Category Archives: Mental and Emotional Well-Being
Tatiana Sadak, PhD, PMHNP, is an assistant professor at the University of Washington School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013-2016). She is working to promote “dementia caregiver activation,” a process of preparing caregivers to become ready to manage the multiple needs of loved ones with dementia while caring for themselves.
The well-documented personal and societal burdens of dementia are the central focus of the National Alzheimer’s Plan, which calls for extensive reforms in the delivery of health care for patients with dementia and their family caregivers. RWJF answered this national call to action by funding several innovative dementia health services research projects and nurturing the careers of junior dementia researchers.
I was fortunate to receive RWJF Nurse Faculty Scholars funding. It will make it possible for me to focus a majority of my time on improving health services for people living with dementia and for their family care partners—or ‘caregivers.’
Dementia patients suffer brain failure that leads to progressive loss of autonomy and the inability to understand and meet personal health care needs. Clinicians conduct health assessments, create care plans, and treat symptoms, but it is dementia family caregivers who deliver the day-to-day care and health management these patients need. There is, however, considerable variation in their capacity to assist care recipients in making health care decisions, for providing daily care, and for navigating health care systems.
I live in rural Minnesota, and my passion is to make a significant contribution to improving dementia care in our society and to be an advocate for all seniors with dementia in their quest to maintain their basic human right to dignity, choice, and quality of life until their death.
My mother, Evelyn Holly, passed away 16 years ago. She spent the last seven years of her life being bounced from one nursing home or residential dementia facility to another, and in and out of hospital geri-psych units, all because of her so-called “challenging and aggressive behavior.” She spent the last year of her life strapped in a chair and drugged so she would be “compliant.” I imagine many of you have had similar experiences. Click on this link to view a video about my personal struggle with dementia care—a struggle that has fueled my passion to improve it.
After many years of heartache and frustration in my struggle to find appropriate care for my mother, and after being told repeatedly by others in the health care industry that the kind of dignified care that I visualized was impossible because it was too expensive, I discovered that I could not find any financial support for trying something different. I decided to use my own life savings to try to develop a model of specialized dementia care that would focus on the unmet emotional and spiritual needs of persons with dementia, many of whom are unable to communicate those needs, and to meet their physical needs as well.
Janet Chang, PhD, is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant research scientist at the University of Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups.
In the past year, there has been heightened national press coverage of anti-minority sentiments, and public outcry over discriminatory incidents in the United States. The publicized nature of these events stimulated intense debate. Some, especially those who believe in racial colorblindness, have argued that outraged individuals are overly sensitive and quick to assume that prejudice and discrimination are the cause. On the one hand, this perspective provides psychological comfort by downplaying the importance of race, minimizing the impression of bias, emphasizing our common humanity, and upholding egalitarian principles. On the other hand, it is upsetting and harmful because it denies the lived reality of racial/ethnic minorities. Colorblindness renders well-documented racial/ethnic disparities invisible.
Belief in colorblind ideologies perpetuates false notions that discrimination is rare. As a result, colorblindness, along with a complex host of factors, promotes ethnic/racial disparities in wide-ranging important domains, such as health and health care, criminal justice, housing, education, and employment and advancement in the workplace. Colorblindness reinforces the myth of meritocracy, which places value on individual effort and ability but overlooks structural factors that inhibit positive outcomes for vulnerable or disadvantaged populations.
Nicole M. Brown, MD, MPH, MHS, is a general pediatrician at Montefiore Medical Center and an assistant professor of pediatrics in the Division of General Pediatrics at Albert Einstein College of Medicine at Yeshiva University in New York City. She is alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program.
Many patients have left an impression on my heart since I began my journey as a pediatrician, but one I cared for early in my career sticks with me. He was a wiry 8-year-old boy exhibiting symptoms of an anxiety and conduct disorder: He was very aggressive, had acted inappropriately with his younger sister, smeared feces around the house, and was difficult to manage. He had been severely and physically abused, and although child protective services had gotten involved, he had fallen out of the system after the case was “closed” and stopped showing up for therapy.
By the time his grandmother brought him to see me, I was the first doctor to see him in about two years. In the hour that I spent with him that day, it became clear that his treatment—or lack thereof—was inextricably bound up in his family’s various other challenges. His family lived in poverty, and faced food insecurity issues, in addition to a long, cyclical history of abuse and child protective services involvement. His grandmother was shuttling between various social service agencies, doing her best to complete forms and meet the requirements for public assistance. Yet despite her best efforts, she wasn’t really able to manage it all and, as a result, the boy’s health care was falling through the cracks.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts this year. As we usher in 2015, we take a look back at our ten most-read 2014 posts.
Why Do Deaths from Drugs Like Oxycodone Occur in Different Neighborhoods than Deaths from Heroin? This in-depth look at the role neighborhoods play in shaping substance abuse patterns was written by RWJF Health & Society Scholars program alumna Magdalena Cerdá, PhD, MPH. She compares neighborhoods that have more fatal overdoses of opiate-based painkillers to neighborhoods in which heroin and cocaine overdoses are more likely to occur, identifying characteristics of each. Her piece generated a larger audience than any other post published on this Blog this year, with more than 22,000 visits.
How Stress Makes Us Sick was written by RWJF Health & Society Scholar Keely Muscatell, PhD. A social neuroscientist and psychoneuroimmunologist, Muscatell shares her research into the physical manifestations of stress, its relationship to inflammation, and ways people may be able to reframe their responses to stress in order to alleviate the physical reactions it can cause. Understanding how stress makes us sick, she blogs, “is of extreme importance to the health and longevity of our nation.”
Misfortune at Birth, which drew the third-largest audience among the posts published on this Blog in 2014, asks whether some premature babies are simply born in the wrong place. It reports on nurse-led research that finds seven in ten black infants with very low birth weights have the misfortune of being born in hospitals with lower nurse staffing ratios and work environments than other hospitals. The blog post was written by Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, based on their study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative.
Mieke Beth Thomeer, PhD, is an assistant professor of sociology at the University of Alabama, Birmingham, and Debra Umberson, PhD, MSW, is a professor of sociology at the University of Texas at Austin and a 2011 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research. The authors received the 2014 American Sociological Association’s Best Publication Award from the mental health section for an article on marital dynamics and depression that was published in Society and Mental Health.
The Centers for Disease Control and Prevention (CDC) estimates that one in 10 Americans is experiencing depression at any given time.1 Depression is a frequent topic in the media: news reports highlight the toll it takes on the diagnosed person;2,3 celebrities publicly discuss their debilitating experiences with depression;4,5 and researchers investigate biological markers of and cures for depression.6,7
Overwhelmingly, depression is depicted as an individual-level problem, a burden and difficulty for the person with it. Little attention is given to what depression means for her or his loved ones, especially for spouses. Because depression is rarely experienced in isolation, we argue that it is important to ask:
- What is the mental health impact of having a depressed spouse?
- What factors lead to the spread of depression from one spouse to the other?
- How can both spouses be supported during episodes of depression?
Katherine Diaz Vickery, MD, MSc, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, an assistant professor of medicine at the University of Minnesota Medical School, and a clinician-investigator in the Division of General Internal Medicine at Hennepin County Medical Center. On December 5, she will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
People who know me–even just a little–know of my pride for my home state of Minnesota. While there are beautiful lakes, biking trails, farmer’s markets, and a ridiculous state fair (that takes special pride in its offerings of various types of food-on-a-stick), there’s something more... Minnesota has been making strategic efforts to improve the health of its communities for many years.
If I could bring you to Minnesota today (bundle up!), I’d show you what I mean by taking you to Hennepin County Medical Center (HCMC) and specifically to a meeting of the patient advisory board of the Hennepin Health Accountable Care Organization (ACO).
I would introduce you to Jorge, a Mexican-American whose road to recovery from severe depression was paved by his multi-disciplinary care team from Hennepin Health. Jorge might tell you about Susan, the social worker who helped him find transitional housing. Or Lucky, a community health worker who gave him a voucher to get a haircut, a toiletry bag, and helped him find a primary care medical home. And if he really opened up, he might tell you of his career aspirations to take courses to supplement his graduate degree from Mexico and become a family therapist or community health worker.
Jacquelyn Campbell, PhD, RN, FAAN, is director of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program and Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing. Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and an alumna of the RWJF Nurse Faculty Scholars program.
As two scholars who have worked in research, practice and policy arenas around issues of gender-based violence for years, we honor our veterans this week by paying tribute to the Pentagon and the U.S. Department of Veterans Affairs (VA) for addressing intimate partner and sexual violence among active duty and returning military and their families, and urge continued system-wide involvement and innovative solutions.
In our work, we’ve heard outrageous, painful stories. One female servicemember explained to Angela why she was ignoring the sexual harassment she experienced. She knew that hearing that she was inferior because she was a woman, being called “Kitty” instead of her name, and having the number 69 used in place of any relevant number was harassing. She knew it was wrong. But she had decided that she would not let it bother her. I can acknowledge that he is a jerk, but I can’t let that affect me.
I can’t let his behavior define me as a person. On some level this may seem like an accurate way of dealing with a problem person. However, sexual harassment isn’t just about one obnoxious person. Not telling the story doesn’t make the behavior go away. Rather, it sends the message that the behavior is acceptable and that sexist comments are a normal part of the lexicon of male/female interactions.
RWJF Scholars in the News: EpiPens in schools, suicide prevention, financial incentives for wellness, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:
A study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH, shows that keeping supplies of epinephrine, commonly known as EpiPens, in schools saves lives, Health Day reports. Epinephrine injections are given in response to life-threatening allergic reactions to food or to insect stings. Gupta’s study found that epinephrine was administered to 35 children and three adults in Chicago public schools during the 2012-13 school year. “We were surprised to see that of those who received the epinephrine, more than half of the reactions were first-time incidents,” Gupta said. “Many children are trying foods for the first time at school, and therefore it is critical that schools are prepared for a possible anaphylactic reaction.” Forty-one states have laws recommending schools stock epinephrine, according to the article.
Matt Wray, PhD, MA, an RWJF Health & Society Scholars program alumnus, writes in Medical Xpress that when it comes to preventing suicides, it’s important to focus some attention on how a person seeks to end his or her life. According to the article, suicide-prevention research has shown that when people who have begun to act on suicidal impulses find that access to their chosen method is blocked, many do not seek out other means. “Most people don’t have a backup plan,” Wray writes. “So when their initial attempt is stalled, the destructive impulse often passes. Moreover, contrary to what many believe, people who attempt suicide more than once are rare. Less than 10 percent of those who survive an attempt ever end up dying by suicide.”
Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).
Health and disease are on a continuum. We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.
These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.
I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.