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Author(s): David Kealy [sup.1] , Shelly Ben-David [sup.2] , Daniel W. Cox [sup.3] Author Affiliations: (1) grid.17091.3e, 0000 0001 2288 9830, Department of Psychiatry, University of British Columbia, , Vancouver, [...], Meaning in life is an important aspect of wellbeing for young adults transitioning into new roles. While research suggests young adults' quality of family environments is associated with meaning, few studies have examined mechanisms that explain how early parental support may facilitate young adults' sense of meaning. Understanding factors that contribute to the development of meaning can shape helping practices for young adults, particularly those lacking in earlier parental support. The present study explored the relationship between young adults' appraisals of childhood parental support and present meaning in life, through mediation effects of dispositional optimism and identity commitment. A sample of 120 young adults aged 18-25 completed assessments of early parental support, optimism, identity commitment, and meaning in life. Parallel mediation was used to examine the hypothesized model, controlling for neuroticism. Analyses supported the association between early parental support and meaning in life being mediated by optimism and identity commitment. The findings may inform prevention and intervention practices in support of healthy development and wellbeing among youth.

Aim: Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID‐19 pandemic. Methods: Data were analysed for all youth (ages 12–24) accessing both in‐person (April 27th, 2018‐March 31st, 2021) and virtual (May 1st, 2020‐March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018‐March 16th, 2020) and during (March 17th, 2020‐March 31st, 2021) the COVID‐19 pandemic were also examined. Results: A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self‐rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID‐19 pandemic. Conclusions: Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth‐centred data capture practices over time within an integrated youth services context. [ABSTRACT FROM AUTHOR]

As a framework for understanding the structural factors that affect health, the social determinants of health (SDoH) have particular significance during the developmental stage of adolescence. When the global coronavirus pandemic (COVID-19) began, public health measures (PHMs) implemented to curb its spread shifted adolescents' daily lives and routines, initiating changes to their mental health. The purpose of this study was to apply the SDoH to investigating the impacts of the pandemic-related PHMs on the mental health of adolescents in Canada. Using a youth engagement approach, interviews were conducted with 33 adolescents aged 14–19 years from two sites in Alberta, Canada. Participants shared their experiences of adjusting to the PHMs and how these shaped their mental health. Findings indicate that PHMs particularly affected the social determinants of education, access to health services, employment and income security, and social support amongst adolescents as online schooling, loss of connection with peers, income instability, and limited health services affected their mental health. Most commonly, adolescents expressed feeling greater anxiety, depression, or loneliness as the SDoH shifted with the PHMs. As we continue to understand the mental health impacts of the pandemic, the SDoH framework can be used to identify salient social determinants and evaluate these determinants post-pandemic. This study draws attention to the need for policies and programs that protect access to key SDoH at such a critical life stage as adolescence and promote their mental health resilience in shifting SDoH contexts. [ABSTRACT FROM AUTHOR]

Public health measures (PHMs) implemented during the COVID-19 pandemic introduced sudden changes to adolescents' everyday routines and required adolescents to repeatedly adapt their routines at a critical developmental stage. While meant to protect physical health, the PHMs destabilized mental health. Using a youth-engaged approach and interpretive description, this study explored adolescents' perspectives on their mental health in relation to the COVID-19 pandemic-related PHMs in Canada from March 2020 to the time of data collection in March 2022. Four Youth Research Collaborators contributed an adolescent lens to informing study activities, and a total of 33 high-school aged adolescents ages 14 to 19 completed individual interviews. Findings suggest an overarching concept of a "timeline" through which adolescents described their experiences. Most adolescents described their mental health as worsening during the initial lockdown, although some adolescents experienced positive mental health outcomes. Several adolescents felt their mental health had not recovered after the PHMs were fully lifted. This study contributes young Canadians' unique voices to the literature on the pandemic-related PHMs and adolescent mental health. It is essential that the impacts of the pandemic on adolescent mental health continue to be a focus of research and programming to better understand and address its ongoing effects. [ABSTRACT FROM AUTHOR]

Objective: Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. Methods: A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. Results: The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. Conclusions: These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness. [ABSTRACT FROM AUTHOR]

Mental illness in media can shape viewer's beliefs about mental health, help-seeking, and empathic behaviors. The current study sought to investigate how mental health and substance use is depicted in popular media targeted for youth. The visual-verbal video analysis (VVVA) framework was applied to the HBO American drama television series Euphoria to understand how mental illness, substance use, and mental health service use is portrayed, and how characters respond to mental health scenes. Euphoria follows a group of high school students as they navigate adolescence, mental illness and substance use. The VVVA provides a framework for social science and medical researchers to qualitatively analyze multimodal information (e.g., text, cinematography, music and sounds, body language and facial expressions) of visual content. This commentary will briefly describe the VVVA framework, provide an overview of how the framework was applied and adapted to analyze a scene in the television series Euphoria, note similarities and differences to the original VVVA framework, and benefits and drawbacks. The VVVA framework was flexible and effective in coding various elements (e.g., body language, camera angles) in a scene in Euphoria. [ABSTRACT FROM AUTHOR]

The present study used thematic analysis to explore participants' subjective experiences of two group approaches targeting emerging adults' possible selves. Eighty-six emerging adults were randomly assigned to one of the interventions and responded to four open-ended questions following the completion of the group program. The themes that materialized from the researchers' interpretation of the data were organized into three overarching categories. These categories included psychosocial changes (four themes), experiences that facilitated group processes (nine themes), and experiences that hindered group processes (five themes). Themes were associated with one or both interventions. The researcher's analyses of participant experiences highlighted both shared and distinct aspects of the interventions. Findings from the present inquiry provided further support for group intervention as a promising means of strengthening possible selves in emerging adulthood. Moreover, they suggest different possibilities for group counsellors to consider when offering such programming to emerging adult clients. [ABSTRACT FROM AUTHOR]

Although compassionate and reassuring self‐responding has been consistently linked with wellbeing, the involvement of identity dysfunction in this association is unclear. This study examined the interaction of self‐reassurance and identity dysfunction in relation to severity of psychological distress and social impairment among 243 clients attending mental health clinics. Participants completed measures of self‐reassurance, identity dysfunction, psychological distress, and social functioning; correlation and regression analyses were used to examine associations and interaction effects. The interaction between self‐reassurance and identity dysfunction was significant in relation to both distress and impairment, with the negative association between self‐reassurance and distress and impairment stronger as identity dysfunction diminished from high to moderate and to low levels of severity. Thus, higher self‐reassurance was most strongly associated with lower distress and impairment among clients with relatively stable identity, indicating the importance of considering identity dysfunction in counseling to enhance clients' compassionate and reassuring self‐responses. [ABSTRACT FROM AUTHOR]

Objective: With the development of 75% of mental health disorders before age 25, it is alarming that service use among youth is so low. Little theoretically driven research has explored the decision-making process youth make when accessing services. This study utilized a decision-making framework, the Unified Theory of Behavior (UTB), to understand service use among youth attending Foundry, a network of integrated youth services centres designed to support the health and wellbeing of youth. Methods: Forty-one participants were recruited from one Foundry centre in an urban community in Canada. Semi-structured interviews with participants aged 15 -- 24 explored the relationship between UTB constructs and service use. Youth and parent advisory teams were engaged in the research process. Analysts used content analysis methodology to develop a taxonomy of the top categories for each construct. Results: Categories with the most salient and rich content were reported for each construct. The impact of emotions on service use was most commonly discussed in relation to the framework. The UTB constructs 'self-efficacy' and 'knowledge' were found to be interrelated. Differences in UTB categories emerged by symptom severity. Findings pointed towards a dynamic nature of service use, whereby service use experiences, may lead youth to consider future decisions surrounding service use within Foundry. Conclusions: This study contributes to a new understanding of integrated youth services utilization. The results can help shape the development of interventions to increase service access and retention, in addition to informing the design of systems of care that are accessible to all. [ABSTRACT FROM AUTHOR]

Objective: Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be involved in making decisions about their mental health care. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population.Methods: Systematic searches of the literature through April 2020 were conducted and supplemented by hand searching of reference lists of identified studies. A total of 53 independent studies of SDM interventions that were conducted with service users with serious mental illnesses and that included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two authors.Results: Most studies were conducted with middle-age, male, White individuals from Western countries. Interventions fell into the following categories: decision support tools only, multicomponent interventions involving decision support tools, multicomponent interventions not involving decision support tools, and shared care planning and preference elicitation interventions. Most studies were randomized controlled trials with sufficient sample sizes. Outcomes assessed were diverse, spanning decision-making constructs, clinical and functional, treatment engagement or adherence, and other constructs.Conclusions: Findings suggest important future directions for research, including the need to evaluate the impact of SDM in special populations (e.g., young adults and racial-ethnic minority groups); to expand interventions to a broader array of decisions, users, and contexts; and to establish consensus measures to assess intervention effectiveness. [ABSTRACT FROM AUTHOR]

Aim: Identity‐related concerns represent an important aspect of young people's experience in early psychosis. Knowledge regarding clinicians' perspectives on this issue, however, is limited. Thus, the present study was developed to understand Canadian clinicians' perspectives on personal identity‐related concerns in early psychosis. Methods: An online survey was distributed to 331 multiprofessional clinicians working in early psychosis intervention programs in a Canadian province. Clinicians were asked about their opinions regarding the salience of identity in early psychosis using Likert‐rated items and open response questions. Results: Nearly all of the clinicians agreed that identity is an important issue for clinical attention, yet only half of the clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment. Although several clinical strategies were identified, specific evidence‐based approaches for strengthening identity in early psychosis remain lacking. Conclusions: Findings indicate a need for early psychosis programs to invest in identity‐ related training for clinicians. [ABSTRACT FROM AUTHOR]

Objective: This study investigated whether transition-age youth attending a community-based urban outpatient clinic experienced psychosis. The study also explored how those who experienced psychosis, and their social support networks, manage these experiences. Method : Data were collected as part of a feasibility trial of a psychosocial intervention for youth with mental health disorders. The sample included 55 participants ages 16–20. We used Colorado Symptom Index (CSI) psychosis items to corroborate open-ended self-report items on psychosis. Results : Of participants, 29% reported experiences of psychosis. An additional 59% did not endorse psychotic experiences but reported psychotic-like symptoms on the CSI measure. Participants who reported psychotic experiences scored higher on the CSI than those who did not report psychotic experiences. They also reported delayed disclosure, negative emotions, negative messages from family members about their experiences, and coping mechanisms. Conclusions : Multiple assessment strategies are needed to assess for psychotic experiences among youth attending clinics that do not specialize in psychotic illnesses. Social workers in low-resourced clinics are uniquely positioned to identify early stages of psychosis, provide tailored psychosocial interventions, and refer youth to specialized early psychosis clinics. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death among youth globally. In this critical interpretive synthesis, we examined literature on resiliency factors and suicidality. Systematic searches identified 474 articles, 37 of which were included. Results revealed internal (positive self‐appraisal, zest for life, personal traits, and coping skills) and external factors (social support system and inclusive environments) contribute to resilience among youth, with age, sex and gender, and Indigenous identity as important intersecting considerations. Findings validated fostering resilience as primary suicide prevention among youth, with little explanation for how these factors may work to protect youth from suicidality. Continued research in this area requires a focus on how to promote resilience at the community and systems levels. [ABSTRACT FROM AUTHOR]

Background: Engaging youth in research provides substantial benefits to research about youth‐related needs, concerns and interventions. However, researchers require training and capacity development to work in this manner. Methods: A capacity‐building intervention, INNOVATE Research, was co‐designed with youth and adult researchers and delivered to researchers in three major academic research institutions across Canada. Fifty‐seven attendees participated in this research project evaluating youth engagement practices, attitudes, perceived barriers, and perceived capacity development needs before attending the intervention and six months later. Results: The intervention attracted researchers across various career levels, roles and disciplines. Participants were highly satisfied with the workshop activities. Follow‐up assessments revealed significant increases in self‐efficacy six months after the workshop (P =.035). Among possible barriers to youth engagement, four barriers significantly declined at follow‐up. The barriers that decreased were largely related to practical knowledge about how to engage youth in research. Significantly more participants had integrated youth engagement into their teaching activities six months after the workshop compared to those who were doing so before the workshop (P =.007). A large proportion (71.9%) of participants expressed the need for a strengthened network of youth‐engaged researchers; other future capacity‐building approaches were also endorsed. Conclusions: The INNOVATE Research project provided improvements in youth engagement attitudes and practices among researchers, while lifting barriers. Future capacity‐building work should continue to enhance the capacity of researchers to engage youth in research. Researchers notably pointed to the need to establish a network of youth‐engaged researchers to provide ongoing, sustainable gains in youth engagement. [ABSTRACT FROM AUTHOR]

The rights of people with intellectual and developmental disabilities to be included in research is increasingly being recognised. Given this, there is a need for further understanding of the extent to which inclusive research practices with self-advocates have been successful in creating meaningfully collaborative research teams. The following review examined how often descriptions of methods and practice have aligned in inclusive research with people with intellectual and developmental disabilities, using the categories of advisory, leading and controlling, and collaborative group. Did the description of the research process fit the type of inclusive approach intended? A sample of 53 studies was systematically selected. Findings indicated that 48 of the 53 studies described their research process in terms of the advisory (n = 3), leading and controlling (n = 4), or collaborative group category (n = 41) and matched their intention, while 5 of the 53 studies described a collaborative group approach but enacted an advisory group approach. While the majority of articles described their process as congruent with the intentions that they set out, improvement in inclusive research practices is still needed. The use of a collaborative approach dominated, and leadership and control by people with intellectual and developmental disabilities was rare. Future research should explore the potential for self-advocates to lead. Also, the majority of the studies tended to collaborate with individuals with mild to moderate intellectual and developmental disabilities. Future research should consider a commitment to including individuals with severe to profound intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Background: There is increasing emphasis on engaging youth in research about youth, their needs, experiences and preferences, notably in health services research. By engaging youth as full partners, research becomes more feasible and relevant, and the validity and richness of findings are enhanced. Consequently, researchers need guidance in engaging youth effectively. This study examines the experiences, needs and knowledge gaps of researchers. Methods: Eighty‐four researchers interested in youth engagement training were recruited via snowball sampling. They completed a survey regarding their youth engagement experiences, attitudes, perceived barriers and capacity development needs. Data were analysed descriptively, and comparisons were made based on current engagement experience. Results: Participants across career stages and disciplines expressed an interest in increased capacity development for youth engagement. They had positive attitudes about the importance and value of youth engagement, but found it to be complex. Participants reported requiring practical guidance to develop their youth engagement practices and interest in a network of youth‐engaged researchers and on‐going training. Those currently engaging youth were more likely to report the need for greater appreciation of youth engagement by funders and institutions. Conclusions: Engaging youth in research has substantial benefits. However, skills in collaborating with youth to design, conduct and implement research have to be learned. Researchers need concrete training and networking opportunities to develop and maximize these skills. They also need mechanisms that formally acknowledge the value of engagement. Researchers and those promoting youth engagement in research are encouraged to consider these findings in their promotion and training endeavours. [ABSTRACT FROM AUTHOR]

Aim: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have the capability to recognize that they have a problem and initiate mental health services, yet there is a paucity of theoretically based research examining this decision‐making process. This is critical to study because there are high rates of underutilization of mental health services among these young people. The following study explored the decision‐making process among young adults at CHR in order to understand mental health services utilization at a CHR clinic. Methods: Semi‐structured face‐to‐face interviews were conducted with 30 young adults at CHR between the ages of 18 and 30, from an Eastern city in the United States. The study applied the unified theory of behaviour (UTB), a decision‐making framework for health behaviour, to examine service use. Content analysis with multiple coders was used. Results: The most salient constructs discussed when participants envisioned seeking services at the clinic included attitudes or beliefs about help‐seeking, social image beliefs and emotional reactions towards seeking services. Differences in UTB responses emerged depending on whether participants were engaged in clinical services and research at the time of the interview or just taking part in research follow‐ups. Conclusion: When designing future interventions to increase service utilization among young adults at CHR, programs can address health beliefs such as how services at the clinic can improve symptoms, stigma and difficult emotions such as fear and shame about seeking services, and particularly among young people who are more ambivalent about seeking clinical services. [ABSTRACT FROM AUTHOR]

Objective: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have difficulties seeking, accessing, and staying engaged with mental health services. The present study explored perspectives on engagement with mental health services among young adults at CHR. Method: In-depth interviews were conducted with 30 participants at CHR, ages 18-30, from an Eastern U.S. state. Grounded theory methodology was used to analyzed qualitative data. Results: Six major categories emerged from the data reflecting participants' perspectives of engagement with services. Contextual factors such as social, community, and online networks mattered to young adults, and individual factors such as level of awareness, stigma, emotions, and environmental factors emerged as critical. These factors suggested a conceptual model of service utilization among young adults at clinical high risk for developing psychosis that builds upon and extends existing conceptual frameworks of service use among young adults. Conclusion and Implications for Practice: A conceptual model of service utilization among young adults at CHR emerged from that data that can inform interventions aimed at improving engagement in services and reduce the amount of time young adults at CHR remain untreated for emerging psychological problems. Furthermore, this study highlights the unique contribution of mental health service use messages received from online networks and a possible relationship between hierarchical stigma and service use. [ABSTRACT FROM AUTHOR]

Research has shown that how people think about their health (or illnesses) shapes their help-seeking behavior. In this mixed-methods study, we employed a simultaneous concurrent design to explore the perceptions of mental illness among an understudied population: marginalized young adults. Participants were 60 young adults (ages 18-25) who had experienced mood disorders and used multiple public systems of care during their childhoods. Semistructured interviews were conducted to understand participants' illness and treatment experiences during the transition to adulthood. A team of analysts used constant comparison to develop a codebook of the qualitative themes, and quantitative data were examined using SAS 9.3. Findings suggest that some theoretical categories identified in past illness-perceptions frameworks are salient to marginalized young adults (e.g., identity, management-or control-of symptoms), but both the developmental transition to adulthood and experiences with public systems of care add nuanced variations to illness and treatment perceptions. Our study demonstrates that young adults possess a set of beliefs and emotions about their mental health and help-seeking options that need to be better understood to improve engagement and quality of mental health care for this population. Implications for practice, research, and policy are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Young adults face an elevated risk of developing mental illness yet are less likely to engage in mental health services than other adult age groups. The purpose of this article is to describe and present qualitative data related to the use of the arts in a group intervention designed to increase mental health service engagement in young adults with mental health challenges. Participants described feeling more understood and connected to group members through the creative arts activities and stated the use of the arts was positive, effective, and helpful in processing grief and loss. Research and practice implications are discussed. [ABSTRACT FROM PUBLISHER]

Examining the sources of health communication that young adults with mental health challenges receive regarding service use is critical to curbing the societal concern of unmet mental health needs of this population. Semistructured interviews were conducted with 59 young adults, all of whom were diagnosed with a mood disorder and used public mental health services and additional public systems of care during childhood. Thematic analysis was utilized. Of the 59 participants, 45 nominated at least one supportive adult, with a total of 97 relationships analyzed. Results indicate that the majority of messages came from informal supports (e.g., family) who spoke positively about mental health services. Fewer messages came from formal supports (e.g., professionals). Messages included statements surrounding beliefs toward services, social norms (approval and disapproval), self-efficacy, and image considerations around using services. These findings can suggest ways that mental health service engagement interventions can leverage communication from informal supports. Future research can explore what messages young adults find most influential in persuading them to use mental health care consistently and the relationship between messages and health behavior. [ABSTRACT FROM AUTHOR]

Background: Transition-age youth have elevated rates of mental disorders, and they often do not receive services. This is a serious public health concern, as mental health conditions persist into adulthood. Continuing to engage this population has been a pervasive challenge for the mental health care system worldwide. Few mental health interventions have been developed for transition-age youth, and even fewer have been found to be effective over the transition to adulthood. Cornerstone, a theoretically guided intervention has shown promise for addressing the mental health and psychosocial needs of this population as they emerge into adulthood. Cornerstone provides case management, trauma-focused cognitive behavioral therapy, mentoring/peer support, community-based in vivo practice, and groups to address stigma, mistrust, and practical skill development to improve the transition to independence among transition-age youth with serious mental health conditions. Methods/design: This study utilizes a hybrid research design and focuses on examining feasibility, acceptability and preliminary impact, along with factors that influence implementation, to maximize new knowledge. The study combines qualitative methods and a randomized controlled trial, using data to inform and refine protocols and manuals, while testing the preliminary impact of the intervention, compared to best available services (treatment as usual, TAU) at a partnering outpatient mental health clinic (n = 60). Contributors to the intervention development research (n = 20) are national experts on mental health services, clinic administrators and staff and young adults with direct experience. The intervention involves intensive staff training and 18 months of ongoing service provision, monitoring and supervision. Quantitative survey data will be collected at baseline, 3 months, 6 months, and 9 months measuring mental health and practical life outcomes via self-report measures. Medical records will be used to triangulate self-report data (i.e., primary diagnosis, treatment planning and attendance). Qualitative data focuses on the intervention development process and implementation research and will use constant comparison coding techniques. In this intention-to-treat analysis, we will conduct basic omnibus analyses to examine whether Cornerstone leads to improved outcomes relative to TAU utilizing t tests across treatment conditions for each outcome measure specified. We will likewise examine whether changes in the proposed mediating variables differ across groups. Discussion: The aim of this study is to refine Cornerstone through an intensive preliminary trial, learning through collaboration with clinic staff, project team members, and leaders in New York State and nationwide on how to best serve transition-age youth with serious mental health conditions. Cornerstone has the potential to fill a large gap in the service system for transition-age youth with serious mental health conditions, and may enhance the menu of care options for those who have been recently diagnosed with a serious mental health condition, and yet, have a long life to live. The program is recovery-oriented, builds on the best evidence to date, and is in line with both local and national health care reform efforts. [ABSTRACT FROM AUTHOR]

Background: A recent narrative review of the research literature (Ben-David & Kealy, 2019) found that identity-related concerns were an important aspect of young people’s experiences in the early stages of psychosis. Themes across articles suggested that the emergence of psychosis leads to identity disruption, which in turn may contribute to additional mental health risks. Moreover, studies indicated the salience to young people of addressing personal identity during the recovery process. Understanding clinicians’ perspectives on issues related to identity in early psychosis is an important next step, particularly to determine needs for knowledge development, clinician support, and intervention practices. The current literature on clinician’s perspective on early psychosis and identity is limited, with more attention placed on clinician’s perspectives on the use of medication, and psychosocial interventions (e.g. cognitive behavioral therapy (CBT)). The purpose of the present study was to understand the perspectives of early psychosis intervention (EPI) clinicians on identity related concerns among young people in the early stages of psychosis. Methods: An online questionnaire was distributed to 331 EPI clinicians in the province of British Columbia, Canada. Participants were asked about their opinions on identity in the early stages of psychosis using fixed and open response questions. The open-ended response question “what kinds of interventions do you think would strengthen clients’ personal identity in the early stages of psychosis?” was coded by two investigators, using content analysis methodology. Results: The response rate was 30%. Of the participants, 98% agreed that personal identity is an important issue for clinical attention among young people in the early stages of psychosis, and 99% agreed that schizophrenia spectrum disorders can have a negative impact on a young person’s identity. Despite near-unanimous acknowledgement of identity as a critical issue in early psychosis, only 53% of clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment, and only 28% agreed that current intervention practices adequately address personal identity. Seventy-four percent of the participants provided qualitative responses regarding intervention approaches that they believed would strengthen clients’ personal identity in the early stages of psychosis. Common themes included social connection and peer support, therapeutic interventions (e.g. CBT, mindfulness, narrative therapy, psychoeducation), focusing on the youths strengths, involving family in the work, connecting youth to personal identity (e.g. exploring culture, values, interests and sources of meaning, storytelling), and enhancing relationships between service providers and youth. Discussion: EPI clinicians in British Columbia agree that personal identity in the early stages of psychosis is an important issue. However, they indicated feeling markedly less confident in their ability to address issues related to identity in treatment. Findings suggest that EPI programs should invest in identity- related training for clinicians. Future research can focus on the impact of identity-related interventions with regard to treatment engagement and client recovery outcomes. [ABSTRACT FROM AUTHOR]

Objective: Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. Methods: Audiotaped interviews were conducted with 27 participants of diverse racial-ethnic backgrounds who were at clinically high risk of psychosis (15 males and 12 females; mean age 21). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. Results: Emergent themes differed by gender. Themes for males were feeling abnormal or "broken," focus on going "crazy," fantasy and escapism, and alienation and despair, with a desire for relationships. Themes for females were psychotic illness among family members, personal trauma, struggle with intimate relationships, and career and personal development. Conclusions: The finding of relative social engagement and future orientation of females identified as at risk for psychosis is novel and has implications for outreach and treatment. [ABSTRACT FROM AUTHOR]

Objective: Race and gender differences in help seeking are well-established; however, reasons for these differences are less clear. This study examined race and gender differences in two potential contributors--perceptions of illness and attitudes toward treatment--in a sample of marginalized young adults. Method: Interviews were conducted with young adults (age 18--25) with prior involvement in public systems of care and mood disorder diagnoses (n = 60). A quantitative interview assessed illness perceptions and attitudes followed by a qualitative interview focused on perceptions of mental illness and treatment. Analyses examined quantitative differences across four race/gender subgroups--White women (n = 13), White men (n = 6), women of color (n = 27), and men of color (n = 14), then qualitative results were reviewed for a subset of cases (n = 30) to understand differences revealed in the quantitative analyses. Results: Women of color had lower scores on illness understanding compared to other groups and men of color had lower scores on chronicity. Attitudes including propensity toward help seeking and stigma resistance were lowest in men of color, followed by women of color. Qualitative findings supported that men of color viewed their symptoms as less chronic and managed symptoms by changing their mindset rather than formal treatments. White participants talked more about their illnesses as chronic conditions and spoke more positively of treatment. Conclusion and Implications for Practice: Race/gender differences were identified, particularly in relation to views of mental illness and stigma. Messaging that highlights independence and strength in relation to managing symptoms may be particularly important for young people of color. [ABSTRACT FROM AUTHOR]

Background/objectives: Anhedonia is associated with poor social function in schizophrenia. Here, we examined this association in individuals at clinical high risk (CHR) for schizophrenia and related psychotic disorders, taking into account social anxiety. We then explored correlations between anhedonia and basal metabolic activity in selected forebrain regions implicated in reward processing., Methods: In 62 CHR individuals and 37 healthy controls, we measured social adjustment (Social Adjustment Self-Report Scale), social and physical anhedonia (Chapman Revised Anhedonia Scales), and social anxiety (Social Anxiety Scale for Adolescents) in cross-section. In a subgroup of 25 CHR individuals for whom high-spatial-resolution basal-state functional magnetic resonance imaging data were available, we also assessed correlations of these socio-affective constructs with basal cerebral blood volume in orbitofrontal cortex and related regions involved in reward processing., Results: Relative to controls, CHR individuals reported social impairment, greater social and physical anhedonia, and more social anxiety, exhibiting impairments comparable to schizophrenia. Regression analyses showed that anhedonia predicted social impairment and correlated negatively with basal cerebral blood volume within the orbitofrontal cortex (all P's<0.05)., Conclusions: Anhedonia and social anxiety are prominent in CHR individuals. Trait-like anhedonia may be a core phenotype related to orbitofrontal cortical function that, independent of symptoms, predicts social impairment. These data provide a rationale for interventions that target anhedonia and related activity in orbitofrontal cortical circuits in CHR individuals.