Family participation in the care of patients in public health disasters

The ethical implications of disaster planning garner increasing scrutiny. The role of families in disaster efforts is a topic that requires additional ethical examination. This article reviews the potential roles for families before and during disasters, with particular attention to the impact on children and vulnerable elderly patients. The potential positive and negative impact of family participation in different aspects of healthcare and disaster efforts is assessed.     

Re-evaluating the therapeutic misconception: response to Miller and Joffe

Responding to the paper by Miller and Joffe, we review the development of the concept of therapeutic misconception (TM). Our concerns about TM's impact on informed consent do not derive from the belief that research subjects have poorer outcomes than persons receiving ordinary clinical care. Rather, we believe that subjects with TM cannot give an adequate informed consent to research participation, which harms their dignitary interests and their abilities to make meaningful decisions. Ironically, Miller and Joffe's approach ends up largely embracing the very position that they inaccurately attribute to us: the belief that, with some exceptions, it is only the prospect of poorer outcomes that should motivate efforts to dispel TM. In the absence of empirical studies on the steps required to dispel TM and the impact of such procedures on subject recruitment, it is premature to surrender to the belief that TM must be widely tolerated in clinical research.     

Necessity, Sufficiency, and Perspective Effects in Causal Conditional Reasoning

A growing body of research indicates that in causal conditional reasoning, the conclusion that P is necessary for Q is suppressed where alternative conditions for Q are available. Similarly, the conclusion that P is sufficient for Q is suppressed where disabling conditions for P or additional requirements for Q are available. This paper describes experiments in which these factors were used to produce 'perspective effects' in causal contexts that appear identical to the perspective effects found in previous research with deontic tasks. It is therefore proposed that deontic perspective effects are themselves also attributable to the influence of pragmatic factors upon perceived necessity and sufficiency. A generalized theory based on a modification of the mental model theory of deontic reasoning is presented, which accounts for perspective effects across the two domains.     

Legal briefing: Crisis standards of care and legal protections during disasters and emergencies

This article outlines current safe harbors in the law for healthcare practitioners who work in a disaster setting. It reviews available legal protection in crisis situations with respect to the Emergency Medical Treatment and Labor Act (EMTALA), criminal liability, and licensure.     

Religions, natural hazards, and disasters: An introduction

This editorial serves as an introduction to the special issue of Religion on Religions, Natural Hazards, and Disasters. It sets out some conceptual background and briefly reviews the existing literature on religion, natural hazards, and disasters. It also provides a brief assessment of the role of religious and groups in reducing the risk of disasters.     

Mental health care for ethnic minority individuals and communities in the aftermath of disasters and mass violence

Findings from research on psychiatric epidemiology, disaster effects, discrepancies in service use, and cross-cultural psychology are reviewed to generate guidelines for culturally responsive postdisaster interventions. Ethnicity and culture influence mental health care at various points: on need for help; on availability and accessibility of help; on help-seeking comfort (stigma, mistrust), and on the probability that help is provided appropriately. There are aspects of disaster mental health practice that may ameliorate many of barriers that contribute to ethnic disparities in service use. It is proposed that interventions should give greater attention to socially engaged emotions and functioning. To promote disaster recovery, practitioners are advised to: assess community needs early and often; provide easily accessible services; work collaboratively and proactively to reduce stigma and mistrust and engage minorities in care; validate and normalize distress and help-seeking; value interdependence as well as independence as an appropriate developmental goal; promote community action; and advocate for, facilitate, or conduct treatment and evaluation research. Notwithstanding the pain and stress they cause, disasters create opportunities to de-stigmatize mental health needs and build trust between providers and minority communities.     

Robustness and Sufficiency of the Theory of Reasoned Action in Longitudinal Prediction

An examination of the theory of reasoned action (Fishbein & Ajzen, 1975) applied to longitudinal data is reported. Data consist of responses of a national sample of high school sophomores concerning their college plans and subsequent achievements. Subjects initially were queried in 1955 and followed up 15 years later. Measurement robustness of the theory constructs was evidenced by confirmation of the predicted relationships despite novel and crude measures. The predictive utility of the theory was demonstrated in substantial prediction of both college attendance (2-3 years subsequent to the measures) and the ultimate level of education attained in the following 15 years. The sufficiency claims of the theory were challenged by the finding of a direct subjective norm-behavior relationship unmediated by intention. The impact of two exogenous, demographic predictors was mediated by this expanded model.     

The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Disability and disasters: the role of self-efficacy in emergency preparedness

Although individuals with physical disabilities have special needs regarding preparedness for a natural or human-made disaster, little is known about the factors involved in motivating members of this population to engage in behaviors which reduce the probability of negative health outcomes. This study proposes and empirically tests an integrated theory-based model for individuals with physical disabilities in which perceived self-efficacy for emergency preparedness moderates the relationship between perceived threat and emergency preparedness behaviors. A nationwide convenience cross-sectional sample of 294 adults self-identifying as having a physical disability completed an online survey. The general linear model was used to assess the effects on preparedness of perceived threat, perceived self-efficacy, and their interaction. In addition to the hypothesized moderating effect of self-efficacy, it was found that minimal (if any) relationship exists between perceived threat and preparedness among those who reported low levels of self-efficacy. Results suggest that self-efficacy and perceived threat operate jointly to motivate individuals with physical disabilities to take precautionary steps to reduce the consequential adverse health effects of natural and human-made disasters. These findings have important implications for the design of effective interventions for individuals with disabilities.     

Identity, place, and bystander intervention: social categories and helping after natural disasters

The authors developed a Self-Categorization Theory (SCT) approach to bystander behavior. Participants were 100 undergraduates at an English university. The authors made either a European or a British identity salient. Participants then rated their likelihood of offering both financial and political help after natural disasters in Europe and South America. When European (but not British) identity was salient, participants were less likely to offer help for disasters in South America than Europe. They were also more likely to offer financial help after disasters in Europe when European non-British identity was salient. There were no differences in levels of emotional response to disasters by identity salience. Results indicate that social category relations rather than geographical proximity or emotional reaction are most important in increasing helping behavior after natural disasters.     

Risk communication of terrorist acts, natural disasters, and criminal violence: comparing the processes of understanding and responding

Risk communication is an important vehicle for the scientific understanding of the perception of and response to various kinds of threats. The present study provides apparently the first empirical attempt to compare perceptions, decision‐making, and anticipated action in response to threats of three kinds: natural disaster, violent crime, and terrorism. A total of 258 college undergraduates were surveyed using a vignette‐based, 2 × 2 × 3 between‐subjects design that systematically manipulated threat imminence (high vs. low), risk level (high vs. low), and nature of the threat (natural disaster vs. crime vs. terrorism). There were substantial differences in participants' perceptions and reported actions in response to natural disaster, relative to the other domains of risk, under conditions of high risk. The risk of natural disaster was more likely to lead participants to report that they would change their daily activities and to relocate. It was also more likely than terrorism to lead to action securing the home. It appears that the mechanisms for perception, decision‐making, and action in response to threats cannot be generalized in a straightforward way across these domains of threat. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological care demand in clinical practice: treatment and results

With the aim of describing the usual clinical context as opposed to the academic or research context, the characteristics of patients and psychological treatments applied in a sample of 856 patients from the Clinic of Psychology of the Complutense University is analyzed. The disorders that require attention, the characteristics of the therapists and their interventions are identified. Out of the total patients, 24.3% withdrew from treatment; 68.3% of the patients who started treatment completed it with therapeutic success. 83% of patients were assessed in 4 sessions or fewer (median=4). 75.3% of patients who finished the treatment received 18 or fewer treatment sessions (median=11). The generalization of the results and their implications for professional clinical practice and for training clinical psychologists are discussed.     

The Impact of Necessity and Sufficiency in The Wason Four-Card Selection Task

Performance in the Wason card selection task is often improved given thematic content. Such content effects have been considered evidence against human rationality. We propose that the role of content lies in specifying premises underlying "if P, then Q" rules. Unlike thematic rules, abstract conditional rules do not explicitly provide material interpretation (P is a sufficient but not necessarily a necessary condition for Q), resulting in nonnormative responses. When necessity–sufficiency relations were explicated, normative responses were elicited and effects of other logically irrelevant components disappeared. The results suggest that content effects are compatible with human rationality.     

Resilience of children in disasters: A multisystem perspective

Interest in resilience is surging in research, policy and practice as threats from disasters rise and humanity confronts a global pandemic. This commentary highlights the importance of defining resilience for portability across system levels and disciplines in order to integrate knowledge and prepare adequately for the challenges posed to children and youth by multisystem disasters. A scalable definition of resilience is recommended: The capacity of a dynamic system to adapt successfully to challenges that threaten the function, survival or development of the system. Major determinants of adaptation among young people in the context of disaster are highlighted, including variations in adversity exposure dose, developmental timing, individual differences and the socio-ecological systems of children's lives that can be mobilised in response. Adaptation of children in disasters depends on the resilience of interconnected systems, including families, schools, communities and policy sectors. Implications of a multisystem perspective for disaster risk reduction and preparedness are discussed with a focus on nurturing the resilience of children and their societies for challenges in the near term and long into the future.     

Personal privacy in the health care system: employer-sponsored insurance, managed care, and integrated delivery systems

Widespread collection and use of identifiable information can promote social goods while, at the same time, infringing on personal privacy. Information systems are developing within the context of a fundamental transformation in the organization, delivery, and financing of health care. Changes in the health care system include rapid development of employer-sponsored health coverage, managed care organizations, and integrated delivery systems. These complex, multifaceted arrangements for delivering and paying for health care require ever-more-sophisticated information systems that facilitate extensive sharing of personal data. Systemic flows of sensitive health information occur both vertically and horizontally among employers, hospitals, insurers, laboratories, and suppliers. Beyond this complex web of vertical and horizontal sharing are the multiple demands for information management, quality assurance, research, governmental regulation, and public health. Theoretical problems exist with the law and ethics of informational privacy. The traditional method of exercising control over personal health information is through informed consent. Informed consent, however, within a modern health information infrastructure becomes highly complex. In this kind of environment, the doctrine of informed consent is flawed and does not provide sufficient control over personal information to assure adequate protection of privacy.     

Managing antidepressants in primary care: physicians' treatment modifications

To examine antidepressant management practices in primary care, patients (N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI-II), the Patient Health Questionnaire-9 (PHQ-9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.