Background:
Little is known about the perspectives of psychiatric patients who are perceived as ‘difficult’ by clinicians. The aim of this paper is to improve understanding of the connections between patients and professionals from patients’ point of view.
Methods:
A Grounded Theory study using interviews with 21 patients from 12 outpatient departments of three mental health care facilities.
Results:
Patients reported on their own difficult behaviours and their difficulties with clinicians and services. Explanations varied but could be summarized as a perceived lack of recognition. Recognition referred to being seen as a patient and a person – not just as completely ‘ill’ or as completely ‘healthy’. Also, we found that patients and professionals have very different expectations of one another, which may culminate in a difficult or ambivalent connection. In order to explicate patient’s expectations, the patient-clinician contact was described by a stage model that differentiates between three stages of contact development, and three stages of substantial treatment. According to patients, in each stage there is a therapeutic window of optimal clinician behaviour and two wider spaces below and above that may be qualified as ‘toxic’ behaviour. Possible changes in clinicians’ responses to ‘difficult’ patients were described using this model.
Conclusions:
The incongruence of patients’ and professionals’ expectations may result in power struggles that may make professionals perceive patients as ‘difficult’. Explication of mutual expectations may be useful in such cases. The presented model gives some directions to clinicians how to do this.
Ambivalent connections: a qualitative study of the care experiences of non-psychotic chronic patients who are perceived as ‘difficult’ by professionals
Antidepressant treatment and cultural differences – a survey of the attitudes of physicians and patients in Sweden and Turkey
Background:
The presenting symptoms of depression can be influenced by cultural differences. This study was conducted to compare the presenting symptoms and response to antidepressant medication of patients in Sweden and Turkey, two culturally different European countries.
Methods:
Recruitment was triggered when adult patients were diagnosed with a depressive or anxiety disorder by a primary care physician and prescribed an antidepressant. Physicians and patients recorded presenting symptoms and completed relevant questionnaires just before and 8 weeks after starting treatment with an antidepressant. These included the Hospital Anxiety and Depression Scale (HADS), the Clinical Global Impressions (CGI) scale, the Sheehan Disability Scale (SDS), and Likert scales gauging the importance of physical and psychological symptoms. Patients also rated severity of prominent symptoms (depression, anxiety, stress, sleep and pain) from zero to ten. The outcomes were compared between patients from Sweden and Turkey using Fisher’s Exact test and two-sample t-tests.
Results:
The study was conducted in 460 patients (107, 23.3% in Sweden; 353, 76.7% in Turkey). Presenting symptoms differed between Sweden and Turkey, with Turkish patients more likely to present with physical symptoms, and report a higher number of physical symptoms (mean 2.4 vs. 1.4, p<0.001). In both countries, the diagnosis made by the physician differed from that derived from the HADS score at the start of the study. The HADS diagnosis varied between the countries with significantly different proportions of patients in each country being diagnosed with depression alone, anxiety alone or depression with anxiety. While all symptoms improved after antidepressant treatment in both countries, Turkish patients showed a greater degree of response than Swedish patients in depression (p=0.048), stress (p=0.014) and pain (p<0.001) as measured by the prominent symptoms assessment (PSA).
Conclusions:
The presenting symptoms of patients diagnosed with a depressive or anxiety disorder by a primary care physician and prescribed an antidepressant differ between Turkey and Sweden. Patients in Turkey were more likely to present with physical symptoms than patients in Sweden and present with more physical symptoms. After 8 weeks of antidepressant treatment, the improvement from baseline was greater in Turkish patients, and this was reflected in their improved functioning.
Social Determinants of Health: The Canadian Facts
Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children
Background:
To understand racial and ethnic disparities in health care utilization and their potential underlying causes, valid information on race and ethnicity is necessary. However, the validity of pediatric race and ethnicity information in administrative records from large integrated health care systems using electronic medical records is largely unknown.
Methods:
Information on race and ethnicity of 325,810 children born between 1998-2008 was extracted from health plan administrative records and compared to birth certificate records. Positive predictive values (PPV) were calculated for correct classification of race and ethnicity in administrative records compared to birth certificate records.
Results:
Misclassification of ethnicity and race in administrative records occurred in 23.1% and 33.6% children, respectively; the majority due to missing ethnicity (48.3%) and race (40.9%) information. Misclassification was most common in children of minority groups. PPV for White, Black, Asian/Pacific Islander, American Indian/Alaskan Native, multiple and other was 89.3%, 86.6%, 73.8%, 18.2%, 51.8% and 1.2%, respectively. PPV for Hispanic ethnicity was 95.6%. Racial and ethnic information improved with increasing number of medical visits. Subgroup analyses comparing racial classification between non-Hispanics and Hispanics showed White, Black and Asian race was more accurate among non-Hispanics than Hispanics.
Conclusions:
In children, race and ethnicity information from administrative records has significant limitations in accurately identifying small minority groups. These results suggest that the quality of racial information obtained from administrative records may benefit from additional supplementation by birth certificate data.
The Effect of Childhood Sexual Abuse on Psychosexual Functioning During Adulthood
psychosexual functioning—emotional, behavioral and evaluative—during adulthood. The sample included 165 adults who were sexually
abused as children. The General Estimating Equation was used to test the relationship among the predictors, moderators and
five binary outcomes: fear of sex and guilt during sex (emotional dimension), problems with touch and problems with sexual
arousal (behavioral), and sexual satisfaction (evaluative). Respondents who were older when they were first abused, injured,
had more than one abuser, said the abuse was incest, and told someone about the abuse were more likely to experience problems
in at least one area of psychosexual functioning. Older children who told were more likely than younger children who told
to fear sex and have problems with touch during adulthood. Researchers and practitioners should consider examining multiple
dimensions of psychosexual functioning and potential moderators, such as response to disclosure.
- Content Type Journal Article
- DOI 10.1007/s10896-010-9340-6
- Authors
- Scott D. Easton, School of Social Work, University of Iowa, 308 North Hall, Iowa City, IA 52242, USA
- Carol Coohey, School of Social Work, University of Iowa, 308 North Hall, Iowa City, IA 52242, USA
- Patrick O’leary, School of Social Sciences, Division of Social Work Studies, Child Well-Being Research Centre, University of Southampton, Southampton, United Kingdom
- Ying Zhang, Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA USA
- Lei Hua, Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA USA
- Journal Journal of Family Violence
- Online ISSN 1573-2851
- Print ISSN 0885-7482
Physical activity and depressive symptoms among pregnant women: the PIN3 study
few studies have examined the influence of physical activity on prenatal depression. Data from 1,220 women enrolled in the
third Pregnancy, Infection, and Nutrition Study (2001–2005) were used to examine the associations between overall and domain-specific
moderate-to-vigorous physical activity (MVPA) and depressive symptoms during pregnancy. Self-reported, past week physical
activity assessed at 17−22 weeks’ gestation was modeled in logistic regression with self-reported depressive symptoms assessed
by the Center for Epidemiologic Studies—Depression Scale at 24–29 weeks’ gestation. Active women with ≤2.67 h/week of total
MVPA had almost half the odds of having high depressive symptoms as compared to women with no MVPA (odds ratio [OR] = 0.56,
95% confidence interval [CI] = 0.38, 0.83). Increased odds of elevated depressive symptoms were found for women participating
in some but ≤2.25 h/week of adult and child care MVPA (OR = 1.84; 95% CI = 1.08, 3.11) and >1 h of indoor household MVPA (OR = 1.63,
95% CI = 0.99, 2.70) when compared to women with no MVPA. While overall MVPA may play a role in reducing the odds of developing
elevated depressive symptoms, adult and child care and indoor household activities may increase it.
- Content Type Journal Article
- DOI 10.1007/s00737-010-0193-z
- Authors
- Zewditu Demissie, Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 306, CB# 7435, Chapel Hill, NC 27599-7435, USA
- Anna Maria Siega-Riz, Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 306, CB# 7435, Chapel Hill, NC 27599-7435, USA
- Kelly R. Evenson, Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 306, CB# 7435, Chapel Hill, NC 27599-7435, USA
- Amy H. Herring, Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, CB# 7420, Chapel Hill, NC 27599-7420, USA
- Nancy Dole, Carolina Population Center, The University of North Carolina at Chapel Hill, 517 Univ Square East, CB# 8120, Chapel Hill, NC 27516, USA
- Bradley N. Gaynes, Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Rm 10306, 1st Floor Neurosciences Hospital, CB# 7160, Chapel Hill, NC 27599, USA
- Journal Archives of Women’s Mental Health
- Online ISSN 1435-1102
- Print ISSN 1434-1816