The impact of organisational change on professionals working within a Community Mental Health Team (CMHT): a psychodynamic perspective

The aim of this study was to explore the effects of organisational change upon staff working in a Community Mental Health Team (CMHT). A grounded theory methodology was employed to analyse data from eight interviews with a range of staff. Analysis identified one core category and five key categories. ‘Corrosion of good work: an ethos in decline’ represents the core category and refers to the staff members’ sense of demoralisation of their professional values and integrity. The first key category, ‘Cultural change’, refers to staff members’ perception of change within the CMHT, with an increased emphasis on regulation, performance management and proceduralisation. Three further key categories were identified: ‘Caring clinicians and uncaring managers’, ‘Confusion regarding professional roles’ and ‘Disconnecting and isolating’. The fifth key ‘Staff departing and increasing risk for clients’, describes the impact of the working culture. These categories and emerging theory were interpreted through a psychodynamic lens, and identified the need for better management practice, support, training and supervision of staff as the foundations of safe practice.     

The relationship between family support; pain and depression in elderly with arthritis

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.     

Youth sports and physical activity: The relationship between perceptions of childhood sport experience and adult exercise behavior

ObjectiveParticipation in organized youth sports has been shown to positively correlate with increased levels of exercise in adulthood. However, there is limited research to suggest why youth sports participation is related to increased physical activity as an adult. One possible explanation is that positive youth sport experiences lead youth to be more positively inclined to engage in physical activity as adults. Research into the positive youth development aspect of organized sports provides the framework for the current investigation.MethodsAdult participants (N = 234, M_age = 35.35) were asked to retrospectively assess their youth sports experiences using the “Four C's” (i.e., competence, confidence, connectedness, character) framework of positive youth development in sport. These assessments were then compared to current physical activity levels and related variables found in the Health Action Process Approach model (HAPA; Schwarzer, 2008).ResultsBivariate correlations revealed statistically significant and moderate correlations among competence, confidence, and connectedness and all of the HAPA variables including physical activity levels. Further, a MANCOVA analysis revealed that when participants were sub-divided into “non-intenders,” “intenders,” and “actors” using a validated staging algorithm, a general linear trend emerged for competence, confidence, and connectedness such that “non-intenders” rated these constructs the lowest and “actors” rated them the highest.ConclusionThese findings provide preliminary evidence that the relationship between participation in organized youth sports and adulthood levels of exercise could be contingent on how positively that experience is perceived.     

The Problem of Integrating Behavioral Health in the Medical Home and the Questions It Leads to

Psychology and other behavioral health professions have amassed a broad empirical and clinical literature suggesting many medical presentations are best responded to with the addition of evidence based behavioral interventions. Despite this, psychology has not achieved a regular presence as part of medical practice. We suggest specific reasons for the current state of affairs including clinical, operational, societal labels, financial and training dimensions. Medical, psychological, administrative, and financial perspectives are reviewed. If the goals of health care system reform are to be reached then we must identify and challenge the current limitations of health care. This paper will identify the elements that need to be changed in order for psychology to be integrated into medicine rather than excluded from its policy, planning and operations.     

Integrated Primary Care: An Inclusive Three-World View Through Process Metrics and Empirical Discrimination

Integrating behavioral health services within the primary care setting drives higher levels of collaborative care, and is proving to be an essential part of the solution for our struggling American healthcare system. However, justification for implementing and sustaining integrated and collaborative care has shown to be a formidable task. In an attempt to move beyond conflicting terminology found in the literature, we delineate terms and suggest a standardized nomenclature. Further, we maintain that addressing the three principal worlds of healthcare (clinical, operational, financial) is requisite in making sense of the spectrum of available implementations and ultimately transitioning collaborative care into the mainstream. Using a model that deconstructs process metrics into factors/barriers and generalizes behavioral health provider roles into major categories provides a framework to empirically discriminate between implementations across specific settings. This approach offers practical guidelines for care sites implementing integrated and collaborative care and defines a research framework to produce the evidence required for the aforementioned clinical, operational and financial worlds of this important movement.     

An intervention study of the effects of the coping strategy of "finding positive meaning" on positive affect and health

Previous research has shown that positive affect (PA) is associated with the coping strategies of "searching for and finding positive meaning." The purpose of this study was to investigate the relationship between the coping strategy of "finding positive meaning" and PA using an intervention method. Additionally, inasmuch as previous research has revealed that PA is associated with physical and mental health status, the current study measured health status in order to carry out a preliminary test as to whether PA increased by the intervention can also improve health. Participants in the intervention group (Japanese graduate students; 13 men and 16 women) reported the most stressful event during the past 3 days and its positive meaning, while those in the control group (13 men and 15 women) reported the most stressful event alone. Both groups reported twice a week for 5 successive weeks using e-mails. Three questionnaires, the Japanese version of the Positive and Negative Affect Schedule scales for measuring positive and negative affects (NA), the situational version of the General Coping Questionnaire for coping strategies, and the Japanese version of the General Health Questionnaire for health status, were administered to all participants just before the start of the intervention, after the conclusion of the intervention, and at the 5-week follow-up session. Results revealed that the "finding positive meaning" coping strategy and PA were enhanced by the intervention in the follow-up for men and women with no changes in NA. For the health scales of the General Health Questionnaire, no significant group-related effects were observed. Thus, the intervention had no significant influence on NA or health status. Implications of these findings for future research are discussed along with a few limitations in this study.     

The association between IQ in adolescence and a range of health outcomes at 40 in the 1979 US National Longitudinal Study of Youth

A link between pre-morbid intelligence and all cause mortality is becoming well established, but the aetiology of the association is not understood. Less is known about links with cause specific mortality and with morbidity. The aim of this study is to examine the association between intelligence measured in adolescence and a broad range of health outcomes ascertained at 40 years of age. We use data on 7476 participants in the US National Longitudinal Survey of Youth 1979 who had their cognitive ability measured at baseline and completed the ‘Health at 40’ interview module between 1998 and 2004. The Health at 40 module includes assessments of general health and depression, nine medically diagnosed conditions, and 33 common health problems. Higher mental test scores were associated with lower depression scores, better general health, significantly lower odds of having five of the nine diagnosed conditions and 15 of the 33 health problems. A health disadvantage of higher cognitive ability was evident for only three of the 33 health problems.     

African-American Women’s Conceptualizations of Health Disparities: A Community-Based Participatory Research Approach

Health disparities among African-American families represent a significant social problem. Nationally, African-American infants have dramatically worse birth outcomes than other racial and ethnic groups. A Community-Based Participatory Research approach was utilized to engage community residents. This study examined participants’ definitions of infant mortality, views on the community impact of infant mortality, and strengths and vulnerabilities in the health care service delivery system. Qualitative data were gathered in a rural North Florida community where health education groups are conducted. Eight focus groups were arranged with African-American women (n = 46), ranging in age from 14 to 35, who were pregnant, parenting children under the age of two. Respondents poignantly described personal experiences of loss associated with infant mortality. They indicated awareness of problems related to lack of accessibility and availability of medical and social services. The use of social-ecological theory and implications for policy and social justice are discussed.     

Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety

Health anxiety (HA) involves persistent worry about one’s health and beliefs one has an illness or may contract a disease. In the present study, gender differences in Noyes et al.’s (2003) interpersonal model of health anxiety (IMHA) were examined. Using a sample of 950 undergraduates (674 women; 276 men), multigroup confirmatory factor analyses suggested the measurement model for key dimensions of the IMHA (i.e., reassurance-seeking, alienation, worry, and absorption) were invariant across gender. This suggests key dimensions of this model are applicable to and generalizable across women and men. Coefficients alpha for and bivariate correlations between these IMHA dimensions were also roughly comparable across women and men. As hypothesized, mean levels of reassurance-seeking and worry were significantly higher in women compared to men. No gender differences were observed in mean levels of alienation or absorption. Reassurance-seeking and worry appear salient in the interpersonal behavior and emotional life of women with HA. The present study helps to clarify gender differences in the IMHA and other HA models involving similar variables.     

Health-Related Quality of Life in a National Sample of Caregivers: Findings from the Behavioral Risk Factor Surveillance System

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers <55 years old had a 35% increased risk of having fair or poor health (odds ratio [OR] = 1.35, 95% confidence interval [CI] 1.28, 1.43) as compared to non-caregivers in that age group, while caregivers 55 years and older had a 3% decreased risk in having fair or poor health (OR = 0.97, 95% confidence interval [CI] 0.92, 1.03) compared to non-caregivers of the same age. In the adjusted models that examined the association of caregiving and healthy days, younger caregivers similarly showed larger deficits in both mental and physical HRQoL compared to older caregivers. For example combining mental and physical days, caregivers <55 had 1.44 fewer healthy days (β = −1.44, standard error (SE) = 0.07), while caregivers 55+ had 0.55 fewer days *β = −0.55, standard error (SE) = 0.13 (compared to non-caregivers in their respective age groups). Implications With increasing population age and the projected increase in caregivers, it is important that we understand the social and public health burden of caregiving and begin to identify interventions to sustain the HRQoL of caregivers. We found that caregivers have a slight to modest decline in HRQoL compared to non-caregivers, and that caregiving affects the HRQoL of younger adults more than older adults. Further research at the population level as to the type and level of burden of caregiving is needed.