Does a short-term intervention promote mental and general health among young adults? – An evaluation of counselling

<p>Abstract</p> <p>Background</p> <p>Since 1988, self-reported mental health problems in Sweden have increased more among young people than in any other age group. Young adults aged 18 – 29 with minor mental health problems were welcomed to four (at most) counselling sessions led by psychotherapists. The present study aimed to evaluate the method's appropriateness and usefulness.</p> <p>Methods</p> <p>The study population was recruited consecutively during six months (N = 74) and consisted of 59 women and 15 men. Fifty-one, 46 women and five men, met the criterion for a <it>personal semi-structured interview </it>three months post intervention. Self-assessed health data were collected on three occasions using the General Health Questionnaire (GHQ-12), Pearlin's Personal Mastery Scale and two items from the Swedish Living Conditions Surveys. Thirteen women and six men were not statistically assessed due to incomplete data, but were <it>interviewed by telephone</it>. Four men refused to be interviewed and became <it>dropouts</it>.</p> <p>Results</p> <p>The largest group of the study population had long been troubled by their problem(s): 43 percent for over three years and 28 percent for over one year. Among those <it>personally interviewed</it>, 76 percent reported psychological distress (> 3 GHQ points) before the counselling. After the counselling, GHQ-12 distress decreased by 50 percent while mastery and perceived health status increased significantly. A majority experienced an improved life situation, found out something new about themselves and could make use of the sessions afterwards. Personal participant session contentment was about 70 percent and all counsellees would recommend the intervention to a friend. Those <it>interviewed by telephone </it>were not statistically assessed due to incomplete health data. Their personal contentment was just under 50 percent, though all except one would recommend the counselling to a friend. Their expectations of the intervention were more result-orientated compared to the more process-directed personally-interviewed group.</p> <p>Conclusion</p> <p>This evaluation shows a clear improvement in self-rated mental and general health, mastery and control in the group completing the study agreement. The intervention seems to be effective for young adults with minor mental health problems, but due to the skewed gender-distribution it is unclear if the method is appropriate for men. After the proposed internal quality improvements, this short-term counselling could enhance mental and general health among young people.</p

Family connections versus optimised treatment-as-usual for family members of individuals with borderline personality disorder: non-randomised controlled study

Background: Borderline personality disorder (BPD) is challenging for family members who are often required to fulfil multiple roles such as those of advocate, caregiver, coach and guardian. To date, two uncontrolled studies by the treatment developers suggest that Family Connections (FC) is an effective programme to support, educate and teach skills to family members of individuals with BPD. However, such studies have been limited by lack of comparison to other treatment approaches. This study aimed to compare the effectiveness of FC with an optimised treatment-as-usual (OTAU) programme for family members of individuals with BPD. A secondary aim was to introduce a long term follow-up to investigate if positive gains from the intervention would be maintained following programme completion. Methods: This study was a non-randomised controlled study, with assessment of outcomes at baseline (pre-intervention) and end of programme (post-intervention) for both FC and OTAU groups, and at follow-up (3 months post-intervention; 12 or 19 months post-intervention) for the FC group. Eighty family members participated in the FC (n = 51) and the OTAU (n = 29) programmes. Outcome measures included burden, grief, depression and mastery. Linear mixed-effects models were used to assess baseline differences in the outcome measures by gender, age group and type of relationship to the individual with BPD. Linear mixed-effects models were also used to estimate the treatment effect (FC versus OTAU) utilising all available data from baseline and end of programme. Results: The FC group showed changes indicating significant improvement with respect to all four outcome measures (p < 0.001). The OTAU group showed changes in the same direction as the intervention group but none of the changes were statistically significant. The intervention effect was statistically significant for total burden (including both subscales; p = .02 for subjective burden and p = .048 for objective burden) and grief (p = 0.013). Improvements were maintained at follow-up for FC participants. Conclusions: The findings of the current study indicate that FC results in statistically significant improvements on key measures while OTAU does not yield comparable changes. Lack of significant change on all measures for OTAU suggests that a three session psycho-education programme is of limited benefit. Further research is warranted on programme components and long-term supports for family members

Cohort differences in 3-year adaptation to health problems among Dutch middle-aged, 1992–1995 and 2002–2005

Midlife is a period during which ageing-related health problems first emerge. In view of increasing life expectancy, it is of great importance that people in midlife adapt to possible health problems, to be able to lead productive and engaged lives as long as possible. It may be expected that given the better circumstances in which more recent cohorts grew up, they are better equipped to adapt to health problems than earlier cohorts. This study addresses the question if the way people in midlife adapt to health problems is or is not improving in the Netherlands. The study is based on the nationally representative 1992–1993 and 2002–2003 cohorts of the Longitudinal Aging Study Amsterdam (ages 55–64 years), with follow-up cycles in 1995–1996 (n = 811) and 2005–2006 (n = 829), respectively. Mastery is considered as a measure of adaptation, and 3-year change in mastery is compared in subjects without and with health problems at baseline. A rise was observed in the prevalence of diabetes, chronic lung disease, arthritis, subthreshold depression, and disability. Subjects without health problems in the recent cohort had better mastery than their counterparts in the early cohort. Regardless of cohort membership, mastery declined over 3 years for those with subthreshold depression, mild disability, chronic lung disease, and stroke. In the recent cohort only, mastery declined for those with cognitive impairment, but improved for those with heart disease. These findings do not support the expectation that recent cohorts are better equipped to deal with health problems for conditions other than heart disease

Developing agency through good work: longitudinal effects of job autonomy and skill utilization on locus of control

An internal locus of control has benefits for individuals across multiple life domains. Nevertheless, whether it is possible to enhance an individual’s internal locus of control has rarely been considered. The authors propose that the presence of job autonomy and skill utilization in work can enhance internal locus of control, both directly and indirectly via job satisfaction. Three waves of data over a four-year period from the Household, Income and Labour Dynamics in Australia Survey (N = 3,045) were analyzed. Results showed that job autonomy directly shaped internal locus of control over time, as did job satisfaction. Skill utilization did not play a role in terms of affecting locus of control, and the indirect effects of both job autonomy and skill utilization via job satisfaction were weak. This study suggests the importance of job autonomy in promoting the development of an employee’s internal locus of control

Chronic psychosocial and financial burden accelerates 5-year telomere shortening: findings from the Coronary Artery Risk Development in Young Adults Study.

Leukocyte telomere length, a marker of immune system function, is sensitive to exposures such as psychosocial stressors and health-maintaining behaviors. Past research has determined that stress experienced in adulthood is associated with shorter telomere length, but is limited to mostly cross-sectional reports. We test whether repeated reports of chronic psychosocial and financial burden is associated with telomere length change over a 5-year period (years 15 and 20) from 969 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal, population-based cohort, ages 18-30 at time of recruitment in 1985. We further examine whether multisystem resiliency, comprised of social connections, health-maintaining behaviors, and psychological resources, mitigates the effects of repeated&nbsp;burden on telomere attrition over 5 years. Our results indicate that adults with high chronic burden do not show decreased telomere length over the 5-year period. However, these effects do vary by level of resiliency, as regression results revealed a significant interaction between chronic burden and multisystem resiliency. For individuals with high repeated&nbsp;chronic burden and low multisystem resiliency (1 SD below the mean), there was a significant 5-year shortening in telomere length, whereas no significant relationships between chronic burden and attrition were evident for those at moderate and higher levels of resiliency. These effects apply similarly across the three components of resiliency. Results imply that interventions should focus on establishing strong social connections, psychological resources, and health-maintaining behaviors when attempting to ameliorate stress-related decline in telomere length among at-risk individuals

Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Unmet need to perform activities of daily living (ADL) is associated with increased use of urgent health services by the elderly. However, the reported associations may be confounded by psychological distress. We examine the independent effects of unmet need and psychological distress upon emergency department (ED) visits.</p> <p>Methods</p> <p>We conducted a prospective study of randomly selected community-dwelling adults aged ≥ 75. We report here the results for women only (n = 530). In-person interviews collected data on self-reported unmet need and the 14-item <it>l'Indice de détresse psychologique de Santé Québec </it>psychological distress scale. ED visits were identified from an administrative database. Multivariable logistic regression was used to identify predictors of any ED visit in the 6 months following the baseline interview.</p> <p>Results</p> <p>In multivariable analysis, unmet need in instrumental ADL was associated with subsequent ED visits (odds ratio = 1.57, 95% confidence interval = 1.02-2.41), as was psychological distress (odds rate = 1.30, 95% confidence interval = 1.02-1.67). The magnitude of the association between unmet need and ED visits was overestimated in statistical models that did not adjust for psychological distress.</p> <p>Conclusions</p> <p>Both unmet need and psychological distress were independent predictors of ED visits. Future investigations of unmet need and health services utilization should include psychological distress to control for confounding and improve the internal validity of statistical models.</p

Divorce, conflict and mental health: how the quality of intimate relationships is linked to post-divorce well-being

Partner relationships, including new relationships after divorce, are found to be beneficial for mental health. However, the impact of their quality remains unclear; this uncertainty applies to past and ongoing relationships between ex-spouses as well. We study the relationship between conflict—in the prior marriage, with the ex-partner, with a new partner—and both positive and negative mental health. Multilevel linear models are carried out on a subsample of 892 divorcees from the dataset “Divorce in Flanders.” Living together with a new partner, either in marriage or cohabitation, seems beneficial for mental health, even in cases of (high) conflict. Nevertheless, conflict places a burden on well-being, especially for women in non-marital relationships. Ongoing conflict with the ex-spouse is also damaging for mental health. In contrast, prior marital conflict does not relate to lower, but to slightly higher, levels of life satisfaction after divorce

Burden, coping, physical symptoms and psychological morbidity in caregivers of functionally dependent family members

Objectives: this study assessed burden, coping, physical symptoms and psychological morbidity in caregivers of functionally dependent family members. Methods: fifty family caregivers completed self-reported measures of burden, physical symptoms, psychological morbidity and coping strategies. Results: there was a significant negative correlation between coping strategies and the different clinical variables, as well as a significant positive correlation between coping strategies and duration of care. It appears that the stronger bond between caregiver and family member leads to a poorer use of adaptive coping strategies. It also appears that the deterioration of the relationship between them and the lower perceived self-efficacy are more prominente in caregivers of family members with cognitive impairment, indicating that caregivers with family members without cognitive impairment face fewer difficulties. Conclusion: these results emphasize the need for interventions to include coping strategies, since they are important in reducing caregivers’ burden, psychological morbidity and physical symptoms

The effects of crisis plans for patients with psychotic and bipolar disorders: A randomised controlled trial

Background: Crises and (involuntary) admissions have a strong impact on patients and their caregivers. In some countries, including the Netherlands, the number of crises and (involuntary) admissions have increased in the last years. There is also a lack of effective interventions to prevent their occurrence. Previous research has shown that a form of psychiatric advance statement - joint crisis plan - may prevent involuntary admissions, but another study showed no significant results for another form. The question remains which form of psychiatric advance statement may help to prevent crisis situations. This study examines the effects of two other psychiatric advance statements. The first is created by the patient with help from a patient's advocate (Patient Advocate Crisis Plan: PACP) and the second with the help of a clinician only (Clinician facilitated Crisis Plan: CCP). We investigate whether patients with a PACP or CCP show fewer emergency visits and (involuntary) admissions as compared to patients without a psychiatric advance statement. Furthermore, this study seeks to identify possible mechanisms responsible for the effects of a PACP or a CCP. Methods/Design: This study is a randomised controlled trial with two intervention groups and one control condition. Both interventions consist of a crisis plan, facilitated through the patient's advocate or the clinician respectively. Outpatients with psychotic or bipolar disorders, who experienced at least one psychiatric crisis during the previous two years, are randomly allocated to one of the three groups. Primary outcomes are the number of emergency (after hour) visits, (involuntary) admissions and the length of stay in hospital. Secondary outcomes include psychosocial fun