An open label pilot trial of low-dose lithium for young people at ultra-high risk for psychosis.

AIM: Lithium, even at low doses, appears to offer neuroprotection against a wide variety of insults. In this controlled pilot, we examined the safety (i.e., side-effect profile) of lithium in a sample of young people identified at ultra-high risk (UHR) for psychosis. The secondary aim was to explore whether lithium provided a signal of clinical efficacy in reducing transition to psychosis compared with treatment as usual (TAU). METHODS: Young people attending the PACE clinic at Orygen, Melbourne, were prescribed a fixed dose (450 mg) of lithium (n = 25) or received TAU (n = 78). The primary outcome examined side-effects, with transition to psychosis, functioning and measures of psychopathology assessed as secondary outcomes. RESULTS: Participants in both groups were functionally compromised (lithium group GAF = 56.6; monitoring group GAF = 56.9). Side-effect assessment indicated that lithium was well-tolerated. 64% (n = 16) of participants in the lithium group were lithium-adherent to week 12. Few cases transitioned to psychosis across the study period; lithium group 4% (n = 1); monitoring group 7.7% (n = 6). There was no difference in time to transition to psychosis between the groups. No group differences were observed in other functioning and symptom domains, although all outcomes improved over time. CONCLUSIONS: With a side-effect profile either comparable to, or better than UHR antipsychotic trials, lithium might be explored for further research with UHR young people. A definitive larger trial is needed to determine the efficacy of lithium in this cohort.

Guidance on Minimum Standards for Canine-Assisted Psychotherapy in Adolescent Mental Health: Delphi Expert Consensus on Health, Safety, and Canine Welfare.

As interest in animal-assisted therapy (AAT) and canine-assisted psychotherapy (CAP) grows, there are increasing calls for the management of related health, safety, and welfare concerns for canines, providers, and clients. Existing health and safety guidelines lack empirical support and are, at times, contradictory. Welfare is increasingly prioritized; however, tools to monitor and manage welfare are underutilized and under-reported. The aim of this study was to provide expert consensus on the minimum health, safety, and welfare standards required to develop and deliver a CAP group program to adolescents experiencing common mental health disorders. Diverse AAT experts were recruited globally. Using Delphi methodology, over two rounds, 40 panelists reached a consensus agreement to include 32 items from a possible 49 into the minimum standards. Health and safety measures included risk assessment, veterinary screening, preventative medicine, training in infection control, and first aid. Welfare measures included training in welfare assessment, documentation of welfare, and flexible, individualized responses to promote wellbeing. Intestinal screening for parasites and the prohibition of raw food were not supported. Flexible and individualized assessment and management of canine welfare were supported over fixed and time-limited work schedules. Clinical practice implications are discussed, and recommendations are made.

The Mental Health of Elite-Level Coaches: A Systematic Scoping Review.

BACKGROUND: Elite-level coaches are exposed to multiple performance, organisational and personal stressors which may contribute to reduced mental health and wellbeing. This systematic scoping review examined the current body of evidence to explore what is known about the mental health of elite-level coaches (i.e. wellbeing and mental ill-health), the risk and protective factors that influence coach mental health, and the relationship between mental health and coaching effectiveness. METHODS: The review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken and updated in September 2022 using six electronic databases. RESULTS: 12,376 studies were identified and screened, with 42 studies satisfying the inclusion criteria. Despite the paucity of high-quality research, findings indicated that 40% of the included studies examined themes connected to wellbeing, with 76% assessing the nature or prevalence of mental ill-health in elite-level coaches. Among studies exploring mental ill-health, coach burnout was the primary focus, while scant research examined symptoms associated with clinical disorders (e.g. anxiety and depression). Overall, psychological outcomes for elite-level coaches were shaped by risk and protective factors operating at the individual, interpersonal, organisational and societal level. Preliminary evidence was also found to suggest that poor mental health may contribute to reduced coaching effectiveness. It is proposed that coaching effectiveness could therefore be employed as a 'hook' to engage elite-level coaches in greater consideration of their mental health needs. CONCLUSION: Alongside the development of methodologically robust research, there is a need to examine dynamic individual (e.g. psychological skills), interpersonal (e.g. strong social supports) and organisational (e.g. workload) factors that aim to preserve the mental health and optimise the efficacy of elite-level coaches.

Childhood sexual abuse in boys and men: The case for gender-sensitive interventions.

OBJECTIVE: To review the literature on the experiences of boys and men exposed to childhood sexual abuse, and to assess the implications of this literature for trials of interventions and tailored services for this population. METHOD: We conducted a narrative review of papers pertaining to boys and men exposed to childhood sexual abuse. Implications of this literature for treatment were critically appraised. RESULTS: Boys and men suffer the negative sequelae of childhood sexual abuse to the same (and sometimes greater) extent as girls and women. Boys and men also experience a number of unique challenges, as the abuse experience may undermine masculine identities and relations. This conflict may contribute to the underreporting of childhood sexual abuse among boys and men. Boys and men are less likely to disclose their abuse experience and wait longer to disclose compared to girls and women. Existing estimates therefore likely underestimate the prevalence of childhood sexual abuse among boys and men. Additionally, to date, intervention trials for individuals exposed to childhood sexual abuse have included a disproportionately low number of boys and men, even based on existing prevalence estimates. CONCLUSIONS: Further investigation into the treatment needs of boys and men exposed to childhood sexual abuse is critically important. To facilitate a better understanding of their needs, intervention studies for this cohort should include a greater proportion of boys and men. Studies should also assess the influence of boys' and men's alignments to masculine norms for moderating treatment outcomes as a means to guide gender-sensitive treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model.

Elite sports contexts are highly pressurised and frequently enforce a win-at-all-costs approach. This narrow focus on performance outcomes can potentially contribute in negative ways to the mental health of those within these environments. In this Current Opinion paper, we propose a model that outlines how key elements contributing to psychologically safe or unsafe environments may contribute to better or worse mental health outcomes, respectively. In an environment in which individuals feel safe to show their authentic selves rather than 'wear a mask', different experiences of mental health are likely to be normalised, help-seeking behaviour increased, and thus, mental health outcomes enhanced. We outline how sports teams and organisations can contribute to this through the creation of appropriate policies and procedures, in addition to leaders modelling and reinforcing positive cultural norms. It is intended that the theoretical model can inform stakeholders in elite sport as well as future research directions.

A randomized wait-list controlled trial of Men in Mind: Enhancing mental health practitioners' self-rated clinical competencies to work with men.

Improved engagement of men in psychotherapy is an essential element in improving male health outcomes. This trial examined whether the Men in Mind intervention improved practitioners' self-rated clinical competencies to engage and respond to male clients in therapy. A parallel, single-blind, wait-list randomized controlled trial was conducted with Australian-based mental health practitioners, currently administering psychotherapy to males, fluent in English, and not currently completing their undergraduate degree. Participants were randomly assigned 1:1, through variable-sized blocks stratified by gender, to either the intervention (Men in Mind) or wait-list control. Men in Mind was offered as a self-led 6-week, five-module online program to upskill practitioners to engage and respond to male clients. The primary outcome was self-reported competency in engaging men in psychotherapy, measured by the Engaging Men in Therapy Scale (EMITS) at 6 weeks. All analyses were by intention-to-treat. Between January 16 and March 17, 2022, 587 participants were randomly assigned to the intervention (n = 300) or wait-list control (n = 287). In total, 492 (84%) participants completed the primary endpoint assessment at 6 weeks. Men in Mind demonstrated a large effect of improved EMITS scores compared to the control group (d = 2.63, 95% CI [2.39, 2.87], p < .001). Men in Mind was effective at increasing mental health practitioners' self-reported efficacy to work with men, which is potentially a key change mechanism in their ability to improve health outcomes for male clients. A limitation of the trial was the use of a bespoke, self-reported primary outcome, while a strength was the gender-responsive intervention design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supporting Clinical Competencies in Men's Mental Health Using the Men in Mind Practitioner Training Program: User Experience Study.

BACKGROUND: Engaging men in psychotherapy is essential in male suicide prevention efforts, yet to date, efforts to upskill mental health practitioners in delivering gender-sensitized therapy for men have been lacking. To address this, we developed Men in Mind, an e-learning training program designed to upskill mental health practitioners in engaging men in therapy. OBJECTIVE: This study involves an in-depth analysis of the user experience of the Men in Mind intervention, assessed as part of a randomized controlled trial of the efficacy of the intervention. METHODS: Following completion of the intervention, participants provided qualitative (n=392) and quantitative (n=395) user experience feedback, focused on successes and suggested improvements to the intervention and improvements to their confidence in delivering therapy with specific subpopulations of male clients. We also assessed practitioner learning goals (n=242) and explored the extent to which participants had achieved these goals at follow-up. RESULTS: Participants valued the inclusion of video demonstrations of skills in action alongside the range of evidence-based content dedicated to improving their insight into the engagement of men in therapy. Suggested improvements most commonly reflected the desire for more or more diverse content, alongside the necessary adaptations to improve the learning and user experience. Participants also commonly reported improved confidence in assisting men with difficulty articulating their emotions in therapy and suicidal men. CONCLUSIONS: The evidence obtained from this study aids in plans to scale Men in Mind and informs the future development of practitioner training interventions in men's mental health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s40359-022-00875-9.

Neo-traditionalist, egalitarian and progressive masculinities in men's heterosexual intimate partner relationships.

Shifts in gender roles, identities and relations since the 1980s are continuing to influence masculinities within intimate partner relationships. Forefront in men's contemporary heterosexual relationships have been calls for gender equality and gender equity as a means to promoting the mental health and well-being of partners and their families. Most previous research has focused on a pathologized role of men in relationships (e.g., intimate partner violence). Little is known about how men perceive intimate partner relationships using a strength-based perspective. The current photovoice study addressed the research question, 'What are the connections between masculinities and men's heterosexual intimate partner relationships?' to highlight young men's (19-43 years-old) experiences of, and perspectives about their intimate partner relationships. Drawing from individual Zoom interviews with 92 heterosexual, cisgender men from 14 countries, we abductively derived three masculine typologies: 1) neo-traditionalist, 2) egalitarian and 3) progressive. Twenty-two (24%) participants embodied neo-traditionalist masculinities characterized by reliance's on traditional masculine norms that assign domesticities as feminine and prize masculine breadwinner and protector roles. Half of the participants (50%, n = 46) purposefully distanced themselves from traditional masculine norms to engage egalitarian masculinities. These men idealized equal (50-50) contributions and reciprocity wherein counts were often used to evaluate each partner's relative efforts and contributions to the relationship. Progressive masculinities were evident in 26% (n = 24) of participants who focused on fairness and social justice, checking their own privilege to justly operate within the relationship, and more broadly in society. The three typologies are grounded in men's heterosexual intimate partner gender relations, and advance masculinity frameworks to guide future health-research, policy and practice. In addition, there are opportunities for men's mental health promotion by prompting readers' reflexivity to thoughtfully consider what they idealize, and where they map in relation to the masculine typologies featured in the current article.

Supporting The Mental Health Of Elite-Level Coaches Through Early Intervention.

Current evidence indicates that elite-level coaches encounter a range of performance, organizational, and personal stressors that may influence or compromise mental health. With exposure to these stressors, supports need to be established to protect and preserve the mental health of elite-level coaches. Given the paucity of evidence available, this article proposes a number of considerations that should be taken into account when developing a mental health and rehabilitation framework for high-performance coaches. We argue that early intervention should be positioned at the core of this framework, to address the onset of symptoms prior to the emergence of a mental disorder or mental health crisis. Mental health screening and monitoring of coaches, the psychological safety of high-performance environments, the mental health literacy of coaches, and the tailored pathways to support are discussed. Beyond these strategies, it is proposed that rehabilitation and reintegration should be addressed to assist coaches who are currently experiencing mental ill health or have left their role due to mental health reasons. Although further research is needed to implement evidence-based strategies, it is recommended that a future mental health framework should incorporate the perspectives of coaches to ensure it is consistent with their needs and experiences.

Psychic Pain Among Men: Factor Structure, Psychosocial Correlates, and Mediation of Social Connectedness and Suicidal Ideation.

ABSTRACT: The Psychic Pain Scale (PPS) measures a form of mental pain involving overwhelming negative affect and loss of self-control. Understanding psychic pain among men is needed to advance efforts for preventing male suicide. The present study examined the factor structure and psychosocial correlates of the PPS among 621 online help-seeking men. Confirmatory factor analysis indicated a higher-order factor comprising affect deluge and loss of control factors. Psychic pain evinced significant associations with general psychological distress, r = 0.64; perceived social support, r = -0.43; social connectedness, r = -0.55; and suicidal ideation, r = 0.65 (all p 's < 0.001)-the latter three remained significant after controlling for general distress. Psychic pain also mediated the association between social disconnection and suicidal ideation (standardized indirect effect = -0.14 [-0.21, -0.09]), after controlling for social support and distress. Findings support the PPS as a promising measure for investigating psychic pain among men and indicate psychic pain as a link between social disconnection and suicidal ideation.

Translation and Validation of the Arabic Version of the Athlete Psychological Strain Questionnaire.

CONTEXT: The international sports community is becoming more proactive in clinical mental health practice and research. An athlete-specific psychological distress screening tool can identify potential mental health illness. DESIGN: The Athlete Psychological Strain Questionnaire (APSQ) is a simple screening tool for detecting early signs of athlete-specific strain and related mental health concerns. METHODS: We evaluated the internal consistency and reliability of the translated and culturally adjusted Arabic version of the APSQ (APSQ-Ar) with Arabic-speaking elite athletes. The final translation underwent standard forward and backward translation, an inspection by a team of experts, and then preliminary testing. The APSQ-Ar was cross-culturally validated and then assessed for internal consistency and reliability among (n = 98) Arabic-speaking athletes. RESULTS: There were no problems with the patients' understanding or interpretation of the items on the APSQ-Ar translation. The intraclass correlation value was .93 (95% confidence interval, .89-.95), and the mean difference was 2.4 with a minimal detectable change of 5.12, demonstrating strong test-retest reliability. Moreover, Cronbach alpha showed excellent internal consistency (.76). CONCLUSIONS: The APSQ-Ar was demonstrated to be good, reliable, and internally consistent. With APSQ-Ar, sports medicine professionals in Arabic-speaking countries will be able to identify psychological distress and symptoms in athletes and, as a result, provide them with mental health support.

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone.

Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). Aim: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. Methods: The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. Expected results: Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. Discussion: This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05435222.

Working with men in the context of distressed and disrupted intimate partner relationships: A qualitative study.

OBJECTIVE: To describe key considerations for working with men experiencing distressed and disrupted intimate partner relationships. METHODS: Individual Zoom interviews were conducted with help-seeking men (n = 25) who had experienced an intimate partnership break-up, and health service providers (n = 30) working with men in the relationships space. Interpretive Description methodology was used to generate considerations for working with men in distressed and disrupted relationships. RESULTS: Three thematic findings were inductively derived; 1) A whole life approach for deconstructing relationships, wherein men engaged in discussions about their broader experiences and circumstances within the context of intimate partnerships; 2) Affirming men's relationship emotions and vulnerabilities as normative and changeable, comprising coaching for embodying transformative masculinities; and 3) Tangible 'to do's' in and after a relationship, outlining men's present and prospective self-work with action-oriented strategies. CONCLUSION: Strategies tailored to men's receptivity and needs can increase connection with professional services and providers to bolster the mental health of men in and after disrupted intimate partner relationships. PRACTICE IMPLICATIONS: With men increasingly accessing professional mental health services, the present study offers key considerations and recommendations regarding assessment, communication, and treatment for health service providers working with men in the relationships space.

Young men and anxiety: Resisting, reckoning and responding.

Anxiety is the most prevalent mental disorder experienced by young men, and when untreated, is predictive of co-morbid mental health challenges and suicide. Despite the rising prevalence, there is a conspicuous absence of qualitative research to distil and theorise young men's anxiety. Twenty-five young Australian men (15-25 years), who had been diagnosed with an anxiety disorder or self-reported anxiety symptoms, took part in individual semi-structured interviews. Interviews were transcribed verbatim and analysed using a constructivist grounded theory approach. A three-process grounded theory (Resisting-Reckoning-Responding; Triple R Anxiety Model) depicted young men's experiences of anxiety, gilded and guided by their masculine socialisation. Initially, young men noticed somatic symptoms (i.e., headaches, nausea and myalgia) but did not connect these symptoms to anxiety. Avoiding anxiety (e.g., denying, distracting) proved unhelpful in the longer term and as symptoms diffused, a subsequent process of reckoning anxiety (i.e., meaning making) ensued. As young men gained insight to the life limiting bounds of their anxiety, some were prompted towards actions of acceptance, seeking help proactively and employing strength-based adaptive coping strategies. This theoretical conceptualisation of young men's anxiety has the capacity to enhance identification and treatment efforts, improving young men's mental health outcomes across the lifespan.

Why do queer men experience negative body image? A narrative review and testable stigma model.

Queer men (i.e., men who are not heterosexual; sexual minority men) are disproportionately affected by negative body image - they experience greater body dissatisfaction are more likely to develop eating disorders than heterosexual men. While existing literature has examined individual-level predictors of negative body image for queer men, less is known about why queer men as a group are disproportionately affected by negative body image. By synthesising existing theoretical frameworks, research, policy, and media reporting, this narrative review moves towards an understanding of systemic-level negative body image for queer men. Through the lens of hegemonic masculinity, we explain how systemic experiences of stigma work to inform unattainable appearance standards for queer men, and how these standards then contribute to pervasive negative body image concerns among this community. Next, we describe how systemic stigma works to exacerbate negative health outcomes for queer men with body image concerns. Finally, we present a synthesized model of the processes outlined in this review, articulate testable predictions for future studies, and describe practical implications that could be widely employed to improve body image for queer men. Our review is the first to propose a comprehensive explanation of systemic negative body image for queer men.

Characteristics and clinical needs of young tertiary students attending a specialist mood disorders clinic.

OBJECTIVE: To investigate the clinical characteristics of tertiary students and non-students attending a specialist clinic for severe mood disorders. METHOD: Medical record audit of clients discharged from the Youth Mood Clinic (YMC). Data extracted included depressive symptomatology, suicidal ideation, self-harm, suicide attempt, tertiary education engagement, drop-out and deferral. RESULTS: Data from 131 clients (M age = 19.58 years, SD = 2.66) were analysed, including 46 tertiary students. Relative to non-students, at intake, tertiary students reported more severe depressive symptomatology (d = 0.43). They were more likely to experience suicidal ideation at intake (V = 0.23), and during treatment (V = 0.18). Tertiary students were also more likely to be living separately to their family of origin (V = 0.20) but were less likely to have experienced parental separation (V = 0.19). 21.73% of tertiary students dropped out or deferred study during care. CONCLUSION: In this cohort, those engaged in tertiary education experience more severe depression and more commonly experienced suicidal ideation. These young people require targeted support for their mental health while they undertake tertiary education.

Suicidal ideation among men during COVID-19: Examining the roles of loneliness, thwarted belongingness, and personality impairment.

Suicidal ideation (SI) is a known precursor to suicide among men. While loneliness and thwarted belongingness (TB) have been identified as key factors influencing SI, no study has reported on all three constructs to investigate whether loneliness is associated with SI by way of TB. Furthermore, it is not clear whether personality impairment has a moderating role on this process. The present study examined the impact of loneliness on SI among men and whether TB mediated this relationship. Additionally, the study investigated whether personality impairment (i.e., self-functioning, interpersonal functioning) moderated the relationship between loneliness and TB. Canadian men (N = 434) completed an online survey that included self-report assessments of the study constructs. Conditional process modeling was used to test the indirect effect of loneliness on SI via the mediating effect of TB. Findings indicated a significant association between loneliness and SI that was mediated by TB. Further, impairment in self-functioning moderated the relationship between loneliness and TB, indicating that the relationship was stronger among men with greater difficulties in self-functioning. The findings are important to consider within the COVID-19 context, as they point to the need to reduce the detrimental impacts of loneliness, thereby potentially mitigating male SI.

Suicidal ideation in men during COVID-19: an examination of protective factors.

BACKGROUND: Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour. METHODS: A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis. RESULTS: Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans. CONCLUSIONS: Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.