Prevention-centered science in mental health

Conclusion This special issue of AJCP is the first attempt to collectively publish some of the research generated by the PIRCs, an effort that we hope conveys the richness and sophistication of prevention research at its best. As seen in the papers, the work encompasses a broad multidisciplinary focus, including the domains of epidemiology, econometrics, sociology, community psychology, social psychology, developmental psychology, and psychiatry. The rigor of the studies is sometimes astonishing given the complexities of implementing field-based research, and speaks to the creativity of the investigators at the PIRCs. The critical role they have carved out for prevention within the broader scientific enterprise should move the field toward greater acceptance by other scientists, and should hasten the achievement of its main goal and an important mission of the NIMH—the prevention of mental disorders and dysfunctions and the promotion of mental health. Editor's Note: This special issue of theAmerican Journal of Community Psychology was organized by Doreen Spilton Koretz, who introduces it with a commentary describing the National Institute of Mental Health program that supports the Preventive Intervention Research Centers. Editorial review was handled by Edward Seidman, Associate Editor, with the assistance of a special review board composed of people listed at the end of the issue.The opinions expressed in this chapter are those of the author and do not necessarily reflect the support or endorsement of the National Institute of Mental Health; the Alcohol, Drug Abuse and Mental Health Administration; or the Public Health Service.     

Quantifying violence in mental health research

Research into mental illness and its relationship with violence has been constrained by inconsistencies in the definition and measurement of violent behavior. We conducted a systematic literature search of Scopus, EMBASE, PsycINFO, and Ovid Medline with search terms relating to the measurement, rating and quantification of violent behavior in mentally disordered populations. We identified nine tools designed to assess violence and critically evaluated them. Broadly, measurement tools tended to focus on multiple, but different, facets of violence, which included: severity of act, severity of outcome, frequency and intent, with each suggested as a valid outcome measure for violent acts. The use of multiple sources of information to inform assessment appears to provide detail; however, that detail is then often diluted as a result of dichotomization of sample groups. This presents methodological challenges for the field. Future studies should give consideration to the trade-off between preserving the richness of data and the difficulties associated with recruiting large patient samples. Studies should move from simply defining violence towards quantification across different dimensions of violence and using multiple sources of information.     

Self-help research and the public mental health system

Discusses views of self-help leaders, researchers, and policy makers from the public mental health system about collaborative research with self-help groups. Topics include assumptions underlying collaborative research, barriers to collaborative research, and the potential benefits of collaborative research. Special attention is given to the rationale and methods for including minorities in self-help research. Initial discussions were held at a meeting convened by the NIMH-funded Center for Self-Help Research and Knowledge Dissemination at the University of Michigan.     

Overview: forging research priorities for women's mental health

After a decade of reports underscoring the inadequacy of existing scientific knowledge for understanding gender differences in mental disorder and its treatment, the National Institute of Mental Health has developed a women's mental health research agenda with five priority areas for research: diagnosis and treatment of mental disorder, mental health issues for older women, violence against women, multiple roles, and poverty. This overview highlights some of the major findings in each of these five areas and introduces the more in-depth treatment given in this Psychology in the Public Form section to the areas of violence, poverty, and multiple roles. It also underscores the importance of identifying sources of gender bias in all mental health research. Women's mental health issues have become officially recognized as part of the NIMH research agenda. Only time and continued monitoring will determine how these official policy priorities will become translated into actual funding and research initiatives.     

Theoretical and applied inputs in mental health center research

Successful implementation of projects in mental health centers aimed at meeting programmatic needs and exploring theoretical issues encounter a number of difficulties. These include time, staffing and funding. While researchers may be interested in complex theoretical questions, agencies require data collected quickly, at minimum cost, and utilizing limited personnel. This paper discusses a model for conducting significant theoretical and applied research in mental health centers. A project undertaken in a mental health center is described to illustrate the model.     

Forging partnerships for mental health: The case of a prefecture in crisis ravaged Greece

Public health and in particular mental health have been severely affected by the multitude of socioeconomic crises experienced by people in Greece. The severe austerity programmes, have reduced access to health services and increased demand for publically funded health care. This paper presents a case study focusing on the impact of these measures on the lives of mental health providers in one prefecture in Crete. Focus group methodology was applied and the data were analysed using thematic analysis. Analyses revealed three superordinate themes that converge at many levels and appear to be going counter to the circumstances: firstly, ‘forging partnerships for mental health’; secondly, ‘extending our reach’; and thirdly ‘transformations in professional identity through praxis’. These themes are discussed using the words of the participants and the relevant literature.     

National suicide prevention lifeline: enhancing mental health care for suicidal individuals and other people in crisis

Linking at-risk callers to ongoing mental health care is a key goal of crisis hotline interventions that has not often been addressed in evaluations of hotlines' effectiveness. We conducted telephone interviews with 376 suicidal and 278 nonsuicidal crisis callers to the National Suicide Prevention Lifeline (Lifeline) to assess rates of mental health care utilization following Lifeline calls and to assess attitudinal and structural barriers to service utilization. Postcall utilization rates were approximately 50% for suicidal and crisis callers who received mental health care referrals. Lack of health insurance and callers' perceptions about mental health problems emerged as significant barriers to accessing continued help.     

Emergency psychiatry and crisis intervention in a primary clinic

The terms Notfall and Krise, and the semantic problems arising, are elucidated; and an analysis of one years work in provision for emergency psychiatry and stress intervention is presented. Psychoreactive syndromes were found to be most common, followed in second place by psychotic conditions. In third place come disorders in connection with alcohol, which display a rising tendency. 40% of the clinic's beds are occupied by acute emergency cases, chiefly of short duration. Emergency provision is thus shown to be a major feature in the work of psychiatric clinics.     

Acculturation and mental health: Current findings and recommendations for future research

Results of existing literature suggest that the relationship between acculturation and mental health is complex. Some studies have found a beneficial association between increased acculturation and mental health, whereas others have found a detrimental association or no relationship at all. We reviewed literature on acculturation and mental health in Hispanics/Latino Americans, Asians/Asian Americans, and other ethnic groups. Results indicate that greater acculturation is associated with increased substance use and abuse. Findings for other disorders and symptoms demonstrate considerable heterogeneity and potential reasons for this variation are provided. Acculturation involves a complex set of processes that appear to have differential impact on mental health outcomes. Critical issues in the measurement of acculturation are discussed, and recommendations for future research are offered.     

National attitudes towards mental health treatment: the importance of research evidence

Most conceptualizations of evidence-based practice view it as a “three legged stool” consisting of: the use of best available research evidence, clinical expertise, and client preferences. Although empirical evidence and clinical expertise have received greater empirical attention, relatively little research has systematically explored client preferences. The present study analyzed self-reported treatment preferences for various clinical and non-clinical presentations. Adult participants (n = 1262) residing in the United States were presented with diagnostic vignettes and rated their relative preferences among 5 treatment variables, including: use of an empirically supported treatment (EST), quality of the client–therapist relationship, therapist empathy, therapist experience, and client speaking for the majority of therapy sessions. Results indicated that participants endorsed significant preference for receiving an EST over other treatment variables for all clinical disorders, with effect sizes ranging from small to large depending on the diagnosis. There was slightly greater variability in treatment preferences for non-clinical issues, though participants generally reported greater preference for receiving an EST. Follow-up questions provided further evidence for EST preferences. The implications of these results are discussed.     

Divergences in American psychiatry during the Depression: somatic psychiatry, community mental hygiene, and social reconstruction

The differences between somatic psychiatrists and mental hygienists, already apparent earlier, became much more pronounced during the Depression years, partly as a consequence of their different perspectives on this social crisis. Somatic psychiatrists, emboldened by the apparent success of new medical treatment methods, reasserted the central position of the mental hospital within psychiatry, attempted to improve the discipline's position within medicine, and promoted basic research. Mental hygienists, following the ideal of prevention, proposed far-reaching programs of community mental hygiene to alleviate widespread mental distress. A small group of mental hygienists embraced socialism and advocated measures of radical social reconstruction.     

Online mental health resources for adolescents: Overview of research and theory

Adolescents use the Internet at higher rates than any other age group. The Internet therefore offers an obvious opportunity for the provision of mental health information for them. Little is known, however, about adolescent behaviour online, especially access of age‐appropriate mental health resources. This review of the published literature examines theoretical and research studies to develop an understanding of adolescent mental health‐seeking behaviour on the Internet. It is clear that adolescents do seek health information online, but little is known about its content, nature or mode of delivery. There appears to be no research specific to mental health resources for adolescents online.     

Structural characteristics of the macroeconomy and mental health: Implications for primary prevention research

Recent research on the impact of economics on mental and physical health has raised fundamental questions about structural elements in the macro-economy. Specifically, five characteristics of our current economic system: instability in the business cycle, unemployment, inequality in income distribution, capital mobility, and fragmentation of the work process, appear to play some pathogenic role in the incidence of behavioral and physical disorders. These macroeconomic elements require intervention at the social policy level since they seem to be more powerful than the individual coping mechanisms of some demographic subgroups. Psychologists can play an important role in policy decisions by providing data on the relative impact of structural economic variables on human functioning. Examples of structural research are presented and the implications for primary prevention are discussed.     

Transpersonal psychology,physical health,and mental health: Theory,research, and practice

Abstract

Throughout its existence, transpersonal psychology has held a strong interest in exploring the implications of consciousness and spirituality for health, both physical and mental. This article provides a brief overview of the theoretical, empirical, and clinical contributions of transpersonal psychology to the understanding and facilitation of human health and well‐being. It also critiques the methodological basis of some of these contributions, concluding that transpersonal psychological studies of the relationship between spirituality and health are still in their infancy and that practitioners interested in using approaches based on these findings need to exercise caution as well as excitement about the interesting developments unfolding at an ever increasing rate.