Born unwanted: mental health costs and consequences

Grounded in the concepts of intendedness and wantedness and research on children born to women denied abortion, this article focuses on the Prague Study, which followed the development and mental well-being over 35 years of 220 children born between 1961 and 1963 in Prague, Czech Republic, to women twice denied abortion for the same unwanted pregnancy. Children were individually pair-matched at age 9 with 220 children born from accepted pregnancies. Five follow-up waves were conducted at ages 9, 14-16, 21-23, 28-31, and 32-35 years. A substudy was also conducted of married unwanted pregnancy and accepted pregnancy participants at ages 26-28 years. To control for potential confounding factors, the study included all siblings of all subjects in the last 2 waves. Differences in psychosocial development widened over time but lessened around age 30. All the differences were consistently in disfavor of the unwanted pregnancy participants, especially for only children (no siblings). They became psychiatric patients more frequently than the accepted pregnancy controls and also more often than their siblings. In the aggregate, denial of abortion for unwanted pregnancies entails an increased risk for negative psychosocial development and mental well-being in adulthood. Implications for public health policy are discussed.     

Adiposity in policing: mental health consequences

Previous research suggests that adiposity is a health problem among police officers. Stress is also a concern in police work and can lead to depression. Although previous studies have demonstrated an association between obesity and depression, this has not been adequately addressed in the police population. MAeasures of adiposity (Body Mass Index [BM1], abdominal height, waist circumference) and depressive symptoms (Center for Epidemiologic Studies Depression [CES-D] scale) were obtained from a random sample of 115 officers in an urban police department. Ninety nine officers (61 men and 38 women) who had complete data and were not on anti-depressive medication were used. Linear regression analysis was conducted separately for men and women. Covariate adjustments were made for age, alcohol use, smoking, pack-years of smoking, marital status, and physical activity. Statistically significant positive trends were observed in multivariate adjusted mean (+/- SE) depression symptom scores across increasing tertiles of BMI (7.0 +/- 1.3, 5.1 +/- 1.2, 8.8 +/- 1.3, p = 0.012) and abdominal height (6.0 +/- 1.4, 5.5 +/- 1.3, 9.2 +/- 1.4, p = 0.048) for men officers. No significant associations were found between CES-D score and adiposity in women officers (p = 0.075 for BMI, p = 0.317 for abdominal height, p = 0.114 for waist circumference). Additional factors that might influence this association should be examined prospectively in future work to help clarify causal direction.     

Community mental health and the schools: Perceptions of educational personnel

In an attempt to obtain basic data concerning the perceptions of professional educators toward a county mental health clinic, a schedule was devised and completed by 217 respondents. The results indicate a felt need on the part of educators for increased mental health assistance in the performance of their duties. Educators apparently feel that school systems do not meet this need and they further feel constrained, by a variety of factors, from seeking such assistance. It might be concluded from this study that educators desire a collaborative relationship with mental health clinics which include approaches in addition to traditional case consultation.At the time this paper was prepared Mr. Ryker was Psychiatric Social Worker with the Dekalb County Mental Health Center, Dekalb, Illinois.     

Tsunami: understanding mental health consequences and the unprecedented response

The 26th December 2004 saw a disaster brought on by massive waves - the Asian Tsunami. Millions of people died or were affected to varying degrees. The mental health aftermath did not only hit the Tsunami affected areas but it also sent ripples globally. Financial and humanitarian aid was overwhelming. This review brings together the mental health consequences and the global response. It provides a systematic overview of the mental health problems both within the affected areas and globally. It considers different levels and intensities of mental health problems both in affected areas and globally and explores the effects on vulnerable groups. It describes the unprecedented response and highlights the importance of providing culturally and contextually sensitive, integrated and co-ordinated interventions, informed by qualitative and quantitative assessment of needs, urgency and resource availability. The review also provides a retrospective view on the drivers of such a response.     

Tsunami: Understanding mental health consequences and the unprecedented response

The 26th December 2004 saw a disaster brought on by massive waves – the Asian Tsunami. Millions of people died or were affected to varying degrees. The mental health aftermath did not only hit the Tsunami affected areas but it also sent ripples globally. Financial and humanitarian aid was overwhelming. This review brings together the mental health consequences and the global response. It provides a systematic overview of the mental health problems both within the affected areas and globally. It considers different levels and intensities of mental health problems both in affected areas and globally and explores the effects on vulnerable groups. It describes the unprecedented response and highlights the importance of providing culturally and contextually sensitive, integrated and co-ordinated interventions, informed by qualitative and quantitative assessment of needs, urgency and resource availability. The review also provides a retrospective view on the drivers of such a response.     

Mental health and psychosocial support in humanitarian settings: a public mental health perspective

Aims.To discuss the potential usefulness of a public health approach for ‘mental health and psychosocial support’ (MHPSS) interventions in humanitarian settings.Methods.Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries.Results.A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between ‘mental health’ and ‘psychosocial’ practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology.Conclusions.The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.Key words: Humanitarian settings, low- and middle-income countries, mental health psychosocial support, public health     

军人中精神障碍流行病学研究现状

精神障碍严重影响部队的战斗力。在平时,官兵在面临调职使用、转业安排时,常因与个人愿望不符、产生心理冲突,而导致精神障碍。在抢险救灾、军事演习、大型军事比武、应付突发事件等急难险重任务时,官兵可因心理准备不足,心理负荷加大,而诱发精神障碍。战争环境下,军人要面对更多重大的心理应激,精神障碍的发生明显增加,本文针对国内外军人精神障碍的流行病学现状综述。     

The litigant-patient: mental health consequences of civil litigation.

Civil litigation often has profound psychological consequences for plaintiffs and defendants alike. For those individuals who are involved in ongoing psychotherapy, or those who enter psychotherapy during litigation, the stress of litigation often adds to whatever issues produced the lawsuit. This article reviews the effects of that stress, the mechanisms through which it arises, and its manifestations in psychotherapy and offers suggestions to increase psychotherapist awareness of the influence of litigation stress on treatment.     

Mental health and the psychosocial consequences of natural disasters in Asia

This article presents an overview of natural disasters in Asia, as well as mental disorders and psychosocial interventions related to disasters. Although most of the top ten worst natural disasters occurred in Asia over the past century, little is known about the mental health and psychosocial aspects. After the tsunami incident in 2004, research reports in international journals related to Asian disasters have been growing. The prevalence rate of post-traumatic stress disorder related to natural disasters is currently between 8.6% and 57.3% depending on assessment methodologies, instruments and timing. Cognitive behaviour therapy has been found to be effective with Asian survivors but needs to be adapted for cultural and local sensitivities. Further research is needed in the areas of epidemiology for mental disorders and suitable psychosocial interventions for disaster survivors in Asia.     

Migration and mental health in Peruvian society: Toward a psychosocial model

Summary This paper addresses the need for theoretical models to clarify the relationship between migration and mental health. It then elaborates one model of the psychosocial impact of rural-to-urban migration occurring within the context of Peruvian society. A set of hypotheses derived from this model is presented, and the generalizability of this model for understanding the consequences of migratory processes in divergent social settings is discussed.     

Preparation of mental health personnel for the delivery of mental retardation services

The developmental experience of an urban community mental health-mental retardation center is presented as a guiding model for other community mental health centers interested in tooling up their mental retardation services. Surveying personnel needs, establishing educational objectives tailored to personnel, presenting specific knowledge about mental retardation, clarifying mandates for community mental health-mental retardation service, and two conceptual frameworks for service delivery are elaborated.A detailed course outline, extensive bibliography, and teaching materials for the seminar described in the paper may be obtained for the authors.     

Needs and utilization of mental health services in schizophrenia

The planning of mental health treatment for people with severe mental disorders constitutes a major public health problem and an important social challenge. This study aims to identify the needs and to describe the utilisation of 20 services or modalities of mental health treatment among a schizophrenic population living in the Estrie region of Quebec. The results confirm that the needs are great and show that the most important deficiencies are in the psychosocial and readaptation services. The implications of these results with regard to the organisation of mental health services for schizophrenics are briefly discussed.     

Future needs for psychiatrists and other mental health personnel.

Approximately 15% of the population suffers a diagnosable mental disorder, and with the increasing availability of community-based mental health services, growing demand is placed on the mental health specialty sector. Though the general health sector and nonmedical mental health specialists provide services to a large proportion of this case load, psychiatrists possess unique skills for the diagnosis and treatment of mental disorder and for the provision of consultation and liaison services to nonpsychiatric physicians. In spite of the need, a number of factors, including restrictions on foreign medical graduates and federal emphasis on the primary care specialties, have created an accelerating reduction in the production of psychiatrists. The federal government and medical schools are encouraged to devise strategies collaboratively to address issues to ensure an adequate supply of psychiatrists for the future.     

飞行员心理健康状况及相关心理社会因素的调查研究

目的探讨心理社会应激因素与飞行员心理健康的关系,为开展心理健康教育和提高军事训练的效率提供科学依据。方法对421名健康疗养飞行员进行问卷调查,包括症状自评量表（SymptomChecklist90,SCL-90）、卡特尔16种人格问卷（Cattell’S16PersonalityFactors,16PF）、社会支持评定量表（SocialsupportRatingScale,SSRS）、紧张性生活事件评定量表（StrainedLifeEventRat—ingScale,SLERS）,并采用SPSS11．0作相关／回归分析。结果飞行员自身的多项性格特点、获得的社会支持、经历的多项紧张性生活事件与其心理健康水平均有相关性;多元回归分析显示,负性的人际关系问题、负性的工作经济问题、负性的学习问题、负性生活事件年心理紧张度,性格特点中紧张性、稳定性、忧虑性、敢为性以及其自身健康等级是影响军事飞行员心理健康的主要因素。结论心理应激有关因素对飞行员心理健康有重要影响。