Measuring Health: A Guide to Rating Scales and Questionnaires

Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General’s report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders. The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs. A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.

Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General

In the first two volumes of this work, Paul Ricoeur examined the relations between time and narrative in historical writing, fiction, and theories of literature. This final volume, a comprehensive reexamination and synthesis of the ideas developed in volumes 1 and 2, stands as Ricoeur's most complete and satisfying presentation of his own philosophy.

Time and Narrative

Behavior change is a critical part of effective health care. The final decision to become healthier, however, is that of the patient and not the practitioner. Anyone who has treated patients knows ...

Motivational Interviewing in Health Care: Helping Patients Change Behavior

"A Different Mirror" is a dramatic new retelling of our nation's history, a powerful larger narrative of the many different peoples who together compose the United States of America. In a lively account filled with the stories and voices of people previously left out of the historical canon, Ronald Takaki offers a fresh perspective - a "re-visioning" - of our nation's past.

A Different Mirror: A History of Multicultural America. First Edition.

Context Although posttraumatic stress disorder (PTSD) and alcohol abuse frequently occur among acutely injured trauma survivors, few real-world interventions have targeted these disorders. Objective We tested the effectiveness of a multifaceted collaborative care (CC) intervention for PTSD and alcohol abuse. Design Randomized effectiveness trial. Participants We recruited a population-based sample of 120 male and female injured surgical inpatients 18 or older at a level I trauma center. Intervention Patients were randomly assigned to the CC intervention (n = 59) or the usual care (UC) control condition (n = 61). The CC patients received stepped care that consisted of (1) continuous postinjury case management, (2) motivational interviews targeting alcohol abuse/dependence, and (3) evidence-based pharmacotherapy and/or cognitive behavioral therapy for patients with persistent PTSD at 3 months after injury. Main Outcome Measures We used the PTSD symptomatic criteria (PTSD Checklist) at baseline and 1, 3, 6, and 12 months after injury, and alcohol abuse/dependence (Composite International Diagnostic Interview) at baseline and 6 and 12 months after injury. Results Random-coefficient regression analyses demonstrated that over time, CC patients were significantly less symptomatic compared with UC patients with regard to PTSD ( P = .01) and alcohol abuse/dependence ( P = .048). The CC group demonstrated no difference (−0.07%; 95% confidence interval [CI], −4.2% to 4.3%) in the adjusted rates of change in PTSD from baseline to 12 months, whereas the UC group had a 6% increase (95% CI, 3.1%-9.3%) during the year. The CC group showed on average a decrease in the rate of alcohol abuse/dependence of −24.2% (95% CI, −19.9% to −28.6%), whereas the UC group had on average a 12.9% increase (95% CI, 8.2%-17.7%) during the year. Conclusions Early mental health care interventions can be feasibly and effectively delivered from trauma centers. Future investigations that refine routine acute care treatment procedures may improve the quality of mental health care for Americans injured in the wake of individual and mass trauma.

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A Randomized Effectiveness Trial of Stepped Collaborative Care for Acutely Injured Trauma Survivors

In a classic statement three decades ago, Gouldner (1960) made an important analytic distinction between reciprocity as a pattern of social exchange and reciprocity as a general moral belief. Gouldner argued that the moral norm of reciprocity constitutes an important `causal force' in social life. The reciprocity norm dictates that Ego should not end up gaining at the expense of Alter's beneficial acts towards him or her. In contrast to equity theory, which suggests that people will react equally negatively to under- and overbenefiting, the reciprocity norm suggests that people will, above all, attempt to avoid overbenefiting from their socially supportive interactions. While many studies of social support have incorporated the concepts of reciprocity and exchange, virtually none has examined the validity of Gouldner's distinction nor its potential implications for the dynamics of social support. This paper explores the evidence for Gouldner's claims from studies on support and reciprocity. Evidence is fo...

Reciprocity Reconsidered: Gouldner's `Moral Norm of Reciprocity' and Social Support

This invited article introduces the concept of grand challenges—ambitious yet achievable goals for society that mobilize the profession, capture the public’s imagination, and require innovation and breakthroughs in science and practice to achieve (Kalil, 2012). We call for broad and deep participation of social work scientists and practitioners in the Grand Challenges for Social Work initiative, which will be coordinated by the American Academy of Social Work and Social Welfare.

https://aaswsw.org/wp-content/uploads/2015/01/1-18-2015-SSWR-Grand-Challenges-Presentation-FINAL.pdf

Grand Challenges for Social Work

Background Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. Methods This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. Results In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. Conclusions High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.

Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers.

The Asian American population comprises historically, socially, and culturally diverse ethnic groups. Given this diversity, investigators caution that combining disparate ethnic groups together may lead to erroneous conclusions. Whether by choice or necessity, however, mental health studies still typically consider Asian Americans as a single ethnic category rather than as separate ethnic groups. Few investigations have addressed the consequences of this practice. This paper examines the implications of conceptualizing Asian Americans as an ethnic category versus ethnic groups, in an investigation of the community functioning status of clients in publicly funded mental health programs in King County, Washington. When treated as a single ethnic category in a multivariate linear regression model, Asian Americans are found to have a lower level of functioning difficulty than their white counterparts. However, when treated as separate ethnic groups (e.g., Vietnamese, Japanese), only one of five Asian ethnic groups has a significantly lower level of difficulty. In a separate analysis of the Asian American subsample, groups are found to differ significantly from one another with respect to functional status. Several factors, including refugee status, account for this difference.

Effects of combining disparate groups in the analysis of ethnic differences: variations among Asian American mental health service consumers in level of community functioning.

Edwina S. Uehara

Papers

A Randomized Effectiveness Trial of Stepped Collaborative Care for Acutely Injured Trauma Survivors

Reciprocity Reconsidered: Gouldner's `Moral Norm of Reciprocity' and Social Support

Grand Challenges for Social Work

Posttraumatic distress, alcohol disorders, and recurrent trauma across level 1 trauma centers.

Effects of combining disparate groups in the analysis of ethnic differences: variations among Asian American mental health service consumers in level of community functioning.