Clinical judgment of the need for professional mental health care in patients with cancer: a qualitative study among oncologists and nurses

Purpose In daily practice, oncologists and nurses frequently need to decide whether or not to refer a patient for professional mental health care. We explored the indicators oncologists and nurses use to judge the need for professional mental health care in patients with cancer. Methods In a qualitative study, oncologists (n = 8) and nurses (n = 6) were each asked to select patients who were or were not referred for professional mental health care (total n = 75). During a semi-structured interview, they reflected on their decision concerning the possible referral of the patient. Thematic analysis was used to analyze the data. Results Respondents reported using a strategy when judging whether professional mental health care was needed. They allowed patients time to adjust, while monitoring patients’ psychological well-being, especially if patients exhibited specific risk factors. Risk and protective factors for emotional problems included personal, social, and disease- and treatment-related factors. Respondents considered referral for professional mental health care when they noted specific indicators of emotional problems. These indicators included lingering or increasing emotions, a disproportionate intensity of emotions, and emotions with a negative impact on a patient’s daily life or treatment. Conclusions This study identified the strategy, risk and protective factors, and the indicators of emotional problems used by oncologists and nurses when judging the need for professional mental health care in patients with cancer. Implications for Cancer Survivors Oncologists and nurses can play an important role in the identification of patients in need of professional mental health care.

Diagnosis experiences from 50 hepatitis B patients in Chongqing, China: a qualitative study

Background The aim of this study was to provide recommendations for reducing the impact of hepatitis B infection on patients with chronic hepatitis B by describing their experiences during the diagnosis process. Methods We conducted face-to-face interviews with 50 hepatitis B patients recruited by convenient sampling from an infectious diseases department of a teaching hospital in Chongqing, China from July to August 2019. Thematic analysis framework included interviewees’ social demographic characteristics, diagnosis approach, signs and symptoms before diagnosis, feelings after diagnosis, and doctor’s instructions. Results Most patients first detected hepatitis B through various types of physical examinations when the patients were asymptomatic or had only mild symptoms. Most patients were shocked, scared, or overwhelmed when they were diagnosed with hepatitis B. They were able to remember the doctor’s instructions about maintaining a healthy lifestyle, but not impressed by the doctor’s advice about regular follow-up liver function tests. The lack of regular follow-up has caused irreversible damage to some patients. Conclusions Most patients are passively diagnosed with hepatitis B due to their lack of awareness on active hepatitis B prevention. Patients need professional mental health care to overcome the negative emotions that following the diagnosis. Physicians’ instruction should emphasize the importance of regular follow-up liver function tests in addition to a healthy lifestyle.

Medical and Social Assistance for the Transgender Community: Difficulties and Particularities in Psychiatric and Psychotherapeutic Assistance

The purpose of this paper was to point out the difficulties faced by the transgender community when using psychiatric or psychotherapeutic services and their impact at the social, psychological, and health state level. Our approach favours the increase in the information degree of the medical and psychotherapeutic community concerning the topic, by placing the transgender community in the current psychosocial context. In order to collect the necessary data, we applied two questionnaires to the transgender community and to the professional mental health community, respectively; the first comprised 20 questions and the second comprised 11 questions, and the results were interpreted statistically. From among them, it is worth highlighting the important percentage of transgender who do not live in accordance to the desired identity and the existence of discriminating situations in the interaction with the physician or the psychologist. The conclusions of this paper reflect the difficulties and gaps related to the assistance of sexual minorities. We thus propose examples of practices that may allow an increase in medical and social support for the transgender community.

Victims of the Terrorist Attacks in Belgium and Professional Mental Health Aid Barriers: A Qualitative Study

Introduction: Terrorist attacks can cause short and long-term stress-reactions, anxiety, and depression among those exposed. Sometimes, professional mental health aid, meaning all types of professional psychotherapy, would be appropriate, but victims often delay or never access mental health aid, even up to a decade after the initial event. Little is known about the barriers terrorist-victims encounter when they try to access professional mental health aid.Method: Using a qualitative design, 27 people exposed to the 22/03/2016 terrorist attack in Belgium were interviewed using half-structured, in-depth interviews, on their experiences with professional mental health aid. A reflexive thematic analysis was employed.Results: Five main barriers for professional mental health aid seeking by victims were found. First, their perception of a lack of expertise of mental health aid professionals. Second, the lack of incentives to overcome their uncertainty to contact a professional. Third, social barriers: people did not feel supported by their social network, feared stigma, or trusted that the support of their social network would be enough to get them through any difficulties. Fourth, a lack of mental health literacy, which seems to be needed to recognize the mental health issues they are facing. Finally, there are financial barriers. The cost of therapy is often too high to begin or continue therapy.Conclusions: This study showed that the barriers for seeking professional mental health aid are diverse and not easily overcome. More mental health promotion is needed, so that there is a societal awareness of possible consequences of being exposed to terrorist attacks, which might result in less stigma, and a quicker realization of possible harmful stress reactions due to a disaster.

Self-Stigma and Its Relationship With Rates of Depression Diagnosis

Background: Self-stigma about suicide might impede people seeking help from mental health professionals. There is little research about self-stigma expressed by suicide decedents. Aims: We aimed to explore (a) self-stigma about suicide through examination of suicide notes; and (b) whether the expression of self-stigma was associated with the formal diagnoses of depression. Method: Data were extracted from notes left by people who died by suicide in two major Chinese cities (Shanghai, 2004–2017; Wuhan, 2005–2019). Note content was examined and self-stigma items were coded. Demographics associated with self-stigma were reported. Rates of depression were compared between note-leavers who expressed self-stigma, and those who did not. Results: Notes were left by 567 suicide decedents (representing about 19% all suicides). Approximately 25% notes contained at least one self-stigma item. Older people made fewer self-stigma references, as did people from Wuhan. Depression was not associated with self-stigma. Limitations: Not all people dying from suicide leave notes, and suicide notes variably report self-stigma, thus self-stigma about suicide may be underestimated. Conclusion: Self-stigma items varied across regions and age groups, but not with depression. Therefore, self-stigma expressed by suicide decedents may not reflect help-seeking behaviours from professional mental health services.

Predicting rejection attitudes toward utilizing formal mental health services in Muslim women in the US: Results from the Muslims’ perceptions and attitudes to mental health study

Background: The underutilization of mental health services is a recognized problem for the growing number of Muslims living in the West. Despite their unique mental health risk factors and the pivotal role they play in determining mental health discourse in their families and in society, Muslim women in particular have not received sufficient study. Aim: To help remedy this research gap, we examined factors that may impact the rejection attitudes of Muslim women toward professional mental health care using the first psychometrically validated scale of its kind; the M-PAMH (Muslims’ Perceptions and Attitudes to Mental Health). Methods: A total of 1,222 Muslim women responded to questions about their cultural and religious beliefs about mental health, stigma associated with mental health, and familiarity with formal mental health services in an anonymous online survey. Results: Hierarchical multiple regression analysis revealed that higher religious and cultural beliefs, higher societal stigma, and lower familiarity with professional mental health services were associated with greater rejection attitudes toward professional mental healthcare. The final model was statistically significant, F (5, 1,216) = 73.778; p < .001, and explained 23% of the variance in rejection attitudes with stigma accounting for the most (12.3%) variance, followed by cultural and religious mental health beliefs (6%), and familiarity with mental health services (2.7%). Conclusions: Findings suggest that although the examined factors contributed significantly to the model, they may not be sufficient in the explanation of Muslim women's rejection attitudes toward mental health services. Future research may explore additional variables, as well as predictive profiles for Muslim women’s perceptions and attitudes of mental health based on a combination of these factors.

Examination of Family Counseling Coursework and Scope of Practice for Professional Mental Health Counselors

This study examined couple and family counseling coursework in the Council for the Accreditation of Counseling and Related Educational Programs (CACREP)–accredited clinical mental health counseling (CMHC) programs and scope of practice related to couple and family counseling based on each state’s licensure regulations for mental health counselors (MHCs). Required and offered courses in couple/family-related content areas for 331 CACREP-accredited CMHC programs were analyzed. In addition, state licensure regulations for all 50 states and Washington, DC, were examined to determine whether MHCs can conduct couple and family counseling based upon licensure regulations. The results of this study indicated a mean of 1.1 couple/family-related courses required and a mean of 2.3 of these courses offered within CMHC programs. All but one of the 51 licensure regulations analyzed either permits or does not specify whether couple/family counseling falls within the scope of practice of MHCs; these 50 state/territory regulations also lack concrete guidelines related to required training or supervised experience in couple and family counseling to provide this service competently as an MHC. Limitations and areas for future research and training opportunities are discussed in light of these results.