Jacob J. Lindenthal

Life events and mental status: a longitudinal study.

This is a preliminary report on relationships between changes in life events and changes in psychiatric symptomatology in a community sample of 720 adults in New Haven, Connecticut. Over a two-year period it was found that the greater the net change in life events the more likely was the individuals mental status to have changed. A net increase in life events was associated with a worsening of symptoms, while a net decrease resulted in improvement. Similar patterns were found for most of the 64 individual life events for which information was gathered as well as for events categorized according to type of social activity, changes in the respondents social field, and degree of desirability.

Life events and psychiatric impairment.

This is a report on relationships between life crises and psychiatric impairment in a community sample of 938 adults in New Haven, Connecticut.It is part of a longitudinal study of the population of a community mental health center catchment area. The theoretical framework for the paper finds its roots in two bodies of socio-medical literature, namely, stress research and epidemiological field studies of mental illness. The specific research question is to determine whether or not there is a relationship between the occurrence of life events, the patterning of such events and the degree of psychological impairment. As in other field studies, we discovered a significant amount of psychiatric impairment in the community. Eighteen per cent of the adults interviewed were classified as having a high symptom level (very impaired), 47 per cent as a medium symptom level (moderately impaired), and 35 per cent as a low symptom level (unimpaired). More important, we found significant relationships between these scores and the occurrence of life events in the year previous to our interview. First, the greater the degree of impairment the more likely is the individual to have experienced at least one of 62 life events for which we gathered information. Equally important, there is a very strong association between the number of events experienced and the individuals mental status: the greater the number of events reported by respondents, the greater the proportional difference between the percentage of unimpaired and the percentage of very impaired who experienced that number of events. When events are categorized according to type of social activity, changes in the respondents social field and degree of desirability impairment are strongly and positively related to the experiencing of life crises. Finally, similar patterns are found for each of the individual life events with the exception of several biopsychosocial situations associated with the family developmental cycle.Certain cultural and social factors, particularly role expectations and values, are discussed as possible factors helping to account for the relationshipsfound above between life crises and psychiatric impairment.

Smoking, psychological status and stress.

The effects of stress and psychological impairment on smoking behavior was analyzed using a final sample of 938 adults (18 years and over) in the metro New Haven area. Information regarding the following were obtained: basic sociodemographic variables physical and mental health status social and instrumental role performance and life crises during the previous year (crisis was any event which could potentially affect the persons sociopsychological balance). 4 hypotheses were tested: the direct relationship of psychological impairment to 1) frequency of smoking; 2) perception of smoking as a problem; 3) increases in smoking at times of crises; and 4) relation between changes in smoking and psychological impairment as the number of crises increased. All 4 hypotheses were confirmed by the findings. Psychologically impaired individuals resorted to smoking with increasing frequency depending on the psychological status quantity and quality of crises. The data regarding the perception of smoking as a problem revealed a paradox in that the psychologically impaired individuals (48%) were more realistic in viewing smoking as a problem compared with individuals who were psychologically healthy (11%). Studies have shown that psychological tension leads to smoking; again this was supported by the high frequency of smoking observed among individuals who were psychologically very impaired because of marital interpersonal health and catastrophic events (Sullivan; Summel). These findings suggest that smokers have trouble quitting the habit because of their relatively little or lack of control of external events which personally affect them.

Psychiatrists, the public, and confidentiality.

This paper represents a comparative study of the attitudes of psychiatrists, people under the regular care of psychiatrists, and those who have never had any experience with psychotherapy toward confidentiality in the doctor-patient relationship. The role played by knowledge of and attitudes toward confidentiality in the seeking of health care is also assessed. The samples consisted of 192 psychiatrists, 76 patients, and 76 nonpatients of psychiatrists. The findings and their implications are discussed.

A Comparative Study of the Handling of Confidentiality

Increasing concern with the problem of confidentiality has prompted the authors to examine factors associated with the handling of confidentiality among a sample of psychiatrists, psychologists, and internists. Significant differences were found among the three groups of clinicians. The nature of professional training and the predominant approach to treatment were found to be related to attitudes toward confidentiality, as was previous professional experience with socially threatening behavior. Implications of the findings are discussed.

Consumers clinicians and confidentiality

Questionnaires on confidentiality in the physician-patient relationship were completed by 131 internists, 76 patients, and 76 nonpatients. The findings and implications of the study are discussed. It is suggested that concerns about confidentiality may undermine the sense of trust important to effective medical care and even deter some nonpatients from seeking treatment.

Psychological Status And The Perception Of Primary And Secondary Support From The Social Milieu In Time Of Crisis

The psychologically impaired apparently are more likely to seek secondary sources of help than the unimpaired in response to a wide variety of crises. (Secondary sources of help are denned in this article as those distinct from family or friends and for which one usually has to leave home and pay a fee.) This implies that psychological impairment predisposes to differential perception of social support as helpful or unhelpful for different types of crises Impairment leads to the perception of formal surroundings as helpful for a much greater number of crises than unimpairment. This implies that the structural elements within society are quite important to those whose adjustment by virtue of impairment is marginal While we can only speculate why individuals perceive one form of help as more useful than another, our attention is directed to the potential problem of knowledgeably increasing the social support structure, formal and informal, within our society so as to minimize the reliance of the impaired on informal supports which apparently have largely failed or been inadequate for the needs of the impaired person

Migration and Mental Health among the Peoples of the Caribbean, 1948-1980

A body of literature suggests that the rates of mental illness among immigrant groups greatly exceed those of the population of their countries of origin [1]. Schizophrenia, in particular, has been found to be associated with migration [1-4]. Some studies have also reported high rates of mental disorders among refugees and exiles [5,6]. The purposes of this paper are severalfold: (1) to review the salient findings in the literature for 1948-1980 dealing with migration and mental health among the peoples of the Caribbean; (2) to highlight some of the important theoretical problems inherent in research on migration and mental health; and (3) to increase awareness of an array of questions that should be raised and of some of the theoretical and methodological issues involved.

Barriers to the Implementation of a Program for Inner-City, Homeless Substance Abusers on General Assistance: Newark

The article describes the implementation of a comprehensive rehabililation program for homeless subslance abusers within an inner-city setting. The program was a joint effort between a university research team and the general welfare deparlment of Ihe City of Newark, NJ. A description of the program is followed by a discussion of the political, economic, philosophical and bureaucratic barriers towards implementation of the project. Strengths and weaknesses of multiple agency efforts to rehabilitate homeless substance abusers are discussed. Complex systems issues that may be generalizable to other similar settings are highlighted. Conclusions and recommendations for implementation of future projccts are presented.

A cross-cultural study of confidentiality.

SummaryAlthough increasing attention is being paid to confidentiality in the clinician-patient relationship, there is a notable paucity of empirically grounded research addressing the problem. The authors present data, which are an extension of research carried out in the United States, which compare the handling of confidentiality among American, Egyptian, and Israeli psychiatrists, and American and Israeli psychologists and internists. The data support the view that no significant differences exist between practitioners of the same professional groups practicing in different countries while also showing significant and parallel between-group differences. The limitations and implications of the findings are discussed.