A Scoping Review of Trauma, Mental Health and First Responders in Australia.

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer-reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders.

Job Loss Due to COVID-19: A Longitudinal Study of Mental Health, Protective and Risk Factors.

The COVID-19 pandemic had a devastating impact on unemployment, which-compounded by the additional stressors associated with the pandemic-had considerable mental health impact. The current study examined the trajectory of mental health amongst those experiencing pandemic-related job loss, alongside the impact of risk and protective factors. Data were obtained from 374 Australian participants who were allocated to a waitlist control arm of a randomised control trial. The outcome variables assessed at baseline and six-month follow-up consisted of depression, anxiety, and suicidality. The assessed risk and protective factors were age, gender, relationship status, education, exercise frequency, COVID-related stress, dispositional resilience, and coping self-efficacy. Re-employment by follow-up was used as a covariate. Overall, there were decreases in depression and anxiety symptoms, and partial evidence of decreased suicidality, demonstrating an apparent capacity for individuals to better cope with their circumstances over time. Demographics and exercise had no effect on changes in mental health. Those with high COVID-related stress, low resilience, and low coping self-efficacy had worse mental health at baseline, although exhibited significantly greater improvements in mental health over time. Obtaining re-employment by follow-up did not predict changes in mental health. The present results offer an optimistic picture of recovery for those experiencing pandemic-related job loss, even for those with the most substantial risk and severity. The likely protective role played by Australian social welfare policies over the course of the study is explored. Stress around one's broader sociocultural or economic circumstances, perceived resilience, and coping self-efficacy are valuable targets for intervention.

Three reasons why parental burnout is more prevalent in individualistic countries: a mediation study in 36 countries.

PURPOSE: The prevalence of parental burnout, a condition that has severe consequences for both parents and children, varies dramatically across countries and is highest in Western countries characterized by high individualism. METHOD: In this study, we examined the mediators of the relationship between individualism measured at the country level and parental burnout measured at the individual level in 36 countries (16,059 parents). RESULTS: The results revealed three mediating mechanisms, that is, self-discrepancies between socially prescribed and actual parental selves, high agency and self-directed socialization goals, and low parental task sharing, by which individualism leads to an increased risk of burnout among parents. CONCLUSION: The results confirm that the three mediators under consideration are all involved, and that mediation was higher for self-discrepancies between socially prescribed and actual parental selves, then parental task sharing, and lastly self-directed socialization goals. The results provide some important indications of how to prevent parental burnout at the societal level in Western countries.

Do mortality cues increase state autonomy? The moderating roles of trait autonomy, flexibility, and curiosity.

This study tested the effects of deep and subtle mortality cues on state autonomy, in addition to the moderating roles of trait autonomy, psychological flexibility, and curiosity. Australian undergraduate students (N = 442) self-reported on moderator variables before being randomly allocated to receive either deep mortality cues, subtle mortality cues, or a control task, and finally reported their state autonomy for life goals. Trait autonomy did not moderate the effect of mortality cues on state autonomy. However, for individuals high on psychological flexibility, any mortality cues led to increased state autonomy compared to the control. For individuals high on curiosity, there was some evidence that only deep mortality cues led to increased state autonomy. These findings help clarify the nature of growth outcomes (in terms of more authentic, autonomous motivation for life goals), and the personal characteristics that facilitate growth-oriented processing of death awareness.

Mental health and unemployment: A systematic review and meta-analysis of interventions to improve depression and anxiety outcomes.

BACKGROUND: Unemployment is associated with substantially greater depression and anxiety, constituting a considerable public health concern. The current review provides the most comprehensive synthesis to date, and first meta-analysis, of controlled intervention trials aimed at improving depression and anxiety outcomes during unemployment. METHODS: Searches were conducted within PsycInfo, Cochrane Central, PubMed and Embase from their inception to September 2022. Included studies conducted controlled trials of interventions focused on improving mental health within unemployed samples, and reported on validated measures of depression, anxiety, or distress (mixed depression and anxiety). Narrative syntheses and random effects meta-analyses were conducted among prevention- and treatment-level interventions for each outcome. RESULTS: A total of 39 articles reporting on 33 studies were included for review (sample sizes ranging from 21 to 1801). Both prevention and treatment interventions tended to be effective overall, with treatment interventions producing larger effect sizes than prevention interventions. The clearest evidence for particular intervention approaches emerged for prevention-level Cognitive Therapy/CBT, followed by prevention-level work-related interventions, although neither produced entirely consistent effects. LIMITATIONS: Risk of bias was generally high across studies. Low numbers of studies within subgroups precluded any comparisons between long-term and short-term unemployment, limited comparisons among treatment studies, and reduced the power of meta-analyses. CONCLUSIONS: Both prevention- and treatment-level mental health-focused interventions have merit for reducing symptoms of anxiety and depression among those experiencing unemployment. Cognitive Therapy/CBT and work-related interventions hold the most robust evidence base, which can inform both prevention and treatment strategies implemented by clinicians, employment services providers, and governments.

Reduced death anxiety as a mediator of the relationship between acute subjective effects of psychedelics and improved subjective well-being.

Research over the past several decades suggests that meaningful psychedelic experiences can engender long-term effects on subjective wellbeing. However, less research has investigated the psychological mechanisms through which these effects may emerge. In the present study, participants (N = 201) completed an online survey that retrospectively measured the acute effects of a meaningful psychedelic experience, as well as changes in subjective well-being and death anxiety. Reductions in death anxiety significantly mediated the effects of mystical experience on satisfaction with life, positive affect, and negative affect. Reductions in death anxiety did not mediate any of the effects of psychological insight. Although correlational, the findings are consistent with the hypothesis that some of the benefits of psychedelic-induced mystical experiences on subjective well-being may emerge due to reductions in death anxiety. Nevertheless, further research is needed to establish a causal effect of reduced death anxiety on well-being in the context of psychedelic experiences.

Exploring the lived experience of mental health and coping during unemployment.

BACKGROUND: Unemployment is known to involve various psychosocial challenges that can negatively impact mental health. However, the intricacies of how individuals experience these challenges and strive to cope within the context of varied sociocultural and individuating factors, remain comparatively understudied. The present qualitative study used an interpretative phenomenological approach to explore the lived experiences of mental health and coping during unemployment. METHODS: Fifteen Australian adults who had recently experienced unemployment (for ≥3 months in the last 2 years), despite being available for and able to work, participated in semi-structured interviews from August to September 2021. Maximum variation sampling ensured participants represented diverse sociodemographic backgrounds. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis within NVivo12 software. RESULTS: Four major themes were identified: 1) disrupted identity and direction in life; 2) navigating conflicting views of contribution and progress; 3) knowing how to cope is not enough; and 4) unemployment as a catalyst for new understandings. Unemployment disrupted participants' sense of purpose, identity and visions for the future. It signified a perceived failure to meet societal standards of value based upon the economic functions of work, which participants struggled to reconcile with their own priorities for work that satisfied psychosocial needs. Participants were aware of effective coping strategies, although these had mixed positive and negative effects on mental health, or were difficult to mobilise during unemployment. The COVID-19 pandemic, while normalising unemployment to some degree, exacerbated future uncertainty and prevented engagement with known coping strategies (e.g., social interaction). However, unemployment could also instigate growth through re-defining markers of achievement, re-aligning goals with one's core values, and developing greater compassion. CONCLUSIONS: Experiences of mental health and coping during unemployment share complex relationships both with each other and with broader personal and sociocultural contexts. Service providers may better meet the mental health needs of those experiencing unemployment by balancing the economic and psychosocial functions of work, understanding that coping is a wholistic issue that goes beyond knowledge of effective strategies, and being aware of the opportunities for self-development that unemployment can create.

Living Authentically in the Face of Death: Predictors of Autonomous Motivation Among Individuals Exposed to Chronic Mortality Cues Compared to a Matched Community Sample.

Despite research demonstrating positive outcomes of conscious death reflection, very little research directly examines a core proposition of existential psychologists-that death reflection provides an opportunity for more authentic living. The current study compared individuals chronically exposed to genuine mortality cues (funeral/cemetery workers, n = 107) to a matched control sample (n = 121) on autonomous motivation. It also assessed the moderating role of six constructs implicated in growth-oriented processing of death reflection: psychological flexibility, curiosity, neutral death acceptance, death anxiety, approach-oriented coping, and avoidant coping. Funeral/cemetery workers were significantly higher on autonomous motivation, and death-related work was found to have a more positive association with autonomous motivation for those higher on flexibility and lower on death anxiety. This has implications for both understanding which individuals are most likely to experience growth motivations when confronting death, and potential avenues for facilitating these motivations to enhance well-being.

Predictors of not receiving mental health services among people at risk of suicide: A systematic review.

BACKGROUND: The majority of people who die by suicide are unknown to formal mental health services. The current review identified predictors of non-receipt of mental health services among individuals experiencing suicidal thoughts or behaviours. Such data provides insight into the needs and preferences of these individuals and inform improvements to existing services. METHODS: PsycInfo, PubMed/Medline, CINAHL, and Web of Science were systematically searched from 1st January 1980 up to 20th September 2021. Included studies examined predictors of not receiving formal mental health services among people at risk of suicide. Study quality was assessed by adapting the Joanna-Briggs Institute Checklist for Analytical Cross-Sectional Studies. Findings were presented with narrative synthesis. PROSPERO registration: CRD42021256795. RESULTS: Included studies (n = 35, sample range = 46-19,243) were predominately conducted in the United States. Non-receipt of services in nationally representative studies was varied (25.7-91.8%). Results indicate that non-receipt of mental health services among people with suicidality is associated with minority ethnicity, better perceived general health, lower psychological distress, lower severity of suicidality, no mental health diagnosis, lower perceived need for treatment and lower use of medical services. LIMITATIONS: Limitations included few studies conducted in low-middle income countries, limited literature on key predictors of interest, and exclusion of informal sources of support. CONCLUSION: Individuals with suicidality who are unknown to mental health services have diverse attributes. For some, non-use of services may result from low suicidal distress and perceived need for treatment. Further research is needed to understand why these predictors are associated with service non-use.

People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review.

INTRODUCTION: The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and "just in time" interventions. METHODS: In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543. RESULTS: Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt. CONCLUSION: People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services. SYSTEMATIC REVIEW REGISTRATION: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.

Embedding existential psychology within psychedelic science: reduced death anxiety as a mediator of the therapeutic effects of psychedelics.

Psychedelic therapies can engender enduring improvements in psychological well-being. However, relatively little is known about the psychological mechanisms through which the salutary effects of psychedelics emerge. Through integrating extant research on psychedelics with contemporary existential psychology, we present a novel hypothesis that reduced death anxiety may be a key mechanism underpinning the therapeutic effects of psychedelics. In developing this hypothesis, we also provide a complementary review of mechanisms through which psychedelics may reduce death anxiety. We conclude that an awareness of the role of death anxiety in psychopathology has the potential to guide future research into psychedelic therapies.

Four hydrophobic amino acids of the factor VIII C2 domain are constituents of both the membrane-binding and von Willebrand factor-binding motifs.

Factor VIII binds to phospholipid membranes and to von Willebrand factor (vWf) via its second C domain, which has lectin homology. The crystal structure of the C2 domain has prompted a model in which membrane binding is mediated by two hydrophobic spikes, each composed of a pair of residues displayed on a beta-hairpin turn, and also by net positive charge and specific interactions with phospho-l-serine. To test this model, we prepared 16 factor VIII mutants in which single or multiple amino acids were changed to alanine. Mutants at Arg(2215), Arg(2220), Lys(2227), Lys(2249), Gln(2213), Asn(2217), and Phe(2196)/Thr(2197) had specific activities that were >70% of the wild type. Mutants at Arg(2209), Lys(2227), Trp(2313), and Arg(2320) were degraded within the cell. Hydrophobic spike mutants at Met(2199)/Phe(2200), Leu(2251)/Leu(2252), and Met(2199)/Phe(2200)/Leu(2251)/Leu(2252) (4-Ala) exhibited 43, 59, and 91% reduction in specific activity in the activated partial thromboplastin time assay. In a phospholipid-limiting factor Xa activation assay, these mutants had a 65, 85, and 96% reduction in specific activity. Equilibrium binding of fluorescent, sonicated phospholipid vesicles to mutants immobilized on Superose beads was measured by flow cytometry. The affinities for phospholipid were reduced approximately 20-, 30-, and >35-fold for 2199/2200, 2251/2252, and 4-Ala, respectively. A dimeric form of mature vWf bound to immobilized factor VIII and the same mutants, but the affinities of the mutants were reduced approximately 5-, 10-, and >20-fold, respectively. In a competition, solution phase enzyme-linked immunosorbent assay, plasma vWf bound factor VIII and the same mutants with the affinities for the mutants reduced >5-, >5-, and >50-fold, respectively. We conclude that the two hydrophobic spikes are constituents of both the phospholipid-binding and vWf-binding motifs. In plasma, vWf apparently binds the inherently sticky membrane-binding motif, preventing nonspecific interactions.