SOCIAL ROLE VALORIZATION IN COMMUNITY MENTAL HEALTH HOUSING: DOES IT CONTRIBUTE TO THE COMMUNITY INTEGRATION AND LIFE SATISFACTION OF PEOPLE WITH PSYCHIATRIC DISABILITIES?

Despite its importance as a theory in the development of programs for populations with disabilities, social role valorization (SRV) has received relatively little attention in community mental health research. We present findings of a study that examined the relationship of housing‐related SRV to community integration and global life satisfaction of persons with psychiatric disabilities. The housing environments and associated supports of a group of 73 persons with psychiatric disabilities living in a mid‐sized city were assessed using the PASSING rating system on the extent that their housing environments facilitated SRV. In addition, in‐person interviews were conducted to determine the levels of physical integration, psychological integration, social integration, and life satisfaction of study participants. Results showed SRV contributing directly to all three types of community integration. Psychological integration was found to mediate the relationship between SRV and life satisfaction. Implications of the findings are discussed.     

Psychological community integration among people with psychiatric disabilities and nondisabled community members

This study examined individual and neighborhood predictors of the psychological community integration of people with psychiatric disabilities and nondisabled community members. One hundred twenty‐three adults (60 psychiatrically disabled, 63 general community residents), completed measures of sense of community, life satisfaction, psychiatric symptoms, and perceptions of neighborhood. Mental health consumers living in independent scatter‐site apartments did not differ from other community members in either sense of community or life satisfaction. Among mental health consumers, neither symptoms nor demographic variables predicted sense of community, whereas objective neighborhood characteristics did. Conversely, among community members, age and symptoms predicted sense of community while objective neighborhood characteristics did not; perceived neighborhood characteristics predicted sense of community in both samples. Findings suggest that consumers living in independent housing may achieve levels of psychological community integration comparable to other community members, and that neighborhood factors impact degree of community integration in this population. © 2011 Wiley Periodicals, Inc.     

Directive support, nondirective support, and health behaviors in a community sample

Social support is associated with improved psychological functioning, physical health, and health-promoting behaviors. However, research suggests that health outcomes might depend upon the type rather than the amount of support provided to recipients. This study assessed the relationship among nondirective and directive support, and health behaviors (i.e., physical activity, fruit and vegetable intake, alcohol use) in a community sample of 304 adults. Results revealed that nondirective support was related to greater fruit and vegetable intake and lower alcohol use; directive support was not associated with these behaviors. For physical activity, a similar trend emerged, but support variables did not explain any variance above that explained by demographic variables. These findings offer a unique contribution to the literature, as they suggest that certain types of supportive behaviors are important in encouraging positive health behaviors.     

The influence of sense of community on the relationship between community participation and mental health for individuals with serious mental illnesses

The goal of the current study is to better understand the association between community participation and mental health by investigating sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning. A survey was administered to 300 adults with serious mental illnesses using community mental health services in the United States in a cross‐sectional design. Hayes PROCESS macro (model 4, version 2.16; Hayes, 2013) was employed to test all of the hypotheses. Results indicate that sense of community partially mediated the association between community participation and psychological distress, as well as mental health functioning. Implications include contributing to the current knowledge base about the influence of community factors on mental health and informing future interventions aimed at promoting community participation of adults with serious mental illnesses.     

CONCEPTUALIZING SOCIAL INTEGRATION AMONG FORMERLY HOMELESS ADULTS WITH SEVERE MENTAL ILLNESS

The multiple dimensions of social integration among formerly homeless adults with severe mental illness have not been well‐studied. Previous studies have focused on clinical measures or narrow components of social integration. We used a multisite study of chronically homeless adults who were provided housing to (a) identify the main factors related to social integration, (b) examine the association between clinical symptoms and social integration, and (c) examine whether social integration is associated with life satisfaction. A factor analysis identified six components of social integration: housing, community participation, civic activities, religious faith, social support, and treatment support. Social integration was found to be largely independent of clinical symptoms and had only a weak association with life satisfaction. These findings suggest supported housing programs needed to focus on improving client outcomes in several domains of social integration regardless of symptoms and that additional efforts are needed to improve life satisfaction among clients.     

The needs of older adults with schizophrenia: implications for psychological interventions

The paper assesses whether the needs of people with schizophrenia over 65 years differ from those of younger adults with the diagnosis. It reviews studies comparing older and younger adults and older adults with schizophrenia and non-clinical or clinical controls on measures of psychosocial functioning. It also considers how psychological interventions can be best designed to cater for the specific needs of older adults. There are relatively few studies assessing how the needs of people with schizophrenia change over the life course and studies comparing the needs of older and younger adults. However, compared to same age peers older adults with schizophrenia have needs in relation to symptoms, cognitive functioning, social functioning, psychological resilience factors, social support, quality of life, physical health and medication adherence. Psychosocial interventions for this group therefore need to target these areas and there is evidence from three groups of researchers in the USA to suggest that cognitive behavioural or social skills interventions can be successfully adapted for older people. The paper concludes by summarising recommendations for future research and treatment.     

Social Support, Health and Satisfaction among the Elderly with Chronic Conditions in Taiwan

This study examines possible relationships between perceived social support, physical and mental health, satisfaction towards hospital services, and satisfaction towards life-asa-whole, among the community elderly with chronic conditions. A sample of 172 Chinese elderly living in a metropolitan Taiwanese city were home-interviewed. Results indicated that (a) the elderly perceived good social support, and tangible support was the most important aspect; (b) the elderly did not perceive great impact of illness(es) upon their life, and both physical and mental health were satisfactory; (c) the elderly were generally satisfied with both the hospital services and life-as-a-whole; (d) apart from health and illness factors, social support appeared to have profound and pervasive protective effects on adjustment and satisfaction of the elderly.     

Adverse experiences,mental health,and substance use disorders as social determinants of incarceration

This study describes how incarcerated people understand: (a) Adverse experiences, mental health, and substance use disorders as determinants of incarceration, (b) the role of gender in impacting this understanding, and (c) strategies to prevent incarceration. Ecosocial theory provides a theoretical framework. Open-ended interviews were conducted (December 2016–January 2017) with recently incarcerated adults in Massachusetts state prisons. Participants described determinants of incarceration and incarceration prevention strategies. Interviews were coded thematically using inductive and deductive approaches. Thirty participants, evenly split by gender, reported themes across four levels: Society (lacking basic needs, discrimination), community (neighborhood factors), interpersonal (trauma), and individual (social isolation, mental health, substance use). However, there were variations in themes by gender. Proposed prevention strategies included early access to quality individualized cross-system services. In conclusion, findings highlight how investing in social and community building services could prevent incarceration. Policies can support these services by redirecting funding.     

Psychological Interventions and Medical Cost Offset: Implications for Integrative Health Care

Chiles, Lambert, and Hatch (this issue) utilize meta-analysis methodology to demonstrate how psychological interventions historically have offset medical costs. Implications for future integrated health care delivery are discussed. Essentials for successful health service integration are identified, including unified substance abuse and mental health Interventions as well as managed care's systemic and financial support. Proposed provider integration involves a three-way partnership of primary care, surgical care, and behavioral care.     

离退休老年人生活质量及心理状态调查

目的：探讨离退休老年人的生活质量和心理状态。方法：采用老年人生活质量调查表及心理健康测查表对816例离退休老年人进行测查。结果：影响离退休老年人生活质量的因素依次为心理卫生，健康状 况，经济收入，社会交往等。不论男女其各分量表除HMA外，其余各量表离退休老年人与常模比较均有显著性差异（P＜0．01），离退休老年人各量表分明显高于常模，可能与离退休老年人躯体不适，精神活动不足和某些人心理压力及个性有关，而干部人员较工人人员的心理问题多，生活满意度低，结论：离退休老年人存在明显的心理问题，个性问题和生活质量问题，改善退休老年人的生活质量和心理有利于离退休老年人身心健康。     

Gendered work conditions, health, and work outcomes

This cross-sectional study of nonfaculty university employees examined associations among gendered work conditions (e.g., sexism and discrimination), job demands, and employee job satisfaction and health. Organizational responsiveness and social support were examined as effect modifiers. Comparisons were made by gender and by the male-female ratio in each job category. The relationship of gendered conditions of work to outcomes differed on the basis of respondents' sex and the job sex ratio. Although the same predictors were hypothesized for job satisfaction, physical health, and psychological distress, there were some differing results. The strongest correlate of job satisfaction was social support; perceived sexism in the workplace also contributed for both men and women. Organizational factors associated with psychological distress differed between female- and male-dominated jobs.     

Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy

The objectives of this study were to evaluate and identify determinants of health related quality of life (HRQoL) during pregnancy. Pregnant women (n = 245) completed questionnaires measuring: HRQoL (Short Form Health Survey SF-36), life stress, social support, sleep, and depressed mood in the third trimester. Demographics and medical variables were also collected. Compared to Canadian normative data, our sample scored significantly poorer on the following HRQoL domains: physical functioning, role limitations due to physical health problems, bodily pain, vitality, and social functioning. Multivariate linear regressions were used to model each of the SF-36 subscales. Experiencing sleep problems emerged as a significant determinant of poorer HRQoL in all domains, with the exception of emotional role. Higher depressed mood scores was independently associated with lower HRQoL in six of the eight domains, including bodily pain, general health, vitality, social functioning, emotional role, and mental health. Greater pregnancy-related anxiety was independently associated with lower scores on physical functioning and role limitations due to physical health problems. Women experience lower HRQoL during pregnancy, particularly in the physical domains. The importance of identifying and managing modifiable determinants early in pregnancy to enhance maternal health status is discussed.     

Interventions to Improve Psychological Functioning and Health Outcomes of HIV-Infected Individuals with a History of Trauma or PTSD

The experience of early or later life trauma in HIV-positive adults can have devastating mental and physical health consequences. Women bear the brunt of this double burden. Depression, posttraumatic stress disorder, and alcohol and drug use disorders are among the most common psychiatric disorders documented, both in infected women and men, in high-, middle-, and low-income countries. Traumatized individuals, particularly those with childhood sexual abuse characterized by repeated traumatization, are at high risk of engaging in risky behaviors, including substance abuse and sexual promiscuity. These issues are further compounded by stigma, discrimination, poverty, and low social support. While there is a significant need to pay more attention to psychiatric and psychological outcomes in the context of HIV-trauma and improve screening for traumatic stress in HIV care settings, there are currently few treatment and secondary prevention studies. Group cognitive-behavioral strategies, including prolonged exposure, coping skills training, and stress management have, to date, shown some evidence for efficacy in HIV-positive individuals with childhood trauma and in those with PTSD.     

Mental illness and/or mental health? Investigating axioms of the complete state model of health

A continuous assessment and a categorical diagnosis of the presence (i.e., flourishing) and the absence (i.e., languishing) of mental health were proposed and applied to the Midlife in the United States study data, a nationally representative sample of adults between the ages of 25 and 74 years (N = 3,032). Confirmatory factor analyses supported the hypothesis that measures of mental health (i.e., emotional, psychological, and social well-being) and mental illness (i.e., major depressive episode, generalized anxiety, panic disorder, and alcohol dependence) constitute separate correlated unipolar dimensions. The categorical diagnosis yielded an estimate of 18.0% flourishing and, when cross-tabulated with the mental disorders, an estimate of 16.6% with complete mental health. Completely mentally healthy adults reported the fewest health limitations of activities of daily living, the fewest missed days of work, the fewest half-day work cutbacks, and the healthiest psychosocial functioning (low helplessness, clear life goals, high resilience, and high intimacy).     

SUPPORT,SENSE OF COMMUNITY,AND PSYCHOLOGICAL STATUS IN THE SURVIVORS OF THE YAAN EARTHQUAKE

This research examined associations among social support, governmental support, sense of community, and psychological status, including depression and life satisfaction, in Yaan earthquake survivors, based on a cross‐sectional survey conducted in June 2014. The survey applied a nonprobability sampling method and a total of 495 survivors aged 18 years and older completed the questionnaire. Regression analyses revealed that social support and sense of community were associated with depression. Sense of community mediated the relationships between depression and both social and governmental support. Governmental support and sense of community were associated with life satisfaction. Sense of community mediated the relationships between life satisfaction and both social and governmental support. The findings suggest that social support, governmental support, and sense of community would enhance the psychological well‐being of disaster survivors.     

Social support and its relationship to psychological,physical health,and immune variables in HIV-infection

The purpose of this review is to examine how social support is related to measures of psychological adjustment, physical health, and immune function among HIV-infected gay men. Within this population, recent literature has demonstrated clear links (both positive and negative) between measures of social support and psychological functioning. In contrast, studies looking at the relationship between social support and both measures of physical health and immune function have yielded inconsistent and inconclusive findings. This article synthesizes and reviews what is currently known about the effects of social support on the psychological, physical health, and immune functioning in HIV-infected gay men. Both beneficial and detrimental effects of social support on health are examined, highlighting those aspects of social support that may be enhanced or discouraged in the context of psychotherapeutic interventions.     

The effects of caregiving resources on the incidence of depression over one year in family caregivers of disabled elderly

The purpose of the study was to investigate the over-time effects of physical, psychological and social resources on the incidence of depression in family caregivers of the disabled elderly. Data were collected twice at a one-year interval from 1,141 primary caregivers of a disabled older person in an urban area of Japan using a self-reported questionnaire survey. The questionnaire included physical health as an indicator of physical resources, caregiving satisfaction and intention to care as indicators of psychological resources, and instrumental and emotional support network and formal home care service utilization as indicators of social resources. The mental health outcome measure was the General Health Questionnaire 12-item version (GHQ-12). Complete data on 235 non-depressed female caregivers were separated into 3 groups according to the relationship type (wife, daughter and daughter-in-law) and analyzed separately. Multivariate logistic regression models controlling for duration of caregiving, care-recipient's gender, ADL dependency and behavioral problems demonstrated that significant predictors of depression were caregiving satisfaction and intention to care in wives, caregiving satisfaction in daughters, and physical health and emotional support network in daughters-in-law. Noteworthy, intention to care increased the risk of depression in wives, while decreasing the risk of depression in daughters-in-law. The findings indicate that the effects of caregivers' resources on mental health may differ by relationship type.     

A longitudinal investigation of interpersonal violence in relation to mental health and substance use

The authors examined longitudinally the mental health status of women as a function of different types and combinations of exposure to interpersonal violence. A structured telephone interview was administered to a household probability sample of 4,008 women (18-89 years of age), who were then recontacted for 1- and 2-year follow-up interviews. Interviews assessed lifetime violence history (i.e., sexual assault, physical assault, witnessed serious injury or violent death), past-year mental health functioning (i.e., posttraumatic stress disorder [PTSD], depression, and substance use problems), and new instances of violence occurring after the baseline interview. Results indicate that (a) lifetime violence exposure was associated with increased risk of PTSD, depression, and substance use problems; (b) odds of PTSD, depression, and substance use problems increased incrementally with the number of different types of violence experienced; (c) relations were fairly stable over a 2-year period; and (d) new incidents of violence between the baseline and follow-up interviews were associated with heightened risk of PTSD and substance use problems. Greater understanding of the cumulative impact of violence exposure will inform service provision for individuals at high risk.     

Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF)

There is a growing consensus that mental health is not merely the absence of mental illness, but it also includes the presence of positive feelings (emotional well-being) and positive functioning in individual life (psychological well-being) and community life (social well-being). We examined the structure, reliability, convergent validity, and discriminant validity of the Mental Health Continuum-Short Form (MHC-SF), a new self-report questionnaire for positive mental health assessment. We expected that the MHC-SF is reliable and valid, and that mental health and mental illness are 2 related but distinct continua. This article draws on data of the LISS panel of CentERdata, a representative panel for Longitudinal Internet Studies for the Social Sciences (N = 1,662). Results revealed high internal and moderate test-retest reliability. Confirmatory factor analysis (CFA) confirmed the 3-factor structure in emotional, psychological, and social well-being. These subscales correlated well with corresponding aspects of well-being and functioning, showing convergent validity. CFA supported the hypothesis of 2 separate yet related factors for mental health and mental illness, showing discriminant validity. Although related to mental illness, positive mental health is a distinct indicator of mental well-being that is reliably assessed with the MHC-SF.     

Posttraumatic distress and physical functioning: a longitudinal study of injured survivors of community violence

This study examines the cross-lagged relationships between posttraumatic distress symptoms and physical functioning, using a sample of 413 persons who were hospitalized for injuries resulting from community violence. Posttraumatic distress was assessed at 1 week, 3 months, and 12 months postinjury, and posttraumatic physical functioning was assessed at 3 months and 12 months. Structural equation modeling was used to assess the prospective relationship between posttraumatic distress symptoms and physical functioning while controlling for demographic characteristics and objective measures of injury severity. Results indicate that posttraumatic distress and physical functioning are reciprocally related. Individuals with high levels of psychological distress at 1 week posttrauma have worse physical functioning at 3 months. Psychological distress at 3 months was not significantly associated with subsequent change in physical functioning at 12 months. Individuals with poor physical functioning at 3 months had higher than expected levels of psychological distress at 12 months. These findings demonstrate a reciprocal relationship between physical and mental health following traumatic injury. Interventions targeting physical recovery may influence subsequent mental health, and therapies aimed at improving early mental health may also have long-term benefits for physical recovery.