Depression screening and treatment among uninsured populations in Primary Care

Uninsured populations have poor treatment engagement and are less likely to receive evidence-based interventions for depression. The objective of the current study was to retrospectively examine depression screening, diagnosis, and treatment patterns among uninsured patients in primary care. Study sample included all patients (N = 11,803) seen in nine community-based clinics. Key variables included depression screener and/or a depression diagnosis, anti-depressant initiation, behavioral health visits, and patient follow up measures. Treatment patterns from the subsample of patients diagnosed with depression were analyzed by collecting the number of behavioral health visits and antidepressant use six months (180 days) following the diagnosis. Utilization of the depression screening tool was high (67%, n = 7,935) and 24% (n = 2,789) of the patients had a diagnosis of depression, however, more than half of the patients with a depression diagnosis did not have a recorded treatment plan (n = 1,474). The odds of anti-depressant use and behavioral visits for Hispanic patients were significantly greater than for Non-Hispanic patients. Universal screening with brief measures in primary care is improving, however, guideline-concordant depression treatment remains elusive for uninsured populations.     

Active school travel is associated with fewer suicide attempts among adolescents from low-and middle-income countries

Background/Objective: This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries (LMICs). Method: We used the data from the Global School-based Health Survey, including 127,097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results: Across all the adolescents, the prevalence of AST was 37% and the prevalence of suicide attempts was 11.60%. Adolescents who engaged in AST were less likely to have suicide attempts irrespective of gender. The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries. Conclusions: AST would appear to be a protective factor for reducing suicide attempts among adolescents. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm the association between AST and suicide attempts.     

Battered women's coping strategies and psychological distress: differences by immigration status

People are rarely passive, and battered women are no exception. This study investigated the types of coping strategies women of Japanese descent (both Japan-born and U.S.-born) chose and their perceived effectiveness in dealing with their partners' violence. Japan-born respondents were significantly less likely to use active strategies and perceived them to be less effective than did U.S.-born respondents. For the Japan-born, the more effective they perceived active strategies, the higher their psychological distress, whereas the more effective they perceived passive strategies, the lower their psychological distress. In contrast, for the U.S.-born, the higher the perceived effectiveness of active strategies, the lower their psychological distress, and the perceived effectiveness of passive strategies had little effect on their psychological distress. The complex relationship between individuals' country of birth, the choice and perceived effectiveness of coping strategies, and psychological distress calls for increased attention to the role of culture in studies of coping and domestic violence.     

Beyond bruises and broken bones: the joint effects of stress and injuries on battered women's health

We investigated the joint mediating effects of injuries and stress on the relationship between abuse and women's health. A community sample of 397 women, half of whom had been assaulted by an intimate partner within the prior 6 months, was interviewed about their experience of intimate partner violence, injuries, stress, income, depression, and physical health problems. Structural equation modeling techniques confirmed the complex model of hypothesized indirect effects of abuse on women's physical health problems through injuries, stress, and depression. Stress accounted for 80% of the indirect effect of abuse on women's physical health. Its direct effect on physical health was somewhat larger than its indirect effect through depression, but both processes played a key role in determining the effect of abuse on women's physical health problems. Furthermore, abuse was a stronger predictor of women's stress than was poverty. Implication and future research are discussed.     

The Use of Multitrait–Multimethod Data for Detecting Nonlinear Relationships: The Case of Psychological Climate and Job Satisfaction

Previous monomethod research has found mixed support for nonlinear effects between certain job characteristics (e.g., job autonomy, job complexity) and outcome variables (e.g., job performance). We hypothesized that these weak nonlinear findings may be due to the prevalence of monomethod research that can lead to a lack of complete measurement and/or introduce common methods variance, either of which may mask the true shape of relationships. Using hierarchical regression analyses and a multitrait–multimethod (MTMM) research design, we found strikingly different results between monomethod and MTMM data when considering the relationships between three psychological climate variables and job satisfaction. While the monomethod results mirrored earlier inconclusive findings, the MTMM data indicated that nonlinear equations explained significantly more of the relationship between all three climate dimensions and job satisfaction. These results suggest that the use of MTMM data allows one to more effectively test for nonlinear effects. Furthermore, these nonlinear results suggest that the format of employee questionnaires should probably change from asking how much an employee has of certain constructs to asking does the employee want more or less of these constructs.     

Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

Pace of Life and Enjoyment of Life

The paper addresses the paradox that people in modern societies believe themselves to be very happy and satisfied with their lives while simultaneously are subjected to increasing time pressure and pace of life. It starts with presenting evidence for time pressure covering objective and subjective indicators. Evidence for Germany is given by comparing time-budgets in 1991/92 and in 1999. Time use among full time employed in Germany and other EU-societies in the 1990s is compared to the US and Japan by means of diary-data. As regards work life, overwork and the gap between actual and preferred working hours are examined. Survey-results on the relationship between work load, time pressure, stress and health are reported.Most of these data support the conclusion that time pressure has emerged as a major social problem. Hence citizens are beginning to consider time prosperity as a dimension of their well-being beyond their consumer wealth.However, this growing pace of life does not reduce life satisfaction and happiness. Here a paradox evolves as increasing time pressure goes hand in hand with increased subjective well-being (SWB) at country level in cross-cultural comparison as well as at individual level.In the third section some answers to this paradox are explored: A first answer is offered through the modernization theory: life satisfaction and QOL are proliferating along with economic growth and living standards. This process at the same time accelerates social life. Hence, the negative effects of time pressure are counterbalanced by various yields of the modernization process resulting in a pattern of "heavy-going" satisfaction.A second explanation is the psychological approach: time pressure fulfils positive functions for mobilizing individual resources. A variation of this argument is that the multiple-choice-society offers a wide variety of attractive options resulting in people engaging in too many activities. Here, the enjoyment of life is equated with taking advantage of every opportunity.However, this paper prefers a third approach based on Simmel's explanation of the ambivalent consequences of modernity. Even where the majority of citizens report high levels of happiness and life satisfaction – which can be explained through "arousal" or "eu-stress" – the need to ease the time-burden of disadvantaged groups and to down-speed work and social life in general is essential.     

Hotep's Story: Exploring the Wounds of Health Vulnerability in the US

A wide variety of forms of domination hasresulted in a highly heterogeneous health riskcategory, ``the vulnerable.' The study of healthinequities sheds light on forces thatgenerate, sustain, and alter vulnerabilities toillness, injury, suffering and death. Thispaper analyzes the case of a high-risk teenfrom a Boston ghetto that illuminatesintersections between ``race' and class in theconstruction of vulnerability in the US.Exploration of his ``wounds' helps specify howlarge-scale social and cultural forces becomeembodied as individual experience of disparatehealth risk. The case demonstrates that healthinequities would not occur if resources –employment, income, wealth, education, housing,profiling in the legal system, and health care– were more justly managed in keeping withstandards outlined in the Universal Declarationof Human Rights. Professional responses to the``wounds of vulnerability' may reveal importantaspects of who we are and what our work asscholars, practitioners, and advocates mustbecome.     

The Role of Referent and Expert Power in Mutual Help

This study explored the roles of referent power (i.e., influence based on sense of identification) and expert power (i.e., influence based on knowledge and expertise) in Schizophrenics Anonymous (SA), a mutual-help group for persons experiencing a schizophrenia-related illness. The study describes SA participants' experience of referent and expert power with SA members, SA leaders, and with mental health professionals. It also examines whether or not referent and expert power ascribed to fellow SA participants predicts the perceived helpfulness of the group. One hundred fifty-six SA participants were surveyed. Participants reported experiencing higher levels of referent power with fellow SA members and leaders than with mental health professionals. They reported higher levels of expert power for mental health professionals and SA leaders than for SA members. The respondents' ratings of their SA group's helpfulness was significantly correlated with ratings of referent and expert power. Although expert power was the best independent predictor of helpfulness, a significant interaction between referent and expert power indicated that when members reported high referent power, expert power was not related to helpfulness. These results are interpreted to suggest that there are multiple forms of social influence at work in mutual help.