Thesis advisor: Judith Shindul-Rothschild PhD, MSN, RN / The issue of mental health awareness has been a familiar topic of concern in recent years, due to increasing incidence of suicide, PTSD, anxiety disorders, and other behavioral illnesses. Patient populations impacted by mental illness are diverse and research has focused on the recognition of symptoms and the treatment. Less research has investigated the barriers that hinder access to mental health services and the early identification of individuals who need mental health assistance. The specific aim of this study is to evaluate how the stigma of mental illness, both perceived and personal, may affect the willingness of college students to obtain behavioral health care. Based upon the findings, recommendations for improving access to mental health services on a college campus will be proposed. / Thesis (BS) — Boston College, 2017. / Discipline: Nursing.

On average 322 million people worldwide are affected by depression. It is one of the leading causes of death in the United States and is often paired with anxiety. Although there are several ways to treat both depression and anxiety, the most popular way is through the use of anti-depressant medication. Typical alternative methods are talk therapy and acupuncture, which brings me to my question: Are anti-depressants truly the most effective way to treat depression or are they ultimately the most cost effective for patients suffering from the mental illness because they are the type of treatment most covered by insurance companies?

Non-compliance to treatment remains one of the greatest challenges in mental health care services, and knowledge about how to improve this is still a problem. The aim of this study is to critically synthesize the best available evidence regarding interventions to promote psychiatric patients’ compliance to mental health treatment. This study aims to provide the clinical practitioner with accessible information on interventions to promote psychiatric patients’ compliance to mental health treatment. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What is the current evidence on interventions to promote psychiatric patients’ compliance to mental health treatment? Selected electronic databases that were accessible were thoroughly searched: SA-Nexus (NRF), ProQuest, EBSCOhost Platform, ScienceDirect, Web of Knowledge, Cochrane Library, Sabinet and Google Advanced Scholar were searched for primary studies that were published from 2001 to 2011. Primary studies in any language with an abstract in English were included in the search results. The following key words were used in the search: intervention, mental health treatment, psychiatric treatment, compliance, adherence, psychiatric patients, mental health care user and combinations thereof. Pre-determined inclusion and exclusion criteria were applied during the selection of studies. Sixteen studies (n = 16) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP), the (JHNEBP) John Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool and the American Dietetic Association’s (ADA) Evidence Analysis manual. Finally only fourteen studies (n = 14) were identified as evidence that answers the literature review question appropriately. Evidence extraction, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in ADA’s manual (ADA, 2008:62). The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, education and research. Study findings indicated several interventions that can improve patients’ compliance in mental health treatment. Adherence therapy and motivational interviewing techniques during in-hospital stay improved the compliance of psychiatric patients. The use of Meds-help Pharmacy-based Intervention and Treatment Adherence Therapy Program for all Healthcare Professionals improved compliance to treatment for severely mentally ill. A Treatment Initiation and Participation Program and the use of Management Flow Sheet Interventions for Depressed Patients in Out-Patient Settings improved overall compliance of depressed patients in out-patient settings. Community mental health nurses trained in Medication Management improved psychiatric patients’ compliance to treatment at the community health care centres. Antipsychotic medication combined with therapeutic antipsychotic psycho-social interventions improved compliance of treatment for early-staged schizophrenia patients in out-patient settings. The use of Risperidone injections during the provision of home care and the long-acting injectable antipsychotic and atypical antipsychotic treatment used for schizophrenic patients served to improve compliance of mental health treatment in out-patient settings for schizophrenic patients. It is thus recommended that nurses should be exposed to clinical training regarding treatment compliance interventions of mental health care users during formal nursing education to enhance the mental health care practice and stimulate more innovative research on treatment compliance on the clinical field. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012

Class of 2007 Abstract / Objectives: This 12-month retrospective, naturalistic study determined medication adherence, psychiatric hospitalizations, cost of services, cost of prescriptions, and rates of polypharmacy (less than 4 versus greater than or equal to 4 concomitant psychotropic medications) for patients receiving clozapine versus quetiapine therapy for the treatment of schizophrenia in an outpatient mental health facility. Methods: The clozapine and quetiapine groups were compared for gender, age, medication adherence rates, hospitalizations, cost of care, polypharmacy, and types of concomitant psychotropic medications over 12-months. The polypharmacy groups for clozapine and quetiapine (e.g., greater than or equal to 4 psychotropic medications versus less than 4 psychotropic medications) were compared for medication adherence. Results: A total of 71 patients met the entry criteria (44 = clozapine and 27 = quetiapine). The two groups were similar for age, gender, court order, average daily dose, and hospitalization rates. The clozapine group had a higher medication adherence rate of 0.901 (e.g., 329 days supply) compared to the quetiapine group’s adherence rate of 0.723 (e.g., 264 days supply) (p=0.007). The clozapine group had higher costs for medication, labs, and other services compared to the quetiapine group, as well as total costs of services (p=0.004). The clozapine group was on fewer concomitant psychotropic medications compared to the quetiapine group based on the rates of polypharmacy. Conclusions: Patient on clozapine therapy had improved medication adherence and lower rates of polypharmacy, but higher costs of care compared to quetiapine. The frequent monitoring required with clozapine may result in medication adherence that results in improved efficacy, less polypharmacy, and lower hospitalization rates. Further studies in larger populations are needed to compare different frequency rates of monitoring patients on outcome measures over a longer period of treatment.

The current prevailing approach to managing offenders in the community involves community supervision professionals such as probation and parole officers partnering with other community professionals, such as psychologists, social workers, and other mental health providers to address offenders’ needs. Each type of professional draws from a unique field with goals, values, and theoretical orientations, which do not necessarily overlap. These relationships are rarely studied, and previous examinations are limited. The current study aims to address this deficit in the empirical literature. Drawing on data obtained from qualitative interviews, four aims were examined. First, using thematic analysis, interview data are analyzed open-endedly to identify major themes. Second, these partnerships are examined against the interprofessional competencies in the healthcare system. Third, the perceived impact of partnerships on offenders’ success in the community is discussed. Finally, differences in themes within community supervision professionals and mental health providers were quantitatively examined by comparing groups using a variety of demographic variables. Major themes identified by mental health providers include the appreciation for and challenges to collaboration, individual characteristics and roles, characteristics of collaboration, elements of interprofessional relationship, and the involvement of the courts. Community supervision professionals discussed issues pertaining to collaboration and services coordination, professional roles, when conflict occurs, and their lack of basic knowledge about other professionals. Themes identified in the initial thematic analysis resembled healthcare values and ethics competencies and roles and responsibilities competences; healthcare competencies regarding interprofessional communication and teamwork showed partial congruence with the current data’s themes. Perceived impact on offender outcomes was most evident in how collaboration helps each professional complement the others’ work. Few significant quantitative patterns within groups were evident. Overall, treatment providers and supervision professionals value interprofessional collaboration. Their priorities differ, which provides better opportunities to address clients’ needs but also creates the potential for conflict. Benefits to re-entry outcomes are the result of treatment providers addressing the needs of clients and supervision professionals addressing the motivation of clients. This research highlights the strengths of this type of interprofessional collaboration, and offers suggestions for improving the efficacy of collaborations.

Former United States military members have consistently faced mental health concerns post discharge from the military. Some researchers have argued that the use of mental health services by veterans does not parallel the prevalence and need of such services (Hoge, Castro, Messer, McGurk, Cotting, & Koffman, 2004; Milliken, Auchterlonie, & Hoge, 2007; Vogt, 2011). Reasons why veterans do not access mental health care are varied and broad, however, they tend to be consistent with explanations rooted in the stigma of mental health care, and in the barriers that prevent the use of mental health care. The degree of the impact of factors contributing to stigma and barriers to mental health care is not fully understood. Particularly lacking from previous research is an examination of how the education received while in the military about mental health symptoms and treatment impacts the likelihood that a service member will access care. In the current study, I used theories of stigma and barriers to care outlined by Overton and Medina (2008) to examine the relationships among demographic characteristics, self-reported diagnoses of common mental health disorders that veterans experience, and likelihood of accessing mental health care based on the education received while in the military with self-reported levels of stigma and barriers to care in a sample of 355 former military service members from several branches. Multiple regression analyses were used to examine the relationships among these variables. Results revealed statistically significant relationships among gender, age, self-reported diagnosis of depression, the impact of education, and stigma. Results also revealed statistically significant relationships among employment and barriers to care. In addition, stigma was found to have significant relationships with the positive impact of education, and the likelihood of accessing care. Lastly, results revealed that when in the presence of the mediation variable impact of education, stigma was no longer associated with the likelihood veterans would access care post discharge.

The purpose of this research study is to explore the role of culture in how Mexican Americans respond to mental health treatment. Cultural background is likely to affect not only the meaning attributed to mental illness, but also help-seeking and responses to treatment. Creating a match between treatment modalities and people's cultural backgrounds requires consideration of a person's cultural context. Cultural characteristics can vary not only across cultural groups, but even within groups can change across time. This study used a quasi-experimental pretest/posttest comparison group design to analyze culturally adapted cognitive behavioral therapy (CACBT) with Mexican Americans diagnosed with depression. A purposive nonprobability sample of 81 adult Mexican Americans diagnosed with depression was recruited from a mental health agency in El Paso, Texas. Forty-eight participants were assigned to a treatment group, which received CACBT, and 33 to a comparison group, which received treatment as usual. Depression was measured using the Patient Health Questionnaire (PHQ-9). Participant acculturation level was measured using the Acculturation Rating Scale for Mexican Americans-II. Independent and paired t tests were used to examine the effectiveness of the culturally adapted intervention. OLS regression analyses examined whether acculturation mediated the relationship between the culturally adapted intervention and depression. No direct effect was found between CACBT and depression relative to treatment as usual. The results showed that CACBT and treatment as usual both decreased depression scores. However, the interaction effect between acculturation and group assignment was significantly related to posttest depression scores. Thus, the effect of CACBT varied according to acculturation level. This study demonstrates the role that acculturation plays in how Mexican Americans respond to mental health treatment. An implication for social work practice is the need to use evidence-based practices that have been tested for their cultural appropriateness with Mexican Americans. / text

Child trauma exposure (CTE) is an important public health concern in the U.S.; more than two-thirds of children report experiencing a traumatic event by the age of 16. CTE may have important acute and long-term physiological, developmental, behavioral, and psychological implications if not addressed. Trauma-focused cognitive behavioral therapy (TF-CBT) is the gold standard for treatment of child trauma and is well-supported for resulting in significant decreases in negative mental health outcomes associated with CTE. Despite the efficacy of evidence-based interventions such as TF-CBT, many children do not receive treatment due to a variety of contextual, logistical, and interpersonal barriers. This mixed-methods exploratory study examines possible predictors of enrollment and completion of TF-CBT, specifically parental trauma exposure, at a community organization that serves abused and traumatized children in the metro Atlanta area. Data were collected during individual assessments consisting of a computer survey and semi-structured interview (n=41). Data analysis focused on parental trauma exposure, and qualitative interviews were examined for common themes regarding intentions for their child’s enrollment and completion of services. Results indicated that caregivers of children referred to services had relatively high (56.1%) rates of trauma exposure. Results from logistical regression indicate that parents with a trauma history were 10.5 times more likely to have a child enroll in therapy. These results indicate that parents with personal trauma histories may be more committed to their child receiving services, therefore public health efforts aimed towards educating parents without trauma histories may be beneficial.

Non-compliance to treatment remains one of the greatest challenges in mental health care services, and knowledge about how to improve this is still a problem. The aim of this study is to critically synthesize the best available evidence regarding interventions to promote psychiatric patients’ compliance to mental health treatment. This study aims to provide the clinical practitioner with accessible information on interventions to promote psychiatric patients’ compliance to mental health treatment. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What is the current evidence on interventions to promote psychiatric patients’ compliance to mental health treatment? Selected electronic databases that were accessible were thoroughly searched: SA-Nexus (NRF), ProQuest, EBSCOhost Platform, ScienceDirect, Web of Knowledge, Cochrane Library, Sabinet and Google Advanced Scholar were searched for primary studies that were published from 2001 to 2011. Primary studies in any language with an abstract in English were included in the search results. The following key words were used in the search: intervention, mental health treatment, psychiatric treatment, compliance, adherence, psychiatric patients, mental health care user and combinations thereof. Pre-determined inclusion and exclusion criteria were applied during the selection of studies. Sixteen studies (n = 16) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP), the (JHNEBP) John Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Tool and the American Dietetic Association’s (ADA) Evidence Analysis manual. Finally only fourteen studies (n = 14) were identified as evidence that answers the literature review question appropriately. Evidence extraction, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in ADA’s manual (ADA, 2008:62). The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, education and research. Study findings indicated several interventions that can improve patients’ compliance in mental health treatment. Adherence therapy and motivational interviewing techniques during in-hospital stay improved the compliance of psychiatric patients. The use of Meds-help Pharmacy-based Intervention and Treatment Adherence Therapy Program for all Healthcare Professionals improved compliance to treatment for severely mentally ill. A Treatment Initiation and Participation Program and the use of Management Flow Sheet Interventions for Depressed Patients in Out-Patient Settings improved overall compliance of depressed patients in out-patient settings. Community mental health nurses trained in Medication Management improved psychiatric patients’ compliance to treatment at the community health care centres. Antipsychotic medication combined with therapeutic antipsychotic psycho-social interventions improved compliance of treatment for early-staged schizophrenia patients in out-patient settings. The use of Risperidone injections during the provision of home care and the long-acting injectable antipsychotic and atypical antipsychotic treatment used for schizophrenic patients served to improve compliance of mental health treatment in out-patient settings for schizophrenic patients. It is thus recommended that nurses should be exposed to clinical training regarding treatment compliance interventions of mental health care users during formal nursing education to enhance the mental health care practice and stimulate more innovative research on treatment compliance on the clinical field. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012

In recent years psychologists have increased awareness and concern regarding the quality of mental health services provided to people of color. For several reasons clients of color often find traditional mental health services foreign or unhelpful. To help diminish obstacles faced by clients of color, several authors have advocated traditional mental health treatments be modified to better match clients' cultural contexts. Researchers have also begun investigating outcomes associated with culturally modified mental health treatments, often contrasting them with traditional mental health services. Recently numerous studies containing empirical data have been published. To date there has been no attempt to review this rapidly growing body of literature. Due to the sheer number of studies analyzing the efficacy of culturally modified treatment, the literature has become large and unwieldy. The present study used meta-analytic methodology to gather and organize quantitative data obtained from such studies. Across 80 studies that met criteria to be included in this meta-analysis, the resulting random effects weighted average effect size was d = .44, indicating a moderately strong benefit of culturally adapted treatments relative to traditional treatments. To further examine whether the association of treatment outcome and culturally modified treatments varied as a function of various sociodemographic variables, a series of categorical (and where appropriate, continuous) moderator analyses were conducted. Moderation effects were ascertained only for participant age and for Hispanic populations, with studies consisting of participants of higher chronological age and higher percentages of Hispanic participants having effect sizes of greater magnitude than studies with participants of younger ages or with few Hispanic participants. These results may indirectly provide evidence for the importance of client acculturation, given that older populations tend to be less acculturated (and therefore more in need of cultural modifications) than younger populations and that Hispanic populations are more likely to speak Spanish, necessitating adaptation of therapy to be conducted in their native language. Other variables, such as participant gender, did not moderate the results. Overall, the findings provide evidence for the benefit of modifying psychotherapy to match the cultural context of the client. Recommendations for future research on the topic are provided.