The epidemiology of mental illness in Afro-Americans

The epidemiologic study of mental illness among Afro-Americans has progressed since the antebellum period when the rate of mental illness among free Afro-Americans living in the North was inflated to justify continued slavery. Community-wide surveys conducted after World War II demonstrated that when socioeconomic variables were controlled, the rate of mental illness among Afro-Americans was no higher than that of other groups. The rates of mental illness and substance abuse of Afro-Americans vary according to socioeconomic class and are also related to differential family structure, early performance in school, and antisocial behavior of fathers. Despite progress, undersampling of middle-class Afro-Americans and poor, unemployed, young, urban Afro-American males are consistent deficiencies of surveys that even the ambitious NIMH Epidemiologic Catchment Area Program seems to share.     

Relationship between self concept and obesity in children and adolescents in various spheres of daily life

This article considers the relation between overweight and the self-concept of children and adolescents in different living areas. The visibility and perceived controllability of obesity is considered. Results of previous studies about this topic are inconsistent. Self-esteem as one aspect of the self-concept is measured by the "list of statements for children and adolescents". Comparing a group of obese (N = 56) with a group of children and adolescents who suffered from other chronic illnesses (N = 22), the obese had a lower self-esteem for the public living areas "school" and "leisure time", but not for the private area "family". A further result shows that the visibility of the illness is significantly related to self-esteem; again this relation is only revealed for the public living areas "school" and "leisure time".     

Impact of rehabilitation on self-concept following traumatic brain injury: An exploratory systematic review of intervention methodology and efficacy

To date, reviews of rehabilitation efficacy after traumatic brain injury (TBI) have overlooked the impact on sense of self, focusing instead on functional impairment and psychological distress. The present review sought to address this gap by critically appraising the methodology and efficacy of intervention studies that assess changes in self-concept. A systematic search of PsycINFO, Medline, CINAHL and PubMed was conducted from inception to September 2013 to identify studies reporting pre- and post-intervention changes on validated measures of self-esteem or self-concept in adults with TBI. Methodological quality of randomised controlled trials (RCTs) was examined using the Physiotherapy Evidence Database (PEDro) scale. A total of 17 studies (10 RCTs, 4 non-RCT group studies, 3 case studies) was identified, which examined the impact of psychotherapy, family-based support, cognitive rehabilitation or activity-based interventions on self-concept. The findings on the efficacy of these interventions were mixed, with only 10 studies showing some evidence of improvement in self-concept based on within-group or pre–post comparisons. Such findings highlight the need for greater focus on the impact of rehabilitation on self-understanding with improved assessment and intervention methodology. We draw upon theories of identity reconstruction and highlight implications for the design and evaluation of identity-oriented interventions that can supplement existing rehabilitation programmes for people with TBI.     

Self-concept and mother-concept in black and white preschool children

Utilizing objective psychological assessment instruments and projective techniques, measures of self-concept and mother-concept were obtained from young black children and white children. No significant differences were found between the self-concepts and mother-concepts of these two groups of children. As predicted, there was significant positive association between the self-concept and mother-concept in both groups. Consideration was given to contradictions between the present findings, plus some from other recent studies, and certain views presented in the older psychological literature. The need for longitudinal studies of self-esteem was emphasized.The author appreciates the assistance of Katie Ahern, Jean Bessette, and Nancy Dadekhian who administered the tests and assisted with the data analyses while enrolled in an undergraduate course on experimental child psychology at Brown University.     

The role of self-concept clarity in prolonged grief disorder

Three studies using independent samples of bereaved individuals were conducted to examine the association of self-concept clarity (SCC) with symptoms of prolonged grief disorder (PGD), a debilitating syndrome than can develop after bereavement. Study 1 (N = 67) showed that lower SCC was associated with greater PGD severity, independent from self-concept content change. Using a retrospective design, Study 2 (N = 116) showed that a loss can coincide with a decline in SCC, the magnitude of which was associated with acute PGD severity. Study 2 also showed that the maintenance of PGD symptoms over time was associated with a smaller increase in SCC beyond the first month of bereavement and not with this acute SCC decline. Using a prospective-longitudinal design, Study 3 (N = 121) showed that the impact of lower SCC on concurrent and prospective PGD severity was mediated by lower self-esteem, depressive avoidance, and rumination. Moreover, lower initial SCC predicted PGD severity 6 months later.     

Investigating the Impacts of Cochlear Implantation on the Happiness and Self-Esteem of Mothers of Children with Severe Hearing Loss

Children with severe hearing loss often struggle to communicate. Mothers of children with hearing loss may also suffer psychologically in their caregiving due to this communication barrier. Cochlear implant surgery improves child’s hearing sense, parent and children’s psychological well-being, and communication between children and their mothers. The aim of the present study is to compare happiness and self-esteem among the mothers of children with severe hearing loss before and after cochlear implantation. This cross sectional study was conducted with 40 mothers of children under the age of 7 with severe hearing loss, all of who were candidates for cochlear implant surgery in Imam Hospital, Ahvaz, Iran. A consecutive non-probabilistic sampling method was used. Mothers of children awaiting cochlear implantation completed the Oxford Happiness Questionnaire and Rosenberg Self-Esteem Inventory before and after their child’s surgery, in addition to a demographic information form. Paired t tests and Wilcoxon tests were used. A significant difference was observed between the happiness and self-esteem scores before and after surgery (p?<?0.001). Cochlear implantation surgery increases happiness and self-esteem in mothers of children with hearing loss. When a child with hearing loss goes through cochlear implant surgery, all family members will benefit from improved hearing in their child and thus, improved family communication overall.     

Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes

OBJECTIVE: The primary purpose of this study was to determine whether multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, can serve as a clinically viable alternative to inpatient psychiatric hospitalization. METHOD: One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization. Assessments examining symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction were conducted at 3 times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment). RESULTS: MST was more effective than emergency hospitalization at decreasing youths' externalizing symptoms and improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths' self-esteem. Consumer satisfaction scores were higher in the MST condition. CONCLUSIONS: The findings support the view that an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents.     

Comparative study of the kinetic family drawing and the animal kinetic family drawing in regard to self-concept assessment in children of divorced and intact families

This study examines the Animal Kinetic Family Drawing (AKFD) as a diagnostic tool to assess how parental divorce affects the self-concept of latency children. A Kinetic Family Drawing (KFD) and an AKFD were administered to latency children from intact and divorced families. A previously validated self-concept scoring system was applied to the interpretation of both KFD and AKFD tasks. Self-concept scores of the divorced and intact family groups were compared for both the KFD and AKFD. Additionally, scores for each task were compared within each study group. Two hypotheses were tested. One states that children of divorced parents will show a lower self-concept score on both the KFD and AKFD than children of intact parents. The other hypothesis states that within the divorce group children will achieve higher self-concept scores on the AKFD than the KFD and there will be no significant difference in the scores of the two tasks in the intact group. This hypothesis is based on the assumption that the AKFD is less threatening and more revealing of unconscious material than the KFD. There were no significant differences in the self-concept scores between the divorce and intact group of children with either task. Nor were there any significant differences between the KFD and AKFD within either group.     

对立违抗性障碍儿童的自我意识及家庭环境因素分析

目的探讨对立违抗性障碍(ODD)儿童的有关影响因素。方法对34例ODD患儿和34名正常对照组儿童采用Piers-Harris儿童自我意识量表(CSCS)及家庭环境量表中文版(FES-CV)进行评估。结果ODD儿童CSCS中的行为分量表得分低于对照组儿童,差异有显著性(t=2.274,P<0.05);ODD儿童FES-CV中的矛盾性分量表得分高于对照组儿童,差异有高度显著性(t=2.725,P<0.01)。结论自我意识程度低以及家庭环境中高的矛盾性,可能是儿童发生ODD的危险因素。提示改善家庭环境,采用科学的养育方式可能有利于预防和减少儿童ODD的发生。     

Ethnicity,Ethnic Identity,Self-Esteem,and At-Risk Eating Disordered Behavior Differences of Urban Adolescent Females

The purpose of this study was two-fold: to determine the relationship between ethnic identity and self-esteem as dimensions of one's self-concept; and to determine if differences exist among one's ethnicity, ethnic identity, and/or self-esteem when examining at-risk eating disordered behaviors. A total of 893 urban adolescent females completed three behavioral subscales: the Eating Disorder Inventory, Rosenberg's Self-Esteem Scale, and Phinney's Multigroup Ethnic Identity Measure. As hypothesized, ethnic identity was significantly associated with self-esteem to form one's self-concept. When compared to Mexican American and White females, only Black females who were in the higher ethnic identity and self-esteem categories had significantly lower at-risk eating disordered scores. Our findings suggest eating disorder status in Mexican American and White females may not be associated as much with ethnic identity as with other acculturation and self-concept factors. Further, this study demonstrated ethnicity, self-esteem, and ethnic identity play significant roles in eating disorder risks.     

Seizure drawings: insight into the self-image of children with epilepsy

Epilepsy is a chronic disorder that is associated with numerous psychological challenges, especially in children. Drawings have been underutilized as a method to obtain insight into psychological issues in children with epilepsy. We asked 105 children with epilepsy, ages 5 to 18 years, to draw a picture of what it is like to have a seizure. Across ages and epilepsy syndromes, the drawings showed evidence of impaired self-concept, low self-esteem, and a sense of helplessness and vulnerability. Overall, the drawings of human figures were less developed than expected for chronological age. In some drawings, indicators of underlying depression were found. When considered by epilepsy syndrome or seizure type, some specific artistic features were noted. Children with simple partial (motor) seizures drew distorted body parts, especially limbs. Those with complex partial seizures depicted sensory symptoms and mental status changes such as confusion. Children with generalized tonic-clonic seizures showed shaking extremities. Drawings by children with absence seizures illustrated mainly staring. In conclusion, drawings are a powerful method to examine the self-concept of children with epilepsy and gain insight into their feelings about themselves and their world.     

Academic self-concept in children with epilepsy and its relation to their quality of life

Abstract

Objectives:

Academic achievement in children with epilepsy is a highly studied topic with many important implications. However, only little attention has been devoted to academic self-concept of such children and the relation of academic self-concept to their quality of life. We aimed to examine academic self-concept in children with epilepsy, to assess its relationship to academic achievement and to determine possible correlations between academic self-concept and quality of life.

Methods:

The study group consisted of 182 children and adolescents aged 9–14 years who completed the student’s perception of ability scale (SPAS) questionnaire to determine their academic self-concept and the modified Czech version of the CHEQOL-25 questionnaire to determine their health-related quality of life.

Results:

We found that academic self-concept in children with epilepsy was on average significantly lower than in their peers without seizures, especially with regard to general school-related abilities, reading, and spelling. On the other hand, the variance in the data obtained from the group of children with epilepsy was significantly higher than in the whole population and the proportion of individuals with very high academic self-concept seems comparable among children with and without epilepsy. Moreover, it was found that correlations between academic self-concept and academic achievement are significantly lower in children with epilepsy than in the whole population.

Discussion:

The presented results suggest that considerable attention should be paid to the role of academic self-concept in education of children with epilepsy and to the factors influencing this self-concept in this group.     

Shame and implicit self-concept in women with borderline personality disorder

OBJECTIVE: Shame is considered to be a central emotion in borderline personality disorder and to be related to self-injurious behavior, chronic suicidality, and anger-hostility. However, its level and impact on people with borderline personality disorder are largely unknown. The authors examined levels of self-reported shame, guilt, anxiety, and implicit shame-related self-concept in women with borderline personality disorder and assessed the association of shame with self-esteem, quality of life, and anger-hostility. METHOD: Sixty women with borderline personality disorder completed self-report measures of shame- and guilt-proneness, state shame, anxiety, depression, self-esteem, quality of life, and clinical symptoms. Comparison groups consisted of 30 women with social phobia and 60 healthy women. Implicit shame-related self-concept (relative to anxiety) was assessed by the Implicit Association Test. RESULTS: Women with borderline personality disorder reported higher levels of shame- and guilt-proneness, state shame, and anxiety than women with social phobia and healthy comparison subjects. The implicit self-concept in women with borderline personality disorder was more shame-prone (relative to anxiety-prone) than in women in the comparison groups. After depression was controlled for, shame-proneness was negatively correlated with self-esteem and quality of life and positively correlated with anger-hostility. CONCLUSIONS: Shame, an emotion that is prominent in women with borderline personality disorder, is associated with the implicit self-concept as well as with poorer quality of life and self-esteem and greater anger-hostility. Psychotherapeutic approaches to borderline personality disorder need to address explicit and implicit aspects of shame.     

Paternal absence and its effect on adolescent self-esteem

Recent research has indicated that father absence is significantly related to self-concept of black adolescent males. Results suggest that where paternal absence exists in the home situation, the level of self-esteem tended to be affected more for males than for females. Where father was absent in the home, males tended also to have lower levels of self-esteem than females. Where self-esteem of the child and core-facilitative conditions in mother were correlated significantly (p less than .05), male self-esteem was likely to be affected negatively. Therefore, presence of maternal core-facilitative conditions can favourably effect self-esteem of both male and female adolescents in father-absent homes.     

Mental Hygiene Consultation Service†

The manifestation, course, and prognosis of schizophrenia are extremely variable, raising an interest in the role of personality and self-concept in the illness’ outcome. Building on voluminous research attesting to the fragility and instability of the self in schizophrenia, we examined the role of four self-concept aspects—self-esteem level, self-esteem instability, self-concept clarity, and the perception of the self as ill—in schizophrenia-spectrum disorders. Eighty-nine outpatients were assessed at baseline, and five days subsequently, regarding these self-concept aspects, symptoms, stress, and quality of life. Six weeks later, participants were again assessed using the baseline battery. Self-esteem instability predicted a decrease in quality of life over the study period. Self-concept clarity predicted an increase in quality of life and in positive symptoms, particularly under low stress. Depressive symptoms predicted a decrease in self-esteem levels and an increase in the perception of the self as ill. Thus, all four self-concept aspects were shown to be pertinent to the experience of schizophrenia, albeit in different ways. Special attention should be directed to self-concept clarity, which embeds both risk and resilience.     

Guardianship primavera: a first look at factors associated with having a legal guardian using a nationally representative sample of community-dwelling adults

Although guardianship is an intrusive intervention that usually removes an adult's basic civil rights, studies of factors that place adults at risk for guardianship have largely been based on small studies of court files. While important and informative, these studies do not allow us to draw anything but tentative conclusions on risk factors for guardianship. The purpose of this article is to examine risk factors for having a legal guardian using a nationally representative sample for the first time. Logistic regression was conducted on the probability of having a legal guardian, using the Andersen model of health care utilization adapted for factors implied by the guardianship literature. The National Health Interview Supplement on Disability (1995) sample consisted of 65,013 adults aged 19 and older, and a sub-sample aged 60 and older (n = 13,784). Results indicate, first, that the prevalence of guardianship in community-dwelling adults is 0.3 percent, or over 750,000 people. Second, particularly for older adults, increasing age, having physical or emotional limitations, a small family network, and not living with a spouse are associated with having a guardian. Decreasing size of family networks and increasing marital disruption in future cohorts of older adults may suggest increasing need for legal guardianship. Further study should be conducted to replicate these findings in other large data sets and in extensive community studies.     

Tourette's syndrome and the law

Diminished legal responsibility and mental capacity have been used in defense of individuals with neurological disorders charged with legal misdemeanors, including criminal behavior. The purpose of this report is to 1) critically examine the mechanisms that may predispose patients with Tourette's syndrome (TS) to potentially, legally liable behaviors; 2) report the results of a nation-wide review of state, federal, and appellate cases involving TS; and 3) instigate awareness within the professional legal community regarding unrecognized organically-based behaviors that may predispose TS patients to unwanted legal disciplinary action. TS is a common neurological movement disorder of childhood onset associated with behavioral comorbidities, including impulse control problems, exhibition of obscene language or gestures, rage attacks, inappropriate obsessions, and other behaviors. To our knowledge, there are no studies (to date) addressing the potential impact of TS on the legal system. A comprehensive review of the neurobehavioral mechanisms underlying comorbid issues in TS is outlined. A comprehensive review of all cases tried in state and federal courts between 1985 and 2003, in which TS was somehow implicated, was conducted using the Westlaw database. As of October, 2003, TS was implicated in more than 150 cases found in the federal and state databases, 21 of which were criminal. Other cases are categorized as civil rights, criminal, education, family, labor, and social security cases. The authors conclude that TS rarely leads to criminal behavior, but patients with TS who have behavioral comorbidities are at risk of being involved with the legal system. The medical-legal community must learn to recognize the vulnerability of this patient population to potential mistreatment by the courts of justice.     

The use of a group mural project to increase self-esteem in high-functioning,cognitively disabled adults

Between 10 and 40% of the population of people with Intellectual Disability (ID) also meet the criteria for some form of psychopathology and are more likely to experience lower levels of self-esteem and self-concept. Traditional therapies may not always be appropriate for ID clients’ and alternative types of therapies have not been empirically tested. The present study hypothesized that a group art therapy intervention would increase self-concept and self-esteem in a group of clients with mild ID. The Tennessee Self-Concept Scale:2 (TSCS:2) was used as a pre- and post-test in a treatment and comparison group design. Participants in the study were not different at pre-test, but the experimental group at post-test had increases on the Social and Identity subscales, as well as a marginal difference on the in Family subscale and Total self-concept score. The efficacy of the mural project is explained in terms of its’ social, empowering, and positive group experience.