Remembering and Responding to Distressing Autobiographical Memories: Exploring Risk and Intervention Targets for Posttraumatic Stress in Traumatized Refugees

2017 ◽  
Vol 5 (5) ◽  
pp. 789-797 ◽  
Author(s):  
Anna Reebs ◽  
Kim Yuval ◽  
Amit Bernstein

It is tragic that more than 65 million people are currently forcibly displaced due to civil war, ethnic cleansing, and related atrocities. They suffer at high rates from trauma- and stress-related mental health problems. To advance development of effective mental health interventions tailored to refugees and asylum seekers, we need to significantly increase knowledge of risk processes and intervention targets. Accordingly, in an experimental laboratory study, we examined the nature and function(s) of remembering and responding to a distressing autobiographical memory among 110 severely traumatized Sudanese refugees. We found that (a) posttraumatic stress symptom severity predicted emotional reactivity, but not avoidance, in response to remembering a distressing memory and that (b) relative to a self-distanced perspective, a self-immersed perspective during memory recall led to lower levels of avoidance, but not emotional reactivity. Findings are discussed with respect to extant theory, intervention development, and implementation for traumatized refugee populations.

Author(s):  
Anja Čuš ◽  
Julian Edbrooke-Childs ◽  
Susanne Ohmann ◽  
Paul L. Plener ◽  
Türkan Akkaya-Kalayci

Nonsuicidal self-injury (NSSI) is a major mental health problem associated with negative psychosocial outcomes and it most often starts in early adolescence. Despite this, adolescents are rarely involved in informing the development of interventions designed to address their mental health problems. This study aimed to (1) assess adolescents’ needs and preferences about future interventions that are delivered through smartphones and (2) develop a framework with implications for designing engaging digital mental health interventions. Fifteen adolescent girls, aged 12–18 years, who met diagnostic criteria for a current NSSI disorder and were in contact with mental health services, participated in semi-structured interviews. Following a reflexive thematic analysis approach, this study identified two main themes: (1) Experiences of NSSI (depicts the needs of young people related to their everyday experiences of managing NSSI) and (2) App in Context (portrays preferences of young people about smartphone interventions and reflects adolescents’ views on how technology itself can improve or hinder engaging with these interventions). Adolescent patients expressed interest in using smartphone mental health interventions if they recognize them as helpful, relevant for their life situation and easy to use. The developed framework suggests that digital mental health interventions are embedded in three contexts (i.e., person using the intervention, mental health condition, and technology-related factors) which together need to inform the development of engaging digital resources. To achieve this, the cooperation among people with lived experience, mental health experts, and human computer interaction professionals is vital.


2021 ◽  
Vol 12 ◽  
Author(s):  
Marilon van Doorn ◽  
Laurens A. Nijhuis ◽  
Mees D. Egeler ◽  
Joost G. Daams ◽  
Arne Popma ◽  
...  

Objective: Between the ages of 12 and 25 the onset of mental disorders typically occurs, and the burden of mental health problems is greatest for this group. Indicated preventive interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders have gained considerable traction. However, the threshold to seek help appears to be high even when help is needed. Online interventions could offer a solution, especially during the COVID-19 pandemic. This scoping review will present an overview of the recent research of indicated online preventive interventions for youth (12–25 years) experiencing the early stages of mental health complaints with the aim of identifying the nature and extent of the research evidence.Methods: The 5-stage framework by Arksey and O'Malley was used. Academic literature published from 2013 onwards in printed or electronic format was included from Scopus, PsychINFO, and Ovid MEDLINE(R) ALL.Results: The search yielded 11,122 results, with the final selection resulting in inclusion of 30 articles for this review. In total, the articles included 4,950 participants. 26.7% of the selected articles focused on youth between 12 and 25 years. Of the articles 60% did not screen for, nor exclude participants with clinical levels of symptoms. Most studies used a common evidence-based therapy for the disorder-category targeted. More than half of the online interventions included some form of human support. Adherence levels ranged between 27.9 and 98%. The results indicate general effectiveness, usability and acceptability of online indicated preventive interventions. The most commonly used approach was CBT (n = 12 studies). Studies varied in their size, rigor of study, effectiveness and outcome measures. Online interventions with a combination of clinical and peer moderation (n = 3 studies) appear to result in the most stable and highest effect sizes.Conclusion: Online indicated preventive mental health interventions for youth with emerging mental health issues show promise in reducing various mental health complaints, and increasing positive mental health indicators such as well-being and resilience. Additionally, high levels of usability and acceptability were found. However, the included studies show important methodological shortcomings. Also, the research has mainly focused on specific diagnostic categories, meaning there is a lack of transdiagnostic approaches. Finally, clear definitions of- as well as instruments to measure- emerging or subclinical mental health symptoms in youth remain are missing.


Author(s):  
Petra C. Gronholm ◽  
Claire Henderson ◽  
Tanya Deb ◽  
Graham Thornicroft

There is a rich literature on the nature of mental health-related stigma and the processes by which it severely affects the life chances of people with mental health problems. Applying this knowledge to deliver and evaluate interventions to reduce stigma in a lasting way is, however, a complex and long-term challenge. This chapter outlines how mental health-related stigma and discrimination have been defined; describes the negative impact they have on people with mental illness; summarizes anti-stigma strategies and the evidence regarding their effectiveness; and makes suggestions for future intervention development and evaluation. It seems likely that short-term interventions may only have a short-term impact, with the implication being the need to study longer-term interventions and to use interim process and outcome data to improve interventions along the way.


2019 ◽  
Vol 79 (4) ◽  
pp. 471-483
Author(s):  
Kevin C Runions ◽  
Rena Vithiatharan ◽  
Kirsten Hancock ◽  
Ashleigh Lin ◽  
Christopher G Brennan-Jones ◽  
...  

Objectives: Children and adolescents with chronic physical health conditions are also at elevated risk of poor mental health; the mechanisms to account for this relationship remain unclear. In this narrative review, we used the socio-ecological model to examine research on experiences of school for children with chronic health conditions and how socio-ecology might be involved in mental health problems. Design: We conducted a scoping review of the existing literature, focused on hearing loss, cystic fibrosis and type 1 diabetes, which examined child and/or adolescent mental health and aspects of the school social setting. Method: PubMed and ScienceDirect databases were searched for the three target conditions; from 353 abstracts, 38 articles were reviewed in detail. Results: Relevant articles that examined social aspects of the experience of school for students with chronic health conditions, including absenteeism due to illness or healthcare, self-perceived difference from peers, stigmatisation and discrimination, bullying and victimisation, and positive aspects of peer support at school were reviewed. Teacher–child aspects including teacher knowledge and/or attitudes about the condition and the possibility of overdependence in the relationship were examined. Each of these processes was considered for its impact on the young person’s mental health. Conclusion: School-based social risk processes in the lives of young people with chronic health conditions, in particular in the peer microsystem, are likely to contribute to risk of psychological problems. These risks cannot be disentangled from mesosystemic, exosystemic and macrosystemic influences. Further research is required on the role of teachers and parents in the school social functioning of children with chronic health conditions.


2019 ◽  
Vol 50 (5) ◽  
pp. 827-837 ◽  
Author(s):  
Elizabeth Spry ◽  
Margarita Moreno-Betancur ◽  
Denise Becker ◽  
Helena Romaniuk ◽  
John B. Carlin ◽  
...  

AbstractBackgroundMaternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied.MethodsWe used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum.ResultsThirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4–3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure.ConclusionsMaternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.


2014 ◽  
Vol 205 (3) ◽  
pp. 236-243 ◽  
Author(s):  
Brendan Mulhern ◽  
Clara Mukuria ◽  
Michael Barkham ◽  
Martin Knapp ◽  
Sarah Byford ◽  
...  

BackgroundGeneric preference-based measures (EuroQoL-5D (EQ-5D) and SF-6D) are used in the economic evaluation of mental health interventions. However, there are inconsistent findings regarding their psychometric properties.AimsTo investigate the psychometric properties of the EQ-5D and SF-6D in different mental health conditions, using seven existing data-sets.MethodThe construct validity and responsiveness of the measures were assessed in comparison with condition-specific indicators.ResultsEvidence for construct validity and responsiveness in common mental health and personality disorders was found (correlations 0.22–0.64; effect sizes 0.37–1.24; standardised response means 0.45–1.31). There was some evidence for validity in schizophrenia (correlations 0.05–0.43), but responsiveness was unclear.ConclusionsEQ-5D and SF-6D can be used in the economic evaluation of interventions for common mental health problems with some confidence. In schizophrenia, a preference-based measure focused on the impact of mental health should be considered.


2004 ◽  
Vol 19 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Paul Bolton ◽  
Alice M. Tang

AbstractThis paper describes a short, ethnographic study approach for understanding how people from non-Western cultures think about mental health and mental health problems, and the rationale for using such an approach in designing and implementing mental health interventions during and after disasters. It describes how the resulting data can contribute to interventions that are more acceptable to local people, and therefore, more effective and sustainable through improved community support.


2021 ◽  
Author(s):  
Dilan Hulaj ◽  
Sophie Antesberger ◽  
Tabea Blum ◽  
Raffaela Böswald ◽  
Hannah M. Brandl ◽  
...  

Importance: Although young adults are on average less affected by the physical consequences of COVID-19 infections, showing less severe disease progression and lower mortality risk, they suffer strongly from the mental health impact of the pandemic.Objective: We, a group of psychology students experiencing these impacts, aim to provide an overview of the existing literature on prevention and intervention efforts to effectively reduce the development of, or suffering from, mental health problems in young adults (18-35) during the COVID-19 pandemic.Evidence Review: A rapid systematic review was conducted to identify studies focusing on the implementation of mental health interventions for young adults of the general population during the COVID-19 pandemic. Literature was searched with Pubmed and Web of Science on June 17, 2021. The quality of each study was assessed by two reviewers with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers.Findings: Of N = 76 records initially screened, eight studies met the inclusion criteria. Six applied web-based interventions, of which four were randomized controlled trials. Interventions were based on Cognitive Behavioral Therapy approaches (n = 5), mindfulness practices, logo-autobiography, and synergistic thinking methods. The interventions varied in length from single sessions to multiple sessions over a period of up to 10 weeks. All interventions were effective in reducing depression and anxiety symptoms, as well as stress with small to medium effect sizes and a symptom reduction up to 78.9%. With only three studies being of high quality, the overall quality was low.Conclusions and Relevance: Research on mental health interventions for young adults in the general population during the pandemic is sparse. However, all interventions resulted in symptoms reductions and thus have been shown to be effective ways of counteracting the potential development of mental disorders during times of uncertainty, with high levels of stress, such as during a pandemic. Therefore, we propose a concept for an innovative and cost-effective web-based platform to structure and raise awareness for existing measures.


2021 ◽  
Author(s):  
Maria Antònia Fiol-DeRoque ◽  
Maria Jesús Serrano-Ripoll ◽  
Rafael Jiménez ◽  
Rocío Zamanillo-Campos ◽  
Aina María Yáñez-Juan ◽  
...  

BACKGROUND The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to healthcare workers (HCWs), who are facing heavy workloads under psychologically difficult situations. OBJECTIVE This trial aims to evaluate the effectiveness of a psychoeducational mobile Health (mHealth) intervention to reduce mental health problems in HCWs during the COVID-19 pandemic. METHODS We carried out a blinded randomized controlled trial. HCWs caring for COVID-19 patients in Spain were randomly assigned (1:1) by a computer-generated randomization sequence to the PsyCovidApp intervention (App targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control App (general recommendations about mental healthcare). Data collection was conducted telephonically at baseline and two weeks. The primary endpoint was a composite of depression, anxiety, and stress. Secondary endpoints were insomnia, burnout, posttraumatic stress, self-efficacy, depression, anxiety, and stress. Differences between groups were analyzed using general linear modeling, according to an intention-to-treat protocol. RESULTS Between 14 May and 25 July 2020, 482 HCWs were randomly assigned to PsyCovidApp (n=248) or the control App (n=234). At two weeks, complete outcome data were available for 436 (91%) HCWs. No significant differences were observed between the groups at two weeks in the primary outcome (standardized mean difference -0.04 [95% CI -0.11 to 0.04]; p=0.15) and in the rest of the outcomes. In our prespecified subgroup analyses, we observed significant (p<0.05) improvements among HCWs consuming psychotropic medications in the primary outcome, and posttraumatic stress, insomnia, anxiety, and stress. Similarly, among HCWs receiving psychotherapy, we observed improvements in the primary outcome, insomnia, anxiety, and stress. CONCLUSIONS In HCWs assisting COVID-19 patients in Spain, PsyCovidApp, compared with a control App, reduced mental health problems at two weeks only among HCWs receiving psychotherapy or psychotropic medications. CLINICALTRIAL ClinicalTrials.gov NCT04393818


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