Journal of Korean Academy of Nursing

Review Paper

Effectiveness of non-pharmacological interventions to reduce internalized stigma in people with severe mental illness: a systematic review and meta-analysis: Soyoung Kim, Sun Hyoung Bae, Myung-Sun Hyun; J Korean Acad Nurs 2025;55(1):1-18. Published online February 25, 2025; DOI: https://doi.org/10.4040/jkan.24072

Abstract PDF ePub: Purpose
This study systematically reviewed and analyzed the effects of non-pharmacological interventions on internalized stigma among people with severe mental illness.
Methods
A systematic review and meta-analysis were conducted following the Cochrane Intervention Research Systematic Review Manual and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. This study targeted people with severe mental illness as the population, interventions aimed at reducing internalized stigma, comparisons with control groups, and internalized stigma as the outcome. A literature search was performed across multiple databases, including PubMed, EMBASE, the Cochrane Library, CINAHL, PsycArticles, RISS, KMbase, and KoreaMed. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Effect sizes were computed using Hedges’s g, and subgroup analyses were conducted with Comprehensive Meta-Analysis software version 4.0.
Results
Of 2,388 papers, 15 were included in the meta-analysis. The overall effect size (Hedges’s g) of the intervention was –0.60 (95% confidence interval, –1.01 to –0.19), indicating a statistically significant reduction in internalized stigma (Z=–2.88, p=.004). Subgroup analyses revealed that the intervention type (p=.008) and session length (p=.011) were significant moderators influencing the effectiveness of the interventions.
Conclusion
Tailoring interventions by considering variables such as the intervention type and session length could enhance the effectiveness of non-pharmacological interventions for reducing internalized stigma among people with severe mental illness (PROSPERO: CRD42023418561).

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Research Papers

Effect of Digital Health Interventions on Psychotic Symptoms among Persons with Severe Mental Illness in Community: A Systematic Review and Meta-Analysis: Oh, Eunjin , Gang, Moonhee; J Korean Acad Nurs 2023;53(1):69-86. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22121

Abstract PDF

Purpose
This study aimed to evaluate the effects of digital health interventions on the psychotic symptoms among people with severe mental illness in the community.
Methods
A systematic review and meta-analysis were conducted in accordance with the Cochrane Intervention Research Systematic Review Manual and PRISMA. A literature search was conducted of published randomized controlled trials (RCTs) for digital health interventions from January 2022 to April 2022. RevMan software 5.3 was used for quality assessment and meta-analysis.
Results
A total 14 studies out of 9,864 studies were included in the review, and 13 were included in meta-analysis. The overall effect size of digital health interventions on psychotic symptoms was - 0.21 (95% CI = - 0.32 to - 0.10). Sub-analysis showed that the reduction of the psychotic symptoms was effective in the schizophrenia spectrum group (SMD = - 0.22; 95% CI = - 0.36 to - 0.09), web (SMD = - 0.41; 95% CI = - 0.82 to 0.01), virtual reality (SMD = - 0.33; 95% CI = - 0.56 to - 0.10), mobile (SMD = - 0.15; 95% CI = - 0.28 to - 0.03), intervention period of less than 3 months (SMD = - 0.23; 95% CI = - 0.35 to - 0.11), and non-treatment group (SMD = - 0.23; 95% CI = - 0.36 to - 0.11).
Conclusion
These findings suggest that digital health interventions alleviate psychotic symptoms in patients with severe mental illnesses. However, well-designed digital health studies should be conducted in the future.

Citations

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A Review of Mobile App-Based Psychosocial Intervention for Personal and Clinical Recovery for People With Psychosis
Dowon You, Narae Jeong
Korean Journal of Schizophrenia Research.2024; 27(1): 1. CrossRef

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Development and Evaluation of an Integrated Health Management Program for Psychiatric Patients with Metabolic Syndrome: Kwak, Yun Bock , Kim, Ji Young; J Korean Acad Nurs 2022;52(3):261-277. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21222

Abstract PDF

Purpose
This study developed an integrated health management program for metabolic syndrome in psychiatric patients and examined its effects on self-efficacy, healthy lifestyle, physiological indicators, knowledge of metabolic syndrome, attitudes toward healthy behavior, and social support.
Methods
A non-equivalent control group pretest posttest design was used. The participants were 65 psychiatric patients with metabolic syndrome in psychiatric rehabilitation centers, with 33 in the experimental group and 32 in the control group. The experimental group participants engaged in daily mobile application and walking exercises three times a week for more than 40 minutes over 8 weeks, while those in the control group were provided education booklets. The outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. Intervention effects were analyzed using the independent t-test, Mann—Whitney U test, ANCOVA, and Ranked ANCOVA.
Results
The experimental group showed a significant increase in self-efficacy (F = 8.85, p = .004, η_p2 = .13) and knowledge of metabolic syndrome (t = 2.60, p = .012, d = 0.60) compared to the control group. Additionally, the experimental group demonstrated a significant decrease in waist circumference (Z = - 2.34, p = .009, d = 0.58) and body mass index (Z = - 1.91, p = .028, d = 0.47) compared to the control group.
Conclusion
The integrated health management program for psychiatric patients with metabolic syndrome is effective in improving self-efficacy and knowledge of metabolic syndrome and decreasing physiological indicators such as waist circumference and body mass index.

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Ji-Su Kim, Minhae Kim, Yeji Seo
European Journal of Oncology Nursing.2023; 63: 102276. CrossRef
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Review Article

Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data: Park, Suin , Park, Sohee , Lee, Young Joo , Park, Choon-Seon , Jung, Young-Chul , Kim, Sunah; J Korean Acad Nurs 2020;50(3):333-348. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19203

Abstract PDF

Purpose
The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data.
Methods
The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling.
Results
Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint.
Conclusion
Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.

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NEAT: Nurse Effort Assessment Tool—Human Factors Considerations in Designing for Appropriate Staffing
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Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review
Irene Ngune, Helen Myers, Amanda Cole, Peter Palamara, Robina Redknap, Michael Roche, Diane Twigg
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Time to readmission in psychiatric inpatients with a therapeutic leave
Tiziana Ziltener, Julian Möller, Lukas Imfeld, Roselind Lieb, Undine E. Lang, Christian G. Huber
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Original Articles

Difficulties in Caring for Psychiatric Patient as Experienced by Non-Psychiatric Nurses: Jaewon Joung, Mi Young Jang, Jihyun Shim, Yoonhi Ko, Sung Hee Shin; J Korean Acad Nurs 2017;47(1):49-59. Published online February 28, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.1.49

Abstract PDF

Purpose

The purpose of this study was to identify non-psychiatric nurses' difficulties in caring for patients with mental illness.

Methods

Data were collected from eighteen general medical-surgical nurses working at a university hospital in Seoul, Korea. This study involved two focus group discussions and three in-depth individual interviews. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis.

Results

General medical-surgical nurses experienced difficulties in 3 categories, 9 subcategories, 27 codes. The three categories were ‘nurse’ related factors, ‘patient’ related factors, ‘resource’ related factors. The nine categories were ‘unpreparedness’, ‘nursing barriers due to stigma’, ‘undervaluing and avoidance of psychiatric nursing’, ‘eroding into the trap of a vicious cycle’, ‘facing unapproachable patients’, ‘dealing with unhelpful family members’, ‘burdening already overburdened staff’, ‘obstructive environment’, and ‘isolation of staff with heavy responsibilities’.

Conclusion

The results of this study indicate the need to develop psychiatric mental health education programs for non-psychiatric nurses. Education about psychiatric mental health and support from institutions for non-psychiatric nurses can reduce their negative attitude toward psychiatric patients and difficulties in caring for psychiatric patients.

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Structural Equation Model for Caregiving Experience of Families Providing Care for Family Members with Mental Disorders: In Ohg Oh, Sunah Kim; J Korean Acad Nurs 2015;45(1):97-106. Published online February 27, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.1.97

Abstract PDF

Purpose

This study was done to develop and test a structural model for caregiving experience including caregiving satisfaction and caregiving strain in families providing care for family members with a mental disorder.

Methods

The Stress-appraisal-coping model was used as the conceptual framework and the structural equation model to confirm the path that explains what and how variables affect caregiving experience in these families. In this hypothesis model, exogenous variables were optimism, severity of illness and uncertainty. The endogenous variables were self efficacy, social support, caregiving satisfaction and caregiving strain. Data were collected using structured questionnaires.

Results

Optimism and caregiving self-efficacy had significant direct and indirect effects on caregiving satisfaction. Optimism, severity of illness and uncertainty had significant direct and indirect effects on caregiving strain. The modified path model explained effects of optimism on caregiving self-efficacy with social support in the path structure as a mediator. Also, there were direct and indirect effects of optimism and uncertainty on caregiving satisfaction with social support and caregiving self-efficacy in the path structure as a mediators.

Conclusion

Results suggest the need to improve caregiving self-efficacy of these families, establish support systems such as a mental health professional support programs for caregiving self-efficacy. Optimism, severity of illness and uncertainty perceived by families need to be considered in the development of support programs in order to increase their effectiveness.

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