnel and prisoners develop a therapeutic/helping relationship (i.e., alliance) that is facilitated by friendliness and warmth to foster social change and citizenship. Many prisoners experience isolation and disconnection with society upon reentry. Given that most prisoners are eventually released into the community, we are obligated not to make them worse. Hence, it is important that prisons create programs that develop citizenship to engender prisoner volition to become positive and active citizens. We focus on the prison and prisoners, however our work is relevant to all total institutions (e.g., mental hospitals, nursing homes, schools, etc.). The prison system favors punishment and mass incarceration over treatment and decarceration. The deleterious effects of incarceration are clear and it is time to implement treatments based on the principles of PEN to improve prisoner wellbeing and citizenship.

Nature exposure sufficiency and insufficiency: The benefits of environmental preservation.

Increasing industrialization, urbanization, and a failure of many world leaders to appreciate the consequences of climate change are deleteriously impacting quality of life as well as diminishing the prospects for long term survival. Economic competitiveness and corporate profitability often pre-empt environmental concerns. The calving of an iceberg in Antarctica and the hurricane activity in the Caribbean during 2017 are unfortunate illustrations of the continuing escalation of environmental issues. We provide historical and current evidence for the importance of Nature Exposure (NE) and introduce the continuum Nature Exposure Sufficiency (NES) and Insufficiency (NEI). Insufficiency includes impoverished environments (e.g., slums and prisons) where nature exposure is very limited. Nature Exposure Sufficiency (NES) is an optimal amount of exposure to nature where many benefits such as reinvigoration can be obtained by everyone. NES also has several benefits for individuals with various health conditions such as arthritis, dementia, or depression. The benefits of NE are not just derivable from parks, forests, and other natural settings. Interiors of buildings and homes can be enhanced with plants and even pictures or objects from nature. Additionally, there is abundant evidence indicating that virtual and artificial environments depicting nature can provide substantial NE and therefore contribute to general wellbeing. Besides the difficulty in achieving cooperation amongst nations, corporations, and other collectives in developing and implementing long range plans to deal with climate change, there is also sometimes an aversion at the individual level whereby people are unwilling to experience nature due to insects and other discomforts. Such individuals are often averse to supplanting the comforts of home, even temporarily, with inadequate facilities that are seemingly less pleasant than their typical dwellings. We propose using the term Nature Exposure Aversion (NEA) to describe such behavior and propose that the aversion is largely due to conditioning. Such behavior may be addressed through desensitization in virtual environments which in turn may contribute to an endorsement of the view that climate change is occurring and must be dealt with. The issues of Nature Exposure Sufficiency and Insufficiency are intertwined with the sustainability of the planet and future planning and efforts to deal with the environment. If the outcome is unfavorable, the descent of civilization will be more rapid than the ascent.

PRN Medication Administration in a Geriatric Psychiatric Hospital: Chart Review and Nursing Perspective.

OBJECTIVE: To improve patient care/outcome, an evaluation was conducted of nursing procedures and protocols for pro re nata (PRN) medications. METHODS: A 14-day chart review was conducted for 27 patients with mood and thought disorders (MTD) and for 24 patients with organic disorders (OD) at a geriatric psychiatric hospital, and a questionnaire was completed by 20 nurses. RESULTS: 377 PRNs were administered to patients in the MTD and OD units (240 and 137, respectively). The majority of PRNs were administered during the evening shifts on the MTD unit and during the day shifts on the OD unit. Chart notes indicated the behavior requiring PRN administration was not always specifically described and therapeutic interventions were not often attempted before PRN administration. Inconsistency between chart notes and medication record books was noted in the majority of cases. It was often not known whether the PRN was initiated by the staff, patient, or family. PRNs were reported to be not effective in the majority of cases. CONCLUSIONS: Documentation was suboptimal and effectiveness was poor. CLINICAL IMPLICATIONS: It would be worthwhile to train all staff in a patient-centered or ecopsychosocial (i.e., non-pharmacological) model of care, which would provide staff alternatives to PRNs. In that context, it would be important to implement standards of practice into geriatric psychiatry inpatient settings for PRN administration and documentation.

The transitional impact scale: assessing the material and psychological impact of life transitions.

The Transitional Impact Scale (TIS) advances the measurement of event cognition into the real world. The TIS was created to provide a measure of change for important life transitions, including an index of their transitional properties and magnitude. Pilot work prior to Study 1 led to the creation of a 95-item version (TIS-95). A principal components analysis of TIS-95 (n = 215) resulted in two dimensions that we rotated to a Varimax criterion and interpreted as (1) material change (e.g., "This event changed where I live") and (2) psychological change (e.g., "This event changed the way I think about things"). TIS-95 was reduced to 25 items. In Study 2, the structure of TIS-25 was replicated (n = 531) using the same method. The best 12 items were retained. TIS-12 was evaluated in two random split-half samples (n = 557 and n = 553). These samples produced essentially identical results, as assessed through factor comparison. The cumulative scales formed from items constituting each factor demonstrated good internal consistency (Cronbach's alpha ranged from .79 to .86).

Accentuate the positive to mitigate the negative: mother psychological coping resources and family adjustment in childhood disability.

BACKGROUND: Mothers' cognitive appraisal of the family impact of childhood disability and their positive affect as a psychological coping resource, both key elements of the process model of stress and coping, were tested as explanatory variables of family adjustment. METHOD: In a sample of Canadian families, 195 mothers of children with intellectual and developmental disability completed telephone interviews. RESULTS: In regression modelling, 35% of the variance in family adjustment was explained by mothers' positive cognitive appraisal of family impacts of childhood disability and by their positivity (ratio of positive to negative affect). After controlling for positivity, negative cognitive appraisal of family impacts of childhood disability was non-significant. CONCLUSIONS: Family adjustment to childhood disability is associated with elements of strength in mothers' psychological coping; namely, their ability to perceive positive family consequences of childhood disability and to maintain higher proportions of positive emotion in their daily activities. The findings of this study provide support for the broaden-and-build theory to explain the role of positivity in mothers' coping and adjustment to childhood disability.

Nonvocational outcomes of vocational rehabilitation: reduction in health services utilization.

BACKGROUND: Numerous studies have demonstrated the beneficial effects of vocational rehabilitation on vocational outcomes in individuals with a mental illness, yet effects on secondary outcomes remain largely unexplored. This study investigates the impact of vocational rehabilitation on the utilization of emergency, ambulatory care and inpatient services in individuals with a mental illness. METHODS: Using a repeated measures study design, the utilization of health services by individuals with a mental illness (n= 37) was compared before and during their engagement in training and employment at a social enterprise - a form of vocational rehabilitation. RESULTS: Individuals with a mental illness had significantly less emergency department visits (p=0.01), ambulatory care visits (p=0.01) and hospital admissions (p=0.05), but no difference in hospital length of stay (p=0.39), during training/employment, compared to pre-training/employment at a social enterprise. CONCLUSION: The reduction in health services utilization found in this study may reflect symptom and overall health improvement, highlighting the importance of vocational rehabilitation programs for individuals with a mental illness. In addition, results from this study can inform stakeholders and policymakers about the impact of vocational rehabilitation on the healthcare system to help guide decisions regarding program implementation or continuation, and funding allocation.

Living in history: how war, terrorism, and natural disaster affect the organization of autobiographical memory.

Memories of war, terrorism, and natural disaster play a critical role in the construction of group identity and the persistence of group conflict. Here, we argue that personal memory and knowledge of the collective past become entwined only when public events have a direct, forceful, and prolonged impact on a population. Support for this position comes from a cross-national study in which participants thought aloud as they dated mundane autobiographical events. We found that Bosnians often mentioned their civil war and that Izmit Turks made frequent reference to the 1999 earthquake in their country. In contrast, public events were rarely mentioned by Serbs, Montenegrins, Ankara Turks, Canadians, Danes, or Israelis. Surprisingly, historical references were absent from (post-September 11) protocols collected in New York City and elsewhere in the United States. Taken together, these findings indicate that it is personal significance, not historical importance, that determines whether public events play a role in organizing autobiographical memory.

An evaluation of the Psychache Scale on an offender population.

This study examined the generalizability of a self-report measure of psychache to an offender population. The factor structure, construct validity, and criterion validity of the Psychache Scale was assessed on 136 male prison inmates. The results showed the Psychache Scale has a single underlying factor structure and to be strongly associated with measures of depression and hopelessness and moderately associated with psychiatric symptoms and the criterion variable of a history of prior suicide attempts. The variables of depression, hopelessness, and psychiatric symptoms all contributed unique variance to psychache. Discussion centers on psychache's theoretical application to the prediction of suicide.

Testosterone, sexual offense recidivism, and treatment effect among adult male sex offenders.

The relationship between serum testosterone and sexual violence was examined in a sample of 501 convicted adult male sex offenders attending an intensive in-hospital group psychotherapy treatment program. It was found that men with higher testosterone tended to have committed the most invasive sexual crimes (p < .001, two-tailed). Further, a positive partial correlation (controlling for age) between testosterone and sexual offense recidivism over a lengthy follow-up period (mean = 8.9 years) was found. When the sample was separated into one group that completed treatment and one group that did not, an important ameliorating treatment effect was observed. Although controlling for age, serum testosterone remained significantly predictive of sexual recidivism for the treatment noncompleter group (p < .05, two-tailed). For those who completed treatment testosterone was no longer predictive of sexual reoffense (p > .05, two-tailed). Among convicted sex offenders, higher serum testosterone appears to be associated with greater likelihood of further sexual violence. Effective therapy, however, appears able to intercede in the influence of testosterone on sexually deviant behavior. It is suggested that serum testosterone may be an informative static risk factor and completion of intensive treatment should be accorded significance in future actuarially based risk prediction instruments.

A coffee can, factor analysis, and prediction of antisocial behavior: the structure of criminal risk.

The predictive accuracy of the Psychopathy Checklist-Revised, Level of Service Inventory-Revised, Violence Risk Appraisal Guide, and the General Statistical Information on Recidivism were compared to four instruments randomly generated from the total pool of original items. None of the four original instruments better predicted post-release failure than the four randomly generated instruments. These results suggest two conclusions: (a) the instruments are only measuring criminal risk, and (b) no single instrument has captured sufficient risk assessment theory to result in better prediction than randomly derived instruments measuring criminal risk. A two-stage factor analysis was completed on 1614 cases. This analysis of the risk items indicated a 4-factor solution and all 4 factors were equal to the original instruments in predicting post-release failure. Thus, the original instruments did not improve prediction over randomly structured scales, nor did the restructuring of items improve risk assessment, suggesting substantial deficiencies in the conceptualization of risk assessment and instrumentation. We argue that developing a risk-based construct, which involves hypothesis testing and an explanation of behavior, is the optimal method to advance risk assessment within the criminal justice and mental health systems. Such an approach would provide targeted areas for clinical intervention that are salient to risk.

Sexual fantasies of adolescent male sex offenders in residential treatment: a descriptive study.

An attenuating sample of 87 male adolescent sexual offenders logged sexual fantasies during their entire time in therapy. These patients were attending residential treatment and kept a log recording all normal and deviant sexual fantasies which they experienced. Patients recorded which fantasies were interrupted and which fantasies were accompanied by masturbation. Typically, at the beginning of treatment, the reported rate of normal fantasies was maximal, the occurrence of deviant fantasies was minimal, and there was little effort to interrupt the deviant fantasies. The reported frequency of deviant fantasies increased substantially (about 380%) during the first 5 months of treatment and then steadily declined (approximately 47%) over the remaining months in therapy. Following an initial decline in the early months of treatment, an increase in the rates of normal fantasies was reported. Additionally, over the course of treatment, the frequency of deviant fantasies decreased relative to all fantasies. While deviant fantasies remained predominant to normal sexual fantasies and were more frequently paired with masturbation, patients reported substantial changes in the proportion of deviant fantasies that were interrupted (from about 20% to 70%). Implications of the results for juvenile sex offender treatment are discussed.