Higher Mental Health Research Articles

Long-term adherence with cardiovascular drug regimens

An increasing number of medications are prescribed for patients with coronary artery disease, but poor adherence may limit realization of their benefits. To characterize adherence to evidence-based cardiovascular medications prescribed at hospital discharge at 1 year. We studied 1326 patients with coronary artery disease undergoing cardiac catheterization between 1998 and 2001. We examined adherence to angiotensin-converting enzyme (ACE) inhibitors, aspirin, beta-blockers (BBs), and statins by comparing baseline prescription at hospital discharge to self-reported medical regimen at 12 months. Patients who reported use of each cardiac medication at 1 year were considered adherent. Clinical and demographic predictors of nonadherence are described. The population had a mean age of 65.7 +/- 10.5 years, and 36% were women. At discharge, aspirin was prescribed in 95%, BBs in 86%, ACE inhibitors in 65%, and statins in 55%. The proportion of patients who discontinued medications was lowest for aspirin (18%) and BBs (22%) and highest for ACE inhibitors/angiotensin receptor blockers (28%) and statins (28%). Only 54% were adherent to all of their initial medications. Patients who discontinued medications were more likely to be older, women, unmarried, and less educated. Multivariable predictors of better adherence were higher mental health, education level, marital status, and no antidepressant use. A higher number of prescribed medications were associated with lower adherence to the recommended regimen. Insurance coverage and physical function did not correlate with adherence. Patients frequently stop medications within 1 year of prescription. Adherence is influenced by marital status, mental health, education, and total number of medications prescribed. Physicians need to be aware of patient factors which influence adherence to facilitate higher use of evidence-based medications.

The impact of war on the mental health of children: A Salvadoran study

Objective: This ecologically conceptualized, intensive study assesses the mental health impact of the Salvadoran Civil War on 54 12-year-olds, born into the war, exposed to different levels of war violence. Methods: Half of the students came from a repopulated country village and half from an industrial neighborhood near the capital city. Children, their mothers or caretakers, and their teachers responded to interviews and some instruments. Results: Children from the repopulated village reported higher war experience and lower mental health. The personal/social impact of the war was more important than family togetherness or war intensity in determining the mental health of the children. Children's intelligence was highly related to surviving with higher mental health. Higher socioeconomic status (SES) and education of parents was related to better mental health. Controlling for intelligence, children who experienced the highest personal-social impact of war showed the poorest mental health. Children with high war experience were most likely to have difficulty in imagining the future. Conclusions: Intelligence and the foreshortening of future vision are variables that should be controlled for and investigated in outcome studies of trauma. Treatment for survivors should include aid in planning for the future.

General ability and opinions about mental illness among psychiatric aides.

Preemployment general ability tests have been found to be significant predictors of post-training mental health knowledg: of psychiatric aides (2). No attempt has been made to determine if performance on general ability tests is related to post-training mental health attitudes. Since research with the Opinions About Mental Illness Scale (1) has indicated more favorable attitudes to be associated with higher mental health knowledge scores (4), a significant correlation between general ability and attitudes would be expected. We studied the relationship between scores on three general ability tests and attitudes 01 71 newly employed psychiatric aides in a state mental hospital. The aides (42 males, 29 fema!es) had a mean age of 26.5 yr. (range 18-58) and a mean education of 11.8 y c. (range 9-15 ). Form 1A of the Otis Employment Test (3). a state Civil Service Test for attendants, and the Personnel Tests for Industry-Verbal Test (5) were administered to the aides prior to employment and the attitude scale was given after completion of a 5-wk. basic training program. On the Authoritarianism factor of the attirude scale the Otis test correlated -.24 (p < .05), the Civil Service Test correlated -.31 (p < .01), and the Personnel Test for Industry-Verbal Test correlated -.28 (p < .05). Two of the ability rests correlated significantly with the Social Restrictiveness factor, i.e., the Otis test correlated -.23 (P < .05) and the Civil Service Test correlated -.25 (p < .05). Significant correlations were found also between the Otis test and the Mental Hygiene Ideology factor (r = .25, p < .05) and between the Verbal Test and Interpersonal Etiology factor (r = .32, p < .01). None of the ability tests were correlated with the Benevolence attitude factor. No significant relationship was found between the attitude factors and age, education, or sex. Although the results indicated that higher general ability scores were associated with more favorable attitudes on several attitude test factors, the correlations were lower than those found between general ability tests and post-training mental health knowledge (2). In the present sample general ability scores accounted for a relatively small amount of the variance in the attitude scores.