心理健康教育与德育教育的相关性研究

心理健康教育作用越来越受到人们的重视。然而,心理健康教育能否取代传统的德育教育,在学生成长中人格与品德的关系是怎样的,心理健康教育与德育教育工作究竟有什么异同之处,他们之间关系如何,这些都是心理健康教育和德育教育工作者提高工作的科学性和有效性必须明确的问题。文章对上述问题作了理论上的探讨和研究,希望能对当前的心理健康教育与德育教育工作起到一定的指导作用。     

劳教干警工作压力源与心理健康的相关性调查研究

目的编制劳教系统干警的工作压力源量表并进行信度效度检验,评价其工作压力源与心理健康状况及其相关性。方法采用新编工作压力源量表和SCL-90量表对武汉市劳教所226名干警工作压力源和心理健康水平进行调查分析。结果经信度效度检验,劳教干警工作压力源量表由工作负荷、职业升迁、职业特殊性、角色冲突和人际关系5个维度的模型拟合数据较好,累计方差贡献率65.14%,总量表的内部一致性Cronbacha系数为0.899,重测信度0.929,分半信度0.888,干警工作总体压力源标准化平均得分为4.05±0.542,在劳教职业特殊性维度,女干警显著性高于男干警。劳教干警SCL-90的各维度因子得分均显著性高于国内常模,工作压力源总量表得分与SCL-90各维度因子得分均呈显著正相关。结论新编制的劳教干警工作压力源量表具有较好的信度效度,可用于劳教干警工作压力评估。劳教干警工作压力大,心理健康存在较多问题,应引起相关部门的高度重视,寻求各种途径缓解其工作压力,提高其身心健康水平。     

北京市2460名医务人员心理健康调查分析

目的探讨北京市医务人员心理健康状况特征,发现可能存在的心理问题。方法应用症状自评量表（SCL-90）和人口学特征问卷,对北京市5所三级综合医院的2460名医务人员进行调查。结果三级综合医院医务人员心理健康状况除阳性项目数高于全国常模外,其他均低于全国常模;不同年龄、性别、文化程度、职称、工龄、工作形式、科室、专业、行政职务等人口学特征的医务人员在SCL-90上差异有统计学意义（P〈0．05）;中度以上心理问题检出率为17．6％,高于一般水平。结论三级综合医院医务人员心理问题比一般人群突出,应注重医务人员的压力管理。     

The prison setting as a place of enforced residence, its mental health effects, and the mental healthcare implications

The subject of place is salient certainly when deliberating the health of prisoners as a social group. This paper provides an overview and assessment of health and place in relation to mental health and the prison locale. Particular attention is devoted to prison culture, both staff and inmate. The incarceration experience (i.e. the nature of enforced residence in the prison environment) can affect negatively prisoners' mental health. The mental health of the prison population is poor, and mental health services in the prison setting have need of further improvement. However, the provision of mental healthcare and the pursuit of good mental health in the prison milieu are challenging. The prison-based—exceedingly complex—three-way relationship between culture–mental and health–mental healthcare is debated.     

Cost shifting to jails after a change to managed mental health care

OBJECTIVE: To determine whether managed mental health care for Medicaid enrollees in King County, Washington, has led to indirect cost-shifting to substitute treatments, such as jails and state mental hospitals that are free goods to providers. DATA SOURCES: Complete service records for 47,300 adults who used at least one of the following systems from 1993 to 1998: King County jail system, Medicaid, or the King County mental health system. Data were also obtained from the Washington State Hospital System. STUDY DESIGN: A quasi-experimental analysis that compares the difference in outcomes between the pre- and post-managed care periods for Medicaid enrollees compared to non-Medicaid enrollees. The outcomes-jail costs, state hospital costs, and county outpatient mental health costs-were estimated with two-part difference-in-differences models. The regressions control for person-level fixed effects on up to 66 months of data per person. DATA COLLECTION METHODS: Administrative data were collected from the jail, Medicaid, and mental health systems, then merged and cleaned. Additional data on costs were obtained in interviews. PRINCIPAL FINDINGS: There is a striking increase in the probability of jail use for persons on Medicaid following the introduction of managed care. There was a significant decrease in expenditures in the county mental health system for outpatient care. CONCLUSIONS: Managed care led to indirect cost-shifting, probably through poor access to services, which may have led to an increased probability of jail detention.     

Single mothers and the use of professionals for mental health care reasons

In the present study, we examine whether higher rates of mental health service use observed among single-parent mothers is due to greater need (psychopathology) or other factors (predisposing and enabling characteristics) using a socio-behavioural model of health care use. We use data from two large surveys in Canada (the 1994-95 National Population Health Survey and the 1990 Ontario Mental Health Supplement). The bivariate results from both surveys revealed that single-parent mothers were two to three times more likely than married mothers to have sought professional help for mental health reasons over a 12-month period. Multivariate analyses showed that differences in predisposing and enabling characteristics between single and married mothers accounted for very little of the relationship between family structure and service use. Rather, differences in the prevalence of psychiatric disorders accounted for the higher use of services among single mothers. Single mothers are more likely than married mothers to seek professional help for mental health concerns. The use of services appears equitable in that need (higher rates of psychopathology) is the major factor differentiating use between married and single mothers. Further work should examine differences in pathways into formal care between single and married mothers.     

The evaluation of a model of primary mental health care in rural Tasmania

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a primary care mental health service. DESIGN: The study used a naturalistic longitudinal design to follow groups of participants who received intervention from a rural mental health worker, or 'usual' mental health service, or no treatment, over a period of 12 months. SETTING: The service was evaluated in a rural primary care setting. PARTICIPANTS: One hundred and forty-five primary care patients. OUTCOME MEASURES: Changes in symptomatology were assessed using the SCL-90R summary scales, and changes in quality of life were assessed using the EuroQOL. RESULTS: Those participants treated by the primary mental health worker showed significant improvements in symptoms and quality of life compared to both the usual and no-treatment groups. CONCLUSION: There are few studies evaluating mental health services in rural settings. This study demonstrated that a particular model of primary mental health care was more effective than usual mental health care and no treatment at resolving symptoms and improving quality of life.     

Evaluating a program of psychological interventions in primary health care: consumer distress, disability and service usage

OBJECTIVE: To evaluate a Better Outcomes of Mental Health Care Access to Allied Psychological Services Program for general practice patients referred for high-prevalence mental disorders. METHODS: Participants were South Australian general practitioners (GPs; n=26) and their patients referred for treatment of high-prevalence psychological disorders, of whom 229 provided baseline measures, 106 provided post-treatment measures, and 85 provided follow-up data three months after termination of treatment. Interventions were Focused Psychological Strategies supplied by mental health specialists; outcome variables included GP satisfaction, patient satisfaction, psychological distress, life impairment, and health service usage. RESULTS: Satisfaction with the treatment program was high for both the GPs and the referred patients. Patients who attended three or more treatment sessions showed reduced distress and disability, and gains were maintained three months later. Health service usage declined with acceptance of referral regardless of treatment experience. CONCLUSIONS: Lack of controls and missing data were methodological weaknesses. Results support the effectiveness of integrated primary mental health care to reduce psychological distress and disability, while impact on service usage warrants further investigation. IMPLICATIONS: Reduction of suffering and increased economic productivity may both result from this public health initiative to increase access to effective treatments for common chronic mental conditions.     

Disparities in access to health care in three French regions

Objectives

This paper compares access to primary and specialty care in three metropolitan regions of France: Ile de France (IDF), Nord-Pas-de-Calais (NPC) and Provence-Alpes-Côte d’Azur (PACA); and identifies the factors that contribute to disparities in access to care within and among these regions.

Methods

To assess access to primary care, we compare variation among residence-based, age-adjusted hospital discharge rates for ambulatory care sensitive conditions (ASC). To assess access on one dimension of specialty care, we compare residence-based, age-adjusted hospital discharge rates for revascularization – bypass surgery and angioplasty – among patients diagnosed with ischemic heart disease (IHD). In addition, for each region we rely on a multilevel generalized linear mixed effect model to identify a range of individual and area-level factors that affect the discharge rates for ASC and revascularization.

Results

In comparison with other large metropolitan regions, in France, access to primary care is greater in Paris and its surrounding region (IDF) than in NPC but worse than in PACA. With regard to revascularization, after controlling for the burden of IHD, use of services is highest in PACA followed by IDF and NPC. In all three regions, disparities in access are much greater for revascularization than for ASC. Residents of low-income areas and those who are treated in public hospitals have poorer access to primary care and revascularizations. In addition, the odds of hospitalization for ASC and revascularization are higher for men. Finally, people who are treated in public hospitals, have poorer access to primary care and revascularization services than those who are admitted for ASC and revascularization services in private hospitals.

Conclusions

Within each region, we find significant income disparities among geographic areas in access to primary care as well as revascularization. Even within a national health insurance system that minimizes the financial barriers to health care and has one of the highest rates of spending on health care in Europe, the challenge of minimizing these disparities remains.     

广东省部分监狱干警心理健康与人格特征的调查

目的研究监狱干警的心理健康状况及其与人格的关系。方法采用精神症状自评量表(SCL-90)和艾森克个性问卷(EPQ)对广东省82名监狱干警和79名非干警人员进行调查。结果监狱干警SCL-90总分超过160分者占26.83%,SCL-90的某些因子存在年龄和职业差异的显著性;与干警人群比较,监狱干警的EPQ中精神质分显著性增高,监狱干警的健康水平与人格密切相关。结论监狱干警的健康状况值得关注,人格的培养和心理素质的提高有利于促进干警的心理健康。     

Unintended effects of reimbursement schedules in mental health care

We evaluate the introduction of a reimbursement schedule for self-employed mental health care providers in the Netherlands in 2008. The reimbursement schedule follows a discontinuous discrete step function—once the provider has passed a treatment duration threshold the fee is flat until a next threshold is reached. We use administrative mental health care data of the total Dutch population from 2008 to 2010. We find an “efficiency” effect: on the flat part of the fee schedule providers reduce treatment duration by 2 to 7% compared to a control group. However, we also find unintended effects: providers treat patients longer to reach a next threshold and obtain a higher fee. The data shows gaps and bunches in the distribution function of treatment durations, just before and after a threshold. About 11 to 13% of treatments are shifted over a next threshold, resulting in a cost increase of approximately 7 to 9%.     

Corporate moral responsibility in health care

The question of corporate moral responsibility – of whether it makes sense to hold an organisation corporately morally responsible for its actions,rather than holding responsible the individuals who contributed to that action – has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom(UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially a moral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish This revised version was published online in July 2006 with corrections to the Cover Date.     

Specialty health care,treatment patterns,and quality: the impact of a mental health carve-out on care for depression

OBJECTIVES: To assess the effect of a mental health carve-out on treatment patterns and quality of care for outpatient treatment of depression. DATA SOURCES: Outpatient and pharmaceutical claims from September 1993 through March 1997 for one large managed care organization in the Midwest that carved-out mental health and substance abuse benefits in September 1995. RESEARCH DESIGN: Using the treatment episode as the unit of analysis (n = 1,747), changes in treatment patterns associated with the change to a carve-out were evaluated. Logistic regression was used to assess whether in the postperiod a treatment episode was more likely to be treated with (1) an antidepressant and (2) a type and intensity of treatment with proven efficacy. To strengthen confidence in a causal relationship, I search for structural breaks in treatment patterns across a wide range of dates, assuming no a priori knowledge of the timing of the impact of the carve-out. RESULTS: I find the carve-out to be associated with an increase in the use of drug treatments. Although I find a decrease in the use of guideline-level treatment over the entire study period, there is an increase in the number of episodes treated with guideline-level treatment over what would be the case in the absence of the carve-out. CONCLUSIONS: The increase in the use of drug treatments suggests previous research that excluded these costs may have overestimated the savings attributable to carve-outs. Guideline-level care appeared to increase as a result of carve-out implementation suggesting the use of management and specialization to reduce costs is not antithetical to quality improvement.     

Experimenting locally with a stepped-care approach for the treatment of mild to moderate mental disorders in France: Challenges and opportunities

In France, publicly funded mental care services are mostly hospital-based and focused on treating severe illnesses. Mild to moderate mental disorders are typically managed by general practitioners (GP) who often lack specific training to treat these conditions. Antidepressant prescribing levels for mild to moderate conditions are inadequately high. Public reimbursement for psychotherapies provided by psychologists is generally not available. This paper presents a local experiment with a stepped-care approach for the treatment of mild to moderate mental disorders in four French départements launched in 2018. The experiment includes the introduction of a standardized assessment protocol for GPs, clear referral guidelines, and full reimbursement of visits to psychologists upon GP referral. Seemingly simple, the policy raises several issues related to the regulation, training and reimbursement of psychologists, and illustrates the need for careful preparation and workforce planning to ensure success and stakeholder support. An independent evaluation of the local experiments is planned, which provides the opportunity to fine-tune the policy before any broader rollout. The issues raised in France and the on-going debate is relevant for other countries preparing similar policies for improving mental care.     

Treatment of common mental disorders in primary care in low- and middle-income countries

Common mental disorders are responsible for up to 10% of the total global disease burden. The growing evidence base for the efficacy and cost-effectiveness of treatments for these disorders raises the possibility of delivering huge health and economic benefits. However, delivering these treatments in resource-constrained settings is challenging. At least one-third of all patients seen in primary care in low- and middle-income countries present with common mental disorders. The majority are not recognised or are ineffectively treated. To address this problem, WHO advocates integrating mental health in primary care. However, the limited evidence base has impeded efforts to develop such services.