Department of Anthropology, Southern Methodist University, Dallas (Myers, Fox); Department of Psychiatry, University of Texas Southwestern Medical School, Dallas (Myers, Sood); Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York (Compton). Ms. Myers was with the Department of Biological Sciences and the Department of Anthropology, Southern Methodist University, Dallas, at the time of this study.
Psychiatr Serv. 2019 Mar 1;70(3):184-190. doi: 10.1176/appi.ps.201700459. Epub 2018 Dec 17.
This study elicited factors that shaped treatment decision making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement.
This prospective, longitudinal, ethnographic study (using home visits, interviews, and hospital-based fieldwork) asked what mattered to 18 young adults primarily from racial-ethnic minority groups and 19 of their self-identified key supporters (N=37) as they made decisions about treatment during the 12-week critical period after an initial hospitalization for psychosis. The analytical approach used inductive coding and constructivist grounded theory methods to analyze interview transcripts and field notes from home visits and generate hypotheses about key factors that seemed to affect treatment decision making. Factors were ranked in order of frequency across all participants (overall, young adults only, and key supporters only).
Among the 37 total participants (young adults and key supporters), more than two-thirds were concerned with getting back to normal, the insufficient mental health care on offer, police involvement in their pathway to care, feeling worse, and needing help with repairing strained relationships. More than one-half were concerned with how young adults would be able to live independently in the future, paying for mental health care, distrusting mental health diagnoses, managing social pressure to use substances, feeling disempowered by hospitalization experiences, and managing transportation challenges.
To better engage young adults with early psychosis in care, including those from racial-ethnic minority groups, there is a need to design services that address the specific concerns of their everyday lives in the context of the initial hospitalization and posthospitalization period.
本研究通过对初次住院治疗精神病后的年轻成年人及其主要支持者进行治疗决策的因素分析，以生成如何改善服务参与度的假设。
本前瞻性、纵向、民族志研究（采用家访、访谈和医院实地工作）询问了 18 名主要来自少数族裔群体的年轻成年人和 19 名他们自我认同的主要支持者（共 37 名）在初次住院治疗精神病后的 12 周关键期内决定治疗时，哪些因素对他们的决策有影响。分析方法采用归纳编码和建构主义扎根理论方法，对家访的访谈记录和实地笔记进行分析，并生成似乎影响治疗决策的关键因素的假设。根据所有参与者（整体、年轻成年人和主要支持者）的频率对因素进行排序。
在 37 名总参与者（年轻成年人和主要支持者）中，超过三分之二的人关心恢复正常、现有的心理健康护理不足、警察介入他们的护理途径、感觉更糟以及需要帮助修复紧张的关系。超过一半的人关心年轻人将来如何能够独立生活、支付心理健康护理费用、不信任心理健康诊断、应对使用物质的社会压力、对住院经历感到无能为力以及应对交通挑战。
为了更好地让有早期精神病的年轻人参与护理，包括来自少数族裔群体的年轻人，有必要设计服务，以解决他们在初次住院和出院后期间日常生活中的具体问题。
