Personality Dysfunction and the Management of Chronic Medical Illness: A Community Health Sample

The purpose of this study was to determine the influence of personality disorders on perceived health status, self-efficacy for management of the chronic illness, and physician perception of patient health. A total of 607 patients with self-identified chronicillness(es) volunteered to participate in the study. Out of this sample, 147 had collaborative physician data indicating a chronic illness. The final sample was 143 due to incomplete data. Results suggested that maladaptive personality characteristics, as measured by the Short-Form of the Coolidge Axis II Inventory (SCATI), were related to a number of important factors that influence self-management of chronic illnesses. When the personality constellations were broken into 3 groups (normal, subclinical, and clinical) significant differences were found on the 3 groups of dependent variables (Subjective Health, Self-Efficacy, Physician Appraisal) for the different personality disorders. These data provide useful information on several factors that influence effective disease management. Clinical implications and directions for future research are provided.     

Profiles of Chronic Illness Knowledge in a Community Sample of American Adults

The author identified profiles of chronic illness knowledge (i.e., heart disease, cancer, diabetes) in a community sample of American adults and examined the effect of sociodemographic influences on relations of illness knowledge to health practices and well-being. Participants were 181 women and 120 men who completed measures of illness knowledge, sociodemographics, personal health practices (e.g., diet, exercise, substance abuse, adaptive healthcare use), well-being (e.g., self-rated physical health, depression, social support), and perceived illness risk. Two-step cluster analyses performed on random subsets of the sample identified three levels of illness knowledge: low, medium, and high. Knowledge groups were differentiated on most measures of health practices, well-being and perceived illness risk. However, effects were substantially attenuated after controlling for differences in age and SES. Findings indicate that age and other sociodemographic factors are related not only to levels of illness knowledge but also to the application of knowledge in relation to health practices and well-being.     

Spontaneous Reports of Religious Coping by Patients with Chronic Physical Illness

Individuals undergoing the stress of physical illness often report the use of religious coping activities. This study compared the frequency of spontaneous reports of religious coping in three groups of patients including those with cancer preparing for a bone marrow transplant (n = 22), chronic pain (n = 36), and cardiovascular disease (n = 53). Participants were asked to respond to a written, open-ended question asking how they were coping with the challenges involved in their medical condition. The question asked them to list the resources, strategies, strengths, or behaviors that they found most helpful. No mention of religion or religious coping was included with the question. Of the 111 participants surveyed, 26.1% included religious coping in their responses. The relative percentage of religious coping was calculated by dividing the total number of coping responses by number of religious responses. Mean percentage of religious coping was highest in participants preparing for a bone marrow transplant (22.9%), followed by the cardiac group (5.7%), and the chronic pain group (3.8%).     

Camping Programs for Children with Chronic Illness as a Modality for Recreation, Treatment, and Evaluation: An Example of a Mission-Based Program Evaluation of a Diabetes Camp

Summer camps have been recognized as a valuable means of delivering services to children with chronic illnesses. Although these camps exist in abundance across the United States, they have been largely underrepresented in the clinical psychology literature. Particularly, there is a staggering discrepancy between the number of camps in existence and the number of published articles pertaining to the systematic evaluation of these camps. We outline the potential benefits of camping programs for children who are chronically ill, describe the importance of systematically evaluating them, and provide a model for this evaluative process. We describe an evaluation of a diabetes summer camp and present implications of this study for camp decision makers and clinical psychologists working in pediatric medical settings.     

Service User Perception of and Satisfaction with Programs Having Higher Education and Employment Goals for People Diagnosed with Mental Illness

This study examined quantitative and qualitative outcomes of service users’ perceptions of and satisfaction with a program having higher education and employment goals. In a one-group post-test design, 48 participants with various mental health diagnoses completed a quantitative questionnaire and 29 of those participated in qualitative focus groups. Participants identified positive and negative aspects of the program and provided recommendations for change. Results indicated that service users with higher education and employment goals benefit from a multi-faceted program that includes person-centered individualized care, concrete, goal-directed activities, practitioners who are compassionate and knowledgeable, and plans addressing setbacks and obstacles.     

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.     

Housing for People with Serious Mental Illness: A Comparison of Values and Research

This article contrasts values associated with the delivery of housing programs for people with serious mental illness with the typical topics pertaining to housing that are studied by researchers. Six values were identified through a search and content analysis of the literature on housing for people with serious mental illness. A second review of the literature was conducted to identify research on housing for this population. A comparison of findings from the two reviews suggested that whereas values concerned with the therapeutic benefits of housing had received considerable research attention, those concerned with a citizenship dimension had received relatively little. The findings are discussed in terms of their implications for the delivery of housing services and for housing research.     

Stigma by Association Among Family Members of People with a Mental Illness: A Qualitative Analysis

People with mental illness are not the sole recipients of stigmatisation; their immediate family members may be subjected to stigma by association. Through semi‐structured interviews, we investigated experiences of stigma by association among 23 immediate family members of people with mental illness. Participants reported experiencing stigma by association from community members, mental health professionals, and civil servants. Familial relationship, co‐residence, and the gender of participants appeared to play a role in their stigma experiences; parents and spouses reported different manifestations of stigma by association than siblings and children, participants who lived together with their family member with mental illness reported increased experiences of stigma by association, and in contrast to male participants, female participants reported others thinking they are overprotective and as such perpetuated, maintained, or sustained their family members' mental illness. The relevance of these factors points to the need for tailored education and emotional support provision to family members of people with mental illness. Moreover, in‐service training for mental health professionals should include the development of relevant social skills that enable the recognition of familial relationships and roles, and family members' fears, concerns, and problems. Copyright © 2014 John Wiley & Sons, Ltd.     

Trauma‐Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma‐informed. While community mental health and other human services settings are moving toward trauma‐informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle‐driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second‐order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.     

A Review of Self-Management Interventions Targeting Academic Outcomes for Students with Emotional and Behavioral Disorders

The purpose of this review was to report on the effectiveness and focus of academic self-management interventions for children and adolescents with emotional and behavioral disorders. Twenty-two studies published in 20 articles and involving 78 participants met inclusionary criteria. The overall mean effect size (ES) across those studies was 1.80 (range –0.46 to 3.00), indicating effects were generally large in magnitude and educationally meaningful. Self-monitoring interventions were the predominant type of self-management technique used by researchers. The mean ES for intervention types were self-evaluation (1.13), self-monitoring (1.90), strategy instruction techniques (1.75), self-instruction techniques (2.71), and multiple-component interventions (2.11). Interventions targeted improvement in math calculation skills more than any other area. The mean ES by academic area were math interventions (1.97), writing (1.13), reading (2.28), and social studies (2.66). There was evidence to support a claim of the generalization and maintenance of findings. Implications, limitations, and areas for future research are discussed.     

Qualitative analysis of feedback on functional imagery training: A novel motivational intervention for type 2 diabetes

Objective: Effective motivational support is needed in chronic disease management. This study was undertaken to improve a novel type 2 diabetes motivational intervention, (functional imagery training, FIT) based on participant feedback and results from a self-management randomised controlled trial.

Design: Qualitative inductive thematic analysis of semi-structured interviews.

Main outcome measures: Open-ended questions on participant experiences of the FIT intervention content, process, most/least helpful features, suggestions for improvement and general feedback.

Results: Eight themes emerged. Participants thought FIT promoted autonomy and self-awareness. They found the intervention interesting and helpful in keeping their health on track through accountability provided by regular phone calls. However, boredom with repetitive use of imagery, feeling inadequately equipped to manage unhealthy cravings, and difficulty with the time commitment was reported by some. Supplementary written material was recommended.

Conclusion: Several well-received features of FIT overlapped with those from traditional motivational interviewing. FIT sessions should ensure content is regularly adapted to new health-enhancing goals. After self-management behaviour becomes habitual, imagery practice could be restricted to challenging contexts. Provision of a written rationale and use of mindfulness for cravings is recommended. With these improvements, the impact of FIT on diabetic control may be substantially enhanced.     

The Future of Psychology in Medicaid's Health Delivery System for People with Disabilities

State Medicaid programs are rapidly converting fee-for-service health delivery systems to managed care for people with disabilities. In theory, managed care models of health delivery will substantially improve the quality of care for people with disabilities, but in reality, few successful models exist. This period of transition holds both opportunities and challenges for psychologists in medical settings. Because Medicaid reforms for people with disabilities may herald similar reforms for both the public and the private sectors, psychology's response will determine its role in the future of health care delivery for this population. Changes in training and increased attention to outcomes research, innovations in practice, and advocacy will be the keys to success.     

精神疾病患者遭受社会歧视的现状及其原因与对策分析

社会对精神疾病患者的歧视由来已久,这种歧视广泛存在于不同的阶层与民族当中,且各有其特点。其对精神病患者及其家属带来的负面影响是显而易见而且是深刻的,这种影响涉及到了患者生活的各个方面。本文对各种歧视的特点及其深层次原因进行了初步分析和探讨,并对如何减少这种歧视进行了探讨。     

Predicting Successful Employment in the Community for People with a History of Chronic Mental Illness

Much work has been done to prepare people with a history of chronic mental illness for vocational placement. Evaluation tools can select some who are likely to be successful in competitive or sheltered work. Many whose psychiatric disability is so severe it interferes seriously with their capacity for work have need for more pre-vocational or vocational skills training. A literature survey shows many programs designed to help this population but little specific outcome data. Other articles state the need for empirical research. With limited funds and a large underserved population, further research is important.     

A Social Ecological Approach to Investigating Relationships Between Housing and Adaptive Functioning for Persons with Serious Mental Illness

This paper seeks to advance mental health—housing research regarding which factors of housing and neighborhood environments are critical for adaptive functioning, health, and recovery for persons with serious mental illness (SMI). Housing and neighborhood environments are particularly important for persons with SMI because of the prevalence of poor housing conditions among this population. Most mental health—housing research has been limited by a focus on problems in environments and functioning. The paper seeks to expand the mental health—housing research agenda to consider protective factors that promote community integration and adaptive functioning. We provide an account of how social ecology theory transformed a research program, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighborhood experiences. The resulting housing environment framework—physical aspects of housing and neighborhoods, social environment of neighborhoods, and interpersonal relationships tied to housing—allows for identification of opportunities for health promotion and facilitation of participation in community-based settings. This program of research draws upon several methods to understand the social experience of persons with SMI living in community settings—survey research, qualitative interviews, Geographic Information Systems, participatory research, and visual ethnography. In this paper, we present how social ecology theory was instrumental in the development of new housing environment measures, the selection of appropriate research methods, and framing research questions that are building a new empirical base of knowledge about promoting adaptive functioning, health, and recovery for persons with SMI living in community settings.     

The dimensional structure of benefit finding in multiple sclerosis and relations with positive and negative adjustment: A longitudinal study

Benefit finding is a meaning making construct that has been shown to be related to adjustment in people with MS and their carers. This study investigated the dimensions, stability and potency of benefit finding in predicting adjustment over a 12 month interval using a newly developed Benefit Finding in Multiple Sclerosis Scale (BFiMSS). Usable data from 388 persons with MS and 232 carers was obtained from questionnaires completed at Time 1 and 12 months later (Time 2). Factor analysis of the BFiMSS revealed seven psychometrically sound factors: Compassion/Empathy, Spiritual Growth, Mindfulness, Family Relations Growth, Lifestyle Gains, Personal Growth, New Opportunities. BFiMSS total and factors showed satisfactory internal and retest reliability coefficients, and convergent, criterion and external validity. Results of regression analyses indicated that the Time 1 BFiMSS factors accounted for significant amounts of variance in each of the Time 2 adjustment outcomes (positive states of mind, positive affect, anxiety, depression) after controlling for Time 1 adjustment, and relevant demographic and illness variables. Findings delineate the dimensional structure of benefit finding in MS, the differential links between benefit finding dimensions and adjustment and the temporal unfolding of benefit finding in chronic illness.     

People who help people: A needs assessment of those who provide interpersonal support to individuals with chronic illnesses

Social support during an ongoing illness has been shown to be beneficial for both the provider and the receiver, but people often struggle with offering effective, appropriate support. There is a lack of communication-focused training not specifically tied to caregiving or training that is designed for all social network members of a person experiencing a chronic illness, which we call interpersonal support providers (ISPs). We conducted a concurrent mixed-methods needs assessment, surveying both ISPs and support receivers, to understand communicative challenges and inform an evidence-based intervention. Analysis of results from an online survey (N_providers = 91, N_receivers = 97), consisting of five open-ended and 15 quantitative items, suggests that ISPs have difficulty managing their worries and emotions while providing comfort to others, which may impact support quality. In addition, ISPs and receivers both identify “listening” as a key skill for ISPs to hone, though ISPs feel they are more skilled at listening than receivers say they are. Lastly, ISPs feel they are good at sharing information and advice, but receivers often perceive it as patronizing or unhelpful. These results will inform the creation of an intervention for everyone offering emotional, esteem, and informational support to individuals with chronic illnesses.     

Living with a Rare Chronic Illness: A Phenomenological,Systemic Examination of Hemophilia Complicated by an Inhibitor

Abstract

Up to 20% of individuals with hemophilia experience the added complication of an inhibitor. An inhibitor results in severe bleeds, joint damage, impaired mobility, and even death. We conducted a focus group with eight individuals affected by inhibitors (three patients and five caregivers). Data were analyzed using the immersion/crystallization method. The following themes emerged: (a) fear and anxiety within the family, (b) social isolation of the patient, (c) unique impacts on caregivers and siblings, and (d) desired changes in treatment. Similar experiences may be common across comparable disorders that are incapacitating, acute, and relapsing in nature.