Search

Background: Digital health interventions are becoming increasingly important and may be particularly relevant for paediatric palliative care. In line with the aims of palliative care, digital health interventions should aim to maintain, if not improve, psychological wellbeing. However, the extent to which the psychological outcomes of digital health interventions are assessed is currently unknown. Aim: To identify and synthesise the literature exploring the impact of all digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care. Design: Systematic review and narrative synthesis. Data sources: MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Midwives Information & Resource Service were searched on the 27th July 2020, in addition to the first five pages of Google Scholar. To be included in the review, papers must have contained: quantitative or qualitative data on psychosocial outcomes, data from patients aged 0–18 receiving palliative care or their families, a digital health intervention, and been written in English. Results: Three studies were included in the review. All looked at the psychological impact of telehealth interventions. Papers demonstrated fair or good quality reporting but had small sample sizes and varied designs. Conclusions: Despite the design and development of digital health interventions that span the technological landscape, little research has assessed their psychosocial impact in the paediatric palliative care community. Whilst the evidence base around the role of these interventions continues to grow, their impact on children and their families must not be overlooked. [ABSTRACT FROM AUTHOR]

There is a growing call for arts-health and community arts professionals to work in 'trauma informed ways' to prevent re-traumatisation and promote healing. This paper reports on a scoping review of existing literature that deal with trauma aware and informed practice and its applications in arts-health and community arts. Trauma informed practice does not seek to target or treat trauma but, rather, seeks to provide a safer and more informed space for people who experience post-traumatic stress conditions and symptoms to engage in facilitated arts activities. We particularly examine the extent to which existing literature acknowledges the presence of oppression-related collective trauma – such as racial trauma – and offers appropriate creative, anti-oppressive and trauma aware practice approaches. A total of 19 articles were included following librarian input and team checking. Included articles were written in English, published in peer reviewed academic journals, included a creative arts component, and adopted an intentional trauma informed or aware approach to practice. An additional three sources were included as part of descriptive synthesis to foreground leading First Nations resources for practice. Although no specific guidelines for trauma aware practice in arts-health or community arts were found, findings are consolidated at the end of the paper to offer interim principles, values and activities for trauma aware and informed practice in arts-health and community arts. Findings can also inform general trauma related research and therapy by highlighting the growing role of arts and creativity in responding to diverse experiences of trauma and its effects. [ABSTRACT FROM AUTHOR]

Most people who experience trauma want to thrive and often find paths to well-being and healthy functioning. This scoping review explores the existing evidence on adversity and resilience in southeastern European countries, focusing on Kosovo. There is a lack of research on trauma and resilience in cultures outside the US and Western Europe. The paper provides a brief cultural and historical overview of this region and the collectivist cultures found there. We draw from a range of interdisciplinary literatures to identify key strengths that have the potential to improve health outcomes for trauma victims in this region. Overall, 42 papers from PsycInfo and PubMed were identified, using keywords such as "resilience" or "health" and "Kosovo," "Balkans," and "Southeastern Europe." Findings from this scoping review show that different cultural values, norms, and societal ecologies impact resilience within these societies. Some strengths, such as social support and sense of purpose, echoed similar research in the US and Western Europe. There was also evidence that factors such as dignity, family solidarity, social activism, and nationwide meaning-making are strengths associated with resilience for these collectivist societies of southeastern Europe. We also consider the implications of the results for other post-conflict societies. Finally, findings from this review call for culturally sensitive strength-based perspectives in promoting health and well-being after the high dosages of trauma common in this region. [ABSTRACT FROM AUTHOR]

Background: COVID-19 accelerated the adoption of remote working in which employers' obligations for employees' health and well-being extended into the home. This paper reports on a systematic review of the health impacts of remote working within the context of COVID-19 and discusses the implications of these impacts for the future role of the occupational health nurse. Method: The review protocol was registered with PROSPERO (CRD42021258517) and followed the PRISMA guidelines. The review covered 2020-2021 to capture empirical studies of remote working during the COVID-19 pandemic, their physical and psychological impacts and mediating factors. Results: Eight hundred and thirty articles were identified. After applying the inclusion criteria, a total of 34 studies were reviewed. Most studies showed low to very low strength of evidence using the GRADE approach. A minority of studies had high strength of evidence. These focused on the reduced risk of infection and negative effects in terms of reduced physical activity, increased sedentary activity, and increased screen time. Conclusion/Application to Practice: The synergy of work and personal well-being with the accelerated expansion of remote working suggests a more active role in the lives of workers within the home setting on the part of occupational health nurses. That role relates to how employees organize their relationship to work and home life, promoting positive lifestyles while mitigating adverse impacts of remote working on personal well-being. [ABSTRACT FROM AUTHOR]

Objective: To systematically review international evidence on the effectiveness and cost-effectiveness of interventions targeting the mental health, wellbeing, and retention of child and family social workers and their impact on child and family outcomes. Method: Systematic review and narrative synthesis of quantitative comparative studies. Published or unpublished research was sought via 12 bibliographic databases, websites, contact with experts, and citation tracking. Studies in any language were eligible for inclusion. Quality was assessed using Cochrane appraisal tools. Results: Fifteen studies were identified from 24 papers. Three studies considered individual-level interventions, with mixed and inconclusive findings. Eleven considered organisational interventions, with mixed but more promising findings. One study considered community-level interventions, with positive findings but a serious risk of bias. Only one study considered costs. Conclusion: The quality of evidence overall does not warrant clear recommendations for services. Organisation-level interventions show some promise. Robust, high-quality interventional studies are needed. [ABSTRACT FROM AUTHOR]

Background and aims: Play-based interventions are used ubiquitously with children with social, communication, and language needs but the impact of these interventions on the mental health of this group of children is unknown. Despite their pre-existing challenges, the mental health of children with developmental language disorder (DLD) and autism spectrum disorder (ASD) should be given equal consideration to the other more salient features of their condition. To this aim, a systematic literature review with meta-analysis was undertaken to assess the impact of play-based interventions on mental health outcomes from studies of children with DLD and ASD, as well as to identify the characteristics of research in this field. Methods: The study used full systematic review design reported to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (PRISMA prisma-statement.org) with pre-specified inclusion criteria and explicit, transparent and replicable methods at each stage of the review. The study selection process involved a rigorous systematic search of seven academic databases, double screening of abstracts, and full-text screening to identify studies using randomised controlled trial (RCT) and quasi-experimental (QE) designs to assess mental health outcomes from interventions supporting children with DLD and ASD. For reliability, data extraction of included studies, as well as risk of bias assessments were conducted by two study authors. Qualitative data were synthesised narratively and quantified data were used in the metaanalytic calculation. Main contribution: A total of 2,882 papers were identified from the literature search which were double screened at the abstract (n = 1,785) and full-text (n = 366) levels resulting in 10 papers meeting the criteria for inclusion in the review. There were 8 RCTs and 2 QEs using 7 named play-based interventions with ASD participants only. Meta-analysis of 5 studies addressing positive mental health outcomes (e.g. positive affect and emotional functioning) found a significant overall intervention effect (Cohen's d = 1.60 (95% CI [0.37, 2.82], p = 0.01); meta-analysis of 6 studies addressing negative mental health outcomes (e.g., negative affect, internalising and externalising problems) found a non-significant overall intervention effect (Cohen's d = 0.04 -0.17 (95% CI [-0.04, 0.51], p = 0.88). Conclusions: A key observation is the diversity of study characteristics relating to study sample size, duration of interventions, study settings, background of interventionists, and variability of specific mental health outcomes. Play-based interventions appear to have a beneficial effect on positive, but not negative, mental health in children with ASD. There are no high quality studies investigating the efficacy of such interventions in children with DLD. Implications: This review provides good evidence of the need for further research into how commonly used play-based interventions designed to support the social, communication, and language needs of young people may impact the mental health of children with ASD or DLD. [ABSTRACT FROM AUTHOR]

This paper reviewed mediators of psychological well-being among healthcare workers responding to pandemics. After registration on PROSPERO, a systematic review was performed in four databases and 39 studies were included. Worse mental health outcomes, such as stress, depressive symptoms, anxiety and burnout were related to demographic characteristics, contact with infected patients and poor perceived support. Self-efficacy, coping ability, altruism and organisational support were protective factors. Despite limitations in the quality of available evidence, this review highlights the prevalence of poor mental health in healthcare workers and proposes target mediators for future interventions. [ABSTRACT FROM AUTHOR]

Introduction: Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds. Aim: The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents' and young people's mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research. Method: An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool. Results: Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified. Conclusions: Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area. [ABSTRACT FROM AUTHOR]

Shift workers support critical 24-hr operations; their health can be impaired by disrupted circadian rhythms and dysfunctional sleep. Shift work sleep disorder (SWSD) is a prevalent condition with significant psychological consequences. Nurse leaders have not yet implemented effective policies to prevent SWSD and optimize shift workers' mental health. The purpose of this integrative review was to examine research about SWSD within the context of neurobiological, sociological, and psychological perspectives that can inform policy changes. The Centers for Disease Control and Prevention Policy Analytic Framework was used to determine the priority recommendations. A search of three databases provided 19 research articles about SWSD and mental health, which illustrated how SWSD is common around the world in many occupations. Backward-rotating schedules and quick returns were risk factors for SWSD. In addition, SWSD was associated with circadian languidity, sleep reactivity, depressive symptoms, and anxiety. Collectively, the studies lacked objective measures of sleep and circadian rhythms, which has hindered the ability to devise interventions that will target the neurobiological causes of SWSD. The research also lacked attention to important sociological factors, such as workers' pay and benefits. Using these findings, nurse leaders can contribute to public policy reforms that increase funding for more rigorous SWSD research. Lawmakers should be advised by nurse leaders to enforce new regulations that provide incentives for employers to create healthier workplaces, such as prohibiting the overuse of schedules that make employees vulnerable to SWSD and providing funds for interventions to prevent SWSD and support mental health. [ABSTRACT FROM AUTHOR]

Autistic girls and women experience more mental health difficulties and poorer well-being than their non-autistic peers. Little emphasis has been placed on the perspectives of the girls and women within the literature. This review aims to provide an overview of the factors that impact autistic females' emotional and social well-being and mental health, as described in self-report qualitative studies. The protocol for the present review was pre-registered on PROSPERO (CRD42020184983), and this article follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycInfo, Academic Search Complete and MEDLINE were systematically searched using a pre-defined search string. This yielded 877 unique records, which were systematically screened by two reviewers, resulting in 52 eligible studies. Structured data extraction and quality appraisal were completed. The present review presents the perspectives of 973 autistic females aged 13–70+. Thematic synthesis identified three themes and nine subthemes. Our findings suggest that autistic girls' and women's experiences can be conceptualised within a social model, where biological and psychological factors ('The Autistic Neurotype') are experienced through the lens of social factors ('The Neurotypical World' and 'Stigma'), together shaping well-being and mental health outcomes. Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had a considerable influence on the medical field, especially for emergency room nurses who confront particular difficulties in responding to the crisis in Israel, including possible mental health effects. However, the exact effects of the present epidemic on the mental health of emergency room nurses in Israel remain largely unclear. Aim: This study aimed to fill up this knowledge vacuum and advance our understanding of the pandemic's consequences on the mental health of emergency room nurses in Israel. Methods: This study employed the systematic review approach. Only studies published between January 2020 and the time of the search. The studies were searched from various databases such as PubMed, Scopus, CINAHL, Web of Science, and PsycINFO. A thematic analysis technique was used to find common themes among the chosen articles as the systematic review concentrates on the impact of the COVID-19 epidemic on the mental health of emergency room nurses in Israel. A total of 12 studies met the eligibility criteria. Results: The main findings are oriented toward the effect of COVID-19 on the mental state of emergency room nurses in Israel. The 12 articles included for this study had various characteristics with majority being cross-sectional studies. Others included multicenter study, questionnaire-based study, and qualitative descriptive study. Using thematic analysis, four dominant themes, such as fear of infection and transmission, increased workload, inadequate support and resources, and coping strategies, emerged from the reviewed literature. Conclusion: This systematic analysis emphasizes how crucial it is to consider emergency room nurses' particular mental health demands during the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

Research highlights that romantic relationships of young people are not all 'puppy love' but can be also abusive. Intimate partner violence (IPV) is a gendered phenomenon as it primarily affects women who are at a higher risk of more severe forms of violence and also suffer more severe consequences than young men. IPV leads to substantial negative outcomes such as mental health decline, economic insecurity and/or academic underachievement. Particularly for young females, education is a powerful protective factor against re-victimisation and economic dependence which often forces women to remain trapped in abusive relationships. This review was conducted to integrate and summarise research available on IPV and its impact on young women's educational well-being to fill a significant gap in the literature. Under the guidance of PRISMA, terms related to the criteria of young women aged 10–24, IPV and education were searched in the databases EBSCO, PsycINFO, Scopus, ProQuest and CINAHL. While the initial search yielded 6005 articles, we were left with only 10 articles for the analysis. In summary, the evidence suggests that females tend to display issues around concentration, absenteeism and academic disengagement, as well as decline in performance such as failing grades and higher drop out rates. [ABSTRACT FROM AUTHOR]

Exposure to childhood victimisation (i.e. abuse, neglect, domestic violence or bullying) can detrimentally impact later psychosocial adjustment. However, this is not the case for all victimised children; some do well despite their experiences and are considered to be resilient. Understanding the factors associated with such resilience is important to inform interventions to support better psychosocial outcomes among victimised children. This review provides an overview of the extant research examining resilience factors for psychosocial outcomes during the transition to adulthood following exposure to childhood victimisation. Studies were identified through a systematic literature search of Embase, PsychINFO and Ovid MEDLINE databases. The 26 included studies spanned a range of psychosocial outcomes between ages 18–25, including education and work, housing and independent living, criminal behaviour, victimisation, and social and psychological adjustment. For each outcome, a variety of putative resilience factors had been investigated including those related to the individual, their family and the wider community within which they lived. However, because few studies had comparable resilience factors and psychosocial outcomes, it is difficult to draw conclusions about which factors are consistently associated with resilience to a particular psychosocial outcome. Additionally, this review revealed that the included studies were of variable methodological quality – many were limited by cross-sectional designs with retrospective self-reports of childhood victimisation, and convenience or unrepresentative samples. In this review, we also highlight gaps in knowledge about the co-occurring impact of multiple resilience factors in combination and the need for studies conducted in non-Western and low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Kinship care is a global phenomenon with a long history, which in high-income countries (HICs) at least, is being increasingly formalized through legislation and policy. There are many benefits to kinship care, including improved child mental health and well-being when compared to other types of out-of-home care. Despite this, kinship care is not without its risks with a lack of support and training for kinship carers putting children at an increased risk of abuse and neglect. This scoping review was conducted across 11 databases to explore the breadth and depth of the literature about abuse and neglect within kinship care in HICs and to provide initial indications about the relationship between kinship care and abuse. Of the 2,308 studies initially identified, 26 met the inclusion criteria. A majority of studies were from the United States, and most used case review methods. From the included studies, rates of re-abuse, and particularly rates of physical and sexual abuse, appear to be lower in kinship care settings when compared to other out-of-home care settings, but rates of neglect are often higher. This review has demonstrated that a small but significant number of children living in kinship care experience neglect or abuse. [ABSTRACT FROM AUTHOR]

The role of a slaughterhouse worker (SHW) involves the authorized killing of living beings, yet there is limited understanding of the consequences this behavior has on their well-being. The purpose of this systematic review is to collate and evaluate the current literature on the psychological impact of slaughterhouse employment. Fourteen studies met the specific a priori inclusion criteria. The findings from this review were demarcated by the focus of studies: (1) the prevalence of mental health disorders, (2) the types of coping mechanisms used, and (3) the link between slaughterhouse employment and crime perpetration. It was found that SHWs have a higher prevalence rate of mental health issues, in particular depression and anxiety, in addition to violence-supportive attitudes. Furthermore, the workers employ a variety of both adaptive and maladaptive strategies to cope with the workplace environment and associated stressors. Finally, there is some evidence that slaughterhouse work is associated with increased crime levels. The research reviewed has shown a link between slaughterhouse work and antisocial behavior generally and sexual offending specifically. There was no support for such an association with violent crimes, however. Based on existing research, we suggest future directions for research (i.e., applying more methodological rigor) but highlight key findings for practitioners and policymakers that warrant attention. [ABSTRACT FROM AUTHOR]

Introduction: The impact of occupational stress on the mental health and well-being of nurses is a growing concern, magnified by the COVID-19 pandemic. Such compromised health is considered an occupational and patient safety risk. Our aim is to critically examine, analyze, and synthesize the evidence regarding MBSR on the perceived stress levels of nurses including overall mental health and well-being. Methods: An integrative review was conducted. Databases included were PubMed, Embase, PsychINFO, CINAHL, and the Cochrane Library. Inclusion criteria were English only, MBSR, and practicing nurses. Results: We identified 833 articles during database searching. After removal of duplicates and two rounds of screening, 15 articles were included in the final analysis. Several themes were derived with 60% of the studies showing a significant effect of MBSR on decreasing stress. Other significant themes were the decrease in burnout and increase in mindfulness. Conclusions: MBSR may be an effective holistic method of improving mental health for nurses during the COVID-19 pandemic. In both the abbreviated and full, 8-week versions of MBSR, the findings indicate the intervention can reduce depression, anxiety, and stress. Future recommendations include larger sample sizes and measurements other than self-reports to promote generalizability. [ABSTRACT FROM AUTHOR]

Health and human service providers who aid traumatized individuals frequently experience vicarious trauma (VT). Although VT plays a critical role in service providers' mental health and well-being, as well as in the quality of their service provision, little information is available concerning the development and implementation of VT interventions for service providers. To advance the development of evidence in this area, we undertook a scoping review in which we reviewed existing interventions intended to address VT among service providers working with traumatized clients. Searches of electronic databases were conducted to identify studies published in peer-reviewed journals, with no date restrictions. Over 1,315 citations were reviewed, and a total of 27 studies were included in the final review. The findings show that VT interventions in the literature can be divided broadly into four categories: psychoeducation, mindfulness intervention, art and recreational programs, and alternative medicine therapy. The VT interventions reviewed generally showed promise in their key outcomes, including reductions in secondary trauma stress, compassion fatigue, burnout, and other mental health outcomes. However, the current body of research is lacking both in rigor and in specificity regarding the definition of VT. Furthermore, existing VT interventions are generally self-care based and tend to focus on general stress management rather than addressing the specific effects of VT. Therefore, we call for an increase in efforts to tailor VT interventions to different service settings and participant characteristics, as well as greater attention to developing primary VT interventions at the organizational level. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aims to examine the effectiveness of interventions that seek to improve outcomes of grandchildren raised by grandparents. Method: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. We searched in Education Resources Information Center (ERIC), Family Studies Abstracts, PubMed, PsycINFO, Social Work Abstracts, Sociological Abstracts, Web of Science, and Google Scholar. Results indicated that grandchildren who participated in these interventions had improvement in their socio-emotional, mental, and behavioral outcomes but had mixed educational outcomes, regardless of research designs and evaluation methods. Two out of eight studies were of high quality, while the rest needed improved rigor in designs and analyses. Conclusions: The review summarized evidence for interventions to improve grandchildren's outcomes and pointed out directions for future research and practice. [ABSTRACT FROM AUTHOR]

Recidivism among released inmates is associated with a substantial societal burden given the financial and medical consequences of victimization. Among incarcerated North Americans, approximately 7% are housed in solitary confinement (SC). Studies show SC can lead to psychological deterioration and dispute it can effectively reduce institutional misconduct or recidivism. This meta-analysis aims to clarify the impact of SC on postrelease recidivism, which we hypothesized would increase following SC. A meta-analysis was conducted using PubMed, PsycINFO, Web of Science, and Google Scholar databases from inception until December 2019. Studies on adult inmates in correctional settings were included if they met an operational definition of SC, measured recidivism, and included a comparison group in general inmate population. Random-effect models were used to assess the impact of SC on multiple types of recidivism. Of the 2,713 identified records, 12 met inclusion criteria (n = 194,078). A moderate association was found between SC and any recidivism (odds ratio [ OR ] = 1.67, 95% confidence interval [1.41, 1.97]), which persisted in controlled studies (OR = 1.41). This association was replicated across types of recidivism comprising violence (OR = 1.41), rearrests (OR = 1.37), and reincarceration (OR = 1.67). Moreover, a more recent exposure to SC increased recidivism risk (OR = 2.02), and a dose–response relationship was found between days in SC and recidivism. The overall database presented high heterogeneity but no publication bias. Findings show a small to moderate association between SC and future crime/violence. Considering the societal costs associated with antisocial behaviors following SC, mental health and psychosocial programming facilitating inmates' successful reentry into society should be implemented and rigorously evaluated in strong research design. [ABSTRACT FROM AUTHOR]

Participatory music engagement has the capacity to support well-being. Yet, there is little research that has scrutinized the processes through which music has an effect. In this meta-ethnography [PROSPERO CRD42019130164], we conducted a systematic search of 19 electronic databases and a critical appraisal to identify 46 qualitative studies reporting on participants' subjective views of how participatory music engagement supports their mental well-being. Synthesis of first-order and second-order interpretations using thematic coding resulted in four third-order pathways that account for how participatory music engagement supports mental well-being: managing and expressing emotions, facilitating self-development, providing respite, and facilitating connections. Our interpretation suggests that people benefit from participatory music engagement by engaging with specific and multiple processes that meet their individual needs and circumstances. These findings inform research directions within the field of music and well-being, as well as guiding the development and delivery of future music interventions. [ABSTRACT FROM AUTHOR]

Despite reports that over 1.3 million school-age children (ages 5–18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population. [ABSTRACT FROM AUTHOR]

There has been growing concern about the quality of health services, including mental health services, within the world’s and prisons. The purpose of the current qualitative interpretive meta-synthesis (QIMS) is to examine the prison environment and how it influences the mental health services delivered to prisoners. It is the hope of these authors that with this QIMS, knowledge improvements and modifications to current policies and practices can begin to take shape. A total of five studies published between 2003 and 2013 were utilized for this QIMS. Participants in all five studies included males and females incarcerated in England, Wales, and the United States. Three overarching themes were identified after analysis: difficulties with accessing services, difficulties with primary staff, and isolation. In each overarching theme, sub-themes are reviewed in detail. These three broad categories are discussed in relation to the person-in-environment system, demonstrating its application in an incarcerated setting. [ABSTRACT FROM AUTHOR]