Convergent Validity of the Early Memory Index in Two Primary Care Samples

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.     

Cost-effective use of Rational Emotive Behavior Therapy in a public mental health service

With the advanced deinstitutionalization of the treatment of the mentally ill, the public mental health services in many parts of Australia are facing serious difficulties in providing adequate community-based treatment to the large numbers of individuals in need. Overreliance on medication and a diminishing supply of suitably trained therapists may result in an increasing proportion of patients being denied the benefit of optimal treatment and care which should include evidence-based psychological and behavioral approaches. In this communication we describe a day program, designed and implemented in Perth, Western Australia, which combines individual and group therapy provision, and is closely integrated with both primary care and the specialist mental health services. The program provides an alternative to in-patient admission and is cost-effective by reducing the demand for acute hospital beds. It is acceptable to patients and produces measurable improvements in symptoms, functioning and subjective well-being. Address correspondence to Anthony Mander, ENHANCE, Inner City Mental Health Service, Royal Perth Hospital, Box X2213, Perth 6000, Western Australia.     

基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用——基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用

在积极心理学的影响下,心理健康双因素模型包含主观幸福感和精神病理学指标。研究旨在验证心理健康双因素模型在老年人中的适用性,考察老化态度在生命意义感和心理健康间的多重中介作用。采用爱丁堡幸福量表、一般健康问卷、老化态度问卷和人生意义问卷调查了283名广州市社区老年人。结果发现：（1）心理健康双因素模型较单因素模型的拟合度更优。（2）生命意义感通过老化态度的三条路径（对身体变化、心理获得和心理社会丧失的积极态度）促进心理健康,但具体机制不同。增强意义体验、意义追寻通过老化态度的完全中介作用,提高主观幸福感。增强意义体验通过老化态度的完全中介作用,减弱意义追寻通过老化态度的部分中介作用,减少精神病理学症状。研究结果扩大了心理健康双因素模型的适用年龄范围,为提升老年人的心理健康提供实证依据。     

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups – frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months post-intervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.     

优抚医院疗养对象的社会支持与幸福感的关系:心理健康的中介作用

考察优抚医院疗养对象的幸福感现状,探讨其心理健康、社会支持与幸福感的关系。采用老年人心理健康问卷、社会支持评定量表、纽芬兰纪念大学幸福度量表对103名平均年龄82.43岁的优抚医院疗养对象进行调查。结果表明:(1)优抚医院疗养对象的幸福感与全国常模无显著差异,心理健康水平与社会支持状况都显著低于对照组;(2)优抚医院疗养对象的社会支持、心理健康水平和幸福感各维度之间存在显著正相关;(3)心理健康在社会支持对幸福感的影响中起中介作用;心理健康的情绪体验维度在客观支持对幸福感的影响中起部分中介作用。     

Reaching Out: Improving the Continuity of Care of Community Mental Health Services Through a Weekly Climbing Group

This mixed-method study examined the impact of a novel activity group on engagement in care. Thirty-two participants were recruited from National Health Service (NHS) community mental health services in three inner-London boroughs. Participants undertook eight weekly sessions of supervised climbing. There was a significant quantitative improvement in the domain “individual progress” (Z = 2.12, p = 0.03). Qualitative data indicated a wide range of benefits. The study identified both direct and indirect benefits to continuity of care. The study validates the use of a climbing activity group to engage and benefit community mental health service users.     

Anxiety Disorders Among Older Primary Care Patients

Data from the 1997 National Ambulatory Medical Care Survey (NAMCS) were accessed to obtain information about naturalistic patterns of recognition, service utilization, and treatment for late-life anxiety in primary care. The NAMCS is a national probability sample survey of office visits to non-Federal, U.S. physicians engaged in patient care. The survey was conducted by the Division of Health Care Statistics, National Center for Health Statistics, and Centers for Disease Control and Prevention (CDC). Data are now in the public domain. For the current report, all cases indicating office visits for patients age 60 and older were selected (n = 7,687). Anxiety disorders were assigned for 1.3% (n = 99) of these visits, with anxiety disorder NOS the most frequent diagnosis. For 20.2% of these visits (n = 20), a coexistent depressive disorder also was diagnosed. Depression without coexistent anxiety was diagnosed for 2.3% of all visits (n = 176). These figures suggest that late-life anxiety may often go unrecognized and may be more difficult to detect than depression. Nevertheless, other data indicate that appropriate pharmacological treatment and mental health services or referrals are often provided when anxiety or depression is recognized. However, visits wherein these disorders are recognized require increased physician time, and significant proportions of patients in some groups may still not receive appropriate mental health care. Results are discussed in terms of the nature of usual care for late-life anxiety and the needs for future research.     

Mental Illness and Mental Health: The Two Continua Model Across the Lifespan

Mental health has long been defined as the absence of psychopathologies, such as depression and anxiety. The absence of mental illness, however, is a minimal outcome from a psychological perspective on lifespan development. This article therefore focuses on mental illness as well as on three core components of positive mental health: feelings of happiness and satisfaction with life (emotional well-being), positive individual functioning in terms of self-realization (psychological well-being), and positive societal functioning in terms of being of social value (social well-being). The two continua model holds that mental illness and mental health are related but distinct dimensions. This model was studied on the basis of a cross-sectional representative internet survey of Dutch adults (N = 1,340; 18–87 years). Mental illness was measured with the Brief Symptom Inventory and mental health with the Mental Health Continuum Short Form. It was found that older adults, except for the oldest-old, scored lower on psychopathological symptoms and were less likely to be mentally ill than younger adults. Although there were fewer age differences for mental health, older adults experienced more emotional, similar social and slightly lower psychological well-being. In sum, today’s older adults have fewer mental illness problems, but they are not in a better positive mental health than today’s younger adults. These findings support the validity of the two continua model in adult development.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.     

Rural mental health in America

Mental health services are in short supply in rural America. This article describes both the mental health service needs in rural areas and the barriers to improving the availability, accessibility, and acceptability of rural mental health services. Federal programs in rural mental health care in the Departments of Health and Human Services, Agriculture, and Education are described, as well as selected congressional initiatives. The role of the federal Office of Rural Health Policy is emphasized, and policy recommendations for improving rural mental health care delivery are presented.     

Outpatient health care utilization of suicide decedents in their last year of life

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care.     

Community-Based Interventions: A Return to Community Mental Health Centers' Origins

Consultation services offered by community mental health centers (CMHC) have gone through several significant changes since the signing of the Community Mental Health Center Act of 1963 (The President's Commission on Mental Health, 1978). Initially, consultation and education services were an integral part of the CMHC mission. With the passage of additional legislation that promoted a shift in focus, consultation services declined. By 1981, with the passage of the Omnibus Budget Reconciliation Act (Cutler, 1992) national mental health policy was adrift. Consultation and education were no longer seen as central components of mental health services, which increasingly were tied to acute care hospitalization. With a renewed focus on consultation and education, a coherent mental health policy can be reintroduced at the community level.     

The Mental Health of Older Buddhists After the Wenchuan Earthquake

This study investigated changes in measures of mental health among elderly Buddhists after the Wenchuan earthquake in China. The mental health status of Buddhists was compared with that of a non-religious group matched for age which was also severely affected by the disaster. The study focused on two geographic areas which were badly damaged by the earthquake, Beichuan and Mianyang, with Beichuan having suffered the greater damage. The Mental Health Inventory for the Elderly (MHIE) was used to measure the cognitive efficiency, emotional state, self-perception, interpersonal communication, and adaptive ability of survivors at two different times and in two different places: in Beichuan at 4?months and 10?months after the earthquake, and in Mianyang at 6?months and 10?months after the disaster. The scores on the Mental Health Inventory for the older Buddhists in Beichuan were significantly lower than those for the non-religious participants there, but no significant differences were found in Mianyang. The mental health scores of older Buddhists in Beichuan 10?months after the earthquake were significantly better than those recorded 4?months after the earthquake. There were no significant differences in the mental health measurements of Buddhists between testing times in Mianyang. The results indicated that religious faith helped Buddhists recover from trauma, but only in areas severely damaged by earthquakes. The lower level of mental health scores was interpreted to mean that those with religious sensitivities were more deeply affected by but had resilience facing the trauma of the earthquake.     

Validity of the SF-12 in a Canadian Old Order Mennonite Community

To assess the validity of the Physical and Mental Component Summary scores (PCS-12 and MCS-12) of the SF-12 Health Survey (SF-12) in an Old Order Mennonite (OOM) community in Ontario, Canada. Most SF-12 validation studies have focused on general populations or clinical groups. This paper adds to the SF-12 literature by validating the instrument in a minority population. Sixty percent of the adult OOM population (n?=?1,171) completed a survey which had the SF-12 embedded within it. The survey also included questions on health determinants and the prevalence of chronic conditions. Factor analysis was used to confirm the two-factor structure of the SF-12. Item-scale correlations were calculated to assess convergent and discriminant validity. PCS-12 and MCS-12 variability by known subgroups were also explored. Factor analysis confirmed the two-factor structure and hypothesized loadings on the latent physical and mental health factors. Item-scale correlations demonstrated satisfactory convergent and discriminant validity. SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents for gender, age, income adequacy, marital status, self-reported health measures, and other health determinants such as coping, trust, social interaction, and spirituality. PCS-12 and MCS-12 scores were lower in those with various chronic conditions compared to those without.The SF-12 appears to be a valid instrument for measuring health status in this minority population. Future SF-12 studies in OOMs and other populations may benefit from using Version 2 of the SF-12, where the dichotomous questions have been replaced by questions offering respondents more choice.     

Poverty and Mental Health: Underclaiming of Welfare Benefits

The study undertaken by a local MIND welfare benefits service found that 51% of people attending a local mental health resource centre were not receiving the welfare benefits to which they were entitled. Being in receipt of correct benefit entitlement was found to be unaffected by: whether a person had a long history of using mental health services; whether they had a care manager; or whether they had previously been given benefits advice. Women were less likely to be receiving their correct benefit entitlement than men. It is argued that the only way to guarantee that people receive their full benefit entitlement is to ensure that highly trained and experienced welfare benefits advisers are readily accessible to all people who use mental health services.     

Exploring Well-Being among Mental Health Professionals in India

An exploratory mixed methods study was designed to understand the construction and experience of happiness and well-being among Mental Health Professionals (MHPs) in India. Through non-probabilistic sampling techniques, 17 MHPs were selected from three government hospitals in a city in North India. Qualitative interview data were triangulated with scores from the Mental Health Continuum-Long Form (MHC-LF). Analysis showed that despite happiness being a desirable and pleasurable state, participants rarely devoted time thinking about it. Happiness was a multidimensional phenomenon which affected personal, interpersonal, social and environmental realms. Happiness was synonymous with contentment and satisfaction and was understood as the opposite of unhappiness. Although recognised as a universal phenomenon, happiness had a subjective and individual-specific understanding, experience and manifestation. Data from the MHC-LF provided scores on overall well-being, and emotional, psychological and social well-being, and indicated that 14 participants had flourishing mental health, and three were moderately mentally healthy. The personal and professional lives of the MHPs were closely intertwined and impacted well-being in multiple ways. Certain temperamental qualities, personal insight from the field, supportive interpersonal relations and management of time, work, thought, behaviour and affect were protective factors of well-being. Additional responsibilities at work, negativities in client narratives, stigma and myths associated with the profession, biases from other professionals, lack of opportunities for personal development and growth, insufficient infrastructural and human resources were threats to well-being. The findings of the study have implications for policy, education and training, and practice for mental health practitioners.     

Similar-other support for men undergoing coronary artery bypass surgery.

This field experiment examined effects of a support intervention on the physical and mental health of coronary artery bypass graft (CABG) surgery patients. Control participants (N = 90) received usual hospital care; experimental participants (N = 100) also received visits from a "similar other" while in the hospital. Similar others were Veterans Administration veterans who had CABG surgery previously and were trained in simple supportive techniques. Outcomes were assessed prior to surgery and at 1, 6, and 12 months afterwards. Unexpectedly, the intervention generally had no effects on participants' well-being. Further analysis showed that participants who talked often with fellow cardiac patients in the hospital ("de facto similar others") experienced improvements in their physical and emotional well-being over time.     

Home‐based intervention after discharge for Latino families of low‐birth‐weight infants

A home‐based intervention designed for impoverished Latino families of low‐birth‐weight infants was implemented, and the efficacy assessed for infants and mothers. Specially trained public health nurses visited the participants' homes for 4 months for the “short” and 12 months for the “extended” intervention groups. Mothers received support and training in infant care. A third group did not receive the intervention. Assessments were at 4‐ to 6‐month intervals from 1 to 24 months. Although the extended visitation group showed no benefits from the intervention, the short visitation group had higher scores on maternal confidence at one month, and on the Bayley Mental Scores at four months than the group receiving no intervention and extended intervention. The nonvisitation group scored significantly higher than both intervention groups on the HOME scores and on the Mother–Infant Interaction and Feeding scores at three different assessment periods. These data suggest that for poor Latino families home intervention is not beneficial across the board. Instead, efforts should be made to identify families that could benefit from intervention and to tailor the program to the specific needs of Latino families. © 2000 Michigan Association for Infant Mental Health.     

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

Background and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.