Mental Health Constructs Research Articles

Expanding the “Ports of Entry” for Speech-Language Pathologists: A Relational and Reflective Model for Clinical Practice

To outline an expanded framework for clinical practice in speech-language pathology. This framework broadens the focus on discipline-specific knowledge and infuses mental health constructs within the study of communication sciences and disorders, with the objective of expanding the potential "ports or points of entry" (D. Stern, 1995) for clinical intervention with young children who are language impaired. Specific mental health constructs are highlighted in this article. These include relationship-based learning, attachment theory, working dyadically (the client is the child and parent), reflective practice, transference-countertransference, and the use of self. Each construct is explored as to the way it has been applied in traditional and contemporary models of clinical practice. The underlying premise in this framework is that working from a relationally based and reflective perspective augments change and growth in both client and parent(s). The challenge is for speech-language pathologists to embed mental health constructs within their discipline-specific expertise. This leads to paying attention to both observable aspects of clients' behaviors as well as their internal affective states.

Broadening the “Ports of Entry” for Speech-Language Pathologists: A Relational and Reflective Model for Clinical Supervision

To offer a framework for clinical supervision in speech-language pathology that embeds a mental health perspective within the study of communication sciences and disorders. Key mental health constructs are examined as to how they are applied in traditional versus relational and reflective supervision models. Comparisons between traditional and relational and reflective approaches are outlined, with reference to each mental health construct and the developmental level of the supervisee. Three stages of supervisee development are proposed based on research from various disciplines, including nursing, psychology, speech-language pathology, social work, and education. Each developmental stage is characterized by shifts or changes in the supervisee's underlying assumptions, beliefs, and patterns of behavior. This article makes the case that both the cognitive and affective dimensions of the supervisor-supervisee relationship need to be addressed without minimizing the necessary development of discipline-specific expertise. The developmental stages outlined in this paradigm can be used to understand supervisees' patterns of change and growth over time, as well as to create optimal learning environments that match their developmental level and knowledge base.

Perceived cultural attitudes toward homosexuality and their effects on Iranian and American sexual minorities.

This study examined the relationship between three mental health constructs and perceived cultural attitudes toward homosexuality among lesbian, gay, and bisexual individuals. Specifically, differences in perceived cultural attitudes and depression, self-esteem, and perceived stress between 49 Iranians and 47 Americans were compared. It was hypothesized that (a) perceived cultural attitudes toward homosexuality would be more negative among Iranians than Americans; (b) perceived cultural attitudes would be related to depression, self-esteem, and perceived stress; and (c) that Iranian participants' scores on the depression, self-esteem, and perceived stress measures would reflect poorer mental health than that of their American counterparts. Results indicated more negative perceptions of cultural attitudes toward homosexuality among Iranians. Contrary to prediction, however, no difference was found in levels of depression, self-esteem, and perceived stress among American and Iranian participants. Findings are discussed in terms of cultural and familial differences with regard to sexual orientation disclosure.

The ‘What’, ‘Why’ and ‘How’ of Employee Well-Being: A New Model

This paper examines the ‘what’, ‘why’ and ‘how’ of employee well-being. Beginning with the ‘what’ of well-being, the construct of mental health was explored with the aim of building a model of employee well-being. It was proposed that employee well-being consists of three core components: (1) subjective well-being; (2) workplace well-being and (3) psychological well-being. Following this, the ‘why’ of employee well-being was investigated; that is, why employee well-being should be an important matter for organisations. It was argued that employee well-being is an important precursor to organisational well-being, as indicated by its links to employee turnover and performance. The next section was concerned with the ‘how’ of employee well-being; that is, how well-being can be reliably enhanced. Drawing on two models of strengths and a practice model of psychological assessment, it was asserted that strength-based development can reliably enhance employee well-being. A solid framework for understanding and measuring employee well-being is offered in the hope that it will foster a more integrated approach to assessing and optimising employee well-being.

Anxiety Prevention in Indigenous Youth

Anxiety is the most prevalent psychopathology in young people, with up to 18% suffering from one or more anxiety disorders. Early prevention is important, as many signs of anxiety are often evident in childhood and adolescence. Anxiety disorders have negative consequences for academic, social and individual outcomes, and have been shown to be a precursor to depression, suicide and substance abuse. It is important to focus on a general population health approach of embedding anxiety prevention programs in the school curriculum as well as providing targeted intervention for indicated and at risk groups. Although there are some excellent evidence-based anxiety and depression prevention programs for children and adolescents, there has been little research into the prevention of anxiety in minority populations such as Indigenous young people. While it is easy to hypothesise that Australian Indigenous youth may suffer high levels of anxiety, data to support this are scant. Issues of appropriate research methodology; differing constructs of mental health; variable stressors and protective factors; and difficulties with culturally appropriate assessments and interventions complicate studies. Prevention and early intervention anxiety programs need to be culturally sensitive and adapted for Indigenous youth. This paper argues for more research to be conducted on the specific prevention needs in this seemingly vulnerable population.

The promotion of emotional wellbeing for children, parents and families what gets in the way?

This paper presents the findings of a qualitative research project concerned with child and family wellbeing. It highlights how, in the context of contemporary professional mental health practices, constructions of children’s behaviour are predominantly based on pathology and deficit. The research data included individual interviews and focus groups with professionals representing both universal and specialist child and family mental health services. This data was subjected to a critical examination including an analysis of the discursive practices and a range of discourses that professionals employ in their everyday practice. This in-depth analysis of the findings uncovered ways in which these practices and discourses reflect values and attitudes to meaning, power and the use of knowledge. Two key discourses were identified, the parent-blame discourse and the professional self-referential discourse. These contribute to levels of fragmentation in the delivery of services that in turn compromise the capacity for advocacy of the child and hearing the voice of the child. The results of the inquiry indicate that the construction of child and family mental health cannot be considered as discrete from the construction of child and family wellness. Improving services for children, parents and families would appear to be inextricably linked with improving the professional, relational and organizational environment in which these services are delivered. The outcome of this inquiry has led to the establishment of a Child and Family Wellness Consultancy.

Reliability and validity in measuring physical and mental health construct of the Portuguese version of MOS SF-36

To identify and evaluate the Psychometric validity of the two general dimensions of the Short Form (SF)-36 Portuguese version. A representative sample of 1446 adults (60,4% women) resident in Porto, Portugal completed a structured questionnaire and a Portuguese version of SF-36, final data allowed the estimation of all 8 sub-dimensions for 1326 (91,7%) participants. The internal consistency was evaluated using the Cronbach's alpha. Principal components analysis (PCA) was used to test the dimensionality. To evaluate the construct validity of the two general dimensions the sample was divided into 4 groups, according to the presence of chronic diseases and depression (evaluated by Beck Depression Inventory). Logistic regression was use to measure how the new dimensions capture the theoretical differences between groups and bootstrapping to check the principal components loadings reliability. To evaluate loss of discrimination power when using only the 2 general dimensions, for the different groups, we compared the area under the ROC curve of the logistic regression with the original dimensions and the logistic regression with the 2 dimensions. The Cronbach s alpha was 0.82 for the physical and 0.87 for the mental dimension. The total variance explained by the extraction of 2 components was 70.4%. The 4 sub-dimensions from physical domain correlated more strongly with the first component (r=[0.69-0.83]), and the 4 sub-dimensions from the mental domain correlated more highly with the second component (r=[0.65-0.88]). The largest standard deviation obtained for principal components loadings of the bootstrapping was 0.05. The general dimensions capture the theoretical differences between groups. There were no significant differences between the areas under the ROC curve of the logistic regression for the original sub-dimensions and the general dimensions. The use of the two SF-36 summary measures, physical and mental health, allows us to analyse the results more efficiently without loss of information and capture different manifestations of health status.

Validating Cultureand Gender-Specific Constructs

SUMMARY Despite on-going calls for developing cultural competency among mental health practitioners, few assessment instruments consider cultural variation in psychological constructs. To meet the challenge of developing measures for minority and international students, it is necessary to account for the influence culture may have on the latent constructs that form a given instrument. What complicates matters further is that individual factors (e.g., gender) within a culture necessitate additional refinement of factor structures on which such instruments are based. The current work endeavors to address these concerns by demonstrating a mixed-methods approach utilized to assess construct validation within a specific culture; and in turn develop culturally-specific instruments. Qualitative methods were used to inform the development of a structured self-report by gaining detailed knowledge of the target culture and creating items grounded in interview and observational data. Factor analysis techniques and triangulation with qualitative analyses validated these findings. Previous work (Sarkar, 2003) suggested a number of gender-specific perceptions of mental health constructs within the target culture and these were investigated using additional mixed-method analyses. This article demonstrates an emerging mixed-method technique for developing culturally sound assessment tools, offers guidance on how to incorporate the overall approach in assessment, and provides a basis for thinking critically about the use of existing instruments when working with diverse populations.

Refugee Resettlement Programmes as Potential Mental Health Promoting Settings? A Qualitative Study of Resettlement Staff's Constructions of Refugees' Mental Health in Everyday Episodes

In order to investigate the potential of refugee resettlement programmes as mental healthpromoting settings, this study examines resettlement staff's constructions of refugees' health in everyday episodes within the resettlement programme. Everyday episodes relating to refugees' health were collected through individual and group interviews with 28 members of staff, and analysed using grounded theory methodology. The constructions of health in these episodes focused on mental health, the latter understood as a concept stressing the dynamic fit between person, programme and external environment. If a comprehensive strategy focusing on creating mental health among refugees through inter‐sectoral co‐ordination is developed, resettlement programmes can probably be developed into mental health‐promoting settings. The model proposed in this paper could be a good starting point to further this programme and policy development.

Cognitive Behavioural Therapy and Homelessness: A Case Series Pilot Study

This paper describes a project set up to treat four homeless men using cognitive behavioural therapy (CBT). The referral criteria were that individuals had alcohol and/or substance misuse problems, were roofless (i.e. sleeping rough) immediately before the intervention began and found it difficult or impossible to access hostel places in Southampton. Excessive alcohol use, violence (against self, others and property) and prison sentences were all features of their presentation. The project involved three levels of CBT intervention provided by the clinical psychologist: 1) training for the staff to enable them to work within this model; 2) continued supervision within model to ensure consistency and sustainability; 3) individual formulation (description of the problem within the CBT framework) and psychotherapy. The house itself was also run on a collaborative basis. A number of measures including mental health and social functioning constructs were used to evaluate the project, in addition to some qualitative data. All residents reduced incidents of theft, violence and alcohol consumption. Risk to self and others was also reduced for all residents. Perceived self-efficacy increased slightly for all residents, and staff perceived that they could be more effective, less hopeless, and therefore possibly less stressed as a result of training. More data will be gathered over time.

Elements of Dynamics V: Resiliency and the Narrative

Although clinicians and researchers are increasingly interested in understanding mental health, the systematic study of resiliency presents unique problems. Constructs of mental health have been used in epidemiologic, population-based studies of wellness. Sociability, self-efficacy, and a sense of meaning appear to be common attributes of resilient people. These attributes seem to benefit individuals over time and despite hardships. Yet research that identifies particularly resilient cohorts may have limited generalizability. Furthermore, constructs of mental health may not capture the variety and dynamism of adaptive coping. Person-centered research methods such as psychoanalytic case studies and ethnographies can supplement population-based studies of resiliency with valuable context and detail. Examples are given of narrative-based studies of resiliency.

Religion and anxiety: A critical review of the literature

Religion's effects on mental health have been debated for years, yet only in the last half century have these theories been empirically tested. While a number of mental health constructs have been linked to religion, one of the most prevalent and debilitating mental health indices, anxiety, has been largely ignored. This paper categorizes and critically reviews the current literature on religion and general indices of anxiety in terms of findings linking decreased anxiety to religiosity, increased anxiety to religiosity, and those finding no relation between anxiety and religiosity. Results from 17 studies are described and synthesized. Conceptual and methodological weaknesses that potentially threaten the validity and generalizability of the findings are discussed. Finally, conclusions and directions for future research are provided.

A Framework for College Counseling Responses to Large Scale Traumatic Incidents

Although most psychotherapists have limited experience dealing with large scale catastrophic incidents, college and university counseling centers today need to be prepared for crisis events such as terrorist attacks, war, and local catastrophes. This article presents a conceptual model for designing counseling center responses to large scale traumatic incidents. Familiar college mental health constructs are applied to the relatively unfamiliar territory of responding to traumatic incidents. First, DSM-IV-TR diagnostic criteria are used to define three levels of student need based on different types of stressful or traumatic events and expected reactions. Next, a corresponding three-part response plan is discussed, including preventive, intermediate, and advanced counseling and psychotherapy interventions. Finally, the college counseling roles of crisis intervention and student development consultation are discussed in relation to the aftermath of large scale traumas. The influence of staff attitudes and values, and other limitations of the model, also are described.

African centered family healing: an alternative paradigm.

African centered family healing posits an alternative paradigm that can be used as a model for family healing. Effective intervention begins with the recognition that what we have been doing has not been working for African American families (Boyd-Franklin, 1989; Kambon, 1998; Logan, Freeman and McRoy, 1990; Owusu-Bempah, 1999; and Weaver, 1992). Social work intervention efforts must integrate mental health constructs that exist in the communities we are attempting to serve. One such concept is communal knowledge. Another such concept is communal values. When one joins communal knowledge and values, one begins to restructure the understanding of mental health in the African American family. The family unit must be viewed as interdependent. This understanding is requisite to family healing. It is therefore necessary that we change our thinking and then our actions. This article posits that social workers must become social healers.

Hospital psiquiátrico: (re)afirmação da exclusão

Nosso objetivo é compreender a situação da instituição psiquiátrica hoje, quanto ao perfil da população internada e quais as suas perspectivas face aos questionamentos e propostas do movimento de reforma psiquiátrica e luta antimanicomial. O projeto foi desenvolvido em uma instituição de Bauru/SP, com a população feminina ali internada. Foi realizada a caracterização da amostra, a partir dos dados constantes do sistema de registro utilizado pela instituição, anotando-se as seguintes variáveis: idade, estado civil, escolaridade, naturalidade, ocupação, local de moradia e diagnóstico. Foi feita a análise quantitativa e qualitativa dos dados coletados. Constatou-se que a função principal da instituição psiquiátrica continua sendo a exclusão. A necessidade de construção dos modelos substitutivos em saúde mental que valorizem a integridade e promovam a cidadania, torna-se a única possibilidade de resistência do movimento antimanicomial.

Physical Exercise and Psychological Wellness

The relationship between regular physical exercise and psychological wellness among gym members was investigated. Regular exercise was defined as exercising for an average of thirty minutes a day at least three times per week. A wellness profile was constructed from various questionnaires chosen on the basis of their relationship with the general construct of mental health and/or psychological well-being as conceptualised in this paper and as established in previous research. Wellness profile components consisted of assessments of mood, lifestyle, satisfaction with life, sense of coherence, fortitude, stress and coping with stress. The wellness profile was administered to 106 exercisers from four local gyms in the Richards Bay area of South Africa. Respondents were given feedback, and further counselling if needed, with regard to their scores on the various components as wellness and a global wellness percentage score. The correlations among wellness components were almost all highly significant. Findings also indicated a highly significant influence of regular exercise on the various components of wellness as operationally defined by various scores on the wellness profile and the final composite wellness percentage itself. Findings provide further support for the vital role that regular exercise plays in the promotion of mental health and wellness.

Studying Early Adolescents' Academic Motivation, Social-Emotional Functioning, and Engagement in Learning: Variable- and Person-Centered Approaches

This study used variable- and person-centered data analytic techniques to examine how early adolescents' academic motivation and social-emotional functioning were associated with their self-reported cognitive and behavioral engagement in the middle school classroom. Regression results showed that both motivational and mental health constructs contributed to the prediction of individual differences in classroom engagement. Person-centered analyses revealed between group variation in classroom engagement as a function of differing patterns of motivation and mental health among different subgroups of adolescents. Convergent and complementary information on these subgroups was provided by using two different grouping approaches. Findings are discussed in terms of broad patterns of promise or problems during early adolescence.

The explanatory models of mental health amongst low-income women and health care practitioners in Lusaka, Zambia.

There is currently much debate about the cultural construction and specificity of mental health. It is thus not surprising that explanatory models, which look at the meaning of illness for those suffering from it, have been widely used within the mental health field. This paper considers the significance of explanatory models and presents a study comparing the explanatory models of mental ill health used by urban women in low-income groups and local health care practitioners in ZAMBIA: To measure mental ill-health status, an instrument recommended by the World Health Organization was used - the Self Reporting Questionnaire, 20 items (SRQ 20). To obtain explanatory models, Kleinman's classic eight questions were adapted. The terms used by the practitioners to define and explain the mental health problems of women in low-income groups were 'stress and depression', with these two concepts being used interchangeably. In contrast, the phrase most frequently used by the women was 'problems of the mind'. The professionals regarded the experience of depression itself as a manifestation of ill health. For the women, however, only the physical symptoms were defined as ill health. There was a common agreement, however, that the women's socioeconomic situation as a major causal factor. Both groups identified the home environment as a key determinant, particularly the quality of marital relationships. Greater awareness of explanatory models may have beneficial effects on mental health policy and planning, both at national levels (where recognition of the true prevalence and burden of mental ill health should have an impact on public health policy) and at the level of local implementation (where training of health professionals to take patients' explanatory models into account might contribute towards the diagnosis of mental health problems).

Assessing the Reliability of Four Standard Health Measures in a Sample of Older, Urban Adults

Increasing attention is being paid to racial and ethnic differences in the structure and measurement of physical health and mental health constructs. The objective of this study was to examine the reliability of four measures of physical health and mental health in a sample of 400 older (50+ years) African Americans and Caucasians. These measures are the instrumental activities of daily living and activities of daily living scales of the National Chronic Care Consortium Health Risk Appraisal Survey, the SF-12, the Multidimensional Health Locus of Control Scale, and the John Henryism Active Coping Scale. The measures were tested by racial group. The results of factor analyses reveal that the overall reliability of each scale, as measured by Cronbach’s alpha, was near or above .70. However, the item-to-scale correlations of many of these scales were low. This finding indicates that the measurement of the constructs may be different for older African Americans and Caucasians.

Mental Health Services for American Indians and Alaska Natives: Need, Use, and Barriers to Effective Care

This special review summarizes and illustrates the state of our knowledge regarding the mental health needs of American Indians and Alaska Natives. These needs are considerable and pervasive. The discussion begins by reflecting on the limits of psychiatric nomenclature and conceptual frameworks for revealing Native constructions of mental health and mental illness. The experience and manifestation of psychopathology can be both different and the same across cultures, hinging upon the extent to which such basic assumptions as the relationship of mind to body--and spirit in the case of Native people--or the primacy of the individual or social collective are shared. Having set the stage, this paper moves to recent empirical evidence regarding the mental health needs of American Indians and Alaska Natives: we review that evidence and consider it within the broader context of available services. The report closes with a brief overview of the most pressing issues and forces for change afoot in Indian country in the US. Most have to do with the structure and financing of care as tribes and other Native community-based organizations seek to balance self-determination and resource management to arrive at effective, fiscally responsible, culturally informed prevention, treatment, and aftercare options for their members. These changes may herald similar trends among First Nations people to the immediate north.