Showing papers on "Mental health published in 1999"

The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.

Abstract: The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.

Public conceptions of mental illness: labels, causes, dangerousness, and social distance.

Abstract: OBJECTIVES: The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance. METHODS: Data were derived from a vignette experiment included in the 1996 General Social Survey. Respondents (n = 1444) were randomly assigned to 1 of 5 vignette conditions. Four vignettes described psychiatric disorders meeting diagnostic criteria, and the fifth depicted a "troubled person" with subclinical problems and worries. RESULTS: Results indicate that the majority of the public identifies schizophrenia (88%) and major depression (69%) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors. Results also show, however, that smaller proportions associate alcohol (49%) or drug (44%) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a d...

Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis

Abstract: This article reviews literature on the prevalence of mental health problems among women with a history of intimate partner violence. The weighted mean prevalence of mental health problems among battered women was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. These were typically inconsistent across studies. Weighted mean odds ratios representing associations of these problems with violence ranged from 3.55 to 5.62, and were typically consistent across studies. Variability was accounted for by differences in sampling frames. Dose-response relationships of violence to depression and PTSD were observed. Although research has not addressed many criteria for causal inferences, the existing research is consistent with the hypothesis that intimate partner violence increases risk for mental health problems. The appropriate way to conceptualize these problems deserves careful attention.

The structure of common mental disorders.

Abstract: Background This report presents the results of confirmatory factor analyses of patterns of comorbidity among 10 common mental disorders in the National Comorbidity Survey, a national probability sample of US civilians who completed structured diagnostic interviews. Methods Patterns of comorbidity among DSM-III-R mental disorders were analyzed via confirmatory factor analyses for the entire National Comorbidity Survey sample (N=8098; age range, 15-54 years), for random halves of the sample, for men and women separately, and for a subsample of participants who were seeing a professional about their mental health problems. Four models were compared: a 1-factor model, a 2-factor model in which some disorders represented internalizing problems and others represented externalizing problems, a 3-factor variant of the 2-factor model in which internalizing was modeled as having 2 subfactors (anxious-misery and fear), and a 4-factor model in which the disorders represented separate affective, anxiety, substance dependence, and antisocial factors. Results The 3-factor model provided the best fit in the entire sample. This result was replicated across random halves of the sample as well as across women and men. The substantial empirical intercorrelation between anxious-misery and fear (0.73) suggested that these factors were most appropriately conceived as subfactors of a higher-order internalizing factor. In the treatment sample, the 2-factor model fit best. Conclusions The results offer a novel perspective on comorbidity, suggesting that comorbidity results from common, underlying core psychopathological processes. The results thereby argue for focusing research on these core processes themselves, rather than on their varied manifestations as separate disorders.

Forming a story: The health benefits of narrative

Abstract: Writing about important personal experiences in an emotional way for as little as 15 minutes over the course of three days brings about improvements in mental and physical health. This finding has been replicated across age, gender, culture, social class, and personality type. Using a text-analysis computer program, it was discovered that those who benefit maximally from writing tend to use a high number of positive-emotion words, a moderate amount of negative-emotion words, and increase their use of cognitive words over the days of writing. These findings suggest that the formation of a narrative is critical and is an indicator of good mental and physical health. Ongoing studies suggest that writing serves the function of organizing complex emotional experiences. Implications for these findings for psychotherapy are briefly discussed. © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 1243–1254, 1999.

The influence of physical activity on mental well-being

Abstract: Objective: The case for exercise and health has primarily been made on its impact on diseases such coronary heart disease, obesity and diabetes. However, there is a very high cost attributed to mental disorders and illness and in the last 15 years there has been increasing research into the role of exercise a) in the treatment of mental health, and b) in improving mental well-being in the general population. There are now several hundred studies and over 30 narrative or meta-analytic reviews of research in this field. These have summarised the potential for exercise as a therapy for clinical or subclinical depression or anxiety, and the use of physical activity as a means of upgrading life quality through enhanced self-esteem, improved mood states, reduced state and trait anxiety, resilience to stress, or improved sleep. The purpose of this paper is to a) provide an updated view of this literature within the context of public health promotion and b) investigate evidence for physical activity and dietary interactions affecting mental well-being. Design: Narrative review and summary. Conclusions: Sufficient evidence now exists for the effectiveness of exercise in the treatment of clinical depression. Additionally, exercise has a moderate reducing effect on state and trait anxiety and can improve physical self-perceptions and in some cases global self-esteem. Also there is now good evidence that aerobic and resistance exercise enhances mood states, and weaker evidence that exercise can improve cognitive function (primarily assessed by reaction time) in older adults. Conversely, there is little evidence to suggest that exercise addiction is identifiable in no more than a very small percentage of exercisers. Together, this body of research suggests that moderate regular exercise should be considered as a viable means of treating depression and anxiety and improving mental well-being in the general public.

Mental Health Consumers' Experience of Stigma

Abstract: The extent to which mental health consumers encounter stigma in their daily lives is a matter of substantial importance for their recovery and quality of life. This article summarizes the results of a nationwide survey of 1,301 mental health consumers concerning their experience of stigma and discrimination. Survey results and followup interviews with 100 respondents revealed experience of stigma from a variety of sources, including communities, families, churches, coworkers, and mental health caregivers. The majority of respondents tended to try to conceal their disorders and worried a great deal that others would find out about their psychiatric status and treat them unfavorably. They reported discouragement, hurt, anger, and lowered self-esteem as results of their experiences, and they urged public education as a means for reducing stigma. Some reported that involvement in advocacy and speaking out when stigma and discrimination were encountered helped them to cope with stigma. Limitations to generalization of results include the self-selection, relatively high functioning of participants, and respondent connections to a specific advocacy organization-the National Alliance for the Mentally Ill.

Unpacking authoritative parenting : Reassessing a multidimensional construct

Abstract: This study examines the independent and joint contributions of three core dimensions of authoritative parenting-acceptance-involvement, strictnesssupervision, and psychological autonomy granting-to adolescent adjustment. A sample of 8, 700 14- to IS-year-olds completed questionnaires that included indices of authoritative parenting and a set of instruments assessing different aspects of adjustment. Behavior problems were related more strongly to behavioral control than to psychological autonomy granting. Psychosocial development and internal distress were more strongly associated with both psychological autonomy granting and acceptance-involvement than with behavioral control Academic competence demonstrated significant relations with all three parenting variables. Curvilinear and interactive relations between parenting practices and adolescent adjustment were observed, but the specific pattern varied as a function of outcome assessed. Over the past four decades, a considerable body of research has accumulated on the relation between psychological well-being in childhood and adolescence and two fundamental aspects of parenting: control and acceptance. This literature has consistently shown that parental acceptance, inductive discipline, nonpunitive punishment practices, and consistency in childrearing are each associated with positive developmental outcomes in children (Maccoby & Martin, 1983). Since the early 1970s, this constellation of practices has come to be known as authoritative parenting, one of several prototypic styles of parenting identified in the seminal studies of Diana Baumrind (1967, 1971). Children who are raised in authoritative homes score higher than their peers raised in authoritarian, indulgent, or neglectful homes on a variety of measures of competence, social development, selfperceptions, and mental health (Maccoby & Martin, 1983). Several recent studies have applied Baumrind's model to explain variations in patterns of adolescent development, including academic achievement, psychosocial development, behavior problems, and psychological symptoms (e.g., Dornbusch, Ritter, Leiderman, Roberts, & Fraleigh, 1987; Lamborn, Mounts, Steinberg, & Dornbusch, 1991; Steinberg, Elmen, & Mounts, 1989; Steinberg, Lamborn, Dornbusch, & Darling, 1992; Steinberg, Mounts, Lamborn, & Dornbusch, 1991), and these reports find that adolescents, like their younger counterparts, benefit from authoritative parenting. Although the strong positive effects of authoritative parenting have been more consistently reported in studies of White, rather than nonWhite, youth (see, for example, Baumrind, 1972; Chao, 1994), no large-scale systematic studies ever have indicated that nonauthoritative parenting has more beneficial effects on adolescent development than authoritative parenting, regardless of the population studied. Despite the breadth and consistency of these findings, most empirical studies of parenting practices and adolescent outcomes continue to focus on single dimensions of the parent-child relationship considered independently. They leave unanswered several questions about the precise nature of this relationship. Three questions, in particular, define the focus of the study presented here. The first concerns the effects of parental control, a construct that continues to evolve amidst debate over its conceptualization (Barber, Olsen, & Shagle, 1994). Although the distinction between psychological control-the relative degree of emotional autonomy that parents allowand behavioral control-the level of monitoring and limit setting that parents use-was articulated more than 30 years ago (Schaefer, 1965; see also Barber et al., 1994, and Steinberg, 1990), little empirical research has focused on the differential effects of these types of control. In light of existing theories about the potential impact of parental intrusiveness (e.g., an excess of psychological control) on the development of internalizing problems and the potential impact of parental leniency (e. …

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study.

Abstract: OBJECTIVES: The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. METHODS: In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. RESULTS: Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. CONCLUSIONS: Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

On the Distinction between Disease and Illness

Abstract: In this century a strong tendency has developed to debate social issues in psychiatric terms. Whether the topic is criminal responsibility, sexual deviance, feminism, or a host of others, claims about mental health are increasingly likely to be the focus of discussion. This growing preference for medicine over morals, which might be called the psychiatric turn, has an obvious appeal. In the paradigm health discipline, physiological medicine, judgments of health and disease are normally uncontroversial. The idea of reaching comparable certainty about difficult ethical problems is an inviting prospect. Unfortunately our grasp of the issues that surround the psychiatric turn continues to be impeded, as does psychiatric theory itself, by a fundamental misunderstanding of the concept of health. With few exceptions, clinicians and philosophers are agreed that health is an essentially evaluative notion. According to this consensus view, a value-free science of health is impossible. This thesis I believe to be entirely mistaken. I shall argue in this essay that it rests on a confusion between the theoretical and the practical senses of "health," or in other words, between disease and illness.

Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity.

Abstract: Background. The paper describes prevalence, impairments, patterns of co-morbidity and other correlates of DSM-IV social phobia in adolescents and young adults, separating generalized and non-generalized social phobics. Methods. Data are derived from the baseline investigation of the Early Developmental Stages of Psychopathology Study (EDSP), a prospective longitudinal community study of 3021 subjects, aged 14‐24. Diagnoses were based on the DSM-IV algorithms of an expanded version of the Composite International Diagnostic Interview. Results. Lifetime prevalence of DSM-IV}CIDI social phobia was 9‐5% in females and 4‐9% in males, with about one-third being classified as generalized social phobics. Twelve-month prevalence was only slightly lower, indicating considerable persistence. Respondents with generalized social phobia reported an earlier age of onset, higher symptom persistence, more co-morbidity, more severe impairments, higher treatment rates and indicated more frequently a parental history of mental disorders than respondents with non-generalized social phobia. Conclusions. History of DSM-IV social phobia was found to be quite prevalent in 14‐24 year-olds. The generalized subtype of social phobia was found to have dierent correlates and to be considerably more persistent, impairing and co-morbid than non-generalized social phobia. Although generalized social phobics are more likely than non-generalized social phobics to receive mental health treatments, the treatment rate in this sample was low despite the fact that mental health services are free in Germany.

Health Risks and Developmental Transitions during Adolescence

Abstract: 1. Negotiating developmental transitions during adolescence and young adulthood: health risks and opportunities John Schulenberg, Jennifer L. Maggs, Klaus Hurrelmann Part I. Sociocultural, Physical and Cognitive Foundations of Adolescent Transitions: 2. Cultural, historical and subcultural contexts of adolescence: implications for health and development Lisa J. Crockett 3. Social change and adolescent well-being: healthy country, healthy teens Peter Noack and Barbel Kracke 4. Self-reported maturational timing and adaptation in adolescence Rainer K. Silbereisen and Barbel Kracke 5. Adolescents' decisions about risks: a cognitive perspective Ruth Beyth-Marom and Baruch Fischhoff Part II. Affiliation Transitions and Health: 6. The family as health risk and opportunity: a focus on divorce and working families Nancy L. Galambos and Marion F. Ehrenberg 7. Transformations in peer relationships at adolescence: implications for health-related behavior B. Bradford Brown, M. Margaret Dolcini and Amy Leventhal 8. Sexuality and developmental transitions during adolescence Jeanne Brooks-Gunn and Roberta Paikoff 9. Child bearing during adolescence: mental health risks and opportunities Cleopatra Howard Caldwell and Toni C. Antonucci 10. Marriage, divorce, and parenthood during the transition to young adulthood: impacts on drug use and abuse Jerald G. Bachman, Katherine N. Wadsworth, Patrick M. O'Malley, John Schulenberg and Lloyd D. Johnston Part III. Achievement Transitions and Health: 11. The association of school transitions in early adolescence with developmental trajectories through High School Jacquelynne S. Eccles, Sarah E. Lord, Robert W. Roeser, Bonnie L. Barber and Debra M. Hernandez Jozefowicz 12. Transitions into part-time work: health risks and opportunities Michael D. Finch, Jeylan T. Mortimer and Seongryeol Ryu 13. Alcohol and binge drinking as goal-directed action during the transition to post-secondary education Jennifer L. Maggs 14. Health risks and deviance in the transition from school to work Eduard Matt, Lydia Seus and Karl F. Schumann Part IV. Identity Transitions and Health: 15. Self definition and mental health during adolescence and young adulthood Jarik-Erik Nurmi 16. Ethnic and racial identity development and mental health Jean S. Phinney and Eric L. Kohatsu 17. Religion and adolescent health compromising behavior John M. Wallace Jr. and David R. Williams Part V. Intervention: Altering Transition-Health Risk Connections: 18. Promoting mental health during the transition into adolescence Anne C. Petersen, Nancy Leffert, Barbara Graham, Jan Alwin and Shuai Ding 19. Preventing health compromising behaviors among youth and promoting their positive development: a developmental-contextual perspective Richard M. Lerner, Charles W. Ostrum and Melissa A. Freel 20. Developmental transitions during adolescence: health promotion implications Jennifer L. Maggs, John Schulenberg and Klaus Hurrelmann.

Physical activity & behavioral medicine

Abstract: `Timely and will be of special interest to health service managers and members of primary care groups because the successful promotion of regular physical activity is a challenge contained in the strategy of Our Healthier Nation and is a candidate for incorporation into health improvement programmes and the service framework for coronary heart disease' - Health Service Journal This crisply written and thought-provoking book integrates theories and studies from several disciplines to examine what is known about physical activity and health. The authors use a behavioural epidemiology framework to organize the book and explore such topics as: physical activity and the health of children, adults and the elderly; the impact of physical activity on mental health; health risks of physical activity; how to measure it; how to promote physical activity to individuals; and community-based physical activity interventions. Highlighting some of the best and most important research in physical activity, the book offers studies of diverse populations, including different ethnic backgrounds and nationalities, age and gender groups and socioeconomic levels. Although the health benefits of physical activity are fairly well-known, this book furthers our understanding of how to help people become active enough to enjoy these benefits.

The effect of unemployment on mental health

Abstract: Sixteen recent longitudinal studies are examined for evidence relevant to the claim that a change to one’s employment status aVects one’s mental health. Although there were limitations to the set of studies examined, most of the studies supported this claimed relationship. Examination was then made of the size of this eVect. In carrying out this examination, the set of study results were divided into two categories: (a) those addressing the question of the extent to which gaining employment impacts on mental well-being; (b) those addressing the question of the extent to which employment loss impacts on mental health. The meta-analyses indicated that there was a weighted eVect size of .54 for the erst question, and a smaller weighted eVect size (.36) for the latter question. Depressive aVect is probably the most frequently studied psychological variable among unemployed people. In the 10 years since O’Brien (1986) reviewed the literature on the psychological eVects of unemployment, 16 longitudinal studies have appeared in MEDLINE or PSYCLIT to complement the large number of cross-sectional studies which have compared employed and unemployed persons on various measures of personality, mood and psychiatric vulnerability. With the addition of these recent longitudinal studies it is possible to attempt to summarize what is known about the mental health consequences of unemployment, even while acknowledging certain methodological issues that continue to constrain the study of this aspect of the psychology of unemployment. In this article we review what is known about the mental health eVects of unemployment. We do not pay detailed attention to personal and contextual factors which might limit the validity of any generalizations about the nature and extent of the relationship between unemployment and negative aVect, as our main aim is to consider the scientiec evidence for the claim that job loss generally aVects the mental health of the unemployed. A second aim of the paper is to describe the size of any demonstrated eVect.

The stress process and the social distribution of depression.

Abstract: Mental health generally and depression in particular have been repeatedly shown to vary in relation to gender, socioeconomic status, marital status, and age. These status differences may be linked to mental health because they tend to define important differences in stress exposure and in the availability of coping resources. This paper examines the capacity of the stress-process model to account for the social distribution of depression. We employ mediation analyses using data from a 1990-1991 survey of Toronto community residents. In general, we found hypothesized risk factors to vary across these statuses with depressive symptoms and disorder and the distribution of protective factors to vary inversely. Results indicate that the model as expressed in our analyses accounts for a substantial minority of observed depression differences across individuals and for a considerable portion of reliably observed variation across social statuses. Our findings with respect to major depressive disorder parallel those for depressive symptomatology. Most compelling is the nearly total explanation of the socioeconomic status association with depressive symptoms and the substantial contribution toward explaining the socioeconomic status-disorder relationship when stress process mediators are accounted for.

Distinguishing between quality of life and health status in quality of life research: A meta-analysis

Abstract: Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.

The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.

Abstract: OBJECTIVES: The authors examined Americans' opinions about financial and treatment competence of people with mental health problems, potential for harm to self or others, and the use of legal means to force treatment. METHODS: The 1996 General Social Survey provided interview data with a nationally representative sample (n = 1444). Respondents were given a vignette based on diagnostic criteria for schizophrenia, major depression, alcohol dependence, or drug dependence, or a "control" case. RESULTS: The specific nature of the problem was the most important factor shaping public reaction. Respondents viewed those with "troubles," alcohol dependence, or depression as able to make treatment decisions. Most reported that persons with alcohol or drug problems or schizophrenia cannot manage money and are likely to be violent toward others. Respondents indicated a willingness to coerce individuals into treatment. Respondent and other case characteristics rarely affected opinions. CONCLUSIONS: Americans report gre...

Low socioeconomic status and mental disorders : A longitudinal study of selection and causation during young adulthood

Abstract: This article examines low socioeconomic status (SES) as both a cause and a consequence of mental illnesses by investigating the mutual influence of mental disorders and educational attainment, a core element of SES. The analyses are based on a longitudinal panel design and focus on four disorders: anxiety, depression, antisocial disorder, and attention deficit disorder. The article shows that each disorder has a unique relationship with SES, highlighting the need for greater consideration of antisocial disorders in the status attainment process and for further theoretical development in the sociology of mental disorders to account for disorder-specific relations with SES.

Psychological abuse: a variable deserving critical attention in domestic violence.

Abstract: Policy makers and researchers give psychological abuse considerably less attention than physical abuse in the partner abuse area. One reason for the relative neglect of psychological abuse is that there are difficulties in arriving at a common definition of psychological abuse that might be useful to both the mental health and legal professions. Another reason for the relative neglect of psychological abuse has been an implicit assumption that physical abuse exacts a greater psychological toll on victims than does psychological abuse. At the extreme level of physical abuse, this assumption seems defensible, but at levels of physical aggression that are most common in marriage and long-term relationships, psychological abuse appears to have as great an impact as physical abuse. Even direct ratings of psychological and physical abuse by women in physically abusive relationships indicate that psychological abuse has a greater adverse effect on them than physical abuse. Retrospective reports, longitudinal research, and treatment dropout research all provide evidence that psychological abuse can exact a negative effect on relationships that is as great as that of physical abuse. Finally, psychological abuse almost always precedes physical abuse, so that prevention and treatment efforts clearly need to address psychological abuse. Eight measures of various forms of psychological abuse that have reasonable psychometric properties and considerable construct validity are reviewed and a definition of psychological abuse in intimate relations is provided.

Obesity stigmatization and coping: Relation to mental health symptoms, body image, and self-esteem.

Abstract: OBJECTIVE: To create inventories of stigmatizing situations faced by obese people and ways of coping with stigmatization, and to examine how stigma and coping are related to psychological distress in an obese patient population. DESIGN: Study 1: Items were generated by asking obese people to list stigmatizing situations they had encountered and their ways of coping. Study 2: Obese patients were surveyed about the frequency with which they encountered each form of stigmatization and employed each form of coping. Cross-sectional data on current psychological adjustment were obtained. SUBJECTS: Study 1: 63 obese patients (body mass index, BMI>40 kg/m2); 38 obese non-patients, seven professionals who work with obese patients and 32 obese female authors from the print media. Study 2: 112 gastric bypass patients (BMI 33.9–80.9 kg/m2) and 34 less obese patients (BMI 27.1–57.2 kg/m2). MEASUREMENT: Study 1: Collection of stigmatizing situations and coping responses. Study 2: Frequency of stigmatizing experiences and coping responses, psychological symptoms, body image, and self esteem measures. RESULTS: Study 1 resulted in two objective questionnaires, consisting of 50 situations and 99 responses. Study 2 found that stigmatization is a common experience, and that obese subjects frequently engage in some effort to cope with stigma. More frequent exposure to stigmatization was associated with greater psychological distress, more attempts to cope, and more severe obesity. Certain coping strategies are associated with greater distress.

Consensus Statement on the Upcoming Crisis in Geriatric Mental Health: Research Agenda for the Next 2 Decades

Abstract: It is anticipated that the number of people older than 65 years with psychiatric disorders in the United States will increase from about 4 million in 1970 to15 million in 2030. The current health care system serves mentally ill older adults poorly and is unprepared to meet the upcoming crisis in geriatric mental health. We recommend the formulation of a 15- to 25-year plan for research on mental disorders in elderly persons. It should include studies of prevention, translation of findings from bench to bedside, large-scale intervention trials with meaningful outcome measures, and health services research. Innovative strategies are needed to formulate new conceptualizations of psychiatric disorders, especially those given scant attention in the past. New methods of clinical and research training involving specialists, primary care clinicians, and the lay public are warranted.

Emotions in Sport

Abstract: The study of emotion in sport and exercise - historical, definitional, and conceptual perspectives cognitive-motivational-relational theory of emotion individual zones of optimal functioning (IZOF) model -emotion-performance relationships in sport competitive anxiety anger, aggressive behaviour and athletic performance joy, fun and flow state in sport successful and poor performance and emotions overtraining in athletes burnout in athletes and coaches maladaptive fatigue syndrome and emotions in sport the injured athlete exercise, emotions, and mental health.

Suicide within 12 months of contact with mental health services: national clinical survey

Abstract: Objective: To describe the clinical circumstances in which psychiatric patients commit suicide. Design: National clinical survey. Setting: England and Wales. Subjects: A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. Main outcome measures: Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. Results: 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. Conclusions: Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.

African Americans' mental health and perceptions of racist discrimination: The moderating effects of racial socialization experiences and self-esteem.

Abstract: This research responded to researchers' calls for investigation of potential moderators of the link between perceptions of racist discrimination and mental health. In a sample of 119 African American young adults, the authors investigated the extent to which 4 theoretically relevant variables moderated the perceived racism-mental health relation. Consistent with predictions, results revealed that greater experience with racial socialization messages attenuated the link between reports of racist events and poorer mental health. Self-esteem also moderated the relation, but in a direction opposite that predicted. Neither racial socialization beliefs nor African American social networks moderated the relation. Overall, results indicated that individual differences shape the extent to which African Americans' mental health is related to perceptions of racist discrimination.

Prenatal and infancy home visitation by nurses: recent findings.

Abstract: This article describes a 20-year program of research on the Nurse Home Visitation Program, a model in which nurses visit mothers beginning during pregnancy and continuing through their children's second birthdays to improve pregnancy outcomes, to promote children's health and development, and to strengthen families' economic self-sufficiency. The results of two randomized trials (one in Elmira, New York, and the second in Memphis, Tennessee) are summarized, and an ongoing trial in Denver, Colorado, is briefly described. Results of the Elmira and Memphis trials suggest the following: The program benefits the neediest families (low-income unmarried women) but provides little benefit for the broader population. Among low-income unmarried women, the program helps reduce rates of childhood injuries and ingestions that may be associated with child abuse and neglect, and helps mothers defer subsequent pregnancies and move into the workforce. Long-term follow-up of families in Elmira indicates that nurse-visited mothers were less likely to abuse or neglect their children or to have rapid successive pregnancies. Having fewer children enabled women to find work, become economically self-sufficient, and eventually avoid substance abuse and criminal behavior. Their children benefitted too. By the time the children were 15 years of age, they had had fewer arrests and convictions, smoked and drank less, and had had fewer sexual partners. The program produced few effects on children's development or on birth outcomes, except for children born to women who smoked cigarettes when they registered during pregnancy. The positive effects of the program on child abuse and injuries to children were most pronounced among mothers who, at registration, had the lowest psychological resources (defined as high levels of mental health symptoms, limited intellectual functioning, and little belief in their control of their lives). Generally, effects in Elmira were of greater magnitude and covered a broader range of outcomes than in Memphis, perhaps because of differences between the populations studied, community contexts, or a higher rate of turnover among home visitors in Memphis than in Elmira. The article concludes that the use of nurses as home visitors is key; that services should be targeted to the neediest populations, rather than being offered on a universal basis; that clinically tested methods of changing health and behavioral risks should be incorporated into program protocols; and that services must be implemented with fidelity to the model tested if program benefits found in scientifically controlled studies are to be reproduced as the program is replicated in new communities.

Homicides by people with mental illness: myth and reality.

Abstract: BACKGROUND Tragic and high profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed. AIMS To consider whether such homicides have become more frequent as psychiatric services have changed. METHOD Data were extracted from Home Office-generated criminal statistics for England and Wales between 1957 and 1995 and subjected to trends analysis. RESULTS There was little fluctuation in numbers of people with a mental illness committing criminal homicide over the 38 years studied, and a 3% annual decline in their contribution to the official statistics. CONCLUSIONS There are many reasons for improving the resources and quality of care for people with a mental disorder, but there is no evidence that it is anything but stigmatising to claim that their living in the community is a dangerous experiment that should be reversed. There appears to be some case for specially focused improvement of services for people with a personality disorder and/or substance misuse.