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The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort
- Authors:
- KENNY Patricia, KING Madeleine T., HALL Jane
- Journal article citation:
- Health and Social Care in the Community, 22(6), 2014, pp.646-659.
- Publisher:
- Wiley
Informal carers represent a substantial proportion of the population in many countries and health is an important factor in their capacity to continue care-giving. This study investigated the impact of care-giving on the mental and physical health of informal carers, taking account of contextual factors, including family and work. The authors examined health changes from before care-giving commenced to 2 and 4 years after, using longitudinal data from the Household Income and Labour Dynamics in Australia survey. The sample comprised 424 carers and 424 propensity score-matched non-carers. Health was self-assessed, measured with the SF-36 Health Survey Mental Health (MH) and Physical Functioning (PF) scales. Care-giving was classified as non-carer, low (<5 hours/week), moderate (5–19 hours/week) and high (20 or more hours/week). PF and MH change scores were regressed on baseline scores, care-giving, covariates (including work, family and socio-demographic characteristics) and interactions to identify impacts for subgroups. The physical and mental health impacts differed by gender, and care-giving hours and carer work hours were important contextual factors. Deterioration in both PF and MH was worse for females after 2 years and deterioration in MH was worse for males after 4 years. Among carers aged 40–64 years, there was a 17-point decline in PF (P = 0.009) and a 14-point decline in MH (P < 0.0001) after 2 years for female high caregivers working full-time and 9.3 point improvement (P = 0.02) for non-working male high caregivers. Change was not significant for non-carers. The study found that not all carers suffer adverse health impacts; however, the combination of high levels of care-giving with workforce participation can increase the risk of negative physical and mental health effects (particularly in female carers). Working carers providing high levels of care represent a vulnerable subgroup where supportive and preventive services might be focused. (Publisher abstract)
Increasing military social work knowledge: an evaluation of learning outcomes
- Authors:
- FORGEY Mary Ann, YOUNG Sharon L.
- Journal article citation:
- Health and Social Work, 39(1), 2014, pp.7-15.
- Publisher:
- Oxford University Press
Service members and veterans face a myriad of health, mental health, and social challenges stemming from the combat and operational stressors experienced during deployment and the challenges of reintegration to civilian life. To intervene effectively with this population, social workers must be knowledgeable about these issues and the cultural context within which they occur. Although schools of social work across the country are developing course work in military social work, little is known about the learning outcomes of these courses. This article describes a military social work course that was developed to increase student preparedness to work with a military or veteran population and the learning outcomes achieved. Using a quasi-experimental pre–post design, this study compared the learning outcomes of students enrolled in the course with a group of students who had not taken the course. To measure this knowledge, the authors developed a 50-item Military Social Work Knowledge Scale for the study. Significant differences between pre- and posttest scores were found for the social work students enrolled in the course. Specific areas of knowledge that increased for the class participants included knowledge about cultural sensitivity to military populations and knowledge about service and advocacy frameworks. (Publisher abstract)
Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study
- Journal article citation:
- British Journal of Psychiatry, 205(6), 2014, pp.473-477.
- Publisher:
- Cambridge University Press
Background: In the UK and other high-income countries, life expectancy in people with schizophrenia is 20% lower than in the general population. Aims: To examine the quality of assessment and treatment of physical health problems in people with schizophrenia. Method: Retrospective audit of records of people with schizophrenia or schizoaffective disorder aged ≥18. We collected data on nine key aspects of physical health for 5091 patients and combined these with a cross-sectional patient survey. Results: Body mass index was recorded in 2599 (51.1%) patients during the previous 12 months and 1102 (21.6%) had evidence of assessment of all nine key measures. Among those with high blood sugar, there was recorded evidence of 53.5% receiving an appropriate intervention. Among those with dyslipidaemia, this was 19.9%. Despite this, most patients reported that they were satisfied with the physical healthcare they received. Conclusions: Assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards. Cooperation and communication between primary and secondary care services needs to improve if premature mortality in this group is to be reduced. (Publisher abstract)
Avoiding delays in diagnosis: the importance of proactive liaison and education of staff in the general hospital
- Authors:
- WALDER Anna, GREEN Robert, SONI Sujata
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(6), 2014, pp.399-402.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to illustrate the difficulties patients with intellectual disabilities face when they present to a general hospital with ambiguous symptoms and highlights the importance of adequate training for general staff in caring for people with learning disabilities. Design/methodology/approach: The authors describe the pathway of a person with a learning disability and mental health problems from A&E, through a general hospital, to discharge and the problems encountered in terms of diagnostic clarity and subsequent treatment. Findings: Delay in recognising a psychiatric cause for his symptoms and wrongly attributing his symptoms to his learning disability may have led to a protracted admission and invasive tests. Originality/value: Education of healthcare professionals and proactive liaison work can help improve outcomes for people with intellectual disabilities when they are admitted to generic services. (Publisher abstract)
Fit for purpose: transforming employment support for disabled people and those with health conditions
- Authors:
- PURVIS Ann, et al
- Publisher:
- Centre for Economic and Social Inclusion
- Publication year:
- 2014
- Pagination:
- 87
- Place of publication:
- London
This report sets out how the employment support system can be transformed to create a system that offers employment opportunity for all, including disabled people and those with health conditions – with the right support to prepare for and take up work. The report, which includes twenty case studies, describes the current and recent landscape of employment support for disabled people and those with health conditions, exploring both mainstream and specialist support with a primary focus on provision funded by DWP. It then describes ‘what works’ in supporting disabled people and those with health conditions both to find and maintain employment. It also set out the evidence on what works for particular groups, such as those with mental health conditions, alongside case studies of more recent practices and innovations. It then reflects on lessons on how support is designed and commissioned – including the use of ‘payment by results’, personal budgets, and how organisations work together in partnership. The report makes a number of practical recommendations, calling for a new national framework for employment support, a new common process for assessing individuals’ needs, joint working between national and local partners, and a greater focus on quality of service and quality management, not just on employment outcomes. (Edited publisher abstract)
The relationship between adult health and childhood maltreatment, as moderated by anger and ethnic background
- Authors:
- RAPOZA Kimberly A., et al
- Journal article citation:
- Child Abuse and Neglect, 38(3), 2014, pp.445-456.
- Publisher:
- Elsevier
Childhood maltreatment, anger, and racial/ethnic background were examined in relation to physical health, psychological well-being, and blood pressure outcomes. This study used data from a diverse sample of African American, Latino, and Caucasian participants (N = 198). Results from a series of multiple regressions indicated anger and total childhood maltreatment were robust predictors of poorer health. Although correlational analyses found maltreatment from the mother and father were associated with poorer health outcomes, when considered as part of the regression models, only a relationship between maltreatment from the mother and physical health was found. Greater anger scores were linked with lower blood pressure, particularly systolic blood pressure. Generally, more psychological and physical symptom reporting was found with greater anger scores, and higher levels of total maltreatment also predicted physical symptoms. The pattern of interactions indicated anger was more detrimental for African American participant's (and marginally so for Latino participant's) physical health. Interestingly, interactions also indicated total childhood maltreatment was related to fewer symptoms for Latino participants. Although child maltreatment may be viewed as a moral and/or human rights issue, this study provides evidence that it can also be viewed as a public health issue. Our study demonstrated that known health risk factors such as anger and maltreatment may operate in a different pattern dependent on ethnic/cultural background. The findings suggest health and health disparities research would benefit from greater exploration of the differential impact of certain moderating variables based on racial/ethnic background. (Publisher abstract)
Transgender women of color: discrimination and depression symptoms
- Authors:
- JEFFERSON Kevin, NEILANDS Torsten B., SEVELIUS Jae
- Journal article citation:
- Ethnicity and Inequalities in Health and Social Care, 6(4), 2014, pp.121-136.
- Publisher:
- Emerald
Purpose: Trans women of colour contend with multiple marginalisations; the purpose of this study is to examine associations between experiencing discriminatory (racist/transphobic) events and depression symptoms. It uses a categorical measure of combined discrimination, and examines a protective association of transgender identity on depression symptoms. Design/methodology/approach: Data from a subset of trans women of color participants in the Sheroes study were analysed with linear and logistic regression. Associations of depression symptoms with racist and transphobic events, combined discrimination, coping self-efficacy, and transgender identity were assessed with odds ratios. Findings: Exposure to discriminatory events and combined discrimination positively associated with depression symptom odds. Increased transgender identity associated with increased coping self-efficacy, which negatively associated with depression symptom odds. Research limitations/implications: Cross-sectional study data prohibits inferring causality; results support conducting longitudinal research on discrimination's health effects, and research on transgender identity. Results also support operationalising intersectionality in health research. The study's categorical approach to combined discrimination may be replicable in studies with hard to reach populations and small sample sizes. Practical implications: Health programmes could pursue psychosocial interventions and anti-discrimination campaigns. Interventions might advocate increasing participants’ coping self-efficacy while providing space to explore and develop social identity. Social implications: There is a need for policy and health programmes to centre trans women of color concerns. Originality/value: This study examines combined discrimination and identity in relation to depression symptoms among trans women of colour, an underserved population. (Edited publisher abstract)
Interrelationship of PTSD, perceived health, and treatment satisfaction
- Author:
- ASTONE-TWERELL Janetta
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 35(1), 2014, pp.21-34.
- Publisher:
- Emerald
Purpose: The residential therapeutic community (TC) treatment modality has been shown to effectively reduce drug use and improve psychiatric/medical health among clients who are often disproportionately impacted by medical conditions and have a co-occurring psychiatric disorder such as Posttraumatic Stress Disorder (PTSD). Yet not much is known regarding how clients’ health may impact their treatment satisfaction. Using path analysis, the interrelationship between PTSD, perceived health, and treatment satisfaction was examined. The paper aims to discuss these issues. Design/methodology/approach – A survey including the Posttraumatic Stress Disorder Checklist-Specific (PCL-S), a perceived health rating, and a Treatment Satisfaction Scale was collected from 303 clients at three comparable long-term residential TC treatment programmes in New York City. Findings: Findings indicated that clients with PTSD rated their health significantly worse than those without PTSD. Although no direct relationship between PTSD and treatment satisfaction was found, there was a significant positive correlation between perceived health and treatment satisfaction. Research limitations/implications: Findings likely constitute a regional sample thus generalisability is limited. Practical implications: Simultaneously addressing addiction, PTSD, and medical issues can improve clients’ treatment satisfaction, consequently increasing treatment retention and producing greater positive post-treatment outcomes. Originality/value: Few if any studies have examined the extent to which PTSD and perceived health impact treatment satisfaction within residential substance abuse treatment programmes. (Edited publisher abstract)
An inpatient Healthy Living Group
- Authors:
- ROSE Lexy, BREEN Olivia, WEBB Zillah
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(2), 2014, pp.128-137.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to evaluate the usefulness of a Healthy Living Group (HLG) for individuals with learning disabilities and mental health problems in an inpatient setting. Design/methodology/approach: Seven sessions were developed. Each session focussed on a different aspect of healthy living, and used psychoeducation and practical skill building to enable individuals to create personalised healthy living plans. Quantitative post-intervention measures and a qualitative focus group were used to determine group participants’ learning and enjoyment. Findings: Principles about healthy living were successfully taught in an enjoyable way to individuals with learning disabilities. Factors that enhanced learning and those that created barriers to developing healthy living plans are explored. Practical implications: Individuals with learning disabilities and mental health problems can be supported to develop personalised healthy living plans. Recommendations for further adaptations to the group structure are made, in order to enable others to run successful groups. Originality/value: The HLG is the first of its kind to be developed for individuals with learning disabilities. (Edited publisher abstract)
The social networks of homeless youth experiencing intimate partner violence
- Author:
- PETERING Robin
- Journal article citation:
- Journal of Interpersonal Violence, 29(12), 2014, pp.2172-2191.
- Publisher:
- Sage
While there is a growing body of research on intimate partner violence (IPV) experienced by the housed youth population, a limited amount is known about IPV experienced by homeless youth. This study examines the relationship between IPV, gender, and social networks among a sample of 386 homeless youth in Los Angeles, California. Results revealed that one fifth of the sample experienced IPV in the past year. Stratified regression models revealed that IPV was not significantly related to any measure of male social networks; however, females who experienced IPV had more male friends than females who did not experience IPV. Female homeless youth who witnessed family violence during childhood had more male friends, but those who experienced sexual abuse during childhood had fewer male friends. Although there was no significant difference in the rate of IPV victimisation across genders, the context of this abuse appears to be drastically different. The results suggest that females with more male friendships are at greater risk for exposure to IPV. To date, there are few effective youth-targeted IPV prevention programmes and none have been shown to be effective with homeless youth. These results provide insight into future programme development. (Edited publisher abstract)