Lynne Briggs

Demoralisation--a useful conceptualisation of non-specific psychological distress among refugees attending mental health services.

Background: While it is recognised that many refugee and migrant clients present at mental health services with non-specific psychological distress little is known about successful intervention strategies. Aims: The aim of this study was to systematically review clinical files to determine the degree of ‘demoralisation’ symptoms among a sample of refugee and migrant clients attending a community-based mental health service. Method: Sixty-four closed cases were reviewed using a specifically designed case review sheet as a checklist which included diagnostic criteria for a Demoralisation Syndrome. Results: The findings indicated that while many of the refugee and migrant clients had attracted a diagnosis of major depressive disorder, in the main they did not benefit from a normal course of treatment. Further analysis suggested that demoralisation may be a preferable concept for many of these clients rather than affective disorder. This finding suggests that demoralisation may be a different construct than low mood or depression. Conclusions: The findings add support to the concept that demoralisation could be a distinct diagnostic entity in its own right that may be useful to clinicians attending refugee and migrant clients.

Demoralization and Psychological Distress in Refugees: From Research to Practice

New Zealand has been offering third country resettlement to refugees, migrants, and their families since the end of the Second World War. Migration itself is a source of considerable distress. The study reported here used a set of self-report scales to determine the degree of demoralization and psychological distress among a sample of refugee and migrant clients living in Australasia. A degree of depression and demoralization was evident across the sample. The findings indicated that while many of the participants had attracted a diagnosis of major depressive disorder, in the main they did not benefit from a course of antidepressants. Additional factors known to impact on mental health were also apparent placing emphasis on the need for further development of culturally competent and evidence-based practice in resettlement and mental health services. While the study is based on refugee experiences in Australasia the perspective is much broader and should be seen in the international context.

Does spirituality facilitate adjustment and resilience among individuals and families after SCI

Abstract Purpose: The purpose of this scoping review was to investigate the role of spirituality in facilitating adjustment and resilience after spinal cord injury (SCI) for the individual with SCI and their family members. Method – data sources: Peer reviewed journals were identified using PsychInfo, MEDLINE, CINAHL, Embase and Sociological Abstracts search engines. Study selection: After duplicates were removed, 434 abstracts were screened applying inclusion and exclusion criteria. Data extraction: The selected 28 studies were reviewed in detail and grouped according to methodological approach. Results: Of the 28 studies relating to spirituality and related meaning-making constructs, 26 addressed the adjustment of the individual with SCI alone. Only two included family members as participants. Quantitative studies demonstrated that spirituality was positively associated with life satisfaction, quality of life, mental health and resilience. The utilisation of meaning-making and hope as coping strategies in the process of adjustment were highlighted within the qualitative studies. Clinical implications included recommendations that spirituality and meaning-making be incorporated in assessment and interventions during rehabilitation. The use of narratives and peer support was also suggested. Conclusions: Spirituality is an important factor in adjustment after SCI. Further research into the relationship between spirituality, family adjustment and resilience is needed. Implications for Rehabilitation Higher levels of spirituality were associated with improved quality of life, life satisfaction, mental health, and resilience for individuals affected by spinal cord injury. Health professionals can enhance the role that spirituality plays in spinal rehabilitation by incorporating the spiritual beliefs of individuals and their family members into assessment and intervention. By drawing upon meaning-making tools, such as narrative therapy, incorporating peer support, and assisting clients who report a decline in spirituality, health professionals can provide additional support to individuals and their family members as they adjust to changes after spinal cord injury.

Moving forward on the journey: Spirituality and family resilience after spinal cord injury.

Purpose/Objective: The aim of this exploratory study was to consider how spirituality (encompassing meaning, hope and purpose), may facilitate family resilience after spinal cord injury (SCI) over time. Research Method/Design: A qualitative, longitudinal study design was adopted. Semistructured interviews were conducted with 10 family dyads (consisting of the individual with SCI and a nominated family member) on 2 occasions, 6 months apart. A thematic analysis was conducted. Results: Participants reported drawing upon a range of different sources of spirituality, including religious faith, the natural world, inner strength, and meaningful connectedness with others. These sources of spirituality were often tested in some way after the SCI. Meaning-making responses to these tests were linked with 3 key outcomes: gratitude, hope, and deeper connectedness with others, assisting families to move forward in their journey after SCI. Over time sources of spirituality did not change significantly; however, the intensity of spiritual experience lessened for some families. Conclusions: This study indicated that spirituality after SCI plays an important role for both the injured individual and their family members. Families draw upon a range of sources of spirituality, and these sources of spirituality may assist the family to move forward together after SCI. Further investigation of how health professionals can better address spirituality during spinal rehabilitation is warranted.

Postdisaster Counselling: Personal, Professional, and Ethical Issues

ABSTRACT Volunteer counsellors face particular challenges in postdisaster interventions. This research investigates personal, professional, and ethical issues faced by mental health volunteer counsellors recruited to a counselling service that emerged following the 2011 earthquakes in the Canterbury region of New Zealand. Earthquakes create major community disruption that can overwhelm existing service systems and require new agency arrangements and increased use of volunteers to manage and provide services. The disaster exposed counsellors to personal challenges in their own lives as well as those of their clients and significantly affected their professional practice. The findings indicate that emergency organisations and professional registration bodies should give further consideration to the management of volunteers and their early intervention work in postdisaster counselling. IMPLICATIONS Delivery of postdisaster services must encompass service management, targeted interventions, and supervision. When counsellors and clients experience the same disaster personal, professional, and ethical aspects are intertwined. Counsellors need self-care and support to manage these events. Further arrangements could be made to ensure professional insurance is available for volunteer counsellors postdisaster.

The role of spirituality in spinal cord injury (SCI) rehabilitation: exploring health professional perspectives

Study designDescriptive, qualitative study.ObjectivesTo explore the perspectives of health professionals (HPs) regarding the role of spirituality in spinal cord injury (SCI) rehabilitation.SettingSingle centre rehabilitation hospital, NSW, Australia.MethodsTwo focus groups (n = 12) were conducted with HPs (e.g., nursing, allied health, medical) working in SCI inpatient rehabilitation. A semi-structured interview was employed, consisting of questions about spirituality and its role in SCI rehabilitation. The groups were audio recorded and transcribed. An inductive thematic analysis was conducted.ResultsSix themes were identified from the focus group data: (i) the meaning of spirituality; (ii) spirituality as a help; (iii) spirituality as a hindrance; (iv) how spirituality is indirectly addressed in practice; (v) perceived barriers to incorporating spirituality into practice; (vi) how spirituality can be better integrated into practice. HPs recognised that spirituality played an important role in the adjustment of many individuals and their families after SCI. However, spirituality was not proactively addressed during SCI rehabilitation, and most often arose during informal interactions with clients. Spirituality, and specifically religious belief, was perceived to sometimes raise difficulties for clients and staff. The use of physical space and a review of rehabilitation processes were suggested by HPs as two ways spirituality could be better incorporated into practice.ConclusionsThe findings of this study reveal that spiritual needs of clients and their family members during SCI rehabilitation are important and could be better addressed. A range of initiatives are proposed, including staff training and the use of standardised spiritual assessment tools.

Faking participant identity: Vested interests and purposeful interference

Misrepresentation and mischief in the research process can impact on ethical conduct, the validity of findings and deliberately change the outcome. This short report presents a scenario about deliberate interference in adoption research by one organisation seeking accreditation to deliver adoption services. Unbeknown to the researchers, fake participants completed an online survey designed to capture the post-adoption needs of adult international adoptees living in Australia. Interference was unexpected as it was naively assumed that all stakeholders involved in adoption would be concerned with meeting post-adoption needs. A definition of politically motivated fake participants, implications for the research process, predicting such interference and strategies to address the problem are discussed.

A Qualitative Exploration of the Adult Intercountry Adoptee Experience in Australia

Abstract Using a post-structuralist narrative approach, this article focuses on insights gained from a qualitative study with 11 Australian intercountry adult adoptees with particular reference to their adoption experiences and post-adoption support needs. From thematic analysis, six interrelated, overlapping themes are reported. These are as follows: connecting to the past, the ambiguous self, the experience of racism, being grateful, safe and unsafe zones, and post-adoption support needs. Key findings relate to the Australian experience of unmet need and support the importance of the adoptee voice in determining appropriate support.

Moral distress as experienced by hospital social workers in South Korea and Australia

ABSTRACT This exploratory, qualitative research explored the ethical problems faced by hospital social workers in South Korea and Australia, and what and who influenced their decision making using a focus group design. Although dilemmas of boundaries, confidentiality, self-determination, and other complex scenarios found in practice were identified, moral distress, a consequence of the unresolvable conflicts, dominated participants’ narratives. This was particularly the case for the Korean social workers in this sample. A thematic analysis of the data yielded three main themes: ‘Under pressure—“It’s very uncomfortable”’; ‘Failing our patients’; and ‘Coping and codes’.

Demoralization: Exploring the Post-Migratory Experiences ofNewcomers Resettling In Canada

This study explored the impact of post-migratory experiences on the psychological well-being of recent immigrants (newcomers)resettling in Canada. A mixed method design(focus groups, individual semistructured interviews, questionnaires and a self-rating scale)was used with a sample of 80 participants living in the Kitchener-Waterloo area and attending one of two programmes aimed at enhancing resettlement. Thisallowed for the degree of non-specific psychological distress among the sample to be determined. Specific factors deemed to impact on successful resettlement were also explored.The results indicated that having family, friends, community supports, an ability to speak English and gaining appropriate employment were significantly associated with symptoms ofnon-specific psychological distress. While the study was undertaken in Ontario and the results may not be able to be generalized to all migrants, the findings do have implications for the overall success of resettlement programmes, and for social workers and other mental health professionals working with newcomers to Ontario.