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Life events as a risk factor for psychological problems in individuals with intellectual disabilities: a critical review
- Authors:
- HULBERT-WILLIAMS L., HASTINGS R.P.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(11), November 2008, pp.883-895.
- Publisher:
- Wiley
Stressful life events such as bereavement, moving house and changing jobs have repeatedly been implicated as risk factors for mental and physical ill health. Since the 1940s, researchers have demonstrated the negative effects of stressful life events, refined methods of recording such events and investigated the relative impact of different types of event. These investigations have generally not extended to include people with intellectual disabilities. A narrative review of research on life events as they occur to people with intellectual disabilities was conducted and the evidence that life events function as a risk factor for psychological problems critically assessed. Evidence was reviewed for an association between life events and a range of outcome variables, including affective disorders, challenging behaviour, psychosis and psychological problems more generally. The methodology behind the current evidence base was critiqued and a number of methodological advances that would help to strengthen it discussed. There is reasonable evidence that life events are associated with psychological problems, and that there is some tentative evidence that life events play a causal role, although to date, no relationship with psychosis in people with intellectual disabilities has been demonstrated. Life events are likely to be pertinent in clinical work with people with intellectual disabilities.
Effectiveness of a stress-relief initiative for primary caregivers of adolescents with intellectual disability
- Authors:
- HU Jung, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 35(1), March 2010, pp.29-35.
- Publisher:
- Taylor and Francis
This study provides a perspective on the mental health status and analyses the effectiveness of a stress-relief programme for primary caregivers of adolescents with intellectual disability. Seventy-seven primary caregivers of people with intellectual disability living in Taiwan were recruited, of which 31 were in the intervention group, and 46 in the non-intervention group. The study involved participation in one stress management workshop (intervention group only) and both groups reading an education booklet on stress management. Findings revealed that 22% of caregivers in the study were at high risk of depressive stress and in need of mental health consultation. This prevalence was nearly six times that of the general population. The effectiveness of mental health initiatives resulted in a significant reduction in depressive stress for the intervention group. The authors concluded that face-to-face workshop were an effective way to decrease levels of depressive stress in the sample group.
Affiliate stigma among caregivers of people with intellectual disability or mental illness
- Authors:
- MAK Winnie W. S., CHEUNG Rebecca Y. M.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 21(6), November 2008, pp.532-545.
- Publisher:
- Wiley
Affiliate stigma refers to the extent of self-stigmatization among associates of the targeted minorities. Given previous studies on caregiver stigma were mostly qualitative in nature, a conceptually based, unified, quantitative instrument to measure affiliate stigma is still lacking. Two hundred and ten caregivers of people with intellectual disability (CPID) and 108 caregivers of people with mental illness (CPMI) were recruited through non-governmental organizations and self help organizations in various districts of Hong Kong to validate the 22-item Affiliate Stigma Scale with caregiving stress, subjective burden and positive perceptions. Exploratory factor analysis suggested that the scale was unidimensional, with excellent internal consistencies for both CPID and CPMI. It showed good predictive validity on subjective burden, after the extent of caregiving involvement and caregiving stress were controlled for. Implications on psychoeducation and stigma reduction were discussed. The newly developed scale provided a quantitative instrument with which affiliate stigma can be compared across different conditions.
A general practice-based prevalence study of epilepsy among adults with intellectual disabilities and of its association with psychiatric disorder, behaviour disturbance and carer stress
- Authors:
- MATTHEWS T., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 52(2), February 2008, pp.163-173.
- Publisher:
- Wiley
The aims of this study were to determine the prevalence and features of epilepsy in a community-based population of adults with ID, and to explore whether the presence of epilepsy was associated with greater psychopathology or carer strain. Data were collected on the age, gender, place of residence, adaptive and challenging behaviour, social abilities and psychiatric status of 318 adults from 40 general practices in South and Mid Wales, together with the degree of malaise and strain of family carers. For participants with epilepsy, a nurse collected information on seizures, investigations, treatment and carer concerns by interview. Association between epilepsy and psychiatric morbidity, challenging behaviour and caregiver malaise or strain, was explored by comparing those with epilepsy with a comparison group matched on adaptive behaviour. Fifty-eight participants (18%) had epilepsy: 26% were seizure free, but 34% had extremely poorly controlled seizures. Earlier onset and seizure frequency were associated with adaptive behaviour. Carer concerns were related to seizure frequency and a history of injury. There were no significant differences in psychopathology, carer malaise or caregiver strain between the matched epilepsy and non-epilepsy groups. This study supports the high occurrence and chronicity of epilepsy among people with ID. While psychopathology and carer strain is common within this population, underlying disability-related factors appear to be more important than the presence of epilepsy per se.
A preliminary study of perceived stress in adults with intellectual disabilities according to self-report and informant ratings
- Authors:
- LUNSKY Yona, BRAMSTON Paul
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 31(1), March 2006, pp.20-27.
- Publisher:
- Taylor and Francis
Stress is a major risk factor for mental health problems in individuals with intellectual disabilities, however few studies on stress have been conducted that take into account the perspective of both the person with the disability and the caregiver. The present study evaluated an informant version of the Lifestress Inventory, and compared it to the self-report version. Seventy individuals with intellectual disability paired with their caregivers completed the Lifestress Inventory, the Inventory of Negative Social Interactions and the Birleson Depression Scale. Informant and self-report ratings on the Lifestress Inventory were internally reliable, showed modest agreement with each other and correlated with the Negative Social Interactions and Depression measures. The most troublesome stressors reported by informants and self-reports differed, however, and families tended to agree more with self-reports than did staff informants. The informant version of the Lifestress Inventory is a suitable parallel instrument but not a replacement for self-reports.
Associations between behaviours that challenge in adults with intellectual disability, parental perceptions and parental mental health
- Authors:
- WAITE Jane, et al
- Journal article citation:
- British Journal of Clinical Psychology, 56(4), 2017, pp.408-430.
- Publisher:
- Wiley
Objectives: This study examined parental perceptions of behaviours that challenge (CB) in their adult children with intellectual disability (ID), and explored whether perceptions mediated associations between CB and parental psychological distress. Design: A within-group correlational design was employed. Methods: Sixty-five parents reported on individuals with genetic syndromes and ID who had chronic CB. Parents completed the Illness Perception Questionnaire-Revised (IPQ-R) adapted to measure perceptions of self-injury, aggression or property destruction, alongside assessments of parental locus of control, attributions about behaviour, parental psychological distress, and CB. Results: A high proportion of parents evidenced anxiety and depression at clinically significant levels (56.9% and 30.8%, respectively). Contrary to predictions, psychological distress was not significantly associated with CB. The perception that the adult with ID exerted control over the parent's life mediated the association between CB and parental psychological distress. Few parents endorsed operant reinforcement as a cause of CB (< 10%). Conclusions: The high levels of psychological distress in parents is notable and of concern. Further research should consider the reasons why parents have causal attributions that might be inconsistent with contemporary interventions. Practitioner points: 1) Parents experience high levels of psychological distress while supporting adults with ID who engage in chronic behaviours that challenge; 2) A stronger belief that the adult with ID exerts control over the parent's life may mediate an association between CB exhibited by the individual with ID and parental psychological distress; 3) Few parents endorsed operant reinforcement as a cause of behaviours that challenge. (Publisher abstract)
Mental health staff views on improving burnout and mental toughness
- Authors:
- POSNER Zoe, JANSSEN Jessie, RODDAM Hazel
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 12(4), 2017, pp.249-259.
- Publisher:
- Emerald
Purpose: Burnout in mental health staff is acknowledged as a major problem. The purpose of this paper is to gain an understanding of mental health staff views on improving burnout and mental toughness in mental health staff. Design/methodology/approach: Ten participants from two mental health rehabilitation units across the north-west of England took part in a Nominal Group Technique. Participants consisted of mental health workers from varied roles in order to capture views from a multidisciplinary team. The main question posed to the staff was “What strategies and techniques do you think could help improve burnout and mental toughness in mental health staff”. Findings: The study revealed that the top three ideas to take forward to help improve burnout and mental toughness in mental health staff were improving the culture/organisation, improving staff wellbeing and education. Additionally, staff were highly motivated and enthusiastic about engaging in discussion about what could be done to improve their wellbeing and the importance of taking this forward. Originality/value: This study is unique in involving mental health staff in discussing their ways of improving their mental health. It is also unique as it has found the nine strategies to do this and these could be used in targeted training for mental health staff (Publisher abstract)
A psychodynamic interpretation of staff accounts of working with people who have learning disabilities and complex needs
- Authors:
- STOREY Judith, COLLIS Mary-Ann, CLEGG Jennifer
- Journal article citation:
- British Journal of Learning Disabilities, 40(3), September 2012, pp.229-235.
- Publisher:
- Wiley
Staff working with patients who have learning disabilities and complex mental health needs may experience negative emotions towards the patients. The aim of this study was to examine whether a psychoanalytical analysis can help in the understanding of staff accounts of their work. Interviews were conducted with 8 staff (6 qualified nurses and 2 nursing assistants) working with people who have a learning disability and complex mental health needs. The interviews aimed to elicit the participant’s conscious and unconscious reactions to their work. The findings were analysed using the free association narrative interview approach. The participants reported that organisational factors such as not having enough permanent staff and having to manage a complex patient mix impacted upon their work. Participants’ unconscious communications were interpreted as evidence that they were experiencing projected anxiety from their patients. Participants did not appear to be given opportunities in work to reflect upon their emotions and often coped by repressing painful experiences or displacing these onto the organisation. The article concludes that staff would benefit from exploring their conscious and unconscious reactions to their patients.
The adaptation and application of mindfulness-based psychotherapeutic practices for individuals with intellectual disabilities
- Author:
- ROBERTSON Bronwyn
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 5(5), 2011, pp.46-52.
- Publisher:
- Emerald
This paper reviews the adaptation and application of mindfulness-based psychotherapeutic practices in the treatment of anxiety, mood disorders, and maladaptive behaviour in individuals with intellectual disabilities (ID). It also explores current research related to mindfulness-based stress management for the parents and caregivers of individuals with ID. Current research and practice supports the clinical efficacy of mindfulness-based psychotherapy in the treatment of anxiety, mood, stress, aggression, and self-injury in individuals with intellectual disabilities. It also suggests that it can enhance coping and stress management in parents and caregivers. The author suggests that the experiential, and skills-based practices of mindfulness-based psychotherapy make it easily adaptable and applicable for use with individuals with intellectual disabilities who have varying mental health and behavioural challenges. She recommends further research and utilisation of mindfulness-based therapy with this population.
Stress, depression, workplace and social supports and burnout in intellectual disability support staff
- Authors:
- MUTKINS E., BROWN R.F., THORSTEINSSON E.B.
- Journal article citation:
- Journal of Intellectual Disability Research, 55(5), May 2011, pp.500-510.
- Publisher:
- Wiley
Work stress, described as when the perceived demands of a job exceed one’s internal and external resources to do the job, is common in staff providing support to people with intellectual disabilities, putting them at increased risk of burnout. Stressors typically reported by those working in this environment include, challenging behaviour, interpersonal issues with colleagues and organisational concerns. The small prior literature provides little consensus on predictors of burnout in disability support staff. This study examined client behaviour, staff psychological stress, anxiety, depression, social support (number and satisfaction), organisational support and burnout in 80 disability support staff in a community setting in Australia. Burnout levels were similar to or slightly lower than normed values for human services staff. Cross-sectional regression analyses indicated that depression symptoms and organisational support were related to worse emotional exhaustion and depersonalisation, whereas less social support was related to less personal accomplishment. Social support satisfaction (but not social support number or organisational support) moderated between high psychological stress and less emotional exhaustion. Taken together, these results suggest that depression symptoms and low organisational support are often concurrent with burnout symptoms. Worker’s personal and organisational supports may help to bolster their sense of personal accomplishment and buffer against the potential for emotional exhaustion.