Identification and classification of postpartum psychiatric disorders.

1. Postpartum depression has been used as a catchall phase for many postpartum emotional symptoms. Categorizing a number of diverse disorders under one title has resulted in an inability to identify who is most at risk for developing postpartum problems. 2. The postpartum period is a particularly vulnerable period for depression, despite the fact that it is perceived as a time of joy and emotional well-being. 3. By increasing awareness among all health care professionals who care for women during the period following childbirth, postpartum psychiatric disorders can be identified early and treated correctly. 4. Limiting postpartum psychiatric disorders to postpartum depression may result in limited or inappropriate treatment options.     

Eco-critical Consciousness Meets Oppositional Consciousness: Reading Early Chicago Housing Activism Through an Environmental Lens

This article integrates the key concept of oppositional consciousness from social movement theory with the broader notion of community work to argue for understanding the environmental activism of African Americans. Oppositional consciousness developed through community work can significantly challenge dominant ideologies pertaining to environment-related advantages, which the authors refer to as “eco-critical consciousness.” Arguing that housing inequality is an integral part of environmental concerns, the authors show that not only did African Americans care about the environmental integrity of their communities, they also took measures to resolve some of the ways environmental degradation affected their health. Using archival information from the Chicago Defender, the authors show that African Americans have consistently challenged conditions of housing discrimination and livability, revealing an intersectional understanding of environmental issues. The analysis reveals the actions, agency, and legacies made by early black Chicagoans on environmental history.     

Recruiting immigrants for long-term care nursing positions

Recent immigrants and workers in foreign countries are two groups frequently identified as potential sources of new workers for nursing positions in long-term care (LTC). Recruiting workers directly from other countries, either permanently or temporarily, is difficult because of restrictive visa classifications; is unlikely to impact significantly the worker shortage; and may have risks that outweigh the potential rewards. On the other hand, with targeted recruitment and retention efforts, the nation's rapidly growing immigrant population (the so-called "New Americans") can become an even more important source of labor for frontline LTC workers. To be successful employees in LTC, however, New Americans will have to overcome a variety of cultural and language barriers. Equally important, the institutions and agencies that comprise the LTC system must exhibit a higher level of sensitivity to cultural differences. Efforts to recruit, train, and retain New Americans for positions in LTC present win-win opportunities and should be expanded.     

Chinese Families in Transition: Cultural Conflicts and Adjustment Problems

Challenged to cope with two different cultures, Chinese American immigrant families face many stressors and conflicts. Such difficulties faced by these individuals usually stem from language, religious, and value differences. Furthermore, family members are faced with role and status changes due to differing rates and levels of acculturation. As a result, there is a great need for mental health services. However, due to cultural barriers, mental health services are not accessible nor acceptable to many Chinese Americans. Effective intervention strategies which integrate the Chinese cultural values and norms with psychotherapy are recommended.     

Career‐Related Parent Support and Career Barriers: An Investigation of Contextual Variables

The authors used social cognitive career theory (Lent, Brown, & Hackett, 1994 ) as the basis for examining the person and contextual variables of gender, ethnicity, educational and career barriers, and career‐related parent support for incoming 1st‐year African American, Asian, Latino, and White college students. Women, as compared to men, perceived significantly higher levels of career barriers but similar levels of coping efficacy in dealing with these barriers. Women also reported receiving more career‐related emotional support from parents than did men. For all participants, career‐related parent support accounted for a significant portion of the variance for perceptions of educational and career barriers and coping efficacy with educational and career barriers.     

Chinese families in transition: Cultural conflicts and adjustment problems

Challenged to cope with two different cultures, Chinese American immigrant families face many stressors and conflicts. Such difficulties faced by these individuals usually stem from language, religious, and value differences. Furthermore, family members are faced with role and status changes due to differing rates and levels of acculturation. As a result, there is a great need for mental health services. However, due to cultural barriers, mental health services are not accessible nor acceptable to many Chinese Americans. Effective intervention strategies which integrate the Chinese cultural values and norms with psychotherapy are recommended.     

Treatment Engagement Using Motivational Interviewing for Low-Income, Ethnically Diverse Mothers with Postpartum Depression

Postpartum depression (PPD) places women, and their children, at risk for many untoward outcomes including lack of responsivity, low self-efficacy, and insecure infant attachment. Especially at risk for untreated PPD are low-income, ethnically diverse mothers. Seeking and accepting treatment for depression may be impeded by the many psychological and social barriers that mothers may bring with them. Obstacles might include a lack of resources (e.g., lack of transportation or child care), stigma, distrust, and a lack of knowledge about stress and depression. To reduce these and other barriers to treatment, this paper points to the value of utilizing motivational interviewing techniques to engage and retain low-income, ethnically diverse women for treatment of PPD. Following a review of PPD and related barriers to treatment, a case study is presented with example dialogue. The suggestions for practice represent starting points for effective engagement of women in any number of treatments provided by social and health services settings. With federal mandates to screen for depression in many settings and to provide treatment, using motivational interviewing may be an effective prelude to treatment adherence.     

Impact of Genetic Relatedness and Emotional Closeness on Intergenerational Relations

Both emotional closeness and genetic relatedness are known to influence helping behavior between family generations, yet few studies have explored them together. The authors investigated the associations between (a) parenthood and perceived emotional closeness toward own parents and parents‐in‐law and (b) emotional closeness and receiving child care from grandparents across and within lineage lines. The data include information on the 8 dyads of possible parent–grandparent relations from a nationally representative survey of young adults in Finland (born 1962–1990, sample N = 1,216). The results show that parenthood was associated with women's emotional closeness to their own mothers and men's emotional closeness to their parents‐in‐law. Maternal grandmothers provided the most grandchild care. After controlling for emotional closeness, the difference in child care provision between one's own mother and one's mother‐in‐law disappeared for women but was accentuated in men. Thus, emotional closeness shapes intergenerational relations differently for kin and in‐laws.     

Exploring the Climate for Overweight and Obese Students in a Student Health Setting

Attitudes and beliefs of health care providers, in conjunction with a nonthreatening physical environment, are important components in establishing a constructive and supportive climate for care of overweight and obese students. Objective: The authors explored providers' attitudes about obesity and assessed the physical environment in a student health clinic to identify areas that may be detrimental to the care of overweight and obese students. Participants: Eighteen direct care providers participated in the project. Methods: The authors conducted focus groups with direct care providers and assessed their experiences and perceived challenges in working with overweight and obese students. The authors also conducted a walk-through assessment of the physical environment. Results: Direct care providers expressed discomfort in deciding how and when to discuss weight with students. The authors found that elements of the physical environment could present barriers to care for overweight and obese students. Conclusions: The authors make recommendations for improving the health care climate for overweight and obese students.     

Searching for Barriers to Adoption of the Videophone in a Hospice Setting

Hospice services care for millions of Americans at the end of their life. To improve this care, videophones have been introduced. However, the use of videophones is often not readily accepted by hospice nurses. This study used three theories, surveys, and focus groups with 25 hospice employees to investigate why there was a lack of acceptance. The survey predicted the videophones would be adopted. However, this was not the case, so focus groups were conducted to expand understanding of nonacceptance. This research demonstrates that leadership, context, and perceptions of the technology were key features effecting videophone acceptance. Future research should further examine these barriers and address the need for new survey instruments regarding nonutilization in this context.     

Boundary-spanning work demands and their consequences for guilt and psychological distress

Using data from a national survey of working Americans (Work, Stress, and Health Survey; N = 1,042), the authors examine the associations between boundary-spanning work demands and self-reported feelings of guilt and distress. The authors document gender differences in the emotional and mental health consequences of boundary-spanning work demands, as indexed by the frequency of receiving work-related contact outside of normal work hours. Specifically, the authors observe that frequent work contact is associated with more feelings of guilt and distress among women only. Analyses also demonstrate that guilt accounts for the positive association between the frequency of work contact and distress among women. Statistical adjustments for levels of guilt reduce the positive association between frequent work contact and distress among women to nonsignificance. The findings underscore the importance of focusing on gender and emotions in work-family interface processes, as well as their implications for psychological health.     

Culturally Relevant Psychotherapy for Perinatal Depression in Low-Income Ob/Gyn Patients

To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression in low-income women, we propose that a culturally relevant version of brief interpersonal psychotherapy (IPT-B) may be an effective approach. IPT-B is a modified form of Interpersonal Psychotherapy (IPT), an efficacious treatment for depression that we have altered to address the needs of women who have difficulty adhering to longer courses of psychotherapy. Culturally relevant additions to IPT-B include (1) a pre-treatment engagement strategy consisting of an ethnographic interview accompanied by psychoeducation to engage women in treatment; (2) convenient delivery of IPT-B in a public care Ob/Gyn clinic where the women receive prenatal services; (3) flexible scheduling of treatment sessions at the clinic or on the phone; and 4) facilitation of access to social services.     

Dementia Caregiving in the Context of Late‐Life Remarriage: Support Networks,Relationship Quality,and Well‐being

Caregiving research has not accounted for increasingly diverse and complex marital and family histories of older Americans. The authors examined social relations and care‐specific positive and negative support networks among late‐life remarried wife dementia caregivers (N = 61) to determine associations among network structure, relationship quality with and support received from network members, and global assessments of family and stepfamily disagreement on caregiver well‐being. Own family and friends predominated in the social relations and positive networks. Although over half (54%) of respondents included a stepfamily member in their positive networks, stepchildren comprised the largest group (35%) in the negative networks. Larger negative networks and actively negative interactions were related to greater caregiver burden, and more global disagreement with stepfamily was associated with greater depression and burden. The findings illustrate the complex nature of support and the value of targeted examinations of caregiving support dynamics among late‐life remarried older adults and stepfamilies facing health demands.     

Depression and Missed Work among Informal Caregivers of Older Individuals with Dementia

Although providing informal care can negatively affect caregiver emotional health and lead to depression, the association between caregiver depression and missed work is unknown. We use data from the National Longitudinal Caregiver Survey to examine the relationship between caregiver depression and missed work among informal caregivers for older veterans with Alzheimer’s disease or vascular dementia. Two-part models are used to estimate the expected hours of work missed among working caregivers. Caregiver depression is statistically significantly associated with the likelihood and amount of time missed at work, resulting in an average of an extra half-day of work missed per month. While the effect of caregiver depression on work missed is modest, it represents another possible benefit from interventions to support caregivers.     

Calibrated Ambitions: Low Educational Ambition as a Form of Strategic Adaptation Among Chinese Youth in Spain

Deemed “model minorities,” second‐generation Chinese‐Americans have, on average, high levels of educational attainment and, as a result, they have experienced more upward mobility than other groups. Yet, on the other side of the Atlantic, a strikingly different story about Chinese immigrants and their offspring emerges. Based on analysis of the Longitudinal Study of the Second Generation in Spain, findings from this study show that Chinese youths in Spain have substantially lower educational ambitions and attainment than youths from every other nationality. Met with discrimination at school and in the labor market, yet finding financial success in niche markets as small business owners, I argue that the Chinese in Spain have, at least temporarily, forged an alternative pathway of mobility based on entrepreneurial endeavors rather than educational accomplishments – a formula passed on from immigrant parents to their offspring. The way Chinese youths in Spain have calibrated their ambition represents a form of strategic adaptation to the barriers put up against immigrant minorities in Spanish society.     

“No Matter What I Do They Still Want Their Family”: Stressors for African American Grandparents and Other Relatives

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.     

Agency-Related Barriers Experienced by Families Seeking to Adopt From Foster Care

ABSTRACT

Although about 100,000 children in foster care await adoption, families approved to adopt encounter obstacles in the adoption process. This nationwide longitudinal study identified agency-related barriers faced by prospective adoptive parents. A pur-posively recruited sample of 300 families seeking to adopt from foster care completed an in-depth, semi-structured telephone interview and quarterly follow-up surveys until they either finalized a foster care adoption (n = 98) or discontinued (n = 102) the process, followed by an exit interview by telephone. Findings revealed the top barriers encountered were adoption process logistics (n = 185, 92.5%), agency communication and responsiveness (n = 159, 79.5%), agency emotional support (n = 130, 65%), availability of services (n = 65, 32.5%), and juris-dictional and interjurisdictional issues (n = 52, 26%). Policy and practice implications are provided with recommendations for improving procedures, services, support, and communication to better retain prospective adoptive parents and improve adop-tion outcomes.     

Cultures of the soul: spiritual beliefs about organ donation in China and the United States

Spiritual beliefs shape ideas about the meaning of life, the moment of death, and the care that must be taken to deliver the body of the loved one to the spiritual realm. This study investigated spiritual beliefs about organ donation for participants in China (n = 364) and the United States (n = 384). Results showed that spiritual connection with the transplant recipient, spiritual concern about removing organs, and attitudes toward organ donation significantly predicted willingness to become an organ donor for participants in both countries. Americans reported being significantly more religious compared to Chinese. However, altruism and religiosity were not significant predictors of willingness to donate organs. Chinese participants showed significantly higher levels of spiritual connection with the potential recipient of transplanted organs. Even so, Chinese participants exhibited more reluctance to become organ donors compared to Americans. Gender differences in organ donation behaviors are also reported. The study discusses the implications of the findings for structuring organ procurement campaigns that will address spiritual beliefs about organ donation.     

Mental health and aging in the 21st century

This article reviews pressing issues in mental health care for older adults in the 21st century. After examining current forces for change in older adults' mental health care and coverage, the authors discuss barriers to accessing mental health care resulting from the fragmentation of the United States health care system as well as the history behind the multiple and competing systems of care for older adults. The article continues with a discussion of goals for the provision of good mental health service delivery for older adults and concludes by addressing potential responses and future target areas regarding mental health care for older adults as well as a potential realistic collaboration to address mental health and aging.