BACKGROUND: Although bereavement is not usually considered the type of stressor associated with posttraumatic stress disorder (PTSD), a risk factor often associated with poorer bereavement outcomes is when a death is sudden and unexpected. AIMS: The purpose of this exploratory study is to describe PTSD symptoms in survivors bereaved by the suicide of a significant other. The relationship of PTSD to mental health and grief were explored, as well as gender differences in PTSD symptoms. METHOD: To measure PTSD symptoms, the 15-item Impact of Event Scale (IES) was used. RESULTS: The IES intrusion and avoidance subscales were significantly correlated with the mental health subscale of the MOS SF-36 (Medical Outcomes Study–Short Form 36), indicating that lower mental health scores were associated with higher PTSD symptoms. Those survivors scoring higher than 25 on the Inventory of Complicated Grief (ICG) had significantly higher scores on both the intrusion and avoidance subscales of the IES compared with those scoring lower than 25 on the ICG. Females reported significantly higher intrusion symptoms and total stress than males. CONCLUSION: Our results suggest that a death by suicide may lead to the development of PTSD symptoms, at least in some individuals, and is associated with lower mental health quality of life and complicated grief responses.
BACKGROUND: Continuous Special Observation (CSO) is commonly ordered for patients at risk to injure themselves or others and involves assigning staff to monitor one patient at all times. CSO is intrusive, costly, and often has deleterious effects on patient care. Two nursing protocols were developed as alternative interventions to CSO. The first protocol, Psychiatric Nursing Availability (PNA), was designed to treat patients having suicidal or self-injurious thoughts. The second protocol, Psychiatric Monitoring and Intervention (PMI), was designed to prevent violent and impulsive behavior. These protocols had their genesis in a model that encourages nursing autonomous decision making. OBJECTIVE: Identify the impact PNA and PMI had on the number of CSO and their duration. STUDY DESIGN: Nine-year descriptive retrospective analysis of CSO, PNA, and PMI. The data were collected from the unit 15-minute rounding sheets. Descriptive analyses were performed. Interrupted time series analysis was used to determine how the protocols affected frequency and duration of CSO. RESULTS: PNA did not significantly affect CSO; however, PMI did affect its use. There was a downward trend in the number of CSOs after PMI was implemented by 0.07 episodes per month (p = .0111). The median duration of CSO dropped from 66 hours to 33 hours after PMI was implemented (p = .0004). CONCLUSION: PMI had the greatest impact on CSO. PMI had a secondary effect of increasing staff availability on the unit that affected CSO’s use. The model of nursing care may have influenced this reduction in CSO.
BACKGROUND: Mothers who abuse substances are more likely to have impaired parenting and lose custody of their young children. OBJECTIVE: The pilot study described mother–child relational quality of women in substance abuse treatment. The identification of mothers’ perceptions of being parented, current level of depression, discrete and potentially modifiable mothering behaviors, and self-appraisals of their role. DESIGN: The descriptive study implemented audio-video–recorded mother–child interactions for coding. RESULTS: Twenty-nine dyads participated with children age 4 weeks to 5 years. Mothers had lower levels of caring from their parents and moderate depression that was correlated with many of the relational quality behaviors. Eleven of 29 maternal behaviors were coded as concerning. Reflections by mothers revealed modest, yet confident self-appraisals of their maternal role. CONCLUSIONS: Women who experienced higher depression demonstrated lower maternal quality. Some maternal behaviors were identified as less optimal although many were strengths.
BACKGROUND: Depression is the number one cause of disability in the world. Hispanic women are at a higher risk for depression than Caucasian and African American women. This is in part due to multiple social determinants of health that affect the individual, family, aggregates, and community. OBJECTIVE: To investigate the social determinants of depression among Hispanic women in South Florida. DESIGN: This is a secondary cross-sectional data analysis. A total of 280 Hispanic women from South Florida between 18 and 50 years of age were analyzed. RESULTS: Depression is prevalent among Hispanic women in South Florida (37.5%). Education, health status, and living with partner were significant predictors of depression in the sample. CONCLUSION: Development of a culturally tailored risk assessment tool that highlights the social determinants of depression in Hispanic women is essential, as it could be used as a standard practice in primary care and other appropriate settings.
BACKGROUND: Nurse practitioners (NPs) are statutorily authorized to provide assessment and cognitive recommendations for concussion in most states. Their scope of practice includes assessment and management of concussion sequalae including anxiety, insomnia, and depression, as well as return to school and activity guidance. OBJECTIVES: Analysis of symptom-based diagnosis of mild traumatic brain injury (TBI) in adolescents, including return to school and school workload recommendations comparing psychiatric and nonpsychiatric NPs. DESIGN: Cross-sectional Web-based survey with embedded videos using standardized actors and scripts randomized for patient sex and sport. A total of 4,849 NPs licensed in Oregon or Washington were invited by e-mail to view and respond to this study, with a response rate of 23%. RESULTS: Psychiatric mental health nurse practitioners (PMHNPs) were 44% less likely than family NPs to report using standardized concussion tools. 17% had completed continuing education on mild TBI compared to 54.5% of family NPs. Seven PMHNPs provided additional feedback related to discomfort in completing the survey due to lack of comfort or experience. Return to school recommendations and reduced workload advice did not significantly differ by NP type. CONCLUSION: PMHNPs may support individualized assessment through concussion evaluation, use of standardized tools, and differential consideration of TBI for mental health symptoms. More research is required related to the role and contribution of cognitive rest to full recovery.
BACKGROUND: Depression and anxiety disorders are two of the most common mental disorders in the United States. These disorders are prevalent among college students. OBJECTIVE: The main objective of this study is to compare the effectiveness of two different types of intervention practices (mindfulness vs. yoga) and a noninterventional control group in mitigating the effects of depression and/or anxiety in college students. METHOD: A sample of 90 students (both genders) over age 18 who had a diagnosis of anxiety and/or depression was recruited from 11,500 undergraduate college students in a mid-size university. The study’s design included stratified-randomized controlled repeated measures with three groups: a mindfulness intervention group, a yoga-only intervention group, and a noninterventional group. Participants were randomly assigned to the aforementioned three groups. Participants in the intervention groups received an 8-week training either in mindfulness or yoga. Depressive, anxiety, stress symptoms, self-compassion, and mindfulness were measured at baseline, Week 4, Week 8, and Week 12. RESULTS: Depressive, anxiety, and stress symptoms decreased significantly (p < .01) from baseline to follow-up conditions in both the mindfulness and yoga intervention groups. The changes in mindfulness scores were also significant in both groups. However, the changes in self-compassion scores were significant only in the mindfulness intervention group. No significant changes in the control group were demonstrated. CONCLUSIONS: The findings from this study can provide useful information to nurses and other health care providers. This study may have implications for a cost-effective treatment for depression and anxiety.
BACKGROUND: Risk perception is a subjective assessment of the actual or potential threat to one’s life or, more broadly, to one’s psychological well-being. Given the various risks associated with later life, a valid and reliable integrative screening tool for assessing risk perception among the elderly is warranted. OBJECTIVES: The study examined the psychometric properties and factor structure of a new integrative risk perception instrument, the Perceived Risk Scale. This eight-item measure refers to various risks simultaneously, including terror, health issues, traffic accidents, violence, and financial loss, and was developed specifically for older adults. DESIGN: An online survey was conducted with 306 participants aged 50 years and older. The scale was examined using exploratory factor analysis and concurrent validity testing. RESULTS: Factor analysis revealed a two-factor structure: later-life risks and terror risks. A high percentage of explained variance, as well as internal consistency, was found for the entire scale and for both factors. Concurrent validity was supported by significant positive associations with participants’ depression and negative correlations with their life satisfaction. CONCLUSION: These findings suggest that the Perceived Risk Scale is internally reliable, valid, and appropriate for evaluating risk perception in later life. The scale’s potential applications are discussed.
Background: In 2015, the Co-Chairs and Steering Committee of the Research Council members recognized the need to reevaluate the council’s priorities. Objective: To determine the top priorities for the Research Council. Design: Use of liberating structures: Impromptu Speed Networking, 1-2-4-all, and Crowd Sourcing. Results: Identified Research Council priorities included the following: efforts to increase psychiatric mental health (PMH) research funding; serve as a connector to bring researchers together; foster research through state chapters; increase collaboration between PhDs and DNPs; and develop models for organizational support for PMH staff nurse involvement in research. Conclusions: The liberating structures used are valuable strategies for engaging groups of people to identify what matters most to the group. Through the use of these novel techniques, the American Psychiatric Nurses Association Research Council has identified priorities for the work of the council. This has led to actions planned for the coming future with the intent to move PMH nursing research forward.
BACKGROUND: Women are faced with the task of gathering information and making subsequent decisions for themselves and their families as they are often the primary caregivers. OBJECTIVE: The purpose of this study was to elucidate prominent themes related to information management and Internet usage in new motherhood. While the advantages to online support have been explored, triggered anxiety has not been a focus of the literature. DESIGN: A focus group study of 31 adult, postpartum women was held at a large, urban medical center in the Northeastern United States. Data related to information management were extracted and analyzed thematically. RESULTS: Women reported experiencing (a) a forcible, internal drive for information related to family health and (b) a high level of anxiety surrounding health-related Internet searches. CONCLUSIONS: Health care providers must be aware that women will consult the Internet for information and that at least a portion of those individuals will experience anxiety as a result.
BACKGROUND: African American (AA) adolescents with depression face serious negative outcomes. Despite racial/ethnic disparities in treatment utilization, few studies have explored how AA adolescents manage their depression. OBJECTIVE: To describe common ways AA adolescents manage depressive symptoms through relationships with people in their lives. DESIGN: Qualitative descriptive methods were used to analyze the narratives of 22 AA young adults who had been depressed as adolescents and 5 AA adolescents in treatment for depression. RESULTS: A typology describing the varied ways AA adolescents manage their depressive symptoms through interactions with other people was constructed and labeled Being With Others. The five categories in the typology are keeping others at bay, striking out at others, seeking help from others, joining in with others, and having others reach out. CONCLUSIONS: Clinicians might use the Being With Others typology to guide discussions related to detecting, assessing, and treating AA adolescents with depression.
BACKGROUND: Considering the high worldwide prevalence of common mental disorders (CMDs), characterizing the association between CMD and quality of life (QoL) constitute a valuable measure to gauge patient’s functional impairment due to CMD symptoms. OBJECTIVE: To investigate factors associated with the incidence of CMD and its impact on the QoL in primary health care (PHC) patients. DESIGN: Cross-sectional study completed in a municipality in Brazil. Standardized tools included the Self-Reporting Questionnaire–20 to detect CMDs and the WHOQOL-brief to assess QoL, in addition to a sociodemographic and treatment-related questionnaire. RESULTS: A total of 41.4% of the patients met cutoff scores for a CMD, and the presence of a CMD was associated with female gender and marital status. Patients with CMDs had lower QoL scores than patients who were negative for a CMD. CONCLUSIONS: CMDs are highly prevalent in PHC settings and affect patients’ QoL. The high frequency of CMD in those that seek care through PHC necessitate incorporating mental health services into the range of available services.
BACKGROUND: Previous studies regarding depressive symptoms and acculturative stress among immigrants have been limited to the initial period after immigration. OBJECTIVE: The relationships between depressive symptoms, acculturation, and acculturative stress among immigrants from the former Soviet Union were examined in this descriptive study. DESIGN: Eighty immigrants from the former Soviet Union who had immigrated within the past 20 years were recruited in various community locations. RESULTS: Participants (N = 80), including recent and longer residing immigrants, reported elevated depressive symptoms and acculturative stress. Acculturative stress predicted depressive symptoms, controlling for dominant culture (American) immersion. However, length of time in the United States was not associated with depressive symptoms, ethnic culture immersion, or acculturative stress. CONCLUSIONS: Our results suggest that elevated depressive symptoms are related to acculturative stress but are not confined to the initial adjustment period. Steps to decrease acculturative stress might help decrease depressive symptoms in immigrants regardless of the number of years lived in the United States.
BACKGROUND: College students are becoming increasingly depressed; however, many do not attend university counseling to seek help. OBJECTIVES: What is the relationship between young adults’ mental health literacy, perceived stigma of depression and treatment, knowledge of treatment benefits and risks, beliefs about alternative therapies, and influence of his or her social network with usage of university counseling? STUDY DESIGN: A survey was administered to N = 107 American undergraduate college students to ascertain the students’ understanding of depression and their views of counseling services on campus. RESULTS: Both likelihood of using alternative therapies and perceived discrimination of social network accounted for 18% of the variance for likelihood of participants seeking campus counseling. CONCLUSIONS: When a young adult college student perceives stigma or discrimination of depression from family and friends, then they may be less likely to seek university counseling for depression as well as possible applications with alternative therapies as a favorable option.
BACKGROUND: Twenty-five percent of American adults experience a diagnosable psychiatric mental health (PMH) problem each year, and acute care medical-surgical nurses carry on average a five- to six-patient load per shift. Traditionally, U.S. PMH clinical experiences have occurred on inpatient units located within acute care hospitals or psychiatric hospital settings. However, many nursing programs are moving much of the PMH clinical experience to community-based settings. OBJECTIVES: This study aims to investigate how prelicensure undergraduate baccalaureate (BSN) student nurses and their faculty perceive students’ ability to achieve learning outcomes in community-based PMH clinical settings. This study’s research questions include the following: (a) What are student nurses’ perceptions of their abilities to achieve learning outcomes in community-based PMH clinical settings? (b) What are faculty’s perceptions of the students’ abilities to achieve learning outcomes in community-based PMH clinical settings? (c) What are student nurses’ perceptions of their abilities to transfer knowledge gained in their community-based PMH clinical experiences to other health care settings? DESIGN: Qualitative descriptive study with data collected through semistructured interviews, questionnaires, focus groups, and campus and clinical site visits. RESULTS: Three student themes emerged from the data: meeting the challenges of developing PMH nursing skills, sharing multiple experiences of feeling competent, and empowering all nurses through PMH nursing skills. Three themes also emerged from the faculty data: seizing the day(s), sharing competency, and broadly empowering nursing students. CONCLUSIONS: Baccalaureate students are able to achieve PMH clinical competencies through the use of community-based experiences and to transfer PMH competencies to other clinical settings.
BACKGROUND: Differences exist in alcohol-related outcomes across subgroups of sexual minority women. Likewise, stressors associated with coming out and living as lesbian or bisexual are hypothesized to be highly variable. Lesbians’ and bisexual women’s risks for hazardous drinking are explored in a 2006 NIAAA-funded interview study of women living in the Northeastern United States. OBJECTIVES: The primary objective of the present study is to replicate and extend an earlier analysis of the relationship between early drinking contexts and current drinking outcomes of adult lesbians with a convenience sample that includes a subgroup of self-identified bisexual women. Potential differences in the early drinking contexts of these two groups of self-identified lesbian and bisexual women are also explored. DESIGN: Bivariate and multiple regression analyses are used to examine relationships between early drinking contexts and current drinking of a racially and age-diverse convenience sample of 145 adult lesbian (N = 94) and bisexually identified (N = 51) women. RESULTS AND CONCLUSIONS: Consistent with previous research, patterns established while coming out have an enduring effect on drinking outcomes of lesbians; findings for bisexual women are inconclusive. Implications for research and practice are discussed.
BACKGROUND: "Systems of care" are strengths-based approaches to treating adolescents and others with disruptive disorders. However, little is known about why some adolescents improve and others do not. OBJECTIVE: To examine changes in personal strengths and family functioning as predictors of behavioral and social functioning among adolescents with disruptive disorders who participated in a system of care program. DESIGN: Secondary analyses of data from 114 adolescents (12-17 years of age) with disruptive disorders and their caregivers who participated in the Dawn Project Evaluation Study. Caregivers completed in-depth interviews conducted by trained data collectors using standardized questionnaires. Baseline and 12- month data are reported here. RESULTS: Improvement in personal strengths was a significant predictor of improvement in adolescent behavioral and social functioning, controlling for demographics (p < .001). CONCLUSION: In adolescents with disruptive disorders, psychiatric nurses should focus on enhancing adolescents’ personal strengths to improve behavioral and social functioning.
Background:A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. Objective: To analyze whether investments in ACT yield savings in primary care and other outpatient health services. Design: Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT (n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services (n = 1,426 and n = 41,717 distinct individuals). Results: We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. Conclusions: Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.
BACKGROUND: Oxytocin is a promising biomarker for psychiatric conditions arising from early relational trauma, childhood maltreatment, and attachment dysregulation, including posttraumatic stress and dissociative disorders. OBJECTIVE: This exploratory pilot study examined plasma oxytocin as a biomarker for alterations in the attachment system. DESIGN: We used a single group, repeated-measures design with 15 women. The protocol used a film clip previously validated as a provocation to the hypothalamic–pituitary–adrenal axis. RESULTS: The repeated-measures ANOVA showed differences in oxytocin across the three time points. Correlations with oxytocin indicated that measures of dissociation and somatization correlated most strongly with higher levels of oxytocin measured during exposure to the film’s bonding scene and posttraumatic stress disorder correlated most strongly with lower levels at the film’s abandonment scene. Post hoc analyses revealed differences in oxytocin response related to psychopathology. CONCLUSION: Replication studies should characterize participants on a range of psychiatric conditions associated with attachment dysregulation.