Balint groups in undergraduate medical education: a systematic review

Objective: Though Balint groups feature increasingly in UK medical school curricula, there is no evidence-based consensus on what undergraduates might gain from participation, and how this might happen. To address this, we systematically reviewed primary research studies involving medical student Balint groups and their relationship with patient-centredness, using narrative synthesis. Data sources: Four major databases were searched from origin until 9 September 2016. The Journal of the Balint Society was hand-searched from 1971 until 9 September 2016. Study selection: English language studies reporting quantitative and/or qualitative methods examining Balint groups in medical students vs. other/no comparator. Results: Eight studies were included. Quantitative findings report statistically significant improvements to student’s empathy and intellectual interest following group participation vs. control (p = 0.03, p = 0.046, respectively). Discussion content was similar across high-income countries. There was considerable heterogeneity when students rated the efficacy of groups. All evidence had high or unclear risk of bias, or was of medium/low quality. Conclusion: Balint groups might help medical students to become more patient-centred, by increasing students’ empathic abilities and supporting their personal and professional growth. Groups are more subjectively effective when optional rather than compulsory. Discussion content is comparable to groups in continuing medical education.     

A systematic review of sexual satisfaction

The present theoretical study is a systematic review of research publications in which sexual satisfaction was the dependent variable. After conducting a literature search in major electronic databases and following a selection process, we provide a summary of the main findings of 197 scientific papers published between 1979 and 2012. The review revealed the complexity and importance of sexual satisfaction, which was associated with the following variables and factors: a) individual variables such as socio-demographic and psychological characteristics as well as physical and psychological health status; b) variables associated with intimate relationships and sexual response; c) factors related to social support and family relationships; and d) cultural beliefs and values such as religion. In conclusion, we observed that sexual satisfaction is a key factor in individuals’ sexual health and overall well-being. However, despite its importance, there is a lack of theoretical models combining the most important factors to explain sexual satisfaction.     

Sexuality education and young people's sexual behavior: a review of studies

Sexuality education for children and young adults is one of the most heavily debated issues facing policy-makers, national AIDS program planners, and educators, provoking arguments over how explicit education materials should be, how much of it there should be, how often it should be given, and at what age instruction should commence. In this context, the World Health Organization's Global Program on AIDS' Office of Intervention Development and Support commissioned a comprehensive literature review to assess the effects of HIV/AIDS and sexuality education upon young people's sexual behavior. 52 reports culled from a search of 12 literature databases were reviewed. The main purpose of the review is to inform policy-makers, program planners, and educators about the impact of HIV and/or sexuality education upon the sexual behavior of youth as described in the published literature. Of 47 studies which evaluated interventions, 25 reported that HIV/AIDS and sexuality education neither increased nor decreased sexual activity and attendant rates of pregnancy and sexually transmitted diseases (STDs). 17 reported that HIV and/or sexuality education delayed the onset of sexual activity, reduced the number of sex partners, or reduced unplanned pregnancy and STD rates Only 3 studies found increases in sexual behavior associated with sexuality education. Inadequacies in study design, analytic techniques, outcome indicators, and the reporting of statistics are discussed.     

A systematic approach to planning a careers education course

The nature of careers education is discussed and a design framework proposed in which careers education is witnessed in terms of process. Five major process skills used by students in choosing a career are identified: discovering, selecting, responding, implementing, and assessing/evaluating. These mediate eight major components each characterised by elements accepted in the literature as impinging upon vocational development and career decision-making. An analysis of the aims, general objectives and specific objectives of careers education is undertaken, and suggestions are made for ways in which the process skills might be used to provide a rationale for programme development and improved classroom interaction.     

Mostly heterosexual as a distinct sexual orientation group: A systematic review of the empirical evidence

We reviewed empirical evidence regarding whether mostly heterosexual exists as a sexual orientation distinct from two adjacent groups on a sexual continuum—exclusively heterosexual and substantially bisexual. We addressed the question: Do mostly heterosexuals show a unique profile of sexual and romantic characteristics that distinguishes them as a separate sexual orientation group? We found sufficient data in four areas to support an affirmative answer. Individuals who acknowledged a mostly heterosexual orientation were distinct from adjacent sexual orientation groups in having a small degree of same-sex sexual and/or romantic attraction and, occasionally, same-sex behavior; constituted a substantial prevalence in the population; were relatively stable in their orientation over time; and reported that this sexual identity was subjectively meaningful to them. Findings suggested that self-identification as mostly heterosexual or an acknowledgment of slight same-sex sexuality increases during the teenage years, peaks around the early twenties (somewhat sooner for men than women), and remains relatively high during young adulthood. Limited evidence suggested that prevalence is lower among older participants. These findings have implications for our conceptualization of sexual orientation as a continuum, the nature of sex differences in sexuality, developmental changes in sexuality, biologically based assessments of sexual orientation, and an etiological theory of mostly heterosexuality.     

Testing the role of adolescent sexual initiation in later-life sexual risk behavior: a longitudinal twin design

The consistent association between adolescent sexual initiation (ASI) and risky adult sexual behavior (RASB) has generally been assumed to indicate that ASI has a causal effect on RASB; consequently, it is assumed that delaying ASI will reduce RASB. Yet the ASI-RASB association might be better accounted for by some third variable. We evaluated the causal role of ASI (initiation of oral, anal, or vaginal sex at or before age 16) in influencing RASB in a longitudinal sample of 2,173 twins (followed from ages 11 to 24 or from ages 17 to 29) using two methods: the discordant-twin design and the propensity-score design. The former controlled for unmeasured genetic and shared environmental factors, and the latter controlled for measured nonshared environmental factors. We replicated the link between ASI and RASB reported in previous research, but results from the discordant-twin and propensity-score analyses suggested that this association is better explained by common genetic or environmental risk factors than as a causal effect. These findings suggest that preventing ASI is unlikely to reduce RASB.     

Custody evaluations: a survey of mental health professionals

Mental health professionals who conduct custody evaluations (N=165, 61% return rate) were surveyed about their practices and attitudes. These experts were primarily licensed psychologists, most with degrees in clinical and counseling. Few had specific training in child custody or forensic evaluation, and although they averaged 8·1 evaluations over the last year, most devoted a modest portion of their practice to custody work. They generally regarded custody evaluations as valuable to the courts, but were critical of the adversarial approach to determining custody. Procedures and priorities have changed little over the past decade, with most experts relying heavily on interviews and observation. Cautions are given regarding overstepping ethical guidelines and using procedures that presently lack established validity. © 1998 John Wiley & Sons, Ltd.     

Suicide survivors' mental health and grief reactions: a systematic review of controlled studies

There has been a debate over several decades whether suicide survivors experience more severe mental health consequences and grief reactions than those who have been bereaved through other causes of death. This is the first systematic review of suicide survivors' reactions compared with survivors after other modes of death. Studies were identified by searching the PsychINFO and MEDLINE databases. Forty-one studies met the eligibility criteria. A qualitative data analysis was performed. There were no significant differences between survivors of suicide and other bereaved groups regarding general mental health, depression, PTSD symptoms, anxiety, and suicidal behavior. The results regarding the overall level of grief are less clear, depending on whether general grief instruments or suicide-specific instruments are used. Considering specific grief variables, suicide survivors report higher levels of rejection, shame, stigma, need for concealing the cause of death, and blaming than all other survivor groups.     

Affirming patterns of adolescent sexual identity: the challenge

Issues concerning sexual identity are not uncommon in therapy with adolescents, although they may manifest in a variety of ways. For young people who have experienced same-gender attractions or sexual experiences there is the question of how to absorb these experiences within the construction of a coherent sexual identity. In many cases the family context plays an important role in sexual identity formation and acceptance. Therapists too may play an important role in terms of two key aspects of sexual identity formation: self-definition and disclosure. Family therapists in particular occupy a unique position with respect to the adolescent and his or her family, opening up not only potential opportunities but also potential risks in practice. Practice issues are identified and explored in this paper.     

Child sexual abuse and adolescent prostitution: a comparative analysis

In several studies, child sexual abuse has been identified as a characteristic of adolescent prostitution. The implication of these findings, especially for girls, is that the two phenomena are related in that childhood sexual abuse perhaps leads to prostitution. The present study explored the relationship between sexual abuse and adolescent prostitution by comparing 70 sexually abused children with 35 prostitution-involved children on 22 variables. Findings suggest that the relationship is not directed, but involves runaway behavior as an intervening variable. It is not so much that sexual abuse leads to prostitution as it is that running away leads to prostitution. Implications for treatment of both sexually abused and prostitution-involved children also are discussed.     

The sexual and mental health problems of street children: a transcultural preventative approach in counselling psychology

Sexual and mental health problems are on the increase world-wide especially among street children. A high proportion of vulnerable children who live in the street suffer exploitation, poor quality of life that often lead to sexual and mental health problems. Evidence is needed on the theoretical perspectives taken to address the existing gaps in counselling psychology research and practice on the plight of street children. It is also important to identify interventions that could be implemented to prevent the expansion of sexual and mental health problems among street children. Because of paucity of evidence in counselling psychology, an attempt has been made to highlight the risks factors associated with street children such as sexual exploitation, engaging in unsafe sex at an early age, promiscuity, unplanned pregnancy which tend to lead to mental health problems. Case studies are presented that illustrate the importance of a preventative transcultural approach in counselling psychology.     

Videoconferencing psychotherapy: a systematic review

Individuals with mental health problems may face barriers to accessing effective psychotherapies. Videoconferencing technology, which allows audio and video information to be shared concurrently across geographical distances, offers an alternative that may improve access. We conducted a systematic literature review of the use of videoconferencing psychotherapy (VCP), designed to address 10 specific questions, including therapeutic types/formats that have been implemented, the populations with which VCP is being used, the number and types of publications related to VCP, and available satisfaction, feasibility, and outcome data related to VCP. After electronic searches and reviews of reference lists, 821 potential articles were identified, and 65 were selected for inclusion. The results indicate that VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy. Although the number of articles being published on VCP has increased in recent years, there remains a need for additional large-scale clinical trials to further assess the efficacy and effectiveness of VCP.     

Religiosity,spirituality, mental health,and mental health treatment outcomes in Australia: a systematic literature review

The relationship between religiosity and mental health is a relatively well-researched field within North America, covering numerous domains of religiosity, including: religion, spirituality, prayer, church attendance, church affiliation and belief in God or a higher power. Considering the Australian literature, there are few papers that explore these dimensions of religiosity and their relationship with health, and in particular, very little research into the field of religiosity and mental health. Using systematic literature review methods, this study explores the Australian research into relationships between religiosity, mental health, and treatment outcomes for psychiatric illness and suicidal behaviour.     

A systematic review of primary prevention strategies for sexual violence perpetration

This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates (Foshee et al., 2004); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003).     

Family functioning and the adolescent mother: a systems approach

This study examines unwanted adolescent pregnancy and early childbearing within the context of the family system. Fifty pregnant adolescents and their families were interviewed prenatally and again during the postpartum period. Utilizing the concepts of structural family theory and therapy as described by Minuchin, certain characteristics of family style and structure of organization were rated. These family variables were then related to aspects of the adolescent mother's adaptation postpartum. Boundaries, in terms of degree of intrusiveness and differentiation, were related to such variables as whether the adolescent is maintained in the household and to her continuing relationship with the baby's father. Similarly, the family's style of dealing with conflict was related to the relationship between the adolescent parents, among other outcome variables. Implications of the findings both for working with these families and for further research are discussed, and issues are raised about hypothesized relationships between independent and dependent variables which were not borne out.     

Psychological determinants of sexual arousal: a review

The literature on the psychological determinants of genital and subjective sexual arousal is reviewed. Various psychological mechanisms are identified and in each instance the available empirical evidence is summarized. Areas requiring further research are indicated and suggestions for methodological improvements are presented.     

Counselling in primary care: a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost‐effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non‐specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost‐effectiveness trials are needed together with surveys of more typical users of primary care services.