Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

Depressed College Students and Tricyclic Antldepressant Therapy

Abstract

Charts of all outpatients (n = 267) seen during three consecutive months of 1977 by a university student mental health clinic were retrospectively reviewed for reports of depression. Over one-fourth of university students (n = 76) seen during this period were noted to present with significant symptoms and signs of depression. Charts of depressed patients were further analyzed for distribution by final diagnostic category, demographic data, and treatment outcome results. The majority of depressed patients were diagnosed as depressive neurosis while the second most common diagnosis was adjustment reaction. A significant proportion of patients with a final diagnosis of depressive neurosis had initially been diagnosed as adjustment reaction. Vegetative signs of depression were Infrequently noted In patients with adjustment reaction. These patients were usually treated with psychotherapy alone and showed symptomatic Improvement in one-half of cases. Vegetative signs, especially sleep disturbance, were noted in one-half of patients with depressive neurosis. These patients were often treated with tricyclic antidepressants plus psychotherapy, which resulted in significantly greater Improvement in both dysphoria and vegetative signs than treatment with psychotherapy only. Treatment outcomes for depressed patients thought to have concomitant character disorders were uniformly poor.

Thus, depressed college students In the present study represented several distinct diagnostic groups, of which patients with depressive neurosis showed optimal treatment outcomes following tricyclic antidepressant therapy.     

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.     

The Efficacy of Internal Family Systems Therapy in the Treatment of Depression Among Female College Students: A Pilot Study

College women are vulnerable to depression due to developmental and transitional life changes. Early diagnosis and effective treatment is critically important. Empirical support exists for the effectiveness of select treatment options (i.e., antidepressant medication, cognitive‐behavioral therapy [CBT], and interpersonal psychotherapy [IPT]), yet a significant percentage of those treated do not benefit. In this pilot study, Internal Family Systems (IFS) therapy was tested as an alternative approach. College women (N = 37) were randomly allocated to IFS treatment or treatment as usual (CBT or IPT). Results demonstrated a decline in depressive symptoms for both conditions and no significant differences in the magnitude or rate of change. The results provide preliminary evidence for the efficacy of IFS in the treatment of depressive symptoms.     

Violence and trauma: predicting the impact on the well-being of African American women with severe mental illness

Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative nonsignificant relationship was found between Posttraumatic Diagnostic Scale (PDS) and wellbeing. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.     

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

Abstract

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between January and April 2006. Methods: A standardized 2-tiered screening approach for an inception cohort of students utilizing primary services. Primary care providers were trained to triage students with depressive symptoms. Results: Six percent of participants had clinically significant depressive symptoms (CSD). Severe depressive symptoms were found in less than 1.0% of participants. Male rates of severe depressive symptoms were more than double that of females. Only 35.7% of untreated depressed participants started treatment within 30 days following identification. Conclusions: Systematic primary care depression screening in a college health center is a promising approach to identify untreated students with depression. More study is needed to improve rates of treatment engagement.     

Caregivers as Comptrollers

The emphasis on cost containment that was the hallmark of the Reagan Administration and the shining of the burden for long-term care onto the informal sector have had a particularly negative impact on women. Women through caregiving are used to help control the public cost of long-term care. This unwritten policy is unlikely to be successful because of a number of factors: (1) the economic condition of women; (2) the lack of available and affordable community services; and (3) the types of social relationships we now have.     

Caregivers as comptrollers: women and long-term care and cost containment

The emphasis on cost containment that was the hallmark of the Reagan Administration and the shifting of the burden for long-term care onto the informal sector have had a particularly negative impact on women. Women through caregiving are used to help control the public cost of long-term care. This unwritten policy is unlikely to be successful because of a number of factors: (1) the economic condition of women; (2) the lack of available and affordable community services; and (3) the types of social relationships we now have.     

Between Endless Needs and Limited Resources: The Gendered Construction of a Greedy Organization

One of the strategies of the modernization of public services is the decentralization of responsibilities and organizing work in autonomous co‐ operative teams with varied tasks. The empowerment of the public service workers in the front line is therefore a strategy in local government in Norway today. Under the assumption that women have ‘natural’ skills in caring, workers on the lowest levels are given responsibility for care and nursing. A study of the decentralization of public care for the elderly in their homes showed that being given interesting tasks and increased responsibility mobilized the efforts of the care workers. However, since the power of resources has been centralized, this has led to an intensification of work. In gendering the relevant discourses by explaining women's experiences of an over‐heavy workload as a result of their ‘mothering’ and their inability to set limits, women care workers were constructed by their managers as unprofessional and not to be taken seriously. This has made the public care organization a greedy organization for the women care workers.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

The state and future of social service enterprises—a Finnish case

There has been a rapid increase in private social services in Finland, where the tradition of social care services has placed the main emphasis on public services. The aim of this article is to compare the situation of Finnish social service enterprises in 2001 and 2005/2006, in the light of two national surveys, in order to increase knowledge about the state and the future of such enterprises as providers of social care. Particular attention is paid to the profiles of men and women as entrepreneurs, as these differed somewhat. The composition of private care enterprises and their management remained fairly similar between 2001 and 2005/2006. Most of the enterprises were owned by middle-aged women with an extensive experience of social and health care. The owners of the older enterprises were more pessimistic about the future than the owners of the more recently-established firms. Social workers have not been active in setting up firms, but the public–private processes should be steered and evaluated from the social work perspective, too, because they are actors who have a relevant part to play in the long-term co-operation and development work of public and private social services.     

Development of a Short-Form Scale of Public Attitudes Toward Homelessness

Nationwide, demographic changes have led to an increased awareness of the impact of cultural diversity on the delivery of medical and psychological care. Due to the over-representation of minority and socially stigmatized groups among those affected by HIV, understanding the effects of psychosocial, linguistic and cultural membership or treatment relationships is crucial. In the psychological treatment of HIV-infected patients, psychotherapists can enhance the lives of their patients and support their involvement and compliance with medical treatment planning Case studies are presented in which psychotherapy helped resolve difficulties in the medical care of three HIV-positive women that were due to cultural misunderstanding between doctors and patients.     

Ethnicity and psychotherapy with HIV-infected patients: Three case studies

Nationwide, demographic changes have led to an increased awareness of the impact of cultural diversity on the delivery of medical and psychological care . Due to the over-representation of minority and socially stigmatized groups among those affected by HIV, understanding the effects of psychosocial, linguistic and cultural membership on treatment relationships is crucial. In the psychological treatment of HIV-infected patients, psychotherapists can enhance the lives of their patients and support their involvement and compliance with medical treatment planning. Case studies are presented in which psychotherapy helped resolve difficulties in the medical care of three HIV-positive women that were due to cultural misunderstanding between doctors and patients.     

Record keeping practices: Consequences of accounting demands in a public clinic

This observational study explores the tensions and negative consequences of record construction for patients and front-line staff in a public clinic providing services to poor women and children. For emphasis, it is possible to say that the routine of the clinic is record driven, not service driven. More is accomplished in clinic work than producing records; patients certainly do receive needed health care. However, tight regulations filtered through heavy paperwork requirements stifle the effective delivery of comprehensive, flexible services especially needed by disadvantaged families. Clinic staff may be motivated to attend to individual patient concerns, but accounting demands generally circumscribe their work and create barriers for patients. The record has a life of its own as a socially constructed artifact in the process of caregiving in bureaucratic settings, where actual services often respond not to the client, but to the countable, accountable mandates of management.     

I don't know who I am: severely mental ill Latina WSW navigating differentness

We examine interviews from a qualitative study designed to examine HIV perceptions, risk, and risk management among Puerto Rican women who have sex with women (WSW) and who also have been diagnosed with major depression, bipolar disorder, or schizophrenia. These women's stories challenge both the lesbian and the Latino communities to reexamine how and why they claim individuals as their own and they similarly challenge professional communities, including HIV educators, health researchers, and medical care providers, to develop effective HIV prevention programs and counseling approaches that facilitate patient/client self-disclosure and consider cultural and contextual barriers to both self-disclosure and the provision of services.     

Racial/Ethnic Differences in Court Referred Pathways to Mental Health Services for Children in Foster Care

Racial/Ethnic disparity in placement patterns and service utilization among children in foster care has been documented in a variety of studies. This study examined the role of the court process in referring children in foster care to mental health services and tested for racial/ethnic differences in the patterns of referral and service use. Court records for 142 children ages 2–16, representing Caucasian, African American, and Hispanic racial/ethnic groups were reviewed. Results indicate that the court process does play a significant role in referring children to services. Significant differences by race and ethnicity in mental health service utilization prior to the child's protective placement, as well as service orders, and post-placement service use were identified. Caucasian youth were more likely to receive orders for psychotherapy and to have documented use of psychotherapy than were African American and Hispanic youth, even when the possible confounding effects of age and type of maltreatment were controlled. Implications for the effective delivery of supportive services to those children most in need are discussed.     

DEPRESSION, BIOLOGY, MARRIAGE AND MARITAL THERAPY

Marital therapists have an, as yet, unrecognized contribution to make to the treatment of depression. It is incumbent upon them to keep abreast of the growing literatures concerning both biological and interpersonal aspects of depression, and to inform other mental health professionals, policy makers, and depressed persons and their families as to what marital therapy has to offer. Consistent with this goal, this article provides an introductory overview of recent findings concerning the biology of depression, the relative merits of medication versus psychotherapy, and the complex relationships between marriage and depression. While there is considerable evidence that many depressions have a biological component and that medication is an efficacious way of providing symptomatic relief, this in no way contradicts findings concerning the efficacy of psychotherapy and the importance of the marital relationship in the outcome of a depressive episode.     

Closing the Need-Service Gap: Gender Differences in Matching Services to Client Needs in Comprehensive Substance Abuse Treatment

Despite the broad recognition in social work that services are more effective when they are tailored to individual client needs, we have only limited evidence of the impact that services matched to client needs have on treatment outcomes. This study examines gender differences in the impact of matched services, access services, and outcome-targeted services on substance abuse treatment outcomes by using data collected from 1992 through 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and clients. The analytic sample consists of 3,027 clients (1,105 women and 1,922 men) who reported needed services from 59 treatment facilities. Findings from the study indicate that overall programs have only limited success in targeting services to client needs, but when they do, receipt of substance abuse counseling and matched services predicts both remaining in treatment and reduced posttreatment substance use for both women and men, but especially for women.     

A Pilot for Improving Depression Care on College Campuses: Results of the College Breakthrough Series–Depression (CBS-D) Project

Abstract

Objective: To implement a pilot quality improvement project for depression identification and treatment in college health. Participants: Eight college health center teams composed primarily of primary care and counseling service directors and clinicians. Methods: Chronic (Collaborative) Care Model (CCM) used with standardized screening to identify, treat, and track depressed students for 12 weeks to monitor predetermined process and clinical outcomes. Results: Of all students receiving primary medical care services between January 2007 and May 2008, 69% (n = 71,908) were screened for depression. A total of 801 depressed students were treated and tracked; most predetermined treatment process and clinical outcome targets were achieved. Conclusion: The CCM for depression shows promise for improving depression identification and care for college students.