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Epilepsy remains the most common neurologic disorder in childhood and adolescence, with certain epilepsy syndromes such as childhood absence epilepsy (CAE) and juvenile myoclonic epilepsy (JME) being more common in girls. Psychiatric disorders are a common comorbidity in children with epilepsy, especially two behavioral conditions: attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder. In addition, psychosocial issues of stigma, bullying and violence remain potent disruptors of patients’ development at this stage in their lives. Emerging information on how cultural, ethnical and gender diversity may affect care should also be taken into consideration and proactively addressed. As the care of children and adolescents with epilepsy has grown more complex over the past decades, the transition from pediatric to adult care systems needs to become purposeful, such as the medical, psychosocial, educational and vocational needs of young adults with long-term medical conditions are actively
Hoarding disorder (HD) is primarily characterised by difficulties with discarding possessions. Evidence-based psychological interventions such as CBT have been found to be of benefit to people with HD. However, people with HD may receive a psychosocial intervention provided by other professions such as social workers or a multi-disciplinary team before receiving psychological therapy, if at all.
Objectives:
The aim of this systematic review is to evaluate psychosocial interventions for HD.
Method:
Searches were conducted on three databases (PsycInfo; MEDLINE; Embase) and grey literature, and the search strategy was designed to capture psychosocial interventions for adults with HD.
Results:
Studies (n=5) were included where the outcome was related to a psychosocial factors, such as fire safety, tenancy preservation and QoL. These psychosocial interventions show improvements in those with HD, with effect sizes ranging from d=0.86 to d=1.41.
Conclusions:
Despite the limited research on psychosocial interventions for HD, this systematic review suggests it is a promising area for further research in this area.
Key learning aims
(1) To identify what psychosocial interventions are available for people experiencing hoarding difficulties.
(2) To identify how available psychosocial interventions for hoarding difficulties are delivered and by whom.
(3) To examine the effectiveness of psychosocial interventions for people experiencing hoarding difficulties.
This study aimed to assess feasibility, acceptability and potential for impact of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA), a co-designed intervention for pregnant adolescents in Malawi. We used a mixed-methods interventional pre-post cohort design. We recruited pregnant adolescents from a rural health centre in Zomba district, Malawi, all of whom were offered a five-session psychosocial intervention delivered by community healthcare workers. Quantitative feasibility indicators related to participant enrolment, session attendance and intervention completion. Feasibility of intervention delivery was explored using in-depth semi-structured interviews with healthcare workers. Acceptability was investigated through in-depth semi-structured interviews with intervention participants and a service user satisfaction questionnaire. Intervention outcomes were assessed using standardised measures of common mental disorders, financial distress and poor mental health and perceived social support. 19 adolescents aged 15–19 years (mean=17.21, SD=1.18) started the intervention, with 18 (94.7%) completing the programme. Significant improvements (p<0.05) were reported across all outcome measures, with moderate to high pre-post effect sizes. Intervention participants reported high levels of service satisfaction, although healthcare workers (n = 6) reported that some feasibility challenges emerged during recruitment and delivery. The FOR MAMA intervention proved to be an acceptable and feasible psychosocial intervention for pregnant adolescents in Malawi.
Edited by
Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston,Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
More women are surviving gynecological cancer with advancements in screening, diagnosis, and treatment. Survivorship care of gynecological cancer includes surveillance for recurrence of disease, monitoring for late effects of treatment, reducing the risk and early detection of other cancer, and assessment of psychosocial function. Even if the surveillance of gynecological cancer survivors has some common features, non-invasive and invasive breast, cervical, endometrial, and ovarian cancer will require an individualized therapeutic approach. Many survivors of gynecologic cancer will have long lasting effects on bone and sexual heath, so these areas should be addressed on a regular basis. In addition, it is important to use every encounter as an opportunity to assess the risk of other cancer and provide appropriate early detection. Survivorship care will also incorporate strategies to decrease the risk of other cancer through lifestyle modifications. Many female cancer survivors will have lifelong issues related to distress, body image, finance, and social support. Assessment of psychosocial issues and referral to appropriate services should be performed at every patient encounter.
Patients with univentricular hearts can only be palliated by a staged surgical procedure that carries a high morbidity and mortality risk. The aim of this study was to examine the emotional demands, psychosocial burden, and quality of life of parents with children with univentricular hearts compared to parents of children with a simple heart defect, those with no heart defect and children with chronic diseases.
Methods:
An anonymous questionnaire was created to interview parents about their quality of life, stressors, needs, strategies for coping with illness, and partnership satisfaction.
Results:
73 families participated in the study. Parents of children with univentricular hearts experience a significantly higher psychosocial burden, limitations in daily life, and distress in family interactions, as well as greater emotional distress compared to the other study groups. When comparing the families of children with other chronic diseases (e.g. cystic fibrosis, chronic arthritis and diabetes), these differences remained significant.
Conclusion:
The study confirms a higher psychosocial burden, restrictions in daily life and a lower quality of life of parents with children with univentricular hearts, compared to parents of children with simple heart defects and parents of heart-healthy children or those with other chronic diseases. Since this condition persists until adolescence and adulthood, the families are exposed to special challenges and stresses throughout their lives. This has yet to be adequately addressed in the management of these families.
This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.
Methods
In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.
Results
Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.
Discussion
Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
Edited by
Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester,Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich,Stephen M. Pereira, Keats House, London
The interaction between mental illness, some personality disorders, psychological and developmental problems and sexual behaviour is a complex area. This chapter focuses on sexually problematic behaviour displayed by adult patients in mental health inpatient settings. It discusses prevalence, definitions and a potential role for the criminal justice system. A clinical case illustrates potential difficulties and solutions in assessment and management which should be multi-faceted.
As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study’s intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.
The colonial reason at the heart of psychoanalysis is increasingly acknowledged, but literature scholars still work with it as an instrument for decolonizing. This essay examines thepossibilities of postcolonial literature itself as a source of epistemological intervention into psychoanalysis.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
This chapter introduces readers to important concepts and practicalities in facilitating, managing, and delivering the wellbeing and psychosocial agendas. It describes the research undertaken by the Social Influences on Recovery Enquiry (SIRE) undertaken in the wake of the Manchester Arena bombing in 2017, and its importance in framing the practical implications for planning and delivering services.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
This case study illustrates approaches to promoting the wellbeing of and initiating psychosocial care to support the mental health of the staff of public sector services in the UK. It focuses on staff who work in emergencies, including in the fire and rescue, police, ambulance, and search and rescue services, often referred to in the UK as the Blue Light services. This case study provides information illustrating what can be done to assist the work of employing organisations to promote the mental health of all employees – that is, senior, middle, junior, general, and professional managers and their staff. It describes important concepts in planning and in delivering interventions.
This review aims to emphasise the impact of poor nutrition on children’s health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.
To explore how the COVID-19 pandemic affected fetal care, social support, and emotional functioning for women carrying a fetus with CHD.
Method:
This was a single-centre qualitative study of 31 women who received a prenatal diagnosis of CHD during the pandemic. Patients completed semi-structured interviews about their experiences with fetal care, social support, and perceptions of risk to themselves and their fetus. Consistent themes regarding the impact of the pandemic were identified using an inductive thematic approach. Demographic data were collected via self-report and chart review.
Results:
Women generally reported consistent access to fetal care throughout the pandemic, with frequent use of telemedicine in addition to in-person care, but negative impacts resulting from restrictions on family support at appointments. Limited access to social support overall and a loss of pregnancy traditions were described. Many women reported feeling isolated and experiencing worries and fears about COVID-19 but also noted feeling supported by their healthcare team. Partner/family support during appointments and connection to peer-to-peer support were identified as recommendations to mitigate negative impacts.
Conclusion:
Women carrying a fetus with CHD during the COVID-19 pandemic experienced unique stressors that may affect mental health. However, many also experienced unexpected supports that may mitigate effects of pandemic-related stressors. Results can inform efforts to promote positive family outcomes during and following the COVID-19 pandemic.
Dance for older adults is increasingly being used to support health and well-being. While dance may be enjoyable for many, understanding its benefits for those with limited physical and cognitive abilities may provide further support for how dance may be used in these contexts. This was a study of Sharing Dance Older Adults, a dance program with remotely streamed sessions. Data were collected from 48 older adults who took part in the On Your Feet version of the program, and from 38 who took part in the In Your Seat version. Measures included interviews, physical fitness tests and surveys on mood, quality of life, and program satisfaction. Physical fitness significantly improved for both groups, unlike for mood, social well-being, or quality of life. This contrasts with qualitative findings, with participants reporting how the program enhanced their mood, social interactions, and quality of life.
Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.
Computer-mediated and telephone communication connecting professionals and patients (eHealth) is well established. Yet there is little information about psychosocial interventions delivered by trained practitioners for a palliative care population. The aim is to describe digitally enabled psychosocial interventions offered to adults with life-shortening or terminal illnesses and carers/families receiving palliative care, and how these are delivered and evaluated.
Methods
Using Joanna Briggs Institute scoping review methodology, 4 databases (MEDLINE, CINAHL, PsycINFO, and Academic Search Ultimate) were searched (January 2011–April 2021). Inclusion criteria: (a) any design reporting and (b) psychosocial interventions delivered digitally by palliative care health and social care practitioners to (c) adults with life-shortening illnesses.
Results
Included papers (n=16) were from Europe ((n=8), Asia (n=2), and the USA (n=6). Research designs encompassed pre- and post-studies, randomized control trials, feasibility, and pilot studies. Tools evaluated psychological, somatic, functional, and psychosocial outcomes. Underpinning approaches included cognitive behavioral therapy, Erikson’s life review, coping skills training, psychoeducation, problem-solving therapy, counseling, emotional support and advice, and art therapy. Delivery tools used were telephones, text messages and emails, websites, videos, workbooks, and compact discs. Practitioners included counselors, psychotherapists, psychologists, art therapists, social workers, registered nurses, and trainees. Patients had Alzheimer’s disease and related dementias, advanced cancers, chronic obstructive pulmonary disease, and heart failure.
Significance of results
COVID-19 has accelerated the usages of digitally enabled psychosocial interventions. Evidence indicates a growing interest in hybrid, novel, synchronous, and asynchronous digital psychosocial interventions for adults with life-shortening illnesses and their caregivers receiving palliative care.
Currently there is no first-line treatment recommended for the negative symptoms of schizophrenia. Psychosocial and behavioural interventions are widely used to reduce the burden of negative symptoms. Meta-analytic studies have summarised the evidence for specific approaches but not compared evidence quality and benefit.
Aim
To review and evaluate the evidence from meta-analytic studies of psychosocial and behavioural interventions for the negative symptoms of schizophrenia.
Method
A systematic literature search was undertaken to identify all meta-analyses evaluating psychosocial and behavioural interventions reporting on negative symptom outcomes in people with schizophrenia. Data on intervention, study characteristics, acceptability and outcome were extracted. Risk of bias was evaluated. Results were summarised descriptively, and evidence ranked on methodological quality.
Results
In total, 31 systematic reviews met the inclusion criteria evaluating the efficacy of negative symptom interventions on 33 141 participants. Exercise interventions showed effect sizes (reduction in negative symptoms) ranging from −0.59 to −0.24 and psychological interventions ranging from −0.65 to −0.04. Attrition ranged between 12% to 32%. Across the studies considered heterogeneity varied substantially (range 0–100). Most of the reviews were of very low to low methodological quality. Methodological quality ranking suggested that the effect size for cognitive remediation and exercise therapy may be more robust compared with other approaches.
Conclusions
Most of the interventions considered had a small-to-moderate effect size, good acceptability levels but very few had negative symptoms as the primary intervention target. To improve the confidence of these effect sizes being replicated in clinical settings future studies should minimise risk of bias.
The COVID-19 pandemic greatly impacted the social lives of older adults across several areas, leading to concern about an increase in loneliness. This study examines the associations of structural, functional, and quality aspects of social connection with increased loneliness during COVID-19 and how these associations vary by sociodemographic factors.
Design:
Secondary data analyses on a nationally representative survey of older US adults.
Setting:
The 2020 Health and Retirement Study (HRS) COVID-19 module.
Participants:
The study sample includes 3,804 adults aged 54 or older.
Measurements:
Increased loneliness was based on respondents’ self-report on whether they felt lonelier than before the COVID-19 outbreak.
Results:
While 29% felt lonelier after COVID-19, middle-aged adults, women, non-Hispanic Whites, and the most educated were more likely to report increased loneliness. Not having enough in-person contact with people outside the household was associated with increased loneliness (OR = 10.07, p < .001). Receiving emotional support less frequently (OR = 2.28, p < .05) or more frequently (OR = 2.00, p < .001) than before was associated with increased loneliness. Worse quality of family relationships (OR = 1.85, p < .05) and worse friend/neighbor relationships (OR = 1.77, p < .01) were related to feeling lonelier. Significant interactions indicated stronger effects on loneliness of poor-quality family relationships for women and insufficient in-person contact with non-household people for the middle-aged group and non-Hispanic Whites.
Conclusions:
Our findings show an increase in loneliness during COVID-19 that was partly due to social mitigation efforts, and also uncover how sociodemographic groups were impacted differently, providing implications for recovery and support.
Extraordinary reproductive technologies are continuing to evolve for people needing medical assistance to have a child, which are replete with complex psychosocial issues. Optimal patient care involves the collaboration of numerous healthcare professionals (physicians, nurses, laboratory scientists, administrative staff, as well as counselors) working together to provide reproductive medical services. This chapter provides a biopsychosocial model for the medical and psychosocial assessment and treatment of individuals and couples seeking reproductive medical assistance. Beginning with an overview of infertility and reproductive physiology/pathophysiology, evaluation and treatment are discussed from a collaborative perspective of medical and psychosocial management. All aspects of reproductive medical care are presented from the lifestyle choices to assisted reproductive technologies including IVF, gamete donation and gestational surrogacy. The complex psychological challenges of patients dealing with significant medical conditions and the consequences of invasive medical procedures, coupled with treatment failures and loss are examined. In addition, a collaborative approach to decision-making in treatment and family building alternatives is discussed. The chapter also serves as a springboard to topics in the second edition of Fertility Counseling covering therapeutic approaches, assessment and preparation in assisted reproduction, addressing the needs of diverse of populations, practice issues, and special topics on pregnancy loss, reproductive trauma and resiliency, postpartum adjustment, and the pregnant therapist.
Embryo donation is a unique and novel disposition option and family-building choice for patients. While there are an estimated one million surplus embryos cryopreserved around the world, embryo donation cases remain low. At the same time, interest in embryo donation is on the rise, as an increasing number of patients consider alternative methods of family creation. The heightened interest in embryo donation necessitates skilled fertility counselors to provide education and counseling to patients on both the donor and recipient side. Potential embryo donors often struggle with decision making around the disposition of their remaining embryos, while potential recipients may grapple with the notion of nongenetic parenting and their relationship to their donors and their donor-conceived children. The fertility counselor can play an integral role in helping patients navigate their decision making and their new relationships and family structure. This chapter explores the historical, logistical, psychosocial and relational considerations of embryo donation. The chapter highlights the important role of the fertility counselor throughout an embryo donation journey, and offers frameworks, best practices, and therapeutic tools that counselors can utilize as they work to support their patients.