Mobile Mental Health Crisis Intervention in the Western Health Region of Newfoundland and Labrador

The impetus for this research is Recommendation #15 of the 2003 Luther Inquiry into the deaths of Norman Reid and Darryl Power: “IT IS FURTHER RECOMMENDED that the Regional Health Boards establish mobile health units to respond to mentally ill persons in crisis where no criminal offence is alleged. Each unit would be developed locally and based on local needs.” Our stakeholder partners in the Western Regional Health Authority asked us to identify a range of mobile crisis intervention service models, some of which may be better suited to lower-density, rural populations and some of which may be better suited to higher-density areas like Corner Brook. Our partners expressed a particular interest in models that can be implemented with minimal additional human resources, but that involve local, face-to-face contact rather than telephone, electronic, or clinic-based models of service delivery. The term “crisis intervention” generally refers to any immediate, short-term therapeutic interventions or assistance provided to an individual or group of individuals who are in acute psychological distress or crisis. The term encompasses a number of after-the-fact interventions – such as rape counseling and critical incident stress debriefing – that would not be relevant to the kinds of situations described in the Luther Report. Given the project parameters specified by our partners at Western Health, we formulated a research question and a literature search strategy that would enable us to focus specifically on forms of crisis intervention that are designed to manage potentially dangerous mental health crises on-site rather than to mediate their impacts after the fact. Our research question is as follows: “What models of mobile– i.e., face-to-face – crisis intervention have proven effective in managing potentially violent mental health crises occurring outside the hospital setting?

Investigating sources and modes of communication through which rural raised drivers learn and experience cultural models of driving and their impact on driving safety

Saskatchewan faces a serious problem with its traffic safety: there are more traffic-related injuries and fatalities in Saskatchewan than in other Canadian provinces. This issue is particularly problematic on rural roads, where young rural drivers are involved in a disproportionately high number of traffic-related fatalities. However, research has yet to determine what and how information is transmitted to young rural-raised drivers or how this information differs after moving to an urban centre. To address these gaps, the present research explores the cultural models of driving in Saskatchewan and how these models are transmitted to young drivers so that they develop either safe or unsafe driving mental models. A survey questionnaire of rural-raised university undergraduates who drive estimated their relative level of driving safety via driving styles, traffic risk perception, and attitudes toward driving. Following a case-based approach to qualitative research, subsequent interviews with seven survey participants permitted an in-depth understanding of which driving mental model components (both safe and unsafe) develop in these drivers and the modes and sources of communication through which this development occurs. Results describe several universalities and discrepancies among young rural-raised drivers’ perceptions of the cultural and individual mental models of driving. For example, rural driving is associated with reckless practices, low police presence, and underage driving, though safety benefits from minimal distractors (besides wildlife). Findings also indicate that, of all cultural model transmission modes, punishment and observation/modeling have the strongest impact on mental model development. Finally, of the sources of cultural model transmission examined, family and friends/peers appear to have the most significant influence on this group’s mental models of driving. Practical applications, limitations, and directions for future research of this exploratory study are also discussed

Perceived interpersonal discrimination and older women’s mental health: accumulation across domains, attributions, and time

Experiencing discrimination is associated with poor mental health, but how cumulative experiences of perceived interpersonal discrimination across attributes, domains, and time are associated with mental disorders is still unknown. Using data from the Study of Women’s Health Across the Nation (1996–2008), we applied latent class analysis and generalized linear models to estimate the association between cumulative exposure to perceived interpersonal discrimination and older women’s mental health. We found 4 classes of perceived interpersonal discrimination, ranging from cumulative exposure to discrimination over attributes, domains, and time to none or minimal reports of discrimination. Women who experienced cumulative perceived interpersonal discrimination over time and across attributes and domains had the highest risk of depression (Center for Epidemiologic Studies Depression Scale score ≥16) compared with women in all other classes. This was true for all women regardless of race/ethnicity, although the type and severity of perceived discrimination differed across racial/ethnic groups. Cumulative exposure to perceived interpersonal discrimination across attributes, domains, and time has an incremental negative long-term association with mental health. Studies that examine exposure to perceived discrimination due to a single attribute in 1 domain or at 1 point in time underestimate the magnitude and complexity of discrimination and its association with health

Schizophrenia: Causes, Crime, and Implications for Criminology and Criminal Justice

This paper is aimed at criminologists and criminal justicians seeking to understand their role in educating law enforcement and correctional personnel who must deal with the mentally ill. It is motivated by William Johnson\u27s (2011) recent call for rethinking the interface between mental illness, criminal justice, and academia, and his call for advocacy. We concur with his concerns, and insist that this rethinking must necessarily include grounding in the etiology of mental illness (specifically, with schizophrenia) as it is currently understood by researchers in the area. Advocacy must go hand in hand with a thorough knowledge of the condition of the people for whom we are advocating. We first examine major etiological models of schizophrenia, emphasizing the neurodevelopmental model that incorporates genetics, neurological functioning, and immunological factors guided by the assumption that the typical criminologist/criminal justician has minimal acquaintance with such material. We then address the link between schizophrenia and criminal behavior, and conclude with a discussion of the implications for criminology and criminal justice

Personalized Prediction of Recurrent Stress Events Using Self-Supervised Learning on Multimodal Time-Series Data

Chronic stress can significantly affect physical and mental health. The advent of wearable technology allows for the tracking of physiological signals, potentially leading to innovative stress prediction and intervention methods. However, challenges such as label scarcity and data heterogeneity render stress prediction difficult in practice. To counter these issues, we have developed a multimodal personalized stress prediction system using wearable biosignal data. We employ self-supervised learning (SSL) to pre-train the models on each subject's data, allowing the models to learn the baseline dynamics of the participant's biosignals prior to fine-tuning the stress prediction task. We test our model on the Wearable Stress and Affect Detection (WESAD) dataset, demonstrating that our SSL models outperform non-SSL models while utilizing less than 5% of the annotations. These results suggest that our approach can personalize stress prediction to each user with minimal annotations. This paradigm has the potential to enable personalized prediction of a variety of recurring health events using complex multimodal data streams

An Evaluation of the EEG Alpha-to-Theta and Theta-to-Alpha Band Ratios as Indexes of Mental Workload

Many research works indicate that EEG bands, specifically the alpha and theta bands, have been potentially helpful cognitive load indicators. However, minimal research exists to validate this claim. This study aims to assess and analyze the impact of the alpha-to-theta and the theta-to-alpha band ratios on supporting the creation of models capable of discriminating self-reported perceptions of mental workload. A dataset of raw EEG data was utilized in which 48 subjects performed a resting activity and an induced task demanding exercise in the form of a multitasking SIMKAP test. Band ratios were devised from frontal and parietal electrode clusters. Building and model testing was done with high-level independent features from the frequency and temporal domains extracted from the computed ratios over time. Target features for model training were extracted from the subjective ratings collected after resting and task demand activities. Models were built by employing Logistic Regression, Support Vector Machines and Decision Trees and were evaluated with performance measures including accuracy, recall, precision and f1-score. The results indicate high classification accuracy of those models trained with the high-level features extracted from the alpha-to-theta ratios and theta-to-alpha ratios. Preliminary results also show that models trained with logistic regression and support vector machines can accurately classify self-reported perceptions of mental workload. This research contributes to the body of knowledge by demonstrating the richness of the information in the temporal, spectral and statistical domains extracted from the alpha-to-theta and theta-to-alpha EEG band ratios for the discrimination of self-reported perceptions of mental workload

The SF36 as an outcome measure of services for end stage renal failure

OBJECTIVE: —To evaluate the use of the short form 36 (SF36) as a measure of health related quality of life of patients with end stage renal failure, document the results, and investigate factors, including mode of treatment, which may influence it. DESIGN: Cross sectional survey of patients with end stage renal failure, with the standard United Kingdom version of the SF36 supplemented by specific questions for end stage renal failure. SETTING: A teaching hospital renal unit. Subjects and methods—660 patients treated at the Sheffield Kidney Institute by haemodialysis, peritoneal dialysis, and transplantation. Internal consistency, percentage of maximal or minimal responses, SF36 scores, effect sizes, correlations between independent predictor variables and individual dimension scores of the SF36. Multiple regression analysis of the SF36 scores for the physical functioning, vitality, and mental health dimensions against treatment, age, risk (comorbidity) score, and other independent variables. RESULTS: A high response rate was achieved. Internal consistency was good. There were no floor or ceiling effects other than for the two “role” dimensions. Overall health related quality of life was poor compared with the general population. Having a functioning transplant was a significant predictor of higher score in the three dimensions (physical functioning, vitality, and mental health) for which multiple regression models were constructed. Age, sex, comorbidity, duration of treatment, level of social and emotional support, household numbers, and hospital dialysis were also (variably) significant predictors. CONCLUSIONS: The SF36 is a practical and consistent questionnaire in this context, and there is evidence to support its construct validity. Overall the health related quality of life of these patients is poor, although transplantation is associated with higher scores independently of the effect of age and comorbidity. Age, comorbidity, and sex are also predictive of the scores attained in the three dimensions studied. Further studies are required to ascertain whether altering those predictor variables which are under the influence of professional carers is associated with changes in health related quality of life, and thus confirm the value of this outcome as a measure of quality of care

Children\u27s Mental Health over the Early Life Course: The Impact of Economic Resources, Neighborhood Disorder, and Family Processes

Drawing upon a stress process and life course framework, and using data from the Child Supplement of the National Longitudinal Survey of Youth, the three papers presented in this dissertation examine the extent to which economic resources, neighborhood disorder, and family processes influence children’s trajectories of mental health. In the first paper, I empirically construct six categories that represent children with comparable profiles of family income over time: increasing, decreasing, fluctuating, and stability across low-, medium-, and high-income families. The income categories are incorporated in multiple group latent growth curve models to assess the extent to which they initiate and shape children’s mental health trajectories from age 4 to 14. Results reveal significant disparities in antisocial behavior and depression/anxiety at age 4 and over time across the income categories. In the second paper, I use these income categories to examine how stability and change in family income influences trajectories of maternal emotional support and the provision of cognitive stimulation in children’s home environments. In subsequent analyses, I examine the extent to which these different economic profiles moderate the relationship between family processes and children’s mental health trajectories. In the third and final paper, I examine the relationship between stability and change in perceived neighborhood disorder and children’s trajectories of mental health. I conceptualize perceived neighborhood disorder as a two-part process involving a binary component that distinguishes between children exposed to minimal vs. high levels of disorder, and a continuous component that represents the actual level of disorder for children in the latter category. These two processes capture stability and change in neighborhood disorder over time, and are included in parallel process latent growth models to examine their separate and distinct impact on children’s trajectories of mental health. The results from these papers underscore that the duration and sequencing of socioeconomic status, both at the family and neighborhood level, have important implications for children’s mental health and family processes. The results also underscore the complex and dynamic ways family processes influence children’s mental health in different economic contexts