A Reason for Optimism in Rural Mental Health Care: Emerging Solutions and Models of Service Delivery

This invited commentary responds to Jameson and Blank's literature review (2007) and utilizes different source materials, such as personal communications among clinicians and policymakers, Internet-based information, and direct professional experience. An update is provided regarding new graduate programs training clinicians for rural service. In addition, perceived barriers to treatment are challenged, because they are drawn from research results that could be interpreted in different ways, given the cultural heritage of southern and central Appalachian people. Lastly, the efforts of the Veterans Affairs Health Care System to reach rural citizens for mental health treatment are summarized. Some of these federal processes could be replicated at the state level, if sociopolitical and economic factors were more directly addressed. The commentary concludes, from the perspective of a professional providing clinical services in a rural setting, that a more optimistic outlook on the state of rural mental health care may be warranted.     

从流行学特征及患者就医现状看当前农村神经症的防治策略

在湖南某农村人群中抽样调查发现,神经症时点患病率为32.14‰。其中,女性、40～49岁组。丧偶者,文化程度低及单纯从事田间劳动者患病率较高。农村神经症近半数患者从未因本症就医。就医者也主要在一般临床科室和民间寻求医治,看过精神科的仅占4.1%;作者据此认为,设法促进就医,加强基层精神卫生保健队伍健设,应列为当前农村神经症防治的重要任务。     

心理测评及生活质量评价中被择答案用词的频数分析

目的:为生活质量评价提供标准化的等间距的被择答案用词.方法:收集了131份量表(心理量表123份、生活质量量表8份),采用SPSS10.0统计软件,分析各答案类型及其用词的频数分布.结果:常用的生活质量、心理量表里的答案中,多数为5级,占31.68%,其次为4级和3级,分别占21.99%和13.35%.答案用词呈多样化.结论:在设计生活质量评价量表的被择答案时,建议采纳5级设计.答案用词宜采用使用频率高,且具有等间距性的规范化用词.     

Poverty,ACEs and stigmatised places: The application of psychology to the challenges of disadvantage

Background

Our life circumstances present continual challenges to our mental health and well-being. For most of us, the politics of economy and society determine our prospects of living a good life. The fact that the ability to control and change things that happen to us is largely vested in the power of remote others has inevitable, mostly negative consequences.

Method

The following opinion piece illustrates the challenge our discipline faces in locating a complimentary contribution alongside those of public health, sociology and other sister disciplines with particular reference to the intractable concerns of poverty, ACES and stigmatised places.

Findings

The piece presents an examination of what psychology as a discipline can do in the context of adversity and challenges that individuals face but over which they have little sense of control. The discipline of psychology needs to play a meaningful part in understanding and addressing the impacts of societal matters, moving from a dominant position of individualised understandings of distress to embrace more fully the context in which people are expected to feel good and function well.

Conclusion

Community psychology offers a useful, established philosophy from which to advance our practices. However, a more sophisticated, discipline-wide narrative and grounded understanding that empathically represents real lives and captures individual functioning within a complex and distant societal system is urgently required.     

陪产丈夫的心理健康状况调查

目的 调查陪产丈夫的心理健康状况.方法 采用临床症状自评量表(SCL-90)对一组临产产妇的陪产丈夫心理状态进行评定,并与对照组,全国常模进行比较.结果 陪产丈夫SCL-90总分中焦虑、抑郁、躯体化、恐怖4个因子分值明显高于常模及对照组(P＜0.01),人际敏感、敌对2个因子分值明显低于全国常模及对照组(P＜0.01).结论 提示家庭陪产的丈夫存在不良的心理状况,产房助产护理工作者在对有丈夫参与陪产的产妇实行责任助产工作时,应重视陪产丈夫的心理帮助和支持.     

不同攻击及受害类型农村儿童的自我感受和学校调节

目的：对农村地区不同攻击、受害类型儿童的自我感受、学习成绩和对学校的态度进行比较。方法：用提名等方式对774名三到五年级农村学校儿童进行测试，并比较不同攻击、受害类型儿童的自我感受、学习成绩和对学校的态度。结果：攻击性受害儿童的学习成绩最差，对学校的正向态度最低，自我感受最差，普通受害儿童的学习成绩稍差，普通攻击儿童的学习成绩与正常儿童差异不显著，普通受害和普通攻击儿童的自我感受和对学校的态度与普通对照儿童差异不显著。结论：攻击性受害儿童具有最多的学校适应问题和最差的自我感受。     

社区老年人心理健康及相关因素分析

目的：探讨社区老人心理健康水平及影响因素。方法：随机选取杭州市居民区60岁以及以上老人440名，采用纽芬兰主观幸福度量表，SCL－90及生活事件评价调查表，进行问卷调查，了解社区老年人主观幸福感及心理健康水平，并分析影响老年人幸福感及心理健康水平的相关因素，结果：杭州市社区老人自觉幸福，心理健康水平较高，老人的年龄，性别及受教育程度与主观幸福度无关，而社会支持和对生活事件的评价是影响老人心理健康的重要因素。结论：社会支持和对生活事件的评价是影响老人心理健康水平的主要因素。     

妊娠心理学的提出

作者参阅了国内外有关资料,提出有必要建立一门新的专门学科——妊娠心理学。文中对什么是妊娠心理学,该学科应重点研究的内容及其功能进行了详细阐述。妊娠心理学的建立,将为更进一步完善妇产科学理论体系做出贡献。     

Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural Areas: A Systematic Review

Background

People living in rural and remote communities have greater difficulty accessing mental health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety and may be particularly useful in rural settings where there are a lack of suitably trained practitioners.

Objective

To systematically review the global evidence regarding the clinical effectiveness and acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote locations.

Methods

We searched seven online databases: Medline, Embase Classic and Embase, PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched reference lists, Internet search engines, and trial protocols. Two stages of selection were undertaken. In the first, the three authors screened citations. Studies were retained if they reported the efficacy, effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed, and written in English. The qualitative data analysis software, NVivo 10, was then used to run automated text searches for the word “rural,” its synonyms, and stemmed words. All studies identified were read in full and were included in the study if they measured or meaningfully discussed the efficacy or acceptability of CCBT among rural participants.

Results

A total of 2594 studies were identified, of which 11 met the selection criteria and were included in the review. The studies that disaggregated efficacy data by location of participant reported that CCBT was equally effective for rural and urban participants. Rural location was found to both positively and negatively predict adherence across studies. CCBT may be more acceptable among rural than urban participants—studies to date showed that rural participants were less likely to want more face-to-face contact with a practitioner and found that computerized delivery addressed confidentiality concerns.

Conclusions

CCBT can be effective for addressing depression and anxiety and is acceptable among rural participants. Further work is required to confirm these results across a wider range of countries, and to determine the most feasible model of CCBT delivery, in partnership with people who live and work in rural and remote communities.     

Managing Multiple Relationships in Rural Communities: Neutrality and Boundary Violations

Mental health practitioners in rural settings have identified managing multiple relationships as their most difficult ethical dilemma (e.g., Sleek, 1994 ). Further, they have indicated that specific suggestions for negotiating this difficulty are rare ( Stockman, 1990 ). This article reviews the current status of the literature addressing the management of multiple relationships in rural communities, and proposes that the psychodynamlc concept of neutrality and empirically determined therapy boundary violations provide a useful way to conceptualize managing multiple relationships in rural communities. Guidelines are provided for regulating behavior with both clients and other members of the community who are considered "prospective" clients.     

Pediatric Psychology Training: An Analysis of Graduate, Internship, and Postdoctoral Programs

The field of pediatric psychology is in the early stages offormulating its own identity relative to other areas, such asclinical child and health psychology. This paper complementsother recent efforts to delineate training practices and guidelines.Questionnaires regarding doctoral, internship, and postdoctoraltraining experiences were obtained from 89% of the membershipof the Society of Pediatric Psychology. From this information,rankings of the most commonly attended programs at each traininglevel were derived. Some overlap was apparent between doctoralprograms that were conducive to training in pediatric and clinicalchild psychology; however, differences between programs in theseareas also were noted. The most commonly attended internshipand postdoctoral settings were those in major medical centersor children's hospitals. Suggestions for investigating the currentstatus of predoctoral, internship, and postdoctoral programsthat may be facilitative of training in pediatric psychologyare discussed.     

本土心理学与心理学研究的中国化

本土心理学是20世纪80年代中后期出现的一种研究取向。一些非欧美国家特别是发展中国家的心理学者开始在理论和应用方面致力于本土心理学的研究。本土心理学具有研究的独立化和自由化．文化契合性和研究的人文性三个基本特征。中国的本土心理学是世界本土心理学的一个重要组成部分，是心理学的中国化，是建立符合中国国情的心理学。     

小组心理干预对新兵心理健康水平的影响

目的：探讨小组心理干预对新兵心理健康水平的影响。方法：采用症状自评量表（SCL－90）和特质应对方式问卷（TCSQ）对512名新兵进行心理测试，将检测出的64名有心理问题的分为两组，A组（31人）为小组心理干预，B组（33人）为对照组。在集体讲授心理卫生课的基础上，对A组采取小组心理干预。结果：经过4周小组心理干预后，A组有效率为61．29％，B组有效率为33．33％，两组比较有显著性差异（P＜0．01）。SCL－90结果：干预后A组中除恐怖因子分没有变化外，其它各项因子得分明显下降（P＜0．01）。A组的SCL－90总分、阳性项目数、躯体化、强迫、人际关系、忧郁、精神病性因子分与B组相比较有明显低（P＜0．05－0．01）。TCSQ结果：A组中的消极应对得分明显降低（P＜0．01），而B组消极应对得分没有变化。结论：小组心理干预在短期内不仅能有效改善新兵的躯体化、强迫、抑郁、人际关系敏感等常见心理问题，还能促进成功应对方式的形成，掌握自我调节方法，对提高新兵的心身健康水平及我军整体素质提高大有裨益，可推广试用。