Widows and widowers in today's society

With the increasing life span in our society, the number of widowed individuals has increased dramatically. The loss of a spouse is one of the most stressful life events for both women and men, yet there is little nursing research on the physical and psychosocial needs of older adults who are experiencing this loss. Some studies suggest that widowed women and men develop significant physical and mental health problems and complicated grief. Thus, it is important for nurses to recognize the diversity of grieving experiences and the increased vulnerability of widowed individuals to psychiatric illnesses that may result in suffering and impairment of daily functioning. With a better understanding of these needs, nurses can provide interventions that help these individuals maintain their health and independence.     

Collaborative care for individuals with bipolar disorder or schizophrenia and co-occurring physical health conditions: A systematic review

While rates of chronic physical health conditions are increasing for the general population, individuals with severe mental illness are at greater risk. Co-occurring mental and physical health conditions are associated with poor health care utilization, socioeconomic, and patient-reported health status outcomes. This study used systematic review procedures to investigate the effectiveness of collaborative care models for improving the health of adults with bipolar disorder or schizophrenia and co-occurring chronic physical health conditions. Six studies met inclusion criteria, and included outcomes related to quality of life, physical health, and mental health. Collective and study-level results are reported and discussed, including implications for social work practice and research.     

Effects of goal-striving stress on the mental health of black Americans

Although many scholars have theorized about how responding to the stress of blocked opportunities can affect the well-being of black Americans, few scholars have empirically examined the relationships between striving efforts, personal goals, and mental health among black Americans. This investigation examines the relationship between goal-striving stress and mental health in a national sample of black Americans. Results indicate that goal-striving stress is significantly related to lower levels of happiness, life satisfaction, self-esteem, and higher levels of psychological distress. We find that poverty status moderates the relationship between goal-striving stress and mental health. Compared to poorer persons, individuals above poverty with high goal-striving stress have significantly lower levels of happiness and life satisfaction. Overall, the findings provide a more complete context for understanding associations among socioeconomic status, goal-striving stress, and adverse mental health outcomes among black Americans.     

Measurement for a human science

This paper argues a number of points about measurement in the sociology of mental health: (1) measurement is critical, (2) measures should represent and assess elements of human experience, taking measure of life as people feel it, sense it, and understand it, and (3) social scientists should create a human science, producing information for the people it studies so that they can better understand and control their own lives. We argue that a human science is best achieved with the use of indexes, not diagnoses, to measure mental health. We present a brief history of diagnostic instruments and detail how a diagnosis is made. We show how use of diagnoses to measure mental health discounts much human suffering. They dichotomize the true range of feelings and emotions into crude either/or distinctions that do not reflect the reality of people's lives, and they often exclude suffering such as that due to loss or illness that does not meet medical model preconceptions about mental disorder. Using diagnoses to measure mental health presents a reified image of hidden disease knowable and manageable only by trained professionals--beyond the capacity of the suffering individuals to understand and control.     

Incorporating children's lives into a life course perspective on stress and mental health

Emerging themes in demography, developmental medicine, and psychiatry suggest that a comprehensive understanding of mental health across the life course requires that we incorporate the lives of children into our research. If we can learn more about the ways in which the stress process unfolds for children, we will gain important insights into the factors that influence initial set points of trajectories of mental health over the life course. This will simultaneously extend the scope of the stress process paradigm and elaborate the life course perspective on mental health. Incorporating children's lives into the sociology of mental health will also extend the intellectual influence of the discipline on sociomedical and biomedical research on mental illness. I contend that sociology's greatest promise in understanding trajectories of mental health across the life course lies in a systematic analysis of the social and social-psychological conditions of children, the stressful experiences that arise out of these conditions, and the processes that mediate and moderate the stress process in childhood. In this regard, there are three major issues that sociologists could begin to address: (1) the identification of structural and institutional factors that pattern children's exposure to stress; (2) the construction of a stress universe for children; and (3) the identification of key elements of the life course perspective that may set or alter trajectories of mental health in childhood and adolescence.     

“Being Grounded”: Benefits of Gardening for Older Adults in Low-Income Housing

This study reports the findings of a qualitative evaluation of gardening programs for low-income minority older adults living in senior housing. A total of 20 individuals from three senior housing buildings participated in focus groups to discuss the benefits of and motivations for community gardening. The nine main themes of why seniors choose to participate in gardening were mental health benefits, the end product (fruits and vegetables), continuation of a past life, something to do/responsibility, beauty and connection to growth, connecting with others, physical health, learning something new, and helping each other out. These findings are placed in the context of theoretical perspectives and past studies. Implications for policy and relevance to senior housing are offered.     

Minority Stress,Emotion Regulation,and the Parenting of Sexual-Minority Youth

ABSTRACT

Despite increasing societal acceptance of sexual-minority individuals, there are still gay, lesbian, and bisexual (GLB) adolescents who experience negative mental health outcomes. Minority stress theory posits that stigma-related stress associated with sexual-minority status drives increased risk among GLB individuals. Furthermore, recent evidence suggests that minority stress impacts emotion regulation (ER), identified as a particularly important risk factor for sexual-minority youth (SMY). Current research has identified some aspects of parenting contribute to GLB youth's mental health. We review the literature in these areas, and also integrate research from the broader developmental field on families and emotion socialization in order to identify the need for studies of parenting that go beyond existing data on parental acceptance and supportiveness of youth's sexual orientation. Limitations of the current literature and directions for future research are discussed, with specific focus on implications for interventions with SMY and their families.     

Issues in mental health care benefits: the costs of mental health parity

This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers. When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable. The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states--Rhode Island, Maine, and New Hampshire--apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA). A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical" preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals. All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits.     

Understanding Very Old Age: Looking Back and Thinking Forward

ABSTRACT

Understanding human development among the oldest old is a sequential building process taking into account building-block data, theories, and models from childhood, adulthood, and old age toward a new territory of oldest-old survivors who have lived way beyond the average life-span. A central question is whether the oldest-old survivors have developed specific survival techniques and/or protective environments that nurture survival. Or are the oldest old statistical outliers who by happenstance continue to survive further into old age? This commentary provides a historical framework on the papers in this series that describe challenges confronted by the oldest-old survivors in order to advance our understanding of survival of the oldest old. A clear understanding of the contributors to longevity could guide public policies toward well-being and life satisfaction among our oldest-old citizens.     

Chapter Four

Mental health professionals contribute in important ways to both the clinical and ethical issues raised by cases of elder mistreatment. Their clinical competencies contribute to improving quality of life by diminishing psychological suffering and the symptoms of mental illness. They are also used for managing the ethical issues raised by these cases. The ethics of mental health care are based on the values of beneficence, nonmaleficence, autonomy, and justice. The value of autonomy in mental health care gives priority to an individual's long-term ability to act as independently, rationally, and fully in all aspects of life as possible. The concepts of legal and clinical competence also aid in managing the ethical problems represented by cases of elder mistreatment. The ethical protocols of mental health professionals may be distinguished from some other disciplines by the premium given to long-term autonomy and by the aim of insuring treatment for all persons involved in cases of elder mistreatment, rather than limiting treatment responsibilities to the victim.     

The Social Process Behind Inequalities in Children's Mental Health: Incorporating an Illness Career Framework

More advantaged children (both in terms of social class and racial/ethnic membership) appear protected from symptoms of mental health problem, but a pattern has emerged in which these children who tend to have better mental health are more likely to be diagnosed with certain mental health disorders. These patterns have led some researchers and professionals to wonder if the qualifications for diagnosis are culturally biased or might unfairly favor the mental health needs of more advantaged individuals in society. Evidence that White and middle‐class children are more likely to be diagnosed with certain mental health disorders raises important and legitimate concerns about the mental health profession, but this problem of social advantage leading to mental health diagnosis has often overlooked the role of social process in how children become diagnosed. Mental health diagnoses represent the culmination of a process that involves several stages and requires initiation and (often times) persistence on the part of the individual being diagnosed. This idea of process has previously been referred to as the “illness career,” and applying this logic to the study of children opens the door for renewed inquiry into understanding who is and who is not diagnosed with a mental health problem.     

Mental health and the media: From illness to wellbeing

The media are a main source of information about mental health for many people, and an ever‐growing body of literature is evaluating their coverage of the topic. To help keep track of such research, several comprehensive but now dated literature reviews have been published. We assess more recent studies (2007–2017) and suggest future directions by integrating (a) the “circuit of mass communication” model from media and communication studies which posits that production, content, and reception need to be analysed for an in‐depth understanding of the media, (b) the holistic view of mental health as comprising both illness and wellbeing, and (3) the critical psychiatry literature questioning the assumptions underlying psychiatric knowledge and practice. We find that recent studies have focused on content and “the illness side” of mental health by examining the representation of particular mental disorders and events involving individuals with specific diagnoses. We identify as a promising development the growing interest in “the wellbeing side” of mental health whereby authors have started to analyse recovery messages. We invite more production and reception research and more critical content studies which use diagnostic labels cautiously and analyse the representation of people with mental health problems as the victims of violence.     

Self-rated quality of life among the young unemployed and the young in work in northern Sweden

This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (H?rnquist's QLcs) covering life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", for young people aged 18-24 in a population-based cross-sectional study in northern Sweden. Of these, 651 were unemployed and 2802 were in work (employed, students and in military service). Results showed that the young unemployed exhibited poorer QoL than the young in work and the greatest difference was found regarding their financial situation. Young men rated somatic health and mental well-being higher than young women. However, QoL in other essential domains was rated higher by young women in work. Close friends and money reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a worse financial situation, shorter education, and fewer leisure activities with other people. Finally, it was concluded that while QoL is poorer when in unemployment - both for the young and those who are older (aged 25-64) - psychological well-being, in contrast to several previous studies, is even poorer for young people than for those who are older. This is worrying in a public health perspective and could have implications for unemployment policies for younger and less well-educated age groups.     

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.     

Becoming married, depression, and alcohol problems among young adults

This paper examines three questions regarding the relationship between marriage and mental health, specifically depression and alcohol problems. First, does marriage lead to improved mental health compared to never marrying? Second, do any mental health benefits of marriage primarily accrue to men? Third, what qualitative aspects of marriage are related to psychological disorder? We explore these questions in a longitudinal sample of young adults sampled at age 21 and again at age 24. We find no indication that marriage reduces depression. Married people do report fewer alcohol problems than the never-married but this could be due to the selection of less problematic drinkers into marriage. We also fail to find that men receive disproportionate mental health benefits from marriage. Finally, we find that marital conflict is associated with problem drinking for men and depression for women. The results indicate the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health.     

Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

Assessment for and response to adverse childhood experiences

Literature strongly suggests that early exposure to adverse childhood experiences (ACEs) disrupts crucial normal stages of childhood development and predisposes these individuals to subsequent psychiatric sequelae. Even with these data, little is found in nursing literature that discusses ACEs and their impact on adult mental health. Therefore, the purpose of this article is to address how nurses approach communication with clients about and assess for traumatic life experiences. In addition, screening measures for ACEs will be presented, along with discussion about ethical responsibilities of health professionals and researchers in asking about abuse.     

Violent behavior: a measure of emotional upset?

Over the past ten years, sociologists have broadened their view of what counts as an appropriate measure of mental health. This reflects a growing recognition that individuals express emotional upset in various ways. For example, some individuals are more likely to become depressed in response to stress while others are more likely to drink heavily. Contemporary studies often include measures of "internalizing" (i.e., more feeling-based measures) and "externalizing" (i.e., more behavioral measures) styles of psychopathology, especially when studying group differences in mental health. Alcohol abuse is the classic measure of externalized distress in sociological research. In this paper, we present a theoretical argument and supporting empirical evidence to argue that violent behavior should be included as a measure of externalized distress in response to stress. Our study suggests that violent behavior is a more likely response to stress among individuals with particular coping and appraisal tendencies. Specifically, violent behavior may be a more likely response to stress among individuals who tend to appraise situations as threatening while also repressing any emotional response to stress. We contend that, since some groups may be more likely than others to respond to stress with violence, it is particularly important to include measures of violent behavior when studying group difference in distress.