Social science & medicine. Part E, Medical psychology最新文献

In a prospective study of 3546 patients with drug overdose and abuse, females outnumbered males in overdose 2:1 while males predominated in drug abuse 2:1. Half of drug abuse patients and 28% of overdose patients were under 21 years of age. In overdose the highest incidence rates were at ages 19–20 for both males and females (800 and 512 per 100,000 population, respectively). Relatively high proportions of females and patients over 60 were admitted to hospital. Females and youth of both sexes frequently ingested salicylates, while barbiturates and other sedatives were chosen more commonly by adult males. Benzodiazepines were the most commonly selected drugs among all age groups irrespective of sex. Concurrent ethanol use, especially among males of all ages, was frequently found. In drug abuse, the choice of benzodiazepines, ethanol, barbiturate, non-barbiturate sedatives, salicylates, other analgesics, cannabis and other hallucinogens were related to age. Cannabis and other hallucinogens were more prevalent among the younger age group and the remaining drugs more prevalent among the older. Our data show that drug overdose and abuse is a major health problem among the youth.

Much of the data available in the literature dealing with psychiatric treatment from the point of view of hospitalized patients stem from qualitative research. Via observations, informal interviews, or masquerading as patients, social scientists have described hospital treatment and patients' attitudes toward it largely in unfavorable terms. Relatively few scientists have taken representative samples of patients, questioned them formally about treatment with objective tests or validated scales, and displayed the findings in statistical format. The present report is a review of this body of quantitative research, with special consideration given to ascertaining patients' degree of favorableness toward treatment. Results indicate that in 34 of the 44 different samples reviewed, or 77%, patients espoused favorable attitudes. Patients proved to be more favorable in their attitude toward treatment at psychiatric hospitals generally than the treatment they received at their own institution. Type of hospital and time of study had a negligible impact on patients' views. Limited data suggest that attitudes improve, or at least do not worsen, as a consequence of hospitalization. Studies that compared patient and staff attitudes reported inconsistent findings. A content analysis of the attitude measures for treatment in general revealed that patients are positive toward the hospital's therapeutic value, assistance with medical problems, restrictions, activities, and involvement of family members, negative toward its patient government and staff/patient relations, and ambivalent toward its patient freedoms and responsibilities. The content analysis of attitudes pertaining to specific therapies disclosed that indvidual, occupational, milieu, physical, recreational, and activity therapies are perceived positively by patients, group therapies negatively, and medication and ECT in an ambivalent manner. Social variables minimally affected the favorableness of patients' responses, and the impact of psychiatric variables was somewhat greater. Interpretations of these results, particularly in regard to the discrepancy between qualitative and quantitative data, are offered.

The recent history and diversification of occupations within the medical profession suggests that members of different occupational groups would perceive other occupations in characteristically different ways. This paper examines the general theme that one might expect an unsympathetic appraisal of a medical or helping profession which seeks to appropriate a field of knowledge, style of operation or client group, which is under the established jurisdiction of another helping profession. A hundred and twenty five people from five different occupational groups within the medical profession indicated their perceptions of their own and eleven other health care occupations. Analysis of variance revealed very different patterns of perceptions particularly across the professional groups doing the experiment. The groups varied particularly in their perception of accessibility and status, though not as much over essentiality and pay. The rank ordering of the twelve professions along a number of the scales revealed particularly interesting findings. Results are discussed in terms of the history of the various professions and implications are drawn for the primary health team, and the relative pay and conditions of the groups.

The purpose was to compare psychological status between high and low stress groups in Anglo, Black, and Cuban cultures. High and low stress groups were significantly different particularly in regard to symptoms of somatization, depression, and anxiety. Cultural groups differed significantly on social participation and social dysfunction. Controlling for locus of control decreased some of the differences between high and low stress and controlling for social class diminished some of the differences in adjustment between cultures. The fact that symptoms differentiated high and low stress groups similarly in each culture suggests that reactions to such stresses as death and illness, which occurred frequently among these older persons, may be a common response that transcends cultural differences.

We analyzed verbatim transcriptions of audiotaped rounds in a large pediatric intensive care unit to determine how physicians refer to families of critically ill children. In almost 4 hours of rounds recorded on 3 days in 1 week, the doctors mentioned the families of 11 of the 25 different patients discussed. There were 19 discreet references to parents or an average of 1 reference every 12$\text{1}\text{2}$ minutes. Nine references were made during the formal presentation of the patients' medical histories. Three references to parents involved discharge of chronically ill children. The 7 remaining references were about the families of 3 children with grim prognoses.

Parental references which occurred in presentations and discharge plans had a ceremonial character. Other references to families were infrequent and only occurred when physicians believed medical measures were no longer efficacious. We conclude that doctors do not consider family matters in the systematic way they discuss technical concerns.

In the last few decades there has been a proliferation of authoritative literature on women's psychosocial adjustment to Breast Cancer and its treatment. This literature is ostensibly concerned with understanding women's experiences in order to recommend effective intervention programmes. The aim of this appraisal is to make explicit some implicit assumptions embodied in that literature, which severely inhibit comprehensive investigation of women's needs. While these assumptions remain implicit, any recommended intervention will necessarily be fragmentary, focusing on only a few features of the experience in only a proportion of the women. In order to illustrate this, the paper will focus on the literature's management of women's reactions to breast loss as treatment for the disease.

The relationship between measures of childhood disadvantage and birth placement was studied in a birth cohort of New Zealand children.

Children who entered single parent families at birth were subject to a systematic pattern of disadvantage including poor preventive health care, greater risks of morbidity, depressed levels of childhood experience and exposure to pre-school education, impaired mother/child interaction patterns, depressed living standards and greater family instability. Adopted children fared best on all measures.

Factor analysis of the various indicators of childhood disadvantage showed that all loaded on a single common factor which had good face validity as being a general measure of multiple childhood disadvantage. Regression and path analyses showed that the apparent correlation between the child's birth placement and the multiple disadvantage score arose from the presence of a variety of conditions which were more prevalent in single parent families. In particular, single parent families had lower income levels, higher residential mobility, mothers in these families reported more problems and difficulties with child-rearing, experienced a greater number of adverse life events and were less satisfied with life in general. In addition, women with no formal educational qualifications and women of Maori or Pacific Island ethnic origin were over-represented in the population of single parent families. While the individual contribution of each of these factors was relatively small, the collective effect of the adverse conditions present for single parent families was to (apparently) produce a situation in which children in these families were clearly disadvantaged when compared with children from two parent and, particularly, adopted families. The implications of these findings are discussed.

The World Health Organization has identified social well-being along with physical and emotional well-being as a major component of health. Operational definitions of social well-being in children are found among developmental screening tests, socioemotional instruments and specific social well-being measures. The objective of this paper is to present criteria for assessing measures of social well-being and to apply these criteria to instruments developed for general (noninstitutionalized) groups of children. The criteria include: general applicability and acceptability, balance in orientation, amenability to index construction, variability, reliability, validity, responsiveness to child development, distinctness from emotional well-being and estimation of possible bias due to proxy (parent) respondents. The dimensions of social well-being covered by available instruments include interpersonal skills and social participation.

This study explored levels of patient and physician satisfaction as a function of events which occur during the clinical encounter. Data which are directly observable (verbal and nonverbal) and obtainable through interviews were considered. Eighty-eight encounters were observed over a one-week period at an outpatient clinic of a university-affiliated hospital. Participants were interviewed subsequent to each interaction. Multiple discriminant analysis showed encounters viewed by patients as relatively unsatisfactory to be characterized by greater distance between parties during information gathering, increased amounts of feedback, highly active physicians, and physicians who were on call. Satisfied patients had encounters marked by increased physician use of (1) nonverbal encouragement, (2) questions about family and social situations, and (3) expressions of continuity from previous visits. Physicians were less satisfied in encounters in which they were active, felt pressed to other medical commitments, and were on call. The most positive physician assessments occurred when patients were seen as compliant and where humor and nonverbal encouragement were used during the interaction. These data suggest variables which are generally amenable to change if physicians are made aware of their potential impact.