The Difficulty of Making Psychology Research and Clinical Practice Relevant to Medicine: Experiences and Observations

Psychology and medicine research and practice have demonstrated substantial and unique bodies of knowledge designed to both improve patient care and respond to contemporary health care needs for use of evidence and cost consciousness. At their full potential they represent a significant paradigm shift in healthcare. Despite impressive successes, it is clear that we are just on the cusp of such a change. These findings have had limited impact and penetration into medical practice, particularly outside of academic medicine and large, organized systems of health care, and there are multiple examples of such limitations in various arenas of health care. There also appear to be common themes to such examples which provide us opportunities to consider how psychologists might move things ahead. They also suggest how our unique position in academic medicine can both limit our impact and provide ways of creating continued shifts in the healthcare paradigm. This paper is based in part on the author’s presentation at the Association of Psychologists in Academic Health Centers 3rd National Conference in Minneapolis, Minnesota, May 2007.     

Psychologists in Academic Health Centers: Traditions and Innovations in Education,Science, and Practice

Psychologists, interns, and postdoctoral fellows convened in Minneapolis May 3–5, 2007 for the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC): “Psychologists in Academic Health Centers: Traditions and Innovations in Education, Science, and Practice.” This paper reviews the development and organization of the conference, which built upon the two previous conferences of the Association of Medical School Psychologists. The articles in this special issue are based on a selected number of the 32 conference presentations, covering a range of timely topics that reflect the conference theme. Participants’ positive perceptions and satisfaction with the conference reveal the value of such conferences focused on the activities, interests, opportunities, and challenges of psychologists who work in academic health centers (AHCs) and teaching hospitals. Moreover, the content and success of the conference underscores the importance of APAHC as an organization serving the needs and promoting the interests of psychologists affiliated with AHCs.

Relationships Among Religiousness,Spirituality, and Health for Individuals with Stroke

The current study evaluated the relationships among spiritual beliefs, religious practices, physical health, and mental health for individuals with stroke. A cross-sectional analysis of 63 individuals evaluated in outpatient settings, including 32 individuals with stroke and 31 healthy controls was conducted through administration of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36). For individuals with stroke, the SF-36 General Mental Health scale was significantly correlated with only the BMMRS Religious and Spiritual Coping scale (r = .43; p < .05). No other BMMRS factors were significantly correlated with SF-36 mental or physical health scales. Non-significant trends indicated spiritual factors were primarily related to mental versus physical health. This study suggests spiritual belief that a higher power will assist in coping with illness/disability is associated with better mental health following stroke, but neither religious nor spiritual factors are associated with physical health outcomes. The results are consistent with research that suggests that spiritual beliefs may protect individuals with stroke from experiencing emotional distress.     

Graduate employment status and health: a longitudinal analysis of the transition from student

The prevalence of unemployment and underemployment was explored longitudinally in 248 recent graduates (73 males and 175 females) over an 18–24 month transition from final year student to 9–12 months post-graduation. Over this period changes in levels of psychological distress, health behaviours, social support, optimism and achievement motivation were measured. Results show that both unemployment and underemployment have deleterious effects on psychological and physical health, social support, optimism and achievement motivation.

Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts

It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks. The opinions expressed are the authors’ own. They do not reflect any position or policy of the National Institutes of Health, US Public Health Service, or Department of Health and Human Services. This research was supported by the Intramural Research Program of the NIH Clinical Center.     

Would Socio-Economic Inequalities in Depression Fade Away with Income Transfers?

A number of recent studies have questioned the conventional view regarding the existence of income-related inequalities in depression and have suggested that other factors have a more marked impact, most notably those socio-environmental effects linked to professional status and educational attainment. This paper seeks to measure and decompose the degree of socio-economic inequality in the factors underlying reported depression by drawing on data from Spain (Spanish National Health Survey, 2003), a country in which mental care coverage is somewhat limited, but where a marked social transformation has been apparent in recent decades. Contrary to recent evidence, our findings point towards the existence of significant income-related inequalities in the prevalence of reported (diagnosed) depression. However, the results from our decomposition analysis are more mixed. While a modest proportion of overall inequalities (6–13%) is accounted for by income alone, labour status, demographics and education appear to be more relevant. However, when controlling for potential endogeneity between income and depression by using instrumental variables (IV), income is found to account for more than 50% of overall inequality in reported depression.

Similitudes et différences de perceptions chez des salariés hommes et femmes

This study investigates men and women perceptions in the work, accros the relations between work conditions and job satisfaction. Similarity and difference are questionned about the mean dimensions of the work conditions (factor analysis) as well as the prédictive value of theses dimensions for the job satisfaction (regression analysis). In the same point of view, similarity and difference are analysed about health, importance of life domains and work-family interferences. Men and women seem to organize in the same way work conditions. Three factors are retained (Relations with superiors, Development and autonomy, Work intensity), wich the first two predict job satisfaction, for the men and the women. Nevertheless we note some differences, both about the force of the prediction and about specific item. Results and and futur works are discussed.     

Rabbis and Health: A Half-Century Review of the Mental and Physical Health Care Literature:1950–1999

Electronic searches were conducted on PubMed and the American Psychological Association's database (PsycINFO) for articles that discussed the role of rabbis in relation to some aspect of healthcare. The two searches were conducted in each electronic database using the search-terms: (1) (rabbi OR rabbinical OR synagogue) OR (2) (Judaism OR Jewish) AND (clergy OR chaplain). Articles were classified by the year of their publication, professional discipline, type of journal (either religious or secular), and type of article: either research, or narrative and expositional. Rabbis were discussed most often in psychology, psychiatry, and behavior-related fields, and close to two-thirds of the articles dealt with mental health concerns. A statistically significant increase in articles across decades was found in the secular journals, r=.98, p≤.01, with over 70% of the articles about rabbis in the secular journals being published between 1980 and 1999. Many of the articles addressed collaboration between rabbis, psychiatrists, and other and mental health professionals and discussed previously identified themes related to professional collaboration and referral.     

Estimating state IQ: Measurement challenges and preliminary correlates

The purpose of this study is threefold. First, an estimate of state IQ is derived and its strengths and limitations are considered. To that end, an indicator of downward bias in estimating state IQ is provided. Two preliminary causal models are offered that predict state IQ. These models were found to be highly predictive of state IQ, yielding multiple R's of 0.83 and 0.89. Second, the extent to which state IQ predicts state outcome variables (e.g., gross state product, health, violent crime, and government effectiveness) is estimated. State IQ shows positive correlations with gross state product, health, and government effectiveness and negative correlations with violent crime. These results are consistent with the extent to which IQ predicts outcomes at the level of the individual. Third, a research agenda is provided for improving estimates of state IQ, identifying factors that cause differences in state IQ, and delineating the role of IQ in predicting important variables.     

Work attitudes,career success and health: Evidence from China

Research on the determinants and implications of career success, and in particular on how they are related to health among Chinese workers is scarce. This research explores the impact and relevance of individual attitudes of trust and organizational citizenship behavior on objective and subjective career success, and their relevance to physical and mental health. Further, we explore the moderating role of a career system on the relationships between work attitudes and career success. Using a random sample of 10,372 people in China we used multi-level linear regression methodology to explore a mediation–moderation model based on organizational theories. We found support for the impact of organizational citizenship behaviors and trust, for both objective and subjective career success as mediators of mental and physical health, and for a career system as a moderator, with significant differences emerging between workers employed in the public and private sectors. The results are important as they shed light on the relationship between work and life attitudes on outcomes of high relevance at national level. The original contribution would be of interest to policy makers at both organizational and national level.