Treatment engagement in adolescents with severe psychiatric problems: a latent class analysis

Motivation is considered a pivotal factor in treatment, but a better understanding of this topic is needed. Drieschner et al. (Clin Psychol Rev 23:1115–1137, 2004) proposed to distinguish treatment motivation and treatment engagement. This study aimed to discover whether it is possible to identify classes of adolescents with severe psychiatric problems having comparable profiles of treatment engagement. To this end, professionals filled out the Treatment Engagement Rating Scale 5 times for 49 adolescents (mean age 18.3 years; SD = 1.6) during the first year of case management treatment. Using a longitudinal latent class analysis, the number of profiles of treatment engagement was investigated and described. Results identified three profiles: high (19 clients, 39 %), medium (20 clients, 41 %) and low (10 clients, 20 %). Adolescents with a high engagement profile were at first equally, and later on more engaged in treatment than clients with a medium engagement profile. Adolescents with a low engagement profile made the least effort to engage, except after 30 weeks. Adolescents with a low engagement profile were often substance-dependent males with the lowest scores on the Global Assessment of Functioning Scale after a year. Only adolescents with a high engagement profile improved on global functioning. In conclusion, it is possible to identify different treatment engagement profiles by asking one question about level of global treatment engagement. Frequent assessment of engagement of the individual client as well as including a behavioural component into assessment and treatment may help to improve case management treatment for adolescents with medium and low engagement profiles. Keywords: Motivation, Case management, Adolescent psychiatry, Latent class analysi

Benefits of employment in people with mental illness: Differential mediating effects of internalized stigma on self‐esteem

Previous research shows a negative relationship between the stigmatization of people with mental illness and self-esteem. Through path analysis, the present study examines the extent to which both perceived individual discrimination and perceived group discrimination predict self-esteem and the extent to which internalized stigma and concealment mediate these relationships. We also test whether this mediation is moderated by the amount of time worked. The participants were 110 Spanish people with mental illness (67 men and 43 women) recruited from Spanish nongovernmental organizations. The sample was divided into two groups according to whether they had a permanent employment contract (which occurs when a person has worked for over 5 months). The results confirmed the mediating role of internalized stigma between individual perceived discrimination and self-esteem in the group with permanent employment contracts. Group discrimination had an indirect positive association with self-esteem through reduced internalized stigma in the whole sample. In sum, our results show that being employed for longer may strengthen the relationship between perceived individual discrimination and self-esteem via internalized stigma and that perceived group discrimination may buffer the negative relationship between internalized stigma and self-esteem in people with mental illness

Beliefs About Health, Health Risks and Health Expectations from the Perspective of People with a Psychotic Disorder

AIM: To examine beliefs about health, health risks and health expectations from the perspective of people diagnosed with a psychotic disorder BACKGROUND: People with psychotic disorders have a threefold higher risk of developing physical health problems than the general population, and prevention of these problems is warranted. Examining patients´ health beliefs could help deepen our understanding of how to plan successful health interventions with this group. METHODS: Qualitative semi-structured interviews were conducted from November 2010 to October 2011 with 17 people with psychotic disorders. Data were analyzed using a qualitative content analysis. RESULTS: An overall positive picture of health was found despite the fact that physical health was found to be hard to verbalize and understand. Health was mainly associated with psychological wellbeing, while health risks were found to be related to uncertain bodily identity, troublesome thoughts and inner voices, and exclusion from society. Interest in learning, and visions and goals of health seemed to increase awareness of health risks and health expectations, while not worrying could be viewed as a hindrance for health expectations. CONCLUSION: There is a lack of expressed awareness of physical health risks, but such awareness is fundamental to performing life-style changes [14]. Nurses thus have an important task to help patients understand and verbalize potential physical health risks, and to find out what motivates them to adopt health behaviors