The illness reframing process in an ethnic-majority population of older people with incurable cancer: variations of cultural- and existential meaning-making adjustments

Increasing numbers of older people in Western countries are living with incurable cancer as a chronic disease, receiving palliative care from specialised healthcare contexts. The study's aim was to understand variations of cultural- and existential meaning-making adjustments in a Norwegian majority population of older people with incurable cancer. Semi-structured interviews from 21 participants, aged 70–88, were analysed according to three identified types of belief frames: atheistic/humanistic, religious, and spiritual. Kleinman's medical anthropology cultural framework was adapted and applied deductively together with a reframing metaphor concept in a four-part analytic process. Independent of the differences among the types of belief frames and heterogeneous illness reframing processes, changes in the existential cultural dimension seemed to facilitate psychosocial adjustments in relation to illness, daily living, relationships, and surroundings. The results point to the need for collecting and assessing the function of this type of patient information for better understanding the patient's framework of interpretation, and for identifying treatment-planning resources.     

Alcohol use: Views of people receiving in-patient care for mental health conditions

This study explored the perceptions of psychiatric in-patients concerning their use of alcohol in a context of community living. A total of 70 psychiatric in-patients at an Ethiopian hospital were the informants in this study (males = 73%; females = 27%, majority diagnosis schizophrenia = 63%). The patients completed a structured interview on possible reasons for and effects associated with alcohol use in psychiatric illness. These were thematically analysed. The patients cited positive features when using alcohol to include keeping one warm, acting as a digestive, controlling the side effects of psychotropic drugs, alleviating boredom or anxiety and improving one’s mood. They noted negative aspects of alcohol consumption as being the risk of bodily harm, absenteeism from work, familial neglect and a loss of control of one’s life. Some patients believed that the use of alcohol while they were under psychiatric care carried the risk of social exclusion and discrimination; yet they also believed that abstinence from alcohol would be difficult for them.     

The effect of relational continuity of care in maternity and child health clinics on parenting self‐efficacy of mothers and fathers with loneliness and depressive symptoms

This study explored the parenting self‐efficacy of the parents of 18‐month‐old children in the context of Finnish maternity and child health clinics. This parenting self‐efficacy was observed in relation with the relational continuity of care and parents' experienced loneliness and depressive symptoms. The relational continuity of care was provided by a public health nurse in maternity and child health clinics. The participating parents were drawn from the STEPS study that is being carried out by the Institute for Child and Youth Research at the University of Turku. The results showed that relational continuity of care provided by the same public health nurse in the maternity and child health clinics was associated with mothers' higher emotional loneliness and with lower scores on three dimensions of parents' parenting self‐efficacy. Loneliness and depressive symptoms negatively influenced parents' parenting self‐efficacy – however, in the case where the family had experienced relational continuity of care, the parents' higher levels of depressive symptoms had not weakened their parenting self‐efficacy beliefs. These results are discussed in terms of organizing maternity and child health clinic services.     

The Impact of Wellness‐Focused Supervision on Mental Health Counseling Practicum Students

Professional counseling organizations tout the importance of wellness for counselors and counselors‐in‐training. The authors used a wellness‐focused supervision model with mental health practicum students to assess the model's degree of treatment effect at improving students' wellness over the course of the semester. Participants' demographics included three women, one man, three European Americans, and one Latino/a. Single‐case design results revealed that ongoing wellness‐focused interventions are helpful in improving participants' level of wellness; implications for practice are provided.     

Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES – Australia

Objective: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

Design: Diabetes MILES–Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (age: M = 52.1, SD = 13.9) with type 1 (T1D; n = 680) or type 2 diabetes (T2D; n = 944), who responded to a version of the survey containing key measures.

Main Outcome Measures: self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA_1c, medication/insulin adherence.

Results: We used Preacher and Hayes’ bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes < .06).

Conclusion: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.     

Principle of Care and Giving to Help People in Need

Theories of moral development posit that an internalized moral value that one should help those in need—the principle of care—evokes helping behaviour in situations where empathic concern does not. Examples of such situations are helping behaviours that involve cognitive deliberation and planning, that benefit others who are known only in the abstract, and who are out‐group members. Charitable giving to help people in need is an important helping behaviour that has these characteristics. Therefore we hypothesized that the principle of care would be positively associated with charitable giving to help people in need, and that the principle of care would mediate the empathic concern–giving relationship. The two hypotheses were tested across four studies. The studies used four different samples, including three nationally representative samples from the American and Dutch populations, and included both self‐reports of giving (Studies 1–3), giving observed in a survey experiment (Study 3), and giving observed in a laboratory experiment (Study 4). The evidence from these studies indicated that a moral principle to care for others was associated with charitable giving to help people in need and mediated the empathic concern–giving relationship. © 2016 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

Factors leading to orphans and vulnerable children living in community-based homes

This study explored the influences on living arrangements of orphans and vulnerable children (OVC) housed at a community-based home in Johannesburg, South Africa. A total of 50 OVC (males = 36%, females = 64%; age range 11 to 18 years) completed an open-ended questionnaire, while some of them also participated in individual interviews and focus group discussions on how they became residents of the community-based home. The data were thematically analysed. Findings suggest their choice to live in a community-based care setting to have been influenced by homelessness with accompanying poverty, health issues, experiences of child abuse and neglect, discrimination, and domestic violence. School psychologists working with OVC from community-based homes should consider pathways by which the children could be provided with needed support for resilient health and wellness.     

Book Reviews

Aronson, Ronald After Marxism
Chambliss, William J. and Zatz, Marjorie S. (Eds) Making Law: The State, the Law, and Structural Contradictions
Kirschner, Don S. Cold War Exile: The Unclosed Case of Maurice Halperin
Earle, Robert L. and Wirth, John D. (Eds) Identities in North America: The Search for Community
Dunn, Susan The Deaths of Louis XVI; Regicide and the French Political Imagination
Brothers, Barbara Jo Peace, War and Mental Health
Singer, Margaret Thaler with Lalich, Janja Cults in Out Midst
Smith, Craig Allen and Smith, Kathy B. The White House Speaks: Presidential Leadership as Persuasion
Renshon, Stanley A. High Hopes: The Clinton Presidency and the Politics of Ambition     

Insurance Coverage and Mental Health Service Use by Adolescents with Serious Emotional Disturbance

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services.     

An Examination of Race Differences in Patients' Psychological Adjustment to Cancer

Although African Americans are at increased risk of cancer morbidity and mortality, very little is known about their psychological adjustment. African American males may be at especially high psychological risk, considering their disproportionately higher cancer mortality. Subjects were 42 African American and 56 White adults similar in age, cancer stage, marital status, and socioeconomic status. Analyses revealed no significant race or gender effects on global indices of psychological adjustment, depression, or anxiety. However, African Americans were more likely than Whites (a) to use avoidant coping strategies in dealing with the exigencies of their illness, (b) to report more cancer-related disruption in family relations, and (c) to identify fewer individuals in their social support network. No significant race differences were found on a measure of health care satisfaction. These findings highlight the need to provide a more comprehensive examination of individual, family, and socioecological variables and their relationship to psychological adaptation among minorities with cancer.