Inequalities in Health and Intergenerational Equity

In the popular folklore three-score-years-and-ten is treated as a fair innings for people, and thereby serves as an informal reference point for judgements about distributive justice within a community. But length of life alone is an insufficient basis for such judgements - a person's health-related quality-of-life also needs to be taken into account. If one of the objectives of public policy is to reduce inequalities in lifetime health, it will be demonstrated that this is very likely to require systematic discrimination against the older members of a community. The notion of community solidatity will also be tested, because a decision will need to be made as to whether the same fair innings applies to all members of the community, or whether some are entitled to more than others. The strength of the fair innings principle is that it brings these issues to the fore in a systematic way which should ais their resolition in a practical context.     

The Relationship Among Major Depression, Depressive Symptoms, and Self-Preoccupation

The present study investigates whether highly self-preoccupied people (exhibiting a tendency to focus primarily on the self and to maintain self-focused attention) were more likely to experience major depressive episodes (MDEs) than those without such tendencies. One hundred nineteen young community residents, aged 18 to 21, took part in semistructured interviews, during which we investigated their past and present history of mental illness, including MDEs, as delineated by the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R). Self-preoccupation was measured by the Self-Preoccupation Scale (SPS). Of the 119 participants interviewed, the lowest and highest quarters in the SPS scores formed the low- and high-self-preoccupation (SP) groups. The lifetime prevalence of the DSM-III-R MDE was significantly greater among those high in SP than in the low SP group. Moreover, the high-SP group had significantly more depressive symptoms than the low-SP group. The contributory role of self-preoccupation to suicide ideation and the interpersonal aspects of self-preoccupation were discussed.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

The import of infancy for individual, family, and societal development: commentary on the special section: does infancy matter?

Across their life spans humans actualize a rich potential for cognitive and behavioral plasticity, a set of developmental changes that require regulation of organism-context relations on the part of both the individual and society. An individual’s action on the context must be started in infancy and maintained in subsequent periods of life for adaptive functioning to occur across ontogeny. The process of the individual acting as an agent of his or her own development is continuous, although the particular ways in which such control is manifested will change in developmentally appropriate ways. As demonstrated by the papers in this special issue, the significance of infancy for the rest of the life-span rests on an integration of this continuity and discontinuity within the person-context developmental system.     

Virtue and the Good Life in the Early Confucian Tradition

This essay examines the role of virtue and the status of non‐moral goods in conceptions of the good human life through an exploration of the thought of Confucius and Mencius. Both Confucius and Mencius lived in quite similar worlds, but their conceptualizations of the world differed from each another. This difference led them to hold different views on the role of virtue and the status of non‐moral goods. On the one hand, Confucius highlighted the self‐sufficiency of virtue, but he acknowledged and appreciated the intrinsic and instrumental value of non‐moral goods. On the other hand, while Mencius underscored the role of virtue as the best means to the best ends, he tried to depreciate the value of non‐moral goods. As a consequence, even though their conceptions of the good life were essentially predicated on virtue, they parted company concerning the status of non‐moral goods in human life.     

Perceived Discrimination and Health-Related Quality of Life: Testing the Reserve Capacity Model in Hispanic Americans

ABSTRACT

This study tested aspects of the Reserve Capacity Model (Gallo & Matthews, 2003 Gallo, L. C. and Matthews, K. A. 2003. Understanding the association between socioeconomic status and physical health: Do negative emotions play a role?. Psychological Bulletin, 129: 10–51. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Gallo, Penedo Espinosa de los Monteros, & Arguelles, 2009 Gallo, L. C., Penedo, F. J., Espinosa de los Monteros, K. and Arguelles, W. 2009. Resiliency in the face of disadvantage: Do Hispanic cultural characteristics protect health outcomes?. Journal of Personality, 77: 1707–1746. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) as a means of understanding disparities in health-related quality of life appraisals among Hispanic Americans. Questionnaire data were collected from 236 Hispanic participants, including measures of perceived discrimination, optimism, social support, symptoms of trait anxiety, and physical and mental health-related quality of life. Path analysis indicated direct, negative associations between perceived discrimination and both forms of health-related quality of life. Results also showed that these relationships were partially mediated by the reserve capacity variable of optimism and by symptoms of anxiety, though evidence for mediation by anxiety was stronger than for optimism. Findings suggest that perceived discrimination depletes intrapersonal reserves in Hispanic Americans, which, in turn, induces negative emotions. Implications for community-level interventions are discussed.     

Integrating Women's Voices and Theory: A Comprehensive Domestic Violence Intervention for Latinas

Using both academic theories and two decades of experience in community, this article presents the work conducted by Caminar Latino (Latino Journey), a comprehensive intervention for Latino families affected by domestic violence. Having developed in both analogous and independent ways from theories in the academic field, Caminar Latino provides a unique opportunity to explore ways in which ecological theory and tenets of feminist therapy can be combined within a social justice framework to address this severe social problem. Of particular relevance to therapists, advocates and others working in this field is the ongoing inclusion of the voices of women participants as a central tenet of the intervention.     

The Owl and the Ostrich: Reply to Sami Pihlström on Ethical Unthinkabilities and Philosophical Seriousness

Sami Pihlström argues in his “Ethical Unthinkabilities and Philosophical Seriousness” that there are some philosophical views that are so dangerous that we should not discuss them. He advances this argument with special reference to my (anti‐natalist) view that being brought into existence is always a serious harm. In response I argue: (a) that there are major flaws in his argument for the conclusion that we should not think about (purportedly) unthinkable views; and (b) that my views about the harm of coming into existence are in any event neither unthinkable nor dangerous.     

The Impact of Neighborhood Factors on the Well-Being of Survivors of Intimate Partner Violence Over Time

Intimate partner violence (IPV) is a pervasive social problem impacting the psychological well-being of millions of US women annually. The extant literature draws our attention to the devastating mental health effects of IPV, but largely overlooks how ecological factors may further explain survivors' well-being. This study examined how neighborhood disadvantage may contribute to survivors' compromised well-being, in addition to the abuse women experienced. Neighborhood disorder and fear of victimization significantly impacted survivors' well-being, over and above abuse. Although between-women effects of neighborhood disorder and fear were unrelated to change in women's depression or quality of life (QOL), significant within-woman effects were detected. Change in neighborhood disorder was negatively associated with change in QOL, and this relationship was fully mediated by fear. While no direct relationship between change in neighborhood disorder and depression was detected, an indirect effect through survivors' fear was revealed. Implications for future research and practice are discussed.