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Much research has focused on ways to promote recovery in people with severe mental illness (SMI), who often suffer dire consequences resulting from their illness. While the unique meaning of [...], The purpose of this study was to determine the relationship between job match and subsequent job tenure in clients with severe mental illness working in competitive employment. We conducted a secondary data analysis of 50 clients participating in a study investigating the Individual Placement and Support (IPS) model of supported employment. Clients obtained a competitive job at baseline or during the preceding six months and received follow-along services from IPS employment specialists. Job match was assessed using the Job Match Survey at baseline and employment outcomes were assessed monthly across the two year follow-up period. Overall, job match was correlated with months worked in the first job. The interest/enjoyment component of job match was most highly related to vocational outcomes. These findings suggest that supported employment services should focus on helping clients find a good job match in order to bolster job tenure outcomes.

Background: It is increasingly acknowledged that satisfaction with sexual relations forms an important aspect of people's lives, but little is known of factors associated with this phenomenon among people with mental illness. Aim: This study aimed to investigate how demographic, social, clinical, and health-related factors were related to satisfaction with sexual relations. Methods: Patients with persistent mental illness (N = 103), recruited from an outpatient unit, were assessed regarding the target variables. Results: No clinical variable, and only one demographic factor, namely being a cohabitant, was found to be important to satisfaction with sexual relations. Several social factors, pertaining to how everyday occupations were valued and how the social network was perceived, were shown to be of importance. General quality of life, but not self-rated health or interviewer-assessed psychopathology, was also important for satisfaction with sexual relations. A multivariate analysis showed that the most significant factor for satisfaction with sexual relations was how everyday activities were valued, and being a cohabitant explained some additional variation. Conclusion: Previous research indicates that the mental health care services largely neglect sexual problems among people with mental illness, and the findings may provide additional knowledge that may be used in the support of this target group.

Aims: To verify the association between the prevalence of mental symptoms and excessive alcohol intake with religious affiliation, church attendance and personal religiosity. Methods: A household survey of 515 adults randomly sampled included the WHO SUPRE-MISS questionnaire, SRQ-20 and AUDIT. Weighted prevalences were estimated and logistic analyses were performed. Results: Minor psychiatric morbidity was greater among Spiritists and Protestants/ Evangelicals than in Catholics and in the 'no-religion' group. The latter had a greater frequency of abusive alcohol drinking pattern and Protestants/Evangelicals showed lower drinking patterns. Conclusions: Although belonging to Protestant/Evangelical churches in Brazil may inhibit alcohol involvement it seems to be associated to a higher frequency of depressive symptoms. Processes of seeking relief in new religious affiliations among sub-groups with previous minor psychiatric symptoms may probably occur in the Brazilian society. Key words: alcohol, Brazil, depression, mental health, religion

Background: Health professionals frequently exhibit negative attitudes toward people with mental disorders. It is not known whether stigmatising attitudes among pharmacy students predict less positive attitudes toward consumer participation in decision-making about medications. Aims: (1) To assess the attitudes of pharmacy students toward people with schizophrenia, and (2) to determine whether stigma predicts less positive attitudes toward concordant medication counselling. Method: All pharmacy students enrolled in a five-year degree program were invited to participate. Students completed the seven-item Social Distance Scale, six items related to stereotypical attributes of people with schizophrenia and the 14-item Leeds Attitudes Toward Concordance Scale. Results: Completed survey instruments were received from 157 students (94% response rate). Previous employment in a pharmacy and personal experience of a mental disorder were associated with low social distance. Later year of study, believing that people with schizophrenia are difficult to talk to, and believing people with schizophrenia have themselves to blame were predictive of high social distance. Low social distance and later year of study were associated with positive attitudes toward providing concordant medication counselling. Conclusion: Mental health stigma was common and predictive of less positive attitudes toward consumer participation in decision-making about medications. Key words: community pharmacy services, concordance, Estonia, schizophrenia, stigma

This study translated and validated the Chinese Version of the Self-stigma of Mental Illness Scale (CSSMIS), which may be used to measure self-stigma of mental health consumers in China. We also examined its correlation with self-esteem, self-efficacy and psychosocial treatment compliance. A cross-sectional observational study was implemented. Some 51 males and 57 females who suffered from severe mental illness were recruited from psychiatric settings in Hong Kong. They were required to complete the Chinese Version of the Self-stigma of Mental Illness Scale, the Rosenberg Self-esteem Scale and the Self-efficacy Scale. Their level of compliance during psychosocial treatment and their demographic information were recorded by their case managers. Exploratory factor analysis revealed two homologous factors for the four subscales of the CSSMIS. Factor 1 was related to the negative beliefs and consequences of having mental disorders, whereas Factor 2 was related to positive beliefs. The perceived stigma subscale and the three self-stigma subscales were strongly inter-correlated. Significant correlations were also found between almost all subscales of the CSSMIS and the remaining scales. The psychometric properties of the CSSMIS are statistically acceptable. The results also suggest that stigma played a detrimental role in undermining self-esteem, self-efficacy and psychosocial treatment compliance. Implications for recovery of mental health consumers are discussed. Key words: measurement, psychosocial treatment compliance, self-efficacy, self-esteem, stigma

Background: In many Western European countries, there is an increasing request for demand-oriented and demand-driven approaches in health care. In these approaches, the emphasis is on the clients' perspective on healthcare policy and healthcare services. A study was conducted to gain insight into the clients' view of health care. Methods: In 2004 a survey was conducted in the Netherlands among 4250 ambulatory mental health clients, by means of a postal questionnaire. To include clients with different experiences of mental health care, the sample was stratified according to the length of the treatment history. A total of 865 clients responded to the survey. Results: Elements that are found to be important to most clients are that 'needs are determined in consultation with the client', that 'the client is treated in a pleasant manner' and that 'the professional informs the client about the possibilities in his/her situation'. Significant differences were found between groups with different background factors: income, education, age, sex and treatment history all had significant correlations. Conclusion: Most clients in ambulatory mental health care appreciate the demand-oriented and demand-driven approaches. However, not all the elements are appreciated in the same manner. In general, clients do not seem to care much about who makes the decisions, but they care much more about the way the decision-making process is carried out. Clients especially value being heard and being involved in the process as a serious party.

The study examined the relationship of extraversion, neuroticism, and impulsiveness with posttraumatic stress reactions of avoidance and intrusion. 36 outpatients from a Trauma Unit at a major metropolitan hospital in Melbourne (Victoria), and 24 age-matched controls completed the Impact of Event Scale, the Eysenck Personality Questionnaire Revised, and the Impulsivity Questionnaire. Intrusion symptoms were predicted both by Extraversion and Neuroticism, after controlling for age and gender, with Neuroticism making a stronger contribution to the prediction. The only predictor of Avoidance symptoms was Neuroticism. Impulsivity correlated with Intrusion symptoms but predicted them only in the trauma group. This finding, along with the observed positive associations of Extroversion with both posttraumatic symptoms, lends support to Gray's model of dispositions influencing responses to trauma, suggesting that impulsive (extroverted) neurotics are more vulnerable to posttraumatic stress than introverted ones.

Lifetime prevalence of traumatic events and current PTSD was assessed among 142 mental health consumers with serious mental illness served by a psychosocial rehabilitation day program. Lifetime exposure to trauma was high (87%). The rate of PTSD based on the PTSD Checklist (PCL) was also high (19-30% depending on different scoring criteria). Overall, the PCL had strong internal reliability for this sample. Documentation of trauma and PTSD was exceptionally low in medical records. Results suggest that trauma and PTSD are significantly overlooked in the public mental health system. Improved recognition of trauma and PTSD are needed in order to provide meaningful services to this highly vulnerable population. KEY WORDS: community mental health; severe mental illness; traumatic events; posttraumatic stress disorder.

Definitions and classification schemes for suicide attempts vary widely among studies, introducing conceptual, methodological, and clinical problems. We tested the importance of the intent to die criterion by comparing self-injurers with intent to die, suicide attempters, and those who self-injured not to die but to communicate with others, suicide gesturers, using data from the National Comorbidity Survey (n = 5,877). Suicide attempters (prevalence = 2.7%) differed from suicide gesturers (prevalence = 1.9%) and were characterized by male gender, fewer years of education, residence in the southern and western United States; psychiatric diagnoses including depressive, impulsive, and aggressive symptoms; comorbidity; and history of multiple physical and sexual assaults. It is possible and useful to distinguish between self-injurers on the basis of intent to die. Keywords: suicide attempt, suicide gesture, intent to die, self-harm, self-injury

Background: Spouses of people with mental disorder experience various forms of objective and subjective burden. This should negatively affect their quality of life. However, until now no single study has addressed this question. Aims: To investigate the quality of life of spouses of people with schizophrenia, depression or anxiety disorders. Method: Spouses of patients suffering from schizophrenia (n = 45), depression (n = 49) and anxiety disorders (n = 39) were consecutively recruited from outpatient services in the city of Leipzig. Quality of life was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organisation. Results: Compared with the general population, the quality of life of the spouses of mentally ill people was lower in the domains 'psychological well-being' and 'social relationships'. There was a significant association between the patient's functional level and the spouse's quality of life. Conclusions: Better treatment, professional support and participation in self-help and advocacy groups may help to improve the quality of life of spouses of mentally ill people.

Aims: Several studies have found an inverse relationship between people's readiness to endorse biogenetic causal explanations of mental disorder and their desire for social distance from people with mental disorders. The aim of this study is to examine why this may be the case. Method: In the spring of 2001, a population survey was carried out among German citizens aged 18 years and older, living in private households. A total of 5025 interviews were conducted, reflecting a response rate of 65.1%. At the beginning of the personal, fully structured interview, respondents were presented with a vignette containing a diagnostically unlabelled psychiatric case history, either depicting a case of schizophrenia or major depressive disorder. Using five-point Likert scales, causal attributions as well as perceived dangerousness, fear and the desire for social distance were assessed. Results: The more respondents endorse a brain disease as a cause, the more dangerous they believe the person with schizophrenia or major depression to be. Respondents who perceive the individual in the vignette as being dangerous express a higher degree of fear and a greater preference for social distance from these individuals. As compared with brain disease, the relationships between heredity and perceived dangerousness are less pronounced for both disorders. Conclusions: Our analysis showed that endorsing biogenetic explanations decreases the likelihood of social acceptance of people with schizophrenia and major depression. Rejecting behavioural responses in the form of social distance desired from people with schizophrenia and major depression result from cognitive emotional processes in which biogenetic causal attributions are linked to lack of self-control, unpredictability and dangerousness, which, in turn, are associated with fear of these people.

The author analyzed quantitative data from an NIMH-funded longitudinal study of 322 women with persistent severe mental illness (SMI) and qualitative data from semistructured interviews with 82 of the women [...]

Much has been written about the relationship between professionals and self-help groups, largely from the professional perspective. This article discusses the perspective of self-help group members on the involvement of [...], This article focuses on an analysis of how members of self-help groups perceived professional involvement and what they defined as the dimensions of such involvement. Models to predict these identified dimensions are also suggested. The instrument developed for the study consisted of two parts: (1) demographic question and (2) 12 statements concerning self-help group members' attitudes toward professional involvement. Based on responses from 183 members of self-help groups, three categories were identified according to their main focus: groups dealing with health issues, groups dealing with alternative lifestyles, and groups based on the 12-step model. Analysis yielded two conceptually different constructs influencing group members' attitudes: collaboration and duality. Keywords group members' perspective professional involvement self-help groups

Participant selection biases can reduce the generalizability of research findings and lead to misestimates of intervention effectiveness. The authors examined factors associated with study participation and attrition among psychiatric outpatients recruited for the initial phase of a health promotion trial. Medical records were reviewed to obtain HIV-risk and substance abuse data, as well as psychiatric and demographic characteristics of potential participants. Of 895 eligible outpatients, 67% (n = 601) consented to participate, among whom 69% (n = 415) completed all baseline appointments. Compared with nonconsenters, consenters were more likely to be at risk for drug problems and to receive care from clinics serving more impaired patients. Study completion was associated with older age, a psychiatric diagnosis other than adjustment disorder, and a recent sexually transmitted disease diagnosis. These findings suggest that patients who could most benefit from risk reduction interventions are more likely to participate.

The authors report a 6-month follow-up study of clinically depressed patients. At baseline, 2 indexes of autobiographical memory functioning were assessed: the presence of spontaneous intrusive memories of stressful life events and performance on the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986), which measures overgeneral memory. The index of overgeneral memory was associated with greater levels of spontaneous intrusion of stressful memories. Overgeneral memory did not predict outcome, but depression at follow-up was predicted by the amount of intrusion and avoidance of stressful memories, even after controlling for initial severity of psychiatric symptoms.

Previous studies suggest that many transsexuals evidence an Axis I diagnosis 1according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more 'normal' in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder. KEY WORDS: gender dysphoria; transsexualism; MMPI; comorbidity of psychiatric disorders.

The purpose of this investigation was to examine three aspects of the construct validity of the Expectations About Counseling-Brief form (EAC-B): whether it measures expectations about counseling rather than other related constructs, whether the test items are clearly understood, and whether the test maintains respondents' attention. This was accomplished by analyzing the cognitions of 16 male and 14 female undergraduates to determine which thought processes were being elicited by the EAC-B. Each item elicited statements about expectations from 70% of the respondents, whereas statements about related constructs essentially occurred at a chance level. These results support the conclusion that each item on the EAC-B possesses at least minimal validity.