Showing papers on "Mental health published in 1992"

Validating the SF-36 health survey questionnaire: new outcome measure for primary care.

Abstract: OBJECTIVES--To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile. DESIGN--Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing. SETTING--Two general practices in Sheffield. PATIENTS--1980 patients aged 16-74 years randomly selected from the two practice lists. MAIN OUTCOME MEASURES--Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics. RESULTS--The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbach9s alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile. CONCLUSIONS--The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.

Overcoming the Odds: High Risk Children from Birth to Adulthood.

Abstract: This study was a follow-up study of a 1955 cohort of births (614 births) on Kauai island in Hawaii. Follow-up was conducted at birth age one and two years age 10 years age 18 years and 31-32 years. The final sample in adulthood was 505 persons. The sample population was comprised of three ethnic groups (Japanese Filipino and part and full Hawaiian) and 54% grew up in poverty. Births were scored for complications as mild moderate or severe. The interviews conducted with mothers postpartum and at one and two years focused on maternal educational level socioeconomic status and family stability; environmental setting was evaluated as favorable to unfavorable on a five-point scale. The 10 year evaluation assessed school work and school behavioral problems mental abilities and stressful life events and illnesses occurring over the preceding 8 years. The home environment was evaluated on the level of educational stimulation emotional support and socioeconomic status. At 18 years a psychological inventory of self-assurance and interpersonal adequacy was conducted and community records were checked for serious mental health or criminal problems. Quality of life of the home environment was also assessed. The follow-up at age 31-32 years assessed the quality of adult adaptation from community records and interview questions which were self-evaluations of personal success satisfaction with family and social life and psychological well-being. Most of the sample led ordinary lives. Some of the stressful life events in childhood and adolescence were associated with coping problems in adulthood.

The strategy of preventive medicine

Abstract: Part 1 The Objectives of Preventive Medicine: The scope for prevention. Why seek to prevent?: the economic and humanitarian arguments. Priorities: a matter of choice Part 2 What needs to be prevented?: Sick individuals: a continuum of disease severity case definitions. A continuum of risk: the prevention paradox mass and individual measures. A unified approach Part 3 The Relation of Risk to Exposure: The dose-effect relationship. The limitations of research methods. Small but widespread risks: a public health disaster? Part 4 Prevention for Individuals and the "High-risk" Strategy Prevention and clinical care The high-risk strategy. Identifying risk-screening. Strengths and weaknesses of the high-risk strategy Part 5 Individuals and Populations: Individual variation: genetic, social and behavioural determinants of diversity. Variation between populations. Sick and healthy populations Part 6 Some Implications of Population change: Effects of the population average on the occurrence of deviance examples from mental health. Health implications for the population as a whole: cardiovascular disease body weight birth weight early development and adult health Down's Syndrome alcohol osteoporosis and fractures occupational and environmental health other fields of application. Safety Part 7 The Population Strategy of Prevention: Principles: the sociological, moral and medical arguments scope proximal and underlying causes. Strengths. Limitations and problems 8. In Search of Health: How do populations change?: the alcohol example. Scientific justification for change. Social engineering versus individual freedom. Freedom of choice. Role of governments. Who takes the decisions? The largest threat to public health: war. Social and economic deprivation. Responsibility for health.

Establishing and maintaining healthy environments. Toward a social ecology of health promotion.

Abstract: Earlier research on health promotion has emphasized behavior change strategies rather than environmentally focused interventions The advantages of integrating lifestyle modification, injury control, and environmental enhancement strategies of health promotion are substantial The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings Directions for future research on the creation and maintenance of health promotive environments also are examined

The concept of mental disorder: On the boundary between biological facts and social values.

Abstract: Although the concept of mental disorder is fundamental to theory and practice in the mental health field, no agreed on and adequate analysis of this concept currently exists. I argue that a disorder is a harmful dysfunction, wherein harmful is a value term based on social norms, and dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it was designed by evolution. Thus, the concept of disorder combines value and scientific components. Six other accounts of disorder are evaluated, including the skeptical antipsychiatric view, the value approach, disorder as whatever professionals treat, two scientific approaches (statistical deviance and biological disadvantage), and the operational definition of disorder as "unexpectable distress or disability" in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). The harmful dysfunction analysis is shown to avoid the problems while preserving the insights of these other approaches.

On the relation between meaning in life and psychological well-being.

Abstract: Meaning in life is an important construct in psychology, but one which has been the focus of limited research. Most research has concentrated on the relation between meaning and psychopathology, and has been conducted with the Purpose in Life Test. This paper examines the relation between meaning in life and psychological well-being using several meaning measures and both positive and negative well-being dimensions. A strong association is found between meaning in life and well-being, which is replicated in two different samples. Meaning in life is found to have a stronger association with positive than with negative well-being dimensions, suggesting the value of taking a salutogenic approach to mental health research. Implications and suggestions for future research are discussed.

Psychological Adjustment to Pediatric Physical Disorders: A Meta-Analytic Review

Abstract: Reviewed 87 studies of children's adjustment to physical disorders in a meta-analysis. Results indicate (a) children with such disorders show increased risk for overall adjustment problems, internalizing and externalizing symptoms; (b) risk was greatest in studies making comparisons to norms rather than to study controls; (c) risk varied by informant (teacher, mental health professional, parent), and by degree of matching with controls; (d) the self-concept of children with physical disorders across all studies appears significant for studies with careful matching or comparisons with norms; (e) there are interdisease differences, but the number of studies within individual disorders, with a few exceptions, are quite small. The need for improved methodology is discussed.

Comparative measurement sensitivity of short and longer health status instruments.

Abstract: Short measures of health status are used increasingly in health services research, yet their sensitivities to clinical change have not been compared with longer, established instruments. In this study, 5 health status measures were administered preoperatively and 3 months postoperatively to 54 patients undergoing total hip arthroplasty. These instruments included the Sickness Impact Profile (SIP)--an established, long measure--and 4 short forms: the SF-36, Functional Status Questionnaire, shortened Arthritis Impact Measurement Scales, and Modified Health Assessment Questionnaire. Scores for physical, psychological, and global dimensions were constructed by aggregating subscales. Sensitivity to change, or responsiveness, was expressed with the standardized response mean (SRM), calculated as the mean change in score divided by the standard deviation of the change in score. The sampling distribution of the SRM was estimated with a jackknife procedure. Preoperative scores were moderately to highly correlated across instruments. The physical and global dimension SRMs of the brief health status measures ranged from 0.85 to 1.27 and were as large as or larger than the corresponding SIP SRMs. The SIP had the highest SRM on the psychological dimension. None of the instruments was significantly more sensitive than the others at the critical value (P = 0.005) adjusted for multiple comparisons. The brief health status measures were equally or more responsive than the SIP after total hip arthroplasty in the physical and global dimensions. Much larger samples are required to demonstrate statistically significant differences in SRMs among instruments.

Methodological issues in the study of sexual abuse effects.

Abstract: Despite its relative infancy, child abuse research has provided a substantial literature on the psychological sequelae of sexual molestation. These findings have been helpful in informing social policy and guiding mental health practice. Because of the recency of interest in this area, however, as well as the costs and time investment associated with more rigorous longitudinal research, many of these studies have used correlational designs and retrospective reports of abuse. The implications of this methodology are outlined, and remedies are suggested where possible. Language: en

Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity.

Abstract: Objective Despite progress in epidemiologic research on posttraumatic stress disorder (PTSD), little is known about factors that distinguish chronic from nonchronic PTSD. In a previous report, the authors identified a set of personal predispositions associated with PTSD following traumatic events in a general population sample of young adults. The purpose of this analysis was to identify characteristics of chronic PTSD and examine whether any of the suspected risk factors for PTSD was associated specifically with chronic PTSD. Method A random sample of 1,007 21- to 30-year-old members of a large health maintenance organization in the Detroit area was interviewed, using the National Institute of Mental Health Diagnostic Interview Schedule (DIS), revised for DSM-III-R. The analysis was performed on data from 394 respondents who reported traumatic events, of whom 93 met criteria for PTSD. Chronic PTSD was defined as duration of symptoms for 1 year or more. Results Persons with chronic PTSD (N = 53) had, on the average, a significantly higher total number of PTSD symptoms and higher rates of overreactivity to stimuli that symbolized the stressor and interpersonal numbing than persons with nonchronic PTSD. The rates of one or more additional anxiety or affective disorders and a variety of medical conditions were higher in persons with chronic than nonchronic PTSD. Family history of antisocial behavior and female sex were associated specifically with chronic PTSD. Conclusions The findings suggest that chronic PTSD may be associated with specific risk factors and clinical features. Longitudinal data on the course of PTSD are needed to determine whether the distinct features and the medical and psychiatric histories of persons with chronic PTSD are complications attendant on a chronic course or coexisting disturbances that inhibit recovery.

A Holistic Model for Wellness and Prevention Over the Life Span

Abstract: A small percentage of our resources for health and human services is devoted to wellness and prevention of illness and social problems. An integrated paradigm for wellness and prevention over the life span is presented for the purpose of theory building, research, clinical application, education, advocacy, and consciousness raising. The model includes 11 characteristics desirable for optimal health and functioning. These characteristics are expressed through the five life tasks of spirituality, self-regulation, work, friendship, and love. Life forces external to the person are noted to understand the interaction between the individual and societal institutions.

Handbook of mental health and aging

Abstract: Background: B.D. Lebowitz and G. Niederehe, Concepts and Issues in Mental Health and Aging. J.C. Anthony and A. Aboraya, Epidemiology of Selected Mental Disorders in Later Life. D. Gutmann, Culture and Mental Health in Later Life. E.P. Stanford and B.C. Du Bois, Gender and Ethnicity Patterns. M.A. Lieberman and H. Peskin, Adult Life Crises. Neurosciences and Aging: A.B. Scheibel, Structural Changes in the Aging Brain. D.G. Morgan, Neurochemical Changes with Aging Predisposition towards Age-Related Mental Disorders. C.L. Grady and S.I. Rapoport, Cerebral Metabolism in Aging and Dementia. B. Gurland and S. Katz, The Outcomes of Psychiatric Disorder in the Elderly: Relevance to Quality of Life. Behavioral Sciences and Aging: F. Schieber, Aging and The Senses. J.A. Sugar and J. M. McDowd, Memory, Learning and Attention. W.R. Cunningham and K.L. Haman, Intellectual Functioning in Relation to Mental Health. H. Thomae, Emotion and Personality. Psychopathology of Later Life: H.G. Koenig and D.G. Blazer, Mood Disorders and Suicide. J.I. Sheikh, Anxiety and Its Disorders in Old Age. J. Sadavoy and B. Fogel, Personality Disorders in Old Age. P.V. Rabins, Schizophrenia and Psychotic States. M.A. Raskind and E.R. Peskind, Alzheimer's Disease and Other Dementing Disorders. R.M. Atkinson, L. Ganzini, and M.J. Bernstein, Alcohol and Substance-Use Disorders in the Elderly. C.C. Hoch, D.J. Buysse, T.H. Monk, and C.F. Reynolds, Sleep Disorders and Aging. M.M. Seltzer, Aging in Persons with Developmental Disabilities. Assessment, Treatment, and Prevention: E.D. Caine and H.T. Grossman, Neuropsychiatric Assessment. A. La Rue, J. Yang, and S. Osato, Neuropsychological Assessment. B.J. Kemp and J. Mitchell, Functional Assessment in Geriatric Mental Health. N.A. Newton and L.W. Lazarus, Behavioral and Psychotherapeutic Interventions. C. Salzman and J. Nevis-Olesen, Psychopharmacologic Treatment. V. Regnier and J. Pynoos, Environmental Interventions for Cognitively Impaired Older Adults. L.K. George, Community and Home Care for Mentally Ill Older Adults. M.H. Wykle, M.E. Segall, and S. Nagley, Mental Health and Aging: Hospital Care--A Nursing Perspective. B. Liptzin, Nursing Home Care. S. Eth and G.B. Leong, Forensic and Ethical Issues. G. Gottlieb, Economic Issues and Geriatric Mental Health Care. The Future: G.D. Cohen, The Future of Mental Health and Aging. Index.

Social support and depressive symptoms in the elderly.

Abstract: The purpose of this study was to examine the effect of characteristics of social networks and support on depressive symptoms in the elderly. The subjects were 1,962 noninstitutionalized persons 65 years and older from the New Haven Establishment of Populations for Epidemiologic Study of the Elderly in 1982, who were available to give a complete follow-up interview in 1985. Baseline depression, functional disability in 1982, and any change in disability by 1985 were considered as additional influences on 1985 depression, requiring adjustment along with sociodemographic variables. Multiple regression procedures were used to simultaneously examine the variables. Baseline depression, functional disability, and change in functional disability made the largest contribution to explaining the variance in depression. Among the social support and network characteristics, loss of a spouse, adequacy of emotional support, and its change during 1982-1985 made the largest contributions. Other significant characteristics in relative order of magnitude of effect, based on contrast tests, included tangible support adequacy and its change, loss of a confidant between 1982 and 1985, number of children making weekly visits and change in this number by 1985, and the absence of a confidant in both 1982 and 1985. For mental health outcomes, these findings emphasize the need to consider specific dimensions of social support and networks rather than global measures.

Counseling for Spiritual Wellness: Theory and Practice.

Abstract: Spiritual wellness is an emerging area of interest in counseling. It still lacks clarity, however, in definition and application. To increase familiarity with and encourage counselor intervention regarding the spiritual dimension, the authors of this article attempt to define more clearly the concept of spiritual health and to describe ways to use techniques for the enhancement of spiritual wellness and the advancement of spiritual development.

The Explanatory Model Interview Catalogue (EMIC). Contribution to cross-cultural research methods from a study of leprosy and mental health.

Abstract: The Explanatory Model Interview Catalogue (EMIC) has been developed to elicit illness-related perceptions, beliefs, and practices in a cultural study of leprosy and mental health in Bombay. Leprosy is an especially appropriate disorder for studying the inter-relationship of culture, mental health and medical illness because of deeply rooted cultural meanings, the emotional burden, and underuse of effective therapy. Fifty per cent of 56 recently diagnosed leprosy out-patients, 37% of 19 controls with another stigmatised dermatological condition (vitiligo), but only 8% of 12 controls with a comparable non-stigmatised condition (tinea versicolor) met DSM-III-R criteria for an axis I depressive, anxiety or somatoform disorder. Belief in a humoral (traditional) cause of illness predicted better attendance at clinic.

Measures of Need and Outcome for Primary Health Care

Abstract: Defining need and outcome Concepts Methods of measurement Measures of functioning Measures of mental illness and mental health Measures of social support Multi-dimensional measures Disease - specific measures Measures of patient satisfaction Miscellaneous measures Final comments.

Gender Disparities in Treatment for Alcohol Problems

Abstract: Objective. —To examine women's access to treatment for alcohol problems in terms of the prevalence, characteristics, and treatment-seeking patterns of problem drinkers in a range of alcohol-specific and nonspecialized health care systems. Design. —In-person survey. Setting. —A Northern California county. Participants. —Consecutive samples of admissions in public alcohol treatment (n=381), drug treatment (n=210), mental health treatment (n=406), emergency health services (n=2626), primary health clinics (n=394), and adults in the county general population (n=3069). Primary Outcome Measures. —Prevalence and relative risk (RR) of problem drinking and rates of alcohol-related treatment episodes. Results. —Rates of problem drinking were higher among men than women across all samples. However, after accounting for gender differences in general population rates, women in all of the non-alcohol-specific clinical samples were at greater risk than men for problem drinking (eg, RR=5.6 for women and RR=2.1 for men in the mental health sample). Men reported a greater variety in types of services sought in past alcohol-related treatment encounters, but women experienced greater symptom severity. Conclusions. —Female problem drinkers were more likely than male problem drinkers to use non-alcohol-specific health care settings, particularly mental health treatment services, and to report greater symptom severity. Future research on women's access to services for alcohol problems should consider a range of health care systems and gender differences in seeking help. (JAMA1992;268:1872-1876)

Child Sexual Assault as a Risk Factor for Mental Disorders among Women: A Community Survey.

Abstract: A community sample of 391 adult women was screened for a history of sexual assault during childhood and assessed for lifetime and current mental disorders using a structured victimization history interview and the Diagnostic Interview Schedule. One third of the women had been victims of rape, molestation, or sexual assault not involving physical contact prior to the age of 18 years. Child rape victims were more likely than nonvictims to have ever met DSM-III diagnostic criteria for a major depressive episode, agoraphobia, obsessive-compulsive disorder, social phobia, and sexual disorders. Molestation victims were overrepresented on major depressive episode, obsessive-compulsive disorder, and sexual disorders. Noncontact child sexual assault was not a significant risk factor for any disorder. Child rape and molestation victims were more likely than victims of noncontact assault to have had crime-related posttraumatic stress disorder. Mental disorder lifetime prevalence risk ratios for child rape and molest...

Social support, AIDS-related symptoms, and depression among gay men.

Abstract: This study examined the impact of social support and HIV-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men aged 25-54 years. The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 year later. Satisfaction with each of three types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 year later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the AIDS crisis and have important practical implications for designing mental health services to meet those needs.

Associations between dimensions of religious commitment and mental health reported in the American Journal of Psychiatry and Archives of General Psychiatry: 1978-1989.

Abstract: The authors assessed all measures of religious commitment (N = 139) reported in research studies published in the American Journal of Psychiatry and Archives of General Psychiatry in 1978 through 1989 (N less than 35). For nearly two-thirds of the measures, the studies either made no hypotheses or reported no results concerning the relationship of religious commitment to mental health status. For the great majority of the measures assessed, the studies reported a positive relationship between religious commitment and mental health.

Toward a more culturally sensitive DSM-IV. Psychoreligious and psychospiritual problems

Abstract: In theory, research, and practice, mental health professionals have tended to ignore or pathologize the religious and spiritual dimensions of life. This represents a type of cultural insensitivity toward individuals who have religious and spiritual experiences in both Western and non-Western cultures. After documenting the "religiosity gap" between clinicians and patients, the authors review the role of theory, inadequate training, and biological primacy in fostering psychiatry's insensitivity. A new Z Code (formerly V Code) diagnostic category is proposed for DSM-IV: psychoreligious or psychospiritual problem. Examples of psychoreligious problems include loss or questioning of a firmly held faith, and conversion to a new faith. Examples of psychospiritual problems include near-death experiences and mystical experiences. Both types of problems are defined, and differential diagnostic issues are discussed. This new diagnostic category would: a) improve diagnostic assessments when religious and spiritual issues are involved; b) reduce iatrogenic harm from misdiagnosis of psychoreligious and psychospiritual problems; c) improve treatment of such problems by stimulating clinical research; and d) encourage clinical training centers to address the religious and spiritual dimensions of human existence.

Women and mental health: the interaction of job and family conditions.

Abstract: Current research on the effects of wives' employment on their well-being focuses on the determinants of those effects. Most studies have used a gender model that concentrates on family conditions as mediators. In contrast, studies of the effects of employment on men typically use a job model and focus on work rather than family conditions as determinants. To understand fully the impact of employment on women, these models should be combined. We predict that certain work and family conditions interact, specifically, that the degree of control at work moderates the effects of demands in the family. Using two data sets on community mental health, we have found some support for this hypothesis.

Factors contributing to the subjective quality of life of the chronic mentally ill

Abstract: Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.

Coping with the stress of illness.

Abstract: How can we cope better, or help others to do so? The answer to this depends on knowing what an individual is coping with. This, in turn, depends on the appraisal, by the individual concerned, of the significance of what is happening for well-being--in effect, the source of harm, threat, challenge. Cases of myocardial infarction, cancer and chronic pain have some harms, threats, and challenges in common but there are also unique factors in each illness. The patient with a chronic illness is continually appraising his or her symptoms, pains, disease progression with respect to their significance for well-being and survival, and coping accordingly. The paper presents a microanalytic, contextual and process-centred approach to coping which is part of a broad system of thought, emphasizing cognitive appraisal and the person's ongoing relationships with the environment as factors of his or her emotional life. Implications for prevention and treatment of illness in a perspective of health promotion are discussed as well as the need for research to predict long-term outcome from stress and coping.

Men's multiple roles and their relationship to men's psychological distress.

Abstract: There is general agreement that men's subjective experiences in their job role affect their psychological health. Less attention has been paid to the incremental contribution of family role variables. In a random sample of 300 employed, married men in two-earner couples, we estimate the relationship between men's subjective experiences in their work and family roles and their level of psychological distress. We also estimate the moderating effects of marital-role quality, parental status, and parental-role quality on the relationship between job-role quality and distress. After controlling for job-role quality, both marital-role and parental-role quality are signifianct predictors of men's psychological distress. Parental status is not. Both marital-role and parental-role quality moderate the relationship between job-role quality and psychological distress.