Qualifying Confidentiality Obligations

Objectives : To test the range of beliefs regarding the ethics of testing, in resource poor settings, new therapies that are less efficacious but more affordable and feasible than the best current therapeutic standard.

Design : Using a web-based survey, we presented a hypothetical scenario proposing to test a therapy for HIV disease ("therapeutic inoculation") known to be less efficacious than highly active antiretroviral therapy (HAART). Respondents evaluated various trial designs as ethical or unethical.

Participants : 604 subscribers to two listservs for individuals interested in international health research ethics.

Main outcome measures : Proportion of respondents endorsing trials testing this "substandard" therapy, and proportion endorsing placebo-controlled trials.

Results : There were 215 respondents from 47 countries. Forty-five percent of respondents were from low or middle income countries; 96% devoted at least some time to research activities; and 75% had "some" or "considerable" research experience in developing countries. Of respondents, 97% (95% CI 94.7 to 99.4) endorsed testing therapeutic inoculation, without HAART, in patients with HIV disease; 86% (95% CI 81.4% to 90.7%) endorsed testing against placebo. Sixty-eight percent explicitly endorsed principles where the standard of care for subjects in clinical trials is determined by local, not universal, standards. There were no differences in responses based on respondent education-level or the income-level of their country of citizenship.

Conclusion : There was broad agreement that a therapy of potential local benefit may be tested, even when that therapy is known to be inferior to the standard of care in wealthy countries. Most agreed that a placebo control may be used in some circumstances.     

Expanding Roles: A Survey of Public Health Genetic Counselors

According to the 2008 National Society of Genetic Counselors (NSGC) Professional Status Survey (PSS), 31 genetic counselor respondents reported spending at least 50% of their time in the area of public health. The NSGC Public Health Special Interest Group (PHSIG) had 49 dues-paying members in 2009. The purpose of this study was to identify the work settings and public health activities in which genetic counselors participate. A novel online survey was disseminated over the NSGC PHSIG Listserv. Forty-one percent (n = 13) of public health genetic counselor respondents worked in a university medical system, while 53% (n = 17) were grant-funded and held a non-clinical appointment. The most common public health activities included educating healthcare professionals (82%) and community members (61%), research (55%), grant writing (55%) and grant administration (36%). Most respondents (82%) reported learning certain public health skills outside of their genetic counseling training programs. Differences in work settings were found, with a significantly greater percentage of public health genetic counselors working in government agencies. Genetic counselors have opportunities to become involved in public health activities as the scope of public health genetics grows. Furthermore, genetic counseling competencies are compatible with the Institute of Medicine’s “10 Essential Public Health Services.” The NSGC and genetic counseling training programs are encouraged to offer more public health learning opportunities for genetic counselors and genetic counseling students interested in this specialty area.     

Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.     

Whose Decision is it? Organ Donation Attitudes Among Young UK South Asians

A questionnaire study examined organ donor card holding rates and attitudes to organ donation among young adult British South Asians and Whites attending institutions of higher education in the UK. There were 382 respondents (166 male, 216 female, average age 21.8 years): 107 Indian (Hindu or Sikh), 104 Pakistani/Bangladeshi (Muslim) and 171 White (Christian or of no religion). Overall, 33% of White but only 9% of South Asian respondents had a donor card. Among Whites, only 6% thought their parents would find it emotionally very upsetting to discuss organ donation, and of the White card holders 70% had told their parents that they had a card. In contrast 18% of Indians and 52% of Pakistanis/Bangladeshis thought that their parents would find it emotionally very upsetting to discuss organ donation, and only 39% of South Asian card holders had told their parents that they had a card. Finally, 41% of White, 54% of Indian and 91% of Pakistanis/Bangladeshi respondents doubted that they would take steps to obtain an organ donor card. White respondents proffered inertia as the main explanation for their not being likely to get a card. The factors underlying South Asian respondents not planning to obtain a card were more varied and included disinterest, emotional distaste, family opposition and religion. These reasons can be interpreted as relating to an interdependent conception of self and donor decisions being a family as well as an individual matter.     

Developing practice in a context of religious faith: A study of psychotherapists who are Quakers

Nineteen Quakers who are also counsellors or psychotherapists were interviewed in a qualitative pkenomenological study about the impact, if any, of their spiritual beliefs on their work. The research was conducted using an approach based on Moustakas' heuristics. The spiritual faith of the therapists impacted on their work in several ways: their sense of their own spiritual journey helped them understand their clients' spiritual journey; their spiritual faith underpinned their work; it gave them something extra, which included inspiration, spiritual preparation before and between therapy sessions, and prayer; and for a minority of respondents there were conflicts which were sometimes expressed in supervision. The implications of these findings are explored in relation to training, supervision, and the secular settings in which these therapists mosdy worked.     

Einstellungen zu Psychotherapie

In a representative survey 2,129 subjects were questioned about their attitudes towards outpatient psychotherapy. This study was carried out on behalf of the Apotheken Umschau (Pharmacy Review) by the “GfK Nürnberg” (Society for Consumer Research Nuremberg) from January 2012 to February 2012. In the survey also people who had once received or were currently undergoing outpatient psychotherapy took part and these respondents were surveyed about their reasons for seeking treatment and their experiences with outpatient psychotherapy. When available results were compared with the findings from a survey carried out in 2003. The majority of respondents appraised psychotherapy as being essential and helpful in treating mental disorders and as being useful in personal crises. Women were more open-minded about psychotherapy than men; nevertheless 34 % considered that it would be embarrassing if neighbours or friends were aware that they were undergoing psychotherapy. Of the respondents 28 % categorically excluded psychotherapy for themselves, 216 declared that they had undergone psychotherapy and of the latter 83 % judged the psychotherapy to be successful.     

Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

Self-reported job responsibilities of public school adapted physical educators

The purpose was to survey adapted physical educators, teaching in the public schools, concerning the nature of their work and the percentage of time spent weekly in 14 specific job roles or responsibilities. Of 102 respondents solicited from national conferences, 66 teachers representing 20 states provided usable data. Most respondents worked in urban settings (77%), served an average of 8 schools per week, had an average caseload of 76 students, and saw each student an average of two times a week. Percentages of time spent each week were greatest in direct instruction (43%), traveling (9%), planning instruction (9%), and assessing students (7%). Findings were similar to those reported previously and discussed in relation to job competencies taught in university classes designed to prepare specialists in adapted physical education.     

Causal Attributions,Perceived Control,and Psychological Adjustment: A Study of Chronic Fatigue Syndrome1

Causal attributions control, beliefs, and helpful and unhelpful support attempts were examined among people experiencing chronic fatigue syndrome (CFS) and their close others. Results revealed that 84% of respondents with CFS believed that their illness was due, at least in part, to physical or external causes, whereas 47% mentioned internal/psychological causes. Reports of internal causal attributions for CFS were positively correlated with indicators of poor psychological adjustment among those with CFS. Having an external locus of control (i.e., to powerful others) was also associated with poorer psychological adjustment among respondents with CFS. Close others' causal attributions to internal factors were related to frequency of self‐reported unhelpful support attempts and to reports of depression and anxiety those respondents with CFS.     

Attitudes Toward Cystic Fibrosis Carrier and Prenatal Testing and Utilization of Carrier Testing Among Relatives of Individuals with Cystic Fibrosis

A questionnaire and an offer of free carrier testing was mailed to 173 relatives of individuals with CF. The questionnaire addressed their knowledge of clinical and genetic aspects of CF, as well as their attitudes toward carrier testing, prenatal diagnosis, and pregnancy termination for CF. Eighty-one individuals returned the questionnaire (47%) and 50 elected carrier testing (29%). Most respondents underestimated their carrier risk (60%), but overestimated their risk to have a child with CF (63%). Most (93%) indicated they would utilize carrier testing, and 70% would use prenatal testing; however, only 7% would consider terminating a pregnancy for CF. The intention to use prenatal testing was correlated with the perceived health of the proband and whether the respondent was planning to have (more) children. The acceptability of abortion was correlated with the respondent's perceived impact or burden of CF.     

An innovative approach to clinical communication in schizophrenia: the approaches to schizophrenia communication checklists

Side effects from antipsychotic medications can have a profound effect on patients' lives and may adversely affect their willingness to comply with treatment. Identification of side effects through improved communication between psychiatrists, other members of the healthcare team, and their patients might increase treatment compliance. The Approaches to Schizophrenia Communication (ASC) Steering Group developed two simple, practical checklists for use in the busy clinical setting. The ASC-Self-Report (ASC-SR) checklist is completed by the patient and comprises a list of the more common or clinically important side effects of antipsychotic treatment. The ASC-Clinic (ASC-C) checklist is completed by both clinician and patient together, being used as the basis for a semi-structured interview. In a multicenter pilot study set up to evaluate the utility of checklists, 86% of patients responding considered the ASC-SR to be useful in communicating their problems to psychiatrists and other members of the healthcare team. All healthcare team respondents found both checklists to be helpful when discussing side effect problems with their patients. Moreover, 41% and 47% of healthcare team respondents reported that the ASC-SR and ASC-C, respectively, had assisted them in identifying side-effect problems not previously acknowledged. Preliminary evaluation of the ASC-SR and ASC-C in this multicenter pilot study suggests that both tools were user-friendly, encouraged communication between patients and healthcare professionals about antipsychotic drug side effects, and could readily integrated into everyday clinical practice.     

Science and behavior therapy: A survey of research in the 1970s

A representative sample of a decade of contributors to the journals Behavior Therapy, Behaviour Research and Therapy, Journal of Applied Behavior Analysis and the Journal of Behavior Therapy and Experimental Psychiatry was asked to report on their motivations for conducting studies that had been published in that journal. Results indicated that the primary motivation of behavioral researchers was to build on prior research through gathering and analysis of data to illuminate applied-clinical issues and validate treatment procedures. Few researchers reported consultation arrangements or efforts to replicate as their motivation for research. Most respondents described the training model in which they had received their doctoral education as oriented toward a scientist-practitioner approach rather than one that focused primarily on research, therapy or assessment training. Most respondents noted that their philosophy of behavior therapy at the time of the study in question to be applied behavior analysis or social-learning theory with far less being affiliated with a neobehavioristic mediational S-R model or cognitive behavior modification. These results are discussed within the context of the relevance of clinical research in behavior therapy and professional psychology.     

Psychological Support for Children with Diabetes: Are the Guidelines Being Met?

The significant role of psychosocial factors in the management of type 1 diabetes in youth has been well documented. The International Society for Pediatric and Adolescent Diabetes (ISPAD) therefore published the Clinical Practice Consensus Guidelines for psychological care of young patients. However, it is unclear if and how these guidelines are being implemented. A questionnaire was created to assess implementation of the guidelines and directed to physicians through the ISPAD listserve via a web-based survey. One hundred fifty-five participants from 47 countries completed the survey. Ninety-six percent of respondents reported that they work in a team with other professionals, and 95 % of teams discuss psychological difficulties associated with diabetes management. Seventy-two percent of respondents reported having “easy access” to a mental health specialist (MHS). In 56 % of practice settings, the MHS is considered to be part of the team; 43 % participate in routine clinic visits and 26 % see all patients. Seventy percent screen for psychological problems and 57 % assess family functioning. Psychosocial or behavioral interventions addressing psychosocial and regimen adherence difficulties are offered by 79 % of teams. Psychological care is available for many children with diabetes worldwide. Yet, nearly 30 % of teams do not have access to a MHS. More training in the recognition of psychosocial problems and counseling skills is warranted. More advocacy is needed to increase availability and utilization of psychological services in routine diabetes care.     

Are immigrants in the nursing industry at increased risk of bullying at work? A one‐year follow‐up study

The purpose of this study was to explore whether (a) immigrant health care workers (HCW) are more at risk of bullying at work than Danish staff members, (b) this association is increased by previous exposure to bullying and (c) immigrants experience more bullying from supervisors, colleagues and clients/residents. We analyzed cross-sectional baseline data from 5,635 health care students of whom 10.4% were immigrants, and conducted a prospective analysis by following 3,109 of these respondents during their first year of employment. More than a third of the respondents had previous experiences with bullying. The baseline analyses showed that immigrants are more at risk of being bullied during both their theoretical education and trainee periods than their Danish co-students. At follow-up we found that 9.1% of the total cohort had been exposed to bullying at work during their first year of employment, hereof 1.8% frequently. "Non-Western" immigrants had a significantly higher risk of exposure to bullying at work during follow-up than the Danish respondents independent of previous experience with bullying. Danish and immigrant health care workers were more exposed to bullying from co-workers than from supervisors with no statistically significant difference between the Danes and the immigrant groups. Both "Western" and "non-Western" respondents were more at risk of bullying from clients/residents than the Danish respondents.     

Does Depression Affect Clinical Practice?

Abstract

While recent autobiographical accounts of women psychotherapists with depressive illnesses have provided vivid and compelling portraits of therapists' experiences in therapy (e.g., Jamison, 1995; Manning, 1995), further research is needed to clarify the impact that depression and its treatment have upon both collegial relationships and clinical practice. A subset of the membership of the Association for Women in Psychology (AWP) was surveyed concerning therapists' experiences with depression and its treatment. Of 220 respondents, 76% reported some form of depressive illness. Eighty-five percent of respondents indicated that they participated in personal therapy. When evaluating their clinical work, respondents reported both positive and negative consequences resulting from their depression. While some respondents noted improvement in collegial relationships, many felt judged and avoided.     

Clergy Response to Domestic Violence: A Preliminary Survey of Clergy Members,Victims, and Batterers

Although the presence of both religious organizations and violence in American communities is pervasive, scant attention has focused on how to best enroll clergy and religiously oriented resources in the battle against family violence. Given that it is not uncommon for women or couples to seek counseling or advice from clergy before accessing community-based resources, the frequency, nature, and utility of these contacts were assessed in this exploratory study from the perspectives of 47 female victims and 70 male perpetrators of domestic violence. Forty-one clergy members from various denominations were also surveyed about their contacts with those seeking help for domestic violence. Results indicated that 43% of the victims and 20% of the perpetrators did seek help from clergy. Almost all of the victims who contacted clergy reported satisfaction with the counsel they received. All clergy respondents reported counseling people who had experienced domestic violence during their career, and 80% had violence-related contacts in the past year. The service-related implications of these clergy contacts from victim, perpetrator, and clergy perspectives are discussed.     

The prevalence of suicidal behaviors, attitudes and associated social experiences in an urban population

The development of an epidemiological study of mental health, social background factors, suicidal behaviors (suicidal ideas, deliberate self-harm, and attempted suicide), values concerning suicide, and experience of suicide in others is described. 679 adult respondents in a stratified random sample of residents of a large Canadian city were interviewed. Results indicate a more accepting attitude to suicide than reported in previous studies; considerable experience of suicide in others; and a much higher rate of suicidal ideas and action than has been reported in previous work. Thirteen percent of the sample had made plans for suicide in their lifetime, 6% had deliberately harmed themselves, and a further 4% had attempted suicide in their lifetime. In the past year, 4% had made plans for suicide, and 2% had deliberately harmed themselves or had attempted suicide.     

Cancer Risk Counseling: How Is It Different?

Fifty-six of 80 (70%) full members of the National Society of Genetic Counselors with interest in cancer genetics responded to a 1994 survey regarding their cancer risk counseling practices. This study was undertaken to describe cancer risk counselors and the services they provide and to identify possible differences from general genetic counseling that warrant further study. Of 56 respondents, 41 (75%) were providing CRC. The components of CRC programs are described. Our results found significant differences between CRC and general genetic counseling in terms of training and experience of genetic counselors providing CRC and length and number of counseling sessions per consultand. 51% of respondents had 1–2 years of working in CRC, compared to 17% with 1–2 years experience in genetic counseling (p<0.05). Over one-third had 10 or more years genetic counseling experience. Counselors were more likely to see individuals at risk for cancer for longer counseling sessions (p<0.05) and for additional sessions (p<0.05).     

Distrustful Complacency and the COVID-19 Vaccine: How Concern and Political Trust Interact to Affect Vaccine Hesitancy

We test the hypothesis that COVID-19 vaccine hesitancy is attributable to distrustful complacency—an interactive combination of low concern and low trust. Across two studies, 9,695 respondents from different parts of Britain reported their level of concern about COVID-19, trust in the UK government, and intention to accept or refuse the vaccine. Multilevel regression analysis, controlling for geographic area and relevant demographics, confirmed the predicted interactive effect of concern and trust. Across studies, respondents with both low trust and low concern were 10%–22% more vaccine hesitant than respondents with either high trust or high concern, and 26%–29% more hesitant than respondents with both high trust and high concern. Results hold equally among White, Black, and Muslim respondents, consistent with the view that regardless of mean-level differences, a common process underlies vaccine hesitancy, underlining the importance of tackling distrustful complacency both generally and specifically among unvaccinated individuals and populations.