Irina Todorova

Perceived discrimination, psychological distress and health

Racism and discrimination can have significant implications for health, through complex biopsychosocial interactions. Latino groups, and particularly Puerto Ricans, are an understudied population in the United States in terms of the prevalence of discrimination and its relevance to health. Participants in our study were 45- to 75-year-old (N = 1122) Puerto Ricans. The measures were perceived discrimination, depressive symptomatology (CES-D), perceived stress (PSS), self-rated health, medical conditions, blood pressure, smoking and drinking behaviours, demographics. Our findings show that 36.9 per cent of participants had at some time experienced discrimination, with men, those with more years of education, currently employed and with higher incomes being more likely to report it. Experiences of discrimination were associated with increased levels of depressive symptoms and perceived stress. When controlling for covariates, perceived discrimination was predictive of the number of medical conditions, of ever having smoked and having been a drinker, and having higher values of diastolic pressure. Depressive symptoms are a mediator of the effect of perceived discrimination on medical conditions, confirmed by the Sobel test: z = 3.57, p < 0.001. Mediating roles of perceived stress, smoking and drinking behaviours were not confirmed. Increased depressive symptoms might be the main pathway through which perceived discrimination is associated with a greater number of medical diagnoses.

Social support, life events, and psychological distress among the Puerto Rican population in the Boston area of the United States

Objectives: The aim of this article is to investigate the role of social network support in ameliorating the psychological impact of life stressors that are prevalent for the older Puerto Rican population. Method: Social support was measured through the Norbeck Social Support Questionnaire, and psychological distress through the Center for Epidemiological Studies Depression Scale and the Perceived Stress Scale. We describe the life stressors (Norbeck Life Events) faced by Puerto Ricans and their implications for psychological distress. We present associations between depression, perceived stress, social support, and socio-demographic indicators. The role of social network support–emotional and instrumental–in buffering the effect of negative events is examined. Attention is given to the interacting effect of gender and the type of support. Results: The analysis shows that dimensions of social support, particularly emotional support, are generally protective of psychological health. However, when delineating the moderating effects of gender, social support is beneficial for men, but manifestly less so for women. Emotional, tangible support and duration of social contacts show a moderate effect on the impact of life stressors on psychological distress which, however, is in a direction opposite to that proposed by the buffering hypothesis. Discussion: Social ties are generally protective, but may also be contributing, particularly for women, to increased psychological distress in the face of stressful life events.

Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania

Objectives:The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities.Methods:Representative samples of women – 1 099 in Bulgaria and 1 053 in Romania, were interviewed through a structured questionnaire.Results:We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history.Conclusions:The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women’s perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries.

Improving quality and safety in the hospital: the link between organizational culture, burnout, and quality of care.

The need to improve quality of care represents a major goal of all health care systems. The objective of this series is to illuminate how the contextual factors of hospitals from eight European countries, and the well-being of their healthcare professionals, contribute to either construct or degrade quality of care. The studies reported here provide an important bottom-up perspective on quality of care, and the way that burnout and organizational culture are intertwined within it. Overall, the collected studies represent an in-depth examination through focus groups of the experiences of 153 physicians, 133 nurses, and 46 patients from Greece, Portugal, Bulgaria, Romania, Ireland, Turkey, Croatia, and the Republic of Macedonia. Each paper makes a unique contribution to the understanding of how institutional contexts, organizational management, and job characteristics impose constrains, both on the capacity of health workers for better treatment decisions and choices, but also on their day-to-day professional satisfaction and quality of life. Taken as a whole, the papers make an even greater contribution, by pointing out the underlying similarities and differences across these eight European countries.

Contextual shifts in Bulgarian women's identity in the face of infertility

The article discusses the experiences of women facing infertility and infertility treatment in Bulgaria with a focus on identity construction. A theoretical framework invoking an understanding of identity as a social and contextual phenomenon, contingent upon local interpersonal relations and cultural meanings, informs our study. We use semi-structured interviews, which are analyzed using Interpretative Phenomenological Analysis. Using this method, we have identified the following overarching themes: Identity as Incomplete, Absent or Invisible; Identity as Present but Separate; Identity Shifts Through Dis/Embodiment; Identity as Nurtured and Nurturing. The study delineates the contextual identity shifts in the social and medical settings and the extent to which the women we interviewed experienced themselves as separate, autonomous and agentic. We discuss some of the possible interpretations of these findings, invoking the meanings and metaphors of the individual and the relational available in Bulgarian culture and societal values.

Burnout and health behaviors in health professionals from seven European countries

ObjectivesWithin an underlying health-impairing process, work stressors exhaust employees’ mental and physical resources and lead to exhaustion/burnout and to health problems, with health-impairing behaviors being one of the potential mechanisms, linking burnout to ill health. The study aims to explore the associations between burnout and fast food consumption, exercise, alcohol consumption and painkiller use in a multinational sample of 2623 doctors, nurses and residents from Greece, Portugal, Bulgaria, Romania, Turkey, Croatia and Macedonia, adopting a cross-national approach.MethodsData are part of the international cross-sectional quantitative ORCAB survey. The measures included the Maslach Burnout Inventory and the Health Behaviors Questionnaire.ResultsBurnout was significantly positively associated with higher fast food consumption, infrequent exercise, higher alcohol consumption and more frequent painkiller use in the full sample, and these associations remained significant after the inclusion of individual differences factors and country of residence. Cross-national comparisons showed significant differences in burnout and health behaviors, and some differences in the statistical significance and magnitude (but not the direction) of the associations between them. Health professionals from Turkey, Greece and Bulgaria reported the most unfavorable experiences.ConclusionsBurnout and risk health behaviors among health professionals are important both in the context of health professionals’ health and well-being and as factors contributing to medical errors and inadequate patient safety. Organizational interventions should incorporate early identification of such behaviors together with programs promoting health and aimed at the reduction of burnout and work-related stress.

Gratitude and longing: Meanings of health in aging for Puerto Rican adults in the mainland.

Puerto Rican adults in the United States mainland live with socioeconomic and health disparities. To understand their contextual experience of aging, we interviewed participants in the Boston Puerto Rican Health Study. Through a Thematic Analysis we identify themes and tensions: normalization and acceptance of aging; gratitude; the importance of aging within social networks; longing to return to Puerto Rico at older age. We address the tensions between ‘acceptance’ and fatalismo as a cultural belief, and a function of structural barriers. The experience of aging is discussed in the context of Puerto Rico’s history and continued dependence on the United States.

Reasoning and personal epistemology: A critical reconstruction

This article aims to initiate a critical reconstruction of theory and research on reasoning and personal epistemology prompted by socio-philosophical critiques of rationalism and by a theoretical perspective according to which both discourses of knowledge and modes of thought are constituted in a power-infused sociocultural order structured materially and discursively by gender, ‘race,’ and socioeconomic class. A new qualitative methodology is introduced, particularizing participants in terms of their social location and modes of thought while also formulating cross-sectional analytical constructs. New analytical constructs for characterizing epistemic resources ostensibly brought into reasoning are interpretively induced from data through a quasi-inductive process informed by critical philosophical perspectives on knowledge. Theoretical implications point to the functional interplay of dominant and subversive discourses of knowledge in the constitution of thought, the complex assemblage of discursive resources flexibly deployed in reasoning, and the social constitution and biographical particularity of reasoners as epistemic agents.

European Health Psychology Society: Welcome to the EHPS Conference, Pisa 2009

On behalf of the European Health Psychology Society, I would like to extend a warm welcome to all delegates at this, the 23rd Conference of our Society, in collaboration with the Italian Heath Psychology Society (Societa Italiana di Psicologia della Salute, SIPSA). EHPS has been eagerly anticipating this conference, as it is taking place in the picturesque and artistic setting of Pisa, where we have the opportunity for stimulating scientific discussions and for meeting old friends and new colleagues. This is the second time in EHPS’ 23 year history that we are meeting in Italy. Delegates have retained warm memories of the 1999 conference in Florence. The conference theme in 1999, Psychology and the Renaissance of Health, alluded to the blossoming of Florence during the Renaissance, a well as to the expansive development of the field of Health Psychology. Maybe serendipitously, or maybe as a testimony to the importance of the last decade for the maturing of health psychology in Italy and elsewhere, the Italian Heath Psychology Society was also established about 10 years ago, shortly before the 1999 EHPS conference. And now, a decade later, we meet here again, to witness the further strides and broad accomplishments of our field – in Italy, Europe and internationally; and of our Society, whose members now represent 40 countries around the world (Todorova & Renner, 2008). Maybe serendipitously, or maybe as a testimony to the importance of discovery, knowledge and gazing far, this year we visit Pisa during Anno Galileiano (The Year of Galileo). Over several months in 2009, Pisa is celebrating 400 years since the first astronomical observations of its great citizen Galileo Galilei, and we have the unique opportunity to be involved in these events. I’d like to draw your attention to one exhibit in particular: The telescope and the paintbrush: New science and new art in the age of Galileo, which focuses on the interactive influences of science and art during Galileo’s time – a theme we can associate with our visit to Pisa, and with aspects of our own work. The 2009 EHPS Conference in Pisa, under the theme Health Psychology: From Knowledge to Interventions, is continuing the tradition of high scientific excellence, as well as the integration of basic research with applications for improving the health of our communities. Many of the contributions to this year’s conference reflect the conference theme and the dedication of health psychology scholars to apply knowledge gained and to be relevant to current developments in health behaviour interventions, health promotion, healthcare, and health policy. This dedication is reflected in the topics of our eminent keynote speakers, Linda Cameron (University of Auckland, New Zealand); Gian Vittorio Caprara (University of Rome ‘‘La Sapienza’’, Italy); James C. Coyne (University of Pennsylvania, USA)

Career Priority Patterns

This research examined correlates of three career priority patterns – career‐primary, modified career‐family, and career‐family – among 218 managerial and professional women in Bulgaria. Data were collected using questionnaires completed anonymously. It attempted to replicate similar research conducted in Canada. Although career‐family women worked fewer hours per week, and were less involved with their jobs than were career‐primary women, many of the differences observed in the Canadian sample were absent in the Bulgarian sample. Offers possible explanations for the differences in the two studies.