HEAD START ENROLLMENT AND CHILDREN'S MENTAL HEALTH TREATMENT

This secondary data analysis from a Head Start program examines the association between children's entry age and enrollment duration and the likelihood of mental health treatment. Study questions are as follows: (a) Do baseline characteristics differ among three groups of Head Start children? (children who enrolled at 3 years of age and stayed for 1 year [group 1], enrolled at 4 years of age and stayed for 1 year [group 2], and enrolled at 3 years of age and stayed for 2 years [group 3]); (b) Does the likelihood of children's mental health treatment differ among the groups?; and (c) Are baseline characteristics associated with the likelihood of mental health treatment? Except ethnicity and family size, other baseline characteristics did not differ across the three groups. Groups 1 and 3 received more mental health treatment than group 2. Different percentages of mental health treatment were found, depending on children's gender, ethnicity, family income, special needs, and bilingual status.     

NEIGHBORHOODS AND MENTAL HEALTH TRAJECTORIES OF LOW‐INCOME MOTHERS

Research has demonstrated a correlation between living in a low‐income neighborhood and mental health. However, neighborhood variables affecting mental health and the extent they serve as risk or protective factors are not well understood. Using longitudinal data from a representative sample of low‐income mothers from the Welfare, Children, and Families: A Three City Study, the trajectories of total mental health, depression, somatization, and anxiety from the Brief Symptom's Inventory are assessed. Then, the effects of two neighborhood concepts–collective efficacy and neighborhood problems–on mental health trajectories are assessed. Results indicate that total mental health, depression, somatization, and anxiety all decrease in this sample over time. Perceiving one's neighborhood to be high in collective efficacy is predictive of healthier trajectories. The presence of neighborhood problems is associated with declines in mental health trajectories. Findings demonstrate the need to address neighborhood conditions to improve mental health for low‐income mothers living in low‐income neighborhoods.     

ADOLESCENT MOTHERHOOD AND CAPITAL: INTERACTION EFFECTS OF RACE/ETHNICITY ON HARSH PARENTING

This study used large, longitudinal data to examine the moderating effects of race and ethnicity of mothers on the associations between (a) adolescent motherhood, (b) human, social, and cultural capital factors, and (c) harsh parenting. The study sample included adolescent mothers who were 19 years old or younger (n = 379) and adult mothers 26 years old or older (n = 881). Of these, about 31% were White, 48% Black, and 21% Hispanic. The Parent to Child version of the Conflict Tactics Scales was used as a proxy for maternal harsh parenting when their children were 3 years old. Results indicated that adolescent motherhood and different capital factors contributed to the prediction of maternal harsh parenting for each racial/ethnic group. The findings suggest the importance of differentiating strategies for preventing adolescent motherhood and for reducing the likelihood of harsh parenting among different racial/ethnic groups of mothers.     

THE RELATIONSHIP OF INDIVIDUAL‐ AND COMMUNITY‐LEVEL SOCIOCULTURAL AND NEIGHBORHOOD FACTORS TO THE MENTAL HEALTH OF ETHNIC GROUPS IN TWO LARGE U.S. CITIES

Using multilevel modeling, the present study examines psychological well‐being as a function of sociocultural factors, neighborhood disadvantage, neighborhood fragmentation, and neighborhood integration, along with individual factors among a sample of 1,306 African and Latino/a Americans living in New York City and Chicago neighborhoods. Neighborhood blocks were prestratified based on racial/ethnic and economic characteristics and then randomly selected within predefined strata, resulting in a total of 140 block (neighborhood) groups. A means‐as‐outcome and slopes‐as‐outcome model was fit to the data. Intraclass correlation coefficients for psychological well‐being for the fully unconditional model revealed that 15% of the variance in psychological well‐being is between neighborhoods. Results from subsequent model building revealed differences in mean levels of psychological well‐being as well as heterogeneity between neighborhoods through varying predictor effects on psychological well‐being (i.e., certain predictor effects varied across neighborhoods). Sociocultural variables such as cultural identity, religious/spiritual coping, and family obligation were significantly associated with psychological well‐being, generally beneficial, and sometimes varying with generation status and across neighborhoods. Different dimensions of neighborhood disadvantage and fragmentation emerged as important factors, although neighborhood integration did not. Our final models explained a substantial proportion of the variance in psychological well‐being within and between neighborhoods. They also revealed the contextual and conditional nature of sociocultural factors.     

CLARIFYING THE PHILOSOPHY BEHIND THE COMMUNITY MENTAL HEALTH ACT AND COMMUNITY‐BASED INTERVENTIONS

The passing of the Community Mental Health Act was supposed to signal a change in the treatment of mental disorders. The idea was to embed interventions as much as possible in a community, so that treatment is accessible and appropriately designed. However, many programs that strive to be community‐based never achieve this status. The problem is that becoming community‐based is often treated as merely a methodological or tactical change, rather than a new philosophy. Clinics were built and services offered without a coherent theory to explain why better assessments and treatments should accompany a community‐based strategy. The purpose of this article, therefore, is to clarify the basis for such an approach so that mental health services are not simply placed in communities, but rather are defined and controlled by the persons who reside in these neighborhoods.     

ESTAMOS TRAUMADOS: THE EFFECT OF ANTI‐IMMIGRANT SENTIMENT AND POLICIES ON THE MENTAL HEALTH OF MEXICAN IMMIGRANT FAMILIES

This study examines the effects of immigration legislation on Mexican immigrant families’ health and mental health. Focus groups were completed with youth and adult participants who were immigrants or children of immigrants (N = 43). Participants shared the risky conditions that are part of their everyday life and feelings of isolation, powerlessness, frustration, fear, stress and chronic trauma they experience. Major themes are as follows: (a) Arriesgando la vida (risking our lives)–participants shared the dangers involved in migrating to the United States; (b) Mirando por la ventana (looking out the window)–participants live in a constant state of fear, of being arrested and deported, which significantly restricts how they live their lives; (c) and Estamos traumados (we are traumatized)– participants share the effects on children, how women's stress is manifested, and men's feelings of powerlessness. Further research is needed on the effect of prolonged trauma particularly on children's development.     

PSYCHIC AND MENTAL BISEXUALITY IN THE DEVELOPMENT OF A SENSE OF SELF AND MIND

Drawing on the ideas of Birksted-Breen (1996 ) and Houzel (2005 ), this paper discusses the concept of bisexuality, which has been viewed in various ways in the psychoanalytic literature. An argument is made for a clearer definition and conceptual distinction using the terms 'psychic' and 'mental' bisexuality. Houzel's 'psychic bisexuality' and Birksted-Breen's 'mental bisexuality' are distinguished as two separate developmental phases which promote the establishment of psychic space and thought. Psychic bisexuality pertains to the structuring of the self and the development of internal space. Mental bisexuality pertains to the functioning of the mind, with the development of space between internal objects and between self and others. Central to these developments are the containing functions of being both close enough to, and distant enough from, the patient. Clinical material illustrates how interwoven problems at the stage of psychic and mental bisexuality can be and demonstrates that the development of internal space, and space between self and others, requires internalization of both the psychic and mental bisexuality of the therapist.     

PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY

ObjectiveShared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation.MethodsA multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender.ResultsA patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians.ConclusionA patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions.Practice ImplicationsFuture SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.     

THE CONTINUITY OF PSYCHOTIC EXPERIENCES IN THE GENERAL POPULATION

Schizophrenia is a severe mental illness that affects 1% of the population. The diagnosis is made according to current diagnostic systems of DSM-IV (American Psychiatric Association, 1994) and ICD-10 (World Health Association, 1992) on the basis of characteristic 'positive' and 'negative' symptoms. The traditional medical model assumes a categorical view of the schizophrenia syndrome and its core symptoms, in which differences between psychotic symptoms and their normal counterparts are considered to be qualitative. An alternative, dimensional approach assumes that schizophrenia is not a discrete illness entity, but that psychotic symptoms differ in quantitative ways from normal experiences and behaviours. This paper reviews evidence for the continuity of psychotic symptoms with normal experiences, focusing on the symptoms of hallucinations and delusions. It concludes by discussing the theoretical and treatment implications of such a continuum.     

IDENTIFYING MENTAL AND PHYSICAL HEALTH CORRELATES OF HOMELESSNESS AMONG FIRST‐TIME AND CHRONICALLY HOMELESS VETERANS

This study examined four categories of self‐reported health and mental health factors and their association with recurrent or chronic homelessness in a sample of homeless Veterans presenting for care for the first time. These factors and their relationship to housing status were examined in a cross‐sectional analysis comparing first‐time or single episode homeless Veterans to chronic or repeat emergency sheltered or unsheltered homeless Veterans. Results revealed that while Veterans with a history of chronic or recurrent homelessness were more likely to self‐report diagnoses of substance abuse problems, any mental health problems, and bipolar disorder, those who were homeless for the first time in their adult life were more likely to report a variety of physical health conditions, economic causes of homelessness, and some other mental health problem. These findings suggest that further work should be undertaken to determine how clinical interventions for Veteran homelessness address different risk profiles and treatment needs based on lifetime homeless history.     

COGNITIVE-ANALYTIC THERAPY FOR BORDERLINE PERSONALITY DISORDER IN THE CONTEXT OF A COMMUNITY MENTAL HEALTH TEAM: INDIVIDUAL AND ORGANIZATIONAL PSYCHODYNAMIC IMPLICATIONS

ABSTRACT Given that borderline personality disorder (BPD) is increasingly managed by community mental health teams (CMHTs), an exploration of the effectiveness of the cognitive-analytic model (Ryle 1997a) was undertaken in this context. A young man with a primary diagnosis of BPD was offered a course of cognitive-analytic therapy (CAT) by a member of the CMHT. Therapy was only partially successful, due apparently to the severity of the disorder but also, critically, to the absence of a shared understanding of the disorder by team members as well as other agencies involved. However, the CAT model, involving explicit reformulation, helped educate key members of the team about the disorder and the part they might play in it and to contain the splitting and anxiety provoked by such a patient. In addition, CAT created a reasonably robust therapeutic alliance, with more regular contact and no re-admission during the period of therapy. An extended'contextual' reformulation can also offer a means of understanding the difficulties encountered in working with such patients, classically described by Main in'The ailment' (1957), and provide the conceptual containment required to work with such'difficult' patients.     

RELATIONSHIP OF EVIDENCE‐BASED PRACTICE AND TREATMENTS: A SURVEY OF COMMUNITY MENTAL HEALTH PROVIDERS

Evidence‐based treatments (EBTs) are interventions that have been proven effective through rigorous research methodologies. Evidence‐based practice (EBP), however, refers to a decision‐making process that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service providers’ knowledge of EBP and perceived advantages, disadvantages, reasons for not implementing full EBT protocols, and attitudes toward EBTs. Qualitative examination of mental health service providers’ definitions of EBP reveals confusion between the terms EBP and EBT. Service providers indicated several advantages and disadvantages of using EBTs. Analysis suggests that many perceived EBT disadvantages would be eliminated if EBTs are implemented as part of the EBP approach, thus allowing for clinician expertise and patient characteristics to be combined with EBTs. Alternatively, distinguishing between EBP and EBT may be more confusing than useful for most community mental health practitioners, which indicates new terminology may be needed.     

CHILDHOOD MENTAL HEALTH: AN ECOLOGICAL ANALYSIS OF THE EFFECTS OF NEIGHBORHOOD CHARACTERISTICS

Research on childhood mental illness traditionally examines risk factors most proximal to the child. However, current trends reflect growing interest in how broader contextual factors contribute to psychopathology risk. In this study, we examined neighborhood‐level indicators as potential sources of chronic strain in a sample of 156 mother–child dyads; children were 8 to 12 years old. For most neighborhood indicators, data were collected at the level of census tracts using publicly available data sets. We hypothesized that these indicators would be both associated with greater overall mental health symptoms and specifically predictive of childhood symptoms of depression. We also examined potential mediators (maternal functioning and family cohesion) and moderators (maternal depression). Neighborhood indicators correlated with parents’ ratings of children's overall mental health problems, but did not correlate with children's self‐report of depression symptoms. Maternal functioning mediated neighborhood effects on children's overall mental health problems. Implications and directions for future research are presented.     

THE ROLE OF SOCIAL SUPPORT ON MENTAL HEALTH AFTER MULTIPLE WILDFIRE DISASTERS

Disasters can erode mental health (MH), even if it does not reach mental illness. This study explored the direct or moderating role of social support on MH after multiple wildfires, with attention to evacuation status and participant sex. Participants (N = 402) responded to a random digit dial telephone survey about their disaster exposure, current MH, MH at the time of the fire, social support, and life stressors since the disaster. For the evacuated, social support moderated the relation of fire stress to MH at the time of the fire, with those with high social support having better MH. For current MH, social support had a direct relation to MH, and moderated the influence of life stressors since the disaster for the evacuated and women. For those with a life stressor, current MH was better with high social support, but worse under average or low social support. Social support had a relation to current MH for women, but not men.