Exploring Resilience Models in a Sample of Combat-Exposed Military Service Members and Veterans: A Comparison and Commentary

Background: The term resilience is applied in numerous ways in the mental health field, leading to different perspectives of what constitutes a resilient response and disparate findings regarding its prevalence following trauma. Objective: illustrate the impact of various definitions on our understanding and prevalence of resilience, we compared various resilience definitions (absence of PTSD, absence of current mental health diagnosis, absence of generalized psychological distress, and an alternative trauma load–resilience discrepancy model of the difference between actual and predicted distress given lifetime trauma exposure) within a combat-exposed military personnel and veteran sample. Method: In this combat-trauma exposed sample (N = 849), of which approximately half were treatment seeking, rates of resilience were determined across all models, the kappa statistic was used to determine the concordance and strength of association across models, and t-tests examined the models in relation to a self-reported resilience measure. Results: Prevalence rates were 43.7%, 30.7%, 87.4%, and 50.1% in each of the four models. Concordance analyses identified 25.7% (n = 218) considered resilient by all four models (kappa = .40, p \u3c .001). Correlations between models and self-reported resilience were strong, but did not fully overlap. Conclusions:The discussion highlights theoretical considerations regarding the impact of various definitions and methodologies on resilience classifications, links current findings to a systems-based perspective, and ends with suggestions for future research approaches on resilience

Evaluating the selection, training, and support of peer support workers in the United Kingdom

This article describes the preparation, selection, training, and support of a group of people with lived experience of mental distress/illness and mental health service use to work as peer support workers (PSWs). The PSWs were recruited to provide support alongside conventional aftercare to service users discharged from acute psychiatric units in London, England. Training was delivered over 12 weekly, 1-day sessions from April to July 2010. Supervision and support were provided by a peer support coordinator and a training facilitator. The overall view of the training by those who went on to work as PSWs was that it was a valuable, challenging, yet positive experience that provided them with a good preparation for the role. A key area for improvement concerned the strength of emotional involvement and feelings PSWs had for their peers, especially in regard to ending the support relationship. Skilled, sensitive supervision and support is essential for the success of such roles

Joint submission to the Australian Government Treasury for the Measuring What Matters second consultation process, May 2023

In April 2023, the Australian Government invited a second round of feedback on the Treasury’s Measuring What Matters Statement; Australia’s first national framework on wellbeing. Recognising that traditional economic indicators provide important insights, but not a complete picture or holistic view of the community’s wellbeing, the Statement sought to define a suite of social and environmental indicators. Treasury set out several key questions and invited organisations and individuals to conduct their own consultation guided by these questions. The Matilda Centre for Research in Mental Health and Substance Use recognised the need to 1) ensure mental health is considered as paramount in any conceptualisation of wellbeing, and 2) centre both academic evidence and the voices of young people. As such, two consultation sessions were held; firstly with Australia’s Mental Health Think Tank, which is chaired by The Matilda Centre’s Professor Maree Teesson; and secondly with the PREMISE Centre of Research Excellence in Prevention and Early Intervention in Mental Illness and Substance Use Youth Advisory Board and The Matilda Centre Youth Mental Health Advisory Team. Chaired by Distinguished Professor Maree Teesson AC, Australia’s Mental Health Think Tank includes mental health experts from around Australia: Mr John Brogden AM, Professor Philip Batterham, Professor Alison Calear, Professor Tom Calma AO, Scientia Professor Helen Christensen AO, Professor Patricia Dudgeon AM, Professor Ian Hickie AM, Professor Frances Kay-Lambkin, Professor Patrick McGorry AO, Professor John McGrath, Professor Marc Stears, and Professor Harvey Whiteford. Eight diverse young people aged 16-25 were involved in the second submission and were reimbursed for their participation. The findings from these consultations and resulting submissions are contained in this document. In July 2023, Treasury released the final Measuring What Matters Framework. Australia’s Mental Health Think Tank, The Matilda Centre and PREMISE look forward to hearing more about the implementation of this framework and tracking of the 50 chosen indicators

Applying the Cry of Pain model as a predictor of deliberate self-harm in an early-stage adult male prison population

Purpose: Deliberate self-harming behaviour is more prevalent within the prison environment than in community samples, with those in the first weeks of imprisonment at greatest risk. Research in this area has been largely atheoretical and a unifying model may improve the predictability of assessment and the development of intervention approaches. This study applied William and Pollock’s (2001) Cry of Pain model as the theoretical process of deliberate self-harm in the early stages of imprisonment. Method: A prospective study of new arrivals at an adult male prison. Participants (n =181) completed questionnaires and it was hypothesised that the factors derived from the model (perceived stress, defeat, entrapment and absence of rescue factors) would be predictive of future deliberate self-harm. Prisoners with active psychosis and non-English speakers were excluded. All participants were followed up for four months for instances of self-harm. Eighteen participants engaged in self-harm during this period. Results: The Cry of Pain Model was supported in the analysis. Hierarchical binary logistic regression confirmed that all features of the model were supported as predictive of future self-harm in prison, even after controlling for previous self-harm, depression and hopelessness. Conclusion: The Cry of Pain model is supported as a predictive model for deliberate self-harm in prison. Suggestions are offered as to the impact on assessment and intervention directions in prison

Disruptive Behaviors in Veterans Affairs Nursing Home Residents: How Different Are Residents with Serious Mental Illness?

To determine the prevalence and correlates of behavior problems of residents of Veterans Affairs (VA) nursing homes and to compare residents with serious mental illness (SMI) with other resident groups. Design : This study combined cross-sectional resident assessments with administrative data for all residents in VA nursing homes. Multivariate ordinal logistic regression was used to evaluate associations between resident characteristics and problem behaviors. Setting : Nursing home care units in the VA healthcare system. Participants : A total of 9,618 nursing home residents assessed as part of the VA's April 2001 national resident census. Measurements : The Patient Assessment Instrument assessed each resident's verbally disruptive, physically aggressive, and socially inappropriate behaviors in the prior 4 weeks. Functional limitations in eating, mobility, toileting, and transfer were assessed. Diagnoses were evaluated for the stay and up to 6 months before assessment. Results : Almost one-fifth (17.9%) of residents received a diagnosis of SMI. Residents with SMI or dementia had greater behavior problems than residents with neither condition. Residents with SMI (and without dementia) exhibited more verbal disruption than residents with dementia (and without SMI), but the two subgroups did not differ in physically aggressive or socially inappropriate behavior. Conclusion : Many VA nursing home residents have SMI. Their level of behavior problems is comparable with that of residents with dementia. Clinical practice and nursing home staff training must encompass geriatric mental health and behavior management to meet the needs of residents with SMI.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65638/1/j.1532-5415.2004.52559.x.pd

Exploring the value of mental health nurses working in primary care in England: a qualitative study

BACKGROUND: General practice is typically the first point of access to healthcare. However, emerging models of providing mental health services in primary care are poorly understood. AIMS: To explore what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. PARTICIPANTS: Ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. METHOD: Semi-structured interviews, based on a topic guide of six open ended questions with prompts, were used to elicit participants' experiences and perspectives on the value of a PCLN service. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. FINDINGS: Five main themes were derived from the thematic analysis of interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. CONCLUSION: This study suggests that the PCLN service can improve the quality of care and is generally highly valued by its professional stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as referral criteria

Mental health, quality of life, wellbeing, loneliness and use of social media in a time of social distancing during the COVID-19 outbreak. A cross-country comparative study

Background The COVID-19 outbreak raised questions about how people experience their mental health, quality of life (QoL), wellbeing and loneliness in the context of social distancing, and the use of social media during this time Aims To examine the experience of mental health, QoL, wellbeing and loneliness and use of social media among people living in Norway, USA, UK and Australia. Methods A cross-country comparative survey of people living in Norway, USA, UK and Australia. Relevant statistical analyses were used to examine differences between the countries and to explore associations between demographic, mental health and psychosocial variables and use of social media. Results There were 3810 respondents from four countries, of which 50 − 74% showed a high level of emotional distress. The Norwegian population reported significantly better mental health, QoL and wellbeing and lower levels of loneliness compared to the other countries. High-frequent use of social media after the COVID-19 outbreak was associated with poorer mental- and psychosocial health. Conclusions The results suggest that the COVID-19 outbreak took a toll on people’s experience of mental health, QoL, wellbeing and experienced loneliness, and high-frequent use of social media was associated with these factors

Epidemiology and trends in non-fatal self-harm in three centres in England, 2000–2012: findings from the Multicentre Study of Self-Harm in England

Objectives: Self-harm is a major health problem in many countries, with potential adverse outcomes including suicide and other causes of premature death. It is important to monitor national trends in this behaviour. We examined trends in non-fatal self-harm and its management in England during the 13-year period, 2000–2012. Design and setting: This observational study was undertaken in the three centres of the Multicentre Study of Self-harm in England. Information on all episodes of self-harm by individuals aged 15 years and over presenting to five general hospitals in three cities (Oxford, Manchester and Derby) was collected through face-to-face assessment or scrutiny of emergency department electronic databases. We used negative binomial regression models to assess trends in rates of self-harm and logistic regression models for binary outcomes (eg, assessed vs non-assessed patients). Participants: During 2000–2012, there were 84 378 self-harm episodes (58.6% by females), involving 47 048 persons. Results: Rates of self-harm declined in females (incidence rate ratio (IRR) 0.98; 95% CI 0.97 to 0.99, p<0.0001). In males, rates of self-harm declined until 2008 (IRR 0.96; 95% CI 0.95 to 0.98, p<0.0001) and then increased (IRR 1.05; 95% CI 1.02 to 1.09, p=0.002). Rates of self-harm were strongly correlated with suicide rates in England in males (r=0.82, p=0.0006) and females (r=0.74, p=0.004). Over 75% of self-harm episodes were due to self-poisoning, mainly with analgesics (45.7%), antidepressants (24.7%) and benzodiazepines (13.8%). A substantial increase in self-injury occurred in the latter part of the study period. This was especially marked for self-cutting/stabbing and hanging/asphyxiation. Psychosocial assessment by specialist mental health staff occurred in 53.2% of episodes. Conclusions: Trends in rates of self-harm and suicide may be closely related; therefore, self-harm can be a useful mental health indicator. Despite national guidance, many patients still do not receive psychosocial assessment, especially those who self-injure

Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis

© The Author(s). 2018Background: As part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales. Methods: Nine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18.10.17 in MEDLINE, Embase, PsycINFO and CINAHL for primary studies between 2012 and 2017 that had not been covered by previous meta-analyses. Results: Forty studies, all conducted in England, were included for our updated meta-analyses on pathways to care. Relative to the White reference group, elevated rates of civil detentions were found for Black Caribbean (OR = 3.43, 95% CI = 2.68 to 4.40, n = 18), Black African (OR = 3.11, 95% CI = 2.40 to 4.02, n = 6), and South Asian patients (OR = 1.50, 95% CI 1.07 to 2.12, n = 10). Analyses of each Mental Health Act section revealed significantly higher rates for Black people under (civil) Section 2 (OR = 1.53, 95% CI = 1.11 to 2.11, n = 3). Rates in repeat admissions were significantly higher than in first admission for South Asian patients (between-group difference p < 0.01). Some ethnic groups had more police contact (Black African OR = 3.60, 95% CI = 2.15 to 6.05, n = 2; Black Caribbean OR = 2.64, 95% CI = 1.88 to 3.72, n = 8) and criminal justice system involvement (Black Caribbean OR = 2.76, 95% CI = 2.02 to 3.78, n = 5; Black African OR = 1.92, 95% CI = 1.32 to 2.78, n = 3). The White Other patients also showed greater police and criminal justice system involvement than White British patients (OR = 1.49, 95% CI = 1.03 to 2.15, n = 4). General practitioner involvement was less likely for Black than the White reference group. No significant variations over time were found across all the main outcomes. Conclusions: Our updated meta-analyses reveal persisting but not significantly worsening patterns of ethnic inequalities in pathways to psychiatric care, particularly affecting Black groups. This provides a comprehensive evidence base from which to inform policy and practice amidst a prospective Mental Health Act reform. Trial registration: CRD42017071663Peer reviewedFinal Published versio