Need for an Integrative Conceptual Framework for Addressing Mental Health Challenges During the COVID-19 Pandemic

The burden of mental illness across the globe, already significant, has grown dramatically since the onset of the COVID-19 pandemic. This is, in part, due to limitations in the current conceptual frameworks for understanding mental illness and resulting methods of practice. This paper provides an overview of the state of mental health and illness in the world, summarizes the prevailing frameworks and practices, and introduces a potential framework which could guide a response to the mental health challenges of the pandemic.

Cyberchondria During the COVID-19 Pandemic

Many factors govern the behavior pertaining to anxiety regarding health – it may be stressors, triggers, adverse situations faced by people. Since the outbreak of the COVID-19 virus, health-related anxiety has been widespread. December 2019 saw the occurrence of a form of pneumonia, not known at that time, from the Wuhan region of China to rapidly proceed into a worldwide pandemic and lockdown. This disrupted normal life across the globe and affected social and economic functioning. Cyberchondria has been one of the coping strategies seen during this time, pertaining to online health-related searches which offer answers and relief as seen at the surface but also bringing a plethora of mental health challenges. The authors in this chapter try to simplify what exactly cyberchondria is and how has it affected the lives of the worldwide population during the COVID-19 crisis, the biggest pandemic of recent times. The origin, development, and prevalence of the concept, along with coping, treatment, and prevention of the condition are discussed.

Applying Salutogenesis in Mental Healthcare Settings

This chapter deals with salutogenesis for a specific and growing group of people with mental health challenges. It emphasizes the importance of high-quality social support in interplay with positive identity development thus promoting salutogenic capacity. Aaron Antonovsky’s core concept of sense of coherence has been shown to be more closely related to mental health than to physical health. Thus, the application of salutogenesis on clients in mental healthcare settings is rather obvious. First, the expression “mental health challenges” is used because it is less disease-focused and encourages one to keep in mind that, despite suffering from mental illness, there always is some level of health and resources present that can be recognized, utilized, and nurtured. Second, it can result in specific forms of salutogenic therapy, for example, talk-therapy groups that aim to support positive salutogenic identity building as a specific resistance resource and to improve the sense of coherence of participants by specific offers of social support. Third, as in all health care, the material and social setting itself should be designed by salutogenic principles as empowering by being comprehensible, meaningful, and manageable. This is especially important for more sensitive people with mental health challenges who also might experience longer stay in mental healthcare organizations.

Families Matter: A Cross-Sectional Study of Parent and Child Mental Health During COVID-19 (Preprint)

BACKGROUND Background: The pandemic has disrupted all aspects of children’s lives and has increased children’s exposure to adversity and traumas known to increase the risk of mental health challenges. Recent studies have reported increased rates of mental health challenges in youth during the pandemic, yet few studies have examined the impact of the pandemic on the mental health of toddlers, preschoolers, and elementary school-age children. The pandemic has also adversely impacted caregiver mental health and other indirect factors, including economic instability, known to increase children’s risk for impairing mental health challenges. OBJECTIVE Objective: This study aimed to characterize the social-emotional challenges of children ages 2 to 12 years old during the pandemic and identify modifiable child, caregiver, and family-related risk factors that contribute to risk and are additional targets for intervention. METHODS Methods: Caregivers (N = 676) of children ages 2-12 completed an online survey in early fall 2021 using standardized screening tools to assess child social-emotional challenges and caregiver anxiety and depression. We used a new 16 scale to assess the impact of the pandemic at the child, caregiver, and family levels. We used hierarchical linear regression and logistic regression to explore the relationship between children’s mental health and caregivers’ mental health. We used path analysis to explore direct and indirect effects of the impact of pandemic stress on child emotional and peer challenges, mediated by caregiver anxiety and depression. RESULTS Results: Eighty-seven percent of the children were ages 2-8 years old (n=588) with 13% (n=88) between 9-12 years old. Caregivers endorsed significant child emotional and peer challenges with 80% (n = 536) of children at risk for clinically-significant emotional challenges and 57% (n = 388) at risk for clinically-significant peer social challenges. Emotional challenges increased with age (r = .20, P <.001). 50% (n=330) of caregivers screened positive for generalized anxiety and 24% (n=160) screened positive for depression. Cumulative COVID-19 impact was directly associated with increased child emotional challenges (r=.29, P<.001), peer challenges (r=.29, P<.001), caregiver anxiety (r = .32, P<.001), and caregiver depression (r = .42, P<.001). Caregiver anxiety accounted for 31% of the total effect of COVID-19 impact on child emotional challenges and 18% of the total effect on peer challenges. CONCLUSIONS Conclusions: The results of our study show that the COVID-19 pandemic is having direct and indirect adverse impacts on the social-emotional health of children ages 2 to 12 years old with impacts on very young children similar to impacts for older children. Only with an integrated, family-focused approach that includes young children will we be able to mitigate the current pediatric mental health crisis. CLINICALTRIAL n/a

Emotions in our lives: the evaluation of a user-centered training course »living e-Motions« in the context of recovery of people with mental health challenges

Purpose This paper aims to evaluate the feasibility and effectiveness of a training course »Living e-Motions« for people living with mental health challenges in the context of their recovery. The course was developed in the joint project of partners from Spain, Estonia, Slovenia and the UK. The curriculum of the course is focused on emotional education. It uses a narrative approach as a practical way for participants to explore and regulate their emotions and consequently take charge of their recovery. Design/methodology/approach Seventeen participants were included in the pilot training in Spain and Estonia. Impact of the training was assessed on measures of life satisfaction, emotion regulation, positive and negative affect and recovery at baseline and directly after training. Findings The analysis revealed that participants reported higher life satisfaction, emotion regulation skills, positive affect and recovery after the training. However, because of the small sample size, the mean differences did not reach statistical significance. Further studies on larger samples are needed to test the effectiveness of the training course. Practical implications Pilot study findings are encouraging and show that the developed training course has a potential for improving key competencies and abilities needed in daily life, concretely in emotion regulation, positive and negative affect, life satisfaction and recovery. Originality/value This paper presents a novel training course that uses a narrative approach and focuses on recovery and improvement of key competencies and abilities of individuals with mental health issues.

Considering Spiritual Care for Religiously Involved LGBTQI Migrants and Refugees: A Tentative Map

This paper describes research relevant to spiritual care for LGBTQI refugees and migrants. The literature indicates some distinct challenges faced by religiously involved LGBTQI migrants and refugees. LGBTQI migrants and refugees may not be able to experience family and religion as supportive compared to migrants and refugees who do not identify as LGBTQI. Such migrants and refugees thus face elevated levels of mental health challenges compared to non-LGBTQI refugees and they also face additional mental health risks compared to non-refugee LGBTQI adults and youth. Such risks include suicidality, depression, substance abuse, social isolation, internalised religious homonegativity, shame and risks to sexual health and a breakdown in the ability to trust others and caregivers. The paper identifies five seminal areas for extending care in the light of the research. These include building trust and properly assessing risk, working towards relational health, helping clients move to new ways of constructing and conceiving of family, easing the influence of internalised homonegativity and shame, and finding written and human resources that will be helpful to clients. These areas of care only present a tentative map as this issue requires more research and reflection.

School Disengagement and Mental Health Service Intensity Need Among Clinically Referred Students Utilizing the interRAI Child and Youth Mental Health Assessment Instrument

Although mental health challenges are widespread, impacting 1 in 5 children and youth, only 25% of these young people receive the required mental health supports. Unmet mental health needs are strongly associated with functional impairments including poor self-care, interpersonal challenges, and school difficulties among young people. School disengagement, or a student's lack of involvement in education through interest, curiosity, motivation, and active participation, is associated with a wide array of detrimental outcomes including chronic mental health difficulties, conduct and delinquent behaviors, criminal justice involvement, and unemployment in adolescence and adulthood. Disengagement observed within the school setting may be indicative of underlying mental health challenges and reflective of service intensity need. The current study extends the literature by examining the relationship between school disengagement and mental health service intensity need among 14,750 clinically referred students across elementary and secondary school utilizing the interRAI Child and Youth Mental Health instrument. Findings indicated that more than 25% of clinically referred students were at heighted risk for school disengagement and required high-intensity services. Further, mental health service intensity need was positively associated with risk of school disengagement among students, along with the specific reason for referral (i.e., psychiatric symptoms, harm to self, harm to others, or addiction or dependency), after controlling for sex and age. Implications of the findings are explored within the context of the school setting and future directions are suggested.

Effectiveness of online mindfulness interventions on medical students’ mental health: a systematic review

Background Medical school typically presents students with a combination of academic and personal stressors that may lead to substandard mental health wellbeing. Meditation practices such as mindfulness facilitate a greater awareness of one's thoughts and feelings, thereby decreasing emotional reactivity. The use of mindfulness-based interventions delivered online has considerable potential in fostering self-care and helping medical students to handle mental health challenges. We examined the available evidence on the use of online mindfulness interventions in order to determine whether they are feasible and effective for improving medical students’ mental health. Methods We performed a systematic review guided by PRISMA guidelines and utilised the following databases: ProQuest, Medline, PubMed, PsycINFO, Web of Science, IEEE Explore, Cochrane, and CINAHL. The key search terms used include mindfulness, cognitive behavioural therapy, acceptance and commitment therapy, online, web, virtual, internet cyber, app, medical students, residency students, and residents. English-language articles published in the last ten years that described online interventions for medical students or residents were included in the review. Results Two studies describing the impact of online mindfulness interventions on medical students’ mental health were identified. Research in this domain is nascent; available qualitative and quantitative evidence suggests benefits in self-compassion, perceived stress, cognitive skill use, mindfulness, creating coping mechanisms, and greater awareness of emotions and feelings. There was no evidence of the effectiveness of online mindfulness interventions on depression, anxiety and burnout. There was, however, general low program usage and participation tended to diminish near the conclusion of the interventions. Conclusions The evidence found in the systematic review exhibits the potential for online mindfulness interventions to be effective in addressing some mental health challenges of medical students. There was insufficient evidence to support the use of online mindfulness interventions for burnout, depression, and anxiety. Longitudinal studies with randomised controlled trials are required to generate stronger and robust evidence.