Biopsychosocial Functioning Research Articles

Mental health intake assessments from a biopsychosocial perspective

Psychotherapists’ approach to intake assessment has a major impact on mental health case conceptualization and treatment. Despite its importance, little is known about therapists’ actual assessment practices. This appears to be the first study to investigate which aspects of biopsychosocial functioning are documented by therapists in their intake assessments, how thoroughly these issues are assessed, and how well the information collected is integrated into the assessment findings. The study found that therapists regularly collect information regarding a wide range of biopsychosocial issues, though not in a detailed or comprehensive manner, nor a manner designed to maximize treatment effectiveness.

Assessment and remediation for physicians with suspected performance problems: An international survey

Little is known about the overall appropriateness and value of the various programs available internationally for assessment and remediation for individual physicians whose performance in their clinical practice has been identified as giving cause for concern. A questionnaire was e-mailed to members of the International Physicians Assessment Coalition and/or the Coalition for Physician Enhancement--organizations that were thought to provide this type of assessment (n = 20). Questions covered the aims, organization, methods, and outcomes of assessment programs and associated remediation. Responses came from 15 regulatory bodies, universities, not-for-profits, and health service organizations in 5 countries. The assessment programs and remediation activities identified were small in scale. Their focus ranged from a narrow concern with identifying and repairing specific knowledge and skills deficits to a wider interest in the biopsychosocial functioning of the physician as a whole. Both "diagnosis" and "treatment" of problems focused on the individual physician. Less attention was given to broader systems or contextual factors that might impact performance. Although progress through remediation was carefully monitored, none of the programs undertook regular systematic follow-up to ascertain the success of their interventions in the longer term. This field of activity is characterized by the use of sophisticated methods for measuring performance/competence, but provision of remediation is more patchy and variable. The small scale of these programs raises questions about the relationship between scale of provision and potential need for remediation. Gaps in information about impact and outcomes mean that the overall impact and value of this type of assessment and remediation is hard to determine.

Pain Prevalence and Risk Distribution Among Inpatients in a German Teaching Hospital

This study was designed to provide a cross-sectional analysis of pain prevalence, chronicity, and severity as well as the impact of pain on psychological and social variables in inpatients in various departments of a German teaching hospital. Patients were asked to complete a questionnaire including sections on sociodemographic and socioeconomic data, pain variables, recent and past health care utilization, and screening questionnaires for depression, anxiety, and health-related quality of life. Of the 438 patients, 386 (88.1%) had experienced pain in the past 12 months; 367 (83.8%) reported having pain in the previous 3 months. Sixty-four percent of the pain patients stated that pain was the main reason for hospital admission; 48% reported having three or more pain sites. The most common location of pain was the back (26.9%). Pain patients showed significantly higher depression and anxiety scores and markedly reduced physical health when compared to non-pain patients. The results of this study indicate that in most medical disciplines pain is more than merely a symptom of disease. In many instances pain should be considered a serious comorbidity that can influence the outcome of medical and surgical treatment. Recent research has shown that prevention of the pain chronification process is the most promising strategy for avoiding the development of intractable pain. Acceptance, recognition, and assessment of pain as a risk factor at an early stage are essential factors. A first step might involve routine screening for pain on admission to any hospital facility, and subsequently evaluating the impact of pain on biopsychosocial functions.

The Two-Track Model of Bereavement Questionnaire (TTBQ): Development and Validation of a Relational Measure

The Two-Track Model of Bereavement Questionnaire (TTBQ) was designed to assess response to loss over time. Respondents were 354 persons who completed the 70-item self-report questionnaire constructed in accordance with the Two-Track Model of Bereavement. Track I focuses on the bereaved's biopsychosocial functioning and Track II concerns the bereaved's ongoing relationship to the range of memories, images, thoughts, and feeling states associated with the deceased. Factor analysis identified 5 factors that accounted for 51% of the variance explained. In accord with the theoretical and clinical model, 3 factors were primarily associated with the relationship to the deceased (Track II): Active Relational Grieving, Close and Positive Relationship, and Conflictual Relationship; and 2 factors with aspects of functioning (Track I): General Biopsychosocial Functioning and Traumatic Perception of the Loss. Construct and concurrent validity were examined and were found satisfactory. Differences by kinship, cause of death, gender, and time elapsed were examined across the 5 factors, the total TTBQ, and the ITG. The new measure is shown to have both construct and concurrent validity. Discussions of the results and implications for the measurement of response to loss conclude the article.

Biopsychosocial functioning of women after mastectomy

The aim of this work was to identify the problems of women after total mastectomy and partial mastectomy with regard to various factors and intensity of discomfort which affect the quality of life. The loss of the attribute of femininity, maternity and sexuality, as the mammary gland is perceived by patients, is a highly traumatic experience, frequently resulting in re-evaluation of life and functioning to date. The survey encompassed 494 women after operational treatment of breast cancer with varying time since the procedure. The research group consisted of women after radical mastectomy, and the control group consisted of patients after partial mastectomy. The intensity of post-traumatic stress was an important factor affecting the level of depression and anxiety. This correlation appeared to be statistically highly significant in the group of women after total mastectomy. Life satisfaction, the level of depression and anxiety in women after such an operation were dependent on the intensity of post-traumatic stress and they caused inferior biopsychosocial functioning. Women after mastectomy require professional long-term support; this need should result in the enhancement of services provided in relevant women's support groups. When evaluating holistically the life of women after mastectomy, all spheres of everyday functioning should be taken into account: physical, cognitive, emotional and social.

Enhancing Forgiveness: A Group Intervention for the Elderly

This article describes a therapeutic model of forgiveness (Enright, 2001) and discusses its applicability to social work intervention with older adults. A total of 20 men and women, aged 57–82, participated in 2 different forgiveness groups, each of which met weekly for 8 sessions with a 4-month follow-up session. Measures of forgiveness, as well as biopsychosocial functioning, were collected before and after the group intervention. Results indicated that participants experienced long-term improvement with respect to forgiveness and depression, short-term improvement of physical health, and no change in relation to anxiety or social support. Clinical issues that emerged during the forgiveness group are discussed, and suggestions for gerontological social workers are offered.

Biopsychosocial Benefits of Spirituality in Adults Aging With HIV

More than 100,000 adults above the age of 50 have been diagnosed with HIV in the United States. It is important to understand how to promote successful aging in this growing population. With the positive effects of spirituality on biopsychosocial functioning in aging, HIV, and chronic diseases, accessing the strengths associated with spirituality may facilitate successful aging in adults surviving to older ages. The inherent nature of the nurse-patient relationship means nurses are in a key position to actively listen, assess spiritual needs, and make clinical referrals. In providing holistic care to patients, nurse scientists are encouraged to study and address the spiritual needs in this growing population.

The effect of parent–child attachment relationships on child biopsychosocial outcomes: a review

Initial progress has been made in the conceptualization and study of attachment stability over time, and substantial evidence has accumulated on the association between attachment classification and biopsychosocial functioning (including social–emotional competence, cognition, physical health and mental health). The literature supports the intuitive belief that parent–child attachment representations affect infant and child development in a variety of domains and across several developmental periods. There is substantial evidence that children with secure attachments in childhood develop more positive social–emotional competence, cognitive functioning, physical health and mental health, whereas children with insecure attachments are more at risk for negative outcomes in these domains. However, problems still remain in controlling for variables that may affect attachment classification throughout the lifespan (e.g. changes in life circumstances, stress, caregiving) and in determining how these variables influence later outcomes. Findings from this review are discussed in terms of health promotion and prevention, and areas for future research are outlined.

Kwaliteit van leven bij patiënten met de ziekte van Parkinson: Een kritische evaluatie

Quality of life in patients with Parkinson’s disease: A critical evaluation This article reviews studies on quality of life (QOL) in patients with Parkinson’s disease (PD). Traditionally, in this literature, there has been an emphasis on morbidity and mortality. Nowadays, however, there is a shift towards subjective outcomes, such as QOL. QOL is often erroneously used interchangeably with terms like health status (HS). QOL, however, is based on patients’ evaluations with regard to broad aspects of life, while HS is specifically focusing on biopsychosocial functioning. As a consequence, a lot of instruments, including diseasespecific ones, claim mistakenly to assess QOL. In fact, they measure HS with only a few questions touching QOL. The available studies reveal that the HS of patients with PD is worse compared with the HS of (healthy) persons. Studies that really assess QOL are very scarce. As a consequence, the answer to the question ‘What is the influence of PD on patients’ QOL?’ is, for all intents and purposes, still unanswered.

An Opioid Screening Instrument: Long‐Term Evaluation of the Utility of the Pain Medication Questionnaire

The Pain Medication Questionnaire (PMQ) was designed to assess the risk for opioid medication misuse in chronic pain patients. A preliminary study showed a positive relationship between higher PMQ scores and concurrent measures of substance abuse, psychopathology, and physical/life-functioning. Using a larger sample size, the present study sought to replicate these findings, and to expand upon them by examining the relationship between PMQ scores and various treatment outcomes. The PMQ was administered to 271 newly evaluated chronic pain patients who were subsequently re-evaluated immediately post-treatment, as well as six months following discharge. Subgroups were then formed according to the lowest (L-PMQ), middle (M-PMQ), and highest (H-PMQ) one-third of PMQ total scores. It was found that the H-PMQ group was 2.6 times more likely to have a known substance-abuse problem, 3.2 times more likely to request early refills of prescription medication, and 2.3 times more likely to drop out of treatment, as compared to the L-PMQ group. They also had diminished biopsychosocial functioning. In addition, at six months following discharge, patients who completed the program experienced a significant decrease in PMQ scores over time relative to those patients who were unsuccessfully discharged from the program or who dropped out. This study represents the second stage in the development of a psychometrically sound screening tool for measuring risk for opioid medication misuse among chronic pain patients, and findings suggest the long-term utility of the PMQ in identifying patients who are more likely to complete and benefit from a pain management program.

Symptom management in hematological patients

Signs and symptoms are among the most common reasons that patients seek healthcare. Being able to identify and distinguish what constitutes a sign or symptom in practice is an important part of nurses’ clinical expertise. Symptoms are multidimensional, complex and subjective phenomena that ‘‘reflect changes in biopsychosocial functioning, sensations, or cognition of an individual.’’ In contrast, signs are the objective abnormalities that indicate a disease or condition that are detectable by the individual or by others. Both signs and symtoms are important cues that bring problems to the attention of patients and clinicians. Signs and symptoms are also important because they impact the functional abilities and quality of life of patient with hematological diseases [4,7,10].

Insomnio: enfoque diagnóstico y terapéutico

El sueño excesivo, insuficiente o desbalanceado disminuye la calidad de vida y afecta el funcionamiento biopsicosocial de la persona. Entre 20 y 50% de los adultos refieren una alteración en su dormir, y esta frecuencia aumenta con la edad. El insomnio es la queja más común en la población general y en los pacientes psiquiátricos; de ahí la importancia de enfocar adecuadamente, desde los puntos de vista diagnóstico y terapéutico, este problema de salud. El insomnio es un síntoma y se deben corregir primero sus causas; el estudio debe incluir el diario del sueño y la información de un testigo del dormir del paciente. El tratamiento varía según el tipo de insomnio y su etiología; las medidas generales pueden o no ser de tipo farmacológico e incluyen: higiene del sueño, intervenciones cognitivo-conductuales, restricción del sueño, técnicas de relajación y administración de medicamentos. En general se acepta que cuando el insomnio lleva menos de tres semanas de evolución no requiere ninguna intervención excepto las medidas sobre higiene del sueño; si esto no es suficiente, se perpetúa en el tiempo o se identifican otras causas, se deberá hacer un manejo de tipo específico.

Salvaged limbs after tibial shaft fractures with extensive soft-tissue injury: a biopsychosocial function analysis.

The purpose of this study was to perform a biopsychosocial function analysis of the outcome in patients with a salvaged leg after tibial shaft fractures associated with extensive soft-tissue injury. A retrospective review of 18 consecutive patients with tibial shaft fractures and extensive soft-tissue damage with a mean Injury Severity Score of 31 was undertaken. All patients were assessed for their physical function, psychological status, and general function. The range of motion and torque of the ankle joint were severely affected. The knee joint was affected, but only with regard to the torque during concentric muscular activities. Nottingham Health Profile scores showed that the general and social function for these patients were significantly affected. Five of 18 patients suffered from depression. Salvage procedures should be advocated if possible, but careful selection of patients on the basis of mental and social factors is crucial for the outcome.

Coping profile differences in the biopsychosocial functioning of patients with temporomandibular disorder.

The objective of this study was to evaluate whether biopsychosocial functioning differences exist between samples of patients with temporomandibular disorder (TMD) who differ in coping profiles as assessed by the Multidimensional Pain Inventory. A total of 322 patients who presented with TMD were administered a comprehensive biopsychosocial assessment battery, and the acute or chronic status of their disorder was determined. A follow-up evaluation was conducted 6 months later to determine the status of their pain. TMD patients with dysfunctional and interpersonally distressed coping profiles demonstrated more acute and chronic psychosocial difficulties than patients with adaptive coper profiles. The data also suggest that having a dysfunctional/distressed coping profile on the Multidimensional Pain Inventory has some predictive value in determining the likelihood of developing chronicity in the absence of treatment. The presence of a dysfunctional/distressed coping profile in patients with TMD is likely to provide clinicians with important information about the biopsychosocial functioning of those patients, which, in turn, will help to determine the most effective treatment modalities to use with TMD patients.

THE TWO-TRACK MODEL OF BEREAVEMENT: OVERVIEW, RETROSPECT, AND PROSPECT

Sustaining meaning in life, maintaining emotional well-being, and balancing attachments to the living and the deceased are features associated with the psychological (and often private) impact of loss. In the Two-Track Model of Bereavement, the loss process is conceptualized along two distinct but interactive axes that attend to these overt and covert aspects of the response to loss. Whereas Track I is concerned with biopsychosocial functioning in the wake of loss, it is Track II that focuses on the bereaved's ongoing emotional attachment and relationship to the deceased. The contributions of the model to theory and research can serve to clarify our thinking about bereavement as a process resonating throughout one's life. Initially, research and clinical findings from bereaved parents are presented to illustrate the Two-Track Model and its contribution to the deepening of our understanding of loss throughout the life cycle. The contributions of the model to clinical practice are then considered for their ability to clarify our thinking and interventions. Two clinical cases illustrate situations where a predominant focus is on one or the other of these tracks. Ultimately, the Two-Track Model of Bereavement's use extends to the organization and clarification of theory, research, and clinical work.

Factors Influencing Nursing-Sensitive Outcomes in Taiwanese Nursing Homes

Outcomes research needs to be conducted in countries beyond the USA if nursing classification is to move into visibility and acceptance in health care delivery around the world. Clinical outcomes that reflect nursing interventions have not been well documented. Recent socioeconomic changes in Taiwan have provided a unique opportunity to measure nursing-sensitive outcomes in nurse-managed nursing homes. The purpose of recently completed research conducted in eight selected nursing homes in Taiwan was to explore factors influencing two nursing-sensitive outcomes, namely, biopsychosocial functioning and patient satisfaction. Nursing-sensitive outcomes are defined as changes in health status upon which nursing care has had a direct influence. The researchers considered the impact of both individual patient factors and organizational factors on the care outcomes. Individual patient factors were found to be significantly more important than organizational factors in determining biopsychosocial function.

Madness in the Family: The “Windigo”

ABSTRACT This paper looks at a particular Native American narrative used to explain problems in biopsychosocial functioning. Specific to the Cree, Ojibwa, and other Algonkian speaking peoples, the windigo is seen as the underlying force behind things that go wrong in life, from bad luck to mental illness. Centered outside of the individual, the windigo effectively separates the person from the problem and serves as a means to not only explain behavior and functioning but to give meaning and empower the individual.

A Family Therapy Model for Working with Persons with AIDS

An HIV positive diagnosis is not considered a predictable part of family development. When a family member becomes infected with the AIDS virus, the family must begin to cope with their emotions relating to the diagnosis, form a system to provide caregiving, and live through their grief. A model is presented to assist practitioners who work with PWA (persons with AIDS) and their families with these tasks. The Functional-Age Model is designed to evaluate changes in biopsychosocial functioning of people who are HIV positive and the concomitant effects on the structure and organization of the family. This model is presented with case examples to demonstrate application to families with HIV positive members.

Male rape: offenders and victims

In an analysis of 22 cases of male rape in a community setting, the gender of the victim did not appear to be of primary importance to some of the rapists, but for others, males appeared to be specific intended targets, and the rapists' assaults were an effort to deal with unresolved and conflictual aspects of their lives. For all offenders the sexual assault was an act of retaliation, an expression of power, and an assertion of their strength and manhood. The impact of rape on the male victims was similar to that on female victims, disrupting their biopsychosocial functioning; however, male rape appears to be underreported due to the stigma associated with it.