Rurality and mental health: the role of accessibility

OBJECTIVE: The absence of an agreed definition of "rural" limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. METHOD: A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. RESULTS: Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. CONCLUSIONS: By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.     

A research agenda to improve the accessibility and quality of mental health care for Latinos

Given the persistent underutilization of mental health services by Latino persons, the mental health research agenda for this population should be shaped by a single practical issue: how to get quality mental health services to Latino consumers and their families. To address this issue, studies are needed that are longitudinal in design, that assess social factors in Latino communities, and that evaluate new and existing interventions. Collaborative investigations that draw on multidisciplinary perspectives and that are informed by multiple stakeholders (service providers, consumers, and policy makers) will increase the likelihood that such research has an impact on existing services. Moreover, careful planning of dissemination and implementation of research findings will enhance the influence that these findings have. A research agenda focused on questions that can be directly translated into accessible high-quality mental health care is needed to address the mental health needs of the nation's growing Latino communities.     

Validation of the brief jail mental health screen

OBJECTIVE: Jails have a substantial legal obligation to provide health and mental health care for inmates; yet screening procedures across American jails are highly variable. Currently, no valid, practical, standardized tool is available. The study reported here sought to validate a revision of the Referral Decision Scale (RDS)--the Brief Jail Mental Health Screen (BJMHS)--which provides an even briefer and more practical tool for use in jails. METHODS: Valid BJMHS data were collected in four jails (two in Maryland and two in New York) from 10,330 detainees. A total of 357 detainees were also administered the Structured Clinical Interview for DSM-IV (SCID) for standardized clinical cross-validation: 125 detainees (74 men and 51 women) who were classified as referrals for further mental health assessment on the basis of BJMHS and 232 detainees (137 men and 95 women) who were not classified as referrals. RESULTS: The BJMHS takes an average of 2.5 minutes to administer. It correctly classified 73.5 percent of males but only 61.6 percent of females on the basis of SCID diagnoses. Overall, the BJMHS identified 11.3 percent of screened detainees for further mental health assessment. CONCLUSIONS: The BJMHS is a practical, efficient tool that jail correction officers can give male detainees on intake screening. However, the screen has an unacceptably high false-negative rate for female detainees.     

Relationship between mental health and job efficiency

A homogeneous group of 153 Merchant Marine Officers were analysed on Seafarers' Mental Health Questionnaire (SMHQ) to evaluate their mental health state. The confidential reports of the officers relating to their job performance were scrutinised to determine the level of job efficiency. Individuals obtaining more than the mean effective percentage score were allotted to the high-efficiency group and those obtaining less, to the low-efficiency group. The results obtained show significant mean differences on almost all the mental health dimensions except sexual satisfaction, thus revealing that the job efficiency of seafarers is influenced by different aspects of mental health adjustments.     

独立学院大学新生心理健康状况调查

目的调查分析独立学院大学新生心理健康状况。方法采用症状自评量表（SCL-90）,通过整群抽样方法选取中国矿业大学徐海学院2009级全体新生,共测评了1798个有效样本,并进行了比较分析。结果独立学院新生中存在中度以上心理问题的学生占3.23%;男生在敌对因子上得分显著高于女生,在恐怖因子上得分显著低于女生;理工科学生在人际关系敏感和敌对因子上得分均显著高于文科学生;独立学院大一新生SCL-90各因子得分均显著低于国内青年组和国内大学生常模水平。结论独立学院新生具有良好的心理健康水平。     

A mental health clinic for toddlers with developmental delays and behavior problems

A mental health clinic was developed for toddlers with developmental disabilities and significant behavior problems from families living in poverty. The clinic was a collaborative effort between a community-based Birth-to-Three agency and a university. The purpose of this clinic was threefold: to provide direct mental health services for these young children, to train graduate students to work with this population, and to begin to contribute to the limited research available in this area. This paper describes the clinical intake procedures and outcomes for the 81 children served by the clinic over a 2-year period. Referral concerns included tantrums, aggression, oppositional behaviors, hyperactivity, and self-injury. The children came from a diverse group of families living in poverty; single mothers with less than a high school education headed most of the households. The clinical intake included direct observations of parent-child interactions, child behavior assessments, and parental interviews and self-report measures. For the present sample, 77% of the children met the criteria for a developmental disability and nearly 70% also met the criteria for a psychiatric disorder. The most common diagnosis was oppositional defiant disorder. Discussion regarding the challenges inherent in working with families of toddlers with developmental delays and psychiatric disorders living in low-income circumstances is included.     

Administrative issues and current mental health research

During the last decade there has been a shift in the focus of mental health research and an increased number of publications in professional journals describing research efforts. There is an increase in the proportion of investigations devoted to biological factors and into the etiology of psychiatric disorders and a decreased emphasis on psycho-behavioral research and research concerning management of psychiatric disorders. There is a significant increase in the sophistication of mental health research. These changes have important and encouraging implications for administrations of mental health programs.Dr. Keill is Chief of Psychiatry at the Buffalo VA Medical Center and Clinical Professor of Psychiatry at the State University of New York at Buffalo. Requests for reprints should be sent to Dr. Keill at the Dept. of Psychiatry, 3495 Bailey Avenue, Buffalo, New York, 14215.     

Revalidating the brief jail mental health screen to increase accuracy for women

OBJECTIVE: Jails need a reliable tool to identify inmates who require further mental health assessment and treatment. This research attempted to revalidate the Brief Jail Mental Health Screen (BJMHS) as such a tool. This research added four items to the original eight-item screen (BJMHS-R), targeting depression and trauma to improve performance of the screen with women. METHODS: BJMHS-R data were collected in four jails from 10,258 detainees. A subset of 464 were administered the Structured Clinical Interview for DSM-IV (SCID) for cross-validation. RESULTS: The original BJMHS outperformed the revised screen. The original correctly classified 80% of males and 72% of females on the basis of SCID diagnoses, compared with classification rates of 72% and 66%, respectively, with the BJMHS-R. Overall, the BJMHS identified 16% of screened detainees as needing referral for further assessment, whereas the BJMHS-R identified 22%. CONCLUSIONS: The original eight-item BJMHS is a practical, efficient tool for intake screening by jail correction officers of male and female detainees.     

Bridging community intervention and mental health services research

OBJECTIVE: This article explores the potential of community intervention perspectives for increasing the relevance, reach, and public health impact of mental health services research. METHOD: The authors reviewed community intervention strategies, including public health and community development and empowerment interventions, and contrast community intervention with practice-based quality improvement and policy research. RESULTS: A model was proposed to integrate health services and community intervention research, building on the evidence-based strength of quality improvement and participatory methods of community intervention to produce complementary functions, such as linking community-based case finding and referral with practice-based quality improvement, enhanced by community-based social support for treatment adherence. CONCLUSIONS: The community intervention approach is a major paradigm for affecting public health or addressing health disparities. Despite challenges in implementation and evaluation, it represents a promising approach for extending the reach of mental health services interventions into diverse communities.     

An analysis of mental health research with American Indian youth

A comprehensive search and review of literature, documents, publications and other material written since 1970, relevant to American Indian mental health research, was completed in order to generate a list of research and of training needs. A content analysis of this literature enabled a synthesis which describes important biopsychosocial issues faced by American Indian communities, gaps in past and current research efforts, specific problems in past research, and recommendations in each of these areas with regards to future research possibilities and needs. The portion of the analysis presented in this paper deals with American Indian infants, preschoolers, children and adolescents. In order of presentation, the specific issue domains dealt with include: otitis media, fetal alcohol syndrome, abuse and neglect, failure-to-thrive/autism/enuresis, which are examined together (early development) in terms of research gaps; and neurosensory disorders/developmental disabilities/handicapping conditions/school-related problems, foster care and adoption, self-concept/identity, conduct disorders/delinquency, drug and alcohol use, and suicide and depression, which are examined (school-age children and adolescents) in relation to research gaps and needs.