The prevention of depressive symptoms in rural Australian women

Two interventions aimed at preventing depressive symptoms in women living in Western Australian rural communities were evaluated against a no‐intervention control condition. The standard intervention was based upon traditional cognitive‐behaviour treatments for depression; the experimental intervention was based upon prevention strategies derived from the learned helplessness model of depression (e.g. Peterson, Maier, & Seligman, 1993 ). Seventy‐six women were randomly assigned to either the standard or the experimental group, and a further 20 women formed a no‐intervention control group. The standard group showed a reduction in depressive symptoms at post‐test, but no effects at 6‐week or 6‐month follow‐ups. In contrast, a reduction in depressive symptoms did not appear for the experimental group until the 6‐week follow‐up at which time a less depressive attributional style was also evident; these effects were even more pronounced at the 6‐month follow‐up. The no‐intervention control group showed no changes across time. It is argued that these results support the applicability of prevention strategies based on the learned helplessness model to this population. Copyright © 2003 John Wiley & Sons, Ltd.     

Interventions to prevent skin cancer: Experimental evaluation of informational and fear appeals

Abstract

Reports experimental and correlational analyses of intentional sunbathing in 82 female and 54 male suntanned adults at high-risk of skin cancer. Random assignment to high or low information conditions allowed evaluation of a widely-distributed American Cancer Society pamphlet. A crossed manipulation assigned subjects to a cancer fear/no fear condition. Personality variables served as correlational predictors of sunbathing attitudes, intentions, and information-seeking behaviors; skin cancer knowledge served as both a predictor and a dependent variable. Skin cancer knowledge, but not fear, emerged as a significant predictor of attitudes, intentions, and behaviors; and simple provision of information affected relevant knowledge. Contrary to the limits often encountered with health behaviors, specific cancer education appears to be somewhat effective in this domain, though indirectly. High risk-taking personalities were less likely to have or seek relevant information, suggesting the need to take into account individual predispositions and routes of knowledge acquisition when designing interventions.     

Frequency and impact of trauma in older women: A military and nonmilitary sample

Understanding the impact of trauma on late-life functioning in older females is needed in order to provide best care. We explored the impact of trauma on late-life psychological and physical health and functioning among older women (n = 48) who served in the military, or participated in a military lifestyle. Eleven of these women were not veterans, but married to military personnel. Number of traumatic exposures and types of events experienced was associated with increased trauma symptom severity. Trauma symptom severity was associated with decreased physical functioning and increased pain. Increased numbing and avoidance was significantly associated with poorer physical functioning and increased pain. Older women in this study remained at risk of experiencing negative consequences of trauma in terms of increased quantity and severity of trauma symptoms and physical decline and pain. Clinical and research implications are discussed.     

Homeless women and their families: Characteristics,life circumstances,and needs

This study investigated the needs of a sample of 100 women from shelters for the homeless in Richmond, Virginia. The women's responses to a 117-item interview were used to obtain information regarding their domicilary status, work history, educational background, family and health history, social support, reasons for homelessness, and social service needs. The results indicated that a significant number of the women had moved as many as six times within the past five years for various reasons, including domestic violence, interpersonal conflict, overcrowding, and eviction. Many women were high school graduates and had job skills in the health care, educational, and clerical fields. Most women were raised by their natural or extended family and the majority of them had a friend or family member who provided social support. Identified needs included housing, food, clothing, and transportation. The needs of homeless women and their children were different from the needs of the homeless chronically mentally ill and require specialized services as well as an increase in the available number of low-income housing units.     

Girls,their fathers,and their mothers: Patterned links to ambition and prohibition in women

Abstract

This paper explores the dilemmas women face when they strive to achieve. It is about why women have trouble with their own deeply held ambitions, how patterns of interaction with important others are internalized in their childhood years that render their own strivings for power unacceptable to them, and how this early sense of prohibition against achievement is reinforced by the larger social and cultural surround. I contend that these interdictions against success are held by the female both in and out of her awareness, and are evoked in situations that trigger pathogenic memories in ever more complex ways. I explore current concepts about gender and gender formation, in particular the ideas of Adrienne Harris articulated in her book, Gender as Soft Assembly. Two clinical cases are described in order to explore and illustrate these issues, one a child and the other an adult.

Estelle Shane. Mädchen, ihre Väter und Mütter: Verbindende Muster zu Erfolgsstreben und Verboten im Leben von Frauen.

Dieser Aufsatz untersucht das Dilemma von Frauen, die nach Erfolg streben. Es geht Frauen, bei denen die Wünsche nach Erfolg in der Tiefe verborgenen sind. Die Muster von internalisierten Beziehungen mit wichtigen Bezugspersonen aus der Kindheit verhindern, dass sie das eigene Streben nach Macht akzeptieren können. Dieses Verbot von Erfolgsstreben ist verstärkt durch die sozialen und kulturellen Verhältnisse in denen sie leben. Im Hin und Her zwischen Bewusstwerdung und Verdrängung der Konflikthaftigkeit von Erfolgsstreben, können Erinnerungen an frühere pathogenene Konflikte ausgelöst werden. Gängige Konzepte der Entstehung von Geschlechtsidentität werden untersucht, speziell die Ideen von Adrienne Harris aus ihrem Buch: “Gender as soft Assembly”. Zwei klinische Fälle werden zur Illustration untersucht, der eines Kindes und der eines Erwachsenen.

Estelle Shane. Las niñas, sus padres, y sus madres: Patrones ligados a la ambición y la prohibición en las mujeres.

Este trabajo explora los dilemas que las mujeres enfrentan cuando luchan por lograr. Trata del porque las mujeres tienen problemas con sus ambiciones más profundamente sostenidas, cómo los patrones de interacción con otros son internalizadas en sus años de infancia, y dan cuenta de sus propias luchas por el poder, inaceptables para ellas, y cómo esta sensación temprana de prohibición en contra del logro es reforzado por el ambiente social y cultural que les rodea. Estas prohibiciones en contra del éxito son sostenidas por las mujeres tanto con o sin conciencia y son evocadas en situaciones que apuntalan recuerdos patogénicos en formas más complejas. Exploro conceptos actuales sobre la formación del género, en particular las ideas de Adrienne Harris articuladas en su libro, Gender and soft Assembly. Dos casos clínicos son descritos para explorar e ilustrar estos aspectos, uno se trata de una niña y otro de una mujer adulta.     

Life values and mental health: A longitudinal study comparing chronically ill women to women without chronic disease

We tested the hypothesis that among women who are chronically ill, a re-ordering of life values maintains mental health. A community-based prospective longitudinal study was conducted in which data were obtained from 601 women in 1986, when the women were with mean age 42 and again in 2003, when the women were with mean age 58. There was a significant change in life values as women aged with more change among women with chronic disease (n = 476) than those without chronic disease (n = 125). Increased valuation of intrinsic life values (health and love) and decreased valuation of extrinsic life values (power, fame and attractiveness) were associated with subsequent better mental health for women with chronic disease, but not for those without chronic disease.     

Health psychology and uptake of preventive health services: A review of 30 years' research on cervical screening

Abstract

A review of thirty years' research in cervical screening was conducted to assess the role of social and psychological factors in screening utilisation. The role of age, social class, attitudes towards and beliefs about screening as well as social influence and personality variables are considered. A reanalysis of reasons for non-attendance following an invitation for screening from ten previous studies is presented and the importance of theoretical accounts of service utilisation in this area are assessed. Research findings show significant associations for both demographic and psychological factors though poor operationalisations and statistical analyses in previous research make difficult the assessment of their importance as additive, interactive or mediational variables. The significance of service provision issues in terms of both providers' behaviour and the flexibility of delivery is highlighted. The need for further research using a theoretical framework which can unify demographic, psychological and service provision variables is identified.     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

Mental Health among Youth in South Australia: A Survey of Flourishing,Languishing, Struggling,and Floundering

The Complete State Model of Mental Health was used to describe the prevalence of flourishing, languishing, struggling, and floundering in life in a sample of young South Australians (n = 3,913; 13–17 years, 52% female). Categorisation was based on the relative proportion of mental health and mental illness symptoms reported on standardised measures and the association of these categories to health‐risk behaviour. Variability in categories and health‐risk behaviour due to gender or region was investigated. Results indicated that a disturbingly small proportion of adolescents (<50%) were flourishing in life, that poorer states of mental health were associated with increased health‐risk behaviour, and that the propensity to engage in health‐risk behaviour did vary by gender and region. The current study extends the platform from which positively focused mental health strategies can be tailored and launched to meet the mental health needs of adolescents.     

HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings

HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman–infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman–infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.     

The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

Embodying sexual subjectivity after cancer: A qualitative study of people with cancer and intimate partners

Research has increasingly recognised the profound impact that cancer can have upon embodied subjectivity. However, there has been little acknowledgement of the centrality of sexuality to subjectivity, and marginalisation of the experiences of intimate partners of people with cancer. This Australian qualitative study explores the post-cancer experiences of embodied sexual subjectivity for 44 people with cancer (23 women and 21 men) and 35 partners of people with cancer (18 women and 17 men) across a range of cancer types and stages. Semi-structured interviews were analysed with theoretical thematic analysis, guided by a post-structuralist approach to sexual subjectivity as a dynamic process of becoming that can change over time, and by Williams’ [(1996). The vicissitudes of embodiment across the chronic illness trajectory. Body and Society, 2, 23–47] framework on post-illness embodiment. Participants took up the following post-cancer subject positions: ‘dys-embodied sexual subjectivity’ – characterised by bodily betrayal, sexual loss, lack of acceptance, depression, and anxiety; ‘re-embodied sexual subjectivity’ – characterised by greater sexual confidence, acceptance, the exploration of non-coital sexual practices and increased relational closeness; and ‘oscillating sexual subjectivity’ – involving a shift between states of sexual dys-embodiment and sexual re-embodiment. The findings point to the importance of focusing on the sexual health of people with cancer and partners across the cancer trajectory.     

Auditory and visual hallucinations in a sample of severely mentally ill Puerto Rican women: an examination of the cultural context

The content, interpretation, and structure of hallucinations experienced by individuals with severe mental illness are influenced by the culture of the individuals who experience them. We analyzed the content of visual and auditory hallucinations of 53 Puerto Rican women in northeastern Ohio with a diagnosis of a severe mental illness (SMI) who were participating in a study of HIV risk among Hispanic women with SMI. Compared to non-hallucinators, hallucinators had lower global assessment of functioning scores and greater suicidality. Hallucinations reflected three themes: religious themes, command hallucinations, and unidentifiable voices. Hallucinators’ subjective experience of their hallucinations ranged from a sense of security to significant distress. Participants developed a wide range of strategies to deal with threatening hallucinations. Provider response to individuals’ experience appeared to impact the quality of the patient–provider relationship. We recommend the inclusion of religious history in the initial assessment of individuals. This will assist the provider in making an accurate diagnosis, distinguishing between religious beliefs and those that reflect underlying pathology, and in increasing the level of cultural competence of the care provided. Religious and spiritual beliefs that provide a source of hope and strength for the patient can be utilized to expand and enhance the patient's coping strategies.     

Family routines and rituals in the context of chronic conditions: A review

This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed‐methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of family's routines and rituals. Second, these whole‐family interactions held important functions for individuals and families, constituting strategic resources in the condition's management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family‐centered care approach to the understanding and treatment of chronic conditions.     

Expulsion prevention: Framework for the role of infant and early childhood mental health consultation in addressing implicit biases

Young children of color—especially boys—are at disproportionate risk for suspension and expulsion from early care and education settings. Infant and Early Childhood Mental Health Consultation (IECMHC) is an approach associated with lower than expected expulsion rates, but the mechanisms through which it may influence preschool expulsion are unknown. This paper reflects on the parallels between IECMHC and interventions created to reduce implicit bias. Based on interviews with leaders in IECMHC practice, implementation, and evaluation, a theoretical framework was created to articulate how IECMHC is hypothesized to affect expulsion by first reducing the influence of implicit bias on disciplinary decisions. Implications for practice and research are provided.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

Quality of life and mental health among women with ovarian cancer: examining the role of emotional and instrumental social support seeking

The purpose of the present study was to examine the role of emotional and instrumental social support seeking in the quality of life (QOL) and mental health of women with ovarian cancer. Participants were recruited through the Pennsylvania Cancer Registry, and one hundred women took part in a mail questionnaire that collected information on their demographics, medical status, social support seeking, QOL and mental health including anxiety, depression and stress. Hierarchical linear regression analyses were conducted to assess the influence of emotional and instrumental social support seeking on QOL and mental health. After controlling for remission status, greater emotional social support seeking was predictive of higher overall QOL, social/family QOL, functional QOL and lower depression scores. Instrumental social support seeking was not significant in the models. The results illustrate that social support seeking as a coping mechanism is an important consideration in the QOL and mental health of women with ovarian cancer. Future studies should examine the psychological and behavioral mediators of the relationship to further understand the QOL and mental health of women with ovarian cancer.     

Using found poetry to illuminate the existential and posttraumatic growth of women with breast cancer engaging in art therapy

Arts-based research (ABR) is an expanding methodological genre, which adapts the tenets of the creative arts to make social science research accessible, evocative, and engaging. It crosses the boundaries of both art and science, but has made few inroads within the discipline of psychology. This article describes a pilot project examining how art-making shaped the trajectories of women diagnosed and treated for breast cancer. Using ABR as a way of distilling the findings, we demonstrate how experiences of existential and posttraumatic growth can be understood more intensely and profoundly through found poetry. Found poems (excerpts from interviews reframed as poetry) offer a richer, more meaningful, and potent evocation of themes than traditional coding categories. Poetry permits the voice of the participant to be more clearly heard and allows the reader to access deeper insights and understandings of the complexities of growth through adversity.     

Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk

This study evaluates the contents of representations of skin cancer risk and their associations with risk appraisals, worry, and protection intentions and behaviors. The Assessment of Illness Risk Representations (AIRR) was used to measure conceptual and imagery contents of risk representations, as delineated by the Common-Sense Model. University students (N?=?120) completed the AIRR; measures of likelihood and severity appraisals, and worry; and measures of skin self-examination, clinical skin examination, and sun protection intentions and behaviors. Beliefs about identity, causal, and timeline risk were positively associated with likelihood appraisals, whereas consequences and timeline risk beliefs were positively associated with severity appraisals. Identity and timeline risk independently predicted worry. Representational attributes, including imagery vividness and valence, independently predicted intentions and behaviors, whereas likelihood and severity appraisals did not. Symptom imagery interacted with worry to predict detection and prevention intentions: worry predicted greater intentions for participants with symptom imagery but not for those without symptom imagery. The findings support the utility of the AIRR for assessing risk representations and identify ways in which risk representations may guide protective behavior.