Witchcraft and Biopsychosocial Causes of Mental Illness: Attitudes and Beliefs About Mental Illness Among Health Professionals in Five Countries.

This study examines the intercorrelation of measures reflecting beliefs about and attitudes toward people with mental illness in a sample of health professionals (N = 902) from five countries: Brazil, China, Ghana, Nigeria, and the United States, and, more specifically, the association of beliefs in supernatural as contrasted with biopsychosocial causes of mental illness. Factor analysis of a 43-item questionnaire identified four factors favoring a) socializing with people with mental illness; b) normalizing their roles in society; c) belief in supernatural causes of mental illness (e.g., witchcraft, curses); and d) belief in biopsychosocial causes of mental illness. Unexpectedly, a hypothesized negative association between belief in supernatural and biopsychosocial causation of mental illness was not found. Belief in the biopsychosocial causation was weakly associated with less stigmatized attitudes towards socializing and normalized roles.

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries.

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

Obstetrician-Gynecologists' Practices, Statistical Literacy, and Risk Communication with Regard to Sexually Transmitted Infections.

In order to best care for women, obstetrician-gynecologists (ob-gyns) must be able to diagnose and treat sexually transmitted infections (STIs), as well as effectively communicate risks regarding STIs. This article provides a narrative review of studies primarily conducted by the Research Department at the American College of Obstetricians and Gynecologists, about missed opportunities for STI risk communication. Missed opportunities include the omission or partial completion of STI risk assessment and counseling, failure to offer screening or testing, lack of follow-up on STI testing/vaccination refusals, and a failure to comply with existing guidelines. We also discuss knowledge level, time constraints, and gaps in statistical literacy as barriers to STI communication. The aim of this article is to highlight common barriers to risk communication, discuss their potential impact, and suggest means by which these obstacles can be addressed. Future directions for training, education, and research are discussed.

Obstetrician-gynecologists' knowledge, attitudes, and practice regarding elder abuse screening.

BACKGROUND: Elder abuse is a prevalent and growing social problem with significant consequences on victims' mental and physical health. Unfortunately, many cases of elder abuse go unreported. Elderly women are at increased risk for abuse and, as such, obstetrician-gynecologists (OB/GYNs) are in a unique position to screen for and report abuse. This study intended to determine OB/GYNs' knowledge, attitudes, and practice regarding elder abuse. METHODS: Two hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) received a survey. Analysis was completed with SPSS 20.0. In addition to descriptive statistics, χ(2) analyses were used to determine differences between groups. FINDINGS: In total, 122 fellows responded (61%). Abuse screening rates differed by abuse type. Few "always" screen for abuse, with half assessing only when it is suspected. Most (81%) had never reported a case of abuse. Younger males reported different clinical practice patterns than other groups. Generally, OB/GYNs were knowledgeable about risk factors and facts about elder abuse, but several knowledge gaps were identified. Most reported that elder abuse screening is within their professional purview. Half of the respondents cited time constraints as a barrier to screening. CONCLUSIONS: Greater education about elder abuse screening is needed. Specifically, training regarding available valid and brief screening tools, local abuse reporting laws, and available community resources. This study identified the potential need to target younger male OB/GYNs for additional training.

Health and well-being of homeless veterans participating in transitional and supported employment: Six-month outcomes.

Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.

Obstetrician-gynecologists' knowledge, attitudes and practices regarding major depressive disorder.

BACKGROUND: Obstetrician-gynecologists (ob-gyns) provide depression screening and treatment, but these practices could be improved. This study investigated the use of depression screening tools and treatment of adolescents with depressive symptoms. METHODS: Surveys were sent to 220 members of the American College of Obstetricians and Gynecologists (ACOG) who had responded to a survey on depression in the past two years. Response rate was 66% (n = 145). Questions included those related to standardized depression screening, antidepressant prescribing behavior, use of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) and knowledge of adolescent depression. RESULTS: A total of 40% use standardized screening tools for depression with 46% using the Beck Depression Inventory-II and only 5% using the Patient Health Questionnaire-2 (PHQ-2). The majority (89%) of ob-gyns do not employ the DSM-IV to confirm a diagnosis of major depressive disorder. Of the ob-gyns indicating treating depression with antidepressants, 97% prescribe selective serotonin reuptake inhibitors. Only 19 respondents do not prescribe antidepressants, and instead refer depressed patients to mental health specialists. Most (79%) ob-gyns identified sexual problems as the primary side effect deterring prescribing of antidepressant medication. Ob-gyns were fairly accurate at estimating the prevalence of adolescent depression. CONCLUSION: Ob-gyns are not utilizing the recommended validated resources such as the DSM-IV or PHQ-2 for diagnosis of depression or prior to prescribing antidepressants.

Specificity of effects of cognitive behavior therapy on coping, acceptance, and distress tolerance in a randomized controlled trial for smoking cessation.

OBJECTIVE: Although there is extensive evidence of the efficacy of cognitive-behavioral therapy (CBT), it is less certain what potential mechanisms of change are specifically affected by CBT interventions. This study was intended to test the specific effects of CBT on compensatory coping skills, acceptance, and distress tolerance or persistence. METHOD: Using data from a randomized controlled trial of 8-session group CBT and a time-matched comparison condition for cigarette smokers, we evaluated CBT effects on compensatory coping skills, self-rated acceptance and behavioral markers of persistence and distress tolerance. Because depression proneness had moderated treatment response in the parent clinical trial (Kapson & Haaga, 2010), we tested not only main effects (CBT vs. comparison condition) but also moderated effects (treatment condition X depression proneness). RESULTS: CBT significantly improved compensatory coping skills only among the less depression-prone participants, who were the subset of smokers who did not benefit from CBT in terms of smoking cessation outcomes. There were no specific effects of CBT on acceptance or behavioral persistence. CONCLUSIONS: To the extent that CBT had specific effects on compensatory coping skills, it was for the participants who did not benefit clinically from the intervention. Much more theory-driven research on multiple candidate change mechanisms is needed to clarify how effective and specific treatments have their effects, for either patients in general or subsets of patients as in moderated effects.

Obstetrician/gynecologists and postpartum mental health: differences between CME course takers and nontakers.

INTRODUCTION: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers. PURPOSE: Obstetrician-gynecologists (OB-GYNs) are health care providers for women, and part of their purview includes mental health, such as postpartum depression (PPD) and psychosis (PPP). This study evaluated OB-GYNs' knowledge, attitudes, and behavior (KAB) regarding PPD/PPP, and compared characteristics of CME course takers and nontakers. METHOD: A survey was sent to 400 OB-GYNs. RESULTS: Response rate was 56%. One-third had taken a CME course on PPD/PPP. Those who consider themselves a "specialist" were less likely to have taken a CME course on postpartum mental health than those who consider themselves "both primary care provider and specialist." Non-CME course takers rely on clinical judgment more. They also are less likely to track patients' psychiatric histories and they utilize validated assessments less frequently. However, CME course takers and nontakers did not differ on knowledge or belief items. CONCLUSION: CME courses on PPD/PPP were associated with increased screening and utilization of validated assessments. There was no association between having taken a course and several knowledge questions. It is unclear if CME courses are effective in disseminating information and altering KAB.

Ethical concerns and career satisfaction in obstetrics and gynecology: a review of recent findings from the Collaborative Ambulatory Research Network.

UNLABELLED: Obstetricians-gynecologists (ob-gyns) are frequently confronted with situations that have ethical implications (e.g., whether to accept gifts or samples from drug companies or disclosing medical errors to patients). Additionally, various factors, including specific job-related tasks, costs, and benefits, may impact ob-gyns' career satisfaction. Ethical concerns and career satisfaction can play a role in the quality of women's health care. This article summarizes the studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists, which encompass ethical concerns regarding interactions with pharmaceutical representatives and patient safety/medical error reporting, as well as ob-gyn career satisfaction. Additionally, a brief discussion regarding ethical concerns in the ob-gyn field, in general, highlights key topics for the last 30 years. Ethical dilemmas continue to be of concern for ob-gyns. Familiarity with guidelines on appropriate interactions with industry is associated with lower percentages of potentially problematic relationships with pharmaceutical industries. Physicians report that the expense of patient safety initiatives is one of the top barriers for improving patient safety, followed by fear of liability. Overall, respondents reported being satisfied with their careers. However, half of the respondents reported that they were extremely concerned about the impact of professional liability costs on the duration of their careers. Increased familiarity with guidelines may lead to a decreased ob-gyn reliance on pharmaceutical representatives and free samples, whereas specific and practical tools may help them implement patient safety techniques. The easing of malpractice insurance and threat of litigation may enhance career satisfaction among ob-gyns. This article will discuss related findings in recent years. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After the completing the CME activity, physicians should be better able to analyze how interactions with pharmaceutical industry may pose ethical dilemmas, examine current barriers to implementing patient safety initiatives, and evaluate the factors that influence career satisfaction among obstetrician-gynecologists.

Obstetrician-gynecologists and women's mental health: findings of the Collaborative Ambulatory Research Network 2005-2009.

BACKGROUND: Many mental illnesses are more prevalent in women than men (e.g., depression). Obstetrician-gynecologists (ob-gyns) are frequent medical contacts for women, and so can play an important role in screening for mental illness. METHODS: This review summarizes studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists that encompass depression, anxiety, and eating disorders (EDs). RESULTS: Ob-gyns were more accurate in identifying depression than anxiety. Treatment with antidepressants was reported as a course of action twice as often as referral to a mental health professional. Physicians were moderately confident that they could recognize anxiety, but were less confident regarding treatment. One-fifth routinely screen pregnant patients for anxiety; level of interest in anxiety was the only significant predictor of screening rates. The main barriers to anxiety screening in pregnancy were time constraints and perceived inadequate training. Almost all believed EDs can harm pregnancy outcome, although few ask about ED histories. Only half view assessment of ED as within routine ob-gyn practice. Those who self-identify as primary care providers, and those who more strongly believe EDs can harm pregnancy outcomes, agreed more strongly that ED assessment is within their role. Ob-gyns perceived training regarding EDs to be poor. Knowledge of risks associated with EDs was low. CONCLUSIONS: Ob-gyns view mental health issues as important topics; however, they are not confident in their abilities to diagnose these conditions and are also concerned about the adequacy of their training. Additional training could prepare ob-gyns to incorporate mental health screening into their practices. TARGET AUDIENCE: Obstetricians & gynecologists, family physicians. LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologists should be better able to evaluate their role relative to diagnosing and treating mental illness; state the negative consequences and signs of major depressive disorder, anxiety, eating disorder, and premenstrual dysphoric disorder (PMDD) in women; examine their peers' attitudes, referral patterns, and preferred treatment methods for mental disorders; and prevent negative health consequences for women and babies resulting from mental illnesses.

Postpartum mental health screening and diagnosis by obstetrician-gynecologists.

Postpartum depression (PPD) and postpartum psychosis (PPP) can impact mother, infant, and family. Obstetrician-gynecologists (ob-gyns) are often the most frequent medical contact for postpartum women, and so are in a position to identify women needing psychological care. This study assessed ob-gyns' knowledge, attitudes, and practices regarding diagnosing PPD/PPP. A survey was sent to 400 members of the American College of Obstetricians and Gynecologists who have volunteered to participate in research. Response rate was 56%. Routine screening for PPD and PPP is conducted by 72% and 30% of respondents, respectively. Personal experience (through friend, family, or self) was associated with increased screening. Perceived PPP screening barriers are similar to those found in the PPD literature: time constraints, lack of training, and lack of knowledge of diagnostic criteria. In responding to standardised vignettes, physicians were more likely to over-diagnose, than under diagnose PPD/PPP. This study is the first to provide exploratory data of ob-gyns' knowledge, attitudes, and practice regarding PPD and PPP. Ob-gyns are screening for PPD/PPP, though not universally so. Future research should identify ways to mitigate screening barriers.

Obstetrician-gynecologists and perinatal infections: a review of studies of the Collaborative Ambulatory Research Network (2005-2009).

BACKGROUND: Maternal infection is associated with adverse pregnancy outcomes, and ob-gyns are in a unique position to help prevent and treat infections. METHODS: This paper summarizes studies completed by the Research Department of the American College of Obstetricians and Gynecologists regarding perinatal infections that were published between 2005 and 2009. RESULTS: Obstetrician-gynecologists are routinely screening for hepatitis B and HIV, and many counsel prenatal patients regarding hepatitis B and toxoplasmosis. However, other infections are not regularly discussed, and many cited time constraints as a barrier to counseling. A majority discusses the transmission of giardiasis and toxoplasmosis, but few knew the source of cryptosporidiosis or cyclosporiasis. CONCLUSIONS: Many of the responding ob-gyns were unaware of or not adhering to infection management guidelines. Obstetrician-gynecologists are knowledgeable regarding perinatal infections; however, guidelines must be better disseminated perhaps via a single infection management summary. This paper identified knowledge gaps and areas in which practice can be improved and importantly highlights the need for a comprehensive set of management guidelines for a host of infections, so that physicians can have an easy resource when encountering perinatal infections.

Changes in and current status of obstetrician-gynecologists' knowledge, attitudes, and practice regarding immunization.

Vaccines are important tools for disease prevention and, in obstetric patients, to prevent transmission to infants. Obstetrician-gynecologists are well situated to screen for immunization status of women of child-bearing age and to provide appropriate vaccinations. A series of research investigated obstetrician-gynecologists' beliefs, practices, and knowledge regarding immunization. Surveys were sent out in 2007 to Fellows of the American College of Obstetricians and Gynecologists. Most obstetrician-gynecologists viewed screening for vaccine-preventable diseases to be within their professional role, and a majority administers at least some vaccines. Over half agreed financial factors (eg, inadequate reimbursement, cost of storing vaccines) were barriers to vaccine administration. Other perceived barriers were a concern over safety of vaccinations during pregnancy and a view that administering vaccines was not part of their usual practice. They were also concerned about their level of training. A majority believed their immunization training was less than adequate, and believed their practice would benefit from continuing medical education courses. One study identified changes in Michigan obstetrician-gynecologists' attitudes, knowledge and practices since 2000. More Michigan ob-gyns are assessing vaccination needs, viewing this as part of their professional purview, and, in general, their knowledge of vaccine recommendations has improved. Concerns over the safety of vaccines in pregnancy as well as financial burdens of immunization have increased. Immunization is an important part of women's health care and has been, at least partially, incorporated into obstetrician-gynecologist practice. Financial burdens and physician concerns over training remain barriers to vaccine administration.

Eating disorders and obstetric-gynecologic care.

OBJECTIVE: Disordered eating can have consequences for gynecologic and obstetric patients and fetuses. Amenorrhea, infertility, hyperemesis gravidarum, and preterm birth have been linked to eating disorders (EDs). This study aimed to evaluate obstetrician-gynecologists' ED-related knowledge, attitudes, and practices. METHODS: Questionnaires were sent to 968 Fellows of the American College of Obstetricians and Gynecologists between November 2007 and March 2008. Data were analyzed separately for generalists (provide obstetric and gynecologic care) and gynecologists only (treat only gynecologic patients). RESULTS: A majority of obstetrician-gynecologists assess body weight, exercise, body mass index, and dieting habits. Less than half assess ED history, body image concerns, weight-related cosmetic surgery, binging, and purging. Over half (54%) of generalists believed ED assessment falls within their purview. Most (90.8%) generalists agreed or strongly agreed that EDs can negatively impact pregnancy outcome. A majority rated residency training in diagnosing (88.5%) and treating (96.2%) EDs as barely adequate or less. Most knew low birth weight (91%) and postpartum depression (90%) are associated with maternal EDs, though over a third was unsure about several consequences. Some gender differences emerged; females screen for more ED indicators and are more likely to view ED assessment as within their role. CONCLUSIONS: Despite the consequences of EDs and the fact that most physicians agree EDs can negatively impact pregnancy, only about half view ED assessment as their responsibility. Only some weight- and diet-related topics are assessed, and there are gaps in knowledge of ED consequences. Obstetrician-gynecologists are not confident in their training regarding EDs. Improvement in knowledge and altering obstetrician-gynecologists' view of their responsibilities may improve ED screening rates.

Obstetrician-gynecologists and the HPV vaccine: practice patterns, beliefs, and knowledge.

STUDY OBJECTIVE: Human papillomavirus (HPV), the most common sexually transmitted infection in the United States, can be contracted by young girls shortly after sexual debut. Human papillomavirus can lead to cervical and anogenital cancers and genital warts. A vaccine has been developed to protect against precancerous lesions. We examined obstetrician-gynecologists' practices, opinions, and knowledge regarding this vaccine. DESIGN: A 37-item questionnaire was sent out by the American College of Obstetricians and Gynecologists (ACOG) to its fellows and junior fellows between May and November of 2007. PARTICIPANTS: Surveys went to 3896 fellows and junior fellows of ACOG. Of these surveys, 771 were Collaborative Ambulatory Research Network (CARN) members who have volunteered to receive several surveys per year. The remaining 3125 questionnaires were sent to all fellows and junior fellows in ACOG's District V (Ohio, Kentucky, Indiana, Michigan and Ontario, Canada). Response rates were 51.0% and 30.7% for CARN and District V, respectively. RESULTS: Of those who administer vaccines, most offer the HPV vaccine. Most know this vaccine protects against 4 HPV types. Fewer knew the percentages of cervical cancers and genital warts prevented. Over 20% knew all 3 answers. Only a minority answered all incorrectly. Approximately 15% view HPV vaccine as safe in pregnancy. Many agree cost is a reason for patient refusal and a deterrent from mandating the vaccine. CONCLUSION: Obstetrician-gynecologists are knowledgeable of the HPV vaccine and are incorporating it into practice. Financial concerns may limit widespread immunization.

Consequences of high incarceration rate and high obesity prevalence on the prison system.

Incarceration and obesity rates have both increased in the United States. An implication is that there will be more obese inmates, which likely will raise the prevalence of obesity-related diseases, affecting the cost and performance of correctional health care. Other issues include increased costs of transport, restraint, and housing. There is surprisingly little published information on inmate obesity prevalence. The few published research studies suggest obesity prevalence in prisons reflects that of their region. Cardiovascular-related prisoner deaths appear to be associated with state-level obesity, though other risk factors are likely involved. Weight gain while incarcerated is common, and the prevalence of diabetes is increasing. The data suggest that preventive care is not a priority in prisons. Evidence from Japan suggests restricted diets and enforced activity can improve inmate health.

Obstetrician-gynecologists' practices and perceived knowledge regarding immunization.

BACKGROUND: Obstetrician-gynecologists can play a key role in providing appropriate vaccinations to women of childbearing age. PURPOSE: This study investigated immunization knowledge and practices, and opinions concerning potential barriers to immunization, among obstetrician-gynecologists. METHODS: In 2007, surveys were sent to Collaborative Ambulatory Research Network members, a representative sample of practicing Fellows of the American College of Obstetricians and Gynecologists; 394 responded (51.2%). Data analysis was completed in 2008. RESULTS: Most responding obstetrician-gynecologists disagreed that "routine screening for vaccine-preventable diseases falls outside of the routine practice of an ob/gyn." A majority (78.7%) stock and administer at least some vaccines. Among those who stock vaccines, 91.0% stock the human papillomavirus vaccine, and 66.8% stock the influenza vaccine. All other vaccines were stocked by <30% of practices that stock vaccines. A majority of physicians agreed that financial factors (e.g., inadequate reimbursement) were barriers to vaccine administration. Most were aware that the influenza (89.8%); hepatitis B (64.0%); and tetanus, diptheria, pertussis (58.6%) vaccines are safe to administer during pregnancy, and that the measles, mumps, rubella (97.5%); and varicella (92.9%) vaccines are not. Most (84.5%) were in concordance with recommendations that all pregnant women should receive the influenza vaccine. A majority believed their immunization training was less than adequate and believed their practice would benefit from continuing medical education courses. CONCLUSIONS: Immunization is an important part of women's health care and has been, at least partially, incorporated into obstetrician-gynecologist practice. Financial burdens and knowledge regarding vaccine recommendations remain barriers to vaccine administration. Additional training and professional information may benefit obstetric-gynecologic practice.

The impact of maternal obesity on maternal and fetal health.

The increasing rate of maternal obesity provides a major challenge to obstetric practice. Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists are well positioned to prevent and treat this epidemic.