Predictors of mental distress and poor physical health among homeless women

Abstract

We tested a latent variable path model in which situational, personal, and social resources predicted several mediators and the key health outcomes of mental distress and poor physical health among 871 homeless women. Mental distress was predicted by risky sexual behavior, less social support, avoidant coping, less self-esteem, client abuse history, social support from deviant sources, less drug self-efficacy and health care utilization. Poor physical health was predicted by a client abuse history, less drug self-efficacy, fewer perceived rewards for drug use, higher perceived costs for drug use, and a doctor visit. Current risky sexual behavior was predicted by a parent drug abuse history, less drug self-efficacy, and more social support from deviant sources. Current drug use was predicted by parent drug abuse history, less drug self-efficacy, more social support from deviant sources and by high perceived costs for drug use. Implications of results for intervention and theory are discussed.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

Spiritual health locus of control and breast cancer beliefs among urban African American women.

The present study examined the relationship between spiritual health locus of control, breast cancer beliefs, and mammography utilization among a sample of 1,227 African American women from urban public health centers. Spiritual health locus of control was conceptualized as having an active and passive dimension, empowering individuals in their health beliefs and behaviors or rendering them to rely on a higher power (e.g., God) to determine their health outcomes, respectively. The active dimension was negatively associated with perceived benefits of mammography and positively associated with perceived barriers to mammography. The active and passive spiritual dimensions are distinct from internal and external health locus of control. Further study of their associations with other health-related beliefs and behaviors is warranted.     

Perceived racism and mental health among Black American adults: a meta-analytic review

The literature indicates that perceived racism tends to be associated with adverse psychological and physiological outcomes; however, findings in this area are not yet conclusive. In this meta-analysis, we systematically reviewed 66 studies (total sample size of 18,140 across studies), published between January 1996 and April 2011, on the associations between racism and mental health among Black Americans. Using a random-effects model, we found a positive association between perceived racism and psychological distress (r = .20). We found a moderation effect for psychological outcomes, with anxiety, depression, and other psychiatric symptoms having a significantly stronger association than quality of life indicators. We did not detect moderation effects for type of racism scale, measurement precision, sample type, or type of publication. Implications for research and practice are discussed.     

Feminist and community mental health center psychotherapists' expectations of mental health for women

Female (n=75) and male (n=55) community mental health center psychotherapists and feminist therapists (n=82) were given the Rosenkrantz, Vogel, Bee, Broverman, and Broverman (1968) Sex-Role Stereotype Questionnaire and were asked to rate either mentally healthy adults, females, wives, or mothers. Female community mental health center therapists and feminist therapists were found to maintain one standard of mental health; that is, their perceptions of mental health for adults, females, wives, and mothers did not differ. In contrast, male therapists perceived mentally healthy adults in more male-valued terms than they perceived mentally healthy females, wives, and mothers. Additionally, both feminist and other female therapists differed from male therapists in their perceptions of health for mothers, but not for adults and wives.This report is based on a dissertation submitted in partial fulfillment of the requirements for the doctoral degree at the College of Education, University of Maryland, 1974. The author wishes to express her appreciation to her dissertation chairperson, Dr. Janice M. Birk, for her invaluable assistance during all phases of this study.     

Social factors and mental health symptoms among women who have experienced involuntary job loss

The growing proportion of women in the labor force and the current economic crisis has made women a target population for job loss. In that situation, they are likely to experience recurrent layoffs, which force them to cope with multiple job loss and with unemployment. The present study aimed to examine sociodemographic factors that help women succeed in coping with single or multiple experiences of job loss, and that even enhance their self-efficacy in returning to work. The population of participants consisted of 134 Israeli women aged 30-45 who had been laid off. The findings indicate that the women who had experienced multiple job loss expressed a stronger desire to return to work than did those who had been laid off only once. Married women showed a greater tendency to become accustomed to stress after being laid off than did never-married women. However, even though multiple job loss might be a forced solution to home-work conflict, never-married women were found to be at risk for distress responses after being laid off. There is a need to develop responses for women who are at risk for multiple job loss, and to enhance employers' awareness of the situation faced by women who are laid off.     

The mutual effects between job resources and mental health: a prospective study among Dutch youth

The current study construes the relation between job resources (such as job autonomy, skill utilization, and variety) and mental health as a reciprocal process. Following conservation of resources theory (S. E. Hobfoll, 1989), the author expected job resources to have a positive effect on mental health. Poor mental health was assumed to impede workers' attempts to maintain or enhance their job resources either by changing the content of their jobs or attempting to find another (less distressing) job. Longitudinal data from a representative sample of 699 Dutch youth were analyzed with analysis of variance and covariance structure modeling. The results provided good support for the proposition that job resources and mental health mutually influence each other. Limitations and implications of the study are discussed.     

Lifestyle and mental health among school-going adolescents in Namibia

This study examined the association between lifestyle behaviours and psychological distress indicators among school-going adolescents. The analysis included 4 531 school children, 11–18 years of age, who completed the Namibia Global School-based Student Health Survey (GSHS) in 2013. Multivariable logistic regression analysis found that engaging in a greater number of harmful consumptive, sedentary and sexual risk behaviours carried an elevated risk for anxiety, suicide attempt and loneliness. Adolescents with co-occurring health risk behaviours have poorer mental health outcomes with socio-economic vulnerability.     

Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England

Although school‐aged children living in foster care have been identified as a high‐risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995 ), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high‐risk group for mental health and developmental disorders. Without age‐appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.     

Abuse, health locus of control, and perceived health among HIV-positive women.

This study of 230 predominantly poor Hispanic and African American women aged 25 to 61 years living with HIV/AIDS in New York City revealed high levels of both sexual (39%) and physical (44%) trauma before the age of 16. Both types of early trauma were correlated with later trauma, and all forms of trauma were significantly associated with current perceived health. In multivariate analyses controlling for relevant covariates, the Powerful Others and Internal Control subscales of the Multidimensional Health Locus of Control Scales (K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) acted as independent predictors of perceived health rather than (as hypothesized) mediators of the association between trauma and perceived health. Findings underscore the importance of addressing trauma and perceptions of control over one's physical health in the provision of health services to HIV-positive women.     

The role of familism in stress and coping processes among African American and White dementia caregivers: effects on mental and physical health.

OBJECTIVE: To explore how familism, burden, and coping styles mediate the relationships between ethnicity and the mental and physical health of caregivers. DESIGN: A probability sample of 65 White and 95 African Americans respondents caring for an older family member with dementia was used to test hypotheses from a sociocultural stress and coping model using path analysis. MAIN OUTCOME MEASURES: Measures of caregivers' health included subjective health, self-reported diseases, blood pressure, and heart rate. Mental health measures included self-reported depression and psychological symptoms. RESULTS: Contrary to the hypothesis, familism had an adverse effect on outcomes and was related to low education levels rather than to African American ethnicity. A buffering effect of active coping between being African American and diastolic blood pressure was found even after controlling for levels of education. CONCLUSIONS: Findings supported a core stress and coping model in which more behavior problems of care recipients were associated with poorer mental health of caregivers via greater burden and more use of avoidant coping. Results also demonstrate that this core model can be extended to physical health.     

Assessing violence risk in Tarasoff situations: a fact-based model of inquiry.

Although significant advances in risk assessment research and practice have been made in recent years, there has not been any analysis in the professional literature regarding how and whether the emerging practice recommendations apply in Tarasoff-type situations. We suggest that, when faced with a Tarasoff-type situation, the appraisal of risk should be guided by a method that is primarily fact-based and deductive, rather than by the more inductive risk assessment approach for general violence recidivism, which is guided primarily by base rates and historical risk factors. We review the principles underlying a fact-based, or threat assessment, approach and outline six areas of inquiry that can guide the appraisal of risk: A-attitudes that support or facilitate violence, C-capacity, T-thresholds crossed, I-intent, O-other's reactions, and N-noncompliance with risk reduction interventions.     

Sexual coercion among women living with a severe and persistent mental illness: Review of the literature and recommendations for mental health providers

Women with severe and persistent mental illness (e.g., schizophrenia, bipolar disorder) are at enhanced risk for sexual coercion and several resulting sexual health complications. We examine the prevalence and types of sexual coercion encountered by women with severe and persistent mental illness and provide recommendations for interventions to reduce the prevalence of sexual coercion. Mental health professionals working with this population need to provide increased attention to the problem of sexual coercion and can take measures to intervene safely and effectively.     

Therapeutic jurisprudence and conflicts among values in mental health law

Therapeutic Jurisprudence provides a conceptual framework for a research agenda designed to promote development of legal rules, procedures, and roles in a manner consistent with the therapeutic mission of the mental health system. As such, it draws attention to the tension between the jurisprudential values of autonomy and well-being that permeates mental health law specifically and the law and ethics of health care generally. This article advances an analysis of these values in the context of the patient-centered approach to health care. The article endorses a priority for the deontic aspect of autonomy over well-being but allows balancing of the consequentialist component of autonomy against well-being. Finally, it applies this framework to several traditionally difficult types of cases.     

Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women.

This study examined the relationship of cardiovascular reactivity to both interpersonal mistreatment and discrimination in a community-based sample of African American and European American women (N=363) in midlife. Subtle mistreatment related positively to diastolic blood pressure (DBP) reactivity for African American participants but not their European American counterparts. Moreover, among the African American participants, those who attributed mistreatment to racial discrimination exhibited greater average DBP reactivity. In particular, these women demonstrated greater DBP reactivity to the speech task, which bore similarities to an encounter with racial prejudice but not to a nonsocial mirror tracing task. These findings are consistent with the hypothesis that racial discrimination is a chronic stressor that can negatively impact the cardiovascular health of African Americans through pathogenic processes associated with physiologic reactivity.     

Religion and mental health among Hindu young people in England

The aim of this study was to explore the relationship between mental health and attitude toward their religious tradition among a sample of 330 young people attending the Hindu Youth Festival in London. The participants completed the Santosh–Francis Scale of Attitude toward Hinduism together with the abbreviated form of the Revised Eysenck Personality Questionnaire which provides measures of neuroticism and psychoticism. The data indicated that a more positive attitude toward Hinduism was associated with lower psychoticism scores but unrelated to neuroticism scores. There is no evidence, therefore, to associate higher levels of religiosity with poorer mental health among young people within the Hindu community.