Emily Hielscher

Intergroup relationships do not reduce racial bias in empathic neural responses to pain

Perceiving the pain of others activates similar neural structures to those involved in the direct experience of pain, including sensory and affective-motivational areas. Empathic responses can be modulated by race, such that stronger neural activation is elicited by the perception of pain in people of the same race compared with another race. In the present study, we aimed to identify when racial bias occurs in the time course of neural empathic responses to pain. We also investigated whether group affiliation could modulate the race effect. Using the minimal group paradigm, we assigned participants to one of two mixed-race teams. We examined event-related potentials from participants when viewing members of their own and the other team receiving painful or non-painful touch. We identified a significant racial bias in early ERP components at N1 over frontal electrodes, where Painful stimuli elicited a greater negative shift relative to Non-Painful stimuli in response to own race faces only. A long latency empathic response was also found at P3, where there was significant differentiation between Painful and Non-Painful stimuli regardless of Race or Group. There was no evidence that empathy-related brain activity was modulated by minimal group manipulation. These results support a model of empathy for pain that consists of early, automatic bias towards own-race empathic responses and a later top-down cognitive evaluation that does not differentiate between races and may ultimately lead to unbiased behaviour.

The availability of evidence-based practices in supported employment for Australians with severe and persistent mental illness

Evidence-based practices in supported employment andvocational rehabilitation for people with severe and per-sistent mental illness (SPMI) are not yet widely avail-able in Australia. SPMI includes schizophrenia, bipolaraffective disorder, and other psychotic disorders, alongwith severe forms of other psychiatric conditions. Muchis known about the most effective practices in helpingpeople with SPMI to obtain and retain competitiveemployment (Bond, Drake & Becker, 2012), yet theseeffective practices continue to be ignored by existingpolicies and programmes (Carr & Waghorn, 2013). Achange of Australian Government in 2013, and subse-quent changes to departmental responsibilities providesa unique opportunity to revisit this problem. The pur-pose of this viewpoint is to inform Occupational Thera-pists about what can be done to make evidence-basedpractices more widely available to people with SPMI.This is important because Occupational Therapistsworking in this field have the qualifications to lead theimplementation of evidence-based supported employ-ment programmes.

Why are psychotic experiences associated with self-injurious thoughts and behaviours? A systematic review and critical appraisal of potential confounding and mediating factors

Psychotic experiences (PEs), including hallucination- and delusion-like experiences, are robustly associated with self-injurious thoughts and behaviours (SITB) in the general population. However, it remains unclear as to why there is an association. The purpose of this systematic review was to elucidate the role of other factors that influence the association between PEs and SITB and, in doing so, highlight potential mechanisms underlying the relationship. A search of electronic international databases was undertaken, including PubMed, PsycINFO and EMBASE, and eligible studies were grouped according to seven confounder categories: sociodemographics, mental disorders, alcohol and substance use, environmental, psychological, intervention and family history/genetic factors. The systematic search strategy identified 41 publications reporting on 1 39 427 participants from 16 different countries. In the majority of studies, where adjustment for other variables occurred, the association between PEs and SITB persisted, suggesting PEs have an independent role. Common mental disorders, psychological distress and negative environmental exposures explained a substantial amount of the variance and therefore need to be considered as potential underlying mechanisms. There was high variability in the variables adjusted for in these studies, and so the question still remains as to whether the association between PEs and self-harm/suicidality can be attributed (fully or in part) to confounding and mediating factors or directly causal mechanisms. Regardless of causality, the now extensive literature reporting an association between these two clinical phenomena supports the broad usefulness of PEs as an indicator of risk for SITB.

The impact of psychotic disorders and co-morbid substance abuse on vocational rehabilitation: results from an Australian national survey of psychosis

Introduction It is unclear from prior research whether or not substance abuse co-morbid with psychosis is an added barrier to success in vocational rehabilitation. The aim of this study was to examine the relationships among three types of co-morbid substance abuse or dependence, by type of employment assistance received (disability employment services, mainstream unemployment services, other government programmes, and own resources), and by type of employment attained (competitive and non-competitive). Method Data were drawn from the Australian National Survey of High Impact Psychosis (N = 1825). The survey was conducted in seven Australian catchment areas March to December 2010. Descriptive statistics and logistic regression methods were used. Results There were no added effects of lifetime substance abuse or dependence on any employment. However, there were some minor substance-specific effects. Past year cannabis use was negatively associated, while alcohol use was positively associated with being employed. All categories of lifetime substance abuse or dependence were associated with reduced utilisation of intensive forms of employment assistance. Conclusion At a population level, lifetime substance abuse or dependence had no added impact on current employment status. Those with psychosis co-morbid with lifetime substance abuse or dependence could benefit from greater utilisation of evidence-based supported employment.

Managing disclosure of personal information: an opportunity to enhance supported employment

OBJECTIVE To first provide an overview of studies that explore mental health disclosure in the workplace; including factors that influence the decision to disclose, and differing approaches to disclosure (binary, multidimensional, and evolving and ongoing). Second, to provide a critical overview of existing tools designed to help clients manage their mental health disclosure decisions. METHOD Electronic searches of PubMed, PsycINFO and ScienceDirect were undertaken, excluding all articles published prior to 1990. The following search terms were used: mental health disclosure, employment, severe and persistent mental illness, psychosis, schizophrenia, supported employment, individual placement and support (IPS). RESULTS We found that mental health disclosure involves a complex decision-making process, and yet clients of IPS supported employment are currently provided with little structured guidance on how to manage their personal information in the workplace. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE More extensive investigations are required of existing mental health disclosure tools before they can be developed into a standardized intervention for practitioners. However, preliminary evidence suggests that facilitating better disclosure decisions and management of personal information is a promising area of future research. This line of investigation is likely to find ways to enhance competitive employment outcomes in supported employment for people with severe and persistent mental illness.

Cognitive and clinical indicators of employment assistance needs from a national survey of individuals living with psychosis

OBJECTIVE The aim of this secondary analysis was to explore global functioning, course of illness (the number of episodes since onset and the degree of recovery between episodes), duration of illness, and cognitive ability as potential indicators of the extent of employment assistance needs. METHOD A secondary analysis of Australias second national survey of psychosis was undertaken. Screening for psychosis took place during March, 2010 at 7 national locations, within public mental health services and nongovernment organizations. Next, 1,825 of the 7,955 who screened positive for psychosis were randomly selected and completed face-to-face interviews. Of those, 1,619 also completed the Digit Symbol Coding Test (DSCT), a measure of current general cognitive ability. RESULTS In epidemiological surveys, employment status is an important proxy indicator of employment assistance needs. The strongest correlates of any versus no employment in the current survey were: global functioning as represented by Personal and Social Performance Scale (PSP) total score, age, general cognitive ability as represented by DSCT scores, course of illness, and educational attainment. These correlates persisted following adjustment in a multivariate model. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Subject to the limitations identified, global functioning, cognitive ability, and course of illness were the most promising clinical and cognitive indicators of more intensive employment assistance needs. The demographic variables age and educational attainment indicated additional labor market disadvantage, which could also help to identify those more likely to need intensive employment assistance. These results inform further investigations aimed at developing a practical measure of employment-related psychiatric disability. (PsycINFO Database Record

An Exploration of the Interaction Between Touch Avoidance and the Pleasant Touch (C-Tactile Afferent) System

C-tactile (CT) afferent fibers are optimally stimulated by slow gentle stroking, and an inverted U-shaped relationship exists between stroking velocity and pleasantness ratings of this type of touch. This study investigated whether an additional and potentially important variable, touch avoidance, interacts with this relationship. While a typical U-shaped velocity–pleasantness relationship was expected, those high in touch avoidance were expected to rate CT-targeted touch (1–10 cm/s) as less pleasant than those low in touch avoidance. Thirty-five participants rated the pleasantness of a brush stroked across their forearm at five velocities (0.3, 1, 3, 10, 30 cm/s) administered by a custom-built touch stimulator (“the touch device”). Participants also completed two self-report measures of touch avoidance. There was an inverted U-shaped relationship between velocity and pleasantness ratings, and high touch avoidance resulted in a downward shift of this curve. The downward shift was across all velocities, including those that do not maximally engage CT afferents. It appears that touch avoidance reduces the pleasantness of all kinds of touch in a similar way, and it is unlikely to be specifically related to CT afferent functioning. Other potential mechanisms leading to touch avoidance are discussed.

Self-stigma and fears of employment among adults with psychiatric disabilities

Introduction Although mental illness stigma has been extensively investigated, it is not known whether stigma experiences increase general fears of employment and impact on employment goals and on attaining employment. The aims of this study were to develop and trial brief measures of employment values and employment fears that could be used to further investigate any impacts of community stigma on personal employment goals. Method The psychometric properties of a new Employment Fears Scale and an Employment Values Scale were examined over a 2–4-week period, following repeated administration to 25 adult community residents with severe mental illness. Concurrent validity with respect to experiences of stigma, self-stigma, and current and previous employment were also examined. Results Employment fears and employment values can be reliably measured. Employment fears were more closely related to self-stigma than either current employment or employment over the previous year. Conclusion The Employment Fears Scale in particular appears to be useful for investigating stigma-related barriers to employment among people with psychiatric disabilities. Occupational therapists can use these tools to explore how those fears might be reduced through tailored interventions aiming to improve an individual’s employment prospects in vocational rehabilitation.

S137. DO HALLUCINATIONS PREDICT THE TRANSITION FROM SUICIDAL THOUGHTS TO ATTEMPTS? RESULTS FROM AN AUSTRALIAN LONGITUDINAL COHORT STUDY

Abstract Background Although suicidal ideation is a well-documented risk factor for suicidal behaviour, the majority of those with suicidal thoughts do not go on to make an attempt. Therefore, it is important to improve prediction of which individuals are more likely to act on their suicidal thoughts, as highlighted in Klonsky and May’s (2015) ideation-to-action framework. Auditory hallucinations (AH) and psychological distress (PD) are strongly associated with both suicidal thoughts and behaviour, but their role in the ideation-to-attempt transition has not been investigated in a longitudinal dataset. Methods Participants were from an Australian longitudinal cohort of 1793 adolescents (12–17 years). Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess AH. PD was categorised using the General Health Questionnaire (GHQ) clinical cut-off. Those reporting suicidal ideation were stratified into four groups: (i) Those who did not have PD or AH (reference group), (ii) AH only, (iii) PD only, and (iv) PD and AH. Using logistic regression, we examined associations between baseline suicidal ideation, and incident suicide attempts during the 12-month follow-up, stratified by the four comparison groups. All analyses were adjusted for age and sex. Results AH were strongly and independently associated with baseline suicidal ideation (OR=3.84; 95%CI=2.46–6.02) and suicide attempts in the following 12 months (OR=3.21; 95%CI=1.18–8.76). Among adolescents with baseline suicidal ideation (n=235; 13.1%), 14 or 6.0% attempted suicide at follow-up. Those with AH only were not at significantly increased risk of transition from suicidal thoughts to attempts (OR=2.97; 95%CI=0.26–34.59). Similarly, adolescents with PD only did not have a significant increase in transition from ideation to attempts (OR=4.48; 95%CI=0.91–22.14). Adolescents who had both PD and AH had an eight-fold increased risk (OR=8.42; 95%CI=1.46–48.67) of acting on their suicidal thoughts. Discussion Adolescents with both PD and AH had the greatest likelihood of acting on their suicidal thoughts. AH alone did not significantly predict the transition from suicidal thoughts to attempts despite high odds ratios, possibly due to the low prevalence of suicide attempts among ideators and consequently limited statistical power. Future studies examining for negative and distressing content of hallucinations may assist in explaining their role in the ideation-to-attempt transition. Screening adolescents who are distressed and have hallucinations may assist with predicting those at greatest risk of future suicide attempts.

Prevalence and correlates of psychotic experiences in a nationally representative sample of Australian adolescents

Objective: Despite growing literature on psychotic experiences, no nationally representative study has reported on the prevalence of both hallucinatory experiences and delusional experiences in Australian adolescents. Also, while many studies have examined the association between psychotic experiences and certain demographic and clinical correlates, there are more variables of interest to be investigated, including disordered eating behaviour and hours of sleep. The aims of this study were to examine (1) the prevalence of hallucinatory experiences and delusional experiences in Australian adolescents, and (2) the associations between different types of psychotic experiences with a broad range of demographic, clinical, and psychosocial variables. Methods: A random sample of Australian adolescents aged 14- to 17-year-olds were recruited in 2013–2014 as part of the Young Minds Matter Survey. Participants completed self-report questions regarding five different psychotic experience types (auditory and visual hallucinatory experiences, and thoughts read, special messages, spied upon) experienced in the past 12 months. Using logistic regression analyses, we investigated associations between psychotic experiences and demographic, clinical, and psychosocial factors. Results: The 12-month prevalence ranged from 3.3% (95% confidence interval = [2.6, 4.3]) for special messages to 14.0% (95% confidence interval = [12.3, 15.8]) for auditory hallucinatory experiences. At the bivariate level, each psychotic experience subtype was associated with increased likelihood of major depression, being bullied, psychological distress, low self-esteem, mental health service use and insufficient sleep (<8 hours per night). Multivariate analyses revealed both auditory and visual hallucinatory experiences were associated with an increased likelihood of four of these variables (depression, being bullied, service use, insufficient sleep), whereas associations with delusional experiences were inconsistent. Conclusion: Hallucinatory and delusional experiences are common in Australian adolescents. Hallucinatory experiences, rather than delusional experiences, may be more clinically relevant in this demographic. When psychotic experiences are endorsed by adolescents, further assessment is indicated so as to ascertain more detail on the phenomenology of the experiences to better understand their clinical relevance.