More Optimistic Recovery Attitudes Are Associated with Less Stigmatization of People with Mental Illness among Healthcare Professionals Working on Acute and Semi-Acute Psychiatric Wards Abstract Stigmatization towards individuals with mental illness is common among mental healthcare professionals, yet poses a key concern regarding the provision of effective support and therapy for those undergoing psychiatric treatment. In this study, we examined to what extent recovery attitudes among mental healthcare professionals are associated with stigmatization. We conducted a survey among staff members (n = 110) of a large psychiatric hospital working on acute or semi-acute wards one year following a multi-professional training session, which included the promotion of recovery orientation as a therapeutic approach. The survey included measures such as gender, age, professional background, years of working experience, ward setting (mostly open or closed doors), recovery attitudes (RAQ-7), and stigmatization of individuals with mental illness (OMS-HC scale). Mental healthcare professionals who attended training in recovery orientation significantly more frequently stated to know the concept of recovery compared to those who did not receive training. In addition, recovery attitudes were more optimistic and significantly associated with levels of stigmatization among professionals who were familiar with the concept of recovery. Despite the cross-sectional study design that did not test causal links, these findings suggest that enhancing recovery attitudes through training may lead to less stigmatization among mental healthcare professionals.

Unmet Needs of People with Serious Mental Illness: Perspectives from Certified Peer Specialists Abstract Examine the unmet needs of people with serious mental illness (SMI) from the perspective of certified peer specialists. 267 certified peer specialists from 38 states completed an online survey (female [73%], 50.9 [SD = 12] years, and non-Hispanic White [79.8%]). Many respondents reported a primary mental health diagnoses (n = 200), 22 respondents reported their diagnosis as schizophrenia spectrum disorder (11%), 46 respondents reported bipolar disorder (22.1%), 47 respondents reported major depressive disorder (22.6%), 29 respondents reported post-traumatic stress disorder (13.9%), 27 respondents reported alcohol/substance use disorder (13%), 2 respondents reported personality disorder (1%), and 12 reported “other” (5.8%). A mixed methods convergence analysis integrated quantitative with qualitative data. Social isolation (n = 160, 59.9%) and feeling lonely (n = 159, 59.6%) were the most highly endorsed unmet need, followed by the need to address chronic health conditions (n = 80, 30%), prevent mental health hospitalization (n = 71, 23.6%), and prevent drug use (n = 66, 24.7%). Four themes emerged: need to address basic necessities, loneliness and social isolation, hope, and addiction. Addressing loneliness and social isolation were identified as the primary unmet needs among people with SMI. Addressing co-morbid health conditions may simultaneously impact other unmet needs. Hope is an important intervention target. Initial insights from this study can be used to guide researchers’ efforts to incorporate certified peer specialists perspectives in developing programs to meet the needs of people with SMI. Future research using participatory research methods can further examine these initial insights.

Determinants of the Proactiveness of Female Migrant Workers with Psychological Distress Seeking Allied Health Services Abstract Seeking utilization of allied health services (AHS) has significant implications for psychological distress self-management. However, utilization of AHS by Chinese female migrant workers (FMWs) has not received enough attention. This study, therefore, aims to explore what contributes to FMWs’ proactiveness in utilizing AHS. A cross-sectional study was conducted to collect data in terms of socio-demographic characteristics, work-related characteristics and AHS accessibility. A logistic regression model was adopted to examine association of these predictors with proactiveness in seeking AHS. 992 FMWs with psychological distress were interviewed with stratified multiple-stage sampling. The results indicated that Basic Public Health Services (BPHS) is a salient predictor affecting proactiveness in seeking AHS. BPHS includes psychological counseling (Odds Ratio (OR) =2.401, 95% Confidence Interval (CI) =1.284–4.490, p = 0.006), psychotherapy (OR = 2.063, 95% CI = 1.438–2.960, p = 0.000) and health knowledge lectures (OR = 1.613, 95% CI = 1.115–2.333, p = 0.011). Moreover, sampled participants under 25 and those who received education for more than 9 years are more likely to seek AHS compared with other groups. In addition, proactiveness in seeking AHS is clearly associated with working hours per day. The probability is only 31.1% for those working more than 12 h per day to seek AHS actively compared with those working below 8 h (95% CI = 0.119–0.812, p = 0.017). There are no differences between those with 8–12 working hours and those working less than 8 h (OR = 1.100, 95% CI = 0.798–1.518, p = 0.560). The present findings suggest that policies be made to improve the coverage of BPHS and to provide specified AHS to meet the increasing demand of different social groups.

Schizophrenia Mortality: Barriers to Progress Abstract Individuals with schizophrenia die, on average, 20 years before their peers, with ‘natural causes’ accounting for 80% of premature deaths. The aim of this narrative review is to address this phenomenon from the perspective of known factors that contribute to long life. The relevant literature from the last decade was searched in PubMed and Google Scholar databases. Four factors have been shown to be common to centarians, people who live to be a hundred: genes, life style behaviors that favor a healthy heart, social support, and a subjective purpose in life. The latter three factors are potentially modifiable but, in the context of schizophrenia, there are barriers to change, namely poverty, illness symptoms, stress, stigma, and side effects of antipsychotic medication. Barriers to change need to be addressed before substantial progress can be made in increasing the health and mortality risk of people with schizophrenia.

Quality of Life in Schizophrenia: A Meta-Analysis of Comparative Studies Abstract Studies and findings regarding the impact of schizophrenia on quality of life (QOL) has been highly variable. This meta-analysis compared QOL between schizophrenia subjects and healthy controls with a focus on standardized measures. A systematic literature search was conducted through Pubmed, PsycINFO, EMBASE, Cochrane Library and Web of Science databases. Only studies using the World Health Organization Quality of Life (WHOQOL) or its brief version or the Short Form-36 Health Survey (SF-36) were included. Fifteen case-control studies with 2195 schizophrenia subjects and 1508 healthy controls were included in this meta-analysis. The WHOQOL/WHOQOL-BREF score was significantly lower in physical health (SMD = -1.80, 95% CI: -2.31 to −1.28, P < 0.001), psychological health (SMD = -1.28, 95% CI: -1.72 to −0.83, P < 0.001), social relationships (SMD = -1.60, 95% CI: -2.05 to −1.15, P < 0.001), and environment domains (SMD = -0.98, 95% CI: -1.38 to −0.59, P < 0.001) in schizophrenia subjects compared to controls. The SF-36 score was significantly lower in both physical (SMD = -1.09, 95% CI: -1.41 to −0.76, P < 0.001 and mental health domains (SMD = -2.08, 95% CI: -3.58 to −0.59, P = 0.006) in schizophrenia subjects than in controls. Subgroup and meta-regression analyses found that age, male gender, illness duration and income have significant moderating effects on QOL. The meta-analysis of studies with standardized measures confirmed that QOL in schizophrenia subjects is significantly lower than healthy controls. Effective interventions should be developed to improve QOL for this population.

Profiles of Service Users with Severe Mental Disorders Based on Adequacy of Help Abstract This study has for aims to develop a typology describing adequacy of help based on socio-demographic, clinical and service utilization variables for 204 service users with severe mental disorders treated in the community. Study participants were recruited in an urban area of Quebec (Canada). Adequacy of help was assessed with the Montreal Assessment of Needs Questionnaire. A cluster analysis identified five profiles of service users. Adequacy of help was mainly related to continuity of care, help given by services, seriousness of needs and, to some extent, quality of life (QOL). Adequacy of help was highest among Class 3 participants, described as older individuals with mood disorders, who lived in autonomous housing and enjoyed good QOL. They received substantial help from both relatives and services. Adequacy of help was lowest for Class 5, which included individuals affected by co-occurring mental disorders but who also lived autonomously. Health service utilization was more strongly related to adequacy of help for this sample than were the socio-demographic and clinical factors tested.

Cyberchondria and its Relationships with Related Constructs: a Network Analysis Abstract Cyberchondria denotes repeated online searches for health information that are associated with increasing levels of health anxiety. The aims of this study were to apply network analysis to investigate the extent to which cyberchondria is a distinct construct, ascertain which of the related constructs have the strongest relationships with cyberchondria and investigate whether some of the symptoms of cyberchondria are more central to the construct of cyberchondria. Questionnaires assessing the severity of cyberchondria, health anxiety, obsessive-compulsive disorder symptoms, intolerance of uncertainty, problematic Internet use, anxiety, depression and somatic symptoms were administered to 751 participants who searched for health information online during a previous 3-month period and were recruited from an online crowdsourcing platform. Network analyses were used to compute the networks, perform community detection tests and calculate centrality indices. Results suggest that cyberchondria is a relatively specific syndrome-like construct, distinct from all related constructs and consisting of interrelated symptoms. It has the strongest relationships with problematic Internet use and health anxiety. No symptom of cyberchondria emerged clearly as more central to the construct of cyberchondria. Future research should aim to deepen our understanding of cyberchondria and its links with psychopathology, especially its close relationship with problematic Internet use.

Comparison of the Effect of Dialectical Behavior Therapy, Mindfulness Based Cognitive Therapy and Positive Psychotherapy on Perceived Stress and Quality of Life in Patients with Irritable Bowel Syndrome: a Pilot Randomized Controlled Trial Abstract This study aimed to compare dialectical behavior therapy (DBT), mindfulness based cognitive therapy (MBCT) and positive psychotherapy (PPT) effects on perceived stress (PS) and quality of life (QOL) among patients with irritable bowel syndrome (IBS). Seventy six eligible patients with a Rome- IV diagnosis were randomly allocated in DBT (n = 18), MBCT (n = 20), PPT (n = 18), and control groups (n = 20). All the patients were evaluated for PS by perceived stress scale (PSS) and QOL by irritable bowel syndrome quality of life (IBS-QOL) on the studied groups at the time of their inclusion in the study and 8 weeks after it. Each of the intervention groups took part in 8 group sessions. Conversely, the control group were evaluated without any intervention. 46 female and 27 male in 4 groups completed the study. The results showed significant differences between the groups based on the variables of the PSS and IBS-QOL (p < 0.05). In addition, levels of PS were significantly lower for the MBCT intervention compared with the other groups; besides, the significant effects of the QOL variables represented the higher scores of the PPT compared to the treatment groups. The interventions could not be generalized to other samples. Some other limitations included the lack of conducting a follow-up plan. This study provides initial evidence that MBCT and PPT are more effective than other treatment groups on PS decrease and QOL improvement among patients with IBS, respectively.

Experiencing and Witnessing Patient Violence - an Occupational Risk for Outpatient Therapists? Abstract Violence against therapists by their clients are a common occurrence across clinical settings and may have a lasting impact on the clinician’s professional and personal functioning. In spite of this, no study to date has looked at the frequency of trauma-induced symptoms in psychotherapists. Using a sample of N = 917 psychotherapists across Germany, Austria, and Switzerland, we analyzed the frequency and sequelae of patient attacks suffered or witnessed by therapists. More than half (51.3%) of the sample reported having been the victim or witness of patient attacks or threats of violence in their career. Among the affected therapists, 27.7% reported posttraumatic symptoms lasting longer than four weeks and 2.7% presented symptoms amounting to a full-PTSD diagnosis. Thus, while the frequency of attacks and trauma-induced symptoms were considerable, estimated PTSD rates were rather low. The findings suggest that practitioners should be conscious of client violence being an occupational risk and that it is advisable to have protective measures in place.

The Effects of Terrorist Attacks on Symptom Clusters of PTSD: a Comparison with Victims of Other Traumatic Events Abstract In the Post-Traumatic Stress Disorder (PTSD) literature, no study assessed differences in symptom clusters among victims of terrorist attacks (TA) as compared with victims of other traumatic events. Due to the intentional nature of the harm infliction, TA may be expected to produce more severe symptoms, particularly avoidance, since this cluster was found to be a severity marker and a maintenance factor of the disorder. As several patients delay treatment-seeking, duration of untreated illness (DUI) is another problem potentially influencing PTSD severity. The current study explored differences in PTSD symptom clusters as a function of the traumatic event type (TA compared with other events), DUI, and sex. One hundred-eight patients with primary PTSD were administered The Clinician Administered PTSD Scale. Mean DUI was approximately 12 years, irrespective of the event type. Patients who had experienced TA had significantly more severe Avoidance/Numbing symptoms and general PTSD severity than those who had experienced other events. No significant effects emerged for DUI and sex on all clusters. Timely recognition and intervention on PTSD may include community psychoeducation programs about its symptoms. Tailored intervention on TA-related PTSD may focus on Avoidance/Numbing by including medication and psychotherapeutic approaches for this symptom cluster.