Narrative interaction: creating a space for therapeutic communication

This theoretical article explores the impact of ethnic appearance on the nurse-client encounter from the perspective of Chicanas, women of Mexican descent. The issues raised for Chicanas, however, are applicable for members of many other ethnic groups, individuals whose identity is often constructed from the stereotypes and myths their appearance evokes. Ethnic minority women often experience a feeling of double jeopardy, enduring the consequences of living in a society that devalues both women and members of specific racial or ethnic groups. Research from nursing, counseling psychology, and sociology provide the bases for an examination of the mental health consequences of this double jeopardy. Narrative interaction, the sharing of personal stories, is offered as a therapeutic form of communication. Through narrative interactions, nurses may begin to understand the context of women's lives and learn what is meaningful for them, from their perspective. It is from the women themselves that nurses will begin to learn new meanings for their appearance and gain some understanding of their world.     

Contemporary approaches to pharmacotherapy in Tourette''s syndrome and obsessive-compulsive disorder

Considerable research on minority health has examined whether members of a minority group experience more rapid health declines than the White majority when both groups reach later life. Researchers have sought to determine if being both old and a member of a minority creates a double disadvantage to health. The primary purpose of this research is to test the double jeopardy to health hypothesis among Black and White Americans using data from a 15-year panel study of adults: National Health and Nutrition Examination Survey I: Epidemiological Follow-up Study (NHEFS). African Americans have poorer health at all three times on a variety of health status measures, but no evidence for double jeopardy was uncovered. There were important racial differences for change in health status but Black Americans of all ages -- including Black older adults -- suffered from growing disability and more negative ratings of health. Black adults are more likely to develop serious illness, and their ratings of health decline more rapidly than is the case for White respondents. While there is little support for the double jeopardy hypothesis as originally stated, there is overwhelming evidence to show that the health of Black Americans of all ages declines at a faster rate. The formulation of the double jeopardy hypothesis is critiqued on several points: ontogenetic fallacy, attribution of discrimination, and selective mortality.     

Double jeopardy in the interrogation room for youths with mental illness.

Comments on the article by J. Owen-Kostelnik, N. D. Reppucci, and J. R. Meyer (see record 2006-05893-002) which reviewed the issues surrounding the police interrogation of minors. This commentary expands on the review by addressing the mental health status of youths who come into contact with police. It stems from two immutable facts: (a) The prevalence of mental illness among justice-involved youths is alarmingly high, and (b) mental illness by itself is a risk factor for false confession. These two facts place suspected youths in double jeopardy in the interrogation room. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological distress and help seeking in rural America

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social–psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social–psychological resources as a mediator between minority stress and health. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p confirmatory fit index = .93, Tucker–Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social–psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Conclusions: Findings indicate a significant impact of minority stressors and social–psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mental health and aging: The need for an expanded federal response.

Discusses the mental health problems that may occur as elderly people must face adjustments because of bereavement, poor physical health, the demands of caring for an ill spouse, drug/alcohol abuse, dementia and cognitive impairments, and multiple health problems. Negative social stereotypes associated with both elderly patients and mental health care, limited access to and a lack of trained professionals in the area of geriatric mental health care, lack of outreach, inadequate benefits under prepaid health plans, Medicare and Medicaid, and special problems of ethnic minority and rural elderly people all contribute to an inadequate mental health care system. The author, a US representative, suggests a redesigning of the system and outlines an initiative that addresses the development of an effective mental health care system for the elderly, modification of Medicare and Medicaid, and improvements in quality assurance and access protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of disability and bereavement on the mental health and recovery of older adults.

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60–80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and the relationship between job experiences and psychological distress: A study of dual-earner couples.

Examines the association between job role quality and psychological distress in a sample of 300 full-time employed dual-earner couples, controlling for such individual level variables as age, education, occupational prestige, and marital quality, and for such couple level variables as length of marriage, parental status, and household income. The magnitude of this effect is compared for men and for women. Results indicate that job role quality is significantly negatively associated with psychological distress for women as well as for men and that the magnitude of the effect depends little, if at all, on gender, casting doubt on the widely held view that job experiences more significantly influence men's mental health states than women's. The results are discussed in the context of differentiating between sex and gender differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of formal and informal sources of mental health care among older African-American public-housing residents

BACKGROUND: Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents. METHOD: Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N = 818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care. RESULTS: Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) than informal sources (18.6%) for care. The strongest correlates of using formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive disorder (OR = 19.71) and having a confidant (OR = 15.07). CONCLUSIONS: Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.     

Predictors of mental health among adolescents from immigrant families in Portugal.

The aims of this study were to investigate the degree of mental health problems among adolescents with immigrant background in Portugal and the factors that may predict mental health problems. The study sample consisted of 755 immigrant adolescents from seven ethnocultural groups (Cape Verdeans, Angolans, Indians, Mozambicans, East Timorese, Sao Tomese, and Guineans) and 320 native Portuguese adolescents. Generally, most respondents did not report major psychological adjustment problems. Adolescents from immigrant families reported fewer mental health problems than their native Portuguese counterparts, and girls reported more mental health problems than did boys. Predictive factors—sociodemographic, intercultural contact, and psychosocial adjustment variables—were significantly linked to youths’ mental health. Major predictors of poor psychological adjustment were perceived discrimination, social difficulties, and behavioral problems. As expected, different factors explained the psychological adaptation of adolescents by gender. Implications of the study for counselors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociodemographic associations with mental health and residential care utilization among juvenile delinquents.

Research has supported the notion that ethnoracial minorities in the juvenile justice system use fewer mental health services than Caucasians do. The authors' aim was to examine potential sociodemographic (including racial background) associations with the use of mental health and residential care among juvenile delinquents adjudicated through court services. The authors extracted demographic, mental health, and residential care data from archival records of 149 juveniles consecutively adjudicated from a midwestern city's juvenile court services facility (from 1999 to 2002). The authors found no significant associations with mental health treatment or residential care utilization based on ethnoracial background, age, gender, and educational level, neither in bivariate nor multivariate analyses. Implications for policy in the juvenile justice system are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who requests psychological services upon admission to prison?

Structuring a system of psychological services for offenders and releasees requires an understanding of the offenders who voluntarily seek psychological services upon admission. To begin to develop such an understanding, a sample set of responses to the Psychological Services Inmate Questionnaire (PSIQ) from 2,674 newly committed male and female federal offenders were examined. About one-tenth of the sample made a request for psychological services upon admission to prison without a mandate or referral, and confirm that a combination of prior mental health treatment and current symptoms are among the factors associated with making the request. Logistic regression analysis indicated male gender, receipt of mental health treatment prior to current incarceration, history of a head injury, current symptoms of depression, hopelessness, nervousness, sleeping problems, and racing thoughts, were independent and significant predictors of service request. Implications for future corrections research, clinical training and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health and psychiatric disorders in older women

An increase in the number and diversity of resources designed to optimize psychosocial function in people and especially women over age 65 is inevitable in the next decade as both the size and political influence of this group increase. The successful implementation of such programs is dependent on widespread change throughout society, involving many disparate groups, including older people themselves, politicians, health care administrators, and researchers from a range of disciplines. Clinicians in medicine and allied professions have a pivotal role in this regard. At present there are many reversible causes of psychiatric morbidity in the elderly, including depression, anxiety, cognitive defects, sensory impairment, malnutrition, and adverse effects of alcohol abuse and polypharmacy that are often not recognized or treated appropriately. It is therefore essential that family practitioners receive both undergraduate and postgraduate training to recognize and manage the wide range of psychosocial disorders prevalent in older women. Intervention may require little more than an opportunity for the women to ventilate concerns or obtain information and advice about community resources. In other circumstances in which there are complex interactions of physical, social, and psychological factors, optimal management may involve interventions that require specific skills beyond the scope of the individual practitioner. Referral to a psychogeriatric team is likely to be helpful in such situations. The team, with its access to a full range of health professionals and community resources, is well placed to deal economically with complex issues. The special care units are best equipped to manage the tertiary care of the chronically ill who do not have adequate community-based support available. Increased information derived from research relating to the spectrum of mental ill health and mental health is essential to adequately address the causes, correlates, and treatments of illness, and to answer questions about the positive aspects of mental health that may have implications for all age groups and both sexes. For example, it is intriguing that older women maintain a high level of psychological health despite greater social disadvantages than any other major section of the community. It is likely that psychological factors, such as better coping skills and ability to adapt to stressful life events, influence both the quality of life in older women and possibly also its duration. Alternatively, it is possible that the commonly held view that the life expectancies of women and men will converge as women undertake more of the roles and activities currently the province of men may occur.(ABSTRACT TRUNCATED AT 400 WORDS)     

Race as a moderator in a model of sexual harassment: An empirical test.

L. F. Fitzgerald, C. L. Hulin. and F. Drasgow (1995) proposed that victim characteristics, such as race, might moderate the relationships between sexual harassment and its job, psychological, and health status outcomes. This study describes 2 theoretical positions, tokenism and double jeopardy, that could account for this possible moderation by race, as well as the alternative view that no moderating effects exist. The effects of race are empirically examined through simultaneous path analysis. Results indicate that whereas, mean levels of harassment differ across race, the phenomenon of sexual harassment unfolds similarly across races; race is not a moderator of the relationships between sexual harassment and the variables proposed as its antecedents and outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health consultant to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants--psychologists and psychiatrists--with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions.     

Psychological rehabilitation: A concept in need of a method.

Research indicates that the field of mental health is not doing an adequate job of rehabilitating psychiatric patients back into the community. The inefficacy of psychological rehabilitation appears to be a function of several variables: (a) the failure of mental health professionals to understand the pressing necessity for a psychological-rehabilitation approach within the mental health system; (b) the mistaken assumption that psychological rehabilitation and psychological prevention are separate and distinct functions (as opposed to the realization that rehabilitation, at the present state of our knowledge, is possibly the best use of our preventive energies); and (c) the inability to develop a psychological-rehabilitation model. As an alternative to the present practice of psychological rehabilitation, a skills-training approach is suggested. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans.

Though the broader literature suggests that women may be more vulnerable to the effects of trauma exposure, most available studies on combat trauma have relied on samples in which women's combat exposure is limited and analyses that do not directly address gender differences in associations between combat exposure and postdeployment mental health. Female service members' increased exposure to combat in Afghanistan and Iraq provides a unique opportunity to evaluate gender differences in different dimensions of combat-related stress and associated consequence for postdeployment mental health. The current study addressed these research questions in a representative sample of female and male U.S. veterans who had returned from deployment to Afghanistan or Iraq within the previous year. As expected, women reported slightly less exposure than men to most combat-related stressors, but higher exposure to other stressors (i.e., prior life stress, deployment sexual harassment). No gender differences were observed in reports of perceived threat in the war zone. Though it was hypothesized that combat-related stressors would demonstrate stronger negative associations with postdeployment mental health for women, only one of 16 stressor × gender interactions achieved statistical significance and an evaluation of the clinical significance of these interactions revealed that effects were trivial. Results suggest that female Operation Enduring Freedom/Operation Iraqi Freedom service members may be as resilient to combat-related stress as men. Future research is needed to evaluate gender differences in the longer-term effects of combat exposure. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attributable factors to the emergence of multidrug-resistant Mycobacterium tuberculosis based on the observation of consecutive drug resistance test results

Determining whether there is evidence of underutilization of outpatient mental health care by Department of Defense (DoD) beneficiaries relative to the general population is the purpose of this study. It analyzes data from the 1994-1995 DoD Health Beneficiary Survey and compares the mental health status and usage rates of active duty members and their families with benchmark levels found in the general population. Although the mental health status for the DoD beneficiary population was found to be generally the same as that of the general U.S. population within gender categories, gender-specific usage rates of mental health services of DoD beneficiaries in the groups examined were well below rates recorded for the general population. The concept of psychological readiness is also introduced. Several recommendations for increasing access to mental health care are presented.     

The effects of interviewer gender in mental health interviews

Despite indications that gender can affect the disclosure of personal information, few studies examine the effects of interviewer gender in eliciting information pertaining to psychological functioning and mental health. Analysis of data collected at the Los Angeles site of the Epidemiological Catchment Area Study reveals that interviewer gender is significantly related to respondents' reports of psychiatric symptoms. Male and female respondents interviewed by women report more symptoms of depression, substance abuse, and conduct disorders than respondents interviewed by men. It is suggested that female interviewers may create conditions more conducive to disclosure and be perceived as more sympathetic than male interviewers. Although limitations of both data and analysis preclude a definitive conclusion, the findings suggest that interviewer gender may influence disclosure in mental health and related types of interviews.     

U.S. mental health policy: Proactive evolution in the midst of health care reform.

Argues that it is vital that psychological and behavioral health care perspectives be explicitly recognized during the coming reform of the US health care system. Mental health policy should not be treated as a mere extension of physical health policy; to do so extends all the flaws of the physical health system into the psychological care arena, resulting in a mismatch with the actual health care needs of the nation. Furthermore, organized psychology must remind policymakers that psychologists provide health services in areas of health care beyond mental health. The challenge to psychology is to ensure the continuation of adequate and timely access to appropriate psychological and behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)