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.     

Romantic Relationships and Health: An Examination of Individuals’ Perceptions of their Romantic Partners’ Influences on their Health

This study examines individuals’ perceptions of the impact their significant others have on their health and the extent to which these perceptions are associated with relationship quality and actual health. Two-hundred and ten participants (105 U.S. couples; mean age = 24.93) completed measures of their relationship quality and health along with an open-ended measure asking them to indicate how they felt their partner influenced their health. Results indicated that participants perceived their romantic partners to be primarily positive health influences, women believed their partners were more influential than did men, and eating and physical activity behaviors were believed to be most affected by partners. Participants’ relationship quality and health were associated with their reports of their perceived partners’ health influences. The research described in this report was supported by an award to Charlotte Markey from Rutgers University.     

An experimental investigation of the impact of biological and psychological causal explanations on anxious and depressed patients' perception of a person with panic disorder

It is often suggested that biological accounts of the cause of mental health problems are beneficial in health education initiatives. However, an alternative view is that the idea of a diseased brain may result in stigma and therapeutic pessimism in sufferers, professionals and the public with implications for the perception of unpredictability and risk. Anxious and depressed patients (n=49) were randomly allocated to three experimental conditions. Prior to watching a video of a person suffering from panic disorder, participants were told either that research indicated that panic was caused by biological factors, by psychological factors or the cause was unclear (control condition). Those in the biological condition were significantly more pessimistic about the patient's prospects for recovery and rated risks as higher compared to those in the psychological condition. The results call into question the widely accepted practice of promoting biological/disease explanations of mental health problems.     

Can I Be Ill and Happy?

Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above.     

Social support, sense of community in school, and self-efficacy as resources during early adolescence: an integrative model

Influences of different sources of social support (from parents and friends), school sense of community, and self-efficacy on psychosocial well being (as measured by self-reported life satisfaction and psychological symptoms) in early adolescence were investigated in an integrative model. The model was tested using structural equation modeling. Multi-group comparisons were used to estimate differences between sex and age groups. The survey sample was composed of 7,097 students in Northern Italy (51.4% male) divided into three age cohorts (equivalent to 6th, 8th, and 10th grades with median ages of 11, 13, and 15). Findings obtained using SEM were consistent with self-efficacy and school sense of community mediating effects of social support on psychosocial adjustment. The multi-group comparison indicates a need for more complex developmental models and more research on how changing forms of support interact with each other as their effects also change during this important stage of the life. Implications for primary prevention and cross-cultural comparisons are discussed.     

Optimism and resources: Effects on each other and on health over 10 years

Dispositional optimism may be associated with growth of social and status resources by virtue of optimists' greater persistence and better performance. Conversely, resource growth may give people a more positive view of their future and increase optimism. Changes in dispositional optimism and resources over 10 years were examined in former law students (N = 61). More optimistic first-year law students made more money 10 years later, but income did not predict later optimism. More optimistic students did not have larger social networks 10 years later, but increases in social network size predicted increased optimism. These changes predicted mental and physical health. Dispositional optimism was less stable than many personality traits (r = .35), potentially because it is responsive to resource change.     

中学生适应取向的心理健康结构初探

在文献综述的基础上,建构了适应取向的中学生心理健康的理论模型,并对中学生和中学教师进行开放式问卷调查,再参考同类量表,拟定了中学生心理健康量表的题项。经对1,567名中学生进行测试,结果表明:适应取向的中学生心理健康包含生活幸福、乐于学习、人际和谐、考试镇静、情绪稳定等五个维度,本研究所编制的中学生心理健康量表具有良好的信效度。     

Nanotoxicology and Ethical Conditions for Informed Consent

While their strength, electrical, optical, or magnetic properties are expected to contribute a trillion dollars in global commerce before 2015, nanomaterials also appear to pose threats to human health and safety. Nanotoxicology is the study of these threats. Do nanomaterial benefits exceed their risks? Should all nanomaterials be regulated? Currently nanotoxicologists cannot help answer these questions because too little is known about nanomaterials, because their properties differ from those of bulk materials having the same chemical composition, and because they differ so widely in their applications. Instead, this paper answers a preliminary ethical question: What nanotech policies are likely to contribute to society’s ability to give or withhold free informed consent to the potential risks associated with production and use of nanomaterials? This paper argues that at least four current policies appear to jeopardize the risk-disclosure condition that is required for informed consent. These are the funding problem, the conflict-of-interest problem, the labeling problem, and the extrapolation problem. Apart from future decisions on how to ethically make, use, and regulate nanomaterials, this paper argues that, at a minimum, these four policies must be modified. Government must spend greater monies on nanotoxicology; ensure independent nanotoxicology research; label consumer products containing nanomaterials; and avoid assuming that nanotoxicological properties are based merely on mass and chemical composition. Otherwise free informed consent to these new technologies and materials may be jeopardized.     

The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination

Couple therapy reduces relational and individual distress and may affect utilization of other health services, particularly among higher service utilizers. Although average decreases in service utilization are predicted among recipients of couple therapy, low utilizers of services may appropriately increase use. The relationship between couple therapy and service utilization was examined among a sample of 179 U.S. military veterans who received treatment in Veterans Affairs (VA) specialty couple therapy clinics. Consistent with hypotheses, overall mental and physical health visits decreased from the 12 months preceding couple therapy to the 12 months following treatment. Moderator analyses showed that decreases were greatest among individuals who were rated by their therapist as having completed a full course of couple therapy, suggesting that change was attributable to intervention. Pretreatment service utilization also moderated observed change—higher utilizers’ use of services decreased substantially, whereas lower utilizers’ slightly increased. Cost analyses revealed that the estimated per person mean cost in our sample decreased by $930.33 in the year following compared to the year prior to couple therapy, as per 2008 VA cost data. As service utilization data were only available for one partner and only for 1 year posttherapy, the true magnitude of this effect may be underestimated. Our findings are relevant to policy makers as they demonstrate that couple therapy reduces average service utilization and associated costs and addresses calls for analyses of cost effectiveness of systemic interventions.