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People living with a mental health issue is elevated both nationally and internationally, and the likelihood of a person interacting with someone who has a mental health issue is high. It is even higher for those who work in the health care profession, so understanding their attitudes on this matter is important. As a review of current literature reveals, there is not only stigma in the health care system, but there is also stigma among health care professionals and students. One of the groups of students that has not been researched to a great extent is nursing students and the degree of stigma they have for caring for those with mental health issues. A cross-sectional survey was conducted to assess the degree of stigma among these individuals. A voluntary online survey was done was administered to undergraduate nursing students at a university in the southeastern part of the United States using the twenty item Opening Minds Scale for Health Care Providers (OMS-HC). The results indicated that mental illness stigma did exist within the student nurse community with no association between gender, classification, and mental health nursing course completion and total score on the OMS-HC scale.

A definitive association between adverse childhood experiences (ACEs) and negative physical and mental health outcomes has been established. There is evidence that individuals in forensic psychiatric facilities are disproportionately exposed to ACEs, which may impact severity, prognosis, and age of onset of psychiatric symptoms, including behavioral concerns of institutional aggression, self-harm behaviors, and suicide attempts. Such psychiatric and behavioral concerns are often managed through multiple psychotropic prescriptions, leading to psychotropic polypharmacy. This study evaluated the relationship between ACEs, mental health and behavioral concerns, and psychotropic polypharmacy through analysis of archival data from a forensic inpatient psychiatric facility. A total of 182 patients met inclusion criteria. Through a comprehensive record review, ACE scores, mental health outcomes, behavioral concerns, and prescription practices were ascertained and subjected to a series of regression analyses. Results indicate that the current participants experience greater prevalence of ACEs and mental health outcomes, as well as higher rates of psychotropic polypharmacy. These relationships are mediated by history of self-harm behaviors. The higher polypharmacy rates yield greater negative side effects with the need to manage with additional medications. Taken as a whole, ACEs are a relevant consideration, as childhood adversity may lead to a lifetime of difficulty with managing emotional distress and symptoms of psychopathology. Pharmacological treatment may be necessary, particularly with those who experience more complex mental health outcomes. However, a primary focus on psychotropic intervention can result in high rates of medications and polypharmacy with significant side effects. Incorporation of non-pharmacological intervention should be a primary consideration with forensic inpatients to circumvent the potential for psychotropic polypharmacy and related negative consequences.

Although adolescents experience psychological difficulty at a rate higher than any other age group, most do not get the support they need. The purpose of this study was to explore perceptions about barriers, facilitating factors, and help-seeking preferences for psychological support among adolescents. This study involved Best, Gil-Rodriguez, Manktelow, and Taylor’s conceptual framework pathways to online help-seeking to help explain adolescents’ perceptions of factors that influence them seeking support as well as identify pathways for support. A qualitative meta-synthesis design was used to synthesize findings of individual qualitative studies into themes around the central phenomenon of adolescent help-seeking. Data were collected by conducting an exhaustive literature review that initially identified 634 potential records, 16 of which met the specific inclusion criteria. The findings of this study indicate that adolescents identify 2 distinct pathways for support: formal and informal sources. Adolescents in the studies identified preferred informal sources of support as family (most often mothers), and school personnel (most often teachers), and most did not see formal sources as a viable option. Trust emerged as a primary factor in who, if anyone, adolescents chose to seek emotional support from. Other indicators of help-seeking included self-reliance, mental health literacy, stigma, and helper characteristics. Social change implications of this study include encouraging opportunities for schools to promote help-seeking by increasing mental health literacy for both students and staff and collaborating with families and professionals to promote transition to formal services.

Data indicated that although African Americans reported fewer occurrences of traumatic events than that of their racial/ethnic counterparts, however, the degree of traumatic events experienced by African Americans tends to be more serious and violent in nature. More so, lower recovery outcomes associated with PTSD among African Americans have been attributed to varying factors, such as financial restrictions, strained health care access, ineffective coping strategies as well as a mistrust of medical and clinical approaches, thus leading African Americans to seek faith-based approaches. This phenomenological study investigated clergy perspectives on religious coping constructs relative to the management of PTSD symptoms. The theory of religious coping was the theoretical framework: Based on Pargament’s assertion that an individual’s spirituality and religious disposition should be considered within the context of biopsychosocial analysis of mental health assessment in order to treat the whole person. Eight clergy members ordained within the African Methodist Episcopal Church denomination were interviewed in order to gain their perspectives relative to if and/or how religious coping constructs were exhibited during the management of PTSD symptoms. This investigation identified 10 themes associated with 4 constructs of religious coping: relevant training, establishment of a new normal, the relevancy of religion and the Black Church, purpose-centered trauma, divine personal encounters, active divine presence, divine reliance, the use of rituals, safe environment, and forgiveness of self, others and God. The results of this investigation reaffirmed that the inclusion of religious coping is a viable component of a holistic approach to addressing mental health adversities alongside medical and clinical approaches.

Clinician attitudes toward a client have a significant influence on outcomes for that client's treatment. Exploring the attitudes of clinicians toward sex offenders can provide additional insights into methods to improve treatments for this population. The purpose of this qualitative grounded theory study was to examine the attitudes of clinical professionals who work with sex offenders to identify the specific ways that these attitudes influenced professional behaviors and client interactions. Grounded theory was used to move beyond a general description of the issue to formulate a theory regarding clinician work with sex offenders and its implications. The sample comprised 10 clinical professionals who worked with sex offenders in community mental health agencies. Open coding and axial coding were used to generate themes from in-depth semistructured interviews to collect data from clinicians who treated sex offenders. Findings indicated that the professionals were mostly concerned for the behavior of sex offenders, were willing to work with them despite feelings of anger and disgust and were curious about the possibility of treatment. Participants treated sex offenders like any other clients but emphasized the importance of safety during treatment. Participants balanced their obligations to the profession and the client with negative images and views of sex offenders. These professionals struggled when providing treatment to sex offenders but described strategies for coping or overcoming negative feelings, emotions, and biases. Clinicians can use these findings to deliver better planned care to this population, resulting in better therapeutic outcomes for sex offenders.

Healthcare resources are especially limited in rural regions of the US. The lack of Primary Care Providers (PCPs) and mental/behavioral health services is problematic, as there are high rates of behavioral and medical concerns within rural populations. Special populations, such as rural persons with Serious Mental Illness (SMI), are medically complex and represent a vulnerable and underserved population. Healthcare outcomes for persons with SMI are poor compared to the general population and commonly lead to premature death. Various barriers prevent this population from accessing optimal healthcare, especially in rural areas, due to negative perceptions/stigma, a lack of understanding from PCPs, and a shortage of resources in general. The current study aimed to determine the extent of mental health training that rural PCPs receive regarding patients with SMI, as well as to evaluate their perceptions, knowledge, and experiences with these patients and understand providers’ perceptions regarding rates of patients with SMI who present to primary care clinics in rural settings. The current study used a sample of rural primary care providers (N = 90) , surveyed via USPS mail. Results indicated significant differences in reported mental health training among providers from different disciplines. Greater reported mental health training significantly predicted lower levels of stigma, more correctly identified medical conditions comorbid with SMI, and greater reported comfort and confidence in treating patients with SMI. Providers reported differences in the number of patients with and without SMI seen in rural clinics. Implications for these findings are discussed.

Abstract Introduction and Background Many people in the pediatric population are be brushed off and misdiagnosed when it comes to depression. I decided to research into pediatric depression and how the effects of their peers, parents, and exposure to violence correspond with depression and how it effects their daily life. Purpose Statement The purpose of this literature review is to systematically and critically appraise current literature to examine the associations between pediatric depression and sleep issues, exposure to violence, peer relationships, and parental criticism. Literature Review For this literature review I gathered a total of 5 articles which are included in this review. All the 5 articles are academic journals. These articles all come from CINAHL complete from the ETSU library database. Findings When the pediatric population is exposed to emotional abuse, emotional neglect, physical abuse, physical neglect, peer victimization and peer fighting, they were reported to have significantly greater depressive symptoms and hopelessness than the pediatric population who did not experience as much violence and neglect (Benton et al. 2020). Children who had preschool-onset major depressive disorder, after receiving parent-child interactive therapy with a focus on emotional development were found to experience a significant reduction in insomnia, daytime fatigue, and total sleeping problems (Hoyniak et al., 2020). There was also a strong correlation that the more parental criticism an adolescence receives, the higher the risk for major depression there is (Nelemans et al., 2020). The CLPM model indicated that depressive symptoms increased the risk for subsequent peer rejection consistently and peer acceptance mainly before eighth grade (Yang et al., 2020). And in the patients who came to the ER with non-psychiatric complaints, after screening for depression many of their results indicated a moderately-severe depression score which presents a need for additional help from a mental health care provider (Arrojo and Hooshmand, 2021). Conclusions Overall, there is a strong correlation between pediatric depression and sleep issues, exposure to violence, peer relationships, and parental criticism. The studies proved that the more parental criticism a child received, the more depressive symptoms they faced, as well as the more sleeping issues they experienced. The data also proved that in adolescence the influence of peers is strong and peer relationships have heavy influence on the depressive symptoms shown by adolescence. When children are exposed to a ‘web of violence’ they are also more inclined to experience depression and many children try to internalize their mental health issues to please their parents. There needs to be more general education about pediatric depression and more implementations of mandatory screenings added to the EHR. For many of these studies, if they were to be performed again, they would benefit from more diversity as well as larger sample sizes. This would provide a more generalizable set of data that could be applied in more places.

A Quality Improvement project to initiate the Confusion Assessment Method (CAM) delirium screening tool at a Skilled Nursing Facility and Rehabilitation Center in East Tennessee -- by S. Joseph Jadav, Doctor of Nursing Practice Candidate at East Tennessee State University. Purpose/Aims: The aim of this project is to implement a delirium screening protocol in a skilled nursing and rehabilitation facility which will aid in early detection of signs and symptoms of delirium in older adults. This early detection followed by an early intervention can help reduce costs and decrease mortality rates with better outcomes. Processes: A CAM screening is conducted on each patient (male & female) for delirium for a period of four weeks. Data collection will comprise of the number of patients assessed and the total number of positive and negative delirium cases. It was determined that the proposed activity is not research involving human subjects according to United States Department of Health and Human Services (DHHS) regulations by the university’s Institutional Review Board (IRB). Results: The project is currently in the data collection phase. Limitations: Refusal to participate either by the patient or family in the screening. Conclusions: While nearly 80% of delirium cases in an acute care setting go undetected or undiagnosed, this project to implement a delirium screening protocol in a skilled nursing facility is even more imperative in early detection and early intervention.