Rethinking a universal framework in the psychiatric symptom-disorder relationship

Research on disparities in health and services should include a critical examination of how social, cultural, and contextual factors affect the connection between symptoms and psychiatric disorders. Systematic differences in this connection by these factors will mean that clinicians using a universalist approach to disorders may make more diagnostic errors for certain patients (e.g., ethnic minorities, the poor). Based on the literature on normative clinical decision-making, this study tests for whether the effect of specific psychiatric disorders on key symptoms is the same for certain groups of the population. The data come from the National Comorbidity Survey. Conditional probabilities of disorders and symptoms, the elements feeding into clinical decision-making, are calculated and tested for equivalence across various racial/ethnic, educational, income, and gender groups. We find some significant differences in the relation of key symptoms to disorders across groups. These findings should encourage testing relativistic frameworks in diagnostic nosology as a step to improve clinical decision-making and reduce diagnostic and treatment disparities in mental health services.     

Paying to improve your chances: Gambling or insurance?

Will a more risk-averse individual spend more or less to improve probabilities, say on marketing efforts that enhance the chance of a sale? For any two payoffs and starting probabilities, the answer is unfortunately indeterminate. However, interpreting gambling as increasing small chances of good outcomes and insurance as reducing small chances of bad outcomes, the more risk-averse individual will pay less (more) to gamble (insure). We find a critical switching probability that depends on the individuals and outcomes involved. If the good outcome is less (more) likely than this critical value, the expenditures represent gambling (insurance).     

Evidence-based Medicine and Child Mental Health Services

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.     

An agenda for future research regarding the mental health of young people with care experience

Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.     

The embodiment of complex trauma in domestic minor sex trafficking victims and the dangers of misidentification

ABSTRACT

Domestic minor sex trafficking (DMST) victims face many barriers to getting appropriate, trauma-informed treatment. Many of these victims experience childhood trauma by trusted adults or by non-familial perpetrators of abuse. Complex trauma, later defined in depth, captures what many DMST victims endure as the harm that they experience is ongoing and cannot be identified as a singular event. Due to the complex trauma these victims experience, they become dissociated as a tool for survival. As a result of trauma, many DMST victims do not embody protective skills, and attempt to gain control of their lives through maladaptive behaviors that can lead to re-victimization. I begin by discussing the literature around embodiment, trauma and the body, and dissociation to demonstrate why a trauma-informed approach in identification and therapy is important when working with DMST victims. Subsequently, I present a case study to explore an example of how the presentation of trauma, or ways it is masked, can lead to misidentification. This case study will illustrate how social workers can effectively advocate for DMST victims at the early stages of identification and also foster a safe, accepting therapeutic space to assist these clients in trust-building and identify formation. Trauma-informed care needs to be integrated from the first interaction with law enforcement, throughout the development of a treatment plan with providers, and for the duration of the therapeutic relationship.     

Race,Gender, and Social Support: A Study of Networks in a Financial Services Organization

A wealth of research indicates that social support improves employees' well-being and job performance. What is not well understood is how employees' race and gender influence the receipt of this type of support. I analyze qualitative and quantitative data to understand how race and gender influence the social support that workers receive. The results suggest that neither structural nor relational factors explain why blacks receive social support from fewer network members than whites. There is some evidence that relational factors contribute to gender differences in the receipt of social support, however. Interviews with workers suggest that gender schemata, the sex-typing of networks, reactions to racial discrimination, and differences in the value placed on social support contribute to race and gender differences in social support.     

Managers' personal values as predictors of importance attached to training and development: a cross-country exploratory study

Few empirical studies have examined the effect of personal values on the importance attached by individuals to training and development in organizations. We argue that personal values play an important role in decision-making processes (i.e. commitment to training and development) and that such values are the product of socialization processes operating at an organizational and societal level. Questionnaire data were collected from 340 Irish and Canadian line managers to test the hypothesis that personal values affect the importance attached by respondents to training and development. Capability values were found to be a significant positive predictor of the perceived importance of training and development. The findings emphasize the need for simultaneously examining both personal values and organizational factors as predictors of training and development activity.     

Corporate Political Activity: A Literature Review and Research Agenda

This paper reviews the diverse literature on corporate political activity (CPA) and develops a framework that details and integrates existing research in this field. A systematic analysis of extant CPA literatures is conducted to order them into domains that have implications for organizational performance. The paper is structured into three such domain emphases, which require further research investigation: resources and capabilities focus; institutional focus; and political environment focus. The contribution of each to an understanding of CPA in pursuit or defence of corporate competitive advantage is discussed. The authors also suggest that the internationalization of business, including the more recent emergence of developing country economies and companies, presents scholars with the challenge of understanding CPA in more varied institutional settings. CPA practices continue to expand as commerce goes increasingly global and, consequently, involves a wider array of political actors and institutions. The paper contributes by increasing the clarity of CPA classification, reflecting on the implications of a multi‐polar world for CPA research and advancing future agendas for scholars in this research community.