Category Archives: Behavioral/mental health

Sep 17 2014
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Shifting the Dialogue: Considering Ray Rice and Intimate Partner Abuse

Thema Bryant-Davis, PhD, is an associate professor of psychology at Pepperdine University and an associate editor of the journal Psychological Trauma. Bryant-Davis is a Robert Wood Johnson Foundation (RWJF) New Connections grantee who studies the intersection of trauma and culture. 

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The assault perpetrated by Ray Rice, which ended in him dragging his unconscious fiancé, Janay Palmer, off an elevator, has captured wide public attention. Unfortunately, most of the dialogue has focused on blaming and shaming Ms. Palmer and other victims of intimate partner violence for staying in abusive relationships. There has also been an attempt to build sympathy for the perpetrator by questioning whether Rice’s punishment, which went from suspension for two games to permanent dismissal from his team, was fair. The most important questions have received far less attention. Why do abusive partners like Ray Rice abuse their spouses? Why does the public support intimate partner abuse either directly with words and actions or indirectly with their silence? What are the consequences of intimate partner abuse? And how can we stop intimate partner violence?

Partner abuse is an action not caused by the victim’s behavior, substance use, mental illness, or biology (being male).  People choose to abuse their partners emotionally, physically, sexually, verbally and financially to exact control over the person and because they believe they have the right to do so.  

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Sep 12 2014
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Changing the Culture of Health to Prevent Suicide

Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.

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When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.

But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?

It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.

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Sep 11 2014
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RWJF Scholars in the News: Mental health and returning service members, children of incarcerated parents, nurse turnover, 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:

When reserve service members return to civilian life, such stresses as marriage and health care problems are more likely to trigger drinking problems than traumatic events that occurred during deployment, according to a study reported by Fox News. When it comes to the “long-term mental health for National Guard members, what matters is what happens after they come home,” said lead author Magdalena Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna. “Financial difficulties, re-integrating, difficulties accessing quality health care, all of those seem to matter.” But deployment stress also has an impact. “[T]he more traumatic events they are exposed to during or after combat, the more problems they have in daily life when they come home,” she said. RWJF Investigator Award in Health Policy Research recipient Sandro Galea, MD, MPH, DrPH, co-authored the study. Health Canal also reported on it.

An estimated 17.5 percent of newly licensed RNs leave their first nursing job within the first year, and one in three leave within two years, according to research conducted by RWJF’s RN Work Project. Advance for Nurses quotes co-directors Christine T. Kovner, PhD, RN, FAAN, and Carol Brewer, PhD, RN, FAAN. “One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “A high rate of turnover at a hospital, if it's voluntary, could be problematic,” Brewer added, “but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.” Nurse.com also covered the study.

Having incarcerated parents is associated with significant health problems and behavioral issues, and may be more harmful to children’s health than divorce or the death of a parent, USA Today reports. “These kids are saddled with disadvantages,” said Kristin Turney, PhD, author of the study that reached those conclusions. She is an RWJF Health & Society Scholars program alumna. “They’re not only dealing with parental incarceration, but also mental health issues.” The study found that having a parent in prison was associated with such conditions as attention deficit hyperactivity disorder, learning disabilities, speech or language problems, and developmental delays. Turney’s study was also covered by US News and World Report, Salon, Psych Central, Healthline and Mother Jones, among other outlets. 

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Sep 10 2014
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I Am Who I Am Because of You

Faith Ikarede Atte, RN, MSN, is a Future of Nursing Scholar studying for her PhD at Villanova University, supported by Independence Blue Cross Foundation. The Future of Nursing program is a project of the Robert Wood Johnson Foundation.

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There are things in life so personal and private that when one vocalizes them, there is fear of being judged. It was eleven years ago that I had a personal encounter with myself. It is admittedly odd to look back at the path that I have walked on, now overgrown and distant—yet still so close to my heart.

Eleven years ago is when I lost a sense of who I was in the eyes of society, and I had to look within myself to find my footing. It is during this time that I had arrived from Kenya, full of vigor, light spirited and quick to laughter. I was hungry for knowledge and the sky was the limit.

Little did I know that life was about to teach me a lesson. It became obvious to me that my accent was different. Most immigrants can identify with the situation of being different. The more I spoke, be it in class or in a group of people, the more I felt isolated due to reactions like, “What did you say? Speak up.  Your accent is too thick. I don’t know what you are saying.”

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Aug 7 2014
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RWJF Scholars in the News: The ACA and mental health treatment, HIV training for nurses, the rise of superbugs, 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:

An Affordable Care Act (ACA) provision that allows parents to keep adult children on their health insurance plans under they reach age 26 has resulted in millions more young people with mental-health and substance-abuse problems getting treatment, according to a study led by Brendan Saloner, PhD. Time reports that over two years, young adults ages 18 to 25 who had screened positive for mental health or substance abuse disorders increased their use of mental-health treatment by 5.3 percent compared to a similar group who were not eligible for their parents’ coverage. Vox and HealthDay were among the outlets to report on the study. Saloner is an RWJF Health & Society Scholar.

Infection Control Today quotes Jason Farley, PhD, MPH, CRNP, on the growing need to train nurses to provide HIV care. An RWJF Nurse Faculty Scholar, Farley developed new HIV curriculum for the John Hopkins School of Nursing, where he is an associate professor. “For many years these specialty training programs in HIV have been available for physicians,” he says. “This is the first time we’re offering them to non-physician providers. It’s quite an important development. When you look at data comparing patient outcomes with physician care and with nurse practitioner care in HIV, whether in the United States or in sub-Saharan Africa, those outcomes are the same.”

Magda Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna, explores the stressors that lead to high numbers of returning National Guard soldiers abusing alcohol, reports Science Codex. Cerda is the lead investigator of the study, which examined 1,095 Ohio National Guard soldiers who served primarily in Iraq or Afghanistan in 2008 and 2009, and found that having just one civilian stressor such as job loss, or legal or financial problems, raised the odds of alcohol use disorders. Medical Daily and Medical Xpress also cover Cerda’s work.

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Aug 4 2014
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Loneliness: A Significant Stressor that Requires Intervention

Laurie A. Theeke, PhD, FNP-BC, is an alumna of the Robert Wood Johnson Foundation Nurse Faculty Scholars program and an associate professor of nursing at West Virginia University School of Nursing.

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The Burden of Stress in America, a new report commissioned by NPR, RWJF, and the Harvard School of Public Health, makes it clear that Americans are experiencing extremely stressful life events that are contributing to poor health outcomes. As a researcher who studies loneliness and how it contributes to poor health, I found the report somewhat alarming. Many of the life events identified by survey respondents are already associated with loneliness in the health and social science literature. Stressful events like new illness and disease, losing a spouse or loved one, or major life transitions can all lead to a personal experience of loneliness. This is very concerning because loneliness is a unique psychological stressor that can be hard to recognize or remedy without professional help.

Loneliness is a significant biopsychosocial stressor that contributes to multiple chronic conditions. We have known since the 1950s that there is an association between loneliness and cardiovascular problems like hypertension (Hawkey, Masi, Berry, & Cacioppo, 2006). More recent studies have identified loneliness as a major predictor of stroke as well.

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Jul 29 2014
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Childhood Trauma: A Public Health Problem that Requires a Robust Response

Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.

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Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.

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Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.

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Jul 23 2014
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Facebook: Friend or Foe?

Linda Charmaraman is a research scientist at the Wellesley Centers for Women at Wellesley College and a former National Institute of Child Health and Human Development postdoctoral scholar. She is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, examining the potential of social media networks to promote resiliency in vulnerable populations.

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If you were stressed out and wanted to vent to your friends about it, how would you let them know? Would you pick up the phone and talk, or text? Would you set up time to grab coffee or go for a brisk walk? Or would you post to Facebook why your day just couldn’t get any worse?

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As I logged into the recent RWJF/NPR/Harvard School of Public Health-sponsored Stress in America discussion, I identified with the panelists who were dispelling stereotypes about “highly stressed” individuals being high-level executives or those at the top of the ladder. Instead of finding work-related stress as a top concern, as is often played out in the media and popular culture, the researchers were finding that individuals with health concerns, people with disabilities, and low-income individuals were experiencing the highest levels of stress. The panelists talked about the importance of qualities like resiliency and the ability to turn multiple, competing stressors into productive challenges to overcome, and the integral role of communities in shaping, buffering, and/or exacerbating stress.

We often consider our communities as living, working, playing in close physical proximity. But what about the online spaces? What about our opt-in networked friendship circles ... our cyber-audience who sign up to read our posts with mundane observations, proud revelations, and the occasional embarrassing photos?

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Jul 17 2014
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RWJF Scholars in the News: Gun violence, suicide, ‘structural’ versus ‘cultural’ competency, 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:

An NPR story quotes RWJF Health & Society Scholars program alumnus Andrew Papachristos, PhD, citing his extensive research on gun violence. Papachristos criticizes the lack of context in media coverage of violence, noting that incidents such as the series of shootings over the Fourth of July weekend in Chicago tend to be treated simply as a long stretch of violent incidents. “Treating Chicagoland violence as merely a tally necessarily dehumanizes its victims, but it also obscures so much of the larger story about that violence. It's data without context.” Not only is the murder rate steadily declining in Chicago, but there is a massive disparity in victims of these crimes: “Eighty-five percent of violence—any shootings—happens among 5 percent of people,” Papachristos says.

In an article about libertarianism and state laws related to guns and other topics, the Economist cites a study about the social costs of gun ownership by RWJF Investigator Award in Health Policy Research recipients Philip Cook, PhD, and Jens Ludwig, PhD. It finds that “more guns empirically lead to more gun-related violence, largely because legally purchased guns somehow end up in the hands of criminals via theft,” gun shows, and online sales, which are largely unregulated. To address these issues, Cook and Ludwig suggest making it costlier to buy guns in high-crime areas, and improving the records used to screen gun buyers by including more information on possible mental-health problems, among other proposals. (Free registration required to view article.)

A study co-authored by RWJF Health & Society Scholars program alumnus Alexander Tsai, PhD, MD, finds that men who are more socially connected are half as likely to commit suicide as men considered loners, NBC News reports. The study looks at data on nearly 35,000 men, ages 40 to 75, and finds that those who are more isolated are at greater risk, even if they are not mentally ill. “Public health practitioners think about things like cardiovascular disease as warranting public health attention,” says Tsai, suggesting that suicide may also need attention.

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Jul 11 2014
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How Stress Makes Us Sick

Keely Muscatell, PhD, is a social neuroscientist and psychoneuroimmunologist. She is a post-doctoral scholar in the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), San Francisco and UC, Berkeley.

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Results from the recent NPR/RWJF/Harvard School of Public Health poll suggesting that Americans are living under high levels of stress probably don’t surprise anyone. In a way, I’ve been taking an informal version of this poll for the last six years, since when I tell people I meet on airplanes or at local bars that I study stress and health, I am unfailingly met with knowing glances and stories about stressors people are facing in their lives. Given that stress is pervasive (and problematic) in modern life, lots of current research in psychology and neuroscience is focused on understanding exactly how stress can get “into our brains” and “under our skin” to make us sick.

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When we think of illness, one of the first things that comes to mind is the immune system, with its lymph nodes, white blood cells, and antibodies hanging around to help us fight off infections and heal our injuries. An especially important component of the immune system involves inflammation. If you’ve ever gotten a paper cut, you’ve probably noticed that the area of skin around the cut tends to turn red and warm up shortly after the injury. This happens because proteins called “pro-inflammatory cytokines” swim through your blood stream to the site of the wound, where they call out to other immune cells to come to the area and help heal the cut. In the short term, this is a good thing; those little cytokines are a key part of healing. But if inflammation becomes widespread throughout the body, cytokines can lead to depression and even physical diseases, like arthritis and heart disease.

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