Attribution Through the Layperson's Lens: Development and Preliminary Validation of an Inclusive,International Measure of Beliefs About the Causes of Mental Illness

Attributions, or beliefs about the causes of mental illness, have traditionally been dichotomized based on their locus, controllability, specificity, and stability. However, scholars have introduced an alternative lay beliefs model identifying attributions related to specific biological, social, and spiritual attributions. This research describes the potential benefits of this alternative model and outlines the validation of a comprehensive, international measure of lay beliefs, the Mental Illness Attribution Questionnaire (MIAQ). Validation included piloting, qualitative rating, confirmatory factor analysis, and evaluation of internal consistency, convergent validity, and test–retest reliability with a sample of 680 U.S.-based international students representing 94 nations. Scales measured attributions related to supernatural forces, social stress, lifestyle, health, substance use, heredity, and personal weakness. This structure was tested across 3 conditions—schizophrenia, depression, and alcoholism—demonstrating strong psychometric properties. The lay beliefs model appears to closely reflect the manner in which laypersons attribute cause for mental health problems, making it a natural fit for community-based research. Further, its validation with 2 international samples supports its utility in diverse populations. Together, the results support the MIAQ as a valid and reliable measure of mental illness attribution with potential for examining help-seeking and stigmatizing behavior across cultures.     

Metabolic syndrome and Alzheimer's disease: a link to a vascular hypothesis?

Current evidence from epidemiological, neuroimaging, pathological, pharmacotherapeutic, and clinical studies indicate an association of Alzheimer's disease with risk factors of vascular atherosclerotic disease either in isolation or in aggregate. "Metabolic syndrome" (MetS) is the name for a clustering of risk factors for cardiovascular disease and type 2 diabetes that are of metabolic origin. These include central obesity, elevated plasma glucose, high blood pressure, atherogenic dyslipidemia, a prothrombotic state, and a proinflammatory state. In this article, we provide an overview of the relevant literature with regard to the relationship of Alzheimer's disease with MetS. Accumulating evidence suggests a "vascular hypothesis" to be related to the pathology of Alzheimer's disease. In the light of this evidence, clinician may consider lifestyle interventions toward an early and effective cardiovascular risk-factor management to reduce the cardiometabolic and the cognitive decline risk, while further research of other preventive strategies may be warranted.     

Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

Responses to Persons with AIDS: Fear of Contagion or Stigma?1

Recently it has been argued that responses to persons with Acquired Immune Deficiency Syndrome (AIDS) are more a function of the association of AIDS with homosexuality than they are concerns about contagion. This research provided a further test of these arguments using an experimental design in which the target disease's contagiousness and association with homosexuality were manipulated. The results indicated that willingness to interact with a disease victim was strongly related to the contagiousness of the disease but only weakly related to its association with homosexuality. These findings are in line with recent research on lay conceptions of physical illness and argue that avoidance of disease victims, including persons with AIDS, primarily reflects concerns over contracting the disease. The implications of these findings for lay illness conceptions and how lay people respond to disease victims are discussed.     

Influence of life event stress on physical illness: substantive effects or methodological flaws?

This study tests the hypothesis that the reported relationship between life event stress and physical illness is primarily a function of criterion and other content contamination in the stress measure. In particular, conventional life event measures include events related to physical health, which overlap with the criterion; events related to neuroticism, which influences the criterion; and events that are vague or subjective and could be affected by individual differences in psychological distress, response sets, and retrospective bias. In this study 386 adult males and females completed standard measures of life events and physical illness. Illness was significantly related to event subscales containing, respectively, health-related events, neuroticism-related events, and subjective events, but not to an "uncontaminated" event subscale. These results support the hypothesis of contamination and suggest that alternative approaches to the conceptualization and measurement of stress may need to be developed.     

Concepts of health and illness: different constructs or variations on a theme?

Although health and illness concepts are thought to be important mediators of health and illness behaviors, little work has been done examining health concepts, and no research has examined the two conceptual structures simultaneously. This study examined concepts of health and illness in 218 adolescents between the ages of 11 and 18 years. Results were consistent with the hypothesis that concepts of health and illness are not opposite ends of a single health dimension, but reflect different and overlapping constructs. The degree of overlap varied as a function of age, with health concepts showing less emphasis on "the absence of illness" with greater maturity. The results suggest that models of health behavior that focus on illness avoidance neglect many components of health salient to lay persons.     

Lay knowledge of eyewitness behaviour: A British survey

One of the recent concerns in the study of eyewitness memory is how well lay knowledge, i.e. ‘common sense’, matches the findings of empirical research. A number of American and Canadian studies, some using questionnaire methodology, have found limitations in lay knowledge of eyewitness behaviour. Further studies have extended this general finding beyond the lay public–who are prospective jurors–to legal professionals such as lawyers and policemen. The present study utilized the Knowledge of Eyewitness Behaviour Questionnaire (KEBQ), an inventory used in previous studies, to replicate the North American studies with a British sample of students, including law students, and the general public. The results showed a great similarity between the North American and British samples' knowledge of eyewitness behaviour. A significant number of correct responses were made to eight of the 14 KEBQ items, with a significant number of incorrect responses to the remainder. It was also found that law students were no more knowledgeable than other subjects; that knowledge did not vary with age; and that previous experience as an eyewitness was not related to knowledge of eyewitness behaviour. In responding to some of the criticisms of questionnaire studies it is argued that the evidence is mounting in favour of the need for a recognized system to make jurors aware of the factors known to influence eyewitness testimony.     

常人疾病观及其对医患关系的影响

常人疾病观是普通人对于某一疾病的认知、解释和态度的集合。与专业医务人员相比, 普通人更关注心理、家庭和社会因素而非生物学因素的致病作用, 就医选择多元而并不遵循标准化的就医模式, 同时更愿意将疾病体验视为个人生活的特殊问题加以建构性理解。常人疾病观与科学医学观之间的不一致性可能降低患者的就医满意、对医信任和医嘱依从性, 从而影响治疗效果。立足中国社会的医学文化与医疗制度, 研究中国人的常人疾病观, 并探讨其对医患关系的影响作用与社会心理机制, 可为改善当下中国医患关系紧张现状提供有益建议。     

Health and behavior: The coming together of science and practice in psychology and medicine after a century of benign neglect

For thousands of years, physicians had available only a few drugs with which to minister to patients and the practice of psychology was an integral and therapeutically powerful component in the practice of medicine. Thus, good bedside medicine consisting of empathy, compassion, and a nurturant attitude toward the ill individual was a major component of the physician's armamentarium until relatively recently. However, the explosion in scientific knowledge in biology, physiology, chemistry, and microbiology which began a century ago and has continued through the twentieth century helped produce several generations of physician specialists and subspecialists with little knowledge of the powerful role psychological factors play in health and illness. As a result, practitioners of medicine and practitioners of psychology have had little or no contact during most of this century. However, as advances in microbiology, public health, and nutrition have eradicated many of the infectious diseases, infirmities associated with one's lifestyle have replaced the latter as the major causes of death today. One offshoot of this shift is that after a century of benign neglect, physicians and psychologists have rediscovered a common ground in the arena labeled health and behavior. Some factors responsible for these recent developments are highlighted.This article was an invited address delivered to a group of Japanese health psychologists as part of a Health Sciences Seminar in Tokyo on July 24, 1993. Concurrent with its publication here in English, it is being published in the Japanese language in the March 1994 issue of the journal,Japanese Health Psychology.     

Knowledge and expectations: Perceived illness in myocardial infarction patients

In a study of 367 patients with myocardial infarction (MI), questionnaires were developed to assess two central aspects of perceived illness: factual and consensual illness knowledge and subjective expectations for the personal consequences of the MI. In a factor analysis, these two aspects of perceived illness were found to load on separate factors, and the patients views of the personal consequences of the MI were only moderately associated with their general cardiac health knowledge. Among a series of sociodemographic, medical, and psychological variables, including a standardized in-hospital patient education programme, the two aspects of perceived illness also proved to have different determinants. Differences in factual and consensual illness knowledge were mainly related to differences in formal education, and this aspect of perceived illness was influenced by the standardized education programme. In contrast, differences in subjective expectations were associated with levels of hopelessness. The implications for psychosocial interventions in the rehabilitation of MI patients are discussed.     

绿色生活方式的结构与测量

基于前人研究,结合对241份访谈问卷进行内容分析,构建绿色生活方式由知、情、意、行四维度组成的理论假设,并依照该理论初步编制绿色生活方式量表。采用调查法回收有效问卷1051份,结果显示:量表的 Cronbach α系数为0.919,分半信度系数为0.876,0.868; 量表与各维度均存在显著的中高等相关,各维度间存在显著的中低等相关; 探索性因素分析的结果与理论构想基本一致,验证性因素分析结果表明模型拟合度良好; 此外,量表能较好区分环境态度与环保行为有不一致倾向的个体。因此,本研究制定的绿色生活方式量表具有较好的信效度,并可为区分“言行一致”或“言行不一”的个体提供一定参考。     

Undone Science and Counter-Expertise: Fighting for Justice in an Argentine Community Contaminated by Pesticides

ABSTRACT

STS and social movement scholars have shown the importance of ‘getting undone science done’ to advance the goals of social movements fighting environmental health injustice. The production and mobilization of counter-expertise, meaning the reliance on expertise, broadly construed, to contest regulatory decisions based on scientific knowledge, must be further analyzed by differentiating among types of expertise and strategies to mobilize them. In social mobilization against the unrestricted use of pesticides in Argentina, the affected community in Ituzaingó Anexo developed three types of expertise. The community first drew upon its own local knowledge of cases of illness and, as lay people, produced the first epidemiological map of this area. Then, they enrolled scientists and NGOs as allies to jointly learn about pesticide contamination as an explanation for illness. The enlisted scientists produced new knowledge by conducting environmental and epidemiological studies. Finally, sympathetic public health authorities, legal experts, and a district attorney designed a successful legal strategy to stop fumigations in that area and enforce local regulations. The case confirms the importance of producing undone science, and shows that its effectiveness can be explained by intertwined strategies deployed by a triad of lay/local, scientific, and legal experts to overcome the expertise barrier.     

Motivational factors in health and disease

Evidence is reviewed that measures of motive strength, as measured through content analysis of associative thought, are related to physiological systems, the functioning of which affect health outcomes. Studies show that affiliative and power motive syndromes assessed in associative thought are associated with health and illness. A relaxed or easygoing affiliative motive syndrome characterizes insulin dependent Type I diabetics and can, if aroused, lead to poorer blood sugar control in such diabetics. A stressed power motive syndrome is associated with sympathetic activation, release of stress hormones, depressed immune functions, and greater susceptibility to infectious diseases. Affiliative trust and a greater sense of agency as measured in associative thought content are associated with better health. An intervention study and a longitudinal study have demonstrated that differences in the levels of these motivational variables are not simply the result of illness but lead to alterations in subsequent health status.     

“You have to be mental to jump off a board any way”: Elite divers' conceptualizations and perceptions of mental health

ObjectivesMental health research in elite sport focuses predominantly on mental illness prevalence rates and help-seeking behaviours. Diving has been identified as a sport that generates particular challenges for maintaining mental health, yet has received scant attention from researchers. Therefore, purpose this paper explores what mental health and mental health related behaviours mean for a group of young, elite athletes as conditioned by their peculiar social context as elite athletes.MethodSemi-structured interviews were conducted with purposely sampled eight elite divers aged between 14 and 24 years with between 5 and 16 years of diving experience who have competed in international level diving competitions including Olympic, Common Wealth and World Cup competitions. Interviews were recorded, transcribed verbatim, and analyzed using inductive thematic analysis.ResultsAnalysis identified mental health literacy, experiences of mental health, risk factors, and opportunities for support as themes. Mental health generated negative connotations for participants attributable to knowledge development occurring through personal and vicarious experience of mental illness. Limited knowledge of symptoms of mental illnesses was evident. Participants identified a range of risk-factors inherent in their sport performance and culture revealing a performative and gendered dimension to mental health.ConclusionsOur results indicate the need to recognize the performative nature of mental health for elite divers and therefore social and cultural influences alongside biophysical. Greater efforts need to be made to help improve the overall mental health literacy of elite divers so they may be able to seek the support and treatment they need.     

Ethnic differences in illness perceptions,self-efficacy and diabetes self-care

This study assessed differences between Europeans, South Asians and Pacific Islanders in illness perceptions, self-efficacy, self-care, metabolic control and retinopathy in diabetes. We also evaluated the role of illness perceptions and self-efficacy in diabetes self-care and metabolic control within each group. A total of 86 Europeans, 86 South Asians, and 87 Pacific Islanders with type-2 diabetes completed self-report measures of illness perceptions, self-efficacy and self-care. Metabolic control and retinopathy data were collected from patient records. Results showed that Pacific Islanders and South Asians held shorter illness timeline perceptions compared to Europeans. Relative to both the other groups, Pacific Islanders also had elevated scores on three illness perceptions subscales: consequences, identity and emotional representations. They had lower medication-specific self-efficacy as well as poorer medication self-care, metabolic control and retinopathy. In all three groups, self-efficacy was fairly consistently related to self-care, but not to metabolic control. Illness perceptions were less consistently related to self-care, but were associated with metabolic control.     

A Mirror to Analysis

Three books written by psychiatrists for a lay audience are examined. Two are novels, and the third is a psychiatrist's account of the years of his psychiatric residency training. In all three books psychoanalysts are portrayed in negative roles, as arrogant, cold, uncaring, and even venal. The reasons why psychiatrists would portray analysis in this light are examined, and some ways in which psychoanalysts will need to re-examine their role in education and in their relationships with psychiatric colleagues in order to counteract this negative mirror are suggested.     

Stress,healthiness and health behaviours: An exploration of the role of life events,daily hassles,cognitive appraisal and the coping process

In a study of 220 participants, the relationship between life events, daily hassles, cognitive appraisal and coping, stress and general healthiness was investigated utilizing a self report methodology. The different aspects of healthiness and health behaviour/lifestyle appear to be related to different appraisal and coping styles. The role of daily hassles and life events in the process also vary across different aspects of health, illness and health behaviours. In fact the number of life events experienced appear to contribute more to hardiness than to vulnerability. It is proposed that to understand the process an integrative model is required which allows for flexibility in analysis.     

Dimensionality of women's career orientation

Two factor analytic studies were conducted in order to determine the dimensionality of women's career orientation defined by various extant measures. In Study I, 86 women employed by an insurance company responded to nine different measures of career orientation. A principal axis analysis produced two oblique factors, which were tentatively named Career Centeredness and Career Commitment, respectively. Study II sought to validate the factors found in Study I in a sample of 335 university women in various disciplines and at various class levels. Using the factor pattern from Study I as the target matrix, a restricted maximum likelihood factor analysis showed that two factors similar to those in Study I accounted for all the significant common variance. Based on both statistical criteria and psychological meaningfulness, the two oblique (r=.43) factors were again named Career Centeredness (lifestyle in which one's career is regarded as more important, time consuming, and satisfying than other aspects of life, particularly family) and Career Commitment (lifestyle involving continued employment throughout life stages regardless of financial need or competing obligations). These findings are discussed in the context of changing societal support for women's roles in business.This report is based on a portion of the first author's doctoral dissertation, supervised by the second author, done in the Department of Psychology of New York University.Both authors are currently at Merrill Lynch, 165 Broadway, New York, New York 10080.     

Demonizing and mental illness: The problem of identification,Hong Kong

Conclusions Our experience in the seminars and our study of the cases has encouraged us to believe that many Christian pastors, theological students, and lay leaders are open to a multiple causation explanation for demonizing and mental illness.At the same time we recognize that the depth and discernment of cases is very limited in our present experience. Our hope is that more definable criteria for demonizing and mental illness may be developed and that theories for spiritual discernment will be more closely related to clinical practice.Our most satisfying conclusion from the seminars was the willingness of students to think about demonizing and mental illness from a variety of viewpoints, to develop more inductive thinking and to begin the process of dynamic rather than behavioral approaches to these related forms of illness.     

The relationship between the need for closure and deviant bias: an investigation of generality and process

The need for closure predicts an evaluative bias against people whose opinions or behaviors deviate from those of other members of their social groups. In the present study, we investigated whether the relationship between the need for closure and deviant bias generalized to nonsocial stimuli, and we examined the process underlying this relationship. Sixty-one undergraduate students completed measures of the need for closure, the need for structure, intolerance for ambiguity, and the ability to be decisive and achieve cognitive structure. They then rated their liking for letters of the Latin alphabet ("A" & "B") whose locations were consistent and inconsistent with relevant categories ("A circle" and "B circle"). Participants liked category-inconsistent letters less than category-consistent letters. Measures related to the need for structure and closed-mindedness correlated positively with this deviant bias, whereas measures related to the ability to be decisive and achieve cognitive structure did not. These results imply that the relationship between the need for closure and deviant bias is a relatively basic and pervasive effect that is not unique to social deviance and is driven by the need for structure and closed-mindedness. Implications for social and nonsocial stimuli are discussed.