Embedding prevention services within systems of care: Strengthening the nexus for children

System-of-care models that offer a continuum of integrated mental health services for children are being widely implemented in local communities. Preventive services, arising from the theoretically grounded prevention sciences, are an important but neglected component of this model. Studies of the use of mental health services by children are reviewed, and an integrative model is proposed to incorporate prevention services as a component of the child mental health service system. Construction of the prevention sciences has followed a linear phase model that has advantages and disadvantages for bridging prevention sciences and services research. As prevention science progresses into broader field tests of its effectiveness, studies of child services can be informative, especially in advancing the applicability and dissemination of research findings. Future directions are outlined to strengthen the nexus between services research and prevention science, and to construct a new genre of prevention services research.     

Innovations in the Identification and Referral of Mothers at Risk for Depression: Development of a Peer-to-Peer Model

This paper describes a feasibility study of a peer-delivered prevention intervention to identify mothers at high risk for depression and facilitate engagement in mental health services for their emotional health. Sixteen family peer advocates and their supervisors partnered with academic researchers over a period of 6 months to develop a four-session intervention that focused on identifying symptoms of depression, providing education about depression and treatment, actively linking caregivers to treatment for their own emotional health, and assisting caregivers in becoming active participants in their mental health care. Collaborating with peers to develop the model enhanced its perceived relevance and utility, and resulted in an intervention that was complimentary to their roles and the mission of peer-delivered support services. Peer/professional partnerships may be beneficial for enhancing the feasibility and acceptability of research efforts; the impact of peers’ participation in the current project and the need for future research to develop and study peer-delivered models is discussed.     

Traumatic stress at work: A public health model

The emergence of the 'New Public Health' movement provides a framework for an integrated and co-ordinated policy for responding to traumatic stress in the workplace. A review of the clinical literature on post-traumatic stress reveals that the components of this framework are available: the challenge is to put in place all the various elements. An organisational response is described which tries to use primary, secondary and tertiary prevention strategies to reduce the impact of traumatic incidents-in this case, armed robberies-on employees of a financial services company. Inter-departmental working, appropriate use of management and social support, pre-trauma training and cognitive-behavioural counselling techniques are all used in an attempt to tailor support to the individual's own needs. Binding the process together is a simple psychological health screening process, offering as a by-product information to improve the responsiveness of the service.     

Effective Treatment for Mental Disorders in Children and Adolescents

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

A prospective test of cognitive vulnerability models of depression with adolescent girls

This study sought to provide a more rigorous prospective test of two cognitive vulnerability models of depression with longitudinal data from 496 adolescent girls. Results supported the cognitive vulnerability model in that stressors predicted future increases in depressive symptoms and onset of clinically significant major depression for individuals with a negative attributional style, but not for those with a positive attributional style, although these effects were small. This model appeared to be specific to depression, in that it did not predict future increases in bulimia nervosa or substance abuse symptoms. In contrast, results did not support the integrated cognitive vulnerability self-esteem model that asserts stressors should only predict increased depression for individuals with a confluence of negative attributional style and low self-esteem, and this model did not appear to be specific to depression.     

Depression in youth: psychosocial interventions

Witnessed over the past 20 years are major advances in knowledge regarding depression in children and adolescents. Although additional research is needed, clinicians can now turn to treatment strategies with demonstrated efficacy. In this article we review the literature on psychosocial interventions for depression in youth and offer a working model to guide the treatment of depressed youth. We begin with a brief overview of the model, followed by a review of the treatment efficacy and prevention literatures. We offer some caveats that impact the ability to move from this treatment literature to the real world of clinical practice. We conclude by considering how extant research can inform treatment decisions and highlight critical questions that need to be addressed through future research.     

The treatment of depression in older adults in the primary care setting: an evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults.     

Developing a Culturally Appropriate Depression Prevention Program: Opportunities and Challenges

This paper describes the experiences of the first author and his colleagues in the development and implementation of a depression prevention program that specifically targets Latina mothers. Building on the earlier papers that highlight the underutilization of mental health services by Latinos in general, this paper will make the case that the situation is particularly concerning with regards to depression. In addition to the fact that depression is a highly prevalent disorder among Latino adults, the potential consequences for children of parents with depression are significant. Thus, the underutilization of formal mental health services by Latinos makes depression a critical public health problem that calls for creative solutions. One possible solution is the careful development and implementation of prevention programs. Depression prevention programs have some advantages over formal mental health treatment in that they can be offered at a relatively low cost, can be packaged in ways that make them less stigmatizing, and if effective, can reduce the incidence of cases that develop into clinical depression.This paper will describe the process of developing a novel depression prevention program, with a particular focus on the attention paid to cultural sensitivity. We describe the complexity inherent in defining cultural sensitivity and illustrate in concrete ways its implementation in the development and evaluation of the prevention program. In addition, we explore some of the challenges that emerge when attempting to balance the creation of a program that is culturally sensitive with the demands of rigorous quantitative evaluation.     

消费心理学中的风险认知

文章回顾了消费心理学研究中有关风险认知的文献,对于双因素模型、多维度模型、复杂模型和整合模型等风险认知的概念模型进行了综合介绍,并分析了影响消费者风险认知的因素、产品风险与服务风险的差异以及降低风险认知的策略。文章最后展望了消费者风险认知的研究趋势,尤其是电子商务中的风险认知问题。     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Children's mental health as a primary care and concern: a system for comprehensive support and service

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country.     

Role of Perceived Social Support on Depression in Chinese Adolescents: A Prospective Study Examining the Buffering Model

In response to the dearth of attempts to examine functions of perceived social support on depression in Chinese adolescents, a prospective study was conducted to examine the relationship among stressful life events, perceived social support, and depression. The present results provided support for the buffering model, indicating that the function of perceived social support in mitigating subsequent depression was prominent only under high stress levels. These results were discussed in terms of the socialized role of Chinese adolescents, as well as the function of esteem enhancement of perceived social support in alleviating depression. Reciprocal relationships between initial depression levels and subsequent levels of social support were also discussed. Possible counseling and prevention programs for Chinese adolescents are proposed.     

A Holistic Model for Wellness and Prevention Over the Life Span

A small percentage of our resources for health and human services is devoted to wellness and prevention of illness and social problems. An integrated paradigm for wellness and prevention over the life span is presented for the purpose of theory building, research, clinical application, education, advocacy, and consciousness raising. The model includes 11 characteristics desirable for optimal health and functioning. These characteristics are expressed through the five life tasks of spirituality, self-regulation, work, friendship, and love. Life forces external to the person are noted to understand the interaction between the individual and societal institutions.     

The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies

In two longitudinal studies, the authors examined the direction of the relationships between trait gratitude, perceived social support, stress, and depression during a life transition. Both studies used a full cross-lagged panel design, with participants completing all measures at the start and end of their first semester at college. Structural equation modeling was used to compare models of direct, reverse, and reciprocal models of directionality. Both studies supported a direct model whereby gratitude led to higher levels of perceived social support, and lower levels of stress and depression. In contrast, no variable led to gratitude, and most models of mediation were discounted. Study 2 additionally showed that gratitude leads to the other variables independently of the Big Five factors of personality. Overall gratitude seems to directly foster social support, and to protect people from stress and depression, which has implications for clinical interventions.     

Cigarette Smoking, Anxiety, and Depression

This review provides a detailed analysis of anxiety and depression as they relate to each stage of the cigarette smoking cycle: initiation, maintenance, and cessation with an emphasis on nicotine withdrawal. An analysis of the literature confirms that cigarette smoking is highly comorbid with anxiety disorders and clinical depression, and that this relationship appears to be moderated by factors such as age of the smoker, type of disorder, and level of nicotine dependence. Studies also offer evidence to suggest a relationship between smoking and both subclinical anxiety and depression. Research findings have not revealed whether common factors influence the development of anxiety, depression, and smoking, whether anxiety and depression lead to smoking, or whether the reverse is true. Nevertheless, a current understanding of the links among smoking, anxiety, and depression confirms current prevention and cessation techniques, as well as suggests new directions for research and clinical practice.     

Social support and emotional adjustment during and after a severe life event: A study of wives of myocardial infarction patients

Abstract

This paper examines the relationship between quantitative and qualitative indicators of social support and anxiety. depression and use of health services in a sample of 37 wives of myocardial infarction (MI) patients. In a prospective design, the wives were interviewed during the acute phase of the illness, three months and 10 years post index-MI. Congruent with previous research, the quantitative aspect of social support, defined as number of persons giving help, was unrelated to adjustment, whereas qualitative aspect of social support, defined as the wives' dissatisfaction with social support, was associated with depression and use of health services. The observed association indicated, however, an effect in the opposite direction of the social support model. The findings were unexpected and may be due to a small sample. An alternative explanation is that long-term relationship between depression and social support is more complex, and more long-term studies are needed in this field.     

Preventing School Violence by Promoting Wellness

This paper presents a framework for school-based health promotion and prevention programming that can serve to guide planning and action. Rather than separating specific prevention programs (such as violence prevention, substance abuse prevention, etc.) from more broad-based youth development efforts, this approach provides an integrated framework that: (a) identifies benchmarks of healthy development and strategies to support this development across contexts; (b) specifies additional factors that contribute to identified problems that are not directly linked to healthy development; and (c) provides for matching services to individual needs. Suggestions for application of this framework are discussed, with a particular focus on its application to the development of school-based Wellness Centers.     

Counselling and primary prevention

Counsellors and counselling services are frequently involved in primary prevention work. Increasingly these services are required to help immediately after major disasters, an implicit assumption being made that normal social support networks will be unable to cope. A review of the literature suggests extensive participation of counsellors in primary prevention activities despite difficulties in definition, training and funding, and evidence that some interventions may be ineffective or harmful. It is suggested that counsellors providing primary prevention services should be aware of the complex practice and philosophy issues surrounding such efforts, and should be rigorous in assessing the real effects of primary prevention activity.     

青少年网络受欺负与抑郁：压力感与网络社会支持的作用

采用网络受欺负量表、压力感量表、网络社会支持问卷和流调中心用抑郁量表对751名初中生进行调查,考察了青少年网络受欺负与抑郁的关系、压力感在网络受欺负与抑郁间的中介作用以及网络社会支持在其中的调节作用。结果表明：（1）青少年网络受欺负与抑郁存在显著正相关;（2）压力感在网络受欺负和抑郁间起完全中介作用;（3）网络社会支持在网络受欺负事件引起的压力感与抑郁间起调节作用,压力感对青少年抑郁的影响,随网络社会支持水平的提高而降低。