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Article

Kim Van Orden, Caroline Silva, and Yeates Conwell

Suicide in later life is a significant public health problem around the world—a problem that will increase in magnitude in the coming years with the impact of population aging. Adults age 70 and older have higher suicide rates than younger groups worldwide in both lower-income and higher-income countries. While suicide rates tend to increase with age, suicide in later life is not an expected or normative response to stressors that accompany the aging process. Instead, a constellation of risk factors places an older adult at elevated risk for suicide. These factors can be remembered as the Five D’s: psychiatric illness (primarily depression); functional impairment (also called disability, often associated with dependency on others); physical illness (particularly multiple comorbid diseases); social disconnectedness (including social isolation, loneliness, family conflict, and feeling like a burden); and access to lethal (deadly) means. The greatest risk occurs when multiple domains of risk converge in a given individual. Approaches to prevention can address the Five D’s. Given that older adults are reluctant to seek out mental healthcare and that standard primary care practice cannot easily provide it, models of primary care-based integrated care management for mental disorders, including in older adulthood, have been developed, rigorously tested, and widely disseminated. These models play an important role in suicide prevention by integrating treatment for physical and mental illness. Upstream, selective prevention strategies that target disconnectedness—such as engaging older adults as volunteers—may serve to reduce disconnectedness and thereby reduce suicide risk. Universal prevention strategies that involve growing the geriatric workforce may address disability by increasing older adults’ access to medical and social service providers with expertise in improving physical, cognitive, and social functioning, as well as improving quality of life. Addressing ageism and building age-friendly communities that use strategies to integrate older adults into society and promote social participation hold promise as universal prevention strategies. Ultimately, effective suicide prevention strategies for older adults must focus on improving quality of life as well as preventing suicide: strategies such as psychotherapy and medication for psychiatric disorders must be supplemented by prevention strategies for older adults give at all ages in addition to treating psychiatric disorders and suicidal thoughts is needed to address the problem of suicide in later life.

Article

In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.

Article

Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.

Article

There is no doubt that exercise, a vital health-promoting activity, regardless of health status, produces numerous well-established physical, functional, and mental health benefits. Many people, however, do not adhere to medical recommendations to exercise consistently, especially if they have chronic illnesses. Put forth to explain this conundrum are numerous potential explanatory factors. Among these are mental health correlates such as anxiety, fear, fatigue, pain, motivation, and depression, as well as various self-efficacy perceptions related to exercise behaviors, which may be important factors to identify and intervene upon in the context of promoting adherence to physical activity recommendations along with efforts to reduce the cumulative health and economic burden of exercise non-adherence among the chronically ill and those at risk for chronic illnesses.

Article

Aaron L. Slusher and Edmund O. Acevedo

Physical activity is essential for optimal human functioning. However, the emergence of modern lifestyle conveniences has contributed to the increased prevalence of sedentary behavior. As a result, the psychobiological nature of physical activity and the positive impact of physical activity on body and brain communication has prompted investigators to utilize a breadth of research strategies and techniques to identify physical activity regimes, associated mental health benefits, and the plausible mechanisms that explain the mental health adaptations. Furthermore, investigators have provided evidence supporting a number of mechanisms that at least partially explain the psychological adaptations to acute (a single bout) and chronic (long-term) physical activity intervention. Through these efforts, the observed efficacy of physical activity as a potential therapeutic intervention strategy to ameliorate the most prevalent mental disorders (i.e., anxiety, depression, bipolar disorder, and schizophrenia), and to enhance mental illness-related and age-related impairments of cognitive function has received some attention in the literature and will likely lead to clarity and confidence for clinical use.

Article

The ability to withstand or adapt to environmental demands is an inherent aspect of performance sport. At the highest level of competition, phenomenal levels of psychological resilience are necessary to attain and sustain success. Although various biopsychosocial factors contribute to the development of this resilience, an important differentiating factor in the emergence of the world’s best athletes is an ability to benefit in some way from the adversity they encounter, to the extent that they psychosocially grow and develop their resilience beyond their pre-trauma functioning, resulting in superior performance. These interrelated experiences of adversity, growth, and resilience involve ongoing complex interactions of numerous personal and situational factors. To briefly elaborate, following adversity-related trauma, athletes go through a “transitional process” whereby growth is facilitated through a combination of internal and external processes. For the world’s best athletes, changes to their motivation and personality appear to be particularly salient psychological aspects of adversarial growth. With regard to the development of resilience, the combined influence of psychological (i.e., personality, motivation, confidence, focus, support) and environmental (i.e., challenge, support) factors underpin athletes’ enhanced ability to withstand or adapt to environmental demands. Although there are a variety of potential beneficial outcomes of these experiences, it appears that there may also be some darker aspects to the world’s best athletes’ development and performance that have less desirable effects on their mental health and relationships. The integrative synthesis of psychological resilience and adversarial growth offers one of the most exciting and insightful avenues for future research in sport and performance.

Article

Zella Moore, Jamie Leboff, and Kehana Bonagura

Major depressive disorder, dysthymia, and bipolar disorder are very common diagnoses seen among athletes, and they are serious conditions that can be debilitating if not properly addressed. These disorders warrant careful attention because they can adversely affect multiple domains of an athlete’s life, including athletic motivation, performance outcomes, interpersonal well-being, health, and overall daily functioning. Key foci include the prevalence of, clinical characteristics of, causes of, and risk factors for major depressive disorder, persistent depressive disorder/dysthymia, bipolar I disorder, and bipolar II disorder. Sport psychologists should integrate such important information into their overall case conceptualization and decision-making processes to ensure that athletes and performers at risk for, or struggling with, such mental health concerns receive the most effective, efficient, and timely care possible.

Article

Athletes’ transition out of elite sport has drawn the attention of psychologists in view of the number of problems retired athletes face with which they are generally unprepared to cope. Research over the past decades has revealed that athletic retirement should not be viewed as a dead-end stop but rather as a process of transition. The quality of this transition is influenced not only by the pre- and post-retirement phases but also by the challenges retiring elite athletes have faced at different levels of their development. Using the holistic athletic career model, challenges faced by retiring athletes are described at the athletic, psychological, psychosocial, academic, vocational, financial, and legal levels of their development. Particular attention is paid to the influence of these multilevel challenges on retirees’ mental health. In conclusion, the roles of psychologists in preparing and supporting elite athletes during the transition out of their sport are considered.

Article

Vindhya Undurti

There is no explicitly defined field as feminist psychology(ies) in India. It is therefore necessary to look beyond the discipline of psychology and examine the scholarship available in other disciplines as well as in activist efforts to illumine questions that are of concern to feminist psychology(ies)—questions of how inequitable access to resources, disproportionate burden of care giving and gender stereotypical identities impact on gender relations and on women’s well-being and identity. From the interface of psychology with feminisms, three thematic areas emerge against the backdrop of past and contemporary socio-political developments in the country that have directly or indirectly influenced and informed the content and direction of research in these thematic areas. The three key themes are (a) mental health and well-being and the influence of the interlinked perspectives of gender, public health, human rights and social justice on this field, (b) gender-based violence and the evolution of psychosocial interventions for reduction and prevention of violence, and (c) the socio-historical construction of identities and the construction of masculinities in particular and that of the “modern Indian woman” in the conundrum of tradition and modernity. First, the literature on gender and mental health emphasizes the need to connect mental health with social determinants, demonstrates the existence of gender bias in access to mental health services, shows that women are represented more in common mental disorders whose aetiology is associated with the social position of women, and highlights the relationship of gender-specific risk factors such as domestic violence to the occurrence of depression in women. Second, the body of work on interventions for reducing and preventing gender-based violence shows services such as one-stop centers hinged on a psychosocial intervention model; and women’s collectives for alternate dispute resolution based loosely on feminist principles, serving as a platform for voicing and recognition of violence and connecting survivors to institutional services. Third, the socio-historical context of identity construction reveals masculinity as a product of interplay of the colonizing and colonized cultures in the nationalist period of pre-independence India, the subsequent turn to “aggressive Hindu communalism” as a model for masculinity and the construction of femininity in the conundrum of tradition and modernity. Thus, despite e some influence and infusion of perspectives on each other, feminisms and psychology in India continue to run parallel to each other, and feminist psychology(ies) in India remains an indistinct field as yet.

Article

Christopher J. Plack and Hannah H. Guest

The psychology of hearing loss brings together many different subdisciplines of psychology, including neurophysiology, perception, cognition, and mental health. Hearing loss is defined clinically in terms of pure-tone audiometric thresholds: the lowest sound pressure levels that an individual can detect when listening for pure tones at various frequencies. Audiometric thresholds can be elevated by damage to the sensitive hair cells of the cochlea (the hearing part of the inner ear) caused by aging, ototoxic drugs, noise exposure, or disease. This damage can also cause reductions in frequency selectivity (the ability of the ear to separate out the different frequency components of sounds) and abnormally rapid growth of loudness with sound level. However, hearing loss is a heterogeneous condition and audiometric thresholds are relatively insensitive to many of the disorders that affect real-world listening ability. Hair cell loss and damage to the auditory nerve can occur before audiometric thresholds are affected. Dysfunction of neurons in the auditory brainstem as a consequence of aging is associated with deficits in processing the rapid temporal fluctuations in sounds, causing difficulties in sound localization and in speech and music perception. The impact of hearing loss on an individual can be profound and includes problems in communication (particularly in noisy environments), social isolation, and depression. Hearing loss may also be an important contributor to age-related cognitive decline and dementia.

Article

Nancy A. Pachana, Nicola W. Burton, Deirdre McLaughlin, and Colin A. Depp

Research on healthy aging has begun to address mental health issues in later life. Despite the debates about exactly what constitutes healthy aging and which are the most useful or valid determinants of this construct to study, there is substantial evidence for several determinants of successful aging, including physical activity, cognitive stimulation, and social networks. All three of these determinants support mental health, including cognition, in later life. Resilience is another construct that plays an important role in healthy aging, but it has not received as much research attention at the end of life as in earlier periods. Factors that reduce the risk of mental distress or promote resilience with respect to mental health in the face of challenges in later life remain fruitful areas for further investigations.

Article

Shauna Shapiro and Elli Weisbaum

Mindfulness practice and protocols—often referred to as mindfulness-based interventions (MBIs)—have become increasingly popular in every sector of society, including healthcare, education, business, and government. Due to this exponential growth, thoughtful reflection is needed to understand the implications of, and interactions between, the historical context of mindfulness (insights and traditions that have been cultivated over the past 25 centuries) and its recent history (the adaptation and applications within healthcare, therapeutic and modern culture, primarily since the 1980s). Research has shown that MBIs have significant health benefits including decreased stress, insomnia, anxiety, and panic, along with enhancing personal well-being, perceptual sensitivity, processing speed, empathy, concentration, reaction time, motor skills, and cognitive performance including short- and long-term memory recall and academic performance. As with any adaptation, skillful decisions have to be made about what is included and excluded. Concerns and critiques have been raised by clinicians, researchers, and Buddhist scholars about the potential impact that the decontextualization of mindfulness from its original roots may have on the efficacy, content, focus, and delivery of MBIs. By honoring and reflecting on the insights, intentions, and work from both historical and contemporary perspectives of mindfulness, the field can support the continued development of effective, applicable, and accessible interventions and programs.

Article

Vanessa L. Burrows

Stress has not always been accepted as a legitimate medical condition. The biomedical concept stress grew from tangled roots of varied psychosomatic theories of health that examined (a) the relationship between the mind and the body, (b) the relationship between an individual and his or her environment, (c) the capacity for human adaptation, and (d) biochemical mechanisms of self-preservation, and how these functions are altered during acute shock or chronic exposure to harmful agents. From disparate 19th-century origins in the fields of neurology, psychiatry, and evolutionary biology, a biological disease model of stress was originally conceived in the mid-1930s by Canadian endocrinologist Hans Selye, who correlated adrenocortical functions with the regulation of chronic disease. At the same time, the mid-20th-century epidemiological transition signaled the emergence of a pluricausal perspective of degenerative, chronic diseases such as cancer, heart disease, and arthritis that were not produced not by a specific etiological agent, but by a complex combination of multiple factors which contributed to a process of maladaptation that occurred over time due to the conditioning influence of multiple risk factors. The mass awareness of the therapeutic impact of adrenocortical hormones in the treatment of these prevalent diseases offered greater cultural currency to the biological disease model of stress. By the end of the Second World War, military neuropsychiatric research on combat fatigue promoted cultural acceptance of a dynamic and universal concept of mental illness that normalized the phenomenon of mental stress. This cultural shift encouraged the medicalization of anxiety which stimulated the emergence of a market for anxiolytic drugs in the 1950s and helped to link psychological and physiological health. By the 1960s, a growing psychosomatic paradigm of stress focused on behavioral interventions and encouraged the belief that individuals could control their own health through responsible decision-making. The implication that mental power can affect one’s physical health reinforced the psycho-socio-biological ambiguity that has been an enduring legacy of stress ever since. This article examines the medicalization of stress—that is, the historical process by which stress became medically defined. It spans from the mid-19th century to the mid-20th century, focusing on these nine distinct phases: 1. 19th-century psychosomatic antecedent disease concepts 2. The emergence of shell-shock as a medical diagnosis during World War I 3. Hans Selye’s theorization of the General Adapation Syndrome in the 1930s 4. neuropsychiatric research on combat stress during World War II 5. contemporaneous military research on stress hormones during World War II 6. the emergence of a risk factor model of disease in the post-World War II era 7. the development of a professional cadre of stress researchers in the 1940s and 50s 8. the medicalization of anxiety in the early post–World War II era 9. The popularization of stress in the 1950s and pharmaceutical treatments for stress, marked by the cultural assimilation of paradigmatic stress behaviors and deterrence strategies, as well pharmaceutical treatments for stress.