Threats to epistemic agency in young people with unusual experiences and beliefs

Houlders, Joseph W.; Bortolotti, Lisa; Broome, Matthew R.

doi:10.1007/s11229-021-03133-4

Cited by 22 publications

(16 citation statements)

References 41 publications

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“…For young people who struggle with their mental health, clinical encounters present a risk that their sense of agency will be undermined (e.g., Houlders et al, 2021 ). This risk may be higher than for other healthcare service users for four reasons.…”

Section: Sense Of Agency In Clinical Encountersmentioning

confidence: 99%

Communication in youth mental health clinical encounters: Introducing the agential stance

Bergen

Bortolotti

Tallent

et al. 2022

Theory & Psychology

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When young people seek support from mental health care practitioners, the encounters may affect the young people’s sense of self, and in particular undermine their sense of agency. For this study, an interdisciplinary team of academics and young people collaboratively analysed video-recorded encounters between young people and mental healthcare practitioners in emergency services. They identified five communication techniques that practitioners can use to avoid undermining the young person’s sense of agency in the clinical encounter. They conceptualise the use of those techniques as the adoption of an agential stance towards the young person. The agential stance consists of: (a) validating the young person’s experiences, (b) legitimising the young person’s choice to seek help, (c) refraining from objectifying the young person, (d) affirming the young person’s capacity to contribute to positive change, and (e) involving the young person in the decision-making process.

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Section: Sense Of Agency In Clinical Encountersmentioning

confidence: 99%

Communication in youth mental health clinical encounters: Introducing the agential stance

Bergen

Bortolotti

Tallent

et al. 2022

Theory & Psychology

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“…3 Prediction models could further disempower patients by undermining their sense of agency (the belief that one can shape one's own life). 4 This may occur if patients misconstrue personalised predictions to infer that significant outcomes (e.g. onset of mental illness, relapse or recovery) are entirely foreseeable and thus entirely predetermined and beyond their ability to influence.…”

Section: Ethical Implicationsmentioning

confidence: 99%

“…In a clinical context, patients may be less motivated to play an active role in shared decision-making and treatment, to the detriment of clinical outcomes. 4 More broadly, patients (and relatives) may impose limitations on their own aspirations for the future, thus curtailing their life experiences. Further, discrimination from external sources could occur if third parties gain access to risk estimates, for example reduced opportunities for employment in certain sectors (e.g.…”

Section: Ethical Implicationsmentioning

confidence: 99%

Towards personalised predictive psychiatry in clinical practice: an ethical perspective

Lane

Broome

2022

Br J Psychiatry

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“…However, diagnosis can be challenging with a lack of objective, reliable diagnostic criteria, and reliance on retrospective self-report influenced by both recall and mood-state associated biases 3 . Young people are particularly vulnerable to deterioration due to barriers in help-seeking, including delay in or lack of access to services, stigma, and difficulty identifying or expressing concerns 4 , often exacerbated by poor communication, disregard of agency 5 , and mismanagement 6,7 . As such, many cases go undetected and untreated, contributing to a trajectory towards full-blown, chronic depression associated with poorer outcomes in adulthood 8 .…”

Section: Introductionmentioning

confidence: 99%

Remote measurement technologies for depression in young people: A realist review with meaningful lived experience involvement and recommendations for future research and practice

Walsh

Naughton

Sharpe

et al. 2022

Preprint

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BackgroundRemote measurement technologies (RMT), such as smartphones and wearables, allow data collection from an individual in real-time during their day-to-day life, from which their mood, physiology, behaviour, and environment can be inferred. As such, RMT could monitor and detect changes relevant to depression for objective screening, symptom management, relapse-prevention, and personalised interventions. Whilst RMT for depression in young people has been previously reviewed, technological capability and digital mental health literature steeply increase each year but with limited scrutiny of the realist and ethical considerations likely to impact the benefits, implementation, and overall potential of RMT in the real-world.MethodsA realist review of RMT for depression in young people aged 14 – 24 years was conducted in collaboration with two young, lived experience co-researchers from The McPin Foundation Young People’s Network (YPN) and in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) for quality and publication. Iterative searches across 10 electronic databases and 7 sources of grey literature, fine-tuning of selection-criteria, data extraction and evidence synthesis with insights from the wider YPN members allowed gradual refinement of an initial framework into a realist intervention theory.ResultsOf 6118 records identified, 104 were included in evidence synthesis. What does and does not work? Smartphones were most preferred, with both passive and active data collection for a holistic approach but a balance between data quality, intrusiveness, and data privacy. From the evidence currently available, depression was best detected by changes in sleep, mobility, smartphone use, social communication, and self- or- parent-reported mood. This had some uses in screening, self-monitoring, and feedback to the healthcare professional but not in relapse-prevention and personalised interventions, where significantly more research is required. How and why? The impact of RMT as an intervention itself on depression outcomes remained unclear but self-monitoring and feedback improved emotional self-awareness, therapeutic relationship, and help-seeking behaviours. For whom? With limited standardisation and investigation of the impact of depression on adherence rates, there may be an overestimation of how much young people are likely to use RMT in the real-world. However, they were most likely to benefit those interested in and motivated by the data-driven nature, who have lower depression severity, no co-morbidities where self-monitoring could cause harm, and the presence of changeable behaviours. In what contexts? RMT facilitated monitoring during transition to university, known to be associated with worsening depression in young people; however, there were significant challenges in health care and school settings. Adaptability was important, such that RMT were culturally compelling and accurate for the local context. Overall, there were many gaps in the evidence and common methodological issues across the literature.ConclusionsFrom the evidence base and lived experience insights, realist and ethical considerations were highlighted, as well as the remaining gaps in evidence and methodological issues common across the literature. For RMT to be the scalable solution for depression in young people rather than a case of overplayed potential, several important recommendations for future research and practice were made.

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Threats to epistemic agency in young people with unusual experiences and beliefs

Cited by 22 publications

References 41 publications

Communication in youth mental health clinical encounters: Introducing the agential stance

Communication in youth mental health clinical encounters: Introducing the agential stance

Towards personalised predictive psychiatry in clinical practice: an ethical perspective

Remote measurement technologies for depression in young people: A realist review with meaningful lived experience involvement and recommendations for future research and practice

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