By Austine Duru, MDiv, MA, BCC
In this issue of Vision, in lieu of publishing a research article, we present eight resources in hopes of assisting readers to sample a broad range of research and research related topics by chaplains and non-chaplain collaborators. Each resource is related to our current Vision theme, focusing on “Fanning the Spark Within: Ministry to the Mentally Ill.” A link to an open-access page has been included to access the articles featured here for further detailed reading.
Megan Andreas Moreno, Dimitri A. Christakis, Katie G. Egan, Lauren A. Jelenchick, Elzabeth Cox, Henry Young, Hope Villiard & Tara Becker. A Pilot Evaluation of Associations Between Displayed Depression References on Facebook and Self-reported Depression Using a Clinical Scale. Journal of Behavioral Health Services & Research. July 2012, Vol. 39, No. 3, Pages 295-304.
rd.springer.com/article/10.1007%2Fs11414-011-9258-7. (41 references)
Social media has been variously identified as a powerful means of communication among young people. Most families will agree that the “sacredness” of dinner time and other family gatherings have been routinely violated by teenage children who continuously text or check their Facebook profile during meal time. Little wonder then that the authors of the study chose to track the Facebook profiles of young people in an effort to glean some helpful information regarding mental illness. In their study, Megan Andreas Moreno, et, al., believed that social media play a vital role in the life of young college age people. This work draws on available research that shows young people display higher levels of self-disclosure when chatting on the computer, partly due to the sense of anonymity that it offers.
The authors reviewed 307 Facebook profiles of freshmen, sophomore and junior undergraduates in two large universities in the United States. Their objective was to “examine the validity of references to depression symptoms on public Facebook profiles by comparing these references to self-reported depression symptoms using the Patient Health Questionnaire (PHQ-9) depression screening tool.” The results were quite impressive and revealing. “A trend approaching significance was noted that participants who scored into a depression category by their PHQ-9 score were more likely to display depression symptom references. Displayed references to depression symptoms were associated with self-reported depression symptoms.” The study hints at the value of innovative ways to identify and provide appropriate mental health intervention to at-risk college-age students.
Lyndon A. Riviere, Athena Kendall-Robbins, Dennis McGurk, Carl A. Castro & Charles W. Hoge. Coming home may hurt: risk factors for mental ill health in U.S. reservists after deployment in Iraq. The British Journal of Psychiatry. 2011, Vol. 198, Pages 136-142.
bjp.rcpsych.org/content/198/2/136.full. (33 references)
It is common knowledge that soldiers and veterans experience higher risks of post-traumatic stress disorder (PTSD) following their return from war. Among this group, National Guard soldiers have been identified as having high percentages of PTSD cases. Studies have shown that this is in part due to their exposure to combat situations. What is not clear, however, are which factors of the veteran’s experience abroad and/or at home directly or indirectly trigger PTSD. In this study, Lyndon Riviere and his colleagues attempt to fill this gap by studying a sample of National Guard soldiers deployed to Iraq. Their aim was to “examine whether financial hardship, job loss, employer support and the effect of deployment absence on co-workers were associated with depression and post-traumatic stress disorder (PTSD).” The authors did a cross-sectional study of two National Guard brigades comprising 4,034 soldiers, at two time points. This yielded some interesting results, as the authors noted. They said, “We believe that our study’s findings offer empirical evidence that the National Guard specific variables examined here are risk factors for developing post-deployment mental health problems after adjusting for combat exposure and demographic variables.” This study is significant for those (including chaplains) who provide care for National Guard veterans, as well as for families, co-workers and employers of veterans.
Yuhua Bao, Lawrence P. Casalino & Harold Alan Pincus. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization. Journal of Behavioral Health Services & Research. 2013, Vol. 40, No. 1, Pages 121-132.
rd.springer.com/article/10.1007%2Fs11414-012-9306-y#page-1 (34 references)
The recent shooting and tragedy in Newtown, CT, has brought the problem of the mental health crisis to the national spotlight. Untreated mental illness is becoming a problem of epidemic proportions, according to Brian Marshal of the National Alliance on Mental Illness (NAMI). Various states have recently closed or significantly reduced the capacity of their mental health institutions, resulting in the transfer of mentally ill patients to correctional facilities, where they clearly do not belong. In most states, like Louisiana, the mental health institutions have been privatized, making it less accessible to those with little means and no insurance. Most healthcare institutions have significantly reduced the number of psychiatric beds or closed their psychiatric units due to lack of proper reimbursement from the government and/or insurance companies. The national and regional conversations on how to deliver and pay for effective healthcare (healthcare reform) have little consideration for mental health reform. In fact, the Mental Health Parity and Substance Abuse Act, passed in 2008, currently remains unenforceable, in large part, because the legislative rules are yet to be written. By 2014, the Affordable Care Act will fully go into effect. It is projected that more mental health patients will have a chance to obtain health insurance; however, some will remain without proper mental healthcare.
This study done by Yuhua Boa and his colleagues direct our attention to the uncomfortable truths regarding mental health issues in our nation, and seeks ways to bring the mentally ill into the mainstream of the U.S. medical care system. It uses a four-quadrant conceptual model of patient populations “defined by their behavioral health conditions and insurance status,” and it looks at the possible benefits and shortcomings of the three core care models being promoted by the Affordable Care Act: the Medical Home, the Health Home and the Accountable Care Organization. The authors evaluate each model within the context of their potentials and limitations, recommendations for accountability and payment policy. This study has enormous implications for behavioral health and those who work with or minister to behavioral health clients and patients.
Jo Griffin. The Lonely Society? Mental Health Foundation, UK. 2010. (43 pages.)
www.mentalhealth.org.uk/content/assets/PDF/publications/the_lonely_society_report.pdf?view=Standard For a summary of this study see: Lee Quinney –
www.communitycare.co.uk/articles/04/02/2011/116227/research-and-evidence-social-isolation.htm. (66 references)
Anecdotal evidence suggests that the line that separates mental well-being from mental illness is often narrow. This study done with the support of the Mental Health Foundation, a leading UK charitable organization working in mental health and learning disabilities, suggests that this line gets even narrower when individuals become more isolated and lonely. The author uses a number of resources to gather useful data for this study and draws on a number of interesting case studies as exemplars that support his research. The author misses important opportunities to add more clarity to some of the claims being made. His central argument is that loneliness, if unattended, can lead to mental problems and something could, and should be done about this. He writes, “One approach to loneliness is preventative: we can stop loneliness becoming chronic and tackle the needs of groups that are socially excluded and at risk of isolation. But the success of such measures depends on creating a new climate in which we can better manage our need for social connection” (pg.7). The volume of this work, though well written, prevents easy summary. However, this should not be alarming. A link is provided here to a short, concise summary of this work that touches on the important points in the findings (if you prefer to read a toned-down version). This study has important significance for all healthcare workers. It is also a good resource for discussing self-care and burn-out.
Jacky T. Thomas, Melanie D. Otis. Intrapsychic Correlates of Professional Quality of Life: Mindfulness, Empathy, and Emotional Separation. Journal of the Society for Social Work and Research. 2012, Vol. 1, No.2, Pages 83-98.
www.jsswr.org/article/view/5361/4504. (74 references)
It is clear from what is now a great deal of research data that helping professionals (including chaplains) often suffer the unintended “occupational hazards” of being exposed to highly stressful situations, which can lead to experiencing compassion fatigue, secondary traumatic stress, vicarious trauma and what is commonly known as burnout. These have significant impact on the mental well-being of these professionals. In this study, the authors attempt to examine those factors that could lead to stress disorders as well as identify those factors that contribute to “compassion satisfaction,” described as, “the positive feelings associated with effectively doing helping work.” Specifically, this study focuses on “mindfulness in relation to compassion fatigue or compassion satisfaction … and the effect of empathy and emotional separation on compassion fatigue, burnout, and compassion satisfaction.” The article draws on numerous sources and data; it is pretty dense. However, the findings reveal important correlation between mindfulness, emotional separation, compassion satisfaction, and burnout. This work has great potential for reshaping training programs for chaplains and other helping professionals. It hints at the urgency of the need for ongoing self-care to promote mental well-being. It is worth reading.
Michaela L. Zajicek-Farber, Lynn M. Mayer & Laura G. Daughtery. Connections Among Parental Mental Health, Stress, Child Routines, and Early Emotional Behavioral Regulation of Preschool Children in Low-Income Families. Journal of the Society of Social Work and Research. February 2012, Vol. 3 No.1, Pages 31-50.
www.jsswr.org/article/view/8930/6926 (85 references)
The impact of poor adult mental health on parenting has been shown to be a significant risk factor for child development. The authors of this study seek to “examine the connections among parental mental health, stress, and engagement in child routine activities with children’s emotional regulatory competence.” Using a secondary data analysis with 2,977 children (birth to 3 years), this study focuses on early childhood interventions in high-risk families with low income for whom access to mental health is limited. The authors describe their methods and how they analyzed the results. Their findings further support behavioral parenting processes within attachment theory. Most importantly, this study implies that even when parents are unable to seek professional help with their own mental health issues, “reducing parental stress and encouraging engagement in a shared bedtime routine offer benefits to children’s regulatory competencies.” This work is a good resource for chaplains working with children and mothers. It is a helpful teaching tool for interdisciplinary collaboration, especially under the psycho-social-spiritual model.
Leonard Miller, Timothy T. Brown, David Pilon, Richard M. Scheffler & Monica Davis. Patterns of Recovery from Severe Mental Illness: A Pilot Study of Outcomes. Community Mental Health Journal. 2010, Vol. 46, Pages 177-187.
rd.springer.com/article/10.1007/s10597-009-9211-x/fulltext.html. (30 references)
In a world where resources are scarce, it is often a challenge to find meaningful ways to channel available resources to target those who will benefit the most from them. In the case of mental health in our society today, policymakers often lack proper knowledge of what is needed and where to channel resources to help an increasing population of mentally ill populations, most of whom are homeless. The authors of this study performed a pilot study to examine the “patterns of recovery from severe mental illness in a model integrated service delivery system using measures from the Milestones of Recovery Scale (MORS).” They argue that with proper intervention, recovery from severe mental health is possible. Recovery from mental health as used in their work is defined as “a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential” (SAMHSA 2004).
This study focuses on one example in the state of California where a mental health facility, Village Integrated Service Agency, received a grant from the state in 1990 to promote integrated service delivery systems. The agency’s success led to the expansion of Full Service Partnerships (FSP) across the state in the passage of California’s Mental Health Services Act. The result shows that after two years, almost half of their initial extreme-risk clients was labeled “coping/rehabilitation,” “early recovery” or “self-reliant.” The study highlights the significant impact of providing broad ranging mental services to severely mentally ill patients. It also makes clear that public policies on the problem of mental health can benefit from deeper analysis of best practices in the programs that work. In this study, 658 clients were observed.
Angelo E. Volandes, Michael K. Paasche-Orlow, Michael J. Barry, Muriel R. Gillick, Kenneth L. Minaker, Yuchiao Chang, E. Francis Cook, Elmer D. Abbo, Areej El-Jawahri & Susan L. Mitchell. Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial. British Medical Journal. 2009, Vol. 338.
www.bmj.com/content/338/bmj.b2159.pdf%2Bhtml. (53 references)
The importance of having the conversation about advance directives cannot be overstressed, as most chaplains are painfully aware. This is truer in cases where the possibility of the onset of dementia is imminent in older populations. This randomized controlled trial done in four primary care clinics in Boston is, perhaps, the first of its kind. The methodology involved combining verbal narratives and a video support tool to aid in decision making at the end of life. The authors reach three important conclusions: 1. When presented a verbal description and a video of a person suffering from advanced dementia, older people are more likely to opt for comfort care at the end of life. 2. A video tool increases knowledge of advanced dementia, and end-of-life care choices are sustained over time. 3. There is a positive correlation between health literacy and end-of-life preferences among older patients.
Austine Duru is staff chaplain at Franciscan St. Margaret Health in Dyer, IN. Chaplain Duru, a member of the NACC’s Editorial Advisory Panel, is also on the NACC’s Task Force on Research.
Involved in research on a topic related to chaplaincy? Looking for a venue to publish? Vision would be interested in learning about your research effort. Contact Austine Duru at firstname.lastname@example.org or Laurie Hansen Cardona at Lcardona@nacc.org.