Although rates of child maltreatment are declining, more than 600,000 children in the United States are substantiated victims of abuse or neglect. The focus of this review is on the relationship ...between maltreatment and mental health problems in childhood and adulthood. Children and adults who are exposed to abuse or neglect in childhood are at risk for a range of poor mental health outcomes, including internalizing and externalizing psychopathology, posttraumatic stress disorder, psychotic symptoms, and personality disorders. I review three potential mechanisms by which maltreatment may increase risk for various forms of psychopathology, (
a
) hypervigilance to threat, (
b
) deficits in emotion recognition and understanding, and (
c
) low responsivity to reward. I also review genetic and psychosocial factors that moderate the relationship between maltreatment and risk for psychopathology. Finally, I discuss methodological limitations of the literature on maltreatment, with an emphasis on the challenges associated with establishing a causal role for maltreatment (and moderators or mediators of maltreatment) in the development of mental health problems and the reliance of many studies on retrospective self-reports.
Stigma is a dehumanizing process, a method of shaming and blaming that is embedded in our beliefs about who does and does not have value within society. In Lazy, Crazy, and Disgusting, medical ...anthropologists Alexandra Brewis and Amber Wutich explore another side of the issue: the startling fact that well-intentioned public health campaigns can create new and sometimes damaging stigma, even when they are successful.
Brewis and Wutich present a novel, synthetic argument about how stigmas act as a massive driver of global disease and suffering, killing or sickening billions every year. They focus on three of the most complex, difficult-to-fix global health efforts: bringing sanitation to all, treating mental illness, and preventing obesity. They explain how and why humans so readily stigmatize, how this derails ongoing public health efforts, and why this process invariably hurts people who are already at risk. They also explore how new stigmas enter global health so easily and consider why destigmatization is so very difficult. Finally, the book offers potential solutions that may be able to prevent, challenge, and fix stigma. Stigma elimination, Brewis and Wutich conclude, must be recognized as a necessary and core component of all global health efforts.
Drawing on the authors' keen observations and decades of fieldwork, Lazy, Crazy, and Disgusting combines a wide array of ethnographic evidence from around the globe to demonstrate conclusively how stigma undermines global health's basic goals to create both health and justice.
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review ...progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co‐occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
Through detailed discussion of inpatient geriatric psychiatry, telehealth models of care, health staff concerns, and social determinants of health, as well as nonclinical factors that affect the ...broader clinical effort, Geriatric Mental Health Care provides techniques that health care providers can use to overcome the challenges of the current pandemic-and prepare for the next one.
Therapeutic Revolutionsexamines the evolving relationship between American medicine, psychiatry, and culture from World War II to the dawn of the 1970s. In this richly layered intellectual history, ...Martin Halliwell ranges from national politics, public reports, and healthcare debates to the ways in which film, literature, and the mass media provided cultural channels for shaping and challenging preconceptions about health and illness.Beginning with a discussion of the profound impact of World War II and the Cold War on mental health, Halliwell moves from the influence of work, family, and growing up in the Eisenhower years to the critique of institutional practice and the search for alternative therapeutic communities during the 1960s. Blending a discussion of such influential postwar thinkers as Erich Fromm, William Menninger, Erving Goffman, Erik Erikson, and Herbert Marcuse with perceptive readings of a range of cultural text that illuminate mental health issues--among themSpellbound, Shock Corridor, Revolutionary Road,andI Never Promised You a Rose Garden--this compelling study argues that the postwar therapeutic revolutions closely interlink contrasting discourses of authority and liberation.
Evidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of ...WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health.
Data were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16-70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220-299).
One in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio aOR 2.65, 95% CI 2.02-3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46-0.72) and closeness to others (aOR 0.57, 0.46-0.72). Patterns of association between WBH and mental health were similar in men and women.
These findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.
The pathways to symptoms of common mental disorder and post-traumatic stress symptoms among refugees during resettlement need to be better specified. We aim to identify models of these different ...mental health outcomes among refugees during resettlement, taking pre-migration, migration and post-migration stress conditions, a person’s capacity to handle such stress and socio-demographic variables into consideration. A new questionnaire developed to better cover resettlement stress, as well as pre-resettlement trauma exposures and different measures of a person’s capacity to handle stress, was administered to 124 Middle Eastern refugees that had been granted permanent residency in Sweden only a few months before responding. We found four dimensions of resettlement stress: social and economic strain, alienation, discrimination and status loss and violence and threats in Sweden, that account for 62% of the total variance in resettlement stress. Social and economic strain and alienation are important for explaining symptoms of common mental disorder. In the model of core post-traumatic stress symptoms, pre-resettlement trauma exposure seems to have the strongest impact. A person’s capacity to handle stress plays significant, direct and mediating roles in both models. The impact of resettlement stressors in the context of the whole migration process for different mental health outcomes is discussed.
People with severe mental illness (SMI) face a higher risk of premature mortality due to physical morbidity compared to the general population. Establishing regular contact with a general ...practitioner (GP) can mitigate this risk, yet barriers to healthcare access persist. Population initiatives to overcome these barriers require efficient identification of those persons in need.
To develop a predictive model to identify persons with SMI not attending a GP regularly.
For individuals with psychotic disorder, bipolar disorder, or severe depression between 2011 and 2016 (n = 48,804), GP contacts from 2016 to 2018 were retrieved. Two logistic regression models using demographic and clinical data from Danish national registers predicted severe mental illness without GP contact. Model 1 retained significant main effect variables, while Model 2 included significant bivariate interactions. Goodness-of-fit and discriminating ability were evaluated using Hosmer-Lemeshow (HL) test and area under the receiver operating characteristic curve (AUC), respectively, via cross-validation.
The simple model retained 11 main effects, while the expanded model included 13 main effects and 10 bivariate interactions after backward elimination. HL tests were non-significant for both models (p = 0.50 for the simple model and p = 0.68 for the extended model). Their respective AUC values were 0.789 and 0.790.
Leveraging Danish national register data, we developed two predictive models to identify SMI individuals without GP contact. The extended model had slightly better model performance than the simple model. Our study may help to identify persons with SMI not engaging with primary care which could enhance health and treatment outcomes in this group.
The first comprehensive account of how medical insight and folk psychology met in the courtroom, this book makes clear the tragedy of the crimes, the spectacle of the trials, and the consequences of ...the diagnosis for the emerging field of forensic psychiatry.
Mothers suffering from common mental disorder (CMD), such as anxiety and depression may not be able to function properly, which could adversely affect the mother-infant bond and even result in ...increased infant morbidity and mortality. The purpose of this study was to assess the prevalence of CMD and its determinants among pregnant women in Southeast Ethiopia.
Data was collected from 743 pregnant women via interview-administered, standardised questionnaires during Dec-Jan 2017. The WHO Self-Reported Questionnaire (SRQ) was used to screen CMD. Multivariate logistic regression was conducted and ORs and 95% confidence intervals were calculated.
The prevalence of CMD during pregnancy was 35.8% (95% CI: 34-38%) and the main determinants of CMD were: illiteracy, presence of health risk, financial instability, physical or emotional abuse, having sexual intercourse without her willingness, family history of psychiatric illness and history of chronic medical illness.
CMD prevalence during pregnancy was high, indicating a need to regularly screen pregnant women for CMD and its determinants as part of routine obstetric care.
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