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Accessible summary: What is known on the subject?: Self‐management comprises five core skills: "Problem Solving, Decision‐Making, Resource Utilization, Forming a Patient/Healthcare Provider Partnership and Taking Action."Effective self‐management among patients diagnosed with anxiety can reduce the number of relapses and improve treatment outcomes.Knowledge of the impact of the family atmosphere, well‐being and illness symptoms on self‐management in patients diagnosed with anxiety disorders is limited. What does the paper add to the existing knowledge?: This is the first study in China to explore whether family atmosphere and well‐being of patients diagnosed with anxiety disorders affects self‐management.This paper adds to the list of factors influencing self‐management among patients diagnosed with anxiety disorders.SAS scores are a major factor influencing self‐management among patients diagnosed with anxiety disorders.The subjective well‐being of patients diagnosed with anxiety disorders can influence their self‐management behaviour.Patients who experienced family harmony had significantly higher self‐management scores than those who experienced family disharmony. What are the implications for practice?: Nurses should encourage patients diagnosed with anxiety disorders to manage their condition while receiving treatment at home.Nurses should focus on patients diagnosed with anxiety disorders who have significant anxiety symptoms and low well‐being.Nurses should emphasize the importance of the home environment in family self‐management and affirm that a good home environment promotes patient self‐management. Introduction: Better self‐management can improve treatment outcomes and reduce the number of relapses for patients diagnosed with anxiety disorders. However, the impact of well‐being and the home environment on self‐management among patients diagnosed with anxiety disorders is unclear in China. Aim: This study sought to determine the impact of the home environment, well‐being and illness symptoms on self‐management during home treatment for patients diagnosed with anxiety disorders. Method: This cross‐sectional study was conducted with patients diagnosed with anxiety disorders. Data were collected with SAS, Self‐Management Scale for People with Anxiety Disorders and Index of Well‐being. Frequency, percentage, analysis of variance, Kruskal–Wallis and multiple linear regression analyses were used. Results: Home environment (p <.001), self‐perceived quality of life (p =.015), well‐being index (p =.002) and SAS total score (p =.033) had a major impact on self‐management in patients diagnosed with anxiety disorders (n = 245). Discussion: Family disharmony, poor self‐perceived quality of life, high SAS scores and low levels of well‐being were significant influences on self‐management among people diagnosed with anxiety disorders. Implications for Practice: Nurses should focus on the self‐management of patients diagnosed with significant anxiety symptoms and low well‐being and value the importance of the home environment in facilitating self‐management among patients diagnosed with anxiety disorders. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under‐prepared.The single frontline service approach is time‐intensive and risks a coercive pathway to care.The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal. What the paper adds to existing knowledge: Police and ambulance staff struggled keeping up with the mental health demand, reporting inadequate mental health training, little enjoyment and negative experiences when trying to access help from other services.Most mental health staff had adequate mental health training and enjoyed their work, but many experienced difficulties getting help from other services.Police and ambulance staff found it hard to work with mental health services. What are the implications for practice: The combination of limited training, poor interagency referral processes, and difficulties accessing support from mental health services means that when police and ambulance services attend mental health crises alone, distress may be heightened and prolonged. Enhanced mental health training for first responders and more streamlined referral processes may improve process and outcomes.Mental health nurses have key skills that could be utilized in assisting police and ambulance staff who attend 911 emergency mental health calls.New models such as co‐response teams, whereby police, mental health clinicians and ambulance staff respond conjointly should be trialled and evaluated. Introduction: First responders are increasingly called to assist people experiencing mental health crises but little research exists canvassing multi‐agency perspectives of such work. Aim/Question: To understand the views of police officers, ambulance and mental health staff attending mental health or suicide‐related crises in Aotearoa New Zealand and to discover how they experience current models of cross‐agency collaboration. Methods: A descriptive cross‐sectional survey involving mixed methods. Quantitative data were analysed using descriptive statistics and free text by content analysis. Results: Participants included 57 police officers, 29 paramedics and 33 mental health professionals. Mental health staff felt adequately trained, but only 36% described good processes for accessing inter‐agency support. Police and ambulance staff felt undertrained and unprepared. Accessing mental health expertise was considered difficult by 89% of police and 62% of ambulance staff. Discussion: Frontline services struggle managing mental health‐related 911 emergencies. Current models are not working well. Miscommunication, dissatisfaction and distrust exist between police, ambulance and mental health services. Conclusion: The single‐agency frontline response may be detrimental to service users in crisis and under‐utilizes the skills of mental health staff. New ways of inter‐agency cooperation are required, such as co‐located police, ambulance and mental health nurses responding in partnership. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Prior research has demonstrated that childhood trauma can increase adolescents' suicidal ideation, and perceived stress plays a mediating role in the relationship between childhood trauma and adolescents' suicidal ideation. Character strengths, which are trait‐like positive personality characteristics, have also been found to be closely related to decreased stress and suicidal ideation. However, it is unclear whether character strengths act as a transfer mechanism that links childhood traumatic experiences with perceived stress and eventually suicidal ideation. What the paper adds to existing knowledge?: This study found that character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation. Specifically, childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. This study provided important theoretical implications for preventing suicidal risk among adolescents who are exposed to traumatic events during childhood. What are the implications for practice?: This study highlighted the roles of character strengths and perceived stress in the relationship between childhood traumatic experiences and suicidal ideation, which provided suggestions for designing nursing interventions to reduce adolescents' suicidal ideation, especially for those with traumatic childhood experiences. In addition to family nursing, school‐based regular monitoring and interventions of character strengths and perceived stress are necessary. Aim: This study sought to examine the mediating effects of character strengths and perceived stress on the relationship between childhood trauma and suicidal ideation among adolescents. Methods: A cross‐sectional survey was conducted on a sample of 1069 Chinese adolescents. The Chinese versions of the Suicidal Ideation Scale, Childhood Trauma Questionnaire, Perceived Stress Scale and Character Scale for Adolescents were used to assess adolescents' suicidal ideation, childhood trauma, perceived stress and character strengths. Results: The findings showed that childhood trauma influenced suicidal ideation directly and indirectly via perceived stress. Moreover, character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation, implying that childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. Conclusions: This study highlighted the joint contribution of childhood trauma, character strengths and perceived stress to suicidal ideation, providing theoretical and practical implications to guide mental health nurses to reduce the suicide risk among adolescents. Implications for Practice: These findings highlighted the importance of developing character strengths and stress‐coping strategies. Family nursing and school‐based regular monitoring and interventions of character strengths and perceived stress are necessary among adolescents who exposed to a high level of childhood trauma experiences to reduce their suicidal ideation and foster mental health. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recurrence is common in patients diagnosed with major depressive disorder (MDD). Psychological resilience has been shown to be a protective factor against recurrence of depression. It has important clinical nursing significance to analyse the influencing factors of psychological resilience in major depressive disorder in remission (MDDR) patients. What the paper adds to existing knowledge?: There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with MDDR. We found the education levels, personal monthly income, social support, well‐being and self‐efficacy were influencing factors of psychological resilience in patients diagnosed with MDDR. What are the implications for practice?: According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression. Nurses should strengthen the nursing of patients with <12 years of education, and patients with personal monthly income less than 5000 RMB. In addition, nurses should cultivate patients' awareness of social support and identity, cultivate their ability to strive for social support, cultivate interpersonal skills and positive emotional experience to improve subjective well‐being and carry out self‐efficacy training to improve psychological resilience by enhancing patients' internal protective factors. Aim: Psychological resilience is closely related to recurrence of depression. There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with major depressive disorder in remission (MDDR). Here, we investigated the current status of resilience in patients diagnosed with MDDR and its influencing factors. Methods: A descriptive cross‐sectional study was conducted from June 2019 to April 2021. One hundred and forty‐two patients diagnosed with MDDR were recruited from the Department of Psychiatry and Psychology of the General Hospital of Northern Theater Command. Demographic information, social support, well‐being, self‐efficacy and psychological resilience were collected using self‐reported questionnaires. Results: The psychological resilience of MDDR patients was lower than that of the healthy Chinese adults in China. Multiple logistic regression analysis showed that education, personal monthly income, social support, well‐being and self‐efficacy were associated with psychological resilience. Receiver operating characteristic (ROC) curve analysis further confirmed that social support, well‐being and self‐efficacy were associated with psychological resilience. Conclusion: The psychological resilience of MDDR patients was lower than that of the general population in China. The education levels, personal monthly income, social support, well‐being and self‐efficacy were influencing factors of psychological resilience. Implications for Practice: According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The importance of and interest in nurses' attitudes towards and subjective experience with workplace violence in clinical settings is increasing.The prevalence of patient‐perpetrated violence against Korean nurses in hospital settings is highly prevalent.Only few instruments are available to measure the nurses' perception of patient aggression in Korea. What the paper adds to existing knowledge?: This is the first study to assess the linguistic and psychometric reliability and validity of an instrument that evaluates the attitude of Korean nursing staff towards patient‐perpetrated workplace violence. What are the implications for practice?: This valid and reliable instrument could be used to assess and monitor the nurses' attitudes towards aggressive tendencies in the workplace.The results could contribute to the development of relevant interventions for coping with violence by patients towards nursing staff and the implementation of practical training to cultivate healthy perceptions towards patients to foster therapeutic nurse–patient relationships. Introduction: Despite the high prevalence of patient‐perpetrated violence against Korean nurses globally, reliable and valid measures of patient aggression are lacking in Korean. Aim: We translated the 12‐item Perception of Aggression Scale (POAS) into Korean and psychometrically assessed its utility in measuring nurses' attitudes towards aggression. Methods: The 12‐item Korean POAS was obtained through forward–backward translation and cognitive debriefing. It was administered online to 319 nurses (mean age = 32.64 years; females = 96.2%), of which 206 completed it again after two weeks. Confirmatory factor analysis validated the 3‐factor structure as hypothesized in the original version. The intra‐class correlation coefficient was used to assess the test–retest reliability. Results: The originally hypothesized 3‐factor structure showed a good fit. The 3 dimensions: aggression as a dysfunctional or undesirable phenomenon, aggression as a functional or comprehensible phenomenon, and aggression as a protective measure had internal consistencies of 0.74, 0.86 and 0.90 and corresponding ICCs of 0.70, 0.86 and 0.90, respectively. Discussion: The 12‐item Korean POAS is a valid and reliable scale that might aid investigating nurses' attitudes towards patient aggression. Implications for practice: The 12‐item Korean POAS can help Korean nurses adopt protective behaviours and develop interventions to cope with aggression. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Patient and public involvement (PPI) is recognized as an increasingly important feature of healthcare research, education and public policy.In mental health, PPI is increasingly seen as evidence of the further democratization of services, which started with de‐institutionalization in the 1960s and the recovery movement in the 1990s.While much is known about learning enablers and learning gains on generic community‐based training programmes, less is known about PPI‐specific programmes in mental health. What this paper adds to existing knowledge?: Participants at a national training programme to support the engagement of service users, their families and carers in mental health services identified training topics of greatest importance to them and reported on what they learnt and what helped their learning.Patient and public involvement training initiatives aimed at supporting the engagement of service users, their families and carers should emphasize individual needs and local contexts.Training programmes should not make artificial or actual distinctions between the programme participants who are health professionals and those who are non‐professionals, such as service users.To our knowledge, this PPI initiative is the first time a national health service provider has sought to develop an engagement structure in mental health on a state‐wide basis. What are the implications for practice?: Participants in training programmes designed to support patient and public involvement believe that such programmes should include understanding how conflict is resolved, how committees work effectively and how to develop interpersonal and facilitation skills.Training programmes in mental health involving both professional and non‐professional participants requires all the participants to work together in particular at commissioning and design stages to achieve their desired outcome.The evaluation of the training programme to support the roll‐out of this initiative offers lessons to others who may wish to pursue similar structures in other jurisdictions. Introduction: The Irish national mental health service provider commissioned a national training programme to support a patient and public involvement (PPI) initiative in mental health services. The programme evaluation afforded an opportunity to describe the learning gains and learning enablers and the factors that support PPI in mental health. Aim: We aimed to evaluate a PPI training programme across nine regional administrative units in a national mental health service. Methods: We conducted a participant exit survey, using the Student Assessment of Learning Gains (SALG) instrument. We analysed the survey responses using SPSS version 24 software and applied directed content analysis to the narrative comments provided in open‐ended questions. Results: A total of 54 participants returned the completed questionnaire, yielding a response rate of 60%. The overall mean SALG score yielded was 3.97 (SD 0.66; range 1–5), indicating that participants reported very good to excellent gains in their learning from the programme. Participants who offered narrative comments indicated an overall positive experience but suggested that all stakeholders should work together to co‐produce the training. Discussion: All the stakeholders in a PPI training initiative to support the engagement of service users, their families and carers in mental health should work together to achieve their desired outcome. This requires co‐production in the design, delivery and evaluation of the training initiative, and co‐production can impact at both individual and local levels. Implications for Practice: PPI training initiatives in mental health should retain a focus on understanding conflict resolution, committee effectiveness, interpersonal and facilitation skills. Ensuring a shared understanding of key concepts, such as co‐production, is a necessary prerequisite at the co‐commissioning, co‐design, co‐planning, co‐delivery and co‐assessment stages of programme development, as is the need to avoid artificial or actual distinctions between health professionals and those who are non‐professionals, such as service users. Relevance statement: Mental health engagement and PPI are key principles underpinning modern mental health services and may increasingly impact on wider health service provision including policy and research imperatives. This paper discusses the evaluation of a PPI training programme and offers practical insights as to how such initiatives can be improved. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on this subject?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally.Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes.No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. What this paper adds to existing knowledge?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care.Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. What are the implications for practice?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring.Guidelines may have a role to play in improved monitoring but need service‐level support in order to be effective. Introduction: People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim: To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method: An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results: Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion: Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort.The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions.Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression.Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. What the paper adds to existing knowledge?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil."Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists.Emotions play an important role in decision‐making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups.Staff members consider reflective interventions, such as team supervisions or post‐seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely.Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. What are the implications for practice?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions.Structured post‐seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. Introduction: Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim: The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method: Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results: Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post‐seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion: The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications: The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences.AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities.However, the use of AHDs as described above is not yet a reality in Spain. What the paper adds to existing knowledge?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice.Although providers had a moderate–low level of knowledge about AHDs, they presented positive attitudes towards them. What are the implications for practice?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up‐to‐date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process.More in‐depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation.The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. Introduction: Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim: To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method: We cross‐sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results: Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing‐care technician was associated with stronger positive attitudes. Discussion: Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice: The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many nursing students have inadequate preparation for practice in mental health nursing in the United States and China. The concept of mental illness has different connotations in different cultures. Studies differ from country to country concerning the influence of nursing education on students’ knowledge about and attitudes towards mental disorders. There is a lack of cross‐cultural research that takes a broad perspective to explore how nursing students’ knowledge and beliefs about mental disorders are influenced by the culture within education and healthcare systems. What this paper adds to existing knowledge?: Nursing students in the United States and China shared similar views on a broad range of intervention options including professional help, psychotropic medications and activity interventions for managing depression and schizophrenia. The major difference between the two nursing student groups was that the Chinese students showed more preference to occasional alcohol consumption and specialized therapies including cognitive‐behavioural therapy and electroconvulsive therapy and the US students held less skepticism towards traditional and religious practices as possible treatment options for depression and schizophrenia. What are the implications for practice?: The Chinese nursing students need to be educated about safe alcohol consumption guidelines adopted by the National Health and Family Planning Commission. The US nursing students need to increase their awareness of national practice guidelines for managing mental disorders, particularly with respect to the use of specialized therapies such as cognitive‐behavioural therapy and electroconvulsive therapy. We support professional and psychosocial interventions in caring for patients with mental disorders. Abstract: INTRODUCTION: Nursing students in the United States and China have reported inadequate preparedness for practice in mental health nursing. It is important to investigate nursing students’ mental health literacy levels for a better understanding of their practice readiness in mental health field upon completion of their education. Aim: This study was aimed at developing an understanding of American and Chinese nursing students’ mental health literacy regarding the effectiveness of specific interventions for managing depression and schizophrenia. Method: The “Australian National Mental Health Literacy Survey” was completed by a group of 310 nursing students including 152 Americans and 158 Chinese between April 2016 and April 2017 to compare students’ rated intervention options on two provided vignettes. Results: The two student groups reached consensus on many intervention options. However, the Chinese students showed more preference to occasional alcohol consumption and specialized therapies and the US students held less skepticism towards traditional practices as treatment options for depression and schizophrenia. Discussion and implications for practice: The findings support professional and psychosocial interventions in caring for patients with mental disorders. There is a significant need for specific education on safe alcohol consumption guidelines for Chinese nursing students and clinical practice guidelines for managing mental disorders for American nursing students. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? Loneliness among people diagnosed with schizophrenia is a serious problem. Recent studies have focused on the loneliness; however, no study has examined the relationships between loneliness and both individual and environmental factors comprehensively., What this paper adds to existing knowledge? The main results indicated that the community-dwelling people diagnosed with schizophrenia in Japan as well as in other countries experienced higher levels of loneliness. Both individual and environmental factors were related to loneliness. Increasing the self-efficacy for community life and self-esteem of individual factors, and not being socially isolated and increasing community integration of environmental factors would improve their loneliness., What are the implications for practice? Health practitioners, in particular, public health nurses in mental health care, should work to develop a partnership with people diagnosed with schizophrenia, their family members, friends and other community-dwelling people in order to decrease and prevent loneliness. For individuals diagnosed with schizophrenia, interventions by cooperating with community resources and using the technique of nurses to assist them with continuous community activity could be useful. For environmental interventions, population approach such as developing daily programmes which family members can participate in, and cooperating with educational institutions and community events could have a positive effects., Abstract Introduction Loneliness among people diagnosed with schizophrenia living in communities can decrease quality of life and may contribute to suicide. Aim The aim of this study was to examine the levels of loneliness among Japanese people diagnosed with schizophrenia and to identify individual and environmental factors related to their loneliness. Method A cross-sectional survey was conducted with 264 people diagnosed with schizophrenia who use local activity support centres in urban areas. The self-administered questionnaires included questions on loneliness, demographic characteristics, individual factors including self-efficacy for community life and self-esteem, and environmental factors including social isolation, community integration and service use. Results The study results indicated that people diagnosed with schizophrenia in Japan experience higher levels of loneliness, corroborating results from other countries. Multiple regression analysis showed that a lower level of self-efficacy for community life, self-esteem, community integration and social isolation predicted a higher level of loneliness, accounting for 55.3% of variance. Implications for Practice Public health nurses in mental health care in Japan can work with individuals diagnosed with schizophrenia and communities using the technique to assist them with continuous activity and cooperating with community resources and educational institutions in order to decrease and prevent loneliness. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Stigma related to mental illnesses is a great burden on societies globally. Factors associated with nurses' attitudes towards people with mental illness in health-care settings are discrepant., Stigmatized attitudes among staff members towards patients with mental illness have widely been studied in various specialized health care contexts, but less often in primary health-care settings., What this paper adds to the existing knowledge? Nurses' attitudes towards people with mental illness in general were positive in primary care health settings. Younger nurses expressed feeling afraid of mentally ill patients., They not only lacked a feeling of safety around these patients but were also often of the opinion that people with mental illness should be segregated from the general population., What are the implications for practice? Systematic and continuous mental health on-the-job training for primary care nurses is recommended to strengthen the positive attitudes of young nurses towards patients., Young nurses especially should be prevented from developing stigmatized attitudes towards patients with mental problems and to ensure a skilled workforce for the future in this demanding area of health care., Abstract Introduction Despite the development of mental health services in many countries, nurses working in different health care specialties may still have concerns and negative attitudes towards people with mental illness. Aim To describe nurses' attitudes towards people with mental illness and examine factors associated with their attitudes in primary care health centres. Method The data were collected from nursing staff ( N = 264, response rate 84%) in 15 primary care health centres in two Finnish cities (spring 2014) with a self-report questionnaire (Attribution Questionnaire-27, Corrigan 2003) and analysed by descriptive statistics and multiway covariance analysis. Results Nurses' attitudes towards people with mental illness were generally positive. The nurses mostly reported willingness to help and feelings of concern and sympathy towards these patients. However, younger nurses or those without additional mental health training expressed a fear of patients. Discussion Special attention should be paid to nursing education and on-the-job training to prevent young nurses from developing stigmatized attitudes towards patients. Implications for practice Higher confidence in nursing staff could ensure a skilled work force in areas of mental health in the future, prevent young nurses from developing a fear of patients at work and support positive attitudes towards patients with mental problems. [ABSTRACT FROM AUTHOR]