The Criminal Sentiments Scale -Modified (CSS-M) has been widely used as a measure of criminal attitudes. This analysis examined CSS-M scores in a large sample of outpatients with serious mental illnesses and a criminal legal system history. We compared total and subscale scores in our sample to scores from two other previously published U.S. studies in which the CSS-M was used, and evaluated associations between total CSS-M score and nine variables (age, educational attainment, gender, race, marital status, employment status, diagnostic category, substance use disorder comorbidity, and adverse childhood experiences (ACE) score). Scores were higher than in two prior U.S. studies involving other types of samples. Independently significant predictors of higher CSS-M scores included being younger ( P < .001), having a higher ACE score ( P < .001), being male ( P = .03), not identifying as White ( P < .001), not having a psychotic disorder ( P < .001), and having a comorbid substance use disorder ( P = .002). Future research should test the hypothesis that these factors increase risk for arrest and that arrest events, and subsequent criminal legal system involvement, are characterized by negative experiences and perceptions of poor procedural justice, which in turn underpin the negative opinions referred to as " criminal sentiments " or criminal attitudes.

Objective: Opening Doors to Recovery (ODR) is a community navigation and recovery support model created in southeast Georgia by diverse, collaborative stakeholders. Following promising results from a quasi-experimental study, this randomized controlled trial hypothesized that, among patients with serious mental illnesses being discharged from inpatient psychiatric settings, compared to those randomized to traditional case management (CM) services, those randomized to ODR would have (1) lower likelihood of hospitalization, fewer hospitalizations, and fewer inpatient days; (2) lower likelihood of arrest, fewer arrests, and longer time to arrest; and, secondarily, (3) greater housing satisfaction and housing stability; and (4) higher scores on several scales measuring recovery-related constructs. Methods: 240 individuals with Structured Clinical Interview for DSM-5 Disorders–based psychotic or mood disorders, functional impairment, and repeated hospitalizations were randomized (December 2014 to June 2018) to ODR or CM. Hospitalization and arrest data were collected from State agencies after 12 months, and housing- and recovery-related measures were collected in person, longitudinally at 4, 8, and 12 months. Intention-to-treat analyses were conducted. Effects of dropout were accounted for, and sensitivity analyses were run. Results: ODR was associated with fewer days hospitalized (RR = 0.86, P = .001), a lower incidence of arrests (OR = 0.35, P < .0005), and longer time to arrest (HR = 0.42, P = .001). In addition, measures of housing satisfaction (Cohen d = 0.45) and recovery (Cohen d = 0.33) were significantly more improved in ODR patients compared to CM patients. Conclusions: The ODR model appears to have advantages over more traditional CM services and could fill a gap in the service array. Studying the mediators of success, cost benefit, dissemination, fidelity, and financing of the model is warranted. Trial Registration: ClinicalTrials.gov identifier: NCT04612777

Objective: Opening Doors to Recovery (ODR) is a community navigation and recovery support model created in southeast Georgia by diverse, collaborative stakeholders. Following promising results from a quasi-experimental study, this randomized controlled trial hypothesized that, among patients with serious mental illnesses being discharged from inpatient psychiatric settings, compared to those randomized to traditional case management (CM) services, those randomized to ODR would have (1) lower likelihood of hospitalization, fewer hospitalizations, and fewer inpatient days; (2) lower likelihood of arrest, fewer arrests, and longer time to arrest; and, secondarily, (3) greater housing satisfaction and housing stability; and (4) higher scores on several scales measuring recovery-related constructs.Methods: 240 individuals with Structured Clinical Interview for DSM-5 Disorders-based psychotic or mood disorders, functional impairment, and repeated hospitalizations were randomized (December 2014 to June 2018) to ODR or CM. Hospitalization and arrest data were collected from State agencies after 12 months, and housing- and recovery-related measures were collected in person, longitudinally at 4, 8, and 12 months. Intention-to-treat analyses were conducted. Effects of dropout were accounted for, and sensitivity analyses were run.Results: ODR was associated with fewer days hospitalized (RR = 0.86, P = .001), a lower incidence of arrests (OR = 0.35, P < .0005), and longer time to arrest (HR = 0.42, P = .001). In addition, measures of housing satisfaction (Cohen d = 0.45) and recovery (Cohen d = 0.33) were significantly more improved in ODR patients compared to CM patients.Conclusions: The ODR model appears to have advantages over more traditional CM services and could fill a gap in the service array. Studying the mediators of success, cost benefit, dissemination, fidelity, and financing of the model is warranted.Trial Registration: ClinicalTrials.gov identifier: NCT04612777.

OBJECTIVE:Acoustic phonetic measures have been found to correlate with negative symptoms of schizophrenia, thus offering a path toward quantitative measurement of such symptoms. These acoustic properties include F1 and F2 measurements (affected by tongue height and tongue forward/back position, respectively), which determine a general "vowel space." Among patients and controls, we consider two phonetic measures of vowel space: average Euclidean distance from a participant's mean F1 and mean F2, and density of vowels around one standard deviation of mean F1 and of F2. METHODS:Structured and spontaneous speech of 148 participants (70 patients and 78 controls) was recorded and measured acoustically. We examined correlations between the phonetic measures of vowel space and ratings of aprosody obtained using two clinical research measures, the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). RESULTS:Vowel space measurements were significantly associated with patient/control status, attributed to a cluster of 13 patients whose phonetic values correspond to reduced vowel space as assessed by both phoenetic measures. No correlation was found between phonetic measures and relevant items and averages of ratings on the SANS and CAINS. Reduced vowel space appears to affect only a subset of patients with schizophrenia, potentially those on higher antipsychotic dosages. CONCLUSIONS:Acoustic phonetic measures may be more sensitive measures of constricted vowel space than clinical research rating scales of aprosody or monotone speech. Replications are needed before further interpretation of this novel finding, including potential medication effects.

There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events—a potentially simple but effective screening tool for health workers on the ground.

Objective:Individuals with serious mental illnesses are overrepresented in all facets of the legal system. State-level criminal histories of patients with serious mental illnesses were analyzed to determine the proportion who had been arrested and number of lifetime arrests and charges, associations of six variables with number of arrests, and the most common charges from individuals’ first two arrests and most recent two arrests. Methods:A total of 240 patients were recruited at three inpatient psychiatric facilities and gave consent to access their criminal history. Information was extracted from Record of Arrest and Prosecution (RAP) sheets for lifetime arrests in Georgia. Results:A total of 171 (71%) had been arrested. Their mean±SD lifetime arrests were 8.6±10.1, and mean lifetime charges were 12.6±14.6. In a Poisson regression, number of arrests was associated with lower educational attainment, Black or African American race, the presence of a substance use disorder, the presence of a mood disorder, and female sex. Common early charges included marijuana possession, driving under the influence of alcohol, and burglary and shoplifting. Common recent charges included probation violations, failure to appear in court, officer obstruction–related charges, and disorderly conduct. Conclusions:Findings point to a need for policy and program development in the legal system (e.g., pertaining to charges such as willful obstruction of an officer), the mental health community (e.g., to ensure that professionals know about clients’ legal involvement and can partner in strategies to reduce arrests), and social services sectors (to address charges, such as shoplifting, often related to material disadvantage).

While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.

AIM:Although the absolute risk of violence is small for individuals with mental illnesses, a specific subgroup of individuals who appear to be at increased risk for violence includes young people experiencing emerging or early psychosis. Prior research has identified risk factors for violence in this population, though no prior studies using a formal risk assessment tool have been identified. This study used the Historical Clinical Risk Management-20, version 3 (HCR-20) to identify risk of future violence among a sample of young adults with early psychosis and relevant predictors of risk unique to this population.METHODS:The HCR-20 was administered to a sample of young adults with early psychosis (N = 53) enrolled at one OnTrackNY site, part of a statewide program providing early intervention services to young adults presenting with a first episode of non-affective psychosis. A Confirmatory Factor Analysis (CFA) was conducted to explore the relative importance of the HCR-20 items for this population.RESULTS:The average age of participants was 21.9 years (SD 3.6 years) and most were male (69.8%, n = 37). Most patients were assessed to be at low risk for future violence based on the Case Prioritization summary risk rating (67.9%, n = 36). The CFA identified 4 items that were not of relative predictive value in identifying the risk of violence in this sample: history of substance use (item H5), history of major mental disorder (item H6), living situation (item R2), and personal support (item R3).CONCLUSION:This study presents a formal approach to assessing violence risk in a population at elevated risk of violence, demonstrates the feasibility of using a standardized risk assessment tool in early intervention services, and identifies factors of particular importance associated with predicting violence in this population. Future research should implement violence risk assessment with a structured tool such as the HCR-20 and assess its accuracy in predicting future violent behavior in this setting.

Automated tools do not yet exist to measure formal thought disorder, including derailment and tangentiality, both of which can be subjectively rated using the Scale for the Assessment of Positive Symptoms after a clinical research interview. CoVec, a new automated tool, measures the semantic similarity among words averaged in a five-and ten-word window (Coherence-5 and Coherence-10, respectively). One prior report demonstrated that this tool was able to differentiate between patients with those types of thought disorder and patients without them (and controls). Here, we attempted a replication of the initial findings using data from a different sample of patients hospitalized for initial evaluation of first-episode psychosis. Participants were administered a semantic fluency task and the animal lists were analyzed with CoVec. In this study, we partially replicated the prior findings, showing that first-episode patients with derailment had significantly lower Coherence-5 and Coherence 10 compared with patients without derailment. Further research is warranted on this and other highly reliable and objective methods of detecting formal thought disorder through simple assessments such as semantic fluency tasks.

Hope and empowerment are key elements of recovery in the context of serious mental illnesses (SMI). We examined predictors of hope among individuals with SMI and tested a hypothesized path model in which perceived social status and perceived discrimination adversely impact hope, directly and through their impacts on depressive symptoms. Data from 232 individuals with SMI receiving care in public-sector settings were used in both a multiple linear regression (predicting Herth Hope Scale scores), and in path analyses examining both direct and indirect effects of perceived social status (Social Status Ladder) and perceived discrimination (Everyday Discrimination Scale). Depressive symptoms, perceived social status, and perceived discrimination were predictive of hope. Path analyses revealed that perceived social status has a direct effect on hope and empowerment but also impacts hope through its effects on depression. Similarly, perceived everyday discrimination affects hope and empowerment, though this effect is mediated through its effects on depression. Two alternative models and a trimmed hypothesized model did not fit the data or improve fit. These social determinants of mental health should provoke program and policy change to improve mental health and enhance recovery among persons with SMI.

Abstract Background Individuals with serious mental illness (SMI) are over-represented in the criminal justice system. One factor that impacts likelihood of incarceration is criminal thinking, and the Criminal Sentiments Scale – Modified (CSS-M) has been shown to predict recidivism. However, no one has examined the CSS-M in outpatients with schizophrenia and other psychotic disorders, and little is known about what predicts high CSS-M scores. Methods The data for the current investigation comes from a larger sample of individuals with SMI receiving services from outpatient mental health clinics who were enrolled in a randomized-controlled trial. The CSS-M was verbally administered to everyone during a baseline assessment. The 264 individuals in the sample all have a diagnosis of schizophrenia or another psychotic disorder, and all had been arrested in the last five years. We first explored the impact of demographic factors and adverse childhood experiences (ACE) on CSS-M scores. For the 258 participants with complete data for all five sub-scales (attitudes towards law, attitudes towards courts, attitudes towards police, tolerance for law violations, and identification with criminal others), we conducted a hierarchical analysis using Ward’s method to explore and define the number of clusters. We determined the number of clusters using the Elbow method. We then repeated the cluster analysis using a non-hierarchical method with the K-means technique and fixing the number of clusters to three. Results The current sample exhibited considerably higher CSS-M scores than those previously published (mean = 32.0±14.4). The total CSS-M score demonstrated high reliability (alpha = 0.898), and four of the sub-scales exhibited moderate to high reliability (α,Law = 0.741; α,Courts = 0.808; α,Police = 0.762; α,TLV = 0.696). When controlling for age, race, gender, and ACE score, the multiple linear regression model accounted for 8.6% of the variability in total CSS-M score (p < 0.001), though only ACE score and age were significant predictors (β = 0.218, p = 0.001; β = -0.167, p = 0.008, respectively). The cluster analysis produced three clusters. Given that the ICO sub-scale had the lowest Cronbach’s alpha (α = 0.328), we repeated the cluster analysis process with the four other sub-scales, which confirmed the three clusters. An ANOVA with the four sub-scales and total CSS-M score showed that the three clusters could be defined as those with low, medium, and high scores on the scales. Confirming the results from the MLR, an ANOVA of the three clusters with ACE scores (F= 4.49, p = 0.012) and age (F = 3.77, p = 0.024) were both significant. Discussion The average total CSS-M score is considerably higher than previous investigations. Both high ACE scores and younger age significantly predicted higher CSS-M scores. Because CSS-M scores have been shown to predict recidivism, it is critical to further understand the foundation of these negative attitudes towards the criminal justice system to prevent the continued over-representation of people with serious mental illness in the criminal justice system.

Abstract Background Environmental pollution is a well-known cause of disease worldwide. According to the World Health Organization, air pollution kills an estimated seven million people worldwide every year. Over the past decade, increasing attention has been drawn to the impact of environmental pollution on mental health. In 2016, our research team (Attademo et al., 2016) performed a literature review focusing on the association with psychotic disorders. The aim of this presentation is to give an update of the science, given the marked increase in the body of literature on this topic. Methods We repeated a search using the Pubmed electronic database for all articles from February 20, 2016 (date of out last search for the previous review) to November 20, 2019, using the same terms that we used in the first review. The search included all languages. Thirty-eight articles were identified. We selected 9 studies related to pollution’s effects on human subjects: seven were research reports and two were review articles. We excluded 29 articles, on the basis of the following exclusion criteria: a) studies unrelated to the topic, and b) letters or commentaries not reporting research findings. For this update, we focus only on research reports. Results Six of the seven research reports (Bai et al., 2019; Duan et al., 2018; Eguchi et al., 2018; Liang et al., 2019; Ma et al., 2018; Newbury et al., 2019; Qiu et al., 2019) focused on air pollution. Only one (Ma et al., 2018) explored the association between serum concentration of six typical toxic metals and risk of schizophrenia in a earth mining area in China and found higher serum levels of antimony, uranium, and lanthanum in patients with schizophrenia. All studies focusing on air pollution considered the following pollutants: particulate matter (PM) 10, PM2.5, and nitrogen dioxide. Some of them also included carbon monoxide, sulfur dioxide, nitric oxide, and carbon dioxide. All the studies found significant associations between pollutant concentrations and psychosis-associated outcomes (adolescent psychotic experience, hospital admissions, and higher Brief Psychiatric Rating Scale scores). Five of the six studies investigating air pollutants also looked into the lag effect between pollutant concentrations and the outcome of the study, supporting the hypothesis of short-term effects (same day or within the first 2–3 days after high concentrations of pollutants). Discussion During our previous review, we found 13 research reports from 1964 to 2016, while in this update in the past 2.5 years, there has been a marked increase in publications on the topic. The association between air pollutants and different aspects of psychotic disorders presentation and manifestation is gaining support and the approaches of looking into this phenomenon are becoming more sophisticated. Nevertheless, further research is needed both at the molecular level to determine the mechanisms that mediate the effects of these pollutants, and at clinical and environmental levels to improve health and well-being of patient with psychotic disorders.

OBJECTIVE:Recent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP).METHODS:Data were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis.RESULTS:143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status.CONCLUSIONS:This study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.

Aims. Aim of the current study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy). Methods. We collected data about daily admissions to psychiatric emergency services of two general hospitals, air pollutants' levels and meteorological data for the time period 1 January 2015 until 31 December 2016. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework. Results. A total of 1860 emergency department admissions for mental disorders were identified. We observed a statistically significant impact of ozone levels on daily admissions. The estimated coefficient of O-3 is statistically significant at the 1% level. All other pollutants were not significantly associated with the number of daily admissions. Conclusions. Short-term exposure to ozone may be associated with increased psychiatric emergency services admissions. Findings add to previous literature on existing evidence for air pollution to have an impact on mental health. Ozone may be considered a potential environmental risk factor for impaired mental health.

Background: Despite the benefits of early intervention services for the initial stages of psychosis ongoing impairments in functioning are common. Aims: To identify 1-year trajectories of occupational and social functioning in individuals enrolled in OnTrackNY, a statewide program offering early intervention services for recent-onset psychosis in community settings. Method: We included 937 persons with recent-onset psychosis enrolled at 19 programs across New York State. Demographic, social and clinical data was collected at program entry and at 3, 6, 9 and 12 months. We used growth mixture models to identify occupational and social functioning trajectories and examined the association between trajectory class, baseline factors and symptoms during 1-year follow-up. Results: Four distinct trajectory classes of occupational and social functioning were identified. The converging (58.0%) class had disparate levels of functioning at baseline (low occupational, higher social) which eventually converged. The other classes had high-stable (14.8%), moderate-stable (17.8%) and low-improving (9.4%) trajectories. Female gender, educational attainment and private insurance status were significantly associated with the trajectory characterized by higher functioning, while living alone, homelessness, a longer period from psychosis onset to program enrollment, a schizophrenia diagnosis and cannabis use at enrollment were associated with the poorest trajectory. The differences in severity of symptoms by trajectory class diminished over time. Conclusions: Trajectories of occupational and social functioning showed substantial variation, but overall, remained stable or improved during 1-year follow-up. The relationship between symptoms and occupational and social functioning attenuated after the acute treatment phase. (c) 2020 Elsevier B.V. All rights reserved.

Abstract Background Air pollution is a major environmental risk to health. Exposure to xenobiotic heavy metals such as lead and cadmium—constituents of air pollution such as particulate matter and nitrogen and sulfur oxides, organic solvents, and other environmental pollutants—could be component causes for schizophrenia and other psychotic disorders. Long-term exposure to ambient air pollution could be an independent risk factor for mental health disorders. Recent studies analysing the association between daily levels of air pollutants and hospital admissions for mental disorders showed significant results for different pollutants considered both for admissions for generic mental disorders and for specific diagnoses such as schizophrenia, depression and substance abuse. Aim of the present study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy) Methods We collected data about daily admissions to psychiatric emergency services of two general hospitals, daily levels of respirable particular matter (PM10 and PM2.5), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), and meteorological data (daily average temperature, pressure, humidity, and maximum and average wind speed) for the time period 1 January 2015 until 31 December 2016 (731 days). We used air monitoring data for the different types of air pollutants which were averaged across up to 16 monitor stations dispersed in the region. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework. Results A total of 1860 cases of emergency department admissions for mental disorders were recorded over the study period. We observe a statistically significant impact of O3 levels on daily admissions. The estimated coefficient of O3 is statistically significant at the 1 percent level. According to our results, an increase of one µg/ m3 of O3 concentration (relative to the average concentration of the last 20 days) results in 0.013 more admissions to the hospitals. All other pollutants are not significantly associated with the number of daily admissions. Discussion We observed a statistically significant association of daily ozone levels and daily number of admissions to psychiatric emergency services. Ozone is a component of photochemical smog and a powerful oxidant, and is considered as one of the most important air pollutants. Ozone may have a relevant interference with CNS physiology, and its exposure may be linked to brain disease and contribute to inflammation and oxidative stress. Ozone exposure may be considered a potential environmental risk factor for impaired mental health. Epidemiological studies found evidence that ozone exposure may affect autism spectrum disorders, lead to motor disorders and cognitive impairment, and have an influence on the incidence of depression and suicide. In recent studies ozone air levels showed an association with increased risk of an emergency department visit for depression. This is one of the first studies worldwide investigating the association between daily concentration of air pollutants and the daily number of visits to a psychiatric emergency unit. Our results add to previous literature on existing evidence for air pollution to have a role in the cause or worsening of mental distress and psychiatric disorders. Contrary to our hypothesis, we did not find a positive association between most of the air pollutants considered in our study. This is in contrast with previous literature on this subject. This could be explained by the methodological limitations of our study.

Multicomponent programs for first-episode psychosis (FEP) offering coordinated specialty care (CSC) aim at maximizing opportunities for recovery by intervening early in the course of the illness. Two key components of recovery include social and occupational functioning. This study identified trajectories of social and occupational functioning in individuals enrolled in OnTrackNY, a statewide CSC program for treatment of early psychosis in community settings. The sample in this naturalistic cohort design included 634 individuals between ages 16 and 30 with recent-onset, non-affective psychosis with at least one CSC follow-up assessment at 20 different sites across New York State. Clinicians collected demographic and clinical data at program entry and quarterly up to one year. Social and occupational functioning were assessed using the MIRECC Global Assessment of Functioning scales.3 Growth mixture models (GMM) were used to identify subgroups of clients with similar social and occupational functioning trajectories. The association between baseline demographic variables and trajectories were tested using chi-square tests and one-way ANOVAs. The GMM with four trajectory classes of social and occupational functioning best fit the data. The majority of the sample (59.1%) exhibited a greatly improving trajectory for occupational functioning from very low at baseline to moderate by 12 months with moderate and stable social functioning across the same period. A subgroup consisting of 14.9% of the sample had a similar moderate and stable trajectory for social functioning as the majority group, but were already exhibiting moderate occupational functioning at baseline and showed further improvement. Another subgroup (14.8%) entered the program high on both domains and remained stable or improved further. The most disabled group (11.4%) started low in both domains and improved across the year but remained at a dysfunctional occupational level. Female gender, higher education, adherence to antipsychotic medication and being employed or in school at enrollment were significantly associated with trajectories leading to more favorable social and occupational functioning. Four identified trajectories of FEP patients enrolled in CSC had improving or high-stable social and occupational functioning patterns. This is in contrast with the long-held view that most individuals with psychotic disorders have a deteriorating course of illness. Most variability in terms of trajectory patterns over 1-year follow-up is observed in occupational functioning, which suggests that this may be an important domain to target for intervention.

Objective: This study aimed to evaluate the effectiveness of Homefront, a six-session, peer-taught family education program by the National Alliance on Mental Illness (NAMI), delivered in person or online, for families or support persons of military service members or of veterans with mental illness. Methods: Program participants completed online surveys at baseline, at the end of the program (postprogram), and at 3-month follow-up, which measured subjective empowerment, burden, coping, psychological distress, family functioning, experience of caregiving, and knowledge of mental illness. A mixed-effects model examined change over time. Results: A total of 119 individuals (in person, N=63 [53%]; online, N=56 [47%]) enrolled. Participants showed statistically significant improvement on all dimensions between baseline, postprogram, and follow-up, except for subjective burden, which improved between baseline and follow-up. Results for in-person and online formats did not differ. Conclusions: The six-session NAMI Homefront program was associated with benefits for military and veteran family members and support persons.

As mental health services are increasingly embracing the recovery model, we conducted a study to better understand how social adversity impacts recovery. We also examined how associations between social adversity and recovery are influenced (moderated or mediated) by symptom severity. Data on seven social adversity measures, eight recovery measures, and symptom severity were collected from 300 English-speaking participants, ages 18–65 years, with a diagnosis of a psychotic or mood disorder, from five community mental health agencies in diverse neighborhoods in Washington, D.C. We employed standard correlation, exploratory factor analyses, analysis of variance, and hierarchic regression procedures. Diagnostic category and gender impacted Home Environment Adversities (e.g., food insecurity, perceived neighborhood disorder), the diagnostic category-by-gender interaction influenced Social and Economic Adversities (e.g., years of education and income), and gender affected Recovery. Controlling for diagnostic category and gender, Social and Economic Adversities accounted for 1.7% of variance in Recovery, while Home Environment Adversities accounted for 8.6% (their joint influence was 3.4%). Although symptom severity did not moderate these associations, it partially mediated the effect of Social and Economic Adversities on Recovery, and substantially mediated the effect of Home Environment Adversities on Recovery. The extent to which patients with serious mental illnesses experience recovery may be meaningfully influenced not only by symptoms, but by their social and environmental circumstances.