Promoting Mental Health Equity: The Role of Integrated Care

People suffering from mental illness experience poor physical health outcomes, including an average life expectancy of 25 years less than the rest of the population. Stigma is a frequent barrier to accessing behavioral health services. Health equity refers to the opportunity for all people to experience optimal health; the social determinants of health can enable or impede health equity. Recommendations from the U.S. government and the World Health Organization support mental health promotion while recognizing barriers that preclude health equity. The United States Preventive Services Task Force recently recommended screening all adults for depression. The Satcher Health Leadership Institute at the Morehouse School of Medicine (SHLI/MSM) is committed to developing leaders who will help to reduce health disparities as the nation moves toward health equity. The SHLI/MSM Integrated Care Leadership Program (ICLP) provides clinical and administrative healthcare professionals with knowledge and training to develop culturally-sensitive integrated care practices. Integrating behavioral health and primary care improves quality of life and lowers health system costs.     

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.     

The Psychosocial Impact of Undergoing Prophylactic Total Gastrectomy (PTG) to Manage the Risk of Hereditary Diffuse Gastric Cancer (HDGC)

Individuals identified as at high risk of developing Hereditary Diffuse Gastric Cancer (HDGC) are advised to undergo prophylactic surgery - have their stomach removed - in their early twenties. Research with (older) cancer patients who undergo gastrectomy for curative reasons suggests that gastric resection has a number of physical and psychosocial sequelae. Because it is difficult to extrapolate the findings of studies of older cancer patients to younger healthy patients who are considering prophylactic total gastrectomy (PTG), the aim of this qualitative interview study was to determine the psychosocial implications of undergoing prophylactic surgery to manage genetic risk. Fourteen men and 13 women from the UK’s Familial Gastric Cancer study who had undergone PTG were invited to participate in qualitative interviews. Most reported that undergoing surgery and convalescence was easier than anticipated. There was evidence that age affected experiences of PTG, with younger patients tending to report faster recovery times and more transient aftereffects. All saw the benefits of risk reduction as outweighing the costs of surgery. Surgery was described as having a range of physical impacts (disrupted appetite, weight loss, fatigue, GI symptoms) that had related psychological, social and economic implications. Those considering PTG need to be aware that its impact on quality of life is difficult to predict and negative sequelae may be ongoing for some individuals.     

A Genetic Component to National Differences in Happiness

National differences in subjective well-being (SWB) have been attributed to socioeconomic, climatic, and genetic factors. We focus on one particular facet of SWB—happiness or positive affect—measured by the nationally representative World Values Survey (WVS). We find that national percentages of very happy people across the three latest WVS waves (2000–2004, 2005–2009, 2010–2014) are consistently and highly correlated with national prevalence of the rs324420 A allele in the FAAH gene, involved in the hydrolysis of anandamide, a substance that reportedly enhances sensory pleasure and helps reduce pain. Climatic differences are also significantly associated with national differences in happiness, whereas economic wealth, recent economic growth, rule of law, pathogen prevalence, and the distribution of short versus long alleles in the serotonin transporter gene SLC6A4 are not significant predictors of national happiness.     

Positive and Negative Structures and Processes Underlying Academic Performance: A Chained Mediation Model

This study proposed and tested a comprehensive, chained mediation model of university students’ academic performance. The hypothesized model included adaptive-positive and maladaptive-negative submodels. The structures and processes in the adaptive-positive submodel were hypothesized to facilitate students’ academic performance, whereas the structures and processes in the maladaptive-negative submodel were hypothesized to undermine it. A sample of 373 university students completed a set of questionnaires measuring their approaches to studying, positive and negative affect, evaluation anxiety, use of creative cognition, motivational orientations, and adaptive and maladaptive metacognitions. Participants’ end-of-semester and prior semester academic performance was retrieved from the university registry. A structural equation model explained 90 % of the variance in students’ future academic performance, supported all but one hypothesized intermediate paths, and revealed that only positive affect in studying and prior academic performance predict directly future academic performance. The theoretical and practical implications of these findings are outlined.     

The Influence of Child-Directed Speech on Word Learning and Comprehension

This paper describes an investigation into the function of child-directed speech (CDS) across development. In the first experiment, 10–21-month-olds were presented with familiar words in CDS and trained on novel words in CDS or adult-directed speech (ADS). All children preferred the matching display for familiar words. However, only older toddlers in the CDS condition preferred the matching display for novel words. In Experiment 2, children 3–6 years of age were presented with a sentence comprehension task in CDS or ADS. Older children performed better overall than younger children with 5- and 6-year-olds performing above chance regardless of speech condition, while 3- and 4-year-olds only performed above chance when the sentences were presented in CDS. These findings provide support for the theory that CDS is most effective at the beginning of acquisition for particular constructions (e.g. vocabulary acquisition, syntactic comprehension) rather than at a particular age or for a particular task.     

The Interplay of Implicit Causality,Structural Heuristics,and Anaphor Type in Ambiguous Pronoun Resolution

Two visual-world eye-tracking experiments investigating pronoun resolution in Finnish examined the time course of implicit causality information relative to both grammatical role and order-of-mention information. Experiment 1 showed an effect of implicit causality that appeared at the same time as the first-mention preference. Furthermore, when we counterbalanced the semantic roles of the verbs, we found no effect of grammatical role, suggesting the standard observed subject preference has a large semantic component. Experiment 2 showed that both the personal pronoun hän and the demonstrative tämä preferred the antecedent consistent with the implicit causality bias; tämä was not interpreted as referring to the semantically non-prominent entity. In contrast, structural prominence affected hän and tämä differently: we found a first-mention preference for hän, but a second-mention preference for tämä. The results suggest that semantic implicit causality information has an immediate effect on pronoun resolution and its use is not delayed relative to order-of-mention information. Furthermore, they show that order-of-mention differentially affects different types of anaphoric expressions, but semantic information has the same effect.