Recovery for all in the community; position paper on principles and key elements of community-based mental health care.

BACKGROUND: Service providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline. With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe. MAIN TEXT: The development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email. High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network. CONCLUSIONS: Discussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.

Overgeneral autobiographical memory predicts higher prospective levels of depressive symptoms and intrusions in borderline patients.

Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N = 54) and at six-month follow-up (N ≥ 31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory-2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD.

Psychometric properties of the multidimensional perfectionism scale of Hewitt in a dutch-speaking sample: associations with the big five personality traits.

We administered the Dutch Multidimensional Perfectionism Scale of Hewitt and Flett (1991, 2004) in a large student sample (N = 959) and performed a confirmatory factor analysis to test the factorial structure proposed by the original authors. The existence of a method factor referring to the negatively keyed items in the questionnaire was investigated by including it in the tested models. Next, we investigated how the 3 perfectionism dimensions are associated with the Five-factor model (FFM) of personality. The 3-factor structure originally observed by the authors was confirmed, at least when a method factor that refers to the negatively keyed items was included in the model. Self-oriented and socially prescribed perfectionism were both distinguished by low extraversion and low emotional stability. Self-oriented perfectionism's positive relationship with both conscientiousness and openness to experience differentiated the 2 perfectionism dimensions from each other. Other-oriented perfectionism was not well-characterized by the Big Five personality traits.

Patient involvement in mental health care: one size does not fit all.

BACKGROUND: Involvement of mental health-care patients in the decision-making processes is considered to be an ethical requirement. Health-care systems worldwide are increasingly emphasizing the value of participatory approaches. There is, however, no consensus on the definition of patient involvement. The literature is particularly inconsistent and lacks clarity. OBJECTIVE: The purpose of this article is to clarify the concept of patient involvement in mental health care (MHC), taking into account its multidimensional nature. SEARCH STRATEGY: We searched the literature in online databases from January 1998 until August 2010 using synonyms of 'patient involvement', combined with the terms 'mental health(care)'. DATA SYNTHESIS: Based on 45 different descriptions found in the literature, we constructed a definition of patient involvement and we drew up a model identifying its determinants and outcomes. RESULTS: We propose a comprehensive model of patient involvement to be used in MHC. This model can serve as a guide for policy makers and field workers to shape policies to stimulate involvement. DISCUSSION AND CONCLUSIONS: There are three main problems in the literature concerning patient involvement. First, there is a proliferation of conceptualizations of the topic, leading to conceptual vagueness. Furthermore, there is a lack of quantitative data, and some aspects of involvement remain underexposed, such as the involvement of specific target groups and practical ways to shape the involvement processes. Involvement processes should be tailored to the specific target group and context.

Physical activity correlates in persons with binge eating disorder: a systematic review.

Understanding the factors that influence physical activity in persons with binge eating disorders can aid the design of more effective interventions. In order to address this, the present paper provides a systematic quantitative review of the correlates of physical activity in people with binge eating disorder. We searched PsycINFO, PubMed and PEDro from inception until June 2013. Keywords included 'binge eating' with 'physical activity' or 'exercise', or 'physical inactivity' or 'sedentary'. Nine papers involving 636 (489 women) persons with binge eating disorders and evaluating 24 correlates were included. No consistent physical activity correlates were reported in four or more studies. The only significant correlate with lower physical activity participation reported in more than one study was a negative body attitude. Further research is required to address this current gap in literature.

Clinical correlates of global functioning in obese treatment seeking persons with binge eating disorder.

BACKGROUND: In recent years, research has called for an increased emphasis on clinical outcomes that are meaningful to patients with binge eating disorder (BED). This cross-sectional study examined the Global Assessment of Functioning (GAF) and its relation to clinical and demographic factors in BED patients. SUBJECTS AND METHODS: Thirty-two patients (28 women and 4 men) with BED (age = 41.1 ± 10.7; body mass index = 38.9 ± 5.8) seeking treatment to a weekly multidisciplinary programme at the UPC KU Leuven, Campus Kortenberg in Belgium, were asked to participate at intake. All participants were assessed with the GAF scale, completed the Eating Disorder Inventory (EDI), the Body Attitude Test (BAT), the Symptoms Checklist-90, the Baecke Physical Activity Questionnaire (BPAQ), and performed a 6 minute walk test. RESULTS: The GAF-score (55.9 ± 13.9) was only significantly associated with the BPAQ score (7.0 ± 1.4) (r = 0.383, p = 0.03) and the BAT score (63.9 ± 16.1) (r=-0.443, p = 0.011). The regression model including both of these variables explained 25.3% of the variability in the GAF-score. CONCLUSIONS: This study highlights the value of clinicians assessing physical activity and body image in patients with BED. Research is needed to elucidate whether incorporating body image treatments and physical activity in the care of patients with BED can promote global functioning.

Missing data in long-term follow-up of patients with eating disorders using the body attitude test.

OBJECTIVE: Incompleteness of data is a major problem within clinical follow-up studies. The aim of present study was to compare different statistical models in the management of follow-up data in patients with eating disorders using the Body Attitude Test. METHOD: A prospective longitudinal investigation with repeated evaluations over fixed time intervals was conducted among 807 female patients with eating disorders using the Body Attitude Test as a dependent-variable. Three types of missing data mechanisms were explored: missing completely at random, missing at random and missing not at random. RESULTS: Multivariate analysis showed that the missing completely at random type of missing data mechanism is less reliable than the missing at random or missing not at random mechanisms. Five years after admission, the body experience of eating disorder patients is less deviant. Compared with normative data, 37% of the eating disorder patients still had a more negative body experience 5 years after admission. DISCUSSION: There is no single correct method for dealing with missing data. Therefore, it is recommended that multiple methods be used under different assumptions of absenteeism.

Variability in affective activation predicts non-suicidal self-injury in eating disorders.

We examined whether affective variability can predict non-suicidal self-injury (NSSI) in eating disorders. Affect was represented by valence (positive versus negative) and activation (high versus low). Twenty-one patients with anorexia nervosa-restricting type, 18 patients with anorexia nervosa-binge-purging type and 20 patients with bulimia nervosa reported their momentary affect at nine random times a day during a one week period using a hand-held computer. Affective variability was calculated as the within-person standard deviation of valence and activation over time. Results indicate that patients displaying greater variability in activation and using selective serotonin reuptake inhibitors have a higher probability to engage in lifetime NSSI after adjustment for depression and borderline personality disorder. Neither variability of valence nor mean level of valence and activation had any predictive association with engaging in NSSI. It is suggested that the treatment of NSSI should focus on affect stabilization rather than reducing negative affect.

Body dissatisfaction moderates weight curves in the inpatient treatment of Anorexia Nervosa.

OBJECTIVE: To examine whether drive for thinness, body dissatisfaction, and restrictive/binge eating-purging subtype at admission moderates the weight curves of patients with Anorexia Nervosa (AN) over the course of inpatient treatment. METHOD: The nature of weight curves, individual differences herein and moderating factors are examined in 92 AN patients by means of multilevel modeling. RESULTS: The average weight curve of AN patients is characterized by a linear weight increase during treatment that levels off near the end of treatment. Substantial individual differences exist in the shape of patients' weight curves. Patients with stronger body dissatisfaction at admission display a slower linear rate of weight gain over the course of treatment. Neither drive for thinness nor restrictive/binge eating-purging subtype predicted patients' weight curve over the course of treatment. DISCUSSION: Body dissatisfaction moderates patients' weight curves over the course of inpatient treatment but more research on factors determining weight curves is needed.