PLOS mental health最新文献

{"title":"Community-engaged adaptation and pilot testing of a mental health and substance use screening and referral process in HIV pre-exposure prophylaxis (PrEP) care in the Southern USA.","authors":"Susan Reif, Sarah M Wilson, Elena Wilson, Haley Cooper, Andy Weinhold, Amy Corneli","doi":"10.1371/journal.pmen.0000148","DOIUrl":"10.1371/journal.pmen.0000148","url":null,"abstract":"<p><p>Mental health and substance use concerns are prevalent in HIV pre-exposure prophylaxis (PrEP)-seeking and priority populations (e.g., same gender loving black men (SGLBM)), often negatively affecting health care outcomes. Identifying individuals who could benefit from access to effective behavioral health treatment remains suboptimal among these populations. We utilized a community-informed process to adapt an evidence-based behavioral health identification and linkage model, Screening Brief Intervention and Referral to Treatment (SBIRT), to include mental health screening and increase cultural responsiveness for use in PrEP care. We piloted the adapted SBIRT model (SBIRT PrEP) in a PrEP clinic in the U.S. South that serves primarily SGLBM. A total of 29 SGLBM participated in the pilot, which involved answering screening questions about anxiety, depression, alcohol, and drug use on an iPad. Participants met with a PrEP navigator to review screening results using a guided model that incorporated participant self-determination and motivational interviewing techniques. SGLBM and staff completed surveys and qualitative interviews that assessed their perceptions of the program. Study findings indicated that the adapted SBIRT PrEP model was acceptable and valued by clinic clients and staff. Survey and interview responses indicated that most clients believed that: 1) substance use and mental health screening was appropriate and important to include in PrEP services; 2) the program was an effective way to address mental health and substance use concerns; and 3) the duration of the screening process was acceptable. A majority of clients reported feeling comfortable answering behavior health screening questions on the iPad and discussing the results with the PrEP navigator. A larger, more rigorous trial is needed to further test the SBIRT PrEP model. Identifying methods to better address behavioral health concerns is critical to enhance PrEP participation and improve quality of life for individuals receiving PrEP.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying the Health Stigma and Discrimination Framework to psychosis stigma in Malawi.","authors":"Melissa A Stockton, Jack Kramer, Joshua Chienda, Abigail M Morrison, Harriet Akello Tikhiwa, Griffin Sansbury, Alex Zumazuma, Hillary Mortensen, Mwawi Ng'oma, Patrick Nyirongo, Isaac Mtonga, Jackson Devadas, Bonginkosi Chiliza, Anthony Peter Sefasi, Patani Mhango, Bradley N Gaynes, Brian W Pence, Kazione Kulisewa","doi":"10.1371/journal.pmen.0000306","DOIUrl":"10.1371/journal.pmen.0000306","url":null,"abstract":"<p><p>Psychotic disorders are highly stigmatized across the globe, negatively impacting people with psychosis and their families. However, little is known about stigma faced by people with psychosis in sub-Saharan Africa. We developed semi-structured qualitative guides based in a constructivist epistemology and formative research methodologies and conducted 36 in-depth interviews (IDIs) and two focus-group discussions (FGDs) with 12 people with lived experience (PWLE) with psychosis; 12 caregivers of PWLE; six traditional healers; six medical providers; six community leaders (1 FGD); and six religious leaders (1 FGD) in Blantyre, Malawi. We drew from the Health Stigma and Discrimination Framework to delineate the stigmatization process. Participants described key drivers of stigma as lack of awareness, prejudice, stereotypes, and fear. Manifestations included experienced, anticipated, witnessed, perceived, internalized and secondary stigma in the form of insults, gossip, abuse, physical violence, restraints, social exclusion, and employment-based discrimination from family and community. With respect to negative outcomes and health and social impacts, stigma impacted quality of care, resilience, mental health, morbidity, social inclusion and quality of life. In Malawi, stigma is pervasive challenge for PWLE, with severe implication for their health and social wellbeing. In partnership with PWLE, investment into the integration of evidence-based stigma reduction activities into existing psychosis management programs is warranted.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent extracurricular activities and perception of risk of harm from binge drinking.","authors":"Claire Szapary, Jenny Meyer, Claudia-Santi F Fernandes, Tyra Pendergrass Boomer, Lynn Fiellin, Kammarauche Aneni","doi":"10.1371/journal.pmen.0000278","DOIUrl":"10.1371/journal.pmen.0000278","url":null,"abstract":"<p><p>Underage binge drinking can lead to numerous adverse health consequences. Preventing excessive alcohol consumption by targeting perception of risk of harm is one approach with demonstrated success. This study examined the association between participation in extracurricular activities and perception of risk of harm from binge drinking among adolescents. A cross-sectional analysis of adolescents aged 12-17 years was performed using the 2019 National Survey on Drug Use and Health dataset. Participation in any extracurricular activity as well as four types of extracurricular activities (e.g., school-based, community-based, faith-based, and other) were the main independent variables. The primary outcome was perception of risk of harm from weekly binge drinking. Bivariate and multivariate logistic regression models were used to examine this association. Of the 11,870 adolescents included in the analysis, 4.2% reported that weekly binge drinking presented no harm. Compared to adolescents who did not participate in any extracurricular activity, adolescents who participated in one or more extracurricular activity, regardless of type, had 86% higher odds of reporting risk of harm from weekly binge drinking after adjusting for relevant covariates (aOR=1.86, 95% CI: 1.39, 2.49). This finding was similar across all levels of school-based, but different for community, faith-based and other types of activities. Compared to adolescents who did not participate in school-based, adolescent who participated in 1, 2, or 3+ school-based activities were more likely to report that weekly binge drinking was harmful (<i>School</i> AOR 1 activity = 1.75, 95% CI: 1.29, 2.37, AOR 2 activities = 1.83, 95% CI:1.32, 2.53, AOR 3+ activities = 1.91, 95% CI:1.35, 2.75), The association between participation in community-based activities and perception of risk of harm was significant at one or two activities but not at three or more activities (<i>Community</i> AOR 1 activity = 1.35, 95% CI: 1.02, 1.79, AOR 2 activities = 1.47, 95% CI:1.06, 2.02, AOR 3+ activities = 1.41, 95% CI: 0.98, 2.02) while the association between participation in faith-based activities and perception of risk of harm from weekly binge drinking was significant only at 3+ activities (<i>Faith</i> AOR 3+ activities = 2.07, 95% CI: 1.48, 2.88). No significant association was found for participation in other activities in the adjusted model. Our results suggest that participation in extracurricular activities may be a factor that contributes to increased perception of risk of harm from weekly binge drinking among adolescents, but this protective effect may vary by type and level of activity, suggesting different mechanistic pathways. Future studies are needed to further elucidate these findings to inform targeted preventive interventions and policy-level support.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral injury and mental health in healthcare workers are linked to organizational culture and modifiable workplace conditions: Results of a national, mixed-methods study conducted at Veterans Affairs (VA) medical centers during the COVID-19 pandemic.","authors":"Natalie Purcell, Daniel Bertenthal, Hajra Usman, Brandon J Griffin, Shira Maguen, Sarah McGrath, Joanne Spetz, Sylvia J Hysong, Haley Mehlman, Karen H Seal","doi":"10.1371/journal.pmen.0000085","DOIUrl":"10.1371/journal.pmen.0000085","url":null,"abstract":"<p><p>Using mixed methods, we examined drivers of risk for moral injury, mental health symptoms, and burnout among frontline healthcare workers in high-risk Veterans Affairs (VA) clinical settings during the COVID-19 pandemic. Across 21 VA medical centers, 2,004 healthcare workers completed an online survey assessing potential risk factors for moral injury, posttraumatic stress, depression, and burnout. Assessed risk factors included: pandemic exposures; individual worker characteristics; aspects of workplace/organizational culture; and facility performance on standardized measures of care quality, patient satisfaction, and employee satisfaction (extracted from VA administrative data). Among surveyed workers, 39% were at risk for moral injury, 41% for posttraumatic stress, 27% for depression, and 25% for persistent burnout. In generalized linear mixed models, significant predictors of moral injury risk included perceived lack of management support for worker health/safety, supervisor support, coworker support, and empowerment to make job-related decisions-all modifiable workplace factors. Pandemic-related risk factors for moral injury included prolonged short-staffing, denying patient-family visits, and high work-family conflict. Predictors of posttraumatic stress, depression, and burnout were similar. Forty-six surveyed workers completed a follow-up qualitative interview about experiences of moral distress in the workplace, and interview themes aligned closely with survey findings. Rapid qualitative analysis identified protective factors that may reduce moral injury risk, including a collaborative workplace community, engaged leadership, empowerment to make changes in the workplace, and opportunity to process distressing events. We conclude with recommendations to mitigate moral injury risk in healthcare organizations. These include involving workers in discussions of high-stakes decisions that will affect them, creating consistent and clear channels of communication between the frontlines and leaders of the organization, practicing leadership rounding to improve leaders' understanding of the daily work of frontline teams, and collaborating to understand how existing processes and policies may contribute to safety risks and moral conflict.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"1 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation of the 5-Question Stigma Indicators in trachoma-affected communities, Ethiopia.","authors":"Misrak Negash, Zerihun Tadesse, Fentie Ambaw, Michael Beka, Tilahun Belete, Melkamu Abte, Kebede Deribe, Julian Eaton, Eve Byrd, E Kelly Callahan, David Addiss, Wim H van Brakel, Abebaw Fekadu, David Macleod, Matthew Burton, Esmael Habtamu","doi":"10.1371/journal.pmen.0000191","DOIUrl":"10.1371/journal.pmen.0000191","url":null,"abstract":"<p><p>Stigma is common in people affected with Neglected Tropical Diseases (NTDs). However, no validated tools are available to assess and monitor stigma in trachoma-affected communities. We tested the cross-cultural equivalence of the 5-question stigma indicator-affected persons (5-QSI-AP) scale in persons with trachomatous trichiasis (TT), the blinding stage of trachoma, and the 5-question stigma indicator-community stigma (5-QSI-CS) scale in person without TT, in Amhara region, Ethiopia. Conceptual, item, semantic, and operational equivalence were assessed through exploratory qualitative methods; measurement equivalence was assessed quantitatively through internal consistency, construct validity, and reproducibility. A total of 390 people participated: 181 were persons with TT, 182 persons without TT, 19 mental health, trachoma, social science, and linguistics experts, and eight interviewers. Items included in both scales were adequately relevant and important to explore stigma in the target culture. Concern about others knowing that they have TT, shame, avoidance by others, and problems getting married or in their marriage were among the issues persons with TT faced in this study community. The 5-QSI-AP had a Cronbach's α of 0.57 for internal consistency and showed adequate discriminant validity where persons with central corneal opacity from TT had higher mean stigma scores than their counterparts. The 5-QSI-CS had a Cronbach's α of 0.70 for internal consistency and a correlation of r = 0.23 with the Social Distance Scale (SDS) for convergent validity. The test-retest reliability analysis between the initial and repeat measures produced an intraclass correlation coefficient of 0.60 and 0.53 for the 5-QSI-AP and 5-QSI-CS respectively, and no evidence of systematic bias in mean stigma scores. The 5-QSI scales have satisfactory cultural validity to assess and monitor stigma in this trachoma-affected Amharic-speaking study population. With further cross-cultural validation, these brief and easy to administer scales would offer the possibility to rapidly measure and monitor stigma associated with NTDs.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"1 6","pages":"e0000191"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Mental Illness Stigma by Disorder and Gender: Population-Based Vignette Randomized Experiment in Rural Uganda.","authors":"Yang Jae Lee, Ryan Christ, Rita Mbabazi, Jackson Dabagia, Alison Prendergast, Jason Wykoff, Samhitha Dasari, Dylan Safai, Shakira Nakaweesi, Swaib Rashid Aturinde, Michael Galvin, Dickens Akena, Scholastic Ashaba, Peter Waiswa, Robert Rosenheck, Alexander C Tsai","doi":"10.1371/journal.pmen.0000069","DOIUrl":"10.1371/journal.pmen.0000069","url":null,"abstract":"<p><p>Understanding and eliminating mental illness stigma is crucial for improving population mental health. In many settings, this stigma is gendered, from the perspectives of both the stigmatized and the stigmatizers. We aimed to find the differences in the level of stigma across different mental disorders while considering the gender of the study participants as well as the gender of the people depicted in the vignettes. This was a population-based, experimental vignette study conducted in Buyende District of Eastern Uganda in 2023. We created 8 vignettes describing both men and women with alcohol use disorder, major depressive disorder, generalized anxiety disorder, and schizophrenia consistent with DSM-5 criteria. Participants from 20 villages in rural Buyende District of Uganda (N=379) were first read a randomly selected vignette and administered a survey eliciting their attitudes (Personal Acceptance Scale [PAS] and Broad Acceptance Scale [BAS]) towards the person depicted in the vignette. We used analysis of variance (ANOVA) with Bonferroni-adjusted, empirical p-values to compare levels of acceptance across disorders and genders. Attitudes towards people with mental illness, as measured by the PAS, varied across different mental disorders (p=0.002). In pairwise mean comparisons, the greater acceptance of anxiety disorder vs. schizophrenia was statistically significant (Mean [SD] PAS: 2.91 [3.15] vs 1.62 [1.95], p=0.008). Secondary analyses examining differences in acceptance across gender combinations within mental disorders showed that PAS varied across gender combinations for depression (p=0.017), suggesting that acceptance is higher for women with depression than men with depression. In this population-based vignette study from rural Uganda, we found that people with schizophrenia were less accepted compared to people with anxiety disorders. We also found that there was greater acceptance of women with depression than men with depression. Anti-stigma initiatives may need to be targeted to specific disorders and genders.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating family life with Hypoplastic Left Heart Syndrome: A qualitative study.","authors":"Michael D Green, Alejandra Prevost-Reilly, Devin M Parker, Elizabeth Carpenter-Song","doi":"10.1371/journal.pmen.0000208","DOIUrl":"10.1371/journal.pmen.0000208","url":null,"abstract":"<p><p>Hypoplastic Left Heart Syndrome (HLHS) is a critical congenital heart abnormality that, prior to 1980, offered no treatment options beyond comfort care. Surgical advancements have since transformed the prognosis, yet the lived experience of affected families remains complex and multifaceted. This study aims to elucidate the psychosocial challenges accompanying the biomedical management of HLHS, exploring both family and provider perspectives to identify opportunities for more holistic care. We conducted semi-structured interviews with five families and two healthcare providers involved in HLHS management a New England health system. Interview transcripts were analyzed inductively to identify emergent themes, with a focus on the lived experience of families and the perceived role of providers in influencing this experience. Our study illuminates the extensive psychosocial challenges and emotional distress encountered by families dealing with HLHS, indicating a disparity between the advanced biomedical treatments available and the broader, more integrative care needs of patients. Despite healthcare professionals' technical proficiency, there exists a pivotal need for empathetic engagement and support that encompasses the full scope of the patient and family experience. Our findings advocate for an integrated care model that incorporates George Engel's biopsychosocial aspects of health, aligning with the emotional and psychological needs of families. The study underscores the importance of socially conscious care and suggests that enhancing empathetic communication and support in clinical practice can improve both patient outcomes and family well-being in the context of chronic and complex conditions like HLHS.</p>","PeriodicalId":520078,"journal":{"name":"PLOS mental health","volume":"1 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}