Pathways to vocational services: factors affecting entry by veterans enrolled in Veterans Health Administration mental health services

The current study provides naturalistic data documenting the pathways-to-care to vocational services for 155 veterans who were receiving some form of mental health care from the Veterans Health Administration and had a vocational need but were not currently enrolled in vocational services. Of the participants, 94.2% had recognized their vocational need, 80.6% reported that they or someone else had sought help to alleviate the need, and 77.4% had previously received some form of vocational services. The median length of the participants' vocational need was more than 4.2 years. Delays associated with recognition, help-seeking, and treatment entry all contributed to the overall delay in entering appropriate care. Filtering factors associated with quicker recognition, seeking help, and receiving services included diagnosis, level of disability, type of vocational need, and support from primary providers, family, and friends. The results provide information for designing interventions to improve service entry by adults with mental health problems and vocational needs.     

Religious Influences on the Reproductive Health Decisions of HIV-Positive Latinas on the Border

The number of HIV-positive Latinas of child-bearing age living on the US–Mexico border is a growing concern. Little is known about how religious beliefs influence the reproductive health decisions of these women in light of disease demands and cultural and religious norms that support high fertility rates and childbearing. Such decisions may be further complicated by the stigma of HIV/AIDS and structural issues related to immigration status and trans-border lives. This paper analyzes extant literature and supports the need for further research so that policy makers and heath and social service providers can develop meaningful and comprehensive reproductive-health related interventions.     

Recognizing creative leadership: Can creative idea expression negatively relate to perceptions of leadership potential?

Drawing on and extending prototype theories of creativity and leadership, we theorize that the expression of creative ideas may diminish judgments of leadership potential unless the charismatic leadership prototype is activated in the minds of social perceivers. Study 1 shows that creative idea expression is negatively related to perceptions of leadership potential in a sample of employees working in jobs that required creative problem solving. Study 2 shows that participants randomly instructed to express creative solutions during an interaction are viewed as having lower leadership potential. A third scenario study replicated this finding showing that participants attributed less leadership potential to targets expressing creative ideas, except when the “charismatic” leader prototype was activated. In sum, we show that the negative association between expressing creative ideas and leadership potential is robust and underscores an important but previously unidentified bias against selecting effective leaders.     

Youth with Oppositional Defiant Disorder at Entry into Home-Based Treatment,Foster Care,and Residential Treatment

We explored and compared rates of youth diagnosed with oppositional defiant disorder (ODD) at entry into three broad program types, home-based care, foster care, and residential care. We also explored factors other than an ODD diagnosis that could be associated with program placement, and compared the presence of these factors in youth with and without an ODD diagnosis. Analyses were conducted using data from an ongoing, private-agency led, outcome measurement project. Programs were grouped into low (home-based), moderate (foster), or high (residential) categories, based upon levels of supervision and structure provided. A sample of 9,564 youth admitted into care between years 2005 and 2007 was used. Results suggested the following rates of ODD: 14.2 % overall; 7.9 % for low level programs; 5.3 % for moderate level programs; 21.1 % for high level programs. Rates were significantly different by program level (p ≤ 0.001). Sixty of 65 additional risk factors were also significantly associated with placement by level of program. No risk factors were unique to youth with ODD. Of the significant factors for youth with ODD, 4 were particularly strong: Classification as a child in need of services (CHINS), history of neglect, verbal aggression, and truancy. Youth classified as CHINS and with substantiated or suspected neglect were more likely placed into a moderate level program. Youth with verbal aggression or truancy were more likely placed into a high level program. Results suggested many factors are considered at program entry. Given the potential for poor prognosis and social costs of ODD, results support an individualized approach to placement determinations, with increased attention to symptoms of ODD and associated features at program entry.     

Dimensions of Religiousness and Spirituality as Predictors of Well-Being in Advanced Chronic Heart Failure Patients

We examined relationships between seven dimensions of religion/spirituality (RS) (forgiveness, daily spiritual experiences, belief in afterlife, religious identity, religious support, public practices, and positive RS coping) and three dimensions of well-being (physical, mental, and existential) in a sample of 111 patients with advanced chronic heart failure. Participants completed questionnaires at baseline and 3 months later. Results showed that fairly high levels of RS were reported on all seven dimensions. Furthermore, RS dimensions were differentially related to well-being. No aspect of RS was related to physical well-being, and only a few aspects were related to mental well-being. Forgiveness was related to less subsequent depression, while belief in afterlife was related to poorer mental health. All aspects of RS were related to at least one aspect of existential well-being. In particularly, daily spiritual experiences were linked with higher existential well-being and predicted less subsequent spiritual strain. These results are consistent with the view that in advanced disease, RS may not affect physical well-being but may have potent influences on other aspects of well-being, particularly existential aspects.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

The Dialectics of Stigma,Silence, and Misunderstanding in Suicidality Survival Narratives

Modern suicidologists have noted a dearth of qualitative research on suicide. The first author conducted 20 in-depth interviews with formerly suicidal adults to understand how they accounted for their experiences contemplating or attempting suicide. According to participants, stigma necessitated impression management, which contributed to the production of silence and misunderstanding. Silence and misunderstanding reinforced stigma. This complex, dialectical, belief system about stigma yields insight into the interpretive culture of surviving suicidal ideation or a suicide attempt. These beliefs about suicide may serve as a barrier to individuals seeking help, recovering from suicidality, and larger social change regarding attitudes toward suicide.     

Wealth inequality and activism: Perceiving injustice galvanizes social change but perceptions depend on political ideologies

What motivates people to engage in activism against wealth inequality? The simple answer is perceiving injustice. However, the current work demonstrates that these perceptions depend on political ideologies. More specifically, for political liberals who frequently question the fairness of the economic system, messages simply describing the extent of the inequality (distributive injustice) are enough to motivate activism (Study 1). For political conservatives, who are inclined to believe that inequality results from fair procedures, messages must also detail how the system of economic forces is unjust (procedural injustice; Studies 2 and 3). Together, these studies suggest perceiving injustice can galvanize social change, but for conservatives, this means more than simply outlining the extent of the inequality.     

Mental Health Utilization Among Diverse Parenting Young Couples

Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social–personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor–Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow‐up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse’s influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.