Margaret L. Fong

THE IMPACT OF ROLE STRESSORS AND PERSONAL RESOURCES ON THE STRESS EXPERIENCE OF PROFESSIONAL WOMEN

This study explored the contributions of role stressors and personal resources in predicting strain symptoms experienced by 117 professional women employed full-time in academia. Results of multiple regression analyses revealed that, while role stressors alone accounted for only a moderate amount of the variance in reported strain symptoms, 51% of the variance was explained when both stressors and personal resources were combined. Women who experienced higher levels of personal control and social support as well as a greater number of roles occupied reported lower levels of strain symptoms. These results support the use of a transactional model of stress in future multiple role research.

Measuring Outcomes in Psychiatry: An Inpatient Model

BACKGROUNDnThis article describes a system for measuring outcomes recently implemented in the department of psychiatry of Baptist Memorial Hospital, a 78-bed inpatient and day treatment unit that represents one service line of a large, urban teaching hospital in Memphis. In June 1993 Baptist Hospital began a 15-month pilot test of PsychSentinel, a measurement tool developed by researchers in the Department of Community Medicine at the University of Connecticut. The hospital identified the following four primary goals for this pilot project: provide data for internal hospital program evaluation, provide data for external marketing in a managed care environment, satisfy requirements of the Joint Commission on Accreditation of Health Care Organizations, and generate studies that add to the literature in psychiatry and psychology.nnnDESCRIPTION OF MEASUREnPsychSentinel is based on the standardized diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The outcome measure assesses the change in the number of symptoms of psychopathology that occurs between admission and discharge from the hospital. Included in the nonproprietary system are risk adjustment factors, as well as access to a national reference database for comparative analysis purposes. Data collection can be done by trained ancillary staff members, with as much or as little direct physician involvement as desired. The system has proven to be both time effective and cost effective, and it provides important outcome information both at the program level and at the clinician level.nnnRESULTSnAfter the pilot test, the staff at Baptist Memorial Hospital determined that the system met all initial objectives identified and recently adopted the system as an ongoing measure of quality patient care in the department of psychiatry.

Primary Prevention: Looking for a Middle Ground

When I read the debate by Dr. Albee, Goldston, Lamb, and Zusman regarding the validity of primary prevention in mental health I had a feeling of deja vu for another series of famous debates; the Carl Rogers (humanists~ versus B.F. Skinner (behavioristl debates. In those debates and in this one, both sides were forced into a polarized stance and there seemed to be one side that was soft and fuzzy (humanist and pro-prevention} and the other side hardnosed (behavioralist and antiprevention}. Today the boundaries between humanistic and behavioral therapies are quite overlapping and I sincerely hope for the welfare of our country, that this debate over prevention will also be settled by finding a middle ground. What is this middle ground? It appears to be full support for accountable programs to prevent and/or attenuate the development of mental illness. Dr. Lamb, while rightfully noting the primitive state of prevention research, seemed to ignore the fact that at present mental health professionals are also not able to cure mental illness. Even programs that are aimed at secondary and tertiary prevention (rehabilitation) have limited success. So since we cant cure mental illness, wed be best off putting more research and program effort into prevention. However, the middle ground is not an unqualified endorsement of primary prevention such as Dr. Albee offered. The debate raised many of the issues about the scope of primary prevention, the role of mental health professionals and federal involvement in funding. Less clearly developed were two areas of concern which need to be carefully addressed before realistic prevention efforts can be developed. One concern is the need for a more comprehensive model of mental health and mental health services; the second concern is the need for accountability in prevention research projects.