关于健康公平现实选择

健康公平是全人类共同追求的目标,然而由于经济、社会和文化等因素又造成了健康的极大不公平。如何在现有条件下满足人们对健康的需要,实现健康公平,揭示了健康公平的内涵,以及现实中健康不公平的表现形式;同时,提出健康公平的现实选择应从我国的现实国情出发,解决目前健康不公平问题。     

Social orientations and adolescent health behaviours in Hungary

Adolescent health behaviours are influenced by a variety of social factors, including social orientations, such as social comparison or competitiveness. The main goal of the present study was to investigate the role that these social orientations might play in health behaviours (both health‐impairing and health‐promoting). Data were collected from high school students (N = 548; ages 14–20 years; 39.9% males) in two counties of the Southern Plain Region of Hungary. The self‐administered questionnaires contained items on sociodemographics, such as age, sex, parental schooling, and socioeconomic status (SES) self‐assessment; school achievement, health behaviours, competitiveness and social comparison. Multiple regression analyses suggest that those who scored higher on competitiveness engaged in more substance use, a pattern that was not present for health‐promoting behaviours. Social comparison, however, was associated with lower levels of substance use. In addition, in relation to health‐impairing behaviours, both competitiveness and social comparison interacted with sex; both social orientation variables proved to be more important for boys. Social comparison also contributed to health‐promoting behaviours among boys. Findings support the idea that the role of social orientations, such as competitiveness and social comparison, can be quite different depending on sex and the nature of the health behaviour. While competitiveness may act as a risk factor for substance use among boys, social comparison may act as a protection. It appears that social orientations play less of a role in girls' health‐related behaviours. More focus is needed on gender differences in influences on adolescents' health‐related behaviours.     

Alternative factor structures of health-related psychological tendencies and their relationship to self-reported health seeking behaviors

Abstract

The MHQ-Multidimensional Health Questionnaire (Snell and Johnson, 1997) and a checklist of twenty Health Promoting Behaviors were administered to 1,011 Italian subjects aged 21 to 80 years. The MHQ measures twenty health related psychological tendencies (e.g, Health Efficacy, Locus of Control, Optimistic Expectations). A Principal Components Analysis was carried out on the twenty scales to study their internal structure. Both a four- and a two-factor solution are discussed, presenting different perspectives on the data. The former solution yielded a larger motivational factor, which we labeled Aspiration for Health, and three smaller factors, which we labeled Optimistic Expectations, Internal Control and Lack of Control. All factors, particularly the first one, discriminated self-reported health seeking behaviors. The latter solution yielded a Health Management factor and a Negative Thinking one, both discriminating health behaviors. Moreover, the two factors provide a useful model for distinguishing efficacy, optimism and internal control in terms of their cognitive and affective components.     

Dimensions of perceived control: A factor analysis of three measures and an examination of their relation to activity level and mood in a student and cross-cultural patient sample

Abstract

This study investigated whether measures of three perceived control (PC) concepts tapped independent dimensions, were invariant to population characteristics of health and culture, were differentially sensitive to health outcomes, and were discriminable from self-report disability. The Multidimensional Health Locus of Control, Generalized Self-efficacy, and Perceived Health Competence (PHC) Scales were administered to 106 Scottish students and 145 Scottish, Spanish and Irish patients, who also completed versions of the Sickness Impact Profile. Principal Components analyses revealed five factors reflecting scale constructions for students and six factors for patients, as PHC items fell on two factors. Disability items fell on a separate factor from all PC items. Results suggest: (a) PC is multidimensional regardless of health and culture; (b) adequate assessment requires multiple PC measures; and (c) it is meaningful to consider PC as a possible influence on disability.     

Epidemiology of alcohol consumption and related problems in Latin American countries: Contributions of psychology

Alcohol consumption is the leading risk factor for morbi‐mortality in many Latin American Countries. However, epidemiologic studies are relatively scarce. Among factors such as limited research capacity, disciplinary traditions and an emphasis on psychopathology within the field of psychology, have been postulated to account for this. The aim of this article is to review epidemiologic research on alcohol in Spanish Speaking Latin American Countries, and to measure the contribution of psychology to the field. A systematic search was performed in English and Spanish using regional and international data bases. We identified 269 articles. Most focused on consumption patterns in youth, with samples from a single school and using a variety of measures. With the exception of multinational efforts like Emergency Room Collaborative Alcohol Analysis Project or those supported by World Health Organization/Pan American Health Organization, studies reviewed reflected little cross country collaboration. Mexico accounted for most of the productivity, while many countries had very few or no articles. Most research was performed by health science researchers with a small contribution from psychology, but which increased significantly over time. The results of this review provide a broad identification of patterns regarding epidemiologic research on alcohol, and demonstrate the need for national scientific policies to promote research on public health topics.     

“Hammered down on every side” versus “just being positive”: A critical discursive approach to health inequality

Socio‐economic and health inequality are strongly linked and are increasingly perpetuated by discourses of individual responsibility. However, little research from a critical discursive perspective has addressed how people affected themselves may account for this relationship. This research examined the ways in which people who are in debt, unemployed, or in insecure, minimum‐wage employment construct health and negotiate identities around it. Data from semistructured interviews with 6 participants were analysed and 3 main interpretative repertoires were identified: a medical repertoire of health as a lack of illness; health as adopting the “right” behaviours and attitudes; and health as being heavily influenced by external factors, such as income and life circumstances. The analysis focuses on how participants managed the tension between these latter 2 repertoires by adopting various subject positions around health: that it is “slipping” away from them; that it requires motivation; and that it is unattainable. Underpinning this is a “common‐sense” idea of health as something that is worked towards through culturally approved actions and attitudes.     

Leisure-Time Physical Activity and Perceived Health in People Living with Osteoporosis

Leisure-time physical activity (LTPA) represents an important factor contributing to the development and management of osteoporosis yet research linking LTPA with perceived health markers has been limited in this cohort. The purpose of this study was to test the relationship between LTPA and perceived health controlling for select demographic factors and chronic conditions in people living with osteoporosis. Population-health survey data from cycle 2.2 of the Canadian Community Health Survey were used in conjunction with linear multiple regression models. Participants were 1538 (n _female = 1371) adults who reported living with osteoporosis. Demographic factors, chronic conditions, and more frequent participation in LTPA accounted for variance in diverse indices representing perceived health. LTPA was the only predictor to account for unique variance in each marker of perceived health. Overall, it would appear that increased use of LTPA as an adjunct to therapeutic interventions may be a viable aid to enhancing self-perceived health amongst Canadians living with osteoporosis.     

Factors Associated with Achieving Complete Mental Health among Individuals with Lifetime Suicidal Ideation

The objective of this study was to identify factors associated with complete mental health among Canadians who had ever seriously considered suicide. Data for this study were obtained from Statistics Canada's 2012 Canadian Community Health Survey–Mental Health (N = 2,844). The outcome variable examined in this study was complete mental health and was analyzed using binary logistic regression. Of the 2,844 respondents with lifetime suicidal ideation, 1,088 (38.2%) had complete mental health (i.e., had flourishing mental health, no mental illness, and no suicidal ideation in the past 12 months). Those who had a confidant were seven times more likely to have complete mental health. Other factors associated with achieving complete mental health among formerly suicidal respondents include being older, being a woman, having higher income, use of religious coping, and never previously having a mental illness. Considering the importance of these protective factors in formulating public health policies will allow for a more wide‐reaching approach to suicide prevention.     

Mental health in infants with esophageal atresia

Chronic somatic illness in infancy may challenge the development of mental health and impinge the infant's capability to form close interpersonal relationships. Esophageal atresia (EA) is a congenital anomaly requiring neonatal surgery, medical aftertreatment, and extended hospitalization. The aim of the study was to assess mental health and to find prognostic factors for mental health among infants with EA. Thirty‐nine infants treated consecutively during 2000 to 2003 and their mothers were included. Infant mental health was assessed by Diagnostic Classification: 0–3 (Zero to Three, 1994). Medical and environmental data were collected from medical records and semistructured interview with the mothers. Child development was assessed with the Bayley scales, second edition (N. Bayley, 1993). Maternal psychological distress, anxiety, and child temperament were assessed by self‐report questionnaires: the General Health Questionnaire, 30‐item version (D. Goldberg & P. Williams, 1988); the State Trait Anxiety Inventory (C.D. Spielberger, R. Gorsuch, & R. Lushene, 1970); and the Infant Behaviour Questionnaire (M.K. Rothbart, 1981). Thirty‐one percent of the infants with EA showed mental health disorders by 1 year of age. Prognostic factors predicting mental health were posttraumatic symptoms reported by mother, more than one operation, mechanical ventilation beyond 1 day, and moderate/severe chronic family strain. Relational trauma, vulnerable attachment, and impaired self‐development are highlighted as possible pathways for psychopathology. Children with EA are vulnerable to mental health disorders, and this study may help clinicians to identify children at risk.     

Development of the Multicultural Mental Health Awareness Scale

The present study describes the development of an instrument to assess the multicultural competencies of mental health professionals in Australia. The scale was developed to assess the effectiveness of a multicultural mental health training program. Mental health professionals from Queensland, Australia (N = 268) participated in the study by completing a questionnaire battery. Items on the new scale were generated to parallel the Queensland Transcultural Mental Health Centre (QTMHC) training program's objectives. The results describe a 35‐item Multicultural Mental Health Awareness Scale. Factor analysis of the scale indicated three factors of multicultural counselling competencies: Awareness, Knowledge, and Skills. These factors were in line with the Sue et al. (1982) multicultural counselling competencies. The scale has satisfactory internal consistency, test–retest reliability, concurrent validity, and discriminant validity and can be used to evaluate the effectiveness of the multicultural competency training programs in mental health.     

Relationships among mental health,coping styles,and mood

The present study investigated the relationships between mental health (measured by the General Health Questionnaire--6 factors: General Illness, Somatic Symptoms, Sleep Disturbance, Social Dysfunction, Anxiety and Dysphoria, Suicidal Depression), coping styles (two strategies: Cognitive centered, Emotional centered), and mood (Tense Arousal, Energetic Arousal). 96 students answered questionnaires before their semester test which was a stressor. Analysis showed that (1) Tense Arousal scores correlated positively with overall General Health scores and all General Health factor scores, and Energetic Arousal scores correlated negatively with overall General Health scores and all General Health factor scores except one; (2) Anxiety and Dysphoria scores predicted Tense Arousal scores the best of General Health factor scores, while both Social Dysfunction scores and General Illness scores predicted Energetic Arousal scores. (3) Participants with high Energetic Arousal scores used a Cognitive centered coping strategy much more than an Emotional centered coping strategy. That is, people with low Energetic Arousal scores seem to use the Emotional centered coping strategy and have anxiety/dysphoria, while people with high Energetic Arousal scores seem to use a Cognitive centered coping strategy and have good health and social activity. These results suggest that there are small but significant relationships among mental health, coping styles, and mood.     

Infant Developmental Outcomes: A Family Systems Perspective

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty‐two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE‐index) of parent–infant interactions. At 5 months postpartum, in‐depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post‐traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.     

Risk Factors for Suicide and Suicidal Behavior Relevant to Emergency Health Care Settings: A Systematic Review of Post‐2007 Reviews

Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high‐quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.     

An Adaptation and Extension of the Attitudes Toward Seeking Professional Psychological Help Scale1

Despite its utility, several conceptual and methodological concerns are raised regarding Fischer and Turner's (1970) Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS). These concerns were addressed in an adaptation and extension of the ATSPPHS using 208 adult volunteers. The new Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) consists of 24 items and 3 internally consistent factors: psychological openness, help‐seeking propensity, and indifference to stigma. We replicated this 3‐factor model with 293 university undergraduates, and established test‐retest reliability with 23 student volunteers. Validity was demonstrated by the ability of the IASMHS to distinguish between those who had and had not used mental health services in the past, and those who would and would not use these services in the future. It also discriminated between participants’ intentions to use professional and nonprofessional help. Finally, expected gender differences in help‐seeking attitudes were demonstrated.     

心理健康双因素模型在大学生及其心理素质中的有效性研究

采用大学生心理素质量表、一般健康量表、生活满意度量表、快乐感量表进行问卷调查,检验西方学者提出的心理健康双因素模型(DFM)在中国大学生及其心理素质中的有效性。结果发现： ⑴心理健康两维结构的拟合指数优于单维结构;⑵DFM成功地将中国大学生划分为了完全心理健康、部分心理健康、部分病态、完全病态四种类型,并在年级的分布上存在显著差异;⑶心理素质水平在四种心理健康状态上存在显著差异;⑷心理素质对积极心理健康的发展性功能相比对消极心理健康的治疗性功能更为突出。研究表明,DFM与中国学者提出的心理素质与心理健康关系模型理论存在相互支持。     

Health Anxiety: Latent Structure and Associations with Anxiety-related Psychological Processes in a Student Sample

Although currently classified as a somatoform disorder, cognitive-behavioral models conceptualize hypochondriasis (HC) as a severe form of health anxiety. The Short Health Anxiety Inventory (SHAI) is a measure derived from this conceptualization that measures health anxiety symptoms across the range of severity. Previous studies have reported inconsistent findings regarding this measure’s factor structure, but these studies employed factor analytic tools that did not account for the categorical nature of SHAI items. The present psychometric study was designed to address these inconsistencies using categorical factor analysis. Using data from a large student sample we found that the SHAI had two factors: Illness Likelihood and Illness Severity. We also examined the relationship between these domains and cognitive variables associated with other anxiety disorders. Results suggested that the psychological processes present in obsessive-compulsive disorder and panic disorder are also associated with health anxiety. Implications for the conceptualization and classification of severe health anxiety are discussed.     

The associations between insecure attachment,rooming‐in,and postpartum depression: A 2 months’ longitudinal study

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming‐in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming‐in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1–4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming‐in conditions. In addition, women in partial rooming‐in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming‐in women. A situational factor such as full rooming‐in, which occurs at a critical time point for the mother–infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming‐in, can be personalized and thus beneficial in moderating personal risk factors for PPD.     

心理健康素养：概念、评估、干预与作用

心理健康素养是促进心理健康的重要途径。狭义概念指帮助人们认识、处理和预防心理疾病的相关知识和信念; 广义概念指综合运用心理健康知识、技能和态度, 保持和促进心理健康的能力。心理健康素养常采用情景案例问卷、单维或多维评估量表等进行评估, 可以通过社会运动、学校教育、自助式应用程序、心理健康急救培训等方式进行有效干预提高, 其中心理健康知识、心理疾病识别、情绪调节、减少病耻感、积极的求助态度等成分都有促进心理健康的作用。未来研究可以在建构评估指标体系、探索作用机制、扩展涵盖群体与内容、加强实证干预研究等方面深入开展。     

Exploring consumers' health meaning categories: towards a health consumption meaning model

• Health marketplace offers a lucrative business for many companies. However, there is a gap in consumer research in understanding what health as a target of consumption really means to consumers. The subtleties and multiplicity of meanings rural and urban (both younger and older) consumers attach to health in their everyday lives are empirically explored in this article. Findings of a focus group interview‐based interpretive analysis are reported. It was found that meanings consumers associate with health are profound and multi‐faceted (identification of several health‐meaning categories) with some evidence for age‐ and area‐of‐ residency‐related health‐meaning differences. The article is concluded by advancing theory‐building in consumer research in the form of developing a tentative framework model that can be used to analyze health consumption meanings.

Copyright © 2006 John Wiley & Sons, Ltd.