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Benefits of Comprehensive Health Care for Improving Health Outcomes in Women
Abstract
The American Psychological Association Health Care for the Whole Person Task Force was formulated to provide a rationale for integrating behavioral health services in primary care. Collectively, the task force called for a transformation of the biomedical system into one based on the biopsychosocial model. This article is a summary of the Women's Health Committee position paper that reviewed contextual factors in women's health, provided recommendations for clinical service action, and recommended an integrated primary health care system to address women's health needs. This article provides a vision of integrated care and a practical guide for psychology practitioners as they collaborate with other health care providers and health policy groups to improve health outcomes for women over the life course. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Perhaps the most obvious issue is concern about preexisting conditions that have historically been used to deny insurance coverage to women with disabilities. Jarrett, Yee, and Banks (2007) identified lack of health insurance as contributing to ''premature death, disease, and disability'' (p. 311) for women. ...
... Women with disabilities, on average, endure domestic violence for longer periods than women without disabilities and are at high risk for being abused by multiple perpetrators (Banks, 2007). In addition to the emotional, physical, and sexual abuse generally considered as manifestations of domestic violence, Nosek, Foley, Hughes, and Howland (2001) found that women with disabilities described five types of domestic violence: ...
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
... Future directions are delineated to support the integration of empirical findings, clinical practice, and policy development. Additional articles in the Health Care for the Whole Person series are "The Economics of Behavioral Health Services in Medical Settings: A Summary of the Evidence" (Blount et al., 2007), "Benefits of Comprehensive Health Care for Improving Health Outcomes in Women" (Jarrett, Yee, & Banks, 2007), and "A Rural Perspective on Health Care for the Whole Person" (Stamm, Lambert, Piland, & Speck, 2007). ...
Quality health care must be informed by the best available scientific knowledge. This article offers research evidence supporting "health care for the whole person." We present an integrative biopsychosocial framework that can serve as a useful foundation for translational research endeavors and the development, evaluation, and dissemination of evidence-based health and mental health interventions. Pain and depression are used as exemplars of the biopsychosocial model. Empirical support for mental health interventions in primary care settings is highlighted, with particular emphasis on the treatment of depression across the life span. Research, practice, and policy implications based on the extant evidence base for health care for the whole person are offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The purpose of this article is to summarize the evidence about the economic value of behavioral health care, especially in primary medical settings; to recount the history of this kind of study; and to describe some of the clinical, administrative, and financial implications of this evidence. Additional articles in the Health Care for the Whole Person series are "Benefits of Comprehensive Health Care for Improving Health Outcomes in Women" (Jarrett, Yee, & Banks, 2007), "Health Care for the Whole Person: Research Update" (Kaslow et al., 2007), and "A Rural Perspective on Health Care for the Whole Person" (Stamm, Lambert, Piland, & Speck, 2007). ...
The health care system in the United States, plagued by spiraling costs, unequal access, and uneven quality, can find its best chance of improving the health of the population through the improvement of behavioral health services. It is in this area that the largest potential payoff in reduction of morbidity and mortality and increased cost-effectiveness of care can be found. A review of the evidence shows that many forms of behavioral health services, particularly when delivered as part of primary medical care, can be central to such an improvement. The evidence supports many but not all behavioral health services when delivered in settings in which people will accept these services under particular administrative and fiscal structures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The problem is that as baby boomer women age, their need for housing and healthcare services may require new models not currently in place (Hodge, 2004; Jarrett, Yee & Banks, 2007; Quine & Carter, 2006). Specifically, the problem is that although planning has occurred, an in-depth examination of the thoughts, opinions, lived experiences, and expectations of baby boomer women regarding their housing and health concerns has not occurred (Hickey, 2004; Quine & Carter, 2006). ...
A phenomenological study of anticipated housing, healthcare, and biopsychosocial needs of aging female baby boomers
Martha Banks examines her evolving professional life in the context of dynamic intersecting marginalized demographic identities and overcoming challenges to become a leader in two fields: psychology and religion. Her publications and teaching reflect opportunities to pull together multiple interests which continue into her retirement to “renewment,” during which she finds ways to serve as a bridge. She seeks to provide mentoring that was often missing from her training and early career. This article ends with advice for graduate students and early career psychologists, as well as a challenge to repair recent damage to social justice accomplishments of the past four centuries.
Disability is experienced by about 20% of US citizens, and at higher rates among people of color than among those of non-Hispanic European descent. This chapter provides an overview of disability with emphasis on the definition of disability using current models, followed by the cultural and identity meaning of disability, cultural gaps in treating People of Color with Disabilities, and ethical issues. Perceptions and attitudes about disability and People with Disabilities are also discussed, as well as the development of disability identity. Attention is given to cultural gaps in assessment, treatment, and rehabilitation outcomes for People of Color with Disabilities.
Introduction
The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.
Methods
A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines.
Results and discussion
The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research.
Conclusions
This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women's health outcomes.
The authors summarize the health care problems facing rural and frontier America by addressing five key issues within the framework of health care for the whole person: how to (a) provide health care access, (b) ensure health care quality, (c) provide a range of health care or meet the scope of practice demands, (d) address regional, rural-specific characteristics that may exist, and (e) address health professionals' quality of life. When working in rural and frontier areas it is crucial for providers to collaborate across all types of health care to provide better care and better utilize a region's tautly stretched resources. Rural health care resources are provided. The authors attempt to demonstrate characteristics of rural culture and rural and frontier populations' health care disparities, highlighting the need for collaborative care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychology is on the cusp of becoming a major contributor to the health of the people living in the United States. Over the past 50 years, psychology research and psychologically based interventions and prevention strategies have increasingly influenced the health of people and health care services in the United States. In this article, the authors review briefly the first 40 years of psychology's development as a health profession. An overview of the accelerating changes for psychological involvement in health since the millennium follows. Then, a vision for the future is presented. This article has as its theoretical base a biopsychosocialcultural model of health that places increasing influence on the role of culture, which includes race, ethnicity, social class, gender, physical ablebodiness, and developmental age. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article summarizes the rationale for and history of Ronald F. Levant's 2005 American Psychological Association Presidential Initiative, "Health Care for the Whole Person," from which this special section originated. This initiative was intended to have both practice and policy implications in the application of the biopsychosocial model. The articles in this series present the rationale for and details of this integrated model in terms of research, economics, rural applications, and women's health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Integrating health care into primary and specialty physician practices and clinics has potential benefits for women; racial/ethnic minorities; and lesbian, gay, bisexual, transgendered populations, thus making a major contribution to the health disparities in America. Mounting evidence suggests that physical illnesses are accompanied and exacerbated by emotional, social, and cultural factors. Many of the chronic diseases, cardiovascular disease, HIV-AIDS, diabetes, and some cancers can be prevented and altered by behavioral changes and are thus considered behavioral diseases. In addition, nonadherence to medication is a significant factor in less-than-optimal treatment of any illness. Thus, medical treatment without coordinated attempts to also treat the behavioral and social factors compromises its effectiveness. Treatment is often complicated by the lack of timely diagnoses of issues such as domestic violence, substance abuse, and eating disorders. Furthermore, helping patients negotiate medical visits, treatment options, and disease prevention and management can be effectively addressed within an integrated primary care system of health delivery with better outcomes for minorities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article is an application of the Guidelines for Psychological Practice with Girls and Women to psychological issues faced by Women with Disabilities. It includes culture-specific issues faced by Women with Disabilities, the multiple roles of Women with Disabilities, the importance of informal support systems, and the intersection between feminism and disability. The voices of Women with Disabilities from a variety of cultures are included to demonstrate the breadth of disability as it impacts women. Attention is given to the impact of worldview on understanding disability (medical condition, limitation due to socially constructed barriers, gap between individual resources and demand for ability, or segregation by ability status) and development of theories, services, and laws. Perspectives of health professionals, disability advocates, and family members are provided to identify issues that need to be included in a comprehensive psychology of Women with Disabilities.
PURPOSE AND OBJECTIVES: The management of chronic medical conditions is very costly because of poor response to evidence-based treatment plans. Behavioral health disorders have been shown to impact one's inability to adhere to treatment protocols, thus worsening the course of the comorbid state. Traditional management methods have been unsuccessful in diminishing the costs associated with increased utilization of healthcare services that result from poor adherence to treatment plans and treatment failures that ultimately produce poor clinical outcomes. This article examines the use of an alternative approach on an identified high-risk population of individuals with the primary goal of promoting patient-centric self-efficacy and optimal patient care, thereby improving clinical outcomes resulting in a reduction of overall healthcare utilization.
Care coaches, in collaboration with primary care physicians, engaged in telephonic consultation with identified participants from one regional health plan to validate and modify treatment plans in order to conform to evidence-based guidelines.
The approach used in this study demonstrated improved clinical outcomes through decreases in acute care facility admissions, lengths of stay in acute care facilities, and emergency department visits. In addition, a positive return on investment is presented as evidence of the efficacy of this alternative approach.
Predictive modeling and risk stratification methodologies are useful in the identification of individuals at risk for treatment failure and poor outcomes. Individuals who suffer from multiple comorbidities with identified psychosocial issues/barriers have increased health risks and costs that are far greater than those who do not appear to have associated psychopathology or psychosocial factors. Examining the use of the study protocol from a lifetime perspective can further reduce costs in the future and still show a positive return on investment.
This paper highlights the difficulties facing medical and mental health professionals in helping families in which there is violence. Emphasis is placed on how domestic violence presents in primary care medical settings. Physician and patient characteristics that interfere with domestic violence detection are reviewed. A role is outlined for psychologists in primary care settings to facilitate detection and treatment. Facilitative efforts include educating physicians through collaboration and serving as an on-site resource for information and consultation.
African Americans experience HIV and AIDS at a rate 10 times greater than the U.S. White population. Although there have been advances in HIV risk-reduction strategies, these efforts have not been as successful in decreasing HIV infection in the African American population. This article reviews the research base of HIV prevention interventions to identify research that will lead to the development of more effective prevention strategies for African Americans. Major limitations found in the research include the exclusion of African Americans in studies, particularly those at higher risk, and the lack of using culturally based theory to guide research. Recommendations for improving research are offered. They include conducting research that focuses on structural interventions rather than individuals, controlling for diversity within the African American population, defining culture when using it in research, and developing a cadre of African American researchers involved in prevention intervention studies.
Quality health care must be informed by the best available scientific knowledge. This article offers research evidence supporting "health care for the whole person." We present an integrative biopsychosocial framework that can serve as a useful foundation for translational research endeavors and the development, evaluation, and dissemination of evidence-based health and mental health interventions. Pain and depression are used as exemplars of the biopsychosocial model. Empirical support for mental health interventions in primary care settings is highlighted, with particular emphasis on the treatment of depression across the life span. Research, practice, and policy implications based on the extant evidence base for health care for the whole person are offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The health care system in the United States, plagued by spiraling costs, unequal access, and uneven quality, can find its best chance of improving the health of the population through the improvement of behavioral health services. It is in this area that the largest potential payoff in reduction of morbidity and mortality and increased cost-effectiveness of care can be found. A review of the evidence shows that many forms of behavioral health services, particularly when delivered as part of primary medical care, can be central to such an improvement. The evidence supports many but not all behavioral health services when delivered in settings in which people will accept these services under particular administrative and fiscal structures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Socioeconomic status (SES) is strongly associated with risk of disease and mortality. Universal health insurance is being debated as one remedy for such health inequalities. This article considers mechanisms through which SES affects health and argues that a broader and more comprehensive approach is needed.
Published articles surveyed using MEDLINE and review articles and bibliographies.
Research is reviewed on the association of SES with health outcomes in different countries, including those with universal health coverage. Socioeconomic status relates to health at all levels of the SES hierarchy, and access to care accounts for little of this association. Other mechanisms are suggested and implications for policy and clinical practice are discussed.
Health insurance coverage alone is not likely to reduce significantly SES differences in health. Attention should be paid both in policy decisions and in clinical practice to other SES-related factors that may influence patterns of health and disease.
In August 1996, the Personal Responsibility Work Opportunity Reconciliation Act (P.L. 104-193) was signed into law, ending a 60-year federal entitlement guaranteeing families some basic level of assistance during periods of economic hardship. Several components of this new legislation have the potential to impact upon the health and well-being of women and children. We summarize studies examining the relationship between welfare participation and physical and mental well-being of women and what is known about the effects of poverty on health; the patterns of employment among welfare participants and the health consequences of low-wage work on women; domestic violence among welfare recipients; the potential health consequences of the provisions of the new Temporary Assistance to Needy Families (TANF) program for women's and adolescent health; and the consequences of the new TANF provisions for the health and well-being of immigrant women. We discuss the implications for policy makers in monitoring and minimizing the negative impact of welfare reforms on women's health and well-being.
Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system-public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery.
Few depressed older adults receive effective treatment in primary care settings.
To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.
Randomized controlled trial with recruitment from July 1999 to August 2001.
Eighteen primary care clinics from 8 health care organizations in 5 states.
A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).
Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depression, Problem Solving Treatment in Primary Care.
Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life.
At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group.
The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.
Little is known about women's experiences after stopping menopausal hormone therapy.
To describe women's symptoms and management strategies after stopping the intervention in a large estrogen plus progestin trial.
Cross-sectional survey of 8405 women (89.9%; N = 9351) at 40 clinical centers who were still taking study pills (conjugated equine estrogens plus medroxyprogesterone [CEE + MPA] or placebo) when the estrogen plus progestin intervention (Women's Health Initiative) was stopped. Surveys were mailed 8 to 12 months after the stop date. Logistic regression was used to model vasomotor symptoms and pain or stiffness symptoms as functions of former treatment and baseline symptoms, adjusted for appropriate covariates.
Symptoms (vasomotor or pain and stiffness) and management strategies.
Respondents' mean (SD) age at trial stop date was 69.1 (6.7) years. They averaged 5.7 years of taking study pills. Moderate or severe vasomotor symptoms after discontinuing study pill use were reported by 21.2% of former CEE + MPA and 4.8% of placebo group respondents overall and by 55.5% and 21.3%, respectively, with these symptoms at baseline (randomization). Compared with respondents in the former placebo group, moderate or severe vasomotor symptoms (adjusted odds ratio [AOR] 5.82; 95% confidence interval [CI], 4.92-6.89) and pain or stiffness symptoms (AOR, 2.16; 95% CI, 1.95-2.40) were more likely in respondents in the former CEE + MPA group. Both vasomotor symptoms (AOR, 5.36; 95% CI, 4.51-6.38) and pain or stiffness symptoms (AOR, 3.21; 95% CI, 2.90-3.56) also were more likely in women with these symptoms at baseline. Women reported a wide range of strategies to manage symptoms.
More than half of the women with vasomotor symptoms at randomization to active CEE + MPA also reported these symptoms after discontinuing use of the study pills. However, these participants did not include women who were unwilling to be randomized or who had stopped taking the study pills earlier. These findings should be considered when advising women to treat menopausal symptoms with hormone therapy for as short duration as possible. Investigation of alternative strategies to manage menopausal symptoms is warranted.
Psychological Treatment of Chronic Illness: The Biopsychosocial Therapy Approach is unique in its focus on the experience of chronic illness from both the patient's and the provider's perspective. It emphasizes the need for a comprehensive biopsychosocial assessment, case conceptualization, and treatment plan. It also stresses the clinical value of tailoring the treatment process to a patient's personality, family, culture, and health dynamics. In addition, counter-transference and other therapeutic relationship issues are addressed because they are more common and problematic in working with people who are chronically ill than they are with traditional psychotherapy clients. Case studies and extensive session transcriptions further illustrate the process of treating chronic illness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Women who have disabilities represent a very broad spectrum in terms of ability to manage their personal and social affairs. This collection reflects many of the issues faced by Women with Disabilities, the social construction of disability, and suggests development and modifications Of culturally-relevant therapy to meet the needs of those women. Many of the selections address the concerns of age, ethnicity, sexual orientation, size, relationships, and other social situations that complicate the lives of Women with Disabilities. Several authors address safety concerns and the vulnerability of Women with Disabilities, while others focus on successful coping strategies. Many include the voices of Women with Disabilities. Those voices reveal to therapists the need to increase sensitivity and conduct the research that provides the foundation for developing appropriate therapies. Feminist therapists describe the extensions they have made to traditional psychotherapy in order to directly address a wide range of issues faced by Women with Disabilities.
Coronary heart disease (CHD) is a chronic condition that requires medication and causes activity limitations due to ongoing angina or congestive heart failure. This chapter discusses various risk factors for CHD. Family history of CHD, cigarette smoking, hypertension, diabetes mellitus, sedentary lifestyle, levels of high and low density lipoprotein cholesterol, and obesity are major risk factors for CHD in women, although observational studies support racial/ethnic differences in the relative contributions of these factors to CHD risk. Low folate and high homocysteine levels are emerging as potentially important factors as well. The public health implications of these CHD risk factors in women are tremendous in their social, emotional, and fiscal impact on individuals and to the larger health care system. Randomized trials are urgently needed to develop interventions that will assist women in modifying known CHD risk factors and to test the efficacy of such changes on CHD risk. Trials are particularly crucial for minority women, where the CHD burden is greatest.
Research is reviewed that evaluates the extent to which psychologists can reduce medical costs of health problems while still maintaining treatment effectiveness. Specific areas on cost-effectiveness include the following: preparation for anxiety provoking medical procedures, smoking cessation, detection and treatment of somatizing patients, psychological intervention in general rehabilitation, rehabilitation of chronic pain patients, behavioral treatment of cardiovascular disorders, and adherence to medical regimens. Major conclusions on these areas are presented. Difficulties with the research are discussed along with areas for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It is alleged that eating disorders are nonexistent in African American women and that eating disorder symptomatology occurs predominantly among White middle class women (Kumanyika, Wilson, & Guilford-Davenport, 1993; Smolak & Striegel-Moore, 2001). This research attempted to identify differences in eating disorder symptomatology in African American and White American women. An eating disorder is a disability because it can damage the person physically, emotionally and socially. It can be undetected for years and society may reinforce the hidden disorder by being complimentary regarding the thin appearance of the person. The Eating Disorder Inventory (EDI) was used to measure psychological traits and symptom clusters associated with the understanding and treatment of eating disorders (Garner, 1990). Measures of self-esteem, depression and coping were also examined. Findings indicated differences between African American and White women on the Ineffectiveness scale of the EDI, differences between the urban/rural women on Ineffectiveness and Perfectionism, and differences in coping strategies and education among this sample group of women. Successful treatment usually involves psychotherapy and/or medication for depression.
In this chapter, the authors discuss the impact of violence on women's health. The term
violence is used to refer to the intentional use of aggressive physical and verbal behaviors regardless of whether injury is actually incurred. First, the authors discuss the impact of violence on women's health with a focus on injury, systemic health problems, pregnancy-related issues, and the mental health consequences of violence and abuse. Second, they discuss dealing with violence against women. Finally, they address health care, health promotion, and disease prevention by delienating specific steps essential for working with women and violence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
focus on a limited aspect of behavioral medicine, namely, intervention or treatment research, especially empirical research from the last 10 years / addresses the following areas: obesity, smoking, hypertension, chronic pain, and headache / discuss cancer, GI [gastrointestinal] disorders, insomnia, rheumatoid arthritis, and Type A behavior, as well as the emerging field of psychoneuroimmunology (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors summarize the health care problems facing rural and frontier America by addressing five key issues within the framework of health care for the whole person: how to (a) provide health care access, (b) ensure health care quality, (c) provide a range of health care or meet the scope of practice demands, (d) address regional, rural-specific characteristics that may exist, and (e) address health professionals' quality of life. When working in rural and frontier areas it is crucial for providers to collaborate across all types of health care to provide better care and better utilize a region's tautly stretched resources. Rural health care resources are provided. The authors attempt to demonstrate characteristics of rural culture and rural and frontier populations' health care disparities, highlighting the need for collaborative care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[examine aspects of] the surge of activity related to women's health issues / review important changes taking place relating to the creation of the Office of Research on Women's Health and the Women's Health Initiative / discuss methodological and research directions for studying psychosocial factors in women's health / highlight understudied populations of women at risk for physical and psychosocial problems / examine some important gender issues that must be addressed to promote the study of women's health / examine factors affecting career success of women researchers (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Given the dramatic changes in health care and technology over the past decade, this book is not intended to be a restatement of the many well-established and now considered traditional tasks that health psychologists engage in. Rather, by highlighting innovative DoD and other programs, we offer new ways of thinking about health psychology that may serve as a guide for the future. The first chapter in this book, for example, provides a new conceptual model and practical primer for the delivery of services in a primary care setting. Imbedded in this and other chapters are paradigm shifts the reader is encouraged to make. The hallowed 50-minute therapy hour, for example, is replaced with an effective 15- to 30-minute session that complements the primary care physician. Where appropriate, authors provide the reader with helpful hints on how to make the transition to these new models a smooth one. In most training programs, it is the psychosocial aspects of the biopsychosocial model that are emphasized. Unfortunately, the biological aspect invariably gets short shrift. Psychological assessment in primary care and other medical settings demands a greater emphasis on medical history, medical assessment, and medical symptomology, and the authors of chapter 2 address this often missing link. In keeping with the expanding themes of the first two chapters, the third chapter further extends the influence of primary care psychologists through the use of telehealth, with specific attention to the clinical, ethical, and technical issues that emerge with the use of this technology. Next the book presents interventions and treatment models specific to the adult primary care setting. Chapter 4 addresses the importance of a multidisciplinary primary care approach in the treatment of pain management, and this is followed by chapters on treating cardiovascular disease, HIV/AIDS, diabetes mellitus, and insomnia. Pediatric behavioral health consultation, pediatric psychology in primary care, and school-based pediatric psychology models and interventions are presented in the next three chapters. The final three chapters in the book address the role of primary care psychology in women's health, in sexual issues related to women's health, and present future applications of primary care psychology to men's health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the rationale for integrating health psychology services into women's primary care and obstetrics-gynecology (OB-GYN), and presents examples of gender-specific assessment and treatment interventions used by psychologists in these settings. Throughout the chapter, health psychology services refers both to mental health and behavioral medicine interventions. Primary care focuses on the health and well-being of adolescent girls through elderly women who are seen in internal medicine and family practice, as well as OB-GYN. OB-GYN is generally considered a primary care setting because of the significant portion of women--especially those in their reproductive years--who frequently receive all of their health care form these providers. In this chapter the authors emphasize how psychologists can work effectively and collaboratively in primary care settings to address women's biopsychosocial needs across the life span and to promote optimal health and mental health outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early stages of mental illness and to provide evidence-based treatments, but this potential is largely unfulfilled because of significant system-level barriers inherent in primary care. Recent effectiveness research provides an excellent framework for cost-effectively improving care of depression using stepped care principles and strategies effective for improving care of other chronic conditions. Psychologists have the potential to help implement stepped care models by providing training, consultation and ongoing quality assurance, as well as by delivering collaborative care models of acute-phase treatment and relapse prevention interventions.
The importance of psychological treatments in forthcoming national health care plans has been deempha-sized in federally sponsored clinical practice guidelines published to date, and questioned by certain policymakers and consumer groups. Many critics impugn the clinical efficacy and effectiveness of psychological treatment compared to drug treatments. This article reviews evidence suggesting that psychological interventions from a variety of theoretical perspectives have demonstrated effectiveness for a wide range of disorders—either alone or, in some cases, in combination with medications. In most cases these treatments are more effective and often longer lasting than credible alternative psychological interventions serving as “psychological placebos.” Political and public relations issues, as well as problems with dissemination, must be overcome if the public is to benefit fully from powerful and effective psychological interventions in any national health care plan.
National health data are presented to demonstrate that important issues of women’s health are linked to inequality and to the generalized oppression of women. Health issues of violence, reproductive health, coronary health, and mental health are reviewed as they relate to women of color and diverse ethnicity as well as to women in general. Feminist principles are applied to these issues, pointing out inequalities in assessment, treatment and access to care, bias in research and lack of research on topics particularly relevant to women and minorities, and limitations in the education and training of health care providers. It is imperative that these problems, which are not solely biological, be addressed in light of systems-level analysis that includes a feminist lens. Guided by feminist principles and sensibilities, the relevance of behavioral and social science is outlined for research, training, assessment, intervention, evaluation, and overall social change.
Incluye bibliografía e índice
THE AMERICAN MEDICAL Association (AMA) is urging all physicians to help stop the epidemic of family violence that has reached staggering proportions in the United States. Recently, the Centers for Disease Control, Atlanta, Ga, has designated interpersonal violence as a major public health problem that rivals cancer and heart disease in terms of loss of life and cost to society.
Physicians in all specialties are already treating the consequences of domestic violence, sexual abuse, and child and elder abuse. Now the AMA is asking physicians to be aware that violence may be a cause of these injuries and to inform their patients (who are victims) of resources that can help them.
To heighten physician awareness of this major health problem, and to increase knowledge regarding its diagnosis, treatment, and prevention, the AMA specifically has launched the National Campaign Against Family Violence. Details of the campaign were revealed in a press
WOMEN LIVING in violent relationships pay a heavy price with their physical and mental health, and sometimes even their lives. Thirty-four percent of all female homicide victims older than 15 years are killed by their husbands or intimate partners, according to Federal Bureau of Investigation homicide data from 1976 to 1987.
Besides the acute injuries incurred from their battering relationships, these women also develop a broad range of physical illnesses and psychological problems. Typically, as the battering escalates, so do their feelings of profound isolation from the institutions and resources—including medicine—that presumably could help them.
Historically, most physicians treated the physical injuries that are a result of domestic violence and did not address their cause, that is, the patient's abusive relationship (Gender and Society. 1989;3:506-517; Int J Health Serv. 1979;9:461-492 [see p 939]).
"Physicians will often say, 'I'm not a law enforcement officer, and I'm not a social worker. I'm
Major depression is a frequent and disabling psychiatric disorder in the United States. This report examines the prevalence and risk factor profile of both pure and comorbid major depression according to data from the National Comorbidity Survey.
To estimate the prevalence of psychiatric comorbidity in the United States, a national sample of 8,098 persons 15-54 years of age from the 48 conterminous states was surveyed with a modified version of the Composite International Diagnostic Interview. Results: From the survey data the prevalence of current (30-day) major depression was estimated to be 4.9%, with a relatively higher prevalence in females, young adults, and persons with less than a college education. The prevalence estimate for lifetime major depression was 17.1%, with a similar demographic distribution. Both 30-day and lifetime prevalence estimates were higher than estimates from the earlier Epidemiologic Catchment Area study. When pure major depression was compared with major depression co-occurring with other psychiatric disorders, the risk factor profiles exhibited clear differences.
These findings suggest a greater burden of major depression in community-dwelling persons than has been estimated from previous community samples. The risk factor profile showed significant differences between persons with pure and combined major depression.
The dementia caregiving literature is reviewed with the goals of (a) assessing the prevalence and magnitude of psychiatric and physical morbidity effects among caregivers, (b) identifying individual and contextual correlates of reported health effects and their underlying causes, and (c) examining the policy relevance of observed findings. Virtually all studies report elevated levels of depressive symptomatology among caregivers, and those using diagnostic interviews report high rates of clinical depression and anxiety. The evidence is more equivocal and generally weaker for the association between caregiving and physical morbidity, such as self-rated health, number of illnesses, symptomatology, health care utilization, preventive health behaviors, and cardiovascular functioning. Across studies, psychiatric morbidity in caregivers was linked to patient problem behaviors, income, self-rated health, perceived stress, and life satisfaction. Physical morbidity was associated with patient problem behaviors and cognitive impairment, and with caregiver depression, anxiety, and perceived social support. Possible causes of reported effects and policy implications are discussed.
The physical and emotional burden of caring for a functionally impaired spouse may adversely affect the preventive health behavior of the caregiver. This study explores the relationship between caregiving and lifestyle health behaviors and use of preventive services.
The Caregiver Health Effects Study identified spousal caregivers among a sample of more than 3,000 married, community-dwelling older persons, from four counties in the United States, who were enrollees in the Cardiovascular Health Study. High-level caregivers were defined as having a spouse with an ADL impairment (n = 212) and moderate-level caregivers, a spouse with one or more IADL impairments (n = 222). For each caregiver, a control, matched for age and gender, was selected (n = 385). Structured interviews were conducted in the home, following enrollment.
Being a high-level caregiver significantly increased the odds of not getting enough rest, not having enough time to exercise, not having time to rest to recuperate from illness, and forgetting to take prescription medications, compared with noncaregivers. These findings did not hold for moderate-level caregivers. The odds were not significantly different for either level of caregiver compared with noncaregivers for missing meals, missing doctor appointments, missing flu shots, and not refilling medications. Larger proportions of caregivers with a strong sense of control had good preventive health behaviors, compared with caregivers with a weak sense of control.
In previous studies, unadjusted comparisons of mortality and major morbidity after acute myocardial infarction have generally indicated that women have a poorer outcome than men. Much larger studies are needed, with more complete adjustment for coexisting conditions, to determine whether this difference is explained by the older age of the women studied or by the presence of other unfavorable prognostic factors, or both.
As part of the Third International Study of Infarct Survival (ISIS-3), information was collected on deaths during days 0 to 35 and on major clinical events during hospitalization up to day 35 for 9600 women and 26,480 men with suspected acute myocardial infarction who were considered to have a clear indication for fibrinolytic therapy. We compared the outcome among women and men, first without adjustment, then with adjustment for age, and finally with adjustment for other recorded baseline characteristics by means of multiple logistic regression.
The unadjusted odds ratio for death among women as compared with men was 1.73 (95 percent confidence interval, 1.61 to 1.86). The women were significantly older than the men, and after adjustment for age the odds ratio was reduced markedly to 1.20 (95 percent confidence interval, 1.11 to 1.29). Adjustment for other differences in base-line clinical features further reduced the odds ratio to 1.14 (95 percent confidence interval, 1.05 to 1.23). Excesses in other major clinical events among women were generally reduced to a similar extent by adjustment.
It seems likely that there is at most only a small independent association between female sex and early mortality and morbidity after suspected acute myocardial infarction.
To estimate the prevalence and impacts of psychological disorders among primary care patients.
Primary care clinics at Group Health Cooperative of Puget Sound participating in a multi-center, international World Health Organization study.
Prevalence survey of a stratified sample of consecutive primary care patients.
Psychiatric diagnosis, work disability, and health care costs.
Depression, anxiety and somatoform disorders were common among primary care patients. They were associated with significant disability, unfavorable health perceptions and increased health care costs.
Psychological disorders are common among primary care patients and these disorders have significant societal impacts including work disability and increased health care costs. HMOs with integrated delivery systems that have developed public domain research capabilities have a critical role to play in efforts to reduce the burden of these disorders by evaluating innovations in health care services for psychological disorders.
This article, based on data from the Commonwealth Fund 1998 Survey of Women's Health, examines the relationship between socioeconomic status (SES) and women's health. Women living in poverty are less likely than their higher-income counterparts to have health insurance and use preventive services, and more likely to have access problems, suffer from chronic illnesses, and report low overall health scores. Women with low educational attainment are also less likely to have health insurance and to use preventive services, and more likely to report poorer health status than women with a college education. We conclude with implications for public policy.
Attention deficit hyperactivity disorder (ADHD), commonly diagnosed in males, is often a "hidden disorder" in girls and women. This lack of recognition can be partially explained because the symptoms are less overt in females. In addition, coexisting disorders in females are often different from those seen in males who have ADHD. Higher rates of anxiety, mood, and substance disorders, as well as learning disabilities, often complicate the picture. Thus, clinicians are challenged with disentangling the symptoms of ADHD from symptoms of these coexisting conditions. In addition, fluctuating hormone levels may affect ADHD symptoms and treatment in females. Only with gender-sensitive diagnosis and treatment will the public health concern posed by the underdiagnosis of ADHD in females be addressed. This case report of a 23-year-old female illustrates the specific difficulties with the gender-sensitive aspects of the diagnosis and treatment of ADHD in females.
Socioeconomic status and women's health
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Symptom experience after discontinuing use of estrogen plus progestin
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