Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults

The current and lifetime comorbidity of depressive (i.e., major depressive disorder and dysthymia) with other common mental disorders was examined in community samples of older adolescents (n = 1,710) and adults (n = 2,060). Current and lifetime histories of depression in the adolescents were highly comorbid with several other mental disorders. The adults had a lower but statistically significant degree of comorbidity, primarily with substance use disorder. Depression in both groups was more likely to occur after the other disorder rather than to precede it. Comorbidity did not affect the duration or severity of depression. Comorbidity in the adolescents was associated with greater frequency of suicidal behavior and treatment seeking. The findings suggest that early-onset depression is associated with a greater degree of comorbidity and may represent a more serious form of the disorder.     

The biopsychosocial approach to chronic pain: scientific advances and future directions

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.     

Community perceptions of mental disorders: a Greek perspective

The present cross‐sectional study examines the perceptions of residents of a rural community in Greece pertaining to the interpretation, explanation, treatment and prognosis of various psychological problems. In all, 100 community residents took part. A series of vignettes in combination with both qualitative and quantitative data collection procedures was employed. The findings indicate a variation in the endorsement of interpretations and causal attributions as a function of the type of symptomatology presented. The overt psychotic cases of schizophrenia were more likely to be understood within a genetic explanatory framework while the less overt symptoms of mental disorders were perceived as being indicative of emotional problems triggered by personality and social environmental factors. A preference for psychological methods of treatment was expressed. Copyright © 2006 John Wiley & Sons, Ltd.     

Teaching the biopsychosocial perspective: a comparison of two approaches

Two approaches to teaching the biopsychosocial approach were compared. Four outcome measures from 55 patients and 11 resident physicians support a skill-based consultative approach as a more effective teaching method than a traditional didactic method. Implications of this innovative method for the practice of medicine are briefly discussed.     

Social psychology of mental health: the social structure and personality perspective

Previous research has revealed a persistent association between social structure and mental health. However, most researchers have focused only on the psychological and psychosocial aspects of that relationship. The present paper indicates the need to include the social and structural bases of distress in our theoretical models. Starting from a general social and psychological model, our research considered the role of several social, environmental, and structural variables (social position, social stressors, and social integration), psychological factors (self-esteem), and psychosocial variables (perceived social support). The theoretical model was tested working with a group of Spanish participants (N = 401) that covered a range of social positions. The results obtained using structural equation modeling support our model, showing the relevant role played by psychosocial, psychological and social, and structural factors. Implications for theory and intervention are discussed.     

A biopsychosocial formulation of pain communication

We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.     

Pastoral care for the head-injured: A biopsychosocial/spiritual perspective

This article discusses the pastoral role in the individual and family crisis of a head injury. A case study illustrates the nature and consequences of this widespread but little-understood injury. Physical, emotional, and spiritual consequences of this injury are discussed. Finally, this article describes four pastoral responses to head-injured victims and their families: helping the victim to speak the unspeakable, facilitating prayerful imagination, connecting therapeutic efforts among professionals, and advocating for the family with national and community head injury resources.Private Practice, 1542D Honey Grove Dr., Richmond, VA 23229.     

Informed consent in mental health treatment: A sociological perspective

The rise in the mental health movement coincides with a decline in prestige and importance of criminal law. While this may, in part, reflect the greater effectiveness of mental health treatment in dealing with overlapping problems, it also reflects certain problems that criminal law has with the individualistic values of modern society and the value-attractiveness of the mental health professions' commitment to helping the individual. However, many of the same value problems inherent in criminal punishment also apply to some aspects of mental health treatment, especially the paternalism of the doctor-patient relationship and involuntary treatment. Informed consent can be seen as a response to these value conflicts as well as part of the general extension of citizenship rights to the less privileged members of the society. This paper analyzes some of the conflicts inherent in the application of informed consent to mental health treatment from the above perspective.     

Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England

Although school‐aged children living in foster care have been identified as a high‐risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995 ), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high‐risk group for mental health and developmental disorders. Without age‐appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.     

Rethinking the biopsychosocial model of health: Understanding health as a dynamic system

The biopsychosocial model has dominated research and theory in health psychology. This article expands the biopsychosocial model by applying systems theories proposed by developmental scholars, including Bronfenbrenner's ecological models and Sameroff's transactional model, as well as contemporary philosophical work on dynamic systems. The proposed dynamic biopsychosocial model construes human health as a product of the reciprocal influences of biological, psychological, interpersonal, and macrosystem contextual dynamics that unfold over personal and historical time. The importance, or centrality, of these influences varies within a person over time. The model is explicated using two hypothetical case studies derived from existing interdisciplinary health research. Implications for health, theory, research, and policy are discussed.     

Work-family conflict and employee psychiatric disorders: the National Comorbidity Survey

This study examined the relation between work-family conflict and several types of psychiatric disorders: mood, anxiety, substance dependence, and substance abuse. Survey data were obtained from a representative national sample of 2,700 employed adults who were either married or the parent of a child 18 years old or younger. Hierarchical logistic regression analyses revealed that both work-to-family and family-to-work conflict were positively related to having a mood, anxiety, and substance dependence disorder. Depending on the type of work-family conflict and type of disorder, employees who reported experiencing work-family conflict often were 1.99-29.66 times more likely than were employees who reported no work-family conflict to experience a clinically significant mental health problem. No support was found for gender differences.     

Conceptualising mental health in the United Arab Emirates: the perspective of traditional healers

Substantial investments in health-care have ensured the widespread availability of allopathic medical services across the United Arab Emirates (UAE). However, in spite of this accessibility traditional healers (Mutawa) continue to play a significant, albeit, unofficial role in the UAE's health sector. Citizens routinely consult traditional healers for problems that might, from a western biomedical perspective, be considered psychiatric conditions. This qualitative study explores traditional healers' conceptualisations of mental health problems, discussing their perspectives on phenomenology, aetiology, intervention and outcome. Notably, traditional healers distinguished between biomedical illness and states they attributed to demonological or metaphysical causes. The Islamic spiritual narrative was central to discussions of aetiology, intervention and outcome. Greater integration of traditional healers within the UAE's mental health-care services would, in many cases, improve patient experience and outcomes.     

社会网络视角下的同伴关系与心理健康

近年来, 从社会网络视角考察同伴关系与心理健康的相互作用正成为发展心理学和健康心理学研究的热点。研究者多借助整体网和纵向数据, 通过两种作用机制, 即选择过程(selection process) (强调心理和行为变量对社会网络和同伴关系的影响, 如关系的形成、维持和解除)和影响过程(influence process) (强调社会网络和同伴关系对心理和行为变量的影响), 来分析同伴关系与心理健康协同演进的动态过程。实证研究关注的领域集中在青少年健康风险行为(如吸烟、喝酒、药物滥用)和情绪问题(如抑郁、焦虑、孤独感)。未来研究应该注重拓展社会网络的类型和样本、加强理论建构、增加对积极心理和消极关系的研究, 并有望在互联网领域及社会网络的生物学基础等方面取得进展。     

Infant day care: A social and psychological perspective on mental health implications

A review of infant group daycare programs abroad and in the USA leads to the conclusion that the degree of industrial and technological development is a major determinant of infant daycare practices. In the USA a culture gap exists between the middle class providers and the predominantly poor and non-caucasion recipients of the service. Difficulties in implementing programs, especially in transmitting child development information to parents stem from these basically different orientations. Some suggestions are made that may lead to more effective communication and collaboration between families using daycare personnel.     

Cultural competence and evidence-based practice in mental health services: a complementary perspective

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed.     

Psychological aspects of multiple sclerosis and its treatment: toward a biopsychosocial perspective

Multiple sclerosis (MS) is a chronic, progressive neurological disease that produces demyelination of the CNS nerve fibers. With onset most often in young adulthood, the disease produces a variety of neurological symptoms and follows an unpredictable course characterized by exacerbations and remissions. This article reviews the literature on psychological aspects of MS including early psychoanalytic studies and more current psychosocial research. Literature on the relationship between stress and symptoms, and the extent of cognitive impairment experienced is reviewed. A view of psychosocial adjustment to MS based upon an adaptive coping model, and a psychological treatment approach suited to the special needs of individuals with MS are discussed. Finally, a biopsychosocial research model is recommended due to the complex, interactive nature of MS and unique research difficulties it presents.     

Marital dissatisfaction and psychiatric disorders: results from the National Comorbidity Survey

The association between marital dissatisfaction and 12-month prevalence rates of Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., 1987) Axis I psychiatric disorders was examined in married respondents from the National Comorbidity Survey (N = 2,538). Results indicate that marital dissatisfaction was associated with the presence of any disorder, any mood disorder, any anxiety disorder, and any substance-use disorder; dissatisfaction was also associated with 7 of 12 specific disorders for women and 3 of 13 specific disorders for men. To evaluate the unique association between marital dissatisfaction and psychiatric disorders, analyses were conducted controlling for comorbid disorders. Covariance analyses generally attenuated the bivariate associations between marital dissatisfaction and specific disorders and groupings of disorders. Results indicate that marital dissatisfaction was uniquely related to major depression and posttraumatic stress disorder for women and dysthymia for men.