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Background: ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. Methods: Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. Results: The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. Conclusion: The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Home‐visiting mental health professionals (HMHPs) have an important role in identifying suspected child maltreatment in the community. However, it is unclear how professionals in Hong Kong differentiate acceptable discipline behaviours from reportable forms of abuse, and how their characteristics may influence their view. This study examined HMHPs' views on acceptable versus unacceptable parent discipline behaviours. Using Q‐methodology, 50 HMHPs in Hong Kong sorted 52 statements on parent discipline behaviours along a continuum ranging from 'Most Unacceptable' to 'Most Acceptable'. By‐person factor analysis was conducted to uncover prevailing views based on their sorts. Three unique viewpoints in differentiating discipline behaviours from abuse were uncovered, which varied based on how HMHPs prioritised children's physical safety, mental wellness and parental intention. Different views were supported by professionals with different characteristics and occupational backgrounds. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10‐year cardiovascular disease risk (CVD‐R) scores and low quality of life (QOL).There is a lack of understanding about CVD‐R scores in people diagnosed with early psychosis and no studies have quantified CVD‐R using the QRISK®3 calculator in this client group.Establishing potential relationships between modifiable lifestyle behaviours/treatment characteristics with CVD‐R or QOL may identify targets for early intervention. What the paper adds to existing knowledge?: This is the first study to quantify the individual 10‐year CVD‐R of people diagnosed with early psychosis utilising the QRISK®3 calculator.This is also the first study to investigate relationships between QOL and CVD‐R and lifestyle factors in a cohort of Thai people diagnosed with early psychosis.We observed low levels of physical health‐related QOL and high levels of CVR‐R despite participants reporting relatively positive lifestyle behaviours. What are the implications for practice?: The cardiometabolic health state of this client group warrants as much attention as for those with an enduring severe mental illness; early preventative interventions are warranted.It may be useful to routinely quantify the CVD‐R of people diagnosed with early psychosis using the QRISK®3 calculator, even in the absence of immediate concerns about lifestyle behaviours.Mental health nurses should utilise evidence‐based approaches such as increasing activity levels, dietary counselling and behaviour change interventions to mitigate poor physical health in this client group. Introduction: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10‐year cardiovascular disease risk (CVD‐R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims: To quantify CVD‐R in people diagnosed with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD‐R/QOL. Method: Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK®3, BMI and waist circumference). Participants self‐reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD‐R were explored. Results: Participants' relative risk for CVD over 10 years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD‐R or QOL with treatment characteristics and lifestyle factors. Discussion: Despite positive lifestyle behaviours, participants had elevated CVD‐R scores and poor physical health‐related QOL. Quantifying CVD‐R with QRISK®3 may highlight the need for health promotion interventions. Implications for practice: Mental health professionals should be aware that elevated CVD‐R exists in the context of relatively healthy lifestyle behaviours and utilise evidence‐based interventions to address these issues. [ABSTRACT FROM AUTHOR]

Introduction: Even as children experience adversity, they can become resilient adults, in large part due to their social supports as emerging adults. Objective: Authors examine constructs of social support applied to the concept of resilience among emerging adults having experienced adverse childhood experiences (ACE). Method: Authors conducted a meta-ethnography with six databases between January 1998 and October 2019. Inclusion criteria were as follows: (i) original peer-reviewed qualitative or mixed-method studies, (ii) sampling adults aged 18–35 years, (iii) reporting at least one ACE as defined by the World Health Organization, (iv) focused on resilience, and (v) in English. Data were collected from six electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science, and Google Scholar). Studies were appraised using the Critical Appraisal Skills Program Qualitative Checklist. Analysis drew on Bourdieu's constructs of capital following Noblit and Hare's methods. Results: Thirteen studies of 277 emerging adults, aged 18–35 years old (mean 23 years), from six countries, reported resilience as "self-righting" appraisals. These were interdependent of their social supports and within a culturally determined sense of self-reliance. Self-reliance appeared to be a precursor shaping resilience of emerging adults with ACE. Self-reliance may deter self-compassion and, as a self-righting appraisal/capacity, may inhibit accessing social support. Conclusion: This review emphasizes the life stage of emerging adulthood regarding the development of self-righting appraisal skills, which, when enabled with reliance, others help to transform ACEs and allow resilience to grow. [ABSTRACT FROM AUTHOR]

Background: Dimensional models of psychopathology are increasingly common and there is evidence for the existence of a general dimension of psychopathology ('p'). The existing literature presents two ways to model p: as a bifactor or as a higher-order dimension. Bifactor models typically fit sample data better than higher-order models, and are often selected as better fitting alternatives but there are reasons to be cautious of such an approach to model selection. In this study the bifactor and higher-order models of p were compared in relation to associations with established risk variables for mental illness. Methods: A trauma exposed community sample from the United Kingdom (N = 1051) completed self-report measures of 49 symptoms of psychopathology. Results: A higher-order model with four first-order dimensions (Fear, Distress, Externalising and Thought Disorder) and a higher-order p dimension provided satisfactory model fit, and a bifactor representation provided superior model fit. Bifactor p and higher-order p were highly correlated (r = 0.97) indicating that both parametrisations produce near equivalent general dimensions of psychopathology. Latent variable models including predictor variables showed that the risk variables explained more variance in higher-order p than bifactor p. The higher-order model produced more interpretable associations for the first-order/specific dimensions compared to the bifactor model. Conclusions: The higher-order representation of p, as described in the Hierarchical Taxonomy of Psychopathology, appears to be a more appropriate way to conceptualise the general dimension of psychopathology than the bifactor approach. The research and clinical implications of these discrepant ways of modelling p are discussed. [ABSTRACT FROM AUTHOR]

Background. ß-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point of care. Methods. We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at 3 hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving nonpreferred therapy due to severity of their reported allergy. The primary outcome was the proportion of patients receiving the preferred ß-lactam therapy. Results. Of 827 patients with reported ß-lactam allergy over 15 months, ß-lactam therapy was preferred among 632 (76%). During baseline periods, 50% (124/246) received preferred ß-lactam therapy based on history, compared with 60% (232/386) during the intervention periods (P = .02), which improved further to 81% (313/386) upon provision of BLAST (P < .001) without any increase in incidence of adverse drug reactions (4% vs 3%; P = .4). After adjusting for patient variables and the correlation between hospitals, the intervention period was associated with a 4.5-fold greater odds of receiving preferred ß-lactam therapy (95% confidence interval, 2.4-8.2; P < .0001). Conclusions. The use of BLAST at the point of care across 3 hospital ASPs resulted in greater use of preferred ß-lactam therapy without increasing the risk of adverse drug reactions. Longer-term studies are needed to better assess the safety and clinical impact of this ASP intervention. [ABSTRACT FROM AUTHOR]