Showing papers on "Mental health published in 2008"

Facilitating Optimal Motivation and Psychological Well- Being Across Life's Domains

Abstract: Self-determination theory (SDT) differentiates motivation, with autonomous and controlled motivations constituting the key, broad distinction. Research has shown that autonomous motivation predicts persistence and adherence and is advantageous for effective performance, especially on complex or heuristic tasks that involve deep information processing or creativity. Autonomous motivation is also reliably related to psychological health. Considerable research has found interpersonal contexts that facilitate satisfaction of the basic psychological needs for competence, autonomy, and relatedness to enhance autonomous motivation, which comprises intrinsic motivation and well-internalized extrinsic motivation. SDT has been applied in varied cultures and in many life domains, and research is reviewed that has related autonomous and controlled motivation to education, parenting, work, health care, sport, and close relationships.

Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery

Abstract: : Since 2001, 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Evidence suggests the psychological toll of these deployments may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of that study. These results should be of interest to mental health treatment providers; health policy makers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public.

Expenditures and Health Status Among Adults With Back and Neck Problems

Abstract: Context Back and neck problems are among the symptoms most commonly encountered in clinical practice. However, few studies have examined national trends in expenditures for back and neck problems or related these trends to health status measures. Objectives To estimate inpatient, outpatient, emergency department, and pharmacy expenditures related to back and neck problems in the United States from 1997 through 2005 and to examine associated trends in health status. Design and Setting Age- and sex-adjusted analysis of the nationally representative Medical Expenditure Panel Survey (MEPS) from 1997 to 2005 using complex survey regression methods. The MEPS is a household survey of medical expenditures weighted to represent national estimates. Respondents were US adults (> 17 years) who self-reported back and neck problems (referred to as “spine problems” based on MEPS descriptions and International Classification of Diseases, Ninth Revision, Clinical Modification definitions). Main Outcome Measures Spine-related expenditures for health services (inflation-adjusted); annual surveys of self-reported health status. Results National estimates were based on annual samples of survey respondents with and without self-reported spine problems from 1997 through 2005. A total of 23 045 respondents were sampled in 1997, including 3139 who reported spine problems. In 2005, the sample included 22 258 respondents, including 3187 who reported spine problems. In 1997, the mean age- and sex-adjusted medical costs for respondents with spine problems was $4695 (95% confidence interval [CI], $4181-$5209), compared with $2731 (95% CI, $2557-$2904) among those without spine problems (inflation-adjusted to 2005 dollars). In 2005, the mean age- and sex- adjusted medical expenditure among respondents with spine problems was $6096 (95% CI, $5670-$6522), compared with $3516 (95% CI, $3266-$3765) among those without spine problems. Total estimated expenditures among respondents with spine problems increased 65% (adjusted for inflation) from 1997 to 2005, more rapidly than overall health expenditures. The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7% (95% CI, 19.9%-21.4%) to 24.7% (95% CI, 23.7%-25.6%) from 1997 to 2005. Age- and sex-adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997. Conclusions In this survey population, self-reported back and neck problems accounted for a large proportion of health care expenditures. These spine-related expenditures have increased substantially from 1997 to 2005, without evidence of corresponding improvement in self-assessed health status.

Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions.

Abstract: Context Although young adulthood is often characterized by rapid intellectual and social development, college-aged individuals are also commonly exposed to circumstances that place them at risk for psychiatric disorders. Objectives To assess the 12-month prevalence of psychiatric disorders, sociodemographic correlates, and rates of treatment among individuals attending college and their non–college-attending peers in the United States. Design, Setting, and Participants Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43 093). Analyses were done for the subsample of college-aged individuals, defined as those aged 19 to 25 years who were both attending (n = 2188) and not attending (n = 2904) college in the previous year. Main Outcome Measures Sociodemographic correlates and prevalence of 12-month DSM-IV psychiatric disorders, substance use, and treatment seeking among college-attending individuals and their non–college-attending peers. Results Almost half of college-aged individuals had a psychiatric disorder in the past year. The overall rate of psychiatric disorders was not different between college-attending individuals and their non–college-attending peers. The unadjusted risk of alcohol use disorders was significantly greater for college students than for their non–college-attending peers (odds ratio = 1.25; 95% confidence interval, 1.04-1.50), although not after adjusting for background sociodemographic characteristics (adjusted odds ratio = 1.19; 95% confidence interval, 0.98-1.44). College students were significantly less likely (unadjusted and adjusted) to have a diagnosis of drug use disorder or nicotine dependence or to have used tobacco than their non–college-attending peers. Bipolar disorder was less common in individuals attending college. College students were significantly less likely to receive past-year treatment for alcohol or drug use disorders than their non–college-attending peers. Conclusions Psychiatric disorders, particularly alcohol use disorders, are common in the college-aged population. Although treatment rates varied across disorders, overall fewer than 25% of individuals with a mental disorder sought treatment in the year prior to the survey. These findings underscore the importance of treatment and prevention interventions among college-aged individuals.

The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students

Abstract: Background The mental health of university students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress among a group of Turkish university students.

Combat duty in Iraq and Afghanistan, mental health problems and barriers to care.

Abstract: Background The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. Methods We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Results Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. Conclusions This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.

The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan

Abstract: Two new screening scales for psychological distress, the K6 and K10, have been developed using the item response theory and shown to outperform existing screeners in English. We developed their Japanese versions using the standard back-translaton method and included them in the World Mental Health Survey Japan (WMH-J), which is a psychiatric epidemiologic study conducted in seven communities across Japan with 2436 participants. The WMH-J used the WMH Survey Initiative version of the Composite International Diagnostic Interview (CIDI) to assess the 30-day Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV). Performance of the two screening scales in detecting DSM-IV mood and anxiety disorders, as assessed by the areas under receiver operating characteristic curves (AUCs), was excellent, with values as high as 0.94 (95% confidence interval = 0.88 to 0.99) for K6 and 0.94 (0.88 to 0.995) for K10. Stratum-specific likelihood ratios (SSLRs), which express screening test characteristics and can be used to produce individual-level predicted probabilities of being a case from screening scale scores and pretest probabilities in other samples, were strikingly similar between the Japanese and the original versions. The Japanese versions of the K6 and K10 thus demonstrated screening performances essentially equivalent to those of the original English versions.

Psychiatric disorders in pregnant and postpartum women in the United States.

Abstract: Pregnancy and the postpartum period are widely considered periods of increased vulnerability to psychiatric disorders.1–12 Psychiatric disorders during pregnancy are associated with poor maternal health13–19 and inadequate prenatal care.20–22 Maternal psychiatric disorders during pregnancy and the postpartum period are also associated with numerous adverse outcomes for the offspring, including maladaptive fetal growth and development,22–36 poor cognitive development and behavior during childhood and adolescence,23–32 and negative nutritional and health effects.13, 33–38 For these reasons, accurate information about the mental health status of women during pregnancy and the postpartum period is urgently needed. Most of what is known about psychiatric problems among pregnant women comes from findings among clinical samples, often without non-pregnant control groups. In these samples, the prevalence of psychiatric disorders ranges from 15% to 29%.15, 20–22, 39–47 Risk factors identified in these studies include lack of romantic partner, prior history of psychiatric disorder, and lifetime exposure to traumatic events. 22, 41, 42, 45, 48–50 Only 5% to 14% of women received treatment for the psychiatric disorder.15, 40, 41 However, no previous study used sampling methodology permitting accurate estimation of the prevalence of psychiatric disorders among pregnant women in the United States. Further, no previous study included non-pregnant women of comparable age drawn from the general population in order to identify the specific contribution of pregnancy or the postpartum period to the risk of psychiatric disorders. Many studies were limited by use of screening scales rather than diagnostic measures for DSM-IV criteria. Finally, prior studies assessed only mood and anxiety disorders rather than a broader range of psychopathology. As the result of these gaps in research on mental disorders during pregnancy and the postpartum period, accurate national information on the mental health of pregnant women is lacking. Such information is needed for focused planning at the national and local level, and to inform the development of prevention and intervention programs. The current study addresses these critical gaps in knowledge. In a nationally representative sample of pregnant women, we present 12-month prevalence of DSM-IV psychiatric disorders, compare these with the prevalence of psychiatric disorders in non-pregnant women of childbearing age, identify risk factors for such disorders, and provide estimates of lifetime and 12-month rates of treatment-seeking among pregnant and non-pregnant women with DSM-IV psychiatric disorders.

The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods.

Abstract: The Netherlands Study of Depression and Anxiety (NESDA) is a multi-site naturalistic cohort study to: (1) describe the long-term course and consequences of depressive and anxiety disorders, and (2) to integrate biological and psychosocial research paradigms within an epidemiological approach in order to examine (interaction between) predictors of the long-term course and consequences. Its design is an eight-year longitudinal cohort study among 2981 participants aged 18 through 65 years. The sample consists of 1701 persons with a current (six-month recency) diagnosis of depression and/or anxiety disorder, 907 persons with life-time diagnoses or at risk because of a family history or subthreshold depressive or anxiety symptoms, and 373 healthy controls. Recruitment took place in the general population, in general practices (through a three-stage screening procedure), and in mental health organizations in order to recruit persons reflecting various settings and developmental stages of psychopathology. During a four-hour baseline assessment including written questionnaires, interviews, a medical examination, a cognitive computer task and collection of blood and saliva samples, extensive information was gathered about key (mental) health outcomes and demographic, psychosocial, clinical, biological and genetic determinants. Detailed assessments will be repeated after one, two, four and eight years of follow-up. The findings of NESDA are expected to provide more detailed insight into (predictors of) the long-term course of depressive and anxiety disorders in adults. Besides its scientific relevance, this may contribute to more effective prevention and treatment of depressive and anxiety disorders.

Social Cognition in Schizophrenia: An NIMH Workshop on Definitions, Assessment, and Research Opportunities

Abstract: Social cognition has become a high priority area for the study of schizophrenia. However, despite developments in this area, progress remains limited by inconsistent terminology and differences in the way social cognition is measured. To address these obstacles, a consensus-building meeting on social cognition in schizophrenia was held at the National Institute of Mental Health in March 2006. Agreement was reached on several points, including definitions of terms, the significance of social cognition for schizophrenia research, and suggestions for future research directions. The importance of translational interdisciplinary research teams was emphasized. The current article presents a summary of these discussions.

Physical and mental health effects of family caregiving.

Abstract: The associations between physical and psychological health and being an informal caregiver are well established.1,7 In this article, caregiving denotes care that is provided by a family member or friend rather than by a professional who is reimbursed for services. Clinical observation and early empirical research showed that assuming a caregiving role can be stressful and burdensome.8,9 Caregiving has all the features of a chronic stress experience: It creates physical and psychological strain over extended periods of time, is accompanied by high levels of unpredictability and uncontrollability, has the capacity to create secondary stress in multiple life domains such as work and family relationships, and frequently requires high levels of vigilance. Caregiving fits the formula for chronic stress so well that it is used as a model for studying the health effects of chronic stress.2 Caregivers are a critical national health care resource. Families often are a primary source of home care and support for older relatives, contributing services that would cost hundreds of billions of dollars annually if they had to be purchased.10,12 Nurses’ role in home health care has expanded from being primary caregivers to teaching and assisting family members to provide care. Similarly, social workers now play a critical role in providing advice and support to caregivers. Evidence on the health effects of caregiving gathered over the last two decades has helped convince policymakers that caregiving is a major public health issue. Professional advocacy group, including nurses and social workers, have been instrumental in raising awareness about this issue.

Child and adolescent mental disorders: the magnitude of the problem across the globe

Abstract: Objective: Describe objectively the global gaps in policy, data gathering capacity, and resources to develop and implement services to support child mental health. Methods: Report on the World health Organization (WHO) child and adolescent mental health resources Atlas project. The Atlas project utilized key informants and was supplemented by studies that focused on policy. This report also draws on current epidemiological studies to provide a context for understanding the magnitude of the clinical problem. Results: Current global epidemiological data consistently reports that up to 20% of children and adolescents suffer from a disabling mental illness; that suicide is the third leading cause of death among adolescents; and that up to 50% of all adult mental disorders have their onset in adolescence. While epidemiological data appears relatively uniform globally, the same is not true for policy and resources for care. The gaps in resources for child mental health can be categorized as follows: economic, manpower, training, services and policy. Key findings from the Atlas project include: lack of program development in low income countries; lack of any policy in low income countries and absent specific comprehensive policy in both low and high income countries; lack of data gathering capacity including that for country-level epidemiology and services outcomes; failure to provide social services in low income countries; lack of a continuum of care; and universal barriers to access. Further, the Atlas findings underscored the need for a critical analysis of the 'burden of disease' as it relates to the context of child and adolescent mental disorders, and the importance of defining the degree of 'impairment' of specific disorders in different cultures. Conclusions: The recent finding of substantial gaps in resources for child mental health underscores the need for enhanced data gathering, refinement of the economic argument for care, and need for innovative training approaches. Language: en

Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO world mental health surveys

Abstract: Background Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization’s (WHO’s) World Mental Health (WMH) Survey Initiative.

Evaluation of the mental health continuum–short form (MHC–SF) in setswana‐speaking South Africans

Abstract: A continuous assessment and a categorical diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to a random sample of 1050 Setswana-speaking adults in the Northwest province of South Africa. Factor analysis revealed that the mental health continuum–short form (MHC–SF) replicated the three-factor structure of emotional, psychological and social well-being found in US samples. The internal reliability of the overall MHC–SF Scale was 0.74. The total score on the MHC–SF correlated 0.52 with a measure of positive affect, between 0.35 and 0.40 with measures of generalized self-efficacy and satisfaction with life, and between 0.30 and 0.35 with measures of coping strategies, sense of coherence, and community collective self-efficacy. The total score on the MHC–SF correlated −0.22 with the total score on the General Health Questionnaire. Criteria for the categorical diagnosis were applied, and findings revealed that 20% were flourishing, 67.8% were moderately mentally healthy, and 12.2% were languishing. Confirmatory factor analysis supported the hypothesized two-continua model of mental health and mental illness found in the USA. Copyright © 2008 John Wiley & Sons, Ltd.

Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships?

Abstract: Background: Studies have shown associations between health indices and access to “green” environments but the underlying mechanisms of this association are not clear. Objectives: To examine associations of perceived neighbourhood “greenness” with perceived physical and mental health and to investigate whether walking and social factors account for the relationships. Methods: A mailed survey collected the following data from adults (n = 1895) in Adelaide, Australia: physical and mental health scores (12-item short-form health survey); perceived neighbourhood greenness; walking for recreation and for transport; social coherence; local social interaction and sociodemographic variables. Results: After adjusting for sociodemographic variables, those who perceived their neighbourhood as highly green had 1.37 and 1.60 times higher odds of better physical and mental health, respectively, compared with those who perceived the lowest greenness. Perceived greenness was also correlated with recreational walking and social factors. When walking for recreation and social factors were added to the regression models, recreational walking was a significant predictor of physical health; however, the association between greenness and physical health became non-significant. Recreational walking and social coherence were associated with mental health and the relationship between greenness and mental health remained significant. Conclusions: Perceived neighbourhood greenness was more strongly associated with mental health than it was with physical health. Recreational walking seemed to explain the link between greenness and physical health, whereas the relationship between greenness and mental health was only partly accounted for by recreational walking and social coherence. The restorative effects of natural environments may be involved in the residual association of this latter relationship.

Tobacco Use and Cessation in Psychiatric Disorders: National Institute of Mental Health Report

Abstract: The National Institute of Mental Health (NIMH) convened a meeting in September 2005 to review tobacco use and dependence and smoking cessation among those with mental disorders, especially individuals with anxiety disorders, depression, or schizophrenia. Smoking rates are exceptionally high among these individuals and contribute to the high rates of medical morbidity and mortality in these individuals. Numerous biological, psychological, and social factors may explain these high smoking rates, including the lack of smoking cessation treatment in mental health settings. Historically, "self-medication" and "individual rights" have been concerns used to rationalize allowing ongoing tobacco use and limited smoking cessation efforts in many mental health treatment settings. Although research has shown that tobacco use can reduce or ameliorate certain psychiatric symptoms, overreliance on the self-medication hypothesis to explain the high rates of tobacco use in psychiatric populations may result in inadequate attention to other potential explanations for this addictive behavior among those with mental disorders. A more complete understanding of nicotine and tobacco use in psychiatric patients also can lead to new psychiatric treatments and a better understanding of mental illness. Greater collaboration between mental health researchers and nicotine and tobacco researchers is needed to better understand and develop new treatments for cooccurring nicotine dependence and mental illness. Despite an accumulating literature for some specific psychiatric disorders and tobacco use and cessation, many unstudied research questions remain and are a focus and an emphasis of this review.

Looking Beyond Psychopathology: The Dual-Factor Model of Mental Health in Youth

Abstract: In a dual-factor model of mental health (cf Greenspoon & Saklofske, 2001), assessments of positive indicators of wellness (ie, subjective well-being—SWB) are coupled with traditional negative in

Integrating mental health into primary care: a global perspective.

Abstract: Some of the debates reminded me about themes I had been taking for granted. For example, Svab and van Weels’ negative position on ‘Family Medicine should refine its essential attributes’ reminded me that family medicine is an emancipated field of medicine and no longer needed to debate this position (been there, done that). Furthermore, family medicine should get on with improving its image and be rid of ‘the harmful benefits of extreme complexity, uniqueness, exclusivity, and threat’.

Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

Abstract: Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-inform

Loneliness and the health of older people.

Abstract: Background The intense focus on major psychiatric disorders in both contemporary psychiatric research and clinical practice has resulted in the relative neglect of less definable constructs such as loneliness and how such entities might impact on health outcomes. The purpose of this review is to raise awareness among physicians and psychiatrists of the medical impact and biological effects of loneliness as well as making the argument that loneliness should be a legitimate therepeutic target. Methods Using Pubmed we searched the literature for research and review papers looking at loneliness as a construct, how it is measured and its health effects. We reviewed the relevant papers and have summarized their main findings. Results Loneliness has strong associations with depression and may in fact be an independent risk factor for depression. Furthermore loneliness appears to have a significant impact on physical health being linked detrimentally to higher blood pressure, worse sleep, immune stress responses and worse cognition over time in the elderly. There is a relative deficiency in adequate evidence based treatments for loneliness. Conclusion Loneliness is common in older people an is associated with adverse health consequences both from a mental and physical health point of view. There needs to be an increased focus on initiating intervention strategies targeting loneliness to determine if decreasing loneliness can improve quality of life and functioning in the elderly. Copyright © 2008 John Wiley & Sons, Ltd.

The mental health of children affected by armed conflict: Protective processes and pathways to resilience

Abstract: This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain 'invulnerable' children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology.

Maximizing the Implementation Quality of Evidence-Based Preventive Interventions in Schools: A Conceptual Framework

Abstract: Increased availability of research-supported, school-based prevention programs, coupled with the growing national policy emphasis on use of evidence-based practices, has contributed to a shift in research priorities from efficacy to implementation and dissemination. A critical issue in moving research to practice is ensuring high-quality implementation of both the intervention model and the support system for sustaining it. The paper describes a three-level framework for considering the implementation quality of school-based interventions. Future directions for research on implementation are discussed.

Triple P-Positive Parenting Program as a Public Health Approach to Strengthening Parenting

Abstract: Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed.

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.