Basics of qualitative research: Grounded theory procedures and techniques

The MOS social support survey.

Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.

Research in aging has emphasized average age-related losses and neglected the substantial heterogeneity of older persons. The effects of the aging process itself have been exaggerated, and the modifying effects of diet, exercise, personal habits, and psychosocial factors underestimated. Within the category of normal aging, a distinction can be made between usual aging, in which extrinsic factors heighten the effects of aging alone, and successful aging, in which extrinsic factors play a neutral or positive role. Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.

https://science.sciencemag.org/content/sci/237/4811/143.full.pdf

Human aging: usual and successful

Effect of psychosocial treatment on survival of patients with metastatic breast cancer

Developing a continuum of care is considered to be one of the first steps in the process of implementing managed care strategies. This study summarizes the results of a final survey that focused on the ability of Colorado community mental health centers (CMHCs) to build service capacity and create new programs as a result of Medicaid capitation financing. Capitated agencies, compared to those that remained fee-for- service during the study period, reported a much greater ability to develop services as a result of capitation. Decreases in services were minimal for all agencies. Some differences in managed care organizational models were noted, as were differences in the speed of implementation. Gaps in some services still remain. These findings point to important program implementation issues for publicly funded managed care.

Managed care and service capacity development in a public mental health system.

The pain and mood disturbance of 54 women with metastatic carcinoma of the breast were studied over the course of one year. A random sample was offered weekly group therapy during the year, with or without self-hypnosis training directed toward enhancing their competence at mastering pain and stress related to cancer. Both treatment groups demonstrated significantly less self-rated pain sensation (t = 2.5 p less than 0.02) and suffering (t = 2.17, p less than 0.03) than the control sample. Those who were offered the self-hypnosis training as well as group therapy fared best in controlling the pain sensation (F = 3.1, p less than 0.05). Pain frequency and duration were not affected. Changes in pain measures were significantly correlated with changes in self-rated total mood disturbance on the Profile of Mood States and with its anxiety, depression, and fatigue subscales. Possible mechanisms for the effectiveness of these interventions are discussed.

Group therapy and hypnosis reduce metastatic breast carcinoma pain

Objective:Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Methods:Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995–1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Results:Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reduc...

https://ps.psychiatryonline.org/doi/pdfplus/10.1176/ps.62.2.pss6202_0179

Capitation of Public Mental Health Services in Colorado: A Five-Year Follow-Up of System-Level Effects

Status characteristics, leadership consensus and decision-making among nurses.

Aims of the Study: The economic implications of co-morbid depression in patients with chronic medical disorders have been studied mainly in high-income countries. However, the applicability of such findings in developing countries cannot be assumed. In the present study we estimate diabetes related costs and explore the link between depression and diabetes related costs in Romania. In this former communist country, the general perception of practitioners and policy-makers is that psychological issues are far less important than medical concerns for patients with diabetes, a perception that may lead to the misallocation of already scarce resources. Methods: Data related to costs of diabetes care and to co-morbid depression were collected from a sample of 1,171 diabetes patients at the Nutrition and Diabetes Center in Cluj-Napoca, Romania, using the Diabetes Costs Questionnaire (DCQ) and the Patient Health Questionnaire 9 (PHQ9). The gathered data were subjected to a bivariate analysis of the depression-cost relationship, as well as a regression analysis in order to isolate the effect of depression on diabetes related costs from the effect of covariates. Results: Direct and indirect diabetes related costs equally contributed to the total costs. The repartition of the cost burden between the public system and private agents is nearly equal as well. The bivariate analysis of the depression-cost relationship reveals statistically significant larger diabetes related costs for patients with major depression than for patients with minor depression, and the latter have larger diabetes related costs than patients free of depression symptoms. When the pure effect of depression on diabetes related costs was isolated by means of regression techniques, the provisional diagnosis of major depression was found to significantly increase diabetes related costs. Discussion: The equal distribution of diabetes related costs between direct and indirect measures, as well as the cost burden equally split between the public system and private agents can be explained by the costs of medication and the costs associated with time lost by the non-compensated caregivers. Consistent with Romanian cultural traditions, most of the patients rely on their relatives in an informal diabetes caregiving market for assistance. Alongside depression, the multivariate analysis revealed that factors such as Hungarian ethnicity, income, and number of years since diagnosis also significantly contribute to diabetes related costs. Implications for Health Care Provision and Use: Findings that depression increases diabetes related costs bear potential implications for health policies and health care provision (i.e., the effect of depression on costs can be minimized by adequate recognition and treatment). As such, screening and treatment of cooccurring depression in diabetes patients should become part of the diabetes treatment protocol, not only in Romania but in other Central and Eastern European countries as well. Received 3 October 2011; accepted 8 June 2012

Joan R. Bloom

Papers

Managed care and service capacity development in a public mental health system.

Group therapy and hypnosis reduce metastatic breast carcinoma pain

Capitation of Public Mental Health Services in Colorado: A Five-Year Follow-Up of System-Level Effects

Status characteristics, leadership consensus and decision-making among nurses.

Does co-morbid depression impact diabetes related costs? Evidence from a cross-sectional survey in a low-income country.