How Best to Treat Deployment-Related Guilt and Shame: Commentary on Smith,Duax, and Rauch (2013)

We comment on Smith, Duax, and Rauch’s (2013--this issue) explication of their approach to treating perpetration-related guilt and shame using prolonged exposure (PE) therapy, with the aim of promoting a discourse about the mechanisms, techniques, and assumptions that underlie the treatment of moral injury in veterans and service members. We first discuss the theoretical foundation underlying PE and consider the extent to which it accounts for the phenomenology of moral injury. We then examine the treatment strategies used in the PE approach and the mechanisms by which these techniques ameliorate perpetration-related guilt and shame. We also briefly highlight points of similarity and contrast between PE and adaptive disclosure, a brief cognitive behavioral intervention targeting combat-related moral injury and traumatic loss.     

Women Court-Ordered for Domestic Violence: Improvements in Depression

A quasi-experimental design was employed to compare depression at intake and completion of a sample of primarily Latina women court-ordered to a batterer intervention program. Data were derived from the intake assessments of 112 women over 24 months. Overwhelmingly, women reported being abused by their current and former partners. Approximately 58% of the women in this sample were depressed at intake. When culturally competent, gender-appropriate treatment is given to court-ordered women, depression symptomatology may decrease to levels of normal functioning. Further research is needed to understand court-ordered women as well as how to meet their unique needs.     

The roles of leader emotion management and team conflict for team members' personal initiative: A multilevel perspective

Employees' personal initiative (i.e., their active and future-oriented engagement at work) is of high relevance to organizations that strive for innovation and competitiveness. To better understand its drivers and diminishers, the present study refers to Affective Events Theory and examines the impact of leader emotion management, team conflict, and affective well-being on personal initiative. Data from 300 members of 59 work teams in Germany were gathered from multiple sources at three points in time over the course of 2 weeks. Multilevel analyses indicated that leader emotion management positively affected team members' personal initiative and that this effect was mediated by team members' affective well-being. Data also revealed a contrasting negative indirect effect of task conflict within the team on team members' personal initiative via team members' affective well-being. The study's results suggest that the improvement of leaders' emotion management as well as the establishment of work conditions and experiences that foster affective well-being should be seriously considered by organizations wishing to facilitate personal initiative in team settings.     

The relationship between productive and counterproductive work behaviour across four European countries

Research suggesting a similar but different relationship between Organizational Citizenship Behaviour (OCB) and Counterproductive Work Behaviour (CWB) is dominated by North American samples. Little evidence exists on whether these findings are replicated in other countries. To assess if a similar pattern emerged, we used the Social Axioms model (Bond et al., 2004) as a cultural framework and surveyed employees in the UK (105), The Netherlands (203), Turkey (185), and Greece (70) on the relationship between OCB and CWB, and the relationship between these behaviours and personality, justice, and commitment. Analysis supported a multidimensional structure to OCB and CWB and indicated a nonbipolar relationship between these behaviours. Culturally, somewhat different to OCB research in general, we find support for a convergence perspective across countries. Conceptually, linguistically and structurally the scale assessing OCB/CWB was shown to be equivalent across countries and a nonbipolar pattern of relationships was consistent across countries. Overall, findings imply a universal nature to the relationship between OCB and CWB across societal cultural groups.     

Organizational and Individual Values: Their Main and Combined Effects on Work Attitudes and Perceptions

A survey was conducted using a convenient sample of employees (N = 999) from various industries to examine the main and combined effects of organizational and individual values on organizational commitment, perceived organizational support, and procedural justice. Moderated multiple regression analyses showed that employees' reactions were mainly explained by perceived organizational values and value preferences. In contrast, person-organization value fit and interaction effects were marginal. The implications of these findings are discussed.     

Coping Response Inventory: Assessing coping among Iranian college students and introductory development of an adapted Iranian Coping Response Inventory (CRI)

Coping is related to mental and physical health outcomes, but cultural and societal differences may influence its nature and structure. This study reports on the adaptation of the Coping Responses Inventory for Adult (CRI-A) to the Iranian social and cultural context. Study 1 was designed to obtain qualitative data and test the construct and discriminative validity of coping scales. Factor analysis of the CRI and Iranian items yielded seven factors: Religious Coping, Problem Solving, Cognitive Avoidance, Positive Reappraisal, Seeking Guidance and Support, Seeking Alternative Rewards, and Acceptance/Resignation. Internally, consistencies varied considerably from 0.92 to 0.53. All sub-scales from the Coping Responses Inventory for Adult (CRI-A) were resistant to social desirability biases with the exception of Religious Coping and Problem Solving. In Study 2, the replicability of the adapted CRI-A factorial structure and concurrent validity for the newly developed religious coping sub-scale was demonstrated. Given the importance of the role of religious coping in health and well-being outcomes, the expression and use of which may be substantially influenced by cultural practices and norms, it is recommended that future research pursues the validation of context-specific constructs of religious and spiritual coping.     

The Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in the diagnosis of subcortical vascular dementia and Alzheimer’s disease

The aim of this study was to investigate the accuracy of the Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in detecting and differentiating early stage subcortical vascular dementia (SVD) from early stage Alzheimer’s disease (AD). Ninety-two subjects (18 SVD patients, 36 AD patients, and 38 healthy controls) were assessed using the ACE-R. Between-group’s differences were evaluated using the Quade’s rank analysis of covariance. The diagnostic accuracy and discriminatory ability of the ACE-R were examined via receiver operating characteristic (ROC) analysis. The ACE-R was able to successfully discriminate between patients and healthy subjects. The mean ACE-R total scores differed between SVD and AD patients; there were also significant differences in attention and orientation and in memory measures between the groups. An optimal cut-off of 72/73 was found for the detection of AD (sensitivity: 97%; specificity: 92%) and SVD (sensitivity: 100%; specificity: 92%).     

Medical tourism in india: perceptions of physicians in tertiary care hospitals

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.     

Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

Background

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism.

Results

According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision.

Conclusions

The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.