Migration and mental health: an empirical test of depression risk factors among immigrant Mexican women

Empirical research in the field of migration and mental health is rare and its recent appearance follows decades of inconsistent reports in the research literature about the risks posed by numerous precipitating and predisposing factors. This article has 2 goals: 1) to summarize critically selected issues and methodological problems regarding mental health implications of migration-adaptation, and, 2) to test empirically hypotheses derived from the Fabrega Migration Adaptation Model to determine whether they have predictive value for depressive symptomatology in a cross-sectional sample of Mexican immigrant women in San Diego county. Findings from bivariate analyses indicate most of the model's factors were significantly related to depressive symptoms. Multivariate analyses identified 1) demographic factors (education-income), 2) perceived economic opportunity, 3) perceived distance between the 2 centers involved in the migration, and 4) loss of interpersonal ties in Mexico as the most parsimonious subset of depression indicators within the model. Implications are discussed.     

Meeting the mental health needs of elderly clients

1. Older individuals in both community and institutional settings have traditionally underused mental health services. Providers of such care devote a minimum of their professional time to those over 65 years of age. 2. Ageism and difficulty with diagnosis are the most frequent explanations for inadequate mental health care to the elderly. This study found that lack of referrals and failure of the aged to seek services partially accounted for underuse. 3. Legislative changes mandating that aged persons be screened for and receive appropriate mental health services will increase the demand for qualified providers. 4. Nursing's approach to care of the older adult, which focuses on both physiological and psychological needs, can facilitate the delivery of comprehensive effective mental health interventions in and out of the institutional setting.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

Student mental health needs: survey results and implications for service.

In preparation for planning counseling and mental health services at Columbia University, the authors conducted a mental health needs assessment survey that sampled representative numbers of students. Respondents were most concerned about academic and school-related issues, followed by concerns in the area of love relationships. Multiple regression analysis revealed certain subgroups that were more likely to have these concerns and certain health and mental health problems that were significantly associated with these concerns. The study identified serious psychological problems, including suicidal/homicidal thoughts and sexual abuse, and surveyed respondents' treatment preferences. Finally, the authors discuss how the study findings contributed to sharpening and expanding focus on different aspects of program development in the collaboration between mental health and health education.     

Analyzing mental health evaluation: moral and ethical dimensions

Now that evaluators have been sensitized to the importance of moral and ethical issues in their work, it is time to move beyond generalities and examine the moral and ethical implications of specific evaluation models in specific settings. This paper proposes a framework that can be used to examine moral and ethical dimensions of evaluation and illustrates it by analyzing a selected model of mental health evaluation. Such a systematic identification of moral issues can improve evaluation practice both proactively, by shaping the training of evaluators, and retrospectively, by contributing to meta-evaluation.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.     

Meeting the mental health needs of the aging veteran population

The growth in the veterans population parallels the graying of America, accompanied by an increasing need for health care and mental health services from the U.S. Department of Veterans Affairs (VA) health care system. With the incidence of posttraumatic stress disorder (PTSD) rising in veterans of the wars in Iraq and Afghanistan and the already strained mental health resources in use by veterans with persistent PTSD from previous wars, the VA mental health system is and will continue to be in overload. In addition, recent research has noted an increased incidence of dementia in veterans with PTSD. The VA's long-term care facilities cannot meet their current demands, nevermind provide support for veterans with cognitive deficits who can no longer be cared for at home. It is imperative that immediate measures be taken to strengthen resources for research, manpower, and training to accommodate the future mental health needs of our aging veterans.     

The validity of assessing mental health needs with social indicators.

Selection of the appropriate number and types of social indicators for use in mental health planning has been a perennial problem. Social indicators have been associated with several concepts (quality of life, community disorganization, populations at risk) of varying relevance for planning mental health services, and abstracting social indicators from these conceptual domains poses a variety of validity issues. The issues are discussed, and the viability of social indicators in mental health planning is reexamined.     

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.     

Creation and evaluation of a maternal mental health course

Perinatal Mood and Anxiety Disorders (PMADs) engender significant and increasing personal, social, developmental, and economic burdens to women, children, families, and global public health. In the US, a Master of Social Work (MSW) elective course, Introduction to Maternal Mental Health, was created to prepare future social workers to better understand, detect, intervene, and advocate with women struggling with perinatal mental health concerns. A pilot study used pre–post-surveys (N = 10) and a focus group to examine students’ knowledge acquisition, course satisfaction, and perceived self-efficacy. A Wilcoxon signed-rank test showed a statistically significant difference between pre- and post-survey course content knowledge scores. Positive focus group feedback and survey outcomes suggest that students benefitted from the course in terms of increased learning and professional efficacy in maternal mental health; however, the study should be replicated using a larger sample and comparison group. The course outline provided may be used to develop a similar course or to infuse maternal mental health content into existing courses. The paper concludes with implications and recommendations for social work educators.     

Comprehensive behavioral medicine in community mental health. A needs assessment that needs assessment.

It is suggested that the massive costs incurred nationally in health care are in large part a fitting concern of Community Mental Health (CMH). There is considerable data available to suggest that as much as half of the variance in common health disorders is associated with behavioral factors. There is a rapidly growing movement to provide interventions geared toward these behavioral components in health disorders, but much of this has occurred outside of the traditional mental health environment. There are arguments to suggest that CMH should be more involved in the development of comprehensive behavioral medicine services, both in terms of the expertise and resources that it can bring to bear upon these problems, and its potential to reach segments of the population which are otherwise likely to be underserved, if served at all. Implications for CMH planning and financing are discussed, drawing upon a selective literature review and clinical illustrations.     

Community health needs, community participation, and evaluation research

The values which underlie a social program, and the ways in which they are realized in the program itself, are often left unspecified by the program planners. Two procedures to give practical effect to social values in a community health project are discussed in this paper: careful and systematic assessment of need; and community participation and involvement.     

Complexity of process and role in the evaluation of an interdisciplinary mental health education program: The deacon's masterpiece

Research and literature on program evaluation must attend to problems of application, which can have major effect on the outcome. Increasing numbers of innovative, multifaceted programs operating in complex settings are presenting for evaluation. Evaluation process must become flexible, creative, and multifaceted in order to produce valid and comprehensive results, and to meet the needs of this field. Evaluators and evaluation, the evaluated program, and the environment become a mutually interacting system in the process of evaluation. Evaluation goals and roles must be conceptualized, agreed upon, sanctioned, and appropriately implemented or conflict and ineffectiveness will result. Three models of evaluation emerge: objective and independent, objective but serving one interest, and pseudo-scientific public relations. Evaluation of an interdisciplinary mental health education program illustrates these issues. Evaluation technology, process, and roles must all be attended to or the weak link undermines the rest.     

Longitudinal trends in substance use and mental health service needs in child welfare

Caregiver substance use and mental health problems have long been discussed as concerns in promoting positive child welfare outcomes. Yet the absence of longitudinal data focused on racial/ethnic differences in service needs and substance use has limited child welfare systems in their ability to address potential disparities. This study examines racial/ethnic trends in service needs and patterns of substances used among child welfare-involved caregivers over a 15-year period (2000–2015) from a large, urban county located in the Midwestern United States. Substance use service needs showed an increase over time among White non-Hispanic individuals, and declined over time for all racial/ethnic minority groups. Mental health service needs increased over time, with White non-Hispanic individuals experiencing the largest increase. Co-occurring service needs showed a moderate increase for all groups. Trends associated with service needs across the lifespan were relatively similar across racial and ethnic groups, with needs peaking between ages 30 and 35. When examining specific substances used, cocaine use decreased over time for all individuals. However, marijuana use increased substantially for Black/African American individuals, while opioid use increased substantially for White non-Hispanic individuals. These results highlight key areas where trends among child welfare-involved caregivers differ from population-based trends and suggest that improved coordination between child welfare agencies, mental health and substance use treatment providers may be a key step in reducing the disparities observed.     

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses

This article presents the findings of a small pilot study which examined the needs of 13 mothers with severe mental health problems whose children were involved in the child protection system. The use of the diagnosis of ‘personality disorder’ in relation to this group of women is discussed and the finding that all these women had experience of domestic violence is considered in the context of other research findings. The extent to which child protection social workers and mental health professionals worked together on these cases was explored and only limited evidence of good communication and collaboration was found. The need for effective inter‐professional and inter‐agency coordination is argued, but differing conceptions of maternal mental health problems and their relationship to children's needs may make for difficulties in professional communication and decision‐making. The article seeks to identify the differing approaches to maternal mental health problems which appear to be developing out of different groups of research studies and argues that practitioners need to be explicit in identifying their perspectives on the associated issues of maternal mental health problems and child protection. Copyright © 1999 John Wiley & Sons, Ltd.     

Similarities and differences between mental health and health care evaluation studies assessing consumer satisfaction

This paper compares the literatures assessing consumer satisfaction with health care and mental health treatment. Similarities and differences in the quantity, origins, quality, methodology, results, and utilization of findings are examined. The similarities identified far outweigh the differences. The trend toward carefully constructed high quality studies in the health care field is seen as suggesting a promising direction for future research.     

The health needs of elders within an intentional community

A small-scale survey was carried out on the health needs of those members of the Findhorn Bay Community, in northeast Scotland, who were over the age of 60. The survey asked questions about their health, quality of life, support received and perceived needs in these areas. The responses of the elders are summarised and discussed. Most of the elders had health conditions which affected their quality of life, yet almost all were satisfied with the support they received and over half with their quality of life. Implications for the links between community, family, work and perceived health were identified. Une recherche a ete faite sur les besoins en sante des personnes ages de plus de 60 ans qui vivent dans la communaute de Findhorn Bay dans le nord est d'Ecosse. Il y avait un questionnaire qui leur demandait des informations sur leur sante, et qualite de vie; il leur etait aussi demande si ils se sentaient suffisamment soutenus et comment ils percevaient les differents besoins de leur vie. Les responses de les personnes sont brievement evoquees et discutees. Les implications concernant les rapports entre communaute, famille, travail et sante furent identifiees. La plupart d'entre eux avait des problemes de sante qui affectaient leur qualite de vie, cependant la majorite etait satisfaite du soutien recu, et plus de la moitie avec leur qualite de vie.