Using the IPQ and PMDI to predict regular diabetes care‐seeking among patients with Type 1 diabetes

Objectives: The objectives were, first, to identify factors associated with regular diabetes care‐seeking and, second, to compare the performance of the Illness Perception Questionnaire (IPQ) and a modified version of the Personal Models of Diabetes Interview (PMDI) in predicting care‐seeking. Method: This was a cross‐sectional study involving 42 patients who had not attended hospital diabetes clinic for a period of 18 months or more and 42 matched controls receiving specialist care. Differences in illness representations between clinic attenders and non‐attenders were examined. Due to the variability in care‐seeking between non‐attenders (ranging from no contact with health professionals to regular general practitioners care), participants were then reclassified for further analyses into those receiving regular care from either hospital diabetes clinic or general practice (n = 52) and those receiving no regular care (n = 32). Results: Patients not seeking regular care held more negative views of the control, course and consequences of diabetes than those who received regular care. Regression analyses showed that the most important construct was treatment effectiveness. Treatment effectiveness (PMDI) and control (IPQ) dimensions were associated with clinic attendance. PMDI constructs of treatment effectiveness, threat and worries were associated with regular care‐seeking. Conclusions: IPQ and PMDI results were generally consistent. In order to understand diabetes care‐seeking behaviour it is important to measure beliefs about the benefits of treatment recommendations in addition to those of the disease itself. Emotional and cognitive responses to diabetes should be assessed.     

Breast and cervical cancer screening for women with mental illness: patient and provider perspectives on improving linkages between primary care and mental health

Summary Objective: Previous research suggests that women with mental illness may be at increased risk for breast and cervical cancer. This qualitative study of patients and primary care and mental health providers explored challenges to accessing and providing breast and cervical cancer screening for women with mental illness. Method: Key informant patient and provider participants were recruited from a community health setting and teaching hospital. Narrative data from 1) interviews with women in a community primary care setting (n = 16); 2) telephone interviews with women with mental illness (n = 16); and 3) focus groups with primary care providers (n = 9) and mental health providers (n = 26) were collected. Results: Patient, provider, and system factors that may contribute to suboptimal cancer screening among women with mental illness were identified. Communication between primary care and mental health providers was noted as a key area for intervention to enhance screening. Barriers to and possibilities for a more proactive role for mental health providers were also considered. Conclusions: Both patient and provider study participants emphasized the need to address communication gaps between primary care and mental health providers and to promote the active collaboration of mental health providers in preventive cancer screening for women with mental illness.     

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators

Background

While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not.

Method

This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help.

Results

Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO.

Conclusion

Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.     

A qualitative study of healthcare professionals’ perceptions of men and women's mental healthcare seeking in Rwanda

This study aimed to explore health care professionals (HCP’) perceptions about mental-health-seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme “Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects” illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: “Gender differences in health care seeking patterns,” “Gender roles and stigma affect adherence to counselling and treatment,” and “Gender roles exert an influence on family support” and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental-healthcare-seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare-seeking patterns; such actions can improve the health of many citizens.     

A longitudinal study of mental health consumer/survivor initiatives: Part 3—A qualitative study of impacts of participation on new members

This article examines the outcomes of participation in mental health Consumer/Survivor Initiatives (CSIs) and identifies helpful qualities of CSIs through a longitudinal, qualitative study that involved in‐depth interviews of people who experienced severe mental health challenges in Ontario, Canada. We used a nonequivalent control group design in which we compared active participants in CSIs ( n = 15) with nonactive participants ( n = 12) at baseline and at 9‐ and 18‐month follow‐up intervals. Compared with non‐CSI participants, CSI participants reported more stable mental health, enhanced social support, sustained work, stable income, and participation in education and training at 9‐ and 18‐month interviews. The helpful qualities of CSIs that participants reported were (1) safe environments that provide a positive, welcoming place to go; (2) social arenas that provide opportunities to meet and talk with peers; (3) an alternative worldview that provides opportunities for members to participate and contribute; and (4) effective facilitators of community integration that provide opportunities to connect members to the community at large. The findings are discussed in terms of previous research in self‐help and consumer‐run organizations in mental health. © 2006 Wiley Periodicals, Inc.     

Religiosity,spirituality, and help‐seeking among Filipino Americans: Religious clergy or mental health professionals?

Data from structured interviews with 2,285 respondents for the Filipino American Community Epidemiological Survey (FACES) were used to examine help‐seeking for emotional distress among Filipino Americans. The influence of religious affiliation, religiosity, and spirituality upon help‐seeking from religious clergy and mental health professionals was assessed after controlling for need (e.g., negative life events, SCL‐90R scores, and somatic symptoms), demographic (e.g., age, gender, marital status, education, county of residence, generational status, and insurance coverage), and cultural variables (e.g., loss of face and language abilities). Rates of help‐seeking from religious clergy versus mental health professionals were comparable (2.5% vs. 2.9%). High religiosity was associated with more help‐seeking from religious clergy but not less help‐seeking from mental health professionals, whereas high spirituality was associated with less mental health help‐seeking. Implications for understanding how religious variables affect help‐seeking were explored. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 675–689, 2004.     

“We almost had the whole block's phone number on the wall”: A mixed methods investigation of informal helping in a predominantly rural sample

Community psychologists have noted the limitations of professional models of mental health treatment, demonstrating that people are more likely to use informal familial or community support during adversity. However, relatively little is known about the forms and functions of informal help seeking and provision. Semistructured interviews (N = 170), in which a sample of predominantly rural‐dwelling adolescents and adults described significant life experiences, were coded for instances of receiving help. Codes thematically categorized the type of adversity, role of the helper, and nature of the help received. Most participants (67.64%) reported the presence of at least one informal helper; only 8.82% of participants discussed receiving professional help. Chi‐square analyses suggested that the nature of the help received varied by the types of helper and adversity being experienced and that different helpers were more likely to aid with particular adversities. The presence of a nonfamilial, nonprofessional helper was associated with higher posttraumatic growth, generativity, and perceived social support.     

Understanding catastrophizing from a misdirected problem-solving perspective

Objectives. The aim is to explore pain catastrophizing from a problem‐solving perspective. The links between catastrophizing, problem framing, and problem‐solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model ( Eccleston & Crombez, 2007 ) and the fear‐anxiety‐avoidance model ( Asmundson, Norton, & Vlaeyen, 2004 ). Design. In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later. Methods. Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation. Results. The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear‐anxiety‐avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem‐solving behaviour. Conclusion. These findings provide support for viewing catastrophizing from a problem‐solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients.     

Cultural factors in help‐seeking for child behavior problems: Value orientation,affective responding,and severity appraisals among Chinese‐American parents

This study explored the relationships between cultural values, appraisal of child behavior problems, and associated help‐seeking intentions among Chinese‐American parents. Questionnaires were administered to 120 Chinese‐American parents of elementary‐school‐aged children. Parents were asked how they might respond if their child displayed the behavioral problems depicted in a hypothetical vignette. Influences of Chinese value orientation, severity appraisal, and affective reactions on help‐seeking intentions were examined using regression analyses and structural equation modeling. The study examined three hypotheses regarding the nature of the influence of cultural value orientation on help‐seeking intentions: (a) a direct effect model, (b) an indirect effect through cultural differences in severity appraisal, and (c) an indirect effect through cultural differences in affective responding. Results supported the hypothesis that cultural value orientation exerted an indirect effect on help‐seeking intentions through its influence on affective responding. Those parents who had more traditional Chinese values responded with more feelings of shame to child behavior problems and, in turn, reported lower intentions to seek help. Findings are discussed with reference to the literature on help‐seeking among Asian Americans. © 2001 John Wiley & Sons, Inc.     

Social Physique Anxiety: An Exploration of Influence on Sporting Confidence and Participation

Limited research has been undertaken into influences on body image in sporting environments. This study investigates the relationship between social physique anxiety (SPA), body image, and sporting participation. Participants (n = 93) were recruited from an Australian university and sporting clubs, and completed a self‐report questionnaire. Results revealed that females (n = 66) were higher in SPA, appearance orientation, health orientation, and weight preoccupation than males (n = 27). Participants who were higher on sporting confidence had lower appearance orientation and body dissatisfaction, and higher appearance evaluation. Results are discussed with regard to the conflicting research in the area.     

Help‐seeking intentions for breast‐cancer symptoms: A comparison of the self‐regulation model and the theory of planned behaviour

Purpose: Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast‐cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self‐regulation model of illness cognition and the theory of planned behaviour were examined in predicting help‐seeking intentions for potential symptoms of breast cancer in a general population sample. Methods: A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self‐regulation model and the theory of planned behaviour. Help‐seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. Results: Hierarchical multiple regression analysis revealed that the cognitive component of the self‐regulation model accounted for approximately 22% of the variance in help‐seeking intention. Identity (β = 0.45, p < .001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help‐seeking (β = 0.19, p <.001) and perceived behavioural control (β = 0.12, p <.01). Conclusions: Intention to seek medical help for a potential breast‐cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help‐seeking and perceived behavioural control. Although less than one‐third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help‐seeking behaviour in women with breast‐cancer symptoms.     

Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers

Adverse childhood experiences (ACEs) can have long‐term impacts on a person's mental health, which extend into adulthood. There is a high prevalence of ACEs among service members. Further, service members also report frequently experiencing disrupted sleep. We hypothesized that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health. In a cross‐sectional sample (n = 759), we found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep. In a different sample using two time‐points (n = 410), we found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period. Implications, limitations and future research directions are discussed.     

Predicting patient deterioration in youth mental health services: community mental health vs. managed care settings

Objective: To examine differences across a community mental health system and a private managed care system in the accuracy of a warning system designed to identify youth at risk for deterioration in mental health services. Design: Longitudinal outcome data from the Youth Outcome Questionnaire (Y‐OQ) were examined using multilevel modeling for 2,310 youth ages 4–17 who received outpatient treatment. Results: The warning system correctly identified 69% of cases that ultimately ended in deterioration in the community mental health setting, compared to 61% in the managed care setting. The overall hit rate (overall accuracy in classifying cases as deteriorators/non‐deteriorators) was the same in the two settings (75%). Conclusions: Results are consistent with previous research demonstrating that patient‐focused warning systems can be reasonably accurate in identifying youth cases at risk for treatment failure. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–17, 2011.     

Enhancement of attachment and cognitive development of young nursery‐reared chimpanzees in responsive versus standard care

Forty‐six nursery‐reared chimpanzee infants (22 females and 24 males) receiving either standard care (n = 29) or responsive care (n = 17) at the Great Ape Nursery at Yerkes participated in this study. Standard care (ST) consisted primarily of peer‐rearing, with humans providing essential health‐related care. Responsive care (RC) consisted of an additional 4 hr of interaction 5 days a week with human caregivers who were specially trained to enhance species‐typical chimpanzee socio‐emotional and communicative development. At 9 months, ST and RC chimpanzees were examined with the Bayley Scales for Infant Development to assess their Mental Development Index (MDI). At 12 months, the chimpanzees were assessed with their human caregivers in the Ainsworth Strange Situation Procedure (SSP). In this first study to use the SSP in chimpanzees, nursery‐reared chimpanzees exhibited the definite patterns of distress, proximity seeking, and exploration that underpin the SSP for human infants. In ST chimpanzees the attachment classification distribution was similar to that of human infants raised in Greek or Romanian orphanages. RC chimpanzees showed less disorganized attachment to their human caregivers, had a more advanced cognitive development, and displayed less object attachment compared to ST chimpanzees. Responsive care stimulates chimpanzees' cognitive and emotional development, and is an important factor in ameliorating some of the adverse effects of institutional care. © 2008 Wiley Periodicals, Inc. Dev Psychobiol 51: 173–185, 2009     

Physiological reactivity to stress and parental support: comparison of clinical and non‐clinical adolescents

An Alarm Stress Task was developed to study affect regulation in the context of parent–child interactions in adolescents (mean age = 12.72, standard deviation = 2.06) with (n = 20) and without (n = 20) mental health problems. Changes in heart rate (HR), preejection period (PEP) and respiratory sinus arrhythmia (RSA) were used as indicators of affect regulation. HR increased, and PEP and RSA decreased significantly in reaction to a suggested failure on a simple task, indicating that this procedure induced affective arousal in adolescents. During reunion with the parent, RSA increased significantly. Support seeking on reunion was associated with stronger parasympathetic reactivity during stress and reunion, consistent with the model that the parasympathetic system is involved when affect is regulated by social engagement. Quality of parent–adolescent interactive behaviour was overall lower in the clinical sample. Individual and relationship‐based processes of affect regulation may be simultaneously assessed, highlighting the continuing importance of the parent–child relationship in adolescence for affect regulation and mental health. Copyright © 2008 John Wiley & Sons, Ltd.     

A qualitative study: experiences of stigma by people with mental health problems

Objectives

Prior research has examined various components involved in the impact of public and internalized stigma on people with mental health problems. However, studies have not previously investigated the subjective experiences of mental health stigma by those affected in a non‐statutory treatment‐seeking population.

Design

An in‐depth qualitative study was conducted using thematic analysis to investigate the experiences of stigma in people with mental health problems.

Methods

Eligible participants were recruited through a local mental health charity in the North West of England. The topic of stigma was examined using two focus groups of thirteen people with experience of mental health problems and stigma.

Results

Two main themes and five subthemes were identified. Participants believed that (1) the ‘hierarchy of labels’ has a profound cyclical impact on several levels of society: people who experience mental health problems, their friends and family, and institutional stigma. Furthermore, participants suggested (2) ways in which they have developed psychological resilience towards mental health stigma.

Conclusions

It is essential to utilize the views and experiences gained in this study to aid understanding and, therefore, develop ways to reduce the negative impact of public and internal stigma.

Practitioner points

• People referred to their mental health diagnosis as a label and associated that label with stigmatizing views.
• Promote awareness and develop improved strategies (e.g., training) to tackle the cyclical impact of the ‘hierarchy of labels’ on people with mental health problems, their friends and family, and institutional stigma.
• Ensure the implementation of clinical guidelines in providing peer support to help people to combat feeling stigmatized.
• Talking about mental health in psychological therapy or health care professional training helped people to take control and develop psychological resilience.

     

Vietnamese Americans' attitudes toward seeking mental health services: Relation to cultural variables

This study examined the relation between culturally based variables and attitudes toward seeking mental health services among a community sample of Vietnamese Americans ( N = 148) with at least 8 years' residence in the United States (U.S.). Variables included Stigma, Traditional Beliefs about Mental Illness, Help‐Seeking Preferences, Problem Prioritizing, and Disclosure. The results indicated that Disclosure, Help‐Seeking Preferences, and Problem Prioritizing were significant predictors of attitudes. Greater willingness to disclose, greater preference for professional resources over family/community resources, and higher priority placed on mental/emotional health concerns over other concerns were each associated with more favorable attitudes toward seeking mental health services. Stigma and Traditional Beliefs about Mental Illness did not appear to be significant predictors. Implications of the findings are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 213–231, 2005.     

The Outcome Questionnaire (OQ‐45) in a Dutch population: A cross‐cultural validation

The cross‐cultural validity of the Outcome Questionnaire (OQ) in the Dutch population has been examined by comparing the psychometric properties and equivalence in factor structure and normative scores of the Dutch OQ with the original American version. Data were collected from a university (n = 268), in a community (n = 810) and from three mental health care organizations (n = 1920). Results show that the psychometric properties of the Dutch OQ were adequate and similar to the original instrument. Some differences in equivalence were found though. In factor analysis, two additional factors were found: one consisting of social role items and another that reflected anxiety and somatic symptoms. Furthermore, normative scores were different for the Dutch and American samples, and this resulted in different cut‐off scores for estimating a clinically significant change in the Dutch population. Copyright © 2007 John Wiley & Sons, Ltd.     

A longitudinal study of mental health consumer/survivor initiatives: Part 2—A quantitative study of impacts of participation on new members

To evaluate the impacts of participation in mental health Consumer/Survivor Initiatives (CSIs), we used a nonequivalent control group design to compare new, active participants in CSIs ( n = 61) with nonactive participants ( n = 57) at baseline, 9‐month, and 18‐month follow‐up intervals. The two groups were comparable at baseline on a wide range of demographic variables, self‐reported psychiatric diagnosis, service use, and outcome measures. At 9 months, there was a significant reduction in utilization of emergency room services for active participants, but not for nonactive participants. At 18 months, the active participants showed significant improvement in social support and quality of life (daily activities) and a significant reduction in days of psychiatric hospitalization, whereas the nonactive participants did not show significant changes on these outcomes. Also, active CSI participants were significantly more likely to maintain their involvement in employment (paid or volunteer) and/or education over the 18‐month follow‐up period when compared with those who were not active in CSIs. These results are discussed in the context of the self‐help literature and their policy implications for people with mental illness. © 2006 Wiley Periodicals, Inc.