Showing papers on "Mental health published in 2003"

Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence

Abstract: In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications. The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating— even equating— claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental

Racial/ethnic discrimination and health: findings from community studies.

Abstract: The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health. (Am J Public Health. 2003;93:200-208)

Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research.

Abstract: Empirical studies have identified significant links between religion and spirituality and health. The reasons for these associations, however, are unclear. Typically, religion and spirituality have been measured by global indices (e.g., frequency of church attendance, self-rated religiousness and spirituality) that do not specify how or why religion and spirituality affect health. The authors highlight recent advances in the delineation of religion and spirituality concepts and measures theoretically and functionally connected to health. They also point to areas for areas for growth in religion and spirituality conceptualization and measurement. Through measures of religion and spirituality more conceptually related to physical and mental health (e.g., closeness to God, religious orientation and motivation, religious support, religious struggle), psychologists are discovering more about the distinctive contributions of religiousness and spirituality to health and well-being.

Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study.

Abstract: OBJECTIVE: This study examined the prevalence of a history of various combinations of childhood maltreatment types (physical abuse, sexual abuse, and witnessing of maternal battering) among adult members of a health maintenance organization (HMO) and explored the relationship with adult mental health of the combinations of types of childhood maltreatment and emotional abuse in the childhood family environment. METHOD: A total of 8,667 adult members of an HMO completed measures of childhood exposure to family dysfunction, which included items on physical and sexual abuse, witnessing of maternal battering, and emotional abuse in the childhood family environment. The adults’ current mental health was assessed by using the mental health scale of the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS: The prevalences of sexual abuse, physical abuse, and witnessing of maternal violence were 21.6%, 20.6%, and 14.0%, respectively, when the maltreatment types were considered separately. Among respond...

Mental health of children and adolescents in Great Britain.

Abstract: The findings described in this report and summarized here focus on the prevalence of mental disorders among 5-15 year olds and on the associations between the presence of a mental disorder and biographic, sociodemographic, socio-economic, and social functioning characteristics of the child and the family. Causal relationships should not be assumed for any of the results presented in this report.

The British Child and Adolescent Mental Health Survey 1999: The Prevalence of DSM-IV Disorders

Abstract: Objective To describe the prevalence of DSM-IV disorders and comorbidity in a large population-based sample of British children and adolescents. Method Using a one-phase design, 10,438 children were assessed using the Development and Well-Being Assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians so that information from parents, teachers, and children was combined in a manner that emulated the clinical process. The authors' analysis examined comorbidity and the influence of teacher reports. Results The overall prevalence of DSM-IV disorders was 9.5% (95% confidence interval 8.8–10.1%), but 2.1% of children were assigned "not otherwise specified" rather than operationalized diagnoses. After adjusting for the presence of a third disorder, there was no longer significant comorbidity between anxiety and conduct disorder or attention-deficit/hyperactivity disorder (ADHD), or between depression and oppositional defiant disorder. A comparison of the disorders in children with and without teacher reports suggested that the prevalence of conduct disorders and ADHD would be underestimated in the absence of teacher information. Conclusions Roughly 1 in 10 children have at least one DSM-IV disorder, involving a level of distress or social impairment likely to warrant treatment. Comorbidity reported between some childhood diagnoses may be due to the association of both disorders with a third. Diagnoses of conduct disorder and ADHD may be missed if information is not sought from teachers about children's functioning in school.

The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being.

Abstract: Background. Two new screening scales for psychological distress, the K6 and K10, have been developed but their relative efficiency has not been evaluated in comparison with existing scales.Method. The Australian National Survey of Mental Health and Well-Being, a nationally representative household survey, administered the WHO Composite International Diagnostic Interview (CIDI) to assess 30-day DSM-IV disorders. The K6 and K10 were also administered along with the General Health Questionnaire (GHQ-12), the current de facto standard of mental health screening. Performance of the three screening scales in detecting CIDI/DSM-IV mood and anxiety disorders was assessed by calculating the areas under receiver operating characteristic curves (AUCs). Stratum-Specific Likelihood Ratios (SSLRs) were computed to help produce individual-level predicted probabilities of being a case from screening scale scores in other samples.Results. The K10 was marginally better than the K6 in screening for CIDI/DSM-IV mood and anxiety disorders (K10 AUC: 0·90, 95%CI: 0·89–0·91 versus K6 AUC: 0·89, 95%CI: 0·88–0·90), while both were significantly better than the GHQ-12 (AUC: 0·80, 95%CI: 0·78–0·82). The SSLRs of the K10 and K6 were more informative in ruling in or out the target disorders than those of the GHQ-12 at both ends of the population spectrum. The K6 was more robust than the K10 to subsample variation.Conclusions. While the K10 might outperform the K6 in screening for severe disorders, the K6 is preferred in screening for any DSM-IV mood or anxiety disorder because of its brevity and consistency across subsamples. Precision of individual-level prediction is greatly improved by using polychotomous rather than dichotomous classification.

Internalized stigma of mental illness: psychometric properties of a new measure.

Abstract: The study evaluated the Internalized Stigma of Mental Illness (ISMI) scale, designed to measure the subjective experience of stigma, with subscales measuring Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal and Stigma Resistance. The ISMI was developed in collaboration with people with mental illnesses and contains 29 Likert items. The validation sample included 127 mental health outpatients. Results showed that the ISMI had high internal consistency and test-retest reliability. Construct validity was supported by comparisons against scales measuring related constructs with the same methodology. As expected, the ISMI had positive correlations with measures of stigma beliefs and depressive symptoms, and it had negative correlations with measures of self-esteem, empowerment and recovery orientation. Factor analyses of the joint set of items from the ISMI and each scale supported the distinction between constructs. Having a validated measure of internalized stigma may encourage clinicians to include stigma reduction as a verifiable treatment goal in addition to symptom reduction.

The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital

Abstract: Background: The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational impact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response. Methods: Two principal authors met with core team members and mental health care providers at Mount Sinai Hospital, Toronto, to compile retrospectively descriptions of the experiences of staff and patients based on informal observation. All authors reviewed and analyzed the descriptions in an iterative process between Apr. 3 and Apr. 13, 2003. Results: In a 4-week period, 19 individuals developed SARS, including 11 health care workers. The hospital’s response included establishing a leadership command team and a SARS isolation unit, implementing mental health support interventions for patients and staff, overcoming problems with logistics and communication, and overcoming resistance to directives. Patients with SARS reported fear, loneliness, boredom and anger, and they worried about the effects of quarantine and contagion on family members and friends. They experienced anxiety about fever and the effects of insomnia. Staff were adversely affected by fear of contagion and of infecting family, friends and colleagues. Caring for health care workers as patients and colleagues was emotionally difficult. Uncertainty and stigmatization were prominent themes for both staff and patients. Interpretation: The hospital’s response required clear communication, sensitivity to individual responses to stress, collaboration between disciplines, authoritative leadership and provision of relevant support. The emotional and behavioural reactions of patients and staff are understood to be a normal, adaptive response to stress in the face of an overwhelming event.

National Service Framework for Older People

Abstract: The National Service Framework for Older People (NSF—OP) was published in March, 2001 ([Department of Health, 2001a][1]), 12 months behind schedule and 2 years after the publication of the National Service Framework for Mental Health (NSF—MH) ([Department of health, 1999][2]). Old age psychiatry

Evidence-based psychotherapies for children and adolescents

Abstract: Part I: Foundations of Child and Adolescent Psychotherapy Research. Kazdin, Weisz, Introduction: Context, Background, and Goals. Hoagwood, Cavaleri, Ethical Issues in Child and Adolescent Psychosocial Treatment Research. Holmbeck, Devine, Bruno, Developmental Issues and Considerations in Research and Practice. Part II: Treatments and Problems. A: Internalizing Disorders and Problems. Kendall, Furr, Podell, Child-focused Treatment of Anxiety. Pahl, Barrett, Interventions for Anxiety Disorders in Children Using Group Cognitive-Behavioral Therapy with Family Involvement. Franklin, Freeman, March, Treating Pediatric Obsessive-Compulsive Disorder Using Exposure-based Cognitive-Behavioral Therapy. Stark, Streusand, Krumholz, Patel, Cognitive-Behavioral Therapy for Depression: The ACTION Treatment Program for Girls. Clarke, DeBar, Group Cognitive-Behavioral Treatment for Adolescent Depression. Weersing, Brent, Treating Depression in Adolescents Using Individual Cognitive-Behavioral Therapy. Jacobson, Mufson, Treating Adolescent Depression Using Interpersonal Psychotherapy. B: Externalizing Disorders and Problems. Forgatch, Patterson, The Oregon Model of Parent Management Training: An Intervention for Antisocial Behavior in Children and Adolescents. Zisser, Eyberg, Parent-child Interaction Therapy and the Treatment of Disruptive Behavior Disorders. Webster-Stratton, Reid, The Incredible Years Parents, Teachers, and Children Training Series: A Multifaceted Treatment Approach for Young Children with Conduct Problems. Kazdin, Problem-solving Skills Training and Parent Management Training for Oppositional Defiant Disorder and Conduct Disorder. Lochman, Boxmeyer, Powell, Barry, Pardini, Anger Control Training for Aggressive Youths. Smith, Chamberlain, Multidimensional Treatment Foster Care for Adolescents: Processes and Outcomes. Henggeler, Schaeffer, Treating Serious Antisocial Behavior Using Multisystemic Therapy. Pelham, Jr., Gnagy, Greiner, Waschbusch, Fabiano, Burrows-MacLean, Summer Treatment Programs for Attention-Deficit/Hyperactivity Disorder. C: Other Disorders and Special Applications. Cohen, Mannarino, Deblinger, Trauma-focused Cognitive-Behavioral Therapy for Traumatized Children. Smith, Early and Intensive Behavioral Intervention in Autism. R. L. Koegel, L. K. Koegel, Vernon, Brookman-Frazee, Empirically Supported Pivotal Response Treatment for Children with Autism Spectrum Disorders. Robin, le Grange, Family Therapy for Adolescents with Anorexia Nervosa. Houts, Behavioral Treatment for Enuresis. Robbins, Horigian, Szapocznik, Ucha, Treating Hispanic Youths Using Brief Strategic Family Therapy. Malgady, Treating Hispanic Children and Adolescents Using Narrative Therapy. Waldron, Brody, Functional Family Therapy for Adolescent Substance Use Disorders. Liddle, Treating Adolescent Substance Abuse Using Multidimensional Family Therapy. Part III: Implementation and Dissemination: Extending Treatments to New Populations and New Settings. Fixsen, Blase, Duda, Naoom, Dyke, Implementation of Evidence-based Treatments for Children and Adolescents: Research Findings and Their Implications for the Future. Huey, Jr., Polo, Assessing the Effects of Evidence-based Psychotherapies with Ethnic-minority Youths. Bearman, Ugueto, Alleyne, Weisz, Adapting Cognitive-Behavioral Therapy for Depression to Fit Diverse Youths and Contexts: Applying the Deployment-focused Model of Treatment Development and Testing. Chorpita, Daleiden, Building Evidence-based Systems in Children's Mental Health. Scott, Nationwide Dissemination of Effective Parenting Interventions: Building a Parenting Academy for England. Sanders, Murphy-Brennan, The International Dissemination of the Triple P - Positive Parenting Program. Schoenwald, From Policy Pinball to Purposeful Partnership: The Policy Contexts of Multisystemic Therapy Transport and Dissemination. Part IV: Conclusions and Future Directions. Weisz, Kazdin, The Present and Future of Evidence-based Psychotherapies for Children and Adolescents.

Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36).

Abstract: A great number of questionnaires and instruments have been developed in order to measure psychological distress/mental health problems in populations. The Survey of Level of Living in 1998 conducted by Statistics Norway used both Hopkins Symptom Checklist (SCL-25) and the Short Form 36 (SF-36), including the five-item mental health index (MHI-5). Five-item and 10-item versions of the SCL-25 have also been used in Norwegian surveys. The purpose of this study was to investigate the correlation between the various instruments, and to assess and to compare psychometric characteristics. A random sample of 9735 subjects over 15 years of age drawn from the Norwegian population received a questionnaire about their health containing SCL-25 and SF-36. Response rate was 71.9%. Reliability of the SCLs and MHI-5 were assessed by Cronbach alpha. The scores from full and abbreviated instruments were compared regarding possible instrument-specific effects of gender, age and level of education. The correlations between th...

Poverty and common mental disorders in developing countries

Abstract: A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.

Flourishing: Positive psychology and the life well-lived.

Abstract: Flourishing Under Fire: Resilience as a Prototype of Challenged Thriving-Carol Ryff and Burton Singer Turning Points as Opportunities for Personal Growth-Elaine Wethington Optimism and Flourishing-Chris Peterson and Edward Chang The Constructing of Meaning through Vital Engagement-Jeanne Nakamura and Mihaly Csikszentmihalyi Personal Goals, Life Meaning, and Virtue: Wellsprings of a Positive Life-Robert Emmons Toward a Positive Psychology of Relationships-Harry Reis and Shelly Gable Creativity and Genius-Vincent Cassandro and Dean Simonton Work, Play, and Eating On Making More of More Moments in Life-Amy Wrzesniewski, Paul Rozin, and Gwen Bennett Well-Being in the Workplace: A Review of the Gallup Studies-James Harter, Frank Schmidt, and Corey L. M. Keyes Doing Well by Doing Good: The Health Benefits of Community Participation-Jane Allyn Piliavin Wisdom: A Meta-Heuristic Guiding the Conduct of Life-Paul Baltes and Alexandra Freund Elevation and the Positive Psychology of Morality-Jonathan Haidt Complete Mental Health: An Agenda for the 21st Century-Corey L. M. Keyes

Bullying Among Young Adolescents: The Strong, the Weak, and the Troubled

Abstract: Objectives. Bullying and being bullied have been recognized as health problems for children because of their association with adjustment problems, including poor mental health and more extreme violent behavior. It is therefore important to understand how bullying and being bullied affect the well-being and adaptive functioning of youth. We sought to use multiple data sources to better understand the psychological and social problems exhibited by bullies, victims, and bully-victims. Design, Setting, and Participants. Analysis of data from a community sample of 1985 mostly Latino and black 6th graders from 11 schools in predominantly low socioeconomic status urban communities (with a 79% response rate). Main Outcome Measures. Peer reports of who bullies and who is victimized, self-reports of psychological distress, and peer and teacher reports of a range of adjustment problems. Results. Twenty-two percent of the sample was classified as involved in bullying as perpetrators (7%), victims (9%), or both (6%). Compared with other students, these groups displayed school problems and difficulties getting along with classmates. Despite increased conduct problems, bullies were psychologically strongest and enjoyed high social standing among their classmates. In contrast, victims were emotionally distressed and socially marginalized among their classmates. Bully-victims were the most troubled group, displaying the highest level of conduct, school, and peer relationship problems. Conclusions. To be able to intervene with bullying, it is important to recognize the unique problems of bullies, victims, and bully-victims. In addition to addressing these issues directly with their patients, pediatricians can recommend school-wide antibullying approaches that aim to change peer dynamics that support and maintain bullying.

Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States.

Abstract: Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.

The built environment and mental health.

Abstract: The built environment has direct and indirect effects on mental health. High-rise housing is inimical to the psychological well-being of women with young children. Poor-quality housing appears to increase psychological distress, but methodological issues make it difficult to draw clear conclusions. Mental health of psychiatric patients has been linked to design elements that affect their ability to regulate social interaction (e.g., furniture configuration, privacy). Alzheimer's patients adjust better to small-scale, homier facilities that also have lower levels of stimulation. They are also better adjusted in buildings that accommodate physical wandering. Residential crowding (number of people per room) and loud exterior noise sources (e.g., airports) elevate psychological distress but do not produce serious mental illness. Malodorous air pollutants heighten negative affect, and some toxins (e.g., lead, solvents) cause behavioral disturbances (e.g., self-regulatory ability, aggression). Insufficient daylight is reliably associated with increased depressive symptoms. Indirectly, the physical environment may influence mental health by altering psychosocial processes with known mental health sequelae. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by properties of the built environment. More prospective, longitudinal studies and, where feasible, randomized experiments are needed to examine the potential role of the physical environment in mental health. Even more challenging is the task of developing underlying models of how the built environment can affect mental health. It is also likely that some individuals may be more vulnerable to mental health impacts of the built environment. Because exposure to poor environmental conditions is not randomly distributed and tends to concentrate among the poor and ethnic minorities, we also need to focus more attention on the health implications of multiple environmental risk exposure.

Providing Social Support May Be More Beneficial Than Receiving It Results From a Prospective Study of Mortality

Abstract: This study examines the relative contributions of giving ver- sus receiving support to longevity in a sample of older married adults. Baseline indicators of giving and receiving support were used to predict mortality status over a 5-year period in the Changing Lives of Older Couples sample. Results from logistic regression analyses indicated that mortality was significantly reduced for individuals who reported provid- ing instrumental support to friends, relatives, and neighbors, and indi- viduals who reported providing emotional support to their spouse. Receiving support had no effect on mortality once giving support was taken into consideration. This pattern of findings was obtained after controlling for demographic, personality, health, mental health, and marital-relationship variables. These results have implications for un- derstanding how social contact influences health and longevity.

The influence of ethnic discrimination and ethnic identification on African American adolescents' school and socioemotional adjustment.

Abstract: Do experiences with racial discrimination at school predict changes in African American adolescents' academic and psychological functioning? Does African American ethnic identity buffer these relations? This paper addresses these two questions using two waves of data from a longitudinal study of an economically diverse sample of African American adolescents living in and near a major East Coast metropolis. The data were collected at the beginning of the 7th grade and after the completion of the 8th grade. As expected, experiences of racial discrimination at school from one's teachers and peers predicts declines in grades, academic ability self-concepts, academic task values, mental health (increases in depression and anger, decreases in self-esteem and psychological resiliency), and increases in the proportion of one's friends who are not interested in school and who have problem behaviors. A strong, positive connection to one's ethnic group (our measure of ethnic identity) reduced the magnitude of the association of racial discrimination experiences with declines in academic self-concepts, school achievement, and perception of friends' positive characteristics, as well as the association of the racial discrimination experiences with increases in problem behaviors.

Religiosity and Mental Health: A Meta–Analysis of Recent Studies

Abstract: A meta–analysis was performed in an attempt to clarify the proposed relationship between religiosity and psychological adjustment. Specific focus was given to the issue of definition, namely, whether differences in researchers’ conceptualizations of religiosity and mental health could account for the various contradictory findings by psychologists of religion. Analysis of 34 studies conducted during the past 12 years revealed that the definitions of religiosity and mental health utilized by psychologists in this field were indeed associated with different types and strengths of the correlations between religiosity and mental health. Discussion of results assesses the fit between relevant theory and the pattern of change in effect size across categories of religion and adjustment, and concludes with implications for therapeutic uses of religious involvement.

Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support.

Abstract: The authors evaluated the effects of cultural norms and social contexts on coping processes involved in dealing with perceived racial discrimination. Cross-sectional data derived from personal interviews with Korean immigrants residing in Toronto were analyzed. Among the respondents, active, problem-focused coping styles were more effective in reducing the impacts on depression of perceived discrimination, while frequent use of passive, emotion-focused coping had debilitating mental health effects. The present findings lend greater support to a social contextual explanation than to a cultural maintenance explanation of coping processes. They also suggest that, when empowered with sufficient social resources, racial minority individuals of diverse cultural heritages are more likely to confront than to accept racial bias.

Reducing work related psychological ill health and sickness absence: a systematic literature review

Abstract: A literature review revealed the following: key work factors associated with psychological ill health and sickness absence in staff were long hours worked, work overload and pressure, and the effects of these on personal lives; lack of control over work; lack of participation in decision making; poor social support; and unclear management and work role. There was some evidence that sickness absence was associated with poor management style. Successful interventions that improved psychological health and levels of sickness absence used training and organisational approaches to increase participation in decision making and problem solving, increase support and feedback, and improve communication. It is concluded that many of the work related variables associated with high levels of psychological ill health are potentially amenable to change. This is shown in intervention studies that have successfully improved psychological health and reduced sickness absence.

The experience of recovery from schizophrenia: towards an empirically validated stage model

Abstract: Objective: The consumer movement is advocating that rehabilitation services become recovery-orientated. The objectives of this study are to gain a better understanding of the concept of recovery by: (i) identifying a definition of recovery that reflects consumer accounts; and (ii) developing a conceptual model of recovery to guide research, training and inform clinical practice. Method: A review was conducted of published experiential accounts of recovery by people with schizophrenia or other serious mental illness, consumer articles on the concept of recovery, and qualitative research and theoretical literature on recovery. Meanings of recovery used by consumers were sought to identify a definition of recovery. Common themes identified in this literature were used to construct a conceptual model reflecting the personal experiences of consumers. Results: The definition of recovery used by consumers was identified as psychological recovery from the consequences of the illness. Four key processes of recovery were identified: (i) finding hope; (ii) re-establishment of identity; (iii) finding meaning in life; and (iv) taking responsibility for recovery. Five stages were identified: (i) moratorium; (ii) awareness; (iii) preparation; (iv) rebuilding; and (v) growth. Conclusion: A five-stage model compatible with psychological recovery is proposed, which offers a way forward for attaining recovery-orientated outcomes. After further empirical investigation, a version of this model could be utilized in quantitative research, clinical training and consumer education.

Racial/ethnic bias and health. Racial/ethnic discrimination and health: findings from community studies.

Abstract: The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Measuring well‐being rather than the absence of distress symptoms: a comparison of the SF‐36 Mental Health subscale and the WHO‐Five well‐being scale

Abstract: The health status questionnaire Short-Form 36 (SF-36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well-being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well-being items are also included in the WHO-Five well-being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO-Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self-reported health over the past year has been tested. The results of the study on 9,542 respondents showed that, although the WHO-Five and the mental health subscale were found to be unidimensional, the WHO-Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO-Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not. In conclusion, the WHO-Five, which measures psychological well-being, reflects aspects other than just the absence of depressive symptoms.

Health Status of Adult Long-term Survivors of Childhood Cancer A Report From the Childhood Cancer Survivor Study

Abstract: ContextAdult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status.ObjectivesTo compare the health status of adult survivors of childhood cancer and siblings and to identify factors associated with adverse outcomes.Design, Setting, and ParticipantsHealth status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study, a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986. A randomly selected cohort of the survivors' siblings (n = 2916) served as a comparison group.Main Outcome MeasuresSix health status domains were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety/fears. The first 4 domains were assessed in the control group.ResultsSurvivors were significantly more likely to report adverse general health (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.0; P<.001), mental health (OR, 1.8; 95% CI, 1.6-2.1; P<.001), activity limitations (OR, 2.7; 95% CI, 2.3-3.3; P<.001), and functional impairment (OR, 5.2; 95% CI, 4.1-6.6; P<.001), compared with siblings. Forty-four percent of survivors reported at least 1 adversely affected health status domain. Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female (OR, 1.4; 95% CI, 1.3-1.6; P<.001), lower level of educational attainment (OR, 2.0; 95% CI, 1.8-2.2; P<.001), and annual income less than $20 000 (OR, 1.8; 95% CI, 1.6-2.1; P<.001). Relative to those survivors with childhood leukemia, an increased risk was observed for at least 1 adverse health status domain among those with bone tumors (OR, 2.1; 95% CI, 1.8-2.5; P<.001), central nervous system tumors (OR, 1.7; 95% CI, 1.5-2.0; P<.001), and sarcomas (OR, 1.2; 95% CI, 1.1-1.5; P = .01).ConclusionClinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status, especially among females, those with low educational attainment, and those with low household incomes.

Coping with perceived discrimination: does ethnic identity protect mental health?

Abstract: Using data (N = 2,109) from a large-scale epidemiological study of Filipino Americans, this study examines whether ethnic identity is linked to mental health and reduces the stress of discrimination. The strength of identification with an ethnic group is found to be directly associated with fewer depressive symptoms. In other words, having a sense of ethnic pride, involvement in ethinic practices, and cultural commitment to one's racial/ethnic group may protect mental health. Self-reports of racial/ethnic discrimination over a lifetime and everyday discrimination in the past month not due to race/ethnicity are associated with increased levels of depressive symptoms. Yet ethnic identity buffers the stress of racial/ethnic discrimination. This suggests that ethnic identity is a coping resource for racial/ethnic minorities that should not be overlooked. The strong link between ethnic identity and better mental health has implications for social-psychological theories on race/ethnicity and assimilation in the United States.

Moving to Opportunity: an Experimental Study of Neighborhood Effects on Mental Health

Abstract: Objectives. The health consequences of neighborhood poverty are a public health problem. Data were obtained to examine links between neighborhood residence and mental health outcomes. Methods. Moving to Opportunity was a randomized, controlled trial in which families from public housing in high-poverty neighborhoods were moved into private housing in near-poor or nonpoor neighborhoods, with a subset remaining in public housing. At the 3-year follow-up of the New York site, 550 families were reinterviewed. Results. Parents who moved to low-poverty neighborhoods reported significantly less distress than parents who remained in high-poverty neighborhoods. Boys who moved to less poor neighborhoods reported significantly fewer anxious/depressive and dependency problems than did boys who stayed in public housing. Conclusions. This study provides experimental evidence of neighborhood income effects on mental health.