Returns on investment in public health: effect of public health expenditures on infant health, 1983-1990

In this paper a number of methodological issues relating to research on the relationship between the menopause, mood and hormone replacement therapy (HRT) are discussed. These issues relate to problems of design and statistical analyses, problems which have prevented the reaching of definite conclusions regarding the relationship between menopause, mood and hormones. These problems are discussed under three main headings, namely, the assessment of menopausal status, statistical modelling and the design and analyses of clinical trials. Problems relating to concepts and measurement of dependent variables are the subject matter of the papers that follow. Within the three main headings more specific issues are detailed. The paper concludes with a list of recommendations on how research in this important area might be further advanced.     

The mental health system and older adults in the 1990s.

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather, the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stabilizing support of mental health center programs: Testimony on Community Mental Health Centers Amendments of 1969.

Presents information in support of continued federal funding of community mental health centers. Emphasis is placed on the program features of consultation, education and research, evaluation, and the direct treatment services of a center's program. The necessity of support for preventive efforts, the use of indigenous manpower, and training in special problem areas (alcoholism and narcotic addiction) is also stressed. It is felt that effective functioning of community mental health centers requires a continuing pattern of federal support, especially for those activities which are not inherently self-supporting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symposium on relationships between religion and mental health: Discussion.

"To prepare to serve the personal needs of those who come to the pastor, psychology and clinical training have come into the curriculum of theological education… . It may be noted… that the deeper the psychotherapy the more like a religious conversion it becomes." Ostow finds that the most effective psychological controls in animal and human behavior "are exactly those which religion has developed with conspicuous success." Goodwin Watson notes that amoral therapy is a contradiction in terms, for every personal choice is a moral one. "Mental health is everybody's business. Every profession and every discipline of knowledge is responsible to give from its wisdom to the cause of healthy living on this planet. Psychology and psychiatry are making notable contributions. Religion and ethics too are disciplines needed on this frontier. From the ultimate concern of ethical religion we may ask faithful devotion to the human quest for wholeness." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symposium on relationships between religion and mental health: Introductory remarks.

"We are witnessing a conspicuous change in the climate between religion and science in recent years." In psychology this has been evidenced in seminars on religion and psychiatry, work shops on pastoral care and psychotherapy, grants to universities for developing mental health curricula for theological students, creation of an Academy of Religion and Mental Health, and the establishing of an APA committee to study relationships between religion and mental health. "The hitherto existing chasm between religion and psychology is somewhat unusual because… both concern themselves with human nature and behavior." This symposium spotlights: expanding links between psychology and religion, religious experience and psychological conflict, the nature of religious controls, and moral issues in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of domestic violence on women''s mental health

Broiler chicks were spray treated on the day of hatch with titrated dosages (10(6), 10(7), or 10(8) anaerobic CFU) of a characterized competitive exclusion culture (CF3) and challenged orally on day 3 with 10(4) CFU of Salmonella typhimurium. On day 10, cecal contents from control and CF3-treated chicks were cultured for S. typhimurium to determine the minimal efficacious dosage of the CF3 culture. The experiment was repeated in three replicated trials. Resistance to Salmonella cecal colonization was dosage related and progressively enhanced at the 10(7)- and 10(8)-CFU dosages compared with the 10(6)-CFU dosage. The 10(7)-CFU dosage was selected as the minimal effective dosage and evaluated for efficacy during a 43-day broiler growout study. Six hundred broilers were spray treated on the day of hatch and compared with 600 controls. One-half of the control and CF3-treated birds were challenged orally on day 3 with 10(4) CFU of S. typhimurium and designated "seeders." The remaining unchallenged birds were designated "contacts." Compared with the controls, the recovery of Salmonella cells from the ceca of the CF3-treated broilers was significantly decreased (P < 0.01) in the challenged seeders on days 21 and 43 of growout. Salmonella contamination of floor pen litter was significantly reduced (P < 0.05) in pens of CF3-treated birds compared with controls. The transmission of Salmonella cells from seeder to contact birds in the same pens was decreased significantly (P < 0.01). The results indicated that treatment of broiler chicks on the day of hatch with the 10(7)-CFU dosage of CF3 culture effectively increased resistance to S. typhimurium challenge during growout to market age.     

The impact of payor/provider type on health care use and expenditures among the frail elderly

OBJECTIVES: This study examined whether health care expenditures and usage by the frail elderly differ under three payor/provider types: Medicare fee for service, Medicare health maintenance organization (HMO), and dual Medicare-Medicaid enrollment. METHODS: In-home interviews were conducted among 450 frail elderly patients of a San Diego, Calif, health care system. Cost and use data were collected from providers. RESULTS: Analyses revealed no difference in total expenditures between fee-for-service and HMO enrollees, but Medicare-Medicaid beneficiaries' expenditures were 46.8% higher than those for HMO enrollees and 52.2% higher than those for the fee-for-service group. Fee-for-service participants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two payor/provider groups did not differ. Not were there payor/provider differences in access to home health care, but HMO home health care users received significantly fewer services than the others. CONCLUSIONS: The care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations. This raises compelling questions for future research. For the dually enrolled, stronger cost containment may be required.     

The economics of mental health care.

Attempts to assist psychologists involved in policy discussions regarding the economics of mental health care by summarizing important sources of information on the characteristics and trends of psychological service providers and the cost of such services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's mental health: The gap between what we know and what we do.

There is widespread agreement that over 11% of our nation's children need mental health treatment, but the majority of these children receive inadequate or inappropriate treatment. This gap between what we know should be provided and what is provided is the result of a poorly structured health care financing system and a poorly coordinated treatment system. The treatment system fails to recognize that children's mental health problems are interactions between intraindividual difficulties and environmental conditions. A wealth of models of prevention and treatment have been developed, and a substantial scientific basis for children's mental health interventions now exists, but there is a shortage of community based services and a lack of coordination across services. Public policy toward children with mental health problems must encourage application of knowledge about effective treatment systems and encourage care in the least restrictive and most cost-effective settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between excuses and dropout at a mental health center.

Data from 29 adults and 3 children in a parent training project show that more dropouts than continuers tended to give 1 or more excuses at some point from the intake telephone call to the 5th clinic appointment. By that time, 53% of Ss had dropped out. Comparison of this dropout rate with the identification rate for dropouts suggests the advantage of using excuses to identify dropouts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The politics and economics of mental health 'parity' laws

The enactment of the Domenici-Wellstone amendment in September 1996, which calls for the elimination of certain limits on coverage for mental health care under private insurance, is being hailed as a major step forward in the quest for "parity" in mental health coverage. Parity legislation is being introduced in a number of state legislatures and is finding new enthusiasm in Congress. In this paper we consider the efficiency rationale for these laws and examine their likely impact in the era of managed care. We conclude that although such successes represent important political events, they may offer only small gains in the efficiency and fairness of insurance markets.     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

The effects of widowhood on physical and mental health, health behaviors, and health outcomes: The Women's Health Initiative.

This study examined whether widowhood was associated with physical and mental health, health behaviors, and health outcomes using a cross-sectional (N=72,247) and prospective (N=55,724) design in women aged 50-79 years participating in the Women's Health Initiative observational study (85.4% White). At baseline, married women reported better physical and mental health and generally better health behaviors than widowed women. Whereas women who remained married over the 3-year period showed stability in mental health, recent widows experienced marked impairments and longer term widows showed stability or slight improvements. Both groups of widows reported more unintentional weight loss over the 3-year period. Changes in physical health and health behaviors were inconsistent, with generally small effect sizes. Findings underscore the resilience of older women and their capacity to reestablish connections, but point to the need for services that strengthen social support among women who have difficulty during this transition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health and adjustment of immigrant and refugee children

Although parents may make decisions to leave their homes, either willingly in the hope of improving their lives or involuntarily to escape danger and seek safety for themselves and their families, it is never a voluntary decision for the child. The economic, political, social, and other contextual issues associated with migration are as significant in predicting the child's adjustment to his or her new circumstances as his or her physical and psychological endowment. This article addresses these issues and suggests that particular consideration be given to children whose migration was punctuated by life-threatening danger or whose families were overwhelmed by the stresses of migratory experiences. Child and adolescent psychiatrists and other well-trained mental health professionals can further the understanding of the interactions among the child, family, and new community, which can promote or hinder the process of adaptation to the new setting.     

Research definitions of mental health and mental illness.

The conceptual and methodological difficulties involved in each of the various categories of definitions of mental health outlined in this review are discussed. Suggestions for further research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)