The doctor-patient relationship in the post-managed care era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a "post-managed care era," where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

The Doctor-Patient Relationship in the Post-Managed Care Era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a “post-managed care era,” where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

Hostility and health: current status of a psychosomatic hypothesis.

Recent research has renewed interest in the potential influence of hostility on physical health. This review indicates that the evidence available from prospective studies, although not entirely consistent, suggests that hostile persons may be at increased risk for subsequent coronary heart disease and other life-threatening illnesses. Further, several plausible mechanisms possibly linking hostility and health have been articulated and subjected to initial evaluation. Hostile individuals display heightened physiological reactivity in some situations, report greater degrees of interpersonal conflict and less social support, and may have more unhealthy daily habits. Additional research is needed, and it must address a variety of past conceptual and methodological limitations. Perhaps the most central of these concerns are the assessment of individual differences in hostility and the role of social contexts in the psychosomatic process.     

Physical symptoms and the interplay of work and family roles

The paradigm underlying research on the relationship between work and physical-health symptoms in men has focused on workplace stressors and has ignored men's family roles. Research on women, work, and health suggests several necessary additions to this paradigm, including (a) a focus on job rewards and job concerns and (b) attention to the impact of family roles on the relationship between job rewards and concerns and physical health. We included these variables in a study of a disproportionate random sample of 403 employed 25- to 55-year-old women. Major findings are that (a) work rewards (e.g., helping others at work) are related to reports of low levels of physical symptoms; (b) work concerns (e.g., overload) are associated with reports of high levels of physical symptoms; (c) particular work rewards, which may be different for women than for men, mitigate the negative health effects of work concerns; (d) among employed mothers, satisfaction with salary is negatively related to physical-health symptoms; and (e) women in positive marriages or partnerships were more likely to reap physical-health benefits from the rewards of helping others at work and from supervisor support.     

Managing Behavioral Health Needs of Veterans with Traumatic brain injury (TBI) in Primary Care

Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.     

Resident-Led Neighborhood Development to Support Health: Identifying Strategies Using CBPR

Evidence suggests that where people live, learn, work, and play affects a range of health outcomes for children and adults. Differential access to social, economic, and environmental supports puts some community members at greater risk, leading to disparities in health and well-being. The 2014 release of the For the Sake of All report highlighted persistent health disparities for African Americans in St. Louis, Missouri, and their social and economic impacts on the St. Louis region. This study extends this work by developing partnerships with community organizations and neighborhood residents to address health disparities. Community-based participatory research (CBPR) methods were utilized to engage partners in a 10-month research process to address community concerns that impact health. Seven community residents, neighborhood researchers, engaged in workshops to learn about the research process and used techniques to gather information to implement action strategies. Neighborhood researchers selected 14 vacant lots to implement their action plan, which included visions for repurposing the land into a community park, produced a report for dissemination, and organized a community action forum to communicate their findings. This study highlights a promising approach to promote healthy communities and health equity by empowering neighborhood residents using participatory methodologies.     

Ethnic identity,thin-ideal internalization,and eating pathology in ethnically diverse college women

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N = 816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.     

Health concerns of young adolescents

Assessment of health concerns independent of health knowledge, beliefs, and behaviors is important for understanding health among adolescents, who are being socialized into adult health roles yet have their own particular concerns. The health concerns of 278 young adolescents were examined with respect to 30 topics in a survey of all seventh- and eighth-grade students attending an urban school. Their highest levels of concerns pertained to dental health, friendships, nutrition, and sex; their lowest levels pertained to smoking, birth control, pregnancy, and homosexuality. Younger, female, and less healthy students expressed greater health concerns. Most desired class health presentations (particularly about sex), while relatively few requested private counseling on specific health topics. Health concerns need to be emphasized as a component of theoretical models, and also applied in the development of health education and school health programs.     

Counselling with the ‘worried well’

This paper introduces the ‘worried well’ as the last in a long line of categories which define people who have concerns about their health. In this case, people who are convinced they have AIDS. The paper describes: 1) their presentation, 2) the main dificulties involved in treatment, and 3) suggests a step wise model for counselling the ‘worried well’.     

Targeting Self-Stigma in Returning Military Personnel and Veterans: A Review of Intervention Strategies

Research suggests that mental health-related stigma significantly decreases the use of mental health services by military personnel and veterans. The goal of this article is to review what is known about mental health stigma as it relates to military personnel and veterans, as well as to offer an interpretive review of self-stigma intervention strategies that have been applied within the field. Target areas for future work and the concerns and challenges faced by interventionists are discussed.     

Religion and Mental Health: an exploration of the relationship between the ineffable and the indefinable

This article suggests that the relationship between religion and mental health is both important and complex. It reviews some studies of the relationship and suggests that religion can be good or bad for one's mental health, depending on the content of the religious message. It also presents a model of mental health and suggests that this or some similar scheme can be employed to assess the extent to which one's religious or value system promotes mental health.     

Weight perception, weight change intentions, and alcohol use among young adults

Obesity and binge drinking are important health issues for young adults in the United States. Several studies have investigated the relationship between these constructs with mixed results. One possible explanation to disentangle this relationship suggests that how people feel about their weight, regardless of their actual weight, may explain some variation in alcohol use. This study (n = 4497) investigated the relationship between two types of body weight concerns--weight perception and weight change intentions--and binge drinking. Controlling for measured body weight, we considered whether body weight concerns increase risk for binge drinking. Findings suggest that women who reported trying to lose weight had an increased risk of binge drinking. Conversely, men who perceived themselves overweight were significantly less likely to participate in binge drinking. We conclude with a discussion of the finding's implications.     

Catholic social justice and health care entitlement packages.

This paper explores the implications of Roman Catholic teachings on social justice and rights to health care. It argues that contemporary societies, such as those in North America and Western Europe, have an obligation to provide health care to their citizens as a matter of right. Moral considerations provide a basis for evaluating concerns about the role of equality when determining health care entitlements and giving some precision to the widespread belief that the right to health care requires equal entitlement to health care benefits.     

The Legitimacy of Pseudo‐Expert Discourse in the Public Sphere

This article examines the role of expertise in public debate, specifically the ways in which expertise can be mimicked and deployed as “pseudo‐expert discourse” to generate legitimacy for views that have otherwise been discredited. The article argues that pseudo‐expert discourse having a clear public health or safety impact should be regulated. There have been some attempts to legally regulate this speech through various means; however, these attempts at regulation have been met with fierce resistance, because of free‐speech concerns. The article suggests that these appeals to free speech in the context of pseudo‐expert discourse are both misguided and misplaced. Moreover, because speakers with the relevant expertise or perceived expertise are able to secure uptake of their views, they have a moral responsibility to not deceive or mislead audiences, and may also have various legal responsibilities.     

Trauma Exposure and Health: A Review of Outcomes and Pathways

A growing body of literature has established robust relations between trauma and a variety of adverse physical health outcomes. In both retrospective and prospective research, adults with a history of self-reported or court-substantiated maltreatment report significantly more health concerns than those without maltreatment histories, in both clinical and community samples, whether health problems are self-reported or physician-diagnosed. Two pathways by which poor health outcomes are theorized to occur include the biological pathway, which largely implicates severe stress and subsequent dysregulations in central stress-response systems as the underlying cause of health problems, and the behavioral pathway, which suggests that health risk behaviors are largely responsible for the relations between trauma and health. This article reviews the research evaluating the relations between various types of trauma, particularly physical and sexual abuse in childhood, and three such health outcomes: pain, gastrointestinal disorders, and cardiovascular disease. Evidence to support the biological and behavioral pathways is also reviewed.     

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.     

A counseling/pastoral approach to the homosexual client

This article focuses on a practical approach to dealing with homosexual concerns within a pastoral context. The manner in which a church worker and a mental health professional can practice co-therapy is detailed with some of the limitations and advantages associated with such a team outlined.     

Should and will Inter-collegiate Football Programs be Eliminated?

Abstract

In a recent article in this journal, Lopez Frias and McNamee (2017) raise some concerns about an argument presented in Corlett (2014), also published in this journal. This article is a detailed response to Lopez Frias and McNamee (2017) in clarification and defense of the argument in question in Corlett (2014). The discussion concerns the questions of whether or not inter-collegiate football ought to and will be eliminated, and why or why not. More specifically, the discussion concerns the health care and medical costs to others argument for the elimination of inter-collegiate football articulated in Corlett (2014).     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.     

Online mental health treatment: concerns and considerations.

Concerns and considerations have emerged as mental health professionals contemplate the provision of mental health treatment over the Internet. This paper identifies perceptions of online mental health treatment among a national sample of 2,098 social workers, psychologists, and other professionals. These professionals were unlikely to provide online mental health treatment, although some used the Internet as an adjunct to clinical practice. They noted specific concerns related to the provision of mental health treatment online, including confidentiality of client information and liability issues. We explore these issues and discuss implications for professionals who provide mental health treatment.