Psychosocial Health Care Research Articles

Using the Eco-Map and Ecosystems Perspective to Guide Skilled Nursing Facility Discharge Planning

ABSTRACTGrowing numbers of seniors across the United States require skilled nursing facility care after an inpatient hospital stay. Previous studies indicate that roughly 20 percent of all hospitalized Medicare beneficiaries are admitted to a skilled nursing facility following a qualifying hospital stay. Social workers address psychosocial problems, social support, networks, and healthcare needs during transitions in care, particularly discharge planning. Ecosystems perspective and the eco-map as a discharge planning tool is presented. Social workers can use these tools to examine the patient with respect to their transactional relationships with systems. This will further will facilitate provision of wrap-around services upon discharge.

A Randomized, Controlled Trial of the Effectiveness of a Psychoeducational Intervention on Family Caregivers of Patients with Mental Disorders.

The present study aimed to investigate the effectiveness of a psychoeducational intervention on caregivers of patients assisted by the Center for Psychosocial Health Care (CPHC) focusing on the patient's psychopathology. This was a randomized clinical trial with 130 caregivers with higher mean burden scores assessed using the Zarit Burden Interview Scale (ZBI) (66 caregivers in the intervention group and 64 in the control group). The intervention included six home visits of psychoeducational interventions according to each mental disorder identified in the CPHC records. The intervention group had a reduction of 4.8 points in ZBI mean score (p = 0.008) and in the control group, the reduction was 1.9 points, which was not significant (p = 0.305). It is possible to think that psychoeducation may have served to inform about the disease and how to deal with it, to give emotional support to caregivers and to implement coping strategies and stress management.

The confrontation of those who remain: Qualitative reports of relatives about 3 cases of suicide in a small city in the Northeast Brazil

IntroductionSuicide is serious public health problem. In Brazil, suicides are more frequent in countryside and small cities.ObjectiveTo understand how informants have confronted emotionally the suicide at home by listening to viewpoints reported by such relatives of the deceased.MethodQualitative, exploratory design, conducted in a basic health unit area, in “Pau dos Ferros”, a city with 30,000 inhabitants, State of Rio Grande do Norte (RN), Brazil. Sample constructed by technique of “snowball”, in which the health team presented us the first family, whose member informed about the following; and this, the third one. Data collection through semi-directed interviews with open-ended questions in depth, and submitted to thematic analysis.ResultsIndividuals from relatives who had family bond with the suicidal people were interviewed. From analysis of transcribed interviews, three categories emerged:– “she has never demonstrated” – possible non-perception of potential suicidal behavior by the family;– “I got crazy” – feelings of relatives facing a hard scene of suicide and determined cultural questionings;– “we have no professional support in following days” – absence of psychosocial support and healthcare problems.ConclusionsPossible mood oscillations from suicidal persons were masked by opposite emotional reactions of themselves, and/or oscillations were denied by the observers. Suicide scene seems to have provoked feelings of helplessness and guilt for relatives in not being able to avoid the dramatic act. Feelings of discomfort occurred facing curiosity from many persons who would raise uncomfortable assumptions about suicidal motivations. Family members complained about lack of more effective psychosocial care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mental Disorders in People Affected by Thalidomide.

More than 50 years after the withdrawal of thalidomide from the market, subsequent orthopedic damages and psychosocial impairments dominate the complaints of thalidomide-affected individuals. The aim of the study was to determine the prevalence of mental disorders in this group. A total of 193 thalidomide-affected individuals from North Rhine-Westphalia (mean age 50.5 years, 56.5% women) underwent personal and comprehensive psychodiagnostic testing, which was based on the Structured Clinical Interview for DSM-IV disorders (SCID-I & SCID-II) and self-reporting questionnaires. Overall, the four-week prevalence of mental disorders was 47.2%. Multiple mental disorders were present in 45.1% among the 91 participants with diagnosed mental disorders. The most frequent diagnoses were unipolar depressive disorders (16.5%), somatoform disorders (14.0%), phobic disorders (12.4%), and alcohol-related disorders (6.2%). Immediate mental health care was indicated in 80.2% of participants with current mental disorders, but only 29.7% had used some form of psychosocial treatment in the 12 months preceding the study. Mental disorders occur approximately twice as often (relative risk [RR]: 1.77; 95% confidence interval [1.49; 2.10]) in thalidomide-affected individuals as in the age-matched German population. Together with a very low rate of utilization of mental health care, this finding implies an underuse of psychosocial healthcare. The development of specialized psychosocial treatment services may remove barriers that impede access to the healthcare system.

Psychosocial and Mental Health Care in Rural Environments

Psychosocial and Mental Health Care in Rural Environments

Unfolding case study and Mask-Ed™ high fidelity simulation for chronic illness education: A case study

Student learning of effective care provision for people with chronic illness is an important component of pre-registration nursing curricula and demands specific knowledge and skills. This paper discusses the implementation of the combined pedagogy of unfolding case study and Mask-Ed™ high fidelity simulation within a 12 week unit on chronic illness in an Australian Bachelor of Nursing program. The unfolding case study develops clinical reasoning and decision making through facilitating students to progress through a case study as it develops in complexity. Mask-Ed™ is a high fidelity simulation technique in which a knowledgeable educator portrays an authentic character, but remains hidden from students by a silicone disguise. Using this combined pedagogy creates a unique and innovative opportunity to engage students in learning about the chronic illness experience. This pedagogy can support students to gain a holistic understanding of the psychosocial and physical health care needs of patients and their families and develop their therapeutic skills and clinical judgment. Integration of these interactive learning techniques has the potential to transform student learning about person-centred care within pre-registration curricula.

Validation of the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis.

Objective There is no specific clinical tool for physicians to detect psychosocial and physical distress or health care need in patients with recurrent respiratory papillomatosis (RRP). The main aim of this study is to validate the RRP-adapted Distress Thermometer and Problem List (DT&PL). Study Design Prospective cross-sectional questionnaire research. Setting Academic tertiary care medical centers in Groningen, Netherlands, and Helsinki, Finland. Subjects and Methods Ninety-one juvenile- and adult-onset RRP patients participated from the departments of otorhinolaryngology-head and neck surgery of the University Medical Center Groningen, Netherlands, and Helsinki University Hospital, Finland. The Hospital Anxiety and Depression Scale was used as the gold standard. Results A DT cutoff score ≥4 gave the best sensitivity and specificity. Thirty-one percent of patients had significant distress according to the DT cutoff. Significantly more patients with a score above than under the cutoff had a referral wish. The PL appeared to be reliable. Patients' opinions on the DT&PL were largely favorable. Conclusion The Dutch and Finnish versions of the DT&PL are valid, reliable screening tools for distress in RRP patients.

Missed Opportunities for Postpartum Behavioral and Psychosocial Health Care and Acceptability of Screening Options

ObjectiveTo examine occurrence of health care provider discussion of postpartum women's behavioral and psychosocial health, acceptability of screening, and access to a provider with whom to comfortably discuss sensitive topics. DesignMail survey during the first postpartum year. SettingCommunity dwelling. ParticipantsPostpartum women (N = 168) from diverse backgrounds. MethodsUsing vital records, we drew a random sample that was stratified on race/ethnicity and income from a Southwestern U.S. community. Potential participants were mailed a questionnaire about health care and screening in the areas of depression, diet, physical activity, smoking, and alcohol use during the postpartum period. ResultsWomen reported that discussion of depression most often occurred (51%) during health care encounters, and discussion of weight least often occurred (14%). More than 94% of women indicated they would “welcome” or “not mind” screenings for depression, diet, physical activity, alcohol use, or smoking at health care visits. More than 90% welcomed screening during their infants' pediatric health care visits. Most (86%) reported that screening on an electronic device at their health care visits was acceptable. Most (84%) were interested in completing a screening at home on a Web site. Also, 58% of women without health insurance compared with 24% of those with insurance indicated that they lacked a health professional with whom they could comfortably discuss sensitive topics such as depression. ConclusionWide gaps exist in postpartum behavioral and psychosocial health care. Most women find a variety of screening settings and methods acceptable.

An exploration of caregiver burden for children with nodding syndrome (lucluc) in Northern Uganda.

BackgroundCaregivers of patients with chronic illnesses are often uncompensated for work that is physically demanding, time consuming and emotionally and economically draining. This is particularly true for caregivers of children with nodding syndrome, an emergent neurological disorder of unknown etiology in resource poor settings in Africa.We aimed to explore perceptions of caregivers regarding challenges that a typical caregiver faces when caring for a child with nodding syndrome.MethodsWe used a qualitative exploratory study design with focus group discussions and in-depth interviews to collect data. We analyzed data using the qualitative analysis software package of NVivo and thematic query building.ResultsEmergent themes centered on burden of care with emotional agony as the most prominent. Subthemes reflecting the burden of care giving included child and caregiver safety concerns, burnout, social isolation and rejection, and homicidal ideation. Caregivers also complained of physical and financial constraints associated with the care of children with nodding syndrome.ConclusionsThe findings point to a high burden of care for caregivers of children with nodding syndrome and suggests the need to incorporate community-based psychosocial and mental health care services for the caregivers of affected children into the national health system response.

Post-traumatic stress among rescue workers after terror attacks in Norway

On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims. To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS). A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS. There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (β = 1.7), witnessing injured/dead (β = 2.0), perceived threat (β = 1.1), perceived obstruction in rescue work (β = 1.6), lower degree of previous training (β = -0. 9) and being unaffiliated volunteers (β = 8.3) were significantly associated with PTSS. In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.

Unravelling the potential mechanisms behind hospitalization-associated disability in older patients; the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) cohort study protocol.

BackgroundOver 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the protocol for the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, which aims to unravel the potential mechanisms behind HAD from admission to three months post-discharge.Methods/designThe Hospital-ADL study is a multicenter, observational, prospective cohort study aiming to recruit 400 patients aged ≥70 years that are acutely hospitalized at departments of Internal Medicine, Cardiology or Geriatrics, involving six hospitals in the Netherlands. Eligible are patients hospitalized for at least 48 h, without major cognitive impairment (Mini Mental State Examination score ≥15), who have a life expectancy of more than three months, and without disablement in all six ADLs. The study will assess possible cognitive, behavioral, psychosocial, physical, and biological factors of HAD. Data will be collected through: 1] medical and demographical data; 2] personal interviews, which includes assessment of cognitive impairment, behavioral and psychosocial functioning, physical functioning, and health care utilization; 3] physical performance tests, which includes gait speed, hand grip strength, balance, bioelectrical impedance analysis (BIA), and an activity tracker (Fitbit Flex), and; 4] analyses of blood samples to assess inflammatory and metabolic markers. The primary endpoint is additional disabilities in ADLs three months post-hospital discharge compared to ADL function two weeks prior to hospital admission. Secondary outcomes are health care utilization, health-related quality of life (HRQoL), physical performance tests, and mortality. There will be at least five data collection points; within 48 h after admission (H1), at discharge (H3), and at one (P1; home visit), two (P2; by telephone) and three months (P3; home visit) post-discharge. If the patient is admitted for more than five days, additional measurements will be planned during hospitalization on Monday, Wednesday, and Friday (H2).DiscussionThe Hospital-ADL study will provide information on cognitive, behavioral, psychosocial, physical, and biological factors associated with HAD and will be collected during and following hospitalization. These data may inform new interventions to prevent or restore hospitalization-associated disability.

Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury.

Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury.

Rede de atenção à mulher em situação de violência: os desafios da transversalidade do cuidado

Pesquisa qualitativa, cujo objetivo foi compreender, sob a ótica dos profissionais, como se configura a atenção à mulher em situação de violência. Os dados foram coletados por meio de entrevistas com sete informantes-chave e analisados pelo método de interpretação dos sentidos. Na categoria temática central: Sistema autoeco-organizador das instituições identificou-se dois núcleos de sentido: Eixo da atenção e Funcionalidade da instituição. No primeiro, o eixo de atenção foi classificado em assistência psicossocial, assistência à saúde e assistência policial. Na funcionalidade da instituição, evidenciou-se atendimento às mulheres na captação das demandas e encaminhamentos por meio da triagem. Na perspectiva dos profissionais, apesar dos avanços obtidos nos últimos anos, ainda persiste o “desencontro” da rede na atenção às mulheres em situação de violência, o que não contempla o que se concebe por transversalidade da atenção. O estudo apontou subsídios para fortalecimento da rede, a fim de garantir os direitos da mulher.

Psychosocial Assessment as a Standard of Care in Pediatric Cancer.

This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family resources, family/social support, previous history/premorbid functioning, and family structure/function. Descriptive quantitative studies, systematic reviews, and meta-analyses (n = 149) were reviewed and evaluated using grading of recommendations, assessment development, and evaluation (GRADE) criteria. There is high quality evidence to support a strong recommendation for multifaceted, systematic assessments of psychosocial health care needs of youth with cancer and their families as a standard of care in pediatric oncology.

Need for youth welfare services following child and adolescent psychiatry treatment- a descriptive analysis

Cooperation between health and youth welfare services plays a prominent role in the psychosocial healthcare of children and adolescents with mental disorders. The need analysis presented here measured how many children and adolescents engaged youth welfare services before and after inpatient or daycare treatment. The number of completed treatments from 36 Bavarian daycare and inpatient child and adolescent psychiatric clinics were recorded over a period of 6 months. Besides sociodemographic and diagnostic data, information was collected about indicated and subsequently realized measures of youth welfare following clinical and day care treatment. 33 %of the clinically treated children and adolescents participated in a youth-welfare measure after psychiatric treatment. In the run-up to clinical treatment, 38 % of the treated children and adolescents had engaged services of youth welfare. Half of the children and adolescents contacted both youth welfare services as well as child and adolescent psychiatric services. The residential setting of youth care is of major importance to the cooperative treatment. The provision of both youth welfare services and child and adolescent psychiatry treatment is usually not a matter of going from one system to another, but rather consists of different constellations of complex processes of mutual assistance. The goal is to carry out a structured survey of the common clientele and to develop a crossover system and common care structures in order to improve the overall cooperation.

Physical injury and posttraumatic stress reactions. A study of the survivors of the 2011 shooting massacre on Utøya Island, Norway

ObjectiveThe objective of the study was to investigate the relationship between physical injury (no, moderate and severe) and posttraumatic stress reactions (PTSR) at 4–5months after the attack in survivors of the terror attack at Utøya Island, Norway, 22 July 2011, adjusting for sociodemographic, psychosocial and trauma-related factors. MethodsOverall, 325 young survivors (47% women, mean age 19.4years) were interviewed 4–5months (T1) and 14–15months (T2) after the attack. Variables concerning physical injury, PTSR (UCLA PTSD-RI scale, 0–4), peritraumatic exposure, sociodemographic and psychosocial backgrounds were measured. To evaluate the role of injury, multiple linear regression analyses were conducted. ResultsThe physically injured (n=60) reported higher levels of PTSR than did the non-injured. The difference was statistically significant between the moderately injured (n=37, mean 1.9) and the non-injured (n=265, mean 1.5). No significant differences were found between the moderately and the severely (n=23, mean 1.8) injured. Higher levels of peritraumatic events, peritraumatic reactions and loss of close, female sex and non-Norwegian ethnicity were significantly related to higher levels of PTSR in the full regression model. ConclusionPhysical injury was associated with higher PTSR after the terror attack. Moderately injured survivors may, as those severely injured, exhibit high levels of PTSR, and this should be taken into account when targeting early psychosocial health care after terror.

Problem Gambling in the UK: Implications for Health, Psychosocial Adjustment and Health Care Utilization

Background/Aims: Research indicates that rates of gambling problems are increasing in the UK, but has provided limited consideration of possible implications for individuals, families and communities. This study examines the associations involving problem gambling and indicators of mental and physical health, as well as psychosocial adjustment and health care usage, in a representative sample from England. Methods: Data were derived from the 2007 Adult Psychiatric Morbidity Survey, which is a representative study of adults (n = 7,403). Regression models evaluated the correlates of problem gambling. Results: There were associations with problem gambling and mental health (anxiety, neurotic symptoms and substance use problems) and psychosocial maladjustment (suicidality, financial difficulties and social support). There were limited influences on physical health that were beyond socioeconomic factors and substance use problems. Notwithstanding, the results demonstrated over-representation of gambling problems in certain health-care settings. Conclusions: Findings support recognition of problem gambling as a public health concern in the UK, and initiatives for intervening in health-care services where conditions are over-represented.

HypoAware-a brief and partly web-based psycho-educational group intervention for adults with type 1 and insulin-treated type 2 diabetes and problematic hypoglycaemia: design of a cost-effectiveness randomised controlled trial.

BackgroundProblematic hypoglycaemia is a significant problem among people with insulin-treated type 1 and 2 diabetes mellitus, which adversely affects quality of life and leads to high societal costs. Blood glucose awareness training (BGAT) is a psycho-educational group intervention that has shown to be effective but difficult to implement in clinical practice, due to its demanding nature. The aim of this study is to evaluate the cost-effectiveness of the HypoAware intervention that has its roots in BGAT and helps patients to effectively recognize, treat and prevent hypoglycaemia, while also focussing on the psychosocial consequences of living with the constant risk of hypoglycaemia, both for patients and their significant others.Methods/designAn economic evaluation will be conducted alongside a cluster-randomised controlled trial in eight hospitals in the Netherlands. We aim to include 154 participants who will either receive HypoAware or care as usual. HypoAware consists of three group sessions and is combined with two online modules. The primary clinical outcome is severe hypoglycaemia. Secondary outcomes include mild hypoglycaemia, hypoglycaemia awareness, fear of hypoglycaemia, diabetes distress, anxiety and depression, health-related quality of life, diabetes-specific self-efficacy and HbA1c. Utilities will be measured using the EQ-5D-5 L questionnaire. Costs will be measured from a societal perspective and include health care utilization, medication and lost productivity costs. Measurements will be performed at baseline, 2, 4, and 6 months to compare both groups, and an additional 12 months for the intervention group only. Process outcomes will be gathered after every group meeting via telephone/email contact with health care professionals and via the online environment.DiscussionHypoAware is expected to significantly reduce episodes of severe hypoglycaemia, with subsequent beneficial effects on psychosocial outcomes and health care costs. When proven cost-effective, HypoAware will be incorporated in the clinical guidelines of Dutch diabetes care.Trial registrationDutch Trial Register NTR4538

Predictors of Health Care Use of Women with Breast Cancer: A Systematic Review.

The aim of this study was to identify predictors of health care use among women with breast cancer by conducting a systematic review. Potentially relevant studies were identified by searching the PubMed, EMBASE, PsycINFO, CINAHL, and Cochrane Library databases. Also, backward and forward citation searches were performed. Studies were selected if they addressed associations between (a) sociodemographic, enabling (e.g., income), clinical and health related, or psychosocial predictors, and (b) medical, psychosocial, or paramedical health care use of adult women with breast cancer. The health care types of interest were hospital utilization and provider visits. An evaluation of aggregated findings was performed to determine consistency of findings between studies. Sixteen studies were included in the review. Higher age, a more advanced cancer stage, more comorbid disorders, having a mastectomy, a lymph node dissection, and breast reconstruction were consistently associated with higher hospital utilization. None of the patient characteristics were consistently associated with medical, psychosocial, or paramedical health care use-but psychosocial or paramedical associations were also less examined. In conclusion, sociodemographic, medical, and treatment-related factors were consistently associated with (higher) health care use of breast cancer patients. Practitioners may use this information to anticipate future use of subgroups of patients. Results may also be used in the development of interventions that target relevant predictors, to reduce patients' health care use and accompanying health care costs. Furthermore, more research is needed to identify predictors of psychosocial and paramedical health care use.

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.

Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function. An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. The study will be conducted in a community setting. The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. A self-reported diagnosis of persistent hip pain will be used. The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision.