Meta-analysis of the effectiveness of parenting programmes in improving maternal psychosocial health.

The purpose of this study was to determine whether group-based parenting programmes are effective in improving maternal psychosocial health. Data sources used were English and non-English language articles published between January 1970 and July 2000, retrieved using a keyword search of a number of biomedical, social science, educational, and general reference electronic databases. Two independent reviewers selected the relevant abstracts and articles. Only controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme and one standardised instrument measuring maternal psychosocial health. Means, standard deviations, and information regarding study quality were selected from the included studies by two independent reviewers. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. The results were then combined in a meta-analysis using a fixed-effect model. A total of 23 studies met all the inclusion criteria and 17 of these provided sufficient data with which to calculate effect sizes. Fifteen of these studies provided data on the five main outcomes of interest: depression, anxiety/stress, self-esteem, social support, and relationship with partner. The meta-analyses show statistically significant results favouring the intervention group for depression (-0.3, 95% confidence interval [CI] = -0.4 to -0.1), anxiety/stress (-0.5, 95% CI = -0.7 to -0.3), self-esteem (-0.4, 95% CI = -0.6 to -0.1), and relationship with partner (-0.4, 95% CI = -0.7 to -0.2). However, the meta-analysis of the social support data showed no evidence of effectiveness (-0.04, 95% CI = -0.3 to 0.2). Follow-up data were available for only three of the five outcomes. The results show that there were changes favouring the intervention group for self-esteem (-0.4, 95% CI = -0.7 to -0.2), the mother's relationship with her partner (-0.3, 95% CI = -0.8 to 0.1), and depression (-0.2, 95% CI = -0.4 to 0.002), although the confidence intervals for the mother's relationship with her partner and depression both cross zero. It is concluded that parenting programmes can make a significant contribution to the short-term psychosocial health of mothers. While the limited follow-up data are promising, further evidence of their effectiveness in improving maternal mental health is required. It is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present.     

Incorporating psychosocial health into biocultural models: preliminary findings from Turkana women of Kenya.

This paper investigates the potential benefits and limitations of including psychosocial stress data in a biocultural framework of human adaptability. Building on arguments within human biology on the importance of political economic perspectives for examining patterns of biological variation, this paper suggests that psychosocial perspectives may further refine our understanding of the mechanisms through which social distress yields differences in health and well-being. To assess a model that integrates psychosocial experiences, we conducted a preliminary study among nomadic pastoralist women from northern Kenya. We interviewed 45 women about current and past stressful experiences, and collected anthropometric data and salivary cortisol measures. Focus group and key informant interviews were conducted to refine our understanding of how the Turkana discuss and experience distress. The results suggest that the most sensitive indicators of Turkana women's psychosocial experiences were the culturally defined idioms of distress, which showed high concordance with measures of first-day salivary cortisol. Other differences in stress reactivity were associated with the frequent movement of encampments, major herd losses, and direct experiences of livestock raiding. Despite the preliminary nature of these data, we believe that the results offer important lessons and insights into the longer-term process of incorporating psychosocial models into human adaptability studies.     

Housing quality and mental health

This study examined the potential link between housing quality and mental health. First, the development of a psychometrically sound, observer-based instrument to assess physical housing quality in ways conceptually relevant to psychological health is reported. Then 2 different studies, including a prospective longitudinal design, demonstrate that physical housing quality predicts mental health. Possible underlying psychosocial processes for the housing quality-psychological distress link are discussed.     

Redesigning electronic health record systems to support public health

Current electronic health record systems are primarily clinical in focus, designed to provide patient-level data and provider-level decision support. Adapting EHR systems to serve public health needs provides the possibility of enormous advances for public health practice and policy. In this review, we evaluate EHR functionality and map it to the three core functions of public health: assessment, policy development, and assurance. In doing so, we identify and discuss important design, implementation, and methodological issues with current systems. For example, in order to support public health's traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical data elements, and workflow would have to be examined to determine the optimal way of collecting these data. We also argue that redesigning EHR systems to support public health offers benefits not only to the public health system but also to consumers, health-care institutions, and individual providers.     

Brief report: parent report about health care use: relationship to child's and parent's psychosocial problems.

OBJECTIVE: To investigate the potential utility of asking parents about health care utilization as a means of identifying individuals at risk for psychosocial problems. METHOD: Parents of 366 children ages 2 to 16 completed questionnaires about their own, their child's, and their family's psychosocial functioning and health care utilization. RESULTS: Children and parents with high health care utilization were more likely to have psychosocial problems than those with low health care utilization. Sensitivity and specificity of health care utilization as a marker for psychosocial problems ranged from 43.8% to 68.8%. CONCLUSIONS: Although high rates of child health care utilization are related to the presence of psychosocial problems, use of this measure alone could result in many false-positive and false-negative identifications. Rather, use of health care utilization data in conjunction with other screening measures may be useful for alerting physicians to the possibility of both child and parent psychosocial problems.     

Addressing mental health issues in primary care: An initial curriculum for medical residents

Objective

Many express concern that modern medicine fails to provide adequate psychosocial and mental health care. Our educational system has not trained the primary care providers who care for most of these patients. Our objective here is to propose a quantum change: prepare residents and students during all years of training so that they are as effective in treating psychosocial and mental health issues as they are medical problems.

Method

We operationalize this objective, following Kern, by developing an intensive 3-year curriculum in psychosocial and mental health care for medical residents based on models with a strong evidence-base.

Results

We report an intensive curriculum that can guide others with similar training interests and also initiate the conversation about how best to prepare residency graduates to provide effective mental health and psychosocial care.

Conclusion

Identifying specific curricula informs education policy-makers of the specific requirements they will need to meet if psychosocial and mental health training are to improve.

Practice Implications

Training residents in mental health will lead to improved care for this very prevalent primary care population.     

Relations of caregiving stress and health depend on the health indicators used and gender

Extensive research has evaluated relations between stress and health. These studies have varied in the type of stress examined (acute vs. chronic) and in the way in which health has been operationalized. Here we examine relations between chronic stress and 25 indicators of various health dimensions (e.g., physiological indexes, medical records, and self-reports of global health; symptoms, functional status, health service utilization, and psychosocial distress/quality of life). We also assessed whether such relations are moderated by gender, an individual difference variable that is important to health and longevity. Samples included 157 community-residing older adults (M age = 69.4 years, 31.8% men), approximately half of whom were caregivers for a spouse with Alzheimer’s disease, and half were demographically similar noncaregiver spouses. Principal component analyses on the 25 health measures resulted in 5 factors that met standard criteria for acceptance. In women, caregivers reported worse physical health and psychological health than noncaregivers, but their physiological risk was similar. In men, caregivers had greater physiological risk, but they reported better physical health than did men noncaregivers. Researchers who study chronic stress and health should consider the possibility that the relation between chronic stress and health may vary for men and women depending on the type of health being assessed.     

Detection of child mental health disorders by general practitioners

BACKGROUND: Few children with mental disorders access specialist services. Although previous studies suggest that general practitioner (GP) recognition is limited, parents may not be presenting these problems. AIM: To compare GP recognition of disorders with child mental health data and to examine factors affecting recognition, in particular whether recognition is enhanced if the parent expresses concern during the consultation. DESIGN OF STUDY: A two-phase design involving an initial community survey of children between the ages of 5 and 11 years. In the second phase, primary care attenders who were regarded by their GP as having a mental health disorder were compared with those who were not. SETTING: Five general practices in Croydon, outer London. METHOD: For 186 children attending primary care, GP recognition of disorders was compared with the results of a child mental health questionnaire completed by parents. Accuracy and predictors of GP recognition were examined. RESULTS: Seventy-four per cent of children meeting criteria for caseness were not recognised by GPs as having a mental health disorder. The expression of parental concern in the consultation about a mental health problem increased the sensitivity of recognition from 26% to 88%. Expression of concern also increased GP recognition of non-cases; this reflected GP identification of other mental health and learning problems. Only a third of parents who had concerns expressed these during the consultation. CONCLUSIONS: GPs are responsive to concern and take parental views into account. As well as detecting disorders, GPs are also sensitive to other psychosocial and educational problems that may present in primary care. There is a need for parental education about child mental health disorders.     

Identifying mental health services in clinical genetic settings

The purpose of this study was to examine the mental health needs of individuals at risk for adult onset hereditary disorder (AOHD) from the perspective of their genetic service providers, as it is unknown to what extent psychosocial services are required and being met. A mail-out survey was sent to 281 providers on the membership lists of the Canadian Association of Genetic Counsellors and the Canadian College of Medical Geneticists. The survey assessed psychosocial issues that were most commonly observed by geneticists, genetic counsellors (GCs), and nurses as well as availability and types of psychosocial services offered. Of the 129 respondents, half of genetic service providers reported observing signs of depression and anxiety, while 44% noted patients' concerns regarding relationships with family and friends. In terms of providing counselling to patients, as the level of psychological risk increased, confidence in dealing with these issues decreased. In addition, significantly more GCs reported that further training in psychosocial issues would be most beneficial to them if resources were available. As a feature of patient care, it is recommended that gene-based predictive testing include an integrative model of psychosocial services as well as training for genetic service providers in specific areas of AOHD mental health.     

A link between hostility and disease: poor health habits?

The Cook and Medley Hostility (Ho) Scale has been found to predict the occurrence of coronary heart disease, as well as total mortality, and to be related to the severity of coronary artery disease. It has been proposed that the relationship between Ho scores and health status is mediated by an unhealthy psychosocial risk profile. The present study investigated the health habits of 202 young adults; it used a shortened version of TestWell, a self-report inventory of health behaviors. Subjects were classified as high or low scorers on the Ho scale and their overall TestWell scores and those of four subscales were compared. High scorers reported poorer health habits overall (p = .003) and on three of the four subscales (Physical Fitness, p = .04; Self-Care, p = .04; Drugs and Driving, p = .0001). These results suggest that the poor health habits of individuals with high hostility scores may be an additional explanation of the link between hostility and subsequent disease to the psychosocial risk profile explanation recently proposed.     

The impact of beliefs about mental health problems and coping on outcome in schizophrenia

BACKGROUND: Using the theoretical framework of the Self Regulation Model (SRM), many studies have demonstrated that beliefs individuals hold about their physical health problems are important in predicting health outcomes. This study tested the SRM in the context of a mental health problem, schizophrenia. METHOD: One hundred and twenty-four people with a diagnosis of schizophrenia were assessed on measures of symptom severity, beliefs about their mental health problems, coping and appraisal of outcome at two time points, 6 months apart. RESULTS: Using multivariate analyses and controlling for severity of symptoms, beliefs about mental health were found to be significant predictors of outcome. Beliefs about greater negative consequences were the strongest and most consistent predictors of a poorer outcome in both cross-sectional and longitudinal analyses. CONCLUSIONS: These results suggest that the SRM is a promising model for mental health problems and may highlight important areas for development in clinical, and especially psychosocial interventions.     

Spiritual coping,psychosocial adjustment,and physical health in youth with chronic illness: a meta-analytic review

Objective: The current systematic review and meta-analysis aimed to assess the strength of the relationships between religious/spiritual coping strategies and psychosocial adjustment and physical health in youth with chronic illness. Background: Faced with medical stressors and uncertainty about their illness, spiritual beliefs and behaviours are important for youth with chronic illness. Research suggests that some spiritual coping strategies are helpful (positive), while others are not (negative), and these dimensions of spiritual coping are important predictors of functioning among youth with chronic illness. Method: Fourteen studies, published between 1990 and 2015, met inclusion criteria for the meta-analysis and were analysed using both a fixed effects model and random effects model (REM). Results: Findings revealed significant, small to moderate associations between negative spiritual coping and more concurrent internalising problems (REM r?=?.34), lower quality of life (REM r?=??.34), and poorer health (REM r?=??.08). Under the fixed, but not REM, the combined effects showed small to moderate significant relationships between positive spiritual coping and fewer internalising problems (r?=??.19) and better physical health (r?=?.19). Conclusion: The results reveal that spiritual coping is an important coping strategy for paediatric patients. Consistent with findings among adults with chronic illness, negative spiritual coping puts paediatric patients at risk for psychosocial maladjustment and poorer health. Intervention research is needed to determine if targeting spiritual coping improves health and psychosocial well-being.     

Feelings of professional fulfilment and exhaustion in mental health personnel: the importance of organisational and individual factors

BACKGROUND: Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfillment, an expanded version of job satisfaction. METHODS: A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfillment. RESULTS: Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfillment in mental health professionals. CONCLUSIONS: The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.     

Mental health in schools and system restructuring

Because health is not the primary business of schools, a school's response to mental health and psychosocial concerns usually is limited to targeted problems seen as direct barriers to learning. And because resources are sparse, priority is given to problems defined in legislative mandates. As a result, school-based mental health services are available only to a small proportion of the many students who require assistance, and interventions generally are narrowly focused and short-term. To better meet the needs of those served and to serve greater numbers, emerging trends are pushing for restructuring of school-owned services and greater linkage with community resources to develop multifaceted, comprehensive, integrated approaches. This review (a) provides an overview of what schools currently do related to mental health and psychosocial concerns, (b) clarifies key emerging trends, and (c) explores implications for major systemic changes.     

Healthy Aging in Older Women Living with HIV Infection: a Systematic Review of Psychosocial Factors

Due to life-enhancing effects of antiretroviral therapy, HIV-positive persons have the potential for long life comparable to their uninfected peers. Older women (age 50+) living with HIV (OWLH) are often an under-recognized aging group. We conducted a systematic review to examine psychosocial factors that impact how OWLH live, cope, and age with HIV. Initial key word search yielded 1527 records, and 21 studies met our inclusion criteria of original quantitative or qualitative research published between 2013 and 2016 with results specific to OWLH. These focused on health care and self-management, sexual health and risk, stigma, loneliness, mental health (depression, substance use), and protective factors (coping, social support, well-being). Due to the scarcity of studies on each topic and inconclusive findings, no clear patterns of results emerged. As the number of OWLH continues to grow, more research, including longitudinal studies, is needed to fully characterize the psychosocial factors that impact aging with HIV.     

Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes,health care utilization,and health provider behaviors: A multi-site randomized control trial

ObjectiveThe MHADRO assesses psychosocial and medical needs, provides tailored feedback reports, and connects patients to mental health providers. This study examined the MHADRO’s effect on patient outcomes, health care utilization, and oncology provider documentation and behaviors.Methods836 patients were part of a multi-site RCT and assessments were conducted at baseline, 2, 6 and 12 months.ResultsThe intervention group engaged in less emergency calls to providers. There were no differences in psychosocial outcomes at follow up assessments. Providers of patients in the intervention group were more likely to: document psychosocial symptoms and history; refer to psychosocial services; encourage support groups; seek psychological evaluations during visits. Patients who agreed to a mental health referral had decreased hospitalizations, increased mental health care interactions, and stronger ratings of counseling potential benefits. This group also reported increased psychosocial distress at all follow-up assessments.ConclusionThe MHADRO may increase access to mental health care, lessen utilization, and improve providers’ management of psychosocial needs, but does not appear to impact overall functioning over time.Practice ImplicationsProviders are encouraged to consider incorporating programs, like the MHADRO, into patient care as they may have the potential to impact screening and management of patients’ psychosocial needs.     

Psychosocial health risk factors and resources of medical students and physicians: a cross-sectional study

Background  

Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions.     

White collar stress: what studies of physicians can teach us

The impact of occupational stress on physicians and their medical practice has been subject to much debate but relatively little research. This paper reviews some recent studies concerning the psychosocial work environment of physicians. Psychiatric and cardiovascular epidemiologic data indicate that physicians are at similar or enhanced risk to socioeconomically comparative groups. Clinical studies of physicians reveal associations between psychosocial work characteristics and traditional cardiovascular risk factors. Further work is needed to enhance our understanding of the implication of present work environments on the health and well-being of physicians as well as other health care workers.     

Satisfaction with life, psychosocial health and materialism among Hungarian youth

Previous research suggests that youth's life satisfaction may be influenced by health and certain socioeconomic/sociocultural factors, which may be important in a post-socialist country like Hungary. We investigated the relationship between youth's life satisfaction, materialism and their psychosocial health in a sample of secondary school students (N = 1114) in Hungary. Findings show that youth's psychosocial health may play an important role in their levels of life satisfaction, particularly depressive and psychosomatic symptoms and health behaviors (e.g. diet control and smoking). SES self-assessment and materialistic success were positively, while materialistic happiness was negatively related to youth's life satisfaction.     

Working conditions and health among employees at information technology--enabled services: a review of current evidence

Workers in information technology (IT)-enabled services like business process outsourcing and call centers working with visual display units are reported to have various health and psycho-social disorders. Evidence from previously published studies in peer- reviewed journals and internet sources were examined to explore health disorders and psycho-social problems among personnel employed in IT-based services, for a systematic review on the topic. In addition, authors executed a questionnaire- based pilot study. The available literature and the pilot study, both suggest health disorders and psychosocial problems among workers of business process outsourcing. The details are discussed in the review.