ENACT Study: What has helped health and social care workers maintain their mental wellbeing during the COVID-19 pandemic? Adaptive coping, team resilience, help-seeking behaviour and work based supports

Rapid studies have highlighted the adverse mental health impact of COVID-19 on health and social care workers (HSCWs). Complementing this work, we report on the psychosocial factors that have helped HSCWs adapt to the adversities associated with COVID-19 and protect staff wellbeing in Scotland. The ENACT study collected data from HSCWs (n= 1364) in Scotland during the third national lockdown. Using a cross-sectional design, participants completed an online survey providing quantitative data and free responses. A multi-method approach to analysis was used. The majority of HSCWs were found to have low wellbeing scores, high levels of COVID-19 stress, worry, burnout and risk perception scores and almost half of HSCWs met the clinical cut off for acute stress. Adaptive coping strategies and increased perceived team resilience helped mitigate against the adverse impact that COVID-19 stressors have on HSCWs’ mental wellbeing. HSCWs were significantly more likely to seek informal support for dealing with personal or emotional problems. Barriers to formal help-seeking were identified including stigma and fears of consequence of disclosure. HSCWs most valued peer support, workplace supports, visible leadership and teamwork. Our findings illuminate the complexity of the effects of the COVID-19 pandemic on HSCWs’ wellbeing and will inform future intervention development to increase positive adaptation amongst staff. Addressing barriers to mental health help-seeking among HSCWs is essential. The implications emphasise the importance of lessons learned across health and social care contexts, planning and preparedness for future pandemics.

Communicating Reproductive Coercion in the Context of Domestic and Family Violence: Perspectives of Service Providers Supporting Migrant and Refugee Women

The current study explored the language barriers to help-seeking in the context of reproductive coercion and abuse (RCA), domestic and family violence (DFV), and sexual violence (SV), drawing on observations by key informants supporting women from migrant and refugee communities. A lack of shared language has been identified as a key barrier to help seeking for migrant and refugee women experiencing DFV more broadly, though how language intersects with help seeking in the context of RCA is yet to be investigated. We conducted 6 focus groups with 38 lawyers, counsellors, and social workers supporting women experiencing DFV in Brisbane and Melbourne, Australia. Our findings address two main areas. First, consistent with past research in DFV, our participants identified language as a barrier for women when communicating about sexual and reproductive issues in the context of health and police encounters. More specifically, our findings suggest that the inability of health professionals and police to communicate with women who have low or no English proficiency not only negatively impacted victims/survivors’ ability to access support, but also facilitated the perpetration of RCA. We conclude that language can be a mechanism through which coercive control is enacted by perpetrators of RCA and health and policing systems may not be equipped to recognise and address this issue. We also suggest that greater conceptual clarity of RCA is needed within the DFV sector in order to tailor responses.

Disentangling help-seeking and giving up: differential human-directed gazing by dogs in a modified unsolvable task paradigm

Dogs are renowned for ‘looking back’ at humans when confronted with a problem, but it has been questioned whether this implies help-seeking or giving up. We tested 56 pet dogs from two breed groups (herding dogs and terriers) in a modified unsolvable task paradigm. One reward type (food or toy) was enclosed in a box, while the respective other reward was accessible. With both reward types, human-directed gazing in relation to the box was significantly positively correlated with interaction with the box, as long as an alternative was available. This suggests that both behaviours served to attain the unavailable reward and reflected individual motivation for the inaccessible vs the accessible reward. Furthermore, we varied whether the owner or the experimenter was responsible for handling the rewards. In the owner-responsible group, dogs rarely gazed at the experimenter. In the experimenter-responsible group, dogs preferentially directed box-related gazing (prior to or after looking at or interacting with the box) at the owner. Still, they gazed at the experimenter significantly longer than the owner-responsible group. Conversely, toy-related gazing was directed significantly more at the experimenter. Thus, dogs adjust their gazing behaviour according to the people’s responsibility and their current goal (help-seeking vs play). Gaze duration did not differ between herding dogs and terriers. We conclude that dogs use gazing at humans’ faces as a social problem-solving strategy, but not all gazing can be classified as such. Dogs’ human-directed gazing is influenced by the social relationships with the persons, situational associations, and context (unsolvable problem vs play).

Correlates of disclosure of non-suicidal self-injury amongst Australian university students

Purpose Non-suicidal self-injury (NSSI) is associated with psychological disorders and suicidal thoughts and behaviours; disclosure of NSSI can serve as a catalyst for help-seeking and self-advocacy amongst people who have self-injured. This study aims to identify the socio-demographic, NSSI-related, socio-cognitive and socio-emotional correlates of NSSI disclosure. Given elevated rates of NSSI amongst university students, this study aimed to investigate these factors amongst this population. Design/methodology/approach Australian university students (n = 573) completed online surveys; 80.2% had previously disclosed self-injury. Findings NSSI disclosure was associated with having a mental illness diagnosis, intrapersonal NSSI functions, specifically marking distress and anti-dissociation, having physical scars from NSSI, greater perceived impact of NSSI, less expectation that NSSI would result in communication and greater social support from friends and significant others. Originality/value Expanding on previous works in the area, this study incorporated cognitions about NSSI. The ways in which individuals think about the noticeability and impact of their NSSI, and the potential to gain support, are associated with the decision to disclose self-injury. Addressing the way individuals with lived experience consolidate these considerations could facilitate their agency in whether to disclose their NSSI and highlight considerations for health-care professionals working with clients who have lived experience of NSSI.

Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial

Background Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Methods Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Results A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help–seeking. Conclusions Use of the peer support app was related to reduced NSSI frequency and greater confidence in one’s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help–seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration Open Science Foundation; https://osf.io/3uay9

Suicide and coping: specific coping behaviours associated with suicidal ideation and differences between predicted and actual coping among help-seeking individuals

Suicide is a substantial contributor to global mortality, with suicidal ideation (SI) a significant predictor of suicide. Research has demonstrated relationships between dispositional coping styles and SI. This study aimed to advance this research by moving from the disposition coping level to examining the specific coping strategies people use when experiencing SI. Further, it aimed to examine whether prediction of the coping strategies individuals would use if they experienced SI differs from the actual coping strategies employed by people that have experienced SI. Seventy-seven help-seeking adults (Mage = 31.6, SD = 10.4) with (n = 49) or without (n = 28) history of SI completed measures of SI-related coping (modified Brief COPE) and current emotional distress (DASS-21) via online survey. ANCOVA revealed a significant association between SI history status and endorsement of Problem-Focused coping strategies, while controlling for current emotional distress levels. Participants without SI history reported greater predicted Problem-Focused coping use than actual use reported by participants with SI history. Subsequent facet-level ANCOVAs demonstrated that participants without SI history predicted they would use Active Coping, Use of Informational Support, and Planning strategies to a greater extent than was reported by people who did experience SI. The findings suggest individuals without SI history may overestimate their ability to use such adaptive coping strategies, and may represent an overestimation of overall ability to cope with potential SI. Future research may build on these preliminary findings and examine the factors explaining these differences to help inform programs related to SI and coping.

Social justice, health equity, and mental health

There is considerable evidence to indicate that stigma and discrimination against people with mental illnesses are widely prevalent across nations. Research also shows that individuals with mental illnesses are likely to die 15–20 years younger than those who do not have these illnesses. In addition, they are more likely to experience delays in help-seeking leading to poor outcomes and are more likely to experience physical illnesses. Stigma and discrimination appear to play a major role in depriving people with mental illnesses of their basic rights. Their economic, political, social, and human rights are often ignored. In this article, we describe the capability to be healthy and basic principles of social justice related to mental health. We discuss findings of discrimination often embedded in laws of countries around the world in the context of basic human rights. We believe that clinicians have a key role as advocates for their patients. Clinicians and policymakers need to work together to bring about social and health equity.

Mental health stigma and help-seeking intentions in police employees

Mental health problems among police employees are exacerbated by negative attitudes and beliefs around mental health help-seeking perpetuated by police culture. We collected anonymous survey data from 259 civilian and commissioned police employees to test hypothesized relationships among help-seeking stigma, help-seeking attitudes, and intended help-seeking behavior. Results demonstrated that mental help-seeking stigma was negatively associated with help-seeking attitudes, and in turn with reduced mental health help-seeking intentions. Structural equation modeling provided support for a model linking help-seeking stigma, help-seeking attitudes, and intentions to seek help. This path model was moderated by psychological distress and previous participation in mindfulness training, which had opposing effects on help-seeking stigma and (indirectly) on intended help-seeking. These results support the hypothesis that stigma around mental health help-seeking contributes to reduced help-seeking intentions, and provide insight into policies, practices, and interventions that police agencies may enact to combat stigma and positively influence mental health help-seeking.