The Context of Caretaking in Rural Areas: Family Factors Influencing the Level of Functioning of Seriously Mentally Ill Patients Living at Home

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers’ social support were tested in a model of caretaking that examines the relationship between these factors and patients’ symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.     

Vulnerable Populations in Research: The Case of the Seriously Ill

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces their ability to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research.     

Pilot Effectiveness of a Stress Management Program for Sheltered Homeless Adults With Mental Illness: A Two-Group Controlled Study

This study examined the effectiveness of a stress management intervention for sheltered homeless adults with mental illness. Twelve intervention participants received a 6-week, 1-hour psychoeducation group combined with a 20-minute meditation. Eleven matched pairs did not receive intervention and served as controls. At 1 week post study, intervention participants reported a statistically significant reduction in perceived stress (Z=??2.285, p < .02, d=??1.176) compared to controls. No differences were found at 1 week post study between intervention and control participants on reported quality of life. This study provides pilot data on the effectiveness of an occupation-based stress management program for sheltered homeless adults and warrants further study.     

From the Couch to the Street: Applications of Psychoanalysis to Work with Individuals Who Are Homeless and Mentally Ill

Current-day psychiatric treatment of severely disturbed populations tends to focus on the biological, behavioral, and social dimensions of rehabilitation. This paper addresses the relative neglect of the complex psychodynamic and interpersonal aspects of treatment of individuals who are homeless and mentally ill by presenting two clinical cases that are discussed from various psychoanalytic frames of reference. Based on their clinical experiences, the authors conclude that psychoanalysis offers valuable frameworks to guide the treatment process and the structure of the treatment setting for individuals who are homeless and suffering from severe psychiatric illness.     

Consumer Perspectives of Participation in Vocational Programs by Individuals With Serious Mental Illness: Two Phenomenological Studies

Engagement in worker roles presents significant challenges for individuals with serious mental illnesses. Evolution of vocational rehabilitation programs has yielded evidence-based support for supported employment models. This research presents a phenomenological study of consumer viewpoints concerning participation in earlier vocational rehabilitation programs, followed by a study of supported employment participation perspectives. Initial study themes of Chaos: Living with Disruptions, Mixed Blessings: Vocational Rehabilitation Program, Feelings of Discrepancy, and Searching for Order were reinforced by follow-up study themes of Positive Feelings of Worker Satisfaction and Managing Self/Illness. Consumers identified success in employment outcomes, if able to balance illness and work demands.     

Visual Feedback in Written Imaginal Exposure for Posttraumatic Stress: A Preliminary Study

This study investigated the visual feedback hypothesis, which states that visual feedback from written trauma narratives contributes to the efficacy of written imaginal exposure for posttraumatic stress via the reuptake of traumatic content during production of the narrative. We tested a college sample (n = 61) with clinically elevated posttraumatic stress as measured with the Impact of Events Scale. Participants were randomly assigned to a writing with visual feedback condition, a writing without visual feedback condition, or a control condition. The hypothesis was not supported: Writing with and without visual feedback equally reduced intrusion and avoidance symptoms. Exploratory analyses, however, showed increased intrusion symptoms immediately after writing with visual feedback, which was in contrast with decreased symptom levels in the other conditions. These findings are in line with previous findings regarding immediate symptom development following writing interventions for posttraumatic stress and call for further exploration of the visual feedback hypothesis.     

A Reply to the Commentaries of Drs DiBenedetto and Pakenham

This commentary addresses some of the cogent responses offered by Drs. DiBenedetto and Pakenham and the idea of an alternative approach to addressing the self‐care needs of our profession.     

Consumer Preference Programs for Individuals Who Are Homeless and Have Psychiatric Disabilities: A Drop-In Center and a Supported Housing Program

We illustrate Fairweather's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse. Literally homeless participants were randomly assigned to programs that emphasized consumer choice or to the usual continuum of care, in which housing and services are contingent on sobriety and progress in treatment. A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness, but after 24 months only 38% of participants had moved to community housing. A subsequent apartment program, in which individuals in the experimental condition moved to subsidized apartments directly from the street, with services under their control, had 79% in stable housing (compared to 27% in the control group) at the end of 6 months. Groups in this study did not differ on substance abuse or psychosocial outcomes.     

Caregivers's Stress Secondary to Raising Young Children with HIV Infection: A Preliminary Investigation

This study examined the impact of caring for a child with HIV infection on biological mothers (also infected with HIV), familial caregivers, and foster mothers. Levels of reported parenting stress, emotional functioning, the impact of the child's illness, and coping strategies utilized were compared. Participants were 35 female caregivers of young children (birth to 5 years) with HIV infection. Demographic variables reflected group differences: biological mothers were younger, foster mothers had greater monthly income, and children who were living with relatives were older. Group differences were noted with regards to parent related stress, anxiety, and depression with foster mothers reporting lower levels. The types of coping strategies utilized were generally similar across groups. Results suggest that young, biological caregivers of children with HIV infection may benefit from careful assessment with regard to their need for psychological intervention.     

Job Stress and Dyadic Synchrony in Police Marriages: A Preliminary Investigation

Despite reports documenting adverse effects of stress on police marriages, few empirical studies focus on actual emotional behaviors of officers and spouses. In this preliminary investigation, 17 male police officers and their nonpolice wives completed daily stress diaries for 1 week and then participated in a laboratory‐based discussion about their respective days. Conversations were video‐recorded and coded for specific emotional behaviors reflecting hostility and affection, which are strong predictors of marital outcomes. We examined associations between officers' job stress (per diaries and the Police Stress Survey) and couples' emotional behavior (mean levels and behavioral synchrony) using a dyadic repeated measures design capitalizing on the large number of observations available for each couple (1020 observations). When officers reported more job stress, they showed less hostility, less synchrony with their wives' hostility, and more synchrony with their wives' affection; their wives showed greater synchrony with officers' hostility and less synchrony with officers' affection. Therefore, for officers, greater job stress was associated with less behavioral negativity, potentially less attunement to wives' negativity, but potentially greater attunement to wives' affection—perhaps a compensatory strategy or attempt to buffer their marriage from stress. These attempts may be less effective, however, if, as our synchrony findings may suggest, wives are focusing on officers' hostility rather than affection. Although it will be important to replicate these results given the small sample, our findings reveal that patterns of behavioral synchrony may be a key means to better understand how job stress exacts a toll on police marriages.     

Stress in Doctors: A Pilot Study of the University Teaching Hospital,Lusaka, Zambia

This study had the objective of explored the stressful aspects of a doctor's job at the University Teaching Hospital (UTH) in Lusaka, Zambia. Stress can have a serious effect on the work output of a doctor and on their physical and mental health. The data were collected from 41 doctors at UTH using the Perceived Stress Scale and a stress check list. The results revealed that out of the list of 14 possible stressors, Zambian doctors in this sample identified an average of 7.3 aspects of their job (SD=2.7) as being stressful. Lack of resources to carry out their job, the workload, the low level of reward and the long working hours were most frequently identified as stressors.     

Highlighting the Way Forward: A Review of Community Mental Health Research and Practice Published in AJCP and JCP

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid‐1980s to mid‐2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re‐engaging with community mental health and fostering well‐being, inclusion, and liberation of adults experiencing serious mental health challenges.     

The role of primary prevention in mental health services: A review and critique

Community psychology in the West has had a growing impact on mental health service provision. One facet of this development has been the advocacy of an increased focus on the primary prevention of mental illness. This paper reviews both theoretical and practical work in this area in order to assess the current role and relevance of primary preventive interventions. There is a discussion of primary prevention's historical and theoretical contexts, of its conceptualisations and definitions, of criticisms of its relevance and efficacy, and of examples of its practice. It is argued that primary prevention is inappropriately marginalised in current service provision and that there is a need to engage in the long-term planning and evaluation of primary preventive interventions in order to facilitate their fuller incorporation into national and local policies on mental health.     

Assessing Stress in Families of Children with ADHD: Preliminary Development of the Disruptive Behavior Stress Inventory (DBSI)

This paper describes the initial development of the Disruptive Behavior Stress Inventory (DBSI). This 40-item measure, which provides indices of the number of stressors experienced during the past 6 months and the rated stressfulness of these events, is designed to assess behavior-related family stress experienced by families of children with attention-deficit/hyperactivity disorder (ADHD). Findings provide strong support for the internal consistency of the DBSI and suggest adequate test-retest reliability. Support for the validity of the measure is suggested by findings that DBSI stress indices differentiate between parents of children with ADHD and those with no history of this disorder. Additional support is provided by findings that scores on the DBSI also differentiate between parents of children with ADHD, combined type and parents of children with ADHD, inattentive type. It is suggested that this measure may provide useful clinical information regarding stress levels in families of children with ADHD and that it may be of potential value as an ADHD treatment outcome measure.     

The Association Between Cardiovascular Stress Responsivity and Perceived Stress Among Subjects with Irritable Bowel Syndrome and Temporomandibular Joint Disorder: A Preliminary Analysis

This study sought to evaluate the association between perceived and cardiovascular stress responsivity among subjects with Irritable Bowel Syndrome (IBS) and Temporomandibular Disorder (TMJ). Eight participants with IBS, eight participants with TMJ and 16 nonsymptomatic comparison participants took part in the experiment. Participants completed a series of personality and mood questionnaires as well as a laboratory procedure measuring aerobic fitness, cardiovascular responses (i.e., pulse rate and blood pressure), and perceived stress while performing stressful laboratory tasks (i.e., the Stroop Color Naming Test and a speech task). Although IBS and TMJ participants did not vary significantly from comparison participants in blood pressure or heart rate during the laboratory procedures, IBS and TMJ participants reported experiencing the laboratory tasks as more stressful than comparison participants. Although preliminary due to the small sample size, results suggest that IBS and TMJ sufferers may be more sensitive to perceived stress than others.     

Imagined contact and mental illness stigma in an Asian context: Bolstering the effect and examining the impact of factual information

Imagined contact can be effective at reducing social stigma. However, the effect may depend on the strength of the stigma held. We tested the robustness of imagined contact in an Asian setting where stigmatization of mental illness is stronger than in Western countries. In Experiment 1 (n = 167) with five conditions, only an enhanced version of positive imagined contact was able to decrease stigma towards people with schizophrenia through decreasing intergroup anxiety. Given the potential discrepancy between imaginations and reality about experiences with stigmatized groups, in Experiment 2 (n = 121), we tested the hypothesis that after presenting participants with factual information about a mental illness group, imagined contact might backfire, resulting in more negative perceptions. However, enhanced imagined contact alongside factual message about schizophrenia did not increase stigma. The backfiring hypothesis was therefore not supported. Nevertheless, providing realistic information did negate the positive effects of enhanced imagined contact on stigma reduction. In both experiments, we also showed that intergroup anxiety mediated the effect of enhanced imagined contact on various measures of stigma.     

Cognitive-Behavioral and Systematic Desensitization Procedures in Reducing Stress and Anger in Caregivers for the Disabled

Twenty-six highly stressed family and community caregivers for people with a disability completed scales designed to assess perceived stress, state anger, and trait anger. They were randomly divided into three groups. Subjects in one group underwent stress-reduction training in a self-instructional procedure, subjects in the second group underwent stress-reduction training in systematic desensitization, and subjects in the third group were placed in a wait-list condition. Results showed that state anger and trait anger were correlated with perceived stress at pretreatment, and state anger was correlated with perceived stress at posttreatment and follow-up. Subjects in both the self-instructional and systematic desensitization groups showed a reduction in perceived stress. Subjects in the self-instructional training group also showed a decrease in trait anger. The wait-list group showed no significant change in perceived stress and anger.     

The Tao of a peaceful mind: the representation of emotional health and healing in traditional Chinese literature

This paper explores the representation of emotional health and healing in traditional Chinese literature, and the holistic relationship between traditional Chinese mental medicine and literature as well as philosophy. The philosophical, moral and aesthetic significance assigned to emotional health and healing not only inspired but also mandated the representation of these subjects in Chinese literature. For many Chinese readers, emotional health is more than a medical concern but is integral to their moral and spiritual wholesomeness, the attainment of which necessarily involves the edifying role of literature. The literary representation of emotional health and healing gave rise to a subculture of emotional health and a medical dilettantism in Chinese society. The mutual inclusivity of the professional and the amateurish is peculiar to traditional Chinese mental medicine. While facilitating popular appreciation of emotional health and helping to validate the legitimacy and efficacy of emotional healing, such a phenomenon also caused a certain degree of charlatanization that undercut the rationality and validity of mental medicine. An investigation into the relationship between traditional Chinese literature and mental medicine provides an interdisciplinary perspective from which to examine the latter's history, theory, and practice, thus shedding a cross-cultural light on modern psychology and psychiatry.     

Stress and depression of facing death: Investigation of psychological symptoms in patients with mesothelioma

Cancer often results in psychological impairment, and lung cancer has been associated with greater morbidity and higher levels of psychological distress than any other form. Chronic exposure to asbestos is a significant risk factor for development of lung cancer, called mesothelioma. Few have studied the psychological consequences of chronic asbestos exposure and mesothelioma. This study investigated stress and depression symptoms in 49 men (M = 51.1 years, SD = 6.0) diagnosed with mesothelioma. Participants completed traumatic stress, depression and general psychological health questionnaires. All participants reported significant levels of traumatic stress symptoms, which was associated with increased symptoms of depression, anxiety, somatic complaints and social dysfunction. The results provide important suggestions for clinicians treating such terminally ill patients.