Service use and mental impairment among the elderly: Arguments for consultation and education.

Compared the service use patterns of older adults with varying levels of mental impairment, and assessed the effects of services received on their mental health status over a 1-yr period. Data were obtained from a US General Accounting Office (1977, 1979) study of 531 elderly persons (mean age 76.1 yrs), which included administration of a modified version of the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Ss were interviewed twice, 1 yr apart. 174 Ss were classified as having a mild psychiatric impairment, and 118 Ss had a severe psychiatric impairment. The existence of mental impairment was related to marital status, race, and level of education. Usage of mental health services was low, although mentally impaired Ss were more likely than unimpaired Ss to use social and medical services. Results also suggest that such services can have an important effect on the mental health of older persons. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religiosity of psychotherapists: A national survey.

Explored the religiosity of 425 marriage and family therapists, clinical social workers, psychiatrists, and clinical psychologists. Although 80% of the Ss indicated a religious preference, only 41% regularly attended religious services. According to the Religious Orientation Inventory, 230 of 425 Ss were classified as religious. This is consistent with findings of previous studies (e.g., A. E. Bergin; see record 1980-05877-001). The potential for change toward greater empathy for religious clients is underscored by the significant levels of unexpressed religiosity found among mental health professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support, support groups, and the cancer patient.

Surveys the literature on social support and cancer and reports results from an empirical investigation of the factors that led cancer patients to join social support groups. Questionnaire data from 666 21–89 yr old cancer patients show that although most Ss received high levels of social support following cancer, some experienced isolated instances of rejection or did not receive the type of support they wanted from family, friends, and medical caregivers. This appeared to be 1 impetus for joining cancer support groups, although Ss reporting a lack of social support were not generally more likely to join support groups than were other Ss. The Profile of Mood States suggested that attenders were somewhat less likely to be depressed than were nonattenders. In addition, cancer support group attenders were more likely to be White middle-class females, to report having more problems, and to use social support resources of all kinds than were nonattenders. Implications for outreach to cancer patients are discussed, and it is concluded that while support groups may be beneficial for many cancer patients, current programs tend to be used largely by the same segment of the population that uses traditional mental health services. (81 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of glutamic acid and social stimulation in mental deficiency.

50 male and 8 female residents of Polk State School for mental defectives were used as Ss. Their IQs ranged from 20 to 66 with a mean of 54, resulting from familial mental defect, abnormal developmental conditions, or post-natal brain damage. 2 distinctly different social environments were used, and L+ glutamic acid was used as the experimental drug, and a placebo for control. The findings showed that L+ glutamic acid did not produce significant improvement in mental functioning, that increased personal attention enhanced mental functioning, and that a greater gain in functioning was made by Ss given added attention but with minimal disruption of the familiar environment. 23 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health needs of physically disabled persons: Their perspective.

Evaluated disabled persons' perceptions of the types of problems experienced by the disabled population and the extent of this population's need for psychological services. 145 severely physically disabled former clients of a state rehabilitation commission responded to a questionnaire. Data show that 55% of Ss were aged 16–29 yrs, while 88% were 55 yrs old or less. 61.3% of Ss were males; 41% of Ss were married, 13% were divorced, 8% were separated, and 36% were single. 75% reported substantial need; 8% felt there was minimal or no need. Perceived problem areas included personal/emotional, organic/biological, marital/family, and vocational/career planning. Results suggest that this group of consumers perceives that there is a significant need for mental health services among individuals who are physically disabled. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thai adolescent survivors 1 year after the 2004 tsunami: A mixed methods study.

This study examined the impact of the 2004 Asian tsunami on 400 Thai adolescents 1 year after the disaster. Quantitative analyses showed that youth behavior problems were positively associated with tsunami experiences and negatively associated with positive family functioning. Tsunami exposure, school connectedness, religious beliefs and practices, and availability of mental health services did not predict behavior problems. Sequential regression analysis was performed with age, gender, tsunami experiences, and family functioning predicting youth behavior problems. In-depth interviews with 40 adolescents revealed many losses and difficulties after the tsunami, including death of parents and school difficulties. Positive aspects of recovery were support from family, peers, and other social networks and increased educational opportunities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term psychosocial adjustment following very severe closed head injury.

Examined the cognitive, psychological, and social functioning of 18 community-dwelling male patients who had experienced a severe closed head injury (CHI) at least 18 mo previously and still required contact with rehabilitation services. Results from Ss with CHI were compared with those from 27 normal control Ss. Information on Ss' behavior was also obtained from their significant others. Results show that Ss with CHI exhibited deficits in their cognitive and social functioning but showed no signs of emotional or psychiatric disturbance. Attempts to find a relationship between the cognitive impairment and social functioning of Ss with CHI were partially successful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of children's health care use: an investigation of psychosocial factors

Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while children's depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of children's health care use. When included in a comprehensive analysis, child and family psychosocial characteristics help to explain children's health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed.     

Patient feedback on satisfaction with direct services received at a community mental health center: A partial replication.

At 8–29 mo after termination, 73 former patients at a community mental health center evaluated the services they had received. As in the author's previous study (see record 1982-28825-001), most Ss reported that therapy had been moderately or extremely helpful. The perceived degree of help received was related to perceived therapist interest in the S and to the number of therapy sessions. Most Ss rated the problem that brought them to the mental health center as being very serious, although the largest diagnostic category was "condition not attributable to mental disorder." Most Ss had not sought further treatment and did not feel that they needed it after termination. Ss returning to the center did not evaluate therapy any differently than new patients. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family dynamics of families with mental health problems in Finland

This study forms part of the International Family Dynamics Project. Its purpose was describe the family functioning of families with mental health problems on the basis of Barnhill's framework for healthy family systems. The sample consisted of 160 families in which one family member had mental health problems. Both the patients and their relatives took part. The data were collected by questionnaires, i.e. The Family Dynamics Measure and The Family Dynamics Questionnaire. According to the results, mental health patients described family functioning as fairly poor, while relatives described it as fairly good. However, patients' and relatives' perceptions of family functioning did not differ significantly. There were some statistically significant differences between patients' and relatives' perceptions of different family dynamics dimensions. Relatives reported more mutuality (P = 0.006) and clearer communication (P = 0.009) than patients. Older mental health patients reported more isolation than patients under 30. Relatives who mentioned some serious illness in the family reported more role conflict than those who didn't. No differences were found by gender, family structure or education. The results indicated that the mental health problems of a single family member did not impair family dynamics. The study showed that the resources and functioning of families are fairly good in spite of the illness in the family.     

Fees and therapy: Relation of source of payment to course of therapy at a community mental health center.

Examined the relationship between source of payment, divided into self-payers vs 3rd-party plus self-payers, and 3 therapy process variables for 404 admissions to a community mental health center. Overall analyses found that source of payment was significantly related to number of client contacts and length of stay. These relationships were maintained when the client's social class, age, and sex were taken into account. The implications for national health insurance coverage for mental health services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-related changes in cardiovascular response as a function of a chronic stressor and social support.

The effects of aging, chronic stress, and social support on cardiovascular functioning were examined using a cross-sectional design. 36 family caregivers of Alzheimer's disease victims and 34 control Ss performed 2 active coping tasks while continuous noninvasive measures of cardiovascular activity were monitored. Results revealed that caregivers high in social support displayed typical age-related decreases in heart-rate reactivity, whereas caregivers low in social support displayed age-related increases in heart-rate reactivity. Analyses further indicated that only Ss with low social support were characterized by age-related increases in systolic blood pressure. These results suggest that social support can moderate age-related changes in cardiovascular functioning, particularly in Ss exposed to a chronic stressor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sickle cell disease pain: II. Predicting health care use and activity level at 9-month follow-up.

Examined 9-mo follow-up data obtained from adults with sickle cell disease (SCD) participating in a longitudinal study of pain-coping strategies. Of 99 Ss completing the baseline assessment of pain-coping strategies, 89 (90%) completed a structured pain interview assessing health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for demographics and disease severity revealed that baseline Negative Thinking and Passive Adherence was associated with greater activity reduction and more frequent health care contacts during the subsequent 9 mo. Additional correlational analyses revealed that if levels of Negative Thinking and Passive Adherence increased from baseline to follow-up, this increase was associated with even further reductions in activity level during painful episodes. Changes in disease severity were not associated with any of the follow-up measures. Comparing pain-coping strategies assessed at baseline to pain-coping strategies measured at follow-up revealed that, without intervention, pain-coping strategies were relatively stable over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial adjustment of adolescent children of a depressed, arthritic, or normal parent.

Examined the joint effects of having a parent with a psychological or physical disability and stressful life events on the mental health of 3 groups of adolescents: 16 adolescent children of a depressed parent, 16 adolescent children of a parent with rheumatoid arthritis, and 16 adolescent children of parents free from psychological or physical disability. Ss were asked to complete a battery of assessments, including the SCL-90, Rosenberg Self-Esteem Scale, Family Environment Scale, and scales assessing life events and satisfaction with school. It was found that, in contrast to the normal group, Ss with arthritic parents reported lower self-esteem, whereas Ss with depressed parents reported lower self-esteem and more symptomatology. However, the 2 risk groups did not differ in terms of mental health or family and school adjustment. Both negative and positive life events were strongly related to poorer adjustment, but only for Ss with depressed and arthritic parents. There was a significant interaction effect of parental disability (depressed vs normal) and negative life events on symptomatology, with the Ss with depressed parents who experienced few negative life events reporting symptom levels equivalent to that of the normal group. Within-group analyses revealed that a positive familial social climate was related to better adjustment among all 3 groups: satisfactory school involvements were related to better adjustment among the depressed-parent and normal groups. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of social support and associated social and psychological functioning in women with rheumatoid arthritis.

Investigated the relationship between health status, social integration, qualitative aspects of social support, and social and psychological functioning in 194 women (aged 21–65 yrs) with rheumatoid arthritis. Ss completed a telephone interview that included measures of these variables. Even after controlling for the influences of current physical limitations and social integration, qualitative dimensions of social support as measured by the Quality of Social Support Scale, a scale developed for this study, explained a significant proportion of the variance in home and family functioning and in depression. This demonstrates the importance of social support to both social and psychological functioning with a chronic, painful, and disabling disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval.

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patients were initially functioning as well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping profiles associated with psychiatric, physical health, work, and family problems.

Examined coping profiles of 11 samples (identified in the stress literature) with a total of 1,298 individuals experiencing psychiatric, physical health, work, or family problems. Comparisons were made in Ss with and without anxiety and depression to control for the effects of distress. Coping was similar for Ss in similar problem categories, but different for Ss in different categories. Psychiatric Ss made more use of avoidance and less use of social supports. Ss with physical health problems were among the most frequent users of social supports. Ss with a family problem were among the most frequent users of problem-focused coping and the least frequent users of self-blame. Ss with work stress were the most frequent users of self-blame. Results support the hypothesis that persons with psychopathology cope in maladaptive ways involving dysfunctional strategies that constitute the behavioral disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does a hostel's managing agency determine the access to psychiatric services of its residents?

This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.     

Social support and adaptation to stress by the elderly.

Examined the prospective effects of stress and social support on the physical and mental health of 50 60–88 yr olds, who were assessed twice over a 6-mo period. Instruments included the UCLA Loneliness Scale; Self-Rating Depression Scale; and measures of physical health, social support, and stressful life events. Social support was a significant predictor of physical health status, whereas mental health was related to the stress by social support interaction. Results are consistent with the buffering hypothesis, in that high levels of social support reduced the negative impact of stress on mental health. Ss who were in better mental health at the initial assessment experienced fewer stressful events and higher levels of social support over the subsequent 6-mo period, whereas physical health was directly influenced by social provisions that were related to feeling valued by others. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)