老年慢性病患者心理健康状况及其影响因素

随着社会的发展及人口学特征的改变 ,慢性疾病在我国的危害日趋严重。有调查表明老年人慢性病患病率为 76 %～ 89% [1] 。而当前对一些老年慢性病的治疗目的已不是为了治愈 ,而在于改善功能 ,减轻或限制病情的发展 ,提高生活质量。因此 ,研究和关注这一特殊人群生活质量的问题将成为保健事业的重要内容之一。为了解老年人慢性病患者的心理健康状况 ,本研究采用症状自评量表 (ＳＣＬ - 90 )对15 0例老年慢性病患者进行评估 ,旨在了解其心理健康状况及影响因素。1　对象与方法1.1　对象选择 2 0 0 0年 10月～ 2 0 0 1年 5月我科门诊或住院的年…     

济南市老年人生活质量与心理卫生状况调查分析

目的：为了解济南市老年人生活质量与心理卫生状况。方法：采用心理咨询与体查方法对60岁以老年人进行测查。结果：影响老年人身心健康的主要因素有：生活习惯，慢性病，日常生活自理能力，经济收入，居住条件，老年期性心态，老年人的心理特点和负性生活条件，结论：改善老年人的生活条件，改变不良习惯，加大社会保险力度，发展社区医疗卫生工作是提高老年人健康水平，改善老年人生活质量的关键。     

“Under My Umbrella”: The housing experiences of HIV positive parents who live with and care for their children in Ontario

Positive Spaces, Healthy Places (PSHP) is the first longitudinal community-based research (CBR) initiative in Canada to examine housing stability and its relationship to health related quality of life (HRQOL) for people living with of HIV/AIDS (PHAs). As part of our mixed method data collection strategy in-depth, semi-structured interviews were conducted with 50 PHAs across Ontario to provide a deeper understanding of the impact that housing instability has on their mental and physical health. Emerging from the qualitative interviews were the unique issues and concerns that were reported by parents who live with and care for their children. These parents face dire housing, economic and social challenges that are associated with significant risks for poor health outcomes. Poor housing conditions, unsafe neighborhoods, barriers to supports for themselves and their children, HIV related stigma, discrimination, racism, and poverty have been identified by these families as being among their most pressing concerns. This results in increased stress and anxiety that has a negative impact on the mental health of HIV positive parents. In order to more effectively support HIV positive parents and their children, health and social service practices and policies must respond to the unique challenges that face these families.     

Socioeconomic status and health: the role of sleep

OBJECTIVE: Examine the role of sleep in the relationship between socioeconomic status (SES) and health. METHOD: Self-reported measures of income and education, sleep quantity and quality, and mental and physical health were obtained in a community sample of 1139 adults. RESULTS: More education was associated with higher income (p <.001), and higher income was associated with better physical health (p <.001) and psychological outcomes (p <.001). The effects of income on both mental and physical health were mediated by sleep quality (p values <.01), and sleep quantity was related to both measures of health (p values <.01) but to neither index of SES. CONCLUSION: Sleep quality may play a mediating role in translating SES into mental and physical well-being, and income seems to mediate the effect of education on sleep and, in turn, health.     

Stigmatizing attributions about mental illness

Work and housing opportunities of persons with psychosis, substance abuse disorder, and other mental illnesses are significantly hampered by societal stigma. Earlier research by Weiner and colleagues (1988) examined stigmatizing attitudes associated with general health disabilities in terms of attributions about the controllability and stability of these disabilities. The relevance of this model for describing attributions about four psychiatric disorders is examined in this study. One hundred and fifty two adults rated four psychiatric groups (cocaine addiction, depression, psychosis, and mental retardation) and two physical health groups (cancer and AIDS) on six items corresponding with controllability and stability attributions. Findings from a factor analysis supported the distinction between controllability and stability factors. Results also suggested that mental health disabilities were rated more negatively on these factors than physical disabilities. Participants clearly discriminated among mental health disabilities, with cocaine addiction rated most negative in terms of controllability and mental retardation rated most negative in terms of stability. Attribution analyses provide useful information for changing the community's reactions to persons with mental illness. © 2000 John Wiley & Sons, Inc.     

Health-related quality of life in postpartum depressed women

Summary The objectives of this study were a) to evaluate health-related quality of life (HRQoL) among women with postpartum depression, b) examine the association between severity of depressive symptoms and level of impairment in physical and mental HRQoL and c) to identify contributors to physical and mental HRQoL. Seventy-eight women scoring ≥10 on the Edinburgh Postnatal Depression Scale completed the questionnaires measuring: HRQoL (Medical Outcomes Study 36-item short form SF-36), sleep quality, life stress, and social support. All women underwent a cardiovascular stress test to determine aerobic capacity. Compared to Canadian normative data, women experiencing postpartum depressed mood scored significantly lower on all SF-36 domains, as well as on the SF-36 physical and mental component summary score. Severity of depressed mood was not associated to worse physical health status, while poorer aerobic capacity emerged as a significant independent contributor of physical health status. Severity of depressed mood contributed to worse mental health status. After controlling for severity of depressed mood, the occurrence of pregnancy complications, cesarean delivery, poorer sleep quality, life stress, and less social support predicted poorer mental health status.     

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.     

The relation between suicidal feelings and mental disorders in the elderly: results from the Berlin Aging Study (BASE)

BACKGROUND: The purpose of this study was to demonstrate the influence of several risk factors (particularly physical and mental disorders, loneliness and housing conditions) on the wish to die in the elderly. METHOD: Using data from a population-based sample of 516 senior citizens (70 to 103 years of age) in Berlin (Germany), we compared 54 persons with death wishes with 462 persons without death wishes on several psychosocial risk factors, physical health and psychiatric diagnoses. A logistic regression analysis was also conducted. RESULTS:. The data indicate that the wish to die is strongly associated with the presence of a mental disorder, especially major depression, while higher age, female gender, subjective assessment of physical health and negative living conditions were all only moderately related to death wishes. CONCLUSIONS: Our results emphasize the need for very careful diagnosis of death wishes in the very old and question the view that it is a normal and understandable phenomenon in older age.     

Social networks of unaccompanied women experiencing homelessness

This study explored strengths, barriers, and role of social networks among unaccompanied women experiencing homelessness. Twenty women from two local shelters participated in semistructured, face‐to‐face interviews. A constant comparative analysis revealed 4 themes: support as a coping mechanism, loss of support as a path to homelessness, support as a drain, and support as a way to give. Almost universally, women experienced considerable barriers to housing, including physical health, mental health, substance abuse, or domestic violence. Despite precarious circumstances, women showed optimism, interest, and readiness to move forward and exit homelessness. Most women utilized social networks to cope with their difficult situations. Their networks, however, were limited such that abusive relationships and substance abuse commonly contributed to homelessness and delayed entrance into secure housing. Together with identifying unaccompanied women as a subgroup in the homeless population, targeted interventions can help women capitalize on healthy relationships to promote housing security and well‐being.     

离退休老年人生活质量及心理状态调查

目的：探讨离退休老年人的生活质量和心理状态。方法：采用老年人生活质量调查表及心理健康测查表对816例离退休老年人进行测查。结果：影响离退休老年人生活质量的因素依次为心理卫生，健康状 况，经济收入，社会交往等。不论男女其各分量表除HMA外，其余各量表离退休老年人与常模比较均有显著性差异（P＜0．01），离退休老年人各量表分明显高于常模，可能与离退休老年人躯体不适，精神活动不足和某些人心理压力及个性有关，而干部人员较工人人员的心理问题多，生活满意度低，结论：离退休老年人存在明显的心理问题，个性问题和生活质量问题，改善退休老年人的生活质量和心理有利于离退休老年人身心健康。     

The conceptual relationship between health indicators and quality of life: results from the cross-cultural analysis of the EUROHIS field study

The aim of this study was to determine the performance of various health indicators to predict quality of life, mental health and general health from a conceptual point of view. The EUROHIS study (see Nosikov and Gudex, 2003) includes a broad range of health care and health behaviour related indicators, such as preventive care, health care utilization, use of medicine, physical health, mental health, alcohol consumption, physical activity and quality of life. Data on various health indicators and quality of life were collected from 10 countries, amounting to a sample size of 4849 (2750 females and 2099 males). An analytical approach was employed to investigate the interrelationship between indicators of each particular indicator set (such as alcohol consumption) and between conceptually different indicator sets. Regression analyses as well as structural equation modelling were employed, pooled across all countries as well as separately for different groups of countries. Findings indicate a higher extent of cross-cultural variation in health behaviour and the QOL measures than in mental health and physical health. In regression analyses, results showed strong and consistent effects of various health behaviour indicators to predict quality of life (R² = 0.48), mental health (R² = 0.48) or general health (R² = 0.45). However, a differential effect of socio-demographic variables, in particular education, and health behavioural determinants was found in different groups of countries. In the structural equation modelling, good fit indices were observed for the model determining physical and mental health factors by different health behaviour factors. Findings suggest that quality of life rather mediates mental outcomes in this particular set of health indicators in a European sample than functions as an outcome variable. However, it was not possible to include sociodemographic data in the whole model but only in each of the latent factors. This finding still requires replication, both in different clinical groups and in longitudinal data. Copyright © 2005 John Wiley & Sons, Ltd.     

SOCIAL ROLE VALORIZATION IN COMMUNITY MENTAL HEALTH HOUSING: DOES IT CONTRIBUTE TO THE COMMUNITY INTEGRATION AND LIFE SATISFACTION OF PEOPLE WITH PSYCHIATRIC DISABILITIES?

Despite its importance as a theory in the development of programs for populations with disabilities, social role valorization (SRV) has received relatively little attention in community mental health research. We present findings of a study that examined the relationship of housing‐related SRV to community integration and global life satisfaction of persons with psychiatric disabilities. The housing environments and associated supports of a group of 73 persons with psychiatric disabilities living in a mid‐sized city were assessed using the PASSING rating system on the extent that their housing environments facilitated SRV. In addition, in‐person interviews were conducted to determine the levels of physical integration, psychological integration, social integration, and life satisfaction of study participants. Results showed SRV contributing directly to all three types of community integration. Psychological integration was found to mediate the relationship between SRV and life satisfaction. Implications of the findings are discussed.     

帕金森患者家属生活质量的调查研究

目的了解帕金森患者家属的生活质量。方法采用生活质量综合评定问卷对102名帕金森患者家属及50名正常对照者进行测量。结果帕金森患者家属的总体生活质量(t=7.29,P<0.05)、心理健康维度(t=8.67,P<0.01)、躯体健康维度(t=6.57,P<0.01)、社会功能(t=4.59,P<0.05)及物质生活维度(t=2.52,P<0.05)均低于正常对照组,差异具有统计学意义,其中躯体健康和心理健康对生活质量的影响较大。结论帕金森患者家属的生活质量较差。     

我国大陆地区六部地方性精神卫生条例内容的评估

目的:了解我国大陆地区地方性精神卫生条例在内容上的不足,为精神卫生立法提供建议.方法:采用专题讨论的方法,对我国大陆地区六部地方精神卫生条例按照爯世界卫生组织有关精神卫生立法的检查清单爲进行评价.结果:按照世界卫生组织立法检查清单,六部地方性精神卫生条例彼此之间相差不大,六部地方性精神卫生条例在自愿入院、自愿治疗、非自愿入院、非自愿治疗、社区中的非自愿治疗、特殊治疗、监督调查机制、犯罪的精神障碍患者的处理、保护弱势群体、保护精神障碍患者的就业、住房权利、社会保障等方面的具体规定较少.结论:我国精神卫生立法需要在对非自愿就医的标准、批准机构、复核机构、实施步骤、期限等方面做出明确的规定;需要规定切实可行的审查、监督机制及司法救济途径;需要对精神障碍患者的就业、住房权利和社会保障制订具体的规定或实施细则.     

强迫症患者生活质量及相关因素分析

目的:了解强迫症患者生活质量的现状,探讨其相关影响因素。方法:采用自编一般情况调查表、健康状况问卷(SF-36),Yale-Brown强迫量表(Y-BOCS)、汉密尔顿抑郁量表(HAMD),对60例强迫症患者进行调查。结果:除外生理健康和疼痛,强迫症患者总体生活质量其它各维度均低于中国常模(P<0.001);强迫症患者汉密尔顿抑郁分、强迫症严重程度分、强迫思维分与SF-36各维度均相关(P<0.05,或P<0.01);而强迫行为仅与SF-36中的社会功能、情感职能、精神健康和精力四个维度相关;就业状况与生理职能相关;合并躯体疾病的患者在一般健康、社会功能和精神健康维度得分更低,合并其它精神障碍的患者在疼痛、一般健康、社会功能和精神健康维度得分更低。结论:强迫症患者的生活质量明显低于正常人群,强迫的严重程度,尤其是强迫思维、同时是否合并其它躯体和精神障碍及就业状况对患者的生活质量有很大的影响。     

Posttraumatic Symptoms,Quality of Life,and Survival among Lung Cancer Patients

This longitudinal study characterized psychological adjustment in a sample of lung cancer patients by examining the occurrence of posttraumatic stress and growth and their relationships with mental and physical health quality of life and survival over time. Two waves of consecutive cohort samples, totaling 115 participants diagnosed with lung cancer, were identified from outpatient oncology clinics. Of these, 93 consented and completed the first of three assessments, and 57 completed the study. Prevalence of posttraumatic stress symptoms (PTSD Checklist) and posttraumatic growth (Posttraumatic Growth Inventory) were assessed and used to predict physical and mental health components of quality of life (Short‐Form 36) and survival. Patients reported both negative and positive psychological sequelae, with prevalence of estimated PTSD ranging from 5% to 16% at each assessment as determined by symptom and cut‐off methods. Posttraumatic stress and growth were positively related, but were differentially associated with outcomes. More posttraumatic stress predicted lower mental health quality of life, whereas more posttraumatic growth predicted better physical health quality of life and longer survival. These relationships persisted after accounting for disease variables and attrition due to death or illness. These findings highlight the importance of using longitudinal designs to identify relationships between stress and resilience factors in predicting outcomes.     

Sedentary Behavior and Depression Among Adults: A Review

Background  

Physically inactive lifestyles and sedentary behaviors (SB) are key contributors to ill health. Although the association between SB (e.g., watching TV/using the computer) and physical health has been well documented, increasing research has focused on the possible link between SB and mental health (e.g., depression).     

A scenario analysis of the future residential requirements for people with mental health problems in Eindhoven

Background  

Despite large-scale investments in mental health care in the community since the 1990 s, a trend towards reinstitutionalization has been visible since 2002. Since many mental health care providers regard this as an undesirable trend, the question arises: In the coming 5 years, what types of residence should be organized for people with mental health problems? The purpose of this article is to provide mental health care providers, public housing corporations, and local government with guidelines for planning organizational strategy concerning types of residence for people with mental health problems.     

Psychological distress of fathers attending an Australian early parenting service for early parenting difficulties

Background: Early parenting centres are in a unique position to identify and provide support to fathers experiencing mental health difficulties. However, the extent to which fathers attending these services experience mental health difficulties is not known. This study aimed to assess fathers' mental health, identify specific clinical profiles based on the severity and pattern of self‐reported symptoms of depression, stress, anxiety, and fatigue and identify factors associated with poorer mental health. Methods: Participants were 144 fathers admitted to a residential programme. Socio‐demographic information and symptoms of depression, anxiety, stress, and fatigue were collected using standardised instruments. Results: The proportion of fathers reporting distress in the clinical ranges for stress, anxiety, and depression were 17%, 6%, and 9%, respectively. Latent class analysis identified two distinct groups or clinical profiles of fathers, representing mild (84%) and high distress (16%). Poor physical health, severity of child's sleep disruption, low socio‐economic position, and poor self‐care were associated with high distress. Conclusions: Fathers attending early parenting services are at risk of experiencing significant levels of distress, anxiety, stress, and fatigue. Early Parenting Services can play a critical role in screening and identifying fathers experiencing poor mental health and link them into appropriate mental health support.