Health and Wellness Photovoice Project: Engaging Consumers With Serious Mental Illness in Health Care Interventions

People with serious mental illnesses (SMI) are at increased risk for cardiovascular disease and premature mortality. We used photovoice in two supportive housing agencies to engage consumers with SMI to inform the implementation of health care interventions. Sixteen consumers participated in six weekly sessions in which they took photographs about their health and discussed the meanings of these photographs in individual interviews and group sessions. We identified several implementation themes related to consumers’ preferences. Peer-based approaches were preferred more than clinician-driven models. Participants expressed a desire to learn practical skills through hands-on activities to modify health behaviors. Consumers expressed a desire to increase their physical activity. Participants revealed in their photographs and narratives the important role that communities’ food environments play in shaping eating habits. In this article, we show how photovoice can generate valuable community knowledge to inform the translation of health care interventions in supportive housing agencies

Child abuse and the dynamics of silence

Response to Commentary by Haliburn J. Links Between Child Abuse and Major Mental Illness – Psychiatry’s response.http://anp.sagepub.comhb201

The Australian Royal Commission into institutional responses to child sexual abuse

No abstract available.http://anp.sagepub.com/2015-01-31hb201

Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness

Background: Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community. Methods: The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. Results: The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention. Conclusions: Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the transportability of a health-care manager intervention in order to improve the health of people with SMI

Financial Hardship, Hope, and Life Satisfaction Among Un/Underemployed Individuals With Psychiatric Diagnoses: A Mediation Analysis

BackgroundIndividuals with psychiatric diagnoses who are unemployed or underemployed are likely to disproportionately experience financial hardship and, in turn, lower life satisfaction (LS). Understanding the mechanisms though which financial hardship affects LS is essential to inform effective economic empowerment interventions for this population.AimTo examine if subjective financial hardship (SFH) mediates the relationship between objective financial hardship (OFH) and LS, and whether hope, and its agency and pathways components, further mediate the effect of SFH on LS among individuals with psychiatric diagnoses seeking employment.MethodsWe conducted structured interviews with participants (N = 215) of two peer-run employment programs using indicators of OFH and SFH and standardized scales for hope (overall hope, hope agency, and hope pathways) and LS. Three structural equation models were employed to test measurement models for OFH and SFH, and mediational relationships. Covariates included gender, age, psychiatric diagnosis, race/ethnicity, education, income, employment status, SSI/SSDI receipt, and site.ResultsConfirmatory factor analysis (CFA) for items measuring OFH and SFH supported two separate hypothesized factors. OFH had a strong and significant total effect on SFH [standardized beta (B) = 0.68] and LS (B = 0.49), and a weak-to-moderate effect on hope (B = –0.31). SFH alone mediated up to 94% of the effect of OFH on LS (indirect effect B = –0.46, p < 0.01). The effect of SFH on LS through hope was small (indirect effect B = –0.09, p < 0.05), primarily through hope agency (indirect effect B = –0.13, p < 0.01) and not hope pathways. Black and Hispanic ethno-racial identification seemed to buffer the effect of financial hardship on hope and LS. Individuals identifying as Black reported significantly higher overall hope (B = 0.41–0.47) and higher LS (B = 0.29–0.46), net of the effect of OFH and SFH.ConclusionSFH is a strong mediator of the relationship between OFH and LS in our study of unemployed and underemployed individuals with psychiatric diagnoses. Hope, and particularly its agency component, further mediate a modest but significant proportion of the association between SFH and LS. Economic empowerment interventions for this population should address objective and subjective financial stressors, foster a sense of agency, and consider the diverse effects of financial hardship across ethno-racial groups

Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial

Background The risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese. Methods The Hybrid Trial Type 1 design will combine a randomized effectiveness trial with a mixed-methods implementation study. The effectiveness trial will test the health impacts of a peer-led healthy lifestyle intervention versus usual care in supportive housing agencies. The healthy lifestyle intervention is derived from the Group Lifestyle Balanced Program, lasts 12 months, and will be delivered by trained peer specialists. Repeated assessments will be conducted at baseline and at 6, 12, and 18 months post randomization. A mixed-methods (e.g., structured interviews, focus groups, surveys) implementation study will be conducted to examine multi-level implementation factors and processes that can inform the use of the healthy lifestyle intervention in routine practice, using data from agency directors, program managers, staff, and peer specialists before, during, and after the implementation of the effectiveness trial. Discussion This paper describes the use of a hybrid research design that blends effectiveness trial methodologies and implementation science rarely used when studying the physical health of people with SMI and can serve as a model for integrating implementation science and health disparities research. Rigorously testing effectiveness and exploring the implementation process are both necessary steps to establish the evidence for large-scale delivery of peer-led healthy lifestyle intervention to improve the physical health of racial/ethnic minorities with SMI. Trial registration www.clinicaltrials.gov; NCT02175641, registered 24 June 201

The Main Belt Comets and ice in the Solar System

We review the evidence for buried ice in the asteroid belt; specifically the questions around the so-called Main Belt Comets (MBCs). We summarise the evidence for water throughout the Solar System, and describe the various methods for detecting it, including remote sensing from ultraviolet to radio wavelengths. We review progress in the first decade of study of MBCs, including observations, modelling of ice survival, and discussion on their origins. We then look at which methods will likely be most effective for further progress, including the key challenge of direct detection of (escaping) water in these bodies

Regularity Properties and Pathologies of Position-Space Renormalization-Group Transformations

We reconsider the conceptual foundations of the renormalization-group (RG) formalism, and prove some rigorous theorems on the regularity properties and possible pathologies of the RG map. Regarding regularity, we show that the RG map, defined on a suitable space of interactions (= formal Hamiltonians), is always single-valued and Lipschitz continuous on its domain of definition. This rules out a recently proposed scenario for the RG description of first-order phase transitions. On the pathological side, we make rigorous some arguments of Griffiths, Pearce and Israel, and prove in several cases that the renormalized measure is not a Gibbs measure for any reasonable interaction. This means that the RG map is ill-defined, and that the conventional RG description of first-order phase transitions is not universally valid. For decimation or Kadanoff transformations applied to the Ising model in dimension $d \ge 3$, these pathologies occur in a full neighborhood $\{ \beta > \beta_0 ,\, |h| < \epsilon(\beta) \}$ of the low-temperature part of the first-order phase-transition surface. For block-averaging transformations applied to the Ising model in dimension $d \ge 2$, the pathologies occur at low temperatures for arbitrary magnetic-field strength. Pathologies may also occur in the critical region for Ising models in dimension $d \ge 4$. We discuss in detail the distinction between Gibbsian and non-Gibbsian measures, and give a rather complete catalogue of the known examples. Finally, we discuss the heuristic and numerical evidence on RG pathologies in the light of our rigorous theorems.Comment: 273 pages including 14 figures, Postscript, See also ftp.scri.fsu.edu:hep-lat/papers/9210/9210032.ps.

Toward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative

Background Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2–3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. Methods We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. Discussion Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it