Postpartum depression affects some 10% to 20% of mothers. Its impact on the health and well-being of mothers and their infants is well documented. If not identified and addressed early, it can result in emotional burden, costly hospitalization and treatment, and, at worst, suicide and or infanticide. Empowerment theory was the conceptual framework for this hermeneutic phenomenological study. The purpose was to understand the lived experiences of the screening and treatment processes of 10 women from New York City experiencing postpartum depression and their perceived adequacy of the treatment received. In-depth interviews were used to investigate participants' lived experiences of the screening and treatment processes for their postpartum depression and to explore the extent to which they percieved that their emotional needs were met. From the responses to the interview questions, 6 themes emerged: crying and stress during and after pregnancy, inadequate assessment, feeling bad or unlike oneself, lack of understanding, needing to cope, and prayer was essential for recovery. Participants had tearfulness that began during pregnancy and intensified during the postpartum period, were ineffectively assessed, exhibited bizarre behaviors that could not be explained, had little understanding of what they were experiencing, and were sometimes misunderstood by others. Further, participants at times sought treatment on their own in order to cope. Some reported that prayer was central to the restoration of their mental health. Insights gained through this study can be utilized to foster positive social change by heightening awareness and assisting health care providers in planning appropriate screening and treatment to meet the individual needs of women with postpartum depression.

Lesbian, gay, and bisexual (LGB) individuals are often exposed to stressors based on their nonheterosexual status; they may have unique needs related to help-seeking for mental health in a rural area where more people identify as religious or as politically conservative. To date, there have been no studies on the mental health help-seeking experiences of LGB individuals in rural Northern Michigan. This qualitative, single case study was completed to explore the help-seeking experiences of 10 LGB individuals who were recruited through criterion and snowball sampling. In-depth, semi structured interviews were conducted. Transcribed interview data were entered into Nvivo software for coding and then examined through two perspectives: Meyer's minority stress theory and Bronfenbrenner's ecological systems theory. Thematic analysis identified three themes: (a) reasons for seeking treatment, which included experiences of distal stressors and proximal stress reactions, (b) experiences with the help-seeking process, and (c) suggestions for improving the help-seeking process. Findings of the study were that distal stressors increased feelings of isolation and 'otherness' When individuals sought help, they encountered barriers related to lack of resource options, lack of acceptance or feelings of passivity. This created a sense of distrust with providers, thus affecting future help-seeking. The results of this study draw attention to LGB population in rural Northern Michigan, who may be inadequately treated based on little community acceptance, few provider options, and negative provider reactions. The knowledge generated from this study could lead to improved services and reduce the aforementioned disparities for this population.

As of 2014, an estimated 18.1% or approximately 43.6 million adults, 18 years of age or older in the United States experienced a form of mental illness. Professional counselors subscribe to a wellness or holistic paradigm; however the recovery paradigm, using collaborative strategies and unique treatment planning is the directed approach of mental health services in the United Stated. The purpose of this quantitative study was to understand what factors contribute to counselors' knowledge and attitudes of the recovery paradigm. Survey methodology was used to examine whether, among professional counselors, years of experience, gender, professional setting, and licensure status, as measured by a demographic questionnaire, correlate to professional counselors' (a) attitudes and level of knowledge of the recovery paradigm, (b) knowledge and attitudes of the roles and responsibilities in recovery, (c) understanding and attitudes toward the personal journey of the recovery process, (d) knowledge and attitudes of the roles of self-identity and peer support in recovery, and (e) knowledge and attitudes of the expectations regarding recovery as measured by the 4 subscales of the Recovery Knowledge Inventory (RKI). The target population was 225 masters or doctoral level counselors. The results of a multivariate multiple regression were not significant. However, the results of this study align with previous research outcomes indicating a need for counselors continued education and training on the recovery paradigm which could improve their knowledge and attitudes of the recovery paradigm, directly impacting consumers' achievement of recovery goals.

Homelessness has been a problem in New York City (NYC) for decades. Part of the problem is children who grew up in the shelter system and then returned as adults, a phenomenon known as 2nd-generation homelessness. Literature indicates that no researchers have interviewed second-generation homeless adults about their experiences. The purpose of this study was to explore the experience of 2nd-generation homelessness from the perspective of homeless adults returning to the shelter system. The sample included 1 second-generation homeless adult and 10 case managers at Tier II homeless shelters. Interviews were conducted and data were analyzed using hand coding to uncover themes amongst the interviews. The themes found were: lack of information and resources, generational homelessness is passed down, people should learn from their parents' mistakes, comfort in the homeless shelter system, money, parental abuse and neglect, the role of the case manager, taking advantage of the shelter system, and mental health. The other topics that were discussed on multiple occasions but did not fit into larger categories are: education, drugs and alcohol, lack of family assistance, and activities of daily living. Findings from this study inform social change by indicating a clear need for input from homeless families and case managers when developing interventions to address second-generation homelessness. Future policymakers should include staff and clients when developing ways to address homelessness in New York City. The views and opinions expressed in this manuscript reflect the personal views of the researcher and interviewees; they do not represent the views of NYC Department of Homeless Services or its providers.

Individuals who suffer from depression can be stigmatized by labeling and resort to negative stigma coping orientations such as secrecy and withdrawal, resulting in internalized self-stigma. Self-stigma can have negative effects such as low self-esteem, low self-efficacy, isolation, and feeling like a failure. Guided by modified labeling theory, the purpose of this study was to fill a gap in the literature on predictors of two orientations (challenging and deflecting) of positive stigma coping. Challenging stigma involves taking action, and deflecting is a cognitive strategy; both are used to positively cope with the stigma of mental illness. Predictors included symptom severity, depression literacy, stereotype awareness, treatment seeking, social support, and stigma sentiments in a sample of undergraduates (N = 195). Results from a canonical correlation found that individuals with high scores on deflecting and, simultaneously, low scores on challenging tended to have high scores on stigma sentiments and low scores on both symptom severity and treatment seeking. Analyzed in independent regressions, challenging was significantly predicted only by symptom severity (+), while deflecting was predicted by symptom severity (-), depression literacy (+), and stigma sentiments (+). These findings reinforce the potential for individuals who suffer from depression to address stigma using healthier and more affirming coping orientations. Implications for positive social change include a decrease in self-stigma regarding depression, less negative stigma coping, an increased awareness of how depression stigma affects individuals who suffer from the disorder, and a decrease in the social stigma of depression. Educators and practitioners can apply this information in academia, counseling, and clinical practice.

Individuals who receive residential mental health services rely on caregivers for support, supervision, and a safe living environment. Residential clients exposed to workplace conflict among staff may feel insecure and mistrust their caregivers, which in turn could negatively impact quality of life and treatment outcomes. The theory of therapeutic alliance proposed by Zetzel, emphasizing the client's perception of the therapist as a nurturing beneveolent figure, was used as the conceptual framework for this phenomenological study. Semi-structured interviews were conducted with 6 adults, recruited with homogenious sampling, who had experienced conflict among staff members and who had been discharged from residential mental health services within the last two years. Participants were asked about treatment satisfaction and perceptions of their safety while in treatment. Open-coding, categorizing, and interpretation were used to create theoretical categories for interpretation and analysis. The themes that emerged in situations involving staff conflict included reporting of increased mental health symptoms, feeling ignored by staff, feeling fear, perceiving their basic needs as unmet, and noticing staff splitting. The social change implications of this study include findings can be used to benefit the clients of these facilities and also staff through education about how relationships among staff members impact treatment; these findings may result in improved treatment outcomes that would benefit not only the clients and their families, but also the staff and facility through improved treatment outcomes and satisfaction. In turn, improved mental health outcomes benefit society in general through reduced financial costs and increased productivity.

Prior research has shown a correlation between public stigma and emergency responders' perceptions of mental health patients while providing care. However, research examining public stigma and emergency responders' perceptions of mental health patients is limited in rural areas. The purpose of this study was to explore possible relationships between the dependent variable, public stigma, and the independent variables: social distance, blameworthiness, and fear of unpredictable behavior. Link's modified labeling theory was the theoretical framework for this study. A sample of 92 emergency responders obtained from Facebook completed a questionnaire that consisted of three Likert scales. A multiple regression showed little correlation between public stigma and social distance, blameworthiness, and fear of unpredictable behavior. Only .077 of the variance in public stigma was explained by the combination of independent variables. This study has demonstrated a possible shift in societal attitudes toward mental illness. It is important to determine the cause of this change in results so that continued education regarding mental health awareness may positively affect social change.

American youth are facing a mental health crisis. Rates of depression and suicide continue to rise among all children ages 12-17. While there is considerable research on the mental health of underserved children, much less is known about the mental health status of youth from affluent communities. The purpose of this study was to evaluate the effectiveness of community health assessment (CHA)-driven mental health interventions on the youth of affluent communities. Using a pre and post evaluation model, this study compared the frequencies of self-reported depression and suicide ideation for students in Grades 8, 10, and 12, and geographic location of the youth of affluent communities before and after implementing CHA-driven interventions. The diffusion of innovation theory guided this study and a quantitative quasiexperimental research design was used. The Utah Student Health and Risk Prevention survey provided 2,973 responses from students attending public high school during the 2011, 2013, 2015, and 2017 school years. Acting as the control, survey responses for depression and suicide ideation from 2011, prior to CHA-driven interventions, were compared to postCHA intervention efforts in 2013, 2015, and 2017. Statistical analyses indicated that the change in self-reported frequencies of depression and suicide ideation were not statistically significant for grade level or geographic location before and after CHA-driven mental health interventions. The results of this study might help local public health agencies working in affluent communities understand how the mental health status, especially among the youth demographic, might shape the future of public health and the role of public health practitioners in promoting social change.

Many combat veterans face difficulties coping with their personal lives, relationships, and families when they leave the service and return to civilian life. Most studies examining the effects of combat on veterans focus on posttraumatic stress disorder (PTSD) as well as a collection of related consequences. Interest in the term moral injury of military veterans as a related mental health construct has grown. Researchers have investigated the effects of spiritual wellness of combat veterans. However, there is a paucity of counseling literature on the relationship between spiritual wellness and moral injury when combat veterans return to civilian life. Investigating the relationship between spiritual wellness and moral injury as based in existential theory could offer insights to improve quality of life of veterans, families, and society. This study examined the connection between spiritual wellness and moral injury among combat veterans using a quantitative survey with a cross-sectional, correlational analysis and incorporating demographic variables. Results showed that the relationship of spiritual wellness on moral injury is statistically significant. Participants with low spiritual well-being were likely to have an elevated level of moral injury. Those with strong levels of life meaning and purpose were less likely to experience moral injury. These findings can be used to help combat veterans heal from the wounds of war. Clinical interventions associated with life meaning and purpose could enable successful reintegration of combat veterans into society. Results could be used to identify and test specific treatment options. Outcomes could also be used to explore the relationship of combat veterans to other professions subject to moral injury and further explore the relationship of moral injury to PTSD.

Individuals who experience a traumatic event may have an adverse emotional reaction that negatively impacts their quality of life. The purpose of this qualitative phenomenological study was to explore the influence of training in the martial arts as an intervention in the treatment of interpersonal trauma. The biopsychosocial model provided the framework for the study. The research questions addressed the effects of training in the martial arts and the biological, psychological, and social functioning of individuals who had sustained a form of interpersonal trauma. Data were collected from semistructured interviews with 9 participants. Data were analyzed using Moustakas's modified van Kamm method. Findings indicated that martial arts training was transformative and positive for participants. Benefits included mentorship, a sense of achievement, increased confidence, better parenting, and recovery from substance abuse. Findings may be used to promote martial arts training as a treatment intervention for people who have experienced interpersonal trauma.