Health Policies and Bioethics: A Psychosocial Perspective in Managing the Moral Question

In Western democratic society, the specificity of the bioethical debate over the life-sciences involves bringing together many different study factors. The dilemmas raised by the new scientific discoveries highlight how contemporary common sense is plagued by a profound feeling of anguish over possible future anthropological developments. One of the central problems is the social construction of consent as a psychological strategy seeking to orient public opinion toward accepting new applications of science and technology. On the one hand, the general features in the epistemological analysis of the mind-brain identity are called into question; and on the other, together with all those research directions concerned with the “meaning of life,” we enter the dimension of the complex issue inherent in the possibility of establishing if there exists something transcending thought and what it may be. In both cases a problem is raised on which the meaning of human life and the world depend, while between the two universes described by medical science and ethical-philosophical thought a window of opportunity for important psychological research is opened. In order to understand such phenomena the present article defends the theory that social psychology must adopt as its subject matter “thinking society,” that is, society characterized by discussion and reasoning on themes relevant to bioethics.     

Who Is Afraid of Death? Religiousness,Spirituality, and Death Anxiety in Late Adulthood

SUMMARY

Data from a sample of predominantly white, Christian men and women born in Northern California in the 1920s (N = 155) were used to test the hypothesis that traditional, church-centered religiousness and de-institutionalized spiritual seeking exemplify distinct, but equally adaptive, ways of approaching fear of death in old age. Although both religiousness and spirituality were related to positive psychosocial functioning (an integrated identity and involvement in everyday activities), only religiousness served as a buffer against the fear of death. This effect was consistent with the greater emphasis on conventionality and acceptance of social norms that characterized individuals high in religiousness. The absence of a relation between spirituality and fear of death reflected the spiritual individual's emphasis on personal searching, creativity, and the positive use of reminiscence. The implications of the findings for the management of death anxiety in old age are discussed.     

A School-Based,Primary Violence Prevention Program

Summary

This article presents findings from an evaluative study of a multidisciplinary violence prevention project jointly administered by a family practice clinic and junior high school in Santa Fe, New Mexico. The project team hypothesized that an intervention established on a public health model and aimed at enhancing adolescent self-esteem through cognitive and behavioral strategies would reduce the tendency to engage in violence of participating students. The project united health care personnel, social workers and legal profession-als in an effort to teach students specific cognitive tools for the reduction and avoidance of violent encounters. The experimental results do not reveal Project effectiveness in boosting self-esteem indicators among students, although the Project docs seem to have contributed to the control of students' behavioral aggression. Although a clear relationship between self-esteem and violent behavior is not demonstrated by the experimental results, the project study suggests that school-based, anti-violence programs based on a public health model can have a positive effect in the reduction of physical and verbal aggression among adolescents.     

Academic Counselling for Graduate Research Students with Distance Learning

The study examined academic counselling needs for graduate research students enrolled with a distance education university. Participants were 17 students (males = 10, females = 7; mean years of enrollment =1). They responded to an open ended questionnaire on pertinent counselling needs in these students related to their studies. Data were analyzed qualitatively using thematic content analysis. Findings suggested counselling needs from conflicting work and family commitments. Accessibility and user-friendliness of administrative systems and support, ease of contact and approachability of academic staff and financial strain were also significant concerns. Prospective solutions to these needs included stress management, time management, self-study skills and income generation.     

Effects of different psychological interventions on neck,shoulder and low back pain in female hospital staff

Abstract

One hundred and eleven females volunteered to take part in this intervention study of musculoskeletal pain. They all completed a survey of pain among five hundred and eighty-six female hospital staff and presented mild to severe pain in the neck, shoulder and/or low back. They were randomly assigned to one of the following groups; Focus on job-stress and psychosocial coping (Cognitive), relaxation training (Relaxation), the combination of the two (Combined) or to a control group (Control). Musculoskeletal pain (intensity and duration) was assessed by self-report prior to interventions, immediately after interventions, and at a four months follow-up. Results from multivariate analyses of variance as well as covariance (pre-intervention levels of pain as covariate) showed that magnitude of pain reduction was dependent upon the interaction between area of the back and type of intervention. These trends were more significant for intensity than for duration scores. They were due to reductions of pain in (1) neck and shoulders for the Cognitive and Combined groups and (2) in the low back and shoulders for the Relaxation group. The four month follow-up assessment revealed a significant risk of relapse only for duration of low back pain among subjects in the Combined group. Results from the Cognitive approach to intervention may reflect a causal role for ability to cope with psychosocial job stress in the development of neck and shoulder pain in female hospital staff.     

A discursive analysis of psychosocial issues: Talk in a ‘parent group’ for families who have children with chronic renal failure

Abstract

This paper illustrates a discursive approach to ‘psychosocial issues’ in health care. The analysis examines examples of talk within support groups for parents of children with chronic renal failure. These ran over a 32 month period at a Regional Paediatric Renal Unit within the UK National Health Service. All the parents are directly involved in management of home based peritoneal dialysis of their children. The analysis examines features of the organisation and content of parents' talk about what is commonplace in the management of the demands they face in the difficult circumstances of their child care. Common understandings within the groups are shown to be achieved through the parents' exploration of uncertainties in the care of their children. The value of qualitative analysis of health care talk in the evaluation of support groups for families involved in this form of paediatric care is also discussed.     

Developing a model for online support group use,empowering processes and psychosocial outcomes for individuals living with HIV/AIDS

This study examined the mechanism through which online support group (OSG) participation may promote patient empowerment among 340 individuals living with HIV/AIDS. Results from structural equation modelling revealed that greater use of OSGs was associated with more frequent occurrence of the empowering processes as measured by receiving useful information, receiving social support, finding positive meaning and helping others. Receiving useful information and finding positive meaning were related to higher levels of adaptive coping and lower levels of maladaptive coping, while receiving social support and helping others were related to higher levels of self-care self-efficacy, which in turn was related to higher levels of adaptive coping, and lower levels of maladaptive coping. Finally, higher levels of maladaptive coping were related to poorer quality of life, while higher levels of adaptive coping were related to better quality of life. Results suggest that OSG participation may offer some benefits for those living with HIV/AIDS.     

Posttraumatic growth after childbirth: A prospective study

A growing body of research has examined the potential for positive change following challenging and traumatic events, this is known as posttraumatic growth (PTG). Childbirth is a valuable opportunity to extend previous work on PTG as it allows the role of different variables to be considered prospectively. The aim of this study was to prospectively examine correlates of PTG after birth, including sociodemographic and obstetric variables, social support and psychological distress, using a prospective, longitudinal design. A total of 125 women completed questionnaires during their third trimester of pregnancy and 8 weeks after birth. At least a small degree of positive change following childbirth was reported by 47.9% of women; however, average levels of growth were lower than generally reported in other studies. A regression model of age, type of delivery, posttraumatic stress symptoms during pregnancy and general distress after birth significantly predicted 32% of the variance in growth after childbirth. The strongest predictors of growth were operative delivery (β 0.23–0.30) and posttraumatic stress symptoms in pregnancy (β 0.32). These findings emphasise the importance of assessing pre-event characteristics when considering the development of PTG after a challenging event.     

An investigation of psychosocial factors related to changes in physical activity and fitness among female adolescents

Research examined the effects of a supervised physical activity program on potential psychosocial mediators and determined whether changes in these psychosocial variables predicted changes in physical activity and fitness. Sedentary adolescent females were assigned to an intervention (n?=?79) or comparison (n?=?67) group. Cardiovascular fitness (cycle ergometer), physical activity (3-Day Physical Activity Recall), and psychosocial variables related to physical activity (i.e., self-efficacy, perceived barriers, social support, enjoyment) were assessed at three time points over the 9-month study. An intention-to-treat analysis showed that the intervention did not impact any of the psychosocial variables, with the exception of perceived barriers, which increased in the intervention group. Longitudinal analyses showed that improvements in fitness were associated with positive changes in global self-efficacy and exercise enjoyment. Psychosocial variables did not mediate the program's effects on fitness or activity. However, individual level changes in psychosocial variables were related to changes in cardiovascular fitness.     

The regulation of subjective well-being in cancer patients: An analysis of coping effectiveness

Abstract

The hypothesis that individual coping efforts affect subjective well-being in the face of severe chronic disease is examined with questionnaire data from N=332 cancer patients in a one-year longitudinal study. After depicting conceptual and methodological requirements for the analysis of coping effectiveness, the following five coping modes were investigated in the sample: Rumination, search for affiliation, threat minimization, search for information and search for meaning in religion. Results from a series of hierarchical regression analyses yielded findings that questioned the underlying assumption of a general uniform causal direction within coping-adjustment relationships. Threat minimization proved to be the only coping mode that obviously was “effective” in well-being regulation, that is, was revealed to be predictive of well-being changes over time and to be unaffected by prior levels of well-being. It is argued that the problem of causal directionality has to be carefully examined in future studies on coping effectiveness since interindividual differences in coping behaviors might be a consequence rather than the cause of differences in adjustment status.