Comparison of psychiatrists' and other physicians' assessments of their ability to deliver high-quality care

OBJECTIVE: This study compared psychiatrists' assessments of their ability to deliver high-quality care with those of other physicians. METHODS: Data were used from the Community Tracking Study Physician Survey, a national survey of 12,528 physicians. Linear regression models were used to investigate the effects of type of physician (psychiatrist or other physician), managed care involvement, and ability to obtain inpatient care on four measures of physicians' assessments of quality. RESULTS: In models that did not control for difficulty in obtaining inpatient services, assessments of quality were significantly lower among psychiatrists than among other physicians. Furthermore, although managed care involvement was associated with lower assessments of quality for all physicians in these models, the effects were stronger for psychiatrists than for other physicians. However, after difficulty in obtaining inpatient services was controlled for, psychiatrists' and other physicians' assessments of quality were similar. CONCLUSIONS: Compared with other physicians, psychiatrists' assessments of the quality of care that they provide were lower and their assessments were more influenced by involvement with managed care. These differences may be mediated by difficulty in obtaining inpatient services. When designing and administering behavioral health benefits packages, clinical policy makers should consider the possible effects of reduction in inpatient services on quality of care.     

Religion and medicine IV: religion, physical health, and clinical implications

In the fourth and final article of this religion and medicine series, I summarize the results of a comprehensive and systematic review of research examining religion's relationship to physical health and mortality. This review focuses on pain and disability, cardiovascular disease, immune and neuroendocrine function, susceptibility to infection, cancer, and overall mortality. I also explore what these research findings mean for medical practice and suggest patient-centered applications that are sensitive to ethical concerns.     

Religion, spirituality, and depression in adolescent psychiatric outpatients

This study examines in a preliminary manner the relationship between multiple facets of religion/spirituality and depression in treatment-seeking adolescents. One hundred seventeen psychiatric outpatients aged 12 to 18 completed the brief multidimensional measure of religiousness/spirituality, the Beck Depression Inventory (BDI), a substance abuse inventory. Controlling for substance abuse and demographic variables, depression was related to feeling abandoned or punished by God (p < 0.0001), feeling unsupported by one's religious community (p = 0.0158), and lack of forgiveness (p < 0.001). These preliminary results suggest that clinicians should assess religious beliefs and perceptions of support from the religious community as factors intertwined with the experience of depression, and consider the most appropriate ways of addressing these factors that are sensitive to adolescents' and families' religious values and beliefs.     

Religion and spirituality in psychiatric care: looking back, looking ahead

Cultural psychiatry has been an important contributor to the enhanced dialogue between psychiatry and religion in the past couple of decades. During this time, religion and spirituality have become more prominent in mainstream psychiatry in a number of areas of study and clinical care, including refugee and immigrant health, trauma and loss, psychotherapy, collaboration with clergy, bioethics, and psychiatric research. In looking towards the future, there is a great deal of promise for future enhancement of the study of religion and spirituality in psychiatric education, research, and clinical care.     

Religion,spirituality, and chaplains in the biomedical literature: 1965-2000

In recent years, several prominent medical journals have published articles addressing the relationship between religion/spirituality and medicine, and recognizing the importance of religion in the lives of most Americans, especially in times of illness. We hypothesized that the publication of these articles reflected a trend in the biomedical literature in which greater attention is being given to the role of religion and spirituality in health-care. A correlational design was used, based on an electronic survey of all articles in MEDLINE for the years 1965 through 2000. The search terms used were: 1) religion or religious; 2) spiritual; and 3) chaplain. The number of articles per 100,000 that mentioned religion (religion or religious), spirituality, or chaplains each year was determined. Statistically significant upward trends across years were found for the rates of articles addressing religion (r = .59, p < .001) and spirituality (r = .89, p < .001) and a non-significant trend was found for chaplains (r = .31). The rising rates of articles on religion and spirituality in biomedical journals suggest a growing recognition of the need to address spiritual and religious issues in health-care.     

A model of spirituality for psychotherapy and other fields of mind-body medicine

The spiritual revolution that has permeated our culture challenges psychotherapists and other health practitioners to address the spiritual concerns of their clients and themselves. This challenge is particularly critical in view of the confused, meaningless, and faulty so-called "spiritual" ideas that affect some clients in ways that are toxic to their psychological (and possibly physical) health. However, given the nonspiritual tradition of professional psychology and medicine as a whole, practitioners as a group have no clear and cogent concept or standards with which to acknowledge and address these concerns. The aim of this article is to formulate a concept of spirituality that allows practitioners to include spirituality in their work in a clear, sound, and meaningful way.     

Religion and spirituality in child and adolescent psychiatry: a new frontier

This article introduces the interface between child and adolescent psychiatry and religion and spirituality. Developmental psychopathology has become increasingly diverse in its study of risk and protective factors for child and adolescent psychopathology. The effect of religion and spirituality on clinical conditions is among those factors. This review addresses (1) historical aspects of the relationship between psychiatry and religion/spirituality, (2) definitional issues, and (3) unique factors in child and adolescent work. Considering these factors and some general principles of intervention, it prepares the reader for other articles in this issue. The article concludes with some observations on the "secular family".     

Religion, spirituality and the well-being of informal caregivers: a review, critique, and research prospectus

The purpose of this article is to review and critique the published literature examining the relationships between religion/spirituality and caregiver well-being and to provide directions for future research. A systematic search was conducted using bibliographic databases, reference sections of articles, and by contacting experts in the field. Articles were reviewed for measurement, theoretical, and design limitations. Eighty-three studies were retrieved. Research on religion/spirituality and caregiver well-being is a burgeoning area of investigation; 37% of the articles were published in the last five years. Evidence for the effects of religion/spirituality were unclear; the preponderance (n = 71, 86%) of studies found no or a mixed association (i.e., a combination of positive, negative, or non-significant results) between religion/spirituality and well-being. These ambiguous results are a reflection of the multidimensionality of religion/spirituality and the diversity of well-being outcomes examined. They also partially reflect the frequent use of unrefined measures of religion/spirituality and of atheoretical approaches to studying this topic. Investigators have a fairly large number of studies on religion/spirituality and caregiver well-being on which to build. Future studies should be theory driven and utilize psychometrically sound measures of religion/spirituality. Suggestions are provided to help guide future work.     

Religion and medicine II: religion, mental health, and related behaviors

In this second in a series of articles on religion and medicine, I focus on the relationship between religion and mental health. This discussion is based on a comprehensive and systematic review of a century of research examining religion's relationship to mental health, social support, substance abuse, and other behaviors affecting mental or social functioning. This review includes over 630 separate data-based reports that focus on religion and well-being, hope and optimism, meaning and purpose, depression, suicide, anxiety, psychosis, social support and marital stability, alcohol and drug abuse, cigarette smoking, extra-marital sexual behaviors, and delinquency. Reasons for the associations found are discussed and conclusions drawn in light of the findings.     

Hyperpipecolic acidemia: clinical, biochemical, and radiologic observations

Pipecolic acid is a biochemical marker frequently detected in group 1 peroxisomal disorders (peroxisomal biogenesis disorders). Its presence, in addition to the constellation of particular phenotypic manifestations and pathologic findings, has led to its recent classification under disorders of peroxisomal biogenesis as a separate disease entity (hyperpipecolic acidemia or hyperpipecolatemia). The clinical, biochemical, and radiologic findings observed in three patients diagnosed with hyperpipecolic acidemia are reported.     

Formulation and treatment: integrating religion and spirituality in clinical practice

Developing scientifically sound and clinically meaningful case formulations is so challenging that it may verge on becoming a "lost art." Pressures (scientific, economic, and cultural) remain that prevent child and adolescent psychiatrists from getting a complete understanding of the patient and family. Including a strong consideration of data related to religion, spirituality, and worldview may seem only to complicate an already arduous task. The clinician who includes these factors in treatment is faced with decisions of when to discuss these issues, how to discuss them and in what depth, and finally, when to refer to a religious/spiritual professional. Nonetheless, the importance of these factors in the lives of many children and families leaves no option but to address them as directly as possible. It is well worth the effort and, in many cases, will open new areas for clinical improvement in patients.