Factors influencing placement recommendations for hospitalized individuals with chronic mental illness

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.     

Changing self-perception: success in independent living for individuals with chronic mental illness

Rates of rehospitalization of individuals with serious and persistent mental illness were compared prior to and after they were moved into 4-bed corporate foster homes. Results showed a significant drop in the number of rehospitalizations and in the total number of days hospitalized after moving into a 4-bed home. The data suggest that living in a 4-bed home-like environment may result in significantly fewer and shorter hospitalizations for these types of mentally ill individuals.     

Microaggressions: The experience of individuals with mental illness

The main objective of the study was to investigate the types of microaggressions experienced by individuals with mental illness (MI) based on this marginalized group status. This study included 4 focus groups, comprised of 18 individuals diagnosed with MI(es). The researchers qualitatively identified four themes (a) conveying stereotypes against individuals with MI (i.e. assumptions of inferiority, seeking attention or being dramatic, assumptions of coldness, bringing MI upon themselves, and using MI as an excuse), (b) invalidating the experience of having a MI (i.e. doubting existence, doubting severity, and avoiding acknowledgment of the MI), (c) defining a person by their disorder, and (d) misuse of terminology. Participants revealed the main perpetrators (i.e. family, friends, and professionals) of the microaggressions. The researchers discuss: how the identified themes compare to the three categories of microaggressions (i.e. microinsults, microinvalidations, and microassaults); similarities and differences between the current results and previously identified racial, gender, and sexual orientation microaggressions perpetrated in daily interactions and in therapeutic settings; and the perpetrators of microaggressions as they relate to prejudicial attitudes and social distance. Finally, the authors make recommendations for practitioners and researchers.     

Physicians' nonverbal rapport building and patients' talk about the subjective component of illness

Physicians' nonverbal communication has sometimes been found to be associated with patients' affective satisfaction. Too little attention has been given, however, to the impact of these caregiver behaviors on patients' self‐disclosure. This paper examines the relationship between physicians' nonverbal rapport building and patients' disclosure of information related to the subjective component of illness. Twelve third‐year residents at a large teaching hospital were videotaped during interactions with patients (N = 34). These physicians' nonverbal communication behaviors were coded in the introduction and diagnosis segments of the interactions. Patients' verbal communication behaviors related to disclosure of information about the subjective component of their illnesses were coded across the same segments. Correlation analysis revealed significant relationships between physicians' use of some types of nonverbal behaviors and patients' subjective disclosure, as well as physicians' avoidance of negative facial behaviors and patients' disclosure about life beyond symptoms and structural barriers to wellness. Implications for understanding the role of physicians' nonverbal communication on health care outcomes are considered.     

Meaning in life for individuals with physical disabilities

What makes your life meaningful?" is a question previous researchers explored with people of various ages, but not of individuals who have significant physical impairments. In this study, 26 individuals with physical disabilities were asked to describe what makes their lives meaningful. Analysis showed human relationships were the most frequently reported source of meaning in life, the sources being family members, friends, and people in the community. The second most frequently cited meaning was service, specifically, helping and educating others, such as other people with physical disabilities.     

Age differences in coping with chronic illness

We examined the correlation between age and six coping strategies in a sample of 151 middle-aged and older chronically ill adults. Coping strategies included cognitive restructuring, emotional expression, wish fulfilling fantasy, self-blame, information seeking, and threat minimization. Older adults were less likely to use emotional expression or information seeking than were middle-aged adults in their efforts to cope with the illness. These strategies were related to age even when numerous illness characteristics (e.g., physical limitations) were used as control variables. Interaction effects showed that older adults who perceived their illnesses as highly serious were less likely than were others to cope by seeking information, reconstruing their illness as having positive aspects, or engaging in wishfulfilling fantasies, and more likely to cope by simply minimizing the illness's threat. Consideration of related research studies suggests that the age differences in emotional expression may be due to age-related shifts in the types of stresses experienced, whereas the age differences in information seeking may be more strongly linked to cohort phenomena.     

试析灵性生活对个体基督徒的意义

本文围绕着基督教灵性或灵修生活的界定、范围、构成要素、基本特征以及对于基督徒的影响与意义做出了系统的分析与评介,指出基督教的灵性实践如同其神学思辨一样对个体基督徒的宗教生活具有十分重要的意义。     

Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain

Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared with control-oriented strategies. There is a need, however, to investigate processes of acceptance and control directly in clinical settings. The present study investigated the effects of three brief instructional sets (pain control, pain acceptance, continued practice) on demonstrated physical impairment in 74 individuals with chronic low back pain using an analogue experimental design. After controlling for baseline performance, the pain acceptance group demonstrated greater overall functioning on a set of 7 standardized physical tasks relative to the other two groups, which did not differ from one another. Further, the acceptance group exhibited a 16.3% improvement in impairment, whereas the pain control group worsened by 8.3% and the continued practice group improved by 2.5%. These results suggest that acceptance may be a key process involved in behavior change in individuals with chronic pain.     

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a person's self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.     

Cognitive-behavioral treatment groups for people with chronic physical illness in Hong Kong: reflections on a culturally attuned model

This study describes and evaluates a cognitive-behavioral treatment group for people with chronic physical illness in Hong Kong. We developed a group protocol based on the understanding that Chinese people generally prefer a structured group format, expect group leaders to be active and directive, and are not used to expressing opinions and emotions in groups. The experimental and waitlist control groups had 38 and 35 participants, respectively. A standardized questionnaire was administered to all participants before and after the group treatment. Results suggest that members of the experimental group showed improvements in mental health, negative automatic thoughts, and negative emotions when compared to those in the waitlist control groups, and at the end of group treatment. Implications for designing and running a culturally attuned CBT group for Chinese people are discussed.     

The MMPI‐2 in chronic psychiatric illness

While previous studies on the MMPI‐2 in patients with schizophrenia and depression have used mixed samples of both early stage and chronic psychiatric patients. Here, it is investigated whether chronicity itself might have a differential effect on the MMPI‐2 profiles of these patients and whether demoralization ‘associated with long‐term illness’ affects the scales of the MMPI‐2. Thirty long‐term patients with schizophrenia, 30 long‐term patients with depression, and 30 healthy participants completed the MMPI‐2. Groups were compared on Clinical Scales and on the Restructured Clinical (RC) Scales. Patients with schizophrenia differed from patients with depression on 14 MMPI‐2 scales and from healthy controls on 10 scales, generally showing mean UT‐scores < 65, indicating a subjective experience of (near) normal functioning. Patients with depression differed from healthy controls on 17 scales mostly with UT‐scores > 65, indicating impaired functioning. Demoralization was higher in patients with depression than in patients with schizophrenia and both psychiatric groups differed from the healthy control group. It is concluded that long‐term patients with depression show impaired functioning and high demoralization, while long‐term patients with schizophrenia surprisingly show near normal functioning and less demoralization.     

The physical activity experiences of men with serious mental illness: Three short stories

ObjectivesAlthough a considerable amount of research has explored the effects of physical activity on mental health, the voices of people with mental illness have been largely excluded from published reports. Through this study we aim to foreground service users’ voices in order to shed light on the personal and subjective nature of the relationship between physical activity and serious mental illness (SMI).MethodsAn interpretive case study approach was used to explore in depth the physical activity experiences of three men with SMI. Creative analytic practice was used to write three creative non-fictions which, as first-person narratives, foreground the participants’ voices.ResultsWe present three short stories in an effort to communicate participants’ personal and subjective experiences of physical activity in an accessible, engaging, and evocative manner. We hope to: (i) provide potentially motivating physical activity success stories for others who live with SMI; (ii) increase awareness among mental health professionals of the possibilities of physical activity; and (iii) provide an empathetic understanding of possibilities and problems of living with SMI which may help challenge the stigma surrounding mental illness.ConclusionsFor us, the stories communicate the diversity and difference inherent in the ways men with SMI experience physical activity. We reflect on how the short story form allows these differences to be preserved and respected. We resist making further interpretations of the stories preferring instead to encourage the reader to form her or his own conclusions.     

Vicarious and operant experiences in the etiology of illness behavior: A replication with healthy individuals

The purpose of the present investigation was to replicate a previous study of diabetic patients on the role of parental modeling in the etiology of illness behavior. A random sample of healthy individuals were assigned to an avoidant model (AM) (i.e. parent reported to have avoided work. chores etc. when ill) or non-avoidant model (NAM) group. Subjects subsequently provided retrospective and current information concerning their illness-behavior experiences. The results indicated that individuals with an AM reported more responsibility avoidance when ill currently and as a child compared to the NAM subjects. Additionally. AM subjects reported receiving more positive reinforcement for current illness compared to NAM subjects. It was concluded that the process by which individuals learn to respond to illness may be similar in healthy and chronically-ill individuals but that positive reinforcement for illness may be more likely to be received by healthy individuals during acute illness than by chronically-ill individuals. The present study provides further preliminary support for the learningtheory model of illness behavior.