Yuta Hayashi

Aim: To describe the difficulties experienced by nurses when transferring psychiatric inpatients with physical complications to general hospitals. Design: A cross‐sectional descriptive study. Methods: A total of 300 psychiatric hospitals were randomly selected from psychiatric hospitals nationwide in Japan. Nurses answered an anonymous, self‐administered questionnaire that quantitatively inquired about their experiences of difficulties when psychiatric inpatients with physical complications were transferred to general hospitals. The questionnaire included 17 items with five‐point options. Descriptive statistical analyses were performed. Results: A total of 242 responses from 80 hospitals were included in the analysis. More than 70% of the participants experienced somewhat or more difficulties because they felt that patients with mental illness were treated differently or hard to be understood and accepted when psychiatric inpatients with physical complications were transferred to general hospitals. Information sharing with general hospitals was related to significantly lower difficulties among nurses in psychiatric hospitals about the way healthcare providers in general hospitals viewed patients with mental illness, whereas the extent of cooperation and communication with general hospitals was not significantly associated with difficulties. Conclusion: Information sharing is related to lower difficulties in nurses in psychiatric hospitals when transferring inpatients to general hospitals. Reporting Methods: We followed STROBE statement in this study. Impact: Better linkage between psychiatric and physical healthcare, including improved referral pathways based on the information sharing, is important. Patient or Public Contribution: No patient or public contribution. However, three nurses in psychiatric hospitals engaged in clinical care were involved in the study because the survey was conducted with nurses at psychiatric hospitals.

Background: Promoting personal agency may reduce perceived coercion and facilitate recovery in acute psychiatric care. However, no patient-reported tool currently exists to evaluate support for personal agency in this setting. Objective: This study aimed to develop a patient-reported tool (the Personal Agency Support Questionnaire [PASQ]) to assess perceived support for personal agency and to evaluate its psychometric properties among inpatients in acute psychiatric wards. Methods: We used a literature review and focus group interviews to generate a pool of items for the questionnaire, which was then refined using cognitive interviews and a pretest. We evaluated the construct validity, internal consistency, and test-retest reliability of the newly developed PASQ using a cross-sectional survey of inpatients in acute psychiatric wards. This study was conducted in collaboration with individuals who have lived experiences of mental illness. Results: We analyzed data from 109 respondents (response rate: 109/178, 61.2%; mean age: 52.9, SD 16.9 years; women participants: 59/109, 54.1%; diagnosed with schizophrenia: 61/109, 56%). The 10-item PASQ demonstrated excellent convergent validity and acceptable discriminant validity. Internal consistency was high (Cronbach α=0.92), and test-retest reliability was moderate (intraclass correlation coefficient 0.68). Conclusions: This PASQ is a valuable tool for assessing personal agency support in acute psychiatric wards, demonstrating promise for both clinical use in acute psychiatric wards and clinical research.

Introduction: Sense of coherence is a key concept in psychological science that contributes to mental health by helping people cope with various stressors in their daily lives. A literature review demonstrated the unavailability of a tool for measuring sense of coherence in Bangladesh. This study aimed to translate the 13-item Sense of Coherence scale (SOC-13) into the Bangla language and to examine its validity, dimensionality, and reliability. Method: After translating the SOC-13, a cross-sectional online survey was conducted with 510 undergraduate students at a university in Bangladesh from July to October 2021. Construct validity was assessed through confirmatory factor analysis to analyze the structural validity of the Bangla SOC-13 scale, and by examining correlations with related constructs (self-esteem, well-being, and psychological distress). The alpha coefficient was calculated to examine internal consistency. Data were analyzed using SPSS version 22 and R statistical software. Results: A total of 320 respondents provided valid responses (response rate: 62.7%). The structural validity of the SOC-13, as examined through confirmatory factor analysis, was consistent across studies (a three-factor structure with an acceptable fit), and convergent validity was evidenced through a statistically significant positive relationships between sense of coherence and both self-esteem and well-being, as well as criterion validity was supported by a significant negative relationship with psychological distress. The internal consistency of the total scores by the coefficient alpha was good (α = 0.74), whereas the alphas of each subscale showed mediocre to fair reliability. Conclusion: The Bangla version of the SOC-13 showed good construct validity, acceptable criterion validity, and good reliability based on overall internal consistency. Thus, it can be used to assess sense of coherence in young adults, although there is scope for further examination.

Benefit finding is a concept that represents finding positive changes or benefits through difficult experiences. To map the currently available studies on benefit finding and growth among family caregivers of individuals with mental illness, we conducted a scoping review based on methodological frameworks. A systematic search for studies published in English was conducted using MEDLINE, PsycINFO, PsycARTICLES, CINAHL, and PTSDpubs from inception to August 2023. After screening, 21 articles were included in the review. Of these, 11 studies were cross-sectional studies, 7 were qualitative studies, 2 were mixed-methods studies, and a randomized controlled trial (RCT). Family caregivers experienced various positive psychological changes, such as becoming compassionate/tolerant and resilient, stronger family bonds, change in perspective on life and hope, acquisition of knowledge and coping strategies, and leveraging their experiences and appreciation by others, following various struggles and negative changes. Some indicators of benefit finding and growth, such as positive personal traits, positive reappraisal, good relationships with patients, and social support, were also revealed. The quality assessment demonstrated an acceptable level of quality in most studies, with a few outliers. Future longitudinal studies would reveal the mechanism of benefit finding and growth among family caregivers of individuals with mental illness.

The importance of nurses integrating effective psychological techniques into their clinical practice is widely recognized. Nevertheless, further evidence from real-world settings is needed to establish nurse-led cognitive behavioural therapy (CBT) as an effective approach in clinical practice. This study aimed to examine the clinical effectiveness and predictors of individual CBT for mental disorders delivered by nurses in various routine clinical settings. This pragmatic retrospective cohort study collected data from participants who received nurse-led individual CBT at four institutions from different prefectures in Japan between April 2015 and March 2023. During the study period, 280 clients were referred to nurses for CBT, 240 of whom received nurse-led individual CBT of at least one session. The common primary diagnoses among participants were major depressive disorder (33.8%), social phobia (12.9%), and obsessive–compulsive disorder (10.0%). Of these, 23 participants were ongoing cases at the end of the observation period, and 217 who had completed the course of therapy or discontinued/dropped out from the therapy were included in the analysis (173 completed and 44 discontinued/dropped out (i.e., dropout rate = 20.3%)). Based on the clinical significance definition (primary outcome), 62.4% of the participants who completed the therapy were judged to demonstrate positive clinical significance (recovered or improved), with only a few participants (6.9%) demonstrating deterioration. Significant improvements were observed before and after nurse-led individual CBT across all secondary outcomes, including depression and anxiety symptoms, health-related quality of life, and functional disability (all ps ≤ 0.001). Univariate logistic regression revealed that clients with higher baseline severity of depression and anxiety symptoms were less likely to achieve positive clinical significance following nurse-led individual CBT. The real-world evidence gained through this study will encourage frontline nurses and motivate institutional/organizational leaders and policymakers to employ nurse-led individual CBT, especially for depression and anxiety-related disorders.

Objective: The need for mental health nurses (MHNs) to incorporate psychological techniques into their nursing practice has been recognised worldwide. Further evidence from real-world settings is necessary to demonstrate that MNH-led cognitive behavioural therapy (CBT) is an effective approach that can be used in clinical practice. This study aimed to explore the clinical effectiveness and predictors of MNH-led CBT for mood and anxiety disorders in routine outpatient care settings in Japan. Methods: This retrospective study collected data through a medical record review of 69 participants who underwent MHN-led CBT between January 2015 and December 2019. Results: Participants who received MHN-led CBT demonstrated significant improvements in depressive/anxiety symptoms, health-related quality of life and primary psychiatrists' impressions of condition severity (all p <.001). At the end of therapy, more than half of the participants (56.5%) showed positive clinical significance (recovered/improved) based on cutoff points and reliable change indices of validated depression and anxiety measurement scores. Furthermore, an increase in the baseline anxiety score predicted lower odds of achieving positive clinical significance (odds ratio = 0.87, 95% confidence interval = 0.79-0.96). Conclusions: Despite several limitations, mainly owing to its single-group retrospective design, this real-world evidence of MHN-led CBT bridges the gap between research and clinical practice, contributing to the widespread use of MHN-led CBT in mental health services worldwide.

Background: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. Objective: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. Methods: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety–related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants’ feedback about their experience with the iCT-SAD. Results: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. Conclusions: Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly.

While previous studies have examined antecedents and outcomes of work engagement among general nurses, studies among psychiatric nurses remain limited. This study aimed to explore the antecedents (i.e., job crafting and nursing practice environment) and outcomes (i.e., strength-oriented care attitudes, mental health, and turnover intention) of work engagement among psychiatric nurses in Japan. This cross-sectional study included 309 nurses from three psychiatric hospitals in Japan (valid response rate: 60.4%). Data collection using the self-administered questionnaire took place from July to August 2021. We performed Structural Equation Modeling to examine the directional relationships among variables. Job crafting (β = 0.57, p < 0.01) and nursing practice environment (β = 0.23, p = 0.01) exhibited positive effects on work engagement. Work engagement had positive effects on strength-oriented care attitudes (β = 0.15, p = 0.04) and mental health (β = 0.37, p < 0.01) as well as negative effects on intention to resign from their profession as a nurse (β = −0.17, p = 0.01). Job crafting and a healthier nursing practice environment could help enhance work engagement. Higher work engagement could contribute to improving strength-oriented care attitudes, mental health, and intention to resign from their profession as a nurse.

BACKGROUND Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. OBJECTIVE This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. METHODS This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety–related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants’ feedback about their experience with the iCT-SAD. RESULTS Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. CONCLUSIONS Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly.