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.     

Adolescent health needs. II: Utilization of health care by adolescents

In a random, mailed survey, 730 adolescents supplied information on their patterns and preferences for health care. The majority of respondents reported that they usually receive medical care from a private physician. Girls consulted physicians more frequently than boys, but there was no significant variation by age or social group. As the age of the respondent increased, the proportion visiting pediatricians decreased. When asked what they liked and disliked about their physician, respondents placed great emphasis upon the personal characteristics of the practitioner. Long waiting periods were the most common complaint. A significant proportion of adolescents with health concerns do not consult a health professional, even in cases where efficacious treatment may be available. Nervous/emotional problems, obesity, and birth control are concerns of adolescents which should be discussed with health professionals.     

The future of health psychology interventions.

Progress in health psychology interventions was reviewed to manage chronic illness, treat psychophysiological disorders, and provide complementary treatment for difficult medical symptoms. A closer synergy between research, clinical applications and public policy, and education and training was advocated to guide future work in these areas. Further, the importance of clinical input informing research directions, the need for interventions to focus on a broader range of individual difference and contextual factors, and for effectiveness studies to influence the adoption of treatments in clinical settings was emphasized. In accordance, greater effort should be devoted to disseminating information on treatment effectiveness to professional and lay groups to maximize the public health benefit of established intervention approaches.     

Perceptions of health among lay consumers.

The incongruent perceptions of health by consumers and health professionals may contribute to low rates of adherence to medical regimens and few health promotion behaviors. This study of 65 adults, 21 men and 44 women, examined adults' views of health to identify gender, age, and education differences in health perceptions. A questionnaire with 34 items in 12 health categories was developed, based on the work of Woods and associates. Self-concept, fitness, and role performance were rated highest by all groups. Women rated social involvement and harmony significantly higher than men. Education groups rated body-image, fitness, and self-actualization significantly differently.     

Abuse, health locus of control, and perceived health among HIV-positive women.

This study of 230 predominantly poor Hispanic and African American women aged 25 to 61 years living with HIV/AIDS in New York City revealed high levels of both sexual (39%) and physical (44%) trauma before the age of 16. Both types of early trauma were correlated with later trauma, and all forms of trauma were significantly associated with current perceived health. In multivariate analyses controlling for relevant covariates, the Powerful Others and Internal Control subscales of the Multidimensional Health Locus of Control Scales (K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) acted as independent predictors of perceived health rather than (as hypothesized) mediators of the association between trauma and perceived health. Findings underscore the importance of addressing trauma and perceptions of control over one's physical health in the provision of health services to HIV-positive women.     

Health services and health care economics: the health psychology marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed.     

U.S. mental health policy. Doomed to fail.

Changes in the de facto system of mental health care in the last decade reflect organizational and entrepreneurial responsiveness to changes in health policy, not mental health policy. Various other actions described here reduced statutory or institutional leadership roles in mental health and increased the pace at which mental health policy was becoming dependent on health policy. In turn, U.S. health policy in the 20th century has been inherently flawed. The short-term general hospital--the "doctors' workshop"--emphasizing acute care and surgery, has been the cornerstone of U.S. health policy throughout the 20th century. The mimicry of health services by mental health leads to demonstrably more expensive and less effective mental health care and dooms mental health policy to failure.     

Rural America. Unique opportunities for health care delivery and health services research

A general deterioration is occurring in the quality of life of rural Americans, and it is affecting the quality of health and mental health service delivery. About 24% of the U.S. population lives in nonmetropolitan areas where the citizens are older, less well educated, have lower incomes, and are more homogeneous in terms of race and ethnicity. Medicare and private insurance discriminate against rural services in their reimbursement policies, and there is a shortage of health personnel in rural areas. However, there has been renewed congressional action to meet rural needs. Both the House and Senate have established rural caucuses, and an Office of Rural Health Policy has been established in the federal executive branch. Legislative successes were achieved between 1985 and 1988. Rural initiatives will provide psychology with unique opportunities in the next several years.     

Individual differences in self-assessed health: an information-processing investigation of health and illness cognition.

In 2 studies, the relation between measures of self-assessed health (SAH) and automatic processing of health-relevant information was investigated. In Study 1, 84 male and 86 female undergraduate students completed a modified Stroop task. Results indicated that participants with poorer SAH showed enhanced interference effects for illness versus non-illness words. In Study 2, 27 male and 30 female undergraduate students completed a self-referent encoding task. Results offered a conceptual replication and extension of Study 1 by confirming the specificity of the relation between SAH measures and automatic processing of health (vs. negative or positive general trait) information. These studies provide evidence that individual differences in SAH are reflected in schematic processing of health-relevant information.     

Sleeping problems and health behaviors as mediators between organizational justice and health.

The aim of this longitudinal cohort study was to investigate whether sleeping problems and health behaviors (smoking, alcohol consumption, and sedentary lifestyle) mediate the association between organizational justice and employee health. Health indicators were minor psychiatric morbidity, as assessed by the General Health Questionnaire (U. Werneke, D. P. Goldberg, I. Yalcin, & B. T. Ustun, 2000), and poor self-rated health status. The results of logistic regression analysis of data for 416 male and 3,357 female hospital employees working during the 1998-2000 period in 10 Finnish hospitals suggest that sleeping problems are one of the underlying factors causing the adverse health effects of low organizational justice at work. No support for a mediating role of health behaviors between low organizational justice and health problems was obtained.     

Prevention and public health. Psychology's response to the nation's health care crisis

Psychology as a scientific and applied discipline has a unique responsibility to participate in the pursuit of strategies that reduce the nation's health care needs. As a social and behavioral science, psychology can contribute to unraveling the processes underlying conditions of health and disorder. As an applied discipline, psychology can work to design effective interventions to promote human health and to avoid disease and dysfunction. Insofar as these endeavors are unsuccessful, psychology can help reduce significant contributors to the nation's morbidity and mortality. Achieving such success, however, challenges psychologists to collaborate effectively, to combine science with practice and policy, and to address complex philosophical and ethical issues concerned with individual freedom and public responsibility.     

Nightmare distress and stress-related health problems.

Responses of 289 university students to Belicki's Nightmare Distress Questionnaire and the Stress-related Health Problems Scale were used to test the hypothesis that persons who score high on nightmare distress are more likely to report psychological problems. Since relative to the Low Nightmare Distress group, the High Nightmare Distress group scored significantly higher on all seven of the sets of symptoms that are measured by the Stress-related Health Problems Scale, this hypothesis was supported.     

Assessment of irrational health beliefs: relation to health practices and medical regimen adherence.

The purpose of the present research was to provide initial validation of the 20-item Irrational Health Belief Scale (IHBS). Study 1 included 392 undergraduate psychology students. Results from Study 1 suggested that the IHBS total score is internally consistent and stable over an 18-month time period. Greater health-related cognitive distortion (higher IHBS scores) was associated with weaker internal health locus of control beliefs, lower positive affectivity, stronger chance health locus of control beliefs, and greater negative affectivity. Most important, greater cognitive distortion was uniquely and significantly associated with a less positive pattern of health practices. Study 2 involved 107 individuals with Type I diabetes mellitus. Results indicated that higher IHBS scores were significantly associated with both objective (hemoglobin HbA1) and self-reported diabetic regimen adherence independent of trait neuroticism and conscientiousness.     

The importance of a holistic concept of health for health care. Examples from the clinic

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed.     

Adolescent health. Challenges for behavioral scientists

Clearly, the role of behavioral scientists in adolescent health is not limited to service delivery. They also have a role to play via their contributions to basic knowledge of adolescent health and development, their involvement with the design and evaluation of health systems, their efforts to design and evaluate interventions to reduce adolescent morbidity and mortality, and their contributions to adolescent health policy. The once popular view of adolescence as a period of inevitable storm and stress has been replaced by one that emphasizes the potential of this developmental stage for constructive adaptation and maturation. Behavioral scientists have an important role to play in assuring that the potential of this life stage is reached for future generations of youth.