Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

Autonomy for nursing home residents: the role of regulations

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.     

Depression: Psychological Referrals in Nursing Homes

Studies in nursing homes have consistently shown the presence of mental health disorders. We assessed 300 nursing home residents (referred for psychological testing) to provide preliminary data on referral patterns, assess the cognitive and affective patterns of residents with different diagnoses, and present psychometric data on depression measures, including the Beck Depression Scale (BDI) (as a bivariate index) and the Mood Scale (a shortened version of the Geriatric Depression Scale). Results show that the referrals involved a compromised group of residents, both cognitively and affectively. Despite obvious mean differences, a MANOVA revealed that Major Depressive Disorder did not differ significantly from the Adjustment Disorder and Dementia groups on the bivariate BDI and Mood Scale; the dementia group was lower than the depression and adjustment groups on the MMSE. Patterns on depression inventories also identified a correct classification score of 4 on the BDI (89%) and 3 on the Mood Scale (79%). Discussion endorsed use of the bivariate BDI and addressed depression in these facilities.     

DEPRESSION IN WOMEN AS RELATED TO ANGER AND MUTUALITY IN RELATIONSHIPS

Self-in-relation theory (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991) proposes that a lack of mutuality in women's relationships predisposes them to depression and inhibits their ability to acknowledge and address effectively emotions such as anger. Research linking anger to depression has not examined women's emotional expressivity within the context of their partner relationships. Women's depression as a function of both their level of anger suppression or inappropriate anger expression and the level of perceived relationship mutuality was studied in a sample of 223 college women, aged 18 to 54. Lower levels of mutuality and higher levels of suppressed or inappropriately expressed anger were associated with depression. Moreover, mutuality made contributions to predicting depression beyond that explained by anger. Lower mutuality was also related to higher anger suppression, but unrelated to inappropriately expressed anger.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

MATERNITY LEAVE, ROLE QUALITY, WORK INVOLVEMENT, AND MENTAL HEALTH ONE YEAR AFTER DELIVERY

Employment status, maternity leave, and role quality were investigated as predictors of women's mental health one year after delivery. Homemakers and part-time and full-time employees did not differ on measures of depression, anxiety, anger, or self-esteem. There were no main effects of leave length. Distress was associated with job overload, role restriction, and infant distress. Leave length interacted with the relative salience of work and family, and employment status interacted with employment preference to predict distress. Depression was greatest among women relatively high in work salience when leaves were long. Anxiety and anger were greatest among women whose employment status was not congruent with their preferences. These interactions underscore the importance of individual differences in responses to leave and work.     

A Survey Report of Nursing Home Ministry and Perceived Needs with Implications for Pastoral Care

ABSTRACT

The last 40 years of growth in the development of pastoral care to the sick appears to have virtually bypassed persons in nursing homes. A study within 13 nursing homes in one city revealed that spiritual ministry within those institutions was generally limited to a series of 9 to 13 worship services per month, attended by approximately 20 percent of the patients/residents. Some patients receive an occasional personal visit by a pastor. The staff perceive that pastoral ministry as good, but inadequate, and expressed their views on that which is needed within their institutions and challenge the clergy with specific suggestions for pastoral care for nursing home patients/residents, their families, and staff.     

Sex differences in relationships among anger, depression, and coping strategies of Japanese students

This study investigated sex differences in the relationships among an ger, depression, and coping strategies. Undergraduate students, 77 men and 130 women, 3 not identified by sex, voluntarily participated. Participants made ratings on a self-report about anger, depression, coping strategies, and mental health. Analyses showed that women who reported themselves as angry tended to cope with stress by optimistic and active strategies, while women who reported themselves as depressed tended to cope with stress by withdrawn and passive strategies. Men who reported being depressed tended to select emotion-focused cognitive coping, while men who reported being angry selected no specific coping. Adoption of engaged emotion focused coping strategies were related to mental health only for women.     

Developing a screening instrument and at-risk profile for nonsuicidal self-injurious behavior in college women and men

Archival data (N = 1,048 women, 1,136 men) from a mental health survey of college students were used to investigate incidence of nonsuicidal self-injury (NSSI), including cutting. Significant levels (defined as 4-5 lifetime incidents) were found in 9.3% of women and 5.3% of men. The Counseling Center Assessment for Psychological Symptoms (a global symptom inventory) and an assessment of trauma had been field tested with this sample. We randomly partitioned half of these data into a holdout sample and used the remainder to develop an NSSI screening inventory that included (a) 5 women's screening items, including 1 item to assess trauma experienced; (b) 11 men's screening items; and (c) 12 items common to men and women, including depression, dissociation, anger, unwanted thoughts, nightmares or flashbacks, and having witnessed trauma. Logistic regression and receiver-operating characteristic curve analysis suggested the inventory significantly discriminated NSSI men and women in the holdout sample, p < .001. Cutoff scores were identified to correctly classify about 48% of the true positive male and female NSSI cases, with false positive rates of 13.2% and 8.4% for women and men, respectively.     

A Model of Sexually and Physically Victimized Women’s Process of Attaining Effective Formal Help over Time: The Role of Social Location, Context, and Intervention

As empirical evidence has demonstrated the pervasiveness of sexual assault and intimate partner violence in the lives of women, and the links to poor mental health outcomes, attention has turned to examining how women seek and access formal help. We present a conceptual model that addresses prior limitations and makes three key contributions: It foregrounds the influence of social location and multiple contextual factors; emphasizes the importance of the attainment of effective formal help that meets women's needs and leads to positive mental health outcomes; and highlights the role of interventions in facilitating help attainment. We conclude with research and practice implications.     

Interpersonal Negotiation Strategies in a Sample of Older Women

Suppressed anger resulting from poorly resolved interpersonal conflicts can increase morbidity. The current generation of older women may be particularly susceptible to morbidity caused by anger inhibition due to socialization to be submissive in interpersonal conflicts. For purposes of disease prevention, we asked 35 older women to describe an interpersonal conflict experienced recently, and how they responded to it. Data coding was based on Selman's model of interpersonal negotiation strategies, which has been used to assess the conflicts of children, adolescents, and young adults, but not older adults. We found that many participants used strategies in which they expressed their point of view in order to persuade the other person. Of those who were expressive, however, many ended up submitting to the other person's demands nonetheless. Thus, overall, most participants used submissive strategies. Conflicts with strangers and acquaintances were frequently reported, and reports included comments about feeling vulnerable. Stereotypic beliefs about age and health also emerged in reports, and seemed related to submissive responses. Our findings suggest that older women would benefit from training in constructive strategies for resolving interpersonal conflicts. Training efforts should reflect the ways in which stereotypic beliefs about age, health, and vulnerability may interfere with constructive strategy choice, and should emphasize the health benefits of constructively dealing with conflict.     

Cardiovascular health in women: the role of anger and its expression

The relationships between anger expression (in, out, and control) and cardiovascular health (emotional distress, cardiovascular symptoms reported, and preventive health behaviors) were analyzed in 327 women (range 17-60 years). The same criteria (N= 218), as well as blood pressure (BP) registered in medical checkups (N= 90) were recorded one year later. Four groups according to anger-in and anger-control scores, going from the most hostile (high anger-in and low anger-control) to the least hostile (low anger-in and high anger-control) were considered. The results indicated that the most hostile group, with the least adaptive anger expression, presented worst cardiovascular health than the other three groups, at both temporal moments. Furthermore, the presence of women with pathological BP levels was higher in the groups of high anger-in. These data ratify the role of anger expression, especially its repression (anger-in) and the lack of adequate canalization or control in women's cardiovascular health from a prospective design. Appropriate management of anger feelings and the practice of preventive health behaviors can protect women from cardiovascular problems.     

Beyond bruises and broken bones: the joint effects of stress and injuries on battered women's health

We investigated the joint mediating effects of injuries and stress on the relationship between abuse and women's health. A community sample of 397 women, half of whom had been assaulted by an intimate partner within the prior 6 months, was interviewed about their experience of intimate partner violence, injuries, stress, income, depression, and physical health problems. Structural equation modeling techniques confirmed the complex model of hypothesized indirect effects of abuse on women's physical health problems through injuries, stress, and depression. Stress accounted for 80% of the indirect effect of abuse on women's physical health. Its direct effect on physical health was somewhat larger than its indirect effect through depression, but both processes played a key role in determining the effect of abuse on women's physical health problems. Furthermore, abuse was a stronger predictor of women's stress than was poverty. Implication and future research are discussed.     

Anger, Spiritual Meaning and Support from the Religious Community in Dementia Caregiving

This study explores the relationships between spiritual meaning and social support from the religious community and problem behaviors, anger and depression in 128 dementia caregivers. The results suggest a mediating role of anger in the relationship between the appraisal of problem behaviors and depression. Support from the religious community is directly and negatively associated with anger, but the relationship between spiritual meaning and anger is mediated by caregivers’ appraisals of problem behaviors, suggesting that spiritual beliefs might help caregivers to find meaning in caregiving experiences and thus appraise care recipients’ behavioral problems as less stressful.     

The Impact of Neighborhood Factors on the Well-Being of Survivors of Intimate Partner Violence Over Time

Intimate partner violence (IPV) is a pervasive social problem impacting the psychological well-being of millions of US women annually. The extant literature draws our attention to the devastating mental health effects of IPV, but largely overlooks how ecological factors may further explain survivors' well-being. This study examined how neighborhood disadvantage may contribute to survivors' compromised well-being, in addition to the abuse women experienced. Neighborhood disorder and fear of victimization significantly impacted survivors' well-being, over and above abuse. Although between-women effects of neighborhood disorder and fear were unrelated to change in women's depression or quality of life (QOL), significant within-woman effects were detected. Change in neighborhood disorder was negatively associated with change in QOL, and this relationship was fully mediated by fear. While no direct relationship between change in neighborhood disorder and depression was detected, an indirect effect through survivors' fear was revealed. Implications for future research and practice are discussed.     

A randomized motivational enhancement prevention group reduces drinking and alcohol consequences in first-year college women.

Alcohol consumption among college students has become an increasing problem that requires attention from college administrators, staff, and researchers. Despite the physiological differences between men and women, college women are drinking at increasingly risky rates, placing them at increased risk for negative consequences. The current study tested a group motivational enhancement approach to the prevention of heavy drinking among 1st-year college women. Using a randomized design, the authors assigned participants either to a group that received a single-session motivational enhancement intervention to reduce risky drinking that focused partly on women's specific reasons for drinking (n = 126) or to an assessment-only control group (n = 94). Results indicated that, relative to the control group participants, intervention participants drank fewer drinks per week, drank fewer drinks at peak consumption events, and had fewer alcohol-related consequences over a 10-week follow-up. Further, the intervention, which targeted women's reasons for drinking, was more effective in reducing consumption for participants with high social and enhancement motivations for drinking.     

Anger After Childbirth: An Overlooked Reaction To Postpartum Stressors

Other than postpartum depression, little is known about women's emotional responses to childbirth and subsequent stressors. Anger was explored on the basis of theory and evidence that it is a likely emotional response in this context. During their third trimester of pregnancy and approximately six weeks after delivery, 163 participants completed the Beck Depression Inventory and the anger subset of the Affect Balance Scale. A number of childbirth–relevant variables were examined as predictors of postpartum emotional response, controlling for prepartum levels and for the association between anger and depressed mood. As expected, a substantial group of women reported high levels of anger irrespective of depressed mood. Although the majority of variables predicted depressed mood, childcare stress, age, and religious self–identification were independently predictive of postpartum anger (all p values > .05). Implications for research and clinical intervention are discussed.     

“It Depends on What You Mean by Starting”: An Exploration of How Women Define Initiation of Aggression and Their Motives for Behaving Aggressively

This study explored women's use of aggression, focusing on how they define initiation of aggression and what motives they have for behaving aggressively. Twenty-five women who had used aggression during conflicts with their romantic partners were interviewed. Results indicated that, while the women reported initiating aggression in the majority of conflicts described (54%), they varied in how they defined initiation, with some believing that initiating aggression meant being angry, bringing up the conflict issue, or persistently asking the partner to engage verbally. Twelve categories of motives for the use of aggression were also identified. Theoretical and practical implications are discussed, highlighting the ongoing need for an ecological perspective when studying women's use of aggression.     

Beyond the Individual: Promoting Mental and Behavioural Health in Low- and Middle-income Countries

This brief report describes a programmatic approach to health promotion that can help address the social determinants of mental-health and associated risky behaviours. Using a South African case example, we illustrate that while micro-system interventions help to strengthen individual resilience and immediate proximal protective influences, group system interventions can assist to promote health enhancing social identities and representations. We conclude that multi-level interventions that assume a systemic focus can strengthen community transformative efforts to address social determinants of mental and behavioural health.