Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

PTSD and the influence of context: The self as a social mirror

The principal accepted models of posttraumatic stress disorder (PTSD) are based on both memory processing and biological/brain changes occurring when one's life or well-being is threatened. It is our thesis that these models would be greatly informed by community studies indicating that PTSD is predicted to a greater extent by earlier life experience and experiences that occur distant from the threatening event. These findings suggest posttraumatic responding is best conceptualized through the lens of the self-in-context, as opposed to imprinting that results from a given event at a given time. Moreover, studies of non-Western populations often do not express trauma as PTSD, or at least not primarily as PTSD, which argues against specific neural or memory encoding processes, but rather for a more plastic neural process that is shaped by experience and how the self develops in its cultural context, as a product of a broad array of experiences. We posit that fear and emotional conditioning as well as the ways traumas are encoded in memory are only partial explanatory mechanisms for trauma responding, and that issues of safety and harm, which are long term and developmental, are the common and principal underpinnings of the occurrence of posttraumatic distress, including PTSD.     

The Role of Reflective Functioning in Predicting Marital and Coparenting Quality

Reflective functioning (RF) is a measure of mentalization—the capacity to think about one’s own and others’ thoughts and feelings and to understand the connections between mental states and behaviors. Previous research indicates a decline in marital quality across the transition to parenthood, and some studies have found that parents are less happy than non-parents. Thus, researchers have called for research into possible moderators of these patterns. RF may help couples navigate this transition by more easily taking each other’s (and the infant’s) perspective and understanding each other’s behaviors. Much of the research on RF has focused on mothering behavior; research has not yet examined associations between RF and other family interactions. We examined associations between RF and marital and coparenting quality for both wives and husbands. Reflective functioning was coded from Adult Attachment Interviews conducted during pregnancy. We assessed marital quality at 3.5 months, and coparenting quality at 13 months, after the birth of the target child. Wives’ higher RF was associated with higher levels of positive—and lower levels of negative—marital and coparenting interactions. Wives who were better able to reflect on their early experiences with their parents were involved in marital interactions that were more positive and supportive and less conflicted and undermining. Husbands’ RF did not predict marital or coparenting quality. These findings highlight the importance of reflective functioning in understanding family functioning.     

Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies

Assessment of a patient after hospital‐treated self‐harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self‐harm. Through systematic review and a series of meta‐analyses looking at unassisted clinician risk classification (eight studies; N = 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18–0.50), specificity 0.85 (0.75–0.92), positive predictive value 0.22 (0.21–0.23), and negative predictive value 0.89 (0.86–0.92). Clinician classification was too inaccurate to be clinically useful. After‐care should therefore be allocated on the basis of a needs rather than risk assessment.     

The psychology of confessions: A comparison of expert and lay opinions

Despite a body of confessions research that is generally accepted in the scientific community, courts often exclude experts on the ground that such testimony would not assist the jury, which can use its common sense. To examine whether laypeople know the contents of expert testimony on confessions, we asked 151 lay participants to indicate their beliefs about 30 confession‐related statements used in a recent survey of 87 confession experts (Kassin et al., American Psychologist, 2018, 73, 63–80). Participants agreed with experts on only 10 of the 30 propositions, suggesting that much of the psychology of confessions is not common knowledge and that expert testimony can assist the trier of fact.     

Collaboration in associative recognition memory: using recalled information to defend "new" judgments

S. E. Clark, A. Hori, A. Putnam, and T. J. Martin (2000) showed that collaboration on a recognition memory task produced facilitation in recognition of targets but had inconsistent and sometimes negative effects regarding distractors. They accounted for these results within the framework of a dual-process, recall-plus-familiarity model but showed only weak evidence to support it. The present results of 3 experiments present stronger evidence for Clark et al.'s dual-process view and also show why such evidence is difficult to obtain.     

Interpretive biases in chronic insomnia: an investigation using a priming paradigm

Disorder-congruent interpretations of ambiguous stimuli characterize several psychological disorders and have been implicated in their maintenance. Models of insomnia have highlighted the importance of cognitive processes, but the possibility that biased interpretations are important has been minimally investigated. Hence, a priming methodology was employed to investigate the presence of an interpretive bias in insomnia. A sample of 78 participants, differing in the presence of a diagnosis of insomnia, severity of sleep disturbance, and sleepiness, was required to read ambiguous sentences and make a lexical decision about target words that followed. Sleepiness at the time of the experiment was associated with the likelihood with which participants made insomnia and threat consistent interpretations of ambiguous sentences. The results suggest that there is a general bias towards threatening interpretations when individuals are sleepy and suggests that cognitive accounts of insomnia require revision to include a role for interpretative bias when people are sleepy. Future research is required to investigate whether this interpretive bias plays a causal role in the maintenance of insomnia.     

Mortality Differentials and Religion in the U.S.: Religious Affiliation and Attendance

Using data from the Health and Retirement Study, I examine the relationship between adult mortality and religious affiliation. I test whether mortality differences associated with religious affiliation can be attributed to differences in socioeconomic status (years of education and household wealth), attendance at religious services, or health behaviors, particularly cigarette and alcohol consumption. A baseline report of attendance at religious services is used to avoid confounding effects of deteriorating health. Socioeconomic status explains some but not all of the mortality difference. While Catholics, Evangelical Protestants, and Black Protestants benefit from favorable attendance patterns, attendance (or lack of) at services explains much of the higher mortality of those with no religious preference. Health behaviors do not mediate the relationship between mortality and religion, except among Evangelical Protestants. Not only does religion matter, but studies examining the effect of "religiosity" need to consider differences by religious affiliation.