Rural mental health in America

Mental health services are in short supply in rural America. This article describes both the mental health service needs in rural areas and the barriers to improving the availability, accessibility, and acceptability of rural mental health services. Federal programs in rural mental health care in the Departments of Health and Human Services, Agriculture, and Education are described, as well as selected congressional initiatives. The role of the federal Office of Rural Health Policy is emphasized, and policy recommendations for improving rural mental health care delivery are presented.     

The danger of conflating level-specific effects of control variables when primary interest lies in level-2 effects

In the multilevel modelling literature, methodologists widely acknowledge that a level-1 variable can have distinct within-cluster and between-cluster effects, and that failing to disaggregate these can yield a slope estimate that is an uninterpretable, conflated blend of the two. Methodologists have stated, however, that including conflated slopes of level-1 variables in a model is not problematic if substantive interest lies only in effects of level-2 predictors. Researchers commonly follow this advice and use methods that do not disaggregate effects of level-1 control variables (e.g., grand mean centering) when examining effects of level-2 predictors. The primary purpose of this paper is to show that this is a dangerous practice. When level-specific effects of level-1 variables differ, failing to disaggregate them can severely bias estimation of level-2 predictor slopes. We show mathematically why this is the case and highlight factors that can exacerbate such bias. We corroborate these findings with simulations and present an empirical example, showing how such distortions can severely alter substantive conclusions. We ultimately recommend that simply including the cluster mean of the level-1 variable as a control will alleviate the problem.     

Is Change Bad? Personality Change Is Associated with Poorer Psychological Health and Greater Metabolic Syndrome in Midlife

Personality change is emerging as an important predictor of health and well‐being. Extending previous research, we examined whether two types of personality change, directional and absolute, are associated with both subjective and objective indicators of health. Utilizing the longitudinal Midlife in the United States survey (MIDUS) data, we examined whether both types of change over 10 years were associated with psychological well‐being, self‐reported global health, and the presence of metabolic syndrome (MetS) components and diagnosis. Socially undesirable personality change (e.g., becoming less conscientious and more neurotic) and absolute personality change were independently associated with worse perceived health and well‐being at Time 2. Notably, absolute personality change, regardless of the direction, was also associated with having a greater number of MetS components and a greater probability of diagnosis at Time 2. In sum, too much personality change may be bad for one's health: Socially undesirable and absolute personality change were both associated with worse psychological health and worse metabolic profiles over 10 years. These findings suggest that personality change may contribute to psychological and physical health, and provide initial insight into potential intermediate links between personality change and distal outcomes such as mortality.     

Accounting for Parcel-Allocation Variability in Practice: Combining Sources of Uncertainty and Choosing the Number of Allocations

Item parceling remains widely used under conditions that can lead to parcel-allocation variability in results. Hence, researchers may be interested in quantifying and accounting for parcel-allocation variability within sample. To do so in practice, three key issues need to be addressed. First, how can we combine sources of uncertainty arising from sampling variability and parcel-allocation variability when drawing inferences about parameters in structural equation models? Second, on what basis can we choose the number of repeated item-to-parcel allocations within sample? Third, how can we diagnose and report proportions of total variability per estimate arising due to parcel-allocation variability versus sampling variability? This article addresses these three methodological issues. Developments are illustrated using simulated and empirical examples, and software for implementing them is provided.     

Minimum Muscle-Tension Change Trajectories Predicted by Using a 17-Muscle Model of the Monkey's Arm

Four computational problems to be solved for visually guided reaching movements, hand path, and trajectory formations, coordinate transformation, and calculations of muscle tensions are ill-posed in redundant biological control systems. These problems are ill-posed in the sense that there exist an infinite number of possible solutions. In this article, it is shown that the nervous system can solve those problems simultaneously by imposing a single global constraint: finding the smoothest muscle- tension trajectory that satisfies the desired final hand position, velocity, and acceleration. Horizontal trajectories were simulated by using a l7-muscle model of the monkey's arm as the controlled object. The simulations predicted gently curved hand paths for lateral hand movements and for movements from the side of the body to the front, and a roughly straight hand path for anterioposterior movements. The tangential hand velocities were roughly bell shaped. The simulated results were in agreement with the actual biological movements.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

An Examination of Information Quality as a Moderator of Accurate Personality Judgment

Information quality is an important moderator of the accuracy of personality judgment, and this article describes research focusing on how specific kinds of information are related to accuracy. In this study, 228 participants (159 female, 69 male; mean age = 23.43; 86.4% Caucasian) in unacquainted dyads were assigned to discuss thoughts and feelings, discuss behaviors, or engage in behaviors. Interactions lasted 25–30 min, and participants provided ratings of their partners and themselves following the interaction on the Big Five traits, ego‐control, and ego‐resiliency. Next, the amount of different types of information made available by each participant was objectively coded. The accuracy criterion, composed of self‐ and acquaintance ratings, was used to assess distinctive and normative accuracy using the Social Accuracy Model. Participants in the discussion conditions achieved higher distinctive accuracy than participants who engaged in behaviors, but normative accuracy did not differ across conditions. Information about specific behaviors and general behaviors were among the most consistent predictors of higher distinctive accuracy. Normative accuracy was more likely to decrease than increase when higher‐quality information was available. Verbal information about behaviors is the most useful for learning about how people are unique.     

Mothers' and fathers' support for child autonomy and early school achievement

Data were analyzed from 641 children and their families in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development to test the hypotheses that in the early school years, mothers' and fathers' sensitive support for autonomy in observed parent-child interactions would each make unique predictions to children's reading and math achievement at Grade 3 (controlling for demographic variables), children's reading and math abilities at 54 months, and children's level of effortful control at 54 months and that these associations would be mediated by the level of and changes over time in children's observed self-reliance in the classroom from Grades 1 through 3. The authors found that mothers' and fathers' support for autonomy were significantly and uniquely associated with children's Grade 3 reading and math achievement with the above controls, but only for boys. For boys, the effect of mothers' support for child autonomy was mediated by higher self-reliance at Grade 1 and of fathers' support for child autonomy by greater increases in self-reliance from Grades 1 through 3.