Impact of spirituality and religiousness on outcomes in patients with ALS

The Project of Death in America Study at Columbia Presbyterian Medical Center enrolled 121 patients with ALS from 1996 through 1997, 46 of whom participated in a study assessing the effects of religiousness and spirituality (attachment to life, mental health, support group, health care proxy, and attitudes toward death) on outcomes (technology and death). Spirituality or religion influenced use of percutaneous endoscopic gastrostomy, noninvasive assisted ventilation, tracheotomy, and attitudes toward the dying process.     

The assessment of spirituality and religiousness in schizophrenia

To assess religious coping in schizophrenia, we developed and tested a clinical grid, as no validated questionnaire exists for this population. One hundred fifteen outpatients were interviewed. Results obtained by 2 clinicians were compared. Religion was central in the lives of 45% of patients, 60% used religion extensively to cope with their illness. Religion is a multifaceted construct. Principal component analysis elicited 4 factors: subjective dimension, collective dimension, synergy with psychiatric treatment, and ease of talking about religion with psychiatrist. Different associations were found between these factors and psychopathology, substance abuse, and psychosocial adaptation. The high prevalence of spirituality and religious coping clearly indicates the necessity of addressing spirituality in patient care. Our clinical grid is suitable for this purpose. It proved its applicability to a broad diversity of religious beliefs, even pathological ones. Interjudge reliability and construct validity were high and specific training is not required.     

The place of spirituality and religion in mental health services

Mental health professionals have raised concerns about the role of spirituality and religion in services for people with severe mental disorders, but this chapter offers compelling reasons for increased attention to spiritual issues in service delivery.     

Factors associated with risk of suicide in patients with hemodialysis

Suicide risk (SR) has been associated to several factors; one of them is the presence of psychiatric disorders. This study has the objective of investigating the relationship between the risk factors for suicidal behavior in patient bearers of chronic renal illness who are undertaking hemodialysis treatment. Sixty-nine undertook a short, structured diagnostic interview. The prevalence of some psychiatric disorders showed itself greater in the sample than that in the population in general. A significant positive correlation was found between SR, major depressive episode, and agoraphobia without panic disorder. The religiosity of the patient was also evaluated as an influencing factor of SR. Nonreligious patients had 8 times more chance to have SR compared to religious patients. However, the referred effect only occurred in nondepressed religious patients. The latter indicated that religiosity had its effect annulled in depressed patients. This study shows the importance of measures of intervention in mental health, mainly in relation to prevention and treatment of major depressive episode with a view to reducing SR.     

Pilot study of spirituality and mental health in twins

OBJECTIVE: The goal of this study was to investigate associations between empirically defined dimensions of spirituality, personality variables, and psychiatric disorders in Vietnam era veterans. METHOD: One hundred pairs of male twins from the Vietnam Era Twin Registry were administered the self-report Spiritual Well-Being Scale and a pilot Index of Spiritual Involvement. Correlation analyses were supplemented with regression analyses that examined the relative influence of genetic and environmental factors on aspects of spirituality. RESULTS: Existential well-being was significantly associated with seven of 11 dimensions of personality and was significantly negatively associated with alcohol abuse or dependence and with two of three clusters of personality disorder symptoms. Associations between mental health variables and religious well-being or spiritual involvement were much more limited. CONCLUSIONS: Useful distinctions can be made between major dimensions of spirituality in studies of spirituality, religious coping, and mental health.     

The influence of diet on mental health

The influence of nutritional factors on brain metabolism and the course of mental illness are increasingly being addressed in international research. It is a matter of discussion whether dietary habits, e.g., the amount of fish or vegetables, have an effect on the incidence of certain illnesses. Furthermore an optimized or supplemented diet could offer therapeutic possibilities; one example is the role of polyunsaturated fatty acids as an add-on therapy in affective disorders. The limitations of psychopharmacotherapy (drug interactions, side effects, noncompliance) underline the theoretical and practical relevance of nutrition in mental illness, the more so as mentally ill patients (especially when demented, anorectic, depressed, or schizophrenic) are at higher risk of malnutrition anyway. Even if the therapeutic evidence is still limited and the effects may be relatively weak, nutritional assessment and an optimized diet can be recommended for every patient.     

Combined influence of serious mental illness and criminal offending on suicide risk in younger adults

Purpose

We conducted a national epidemiological study to determine how mental illness and criminal offending combine to influence suicide risk in younger adults.

Methods

Using completely interlinked registers, we generated a nested case–control study from the cohort of all Danish people born 1965 and onwards. We identified 2,384 suicides aged 15–41 years during 1981–2006, and 56,016 age and sex-matched living controls. We examined all criminal charges from 1980, and all psychiatric admissions from 1969 and outpatient episodes from 1995. Exposure odds ratios were estimated using conditional logistic regression models.

Results

A quarter of male and 17 % of female suicides had histories of both criminal justice system contact and secondary care psychiatric treatment, with a marked elevation in risk seen compared with having neither risk factor: male odds ratio (OR) 34.0, 95 % confidence interval (CI) 29.1–39.6; female OR 72.7, CI 49.4–107.1. Among those treated for psychiatric illness, contact with the criminal justice system predicted higher risk: male OR 1.4, CI 1.1–1.7; female OR 1.7, CI 1.1–2.4, although these effects were attenuated and became non-significant with adjustment for socio-demographic risk factors. In men, risk was especially high if first criminal justice system contact occurred before first psychiatric treatment episode, and if these two challenging life events coalesced within a year of each other.

Conclusion

These younger age adults should be monitored carefully for signs of suicidal behaviour. The need for well coordinated multiagency care is indicated, and a broad range of psychiatric illnesses should be considered carefully when assessing their suicide risk.     

监狱警察压力、心理健康素质与心理健康的关系

目的 探讨监狱警察压力、心理健康素质和心理健康之间的关系.方法 采用方便抽样方法进行抽样,使用自编一般资料调查表、自编监狱警察压力量表、中国成年人心理弹性量表（RTS-CA）、中国成年人人际健康素质量表（IHDS-CA）和症状自评量表（SCL-90）对北京市218名监狱警察进行测查.以心理弹性、人际素质、压力、心理健康水平为变量构建路径分析模型.结果 （1）监狱警察在SCL-90的躯体化、抑郁和焦虑分量表上的评分显著高于全国成人常模（P＜0.01）.（2）路径分析模型各拟合指数为CMIN=1.17,GFI=0.93,CFI=0.93,RMSEA=0.031,模型整体路径显著（P＜0.01）.结论 监狱警察的心理健康水平较低,压力通过心理弹性、人际交往素质而影响监狱警察的心理健康水平,强化心理健康素质是维护监狱警察心理健康的有效途径.     

The influence of mental health problems on AIDS-related risk behaviors in young adults.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r = .28]; conduct disorder [r = .27]; depression [r = .16]; suicide [r = .14]; anxiety [r = .16]; and posttraumatic stress [r = .09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a high-risk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B = .10], alcohol/drug abuse or dependence [B = .34], depression [B = .20], suicidality [B = .35], anxiety [B = .13], and posttraumatic stress [B = .14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.     

Culture, spirituality, and mental health. The forgotten aspects of religion and health.

Modern psychiatry has neglected the spiritual dimension of the human mind and the teleologic concept of illness as meaningful sufferings by clinging to the traditional causality principle and rationalistic orientations without clarifying the concepts of religion, spirituality, culture, and mental health. The Jungian viewpoint may bridge the age-old gap in the West between belief and science.     

The influence of whole body cryotherapy on mental health

The paper presents a little known issue about the influence of wholebody cryotherapy on mental health. Observations of patients' behaviour after passing the cryogenic chamber leads to an interesting hypothesis. Short exposition to extreme cold has doubtless a profitable influence on man's frame of mind. Immediately after passing the cryogenic chamber, apart from the well known analgetic effect, we detect changes in patients' mental state such as improvement of mood, deep relaxation, freshening up, consolation, euphoria. This unusual state lasts for a long time after ending the cycle of cryotherapy. Different mechanisms of this effect are considered. New possibilities of this method have been presented. Durability of such an advantageous phenomenon are investigated in our research centre in Wroc?aw.     

自杀未遂急诊患者接受精神卫生服务的障碍因素

自杀是一项全球性的严重社会公共卫生问题。自杀未遂急诊患者接受精神卫生服务存在 诸多障碍因素。现从医院、社会两方面分析现存的障碍因素并提出相应策略,旨在为提升精神卫生服 务可及性提供参考与借鉴,预防和减少患者再自杀。     

The influence of exile and repatriation on mental and physical health

This study tested the association between psychosocial stressors extracted from a previous qualitative study, and psychological distress, long-term illness and self-rated ill-health among Latin American refugees in Lund, Sweden, and among repatriated Latin Americans. The study was designed as a population-based cross-sectional study. A structured questionnaire from the Swedish Annual Level-of-Living Surveys 1989: 2 was translated into Spanish. Latin American refugees in Lund (n=338) and those who had lived in Lund and were repatriated to Santiago de Chile (n=51) and Montevideo, Uruguay (n=9), were interviewed in their homes in Sweden and in Latin America. The data were analysed unmatched with logistic regression in main effect models. Torture was an independent risk indicator for psychological distress, with an estimated odds ratio of 2.71 (1.45–4.85). There was a significant association between discrimination, not feeling secure in everyday life and psychological distress, with estimated odds ratios of 1.93(1.02–3.56) and 3.23(1.62–6.16), respectively. Torture and not feeling secure in everyday life were independent risk factors for long-term illness. Torture, discrimination and not feeling secure in everyday life were significant strong risk factors for ill-health. Repatriated refugees had significantly higher shares of not feeling secure compared with Latin Americans in Sweden. As risk factors of psychological distress and illness, torture, discrimination and not feeling secure proved to be as important as traditional risk factors such as material factors and lifestyle.     

The suicide risk of discharged psychiatric patients

BACKGROUND: The suicide risk of psychiatric patients fluctuated along the course of their illness and was found to be high in the immediate post-discharge period in some settings. The epidemiology and psychiatric services for the suicide population in Hong Kong have differed from those of the West (i.e., low youth suicide rate, high elderly suicide rate, high female/male ratio, and heavily government-subsidized psychiatric service). This study examined the suicide rates within a year of discharge from psychiatric inpatient care in Hong Kong. METHOD: Discharges from all psychiatric hospitals or psychiatric wards in general hospitals in Hong Kong from 1997 through 1999 were followed up for suicides (ICD-9, E950-E959) and "undetermined" causes of deaths (E980-E989) by record linkage with the Coroner's Court until their deaths or Dec. 31, 2000. The suicide rates (/1000 person-years at risk) and standardized mortality ratios (SMRs; assigning a value of 1 to the same age- and sex-specific suicide rates in the general population) were calculated. RESULTS: 21,921 patients (aged over 15 years) were discharged from psychiatric hospitals from 1997 through 1999. Two hundred eighty patients committed suicide within 1 year of discharge; 85 suicides (30%) occurred within 28 days after discharge. The SMRs for suicide in the first 28 days after discharge were 178 (95% CI = 132 to 235) for females and 113 (95% CI = 86 to 147) for males. These rates were 4.0 (95% CI = 2.7 to 5.6) times higher for females and 4.6 (95% CI = 3.2 to 6.3) times higher for males than the rate in the rest of the year. Young adults had higher SMRs than the elderly. No specific diagnoses had higher suicidal risk than others. Calculations including undetermined causes of deaths (N = 53) gave similar results. CONCLUSION: The immediate post-discharge period carries a high risk of suicide for psychiatric patients. The high-risk groups are young adults and females. No diagnosis appears to carry a particularly high risk.     

Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia

OBJECTIVE: Spirituality and religiousness have been shown to be highly prevalent among patients with schizophrenia. However, clinicians are rarely aware of the importance of religion and understand little of the value or difficulties it presents to treatment. This study aimed to assess the role of religion as a mediating variable in the process of coping with psychotic illness. METHOD: Semistructured interviews about religious coping were conducted with a sample of 115 outpatients with psychotic illness. RESULTS: For some patients, religion instilled hope, purpose, and meaning in their lives (71%), whereas for others, it induced spiritual despair (14%). Patients also reported that religion lessened (54%) or increased (10%) psychotic and general symptoms. Religion was also reported to increase social integration (28%) or social isolation (3%). It may reduce (33%) or increase (10%) the risk of suicide attempts, reduce (14%) or increase (3%) substance use, and foster adherence to (16%) or be in opposition to (15%) psychiatric treatment. CONCLUSIONS: Our results highlight the clinical significance of religion in the care of patients with schizophrenia. Religion is neither a strictly personal matter nor a strictly cultural one. Spirituality should be integrated into the psychosocial dimension of care. Our results suggest that the complexity of the relationship between religion and illness requires a highly sensitive approach to each unique story.     

Terrorism, suicide bombing, fear and mental health

This paper is based on the Bruce Burns Memorial Trust Lecture, Terrorism and Mental Health, presented in October 2005, in Birmingham. In addition to written sources, it is informed by the author's experience and contact with military and police experts in this arena over 28 years as a member of the British Army. The diagnosis and treatment of post traumatic mental disorders are not addressed in this paper. The author explores the general phenomenon of terrorism, in an endeavour to inform understanding of terrorist acts. He stresses the need for contextualisation of acts of terror, their perpetrators, their effects on populations and individuals, and attention to the psychology of groups. The author aims to invite and inform further thought and debate on the subject by raising a wide range of issues which do not sit comfortably within a strict psychiatric, research-based paradigm. The author covers a brief history of terrorism; organisational requirements of terror groups and the process of recruiting personnel to them; the means, motives and opportunities terrorists exploit in their work; the need for communication with terror groups; sacrificial death; governmental responses to terrorist acts and fear and mental health. The author proposes that terrorist organisations perform some of the functions of a family; that acts of terror are 'propaganda by deed'; that terrorism, or more precisely the media's treatment of it, breeds 'formless fears' which may directly lead to the development of fear-based symptoms and illness within societies. He notes that terrorism is an enterprise from which many players ('experts', media, politicians, etc.) benefit; that terrorism has its shadow in counter-terrorism, which may range from benign to malignant and that psychiatry could, in this context, acknowledge its bias towards individual psychologies and rectify its lack of understanding of groups and the behaviours of individuals within them.