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Frontiers in Psychology 2020While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial... (Review)
Review
While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. We propose that this failure has limited our understanding of how ISA and denial differentially affect efforts to rehabilitate persons with TBI. In this selective review paper, we summarize early findings in the field and integrate those findings with more recent observations (i.e., 1999-2019). We believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for persons with TBI.
PubMed: 32765359
DOI: 10.3389/fpsyg.2020.01569 -
The American Journal of Managed Care Feb 2022The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid...
OBJECTIVES
The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid managed care organization (MMCO) program.
STUDY DESIGN
Retrospective analysis of utilization review data reported by MMCOs in New York State.
METHODS
Data from the utilization review practices of 15 MMCOs were collected and analyzed for calendar years 2017 and 2018. The data reported are specific to mental health services and include the number of authorization requests, number of clinical denials, and the reasons specified for each denial. Analyses were undertaken to determine the UR denial rates and most common reasons for denials.
RESULTS
A total of 264,901 requests for inpatient mental health service authorizations and 53,687 requests for outpatient mental health service authorizations were made in 2017 and 2018. Of these, 1.5% of inpatient authorization requests and 0.4% of outpatient authorization requests were denied for reasons related to medical necessity. The most common reason for inpatient mental health service denials was that the patient no longer met the standard for the requested level of care.
CONCLUSIONS
Low UR denial rates warrant further examination of the relationship between UR and both quality of care and patient outcomes in mental health care. With the substantial resources spent on UR, findings could point to areas of potential reforms to the system that may minimize these costs and improve care for patients with mental illness.
Topics: Humans; Managed Care Programs; Medicaid; Mental Health Services; Retrospective Studies; United States; Utilization Review
PubMed: 35139293
DOI: 10.37765/ajmc.2022.88824 -
Journal of Public Health (Oxford,... Sep 2021After more than a year of pandemic, SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) remains a relevant health care and society issue. Movements...
After more than a year of pandemic, SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) remains a relevant health care and society issue. Movements doubting the dangerousness or the existence of the virus have emerged and became a challenge to social cohesion. About 3487 individuals (434 Corona doubters and 3053 non-doubters) have participated in an online survey (predominat age group: 35-45 years). Particularly, COVID-19-related anxiety, generalized anxiety (Generalizied Anxiety Disorder Screener, GAD-7), depression (Patient Health Questionnaire, PHQ-2) and functional/adherent safety behaviour were assessed. COVID-19 doubters describe less functional safety behaviour. Fear of the virus is evident, similar to non-doubters. Generalized anxiety and depression were significantly higher in doubters. Repression and denial as psychological defence mechanisms could be the unconscious psychological strategy for coping with the distress variables. The results point out that public strategies may only be successful in managing opinions and beliefs if they address fears and worries.
Topics: Adult; Anxiety; COVID-19; Cross-Sectional Studies; Depression; Humans; Middle Aged; Pandemics; SARS-CoV-2; Stress, Psychological
PubMed: 34018564
DOI: 10.1093/pubmed/fdab168 -
Proceedings of the National Academy of... Feb 2023In online content moderation, two key values may come into conflict: protecting freedom of expression and preventing harm. Robust rules based in part on how citizens...
In online content moderation, two key values may come into conflict: protecting freedom of expression and preventing harm. Robust rules based in part on how citizens think about these moral dilemmas are necessary to deal with this conflict in a principled way, yet little is known about people's judgments and preferences around content moderation. We examined such moral dilemmas in a conjoint survey experiment where US respondents ( = 2, 564) indicated whether they would remove problematic social media posts on election denial, antivaccination, Holocaust denial, and climate change denial and whether they would take punitive action against the accounts. Respondents were shown key information about the user and their post as well as the consequences of the misinformation. The majority preferred quashing harmful misinformation over protecting free speech. Respondents were more reluctant to suspend accounts than to remove posts and more likely to do either if the harmful consequences of the misinformation were severe or if sharing it was a repeated offense. Features related to the account itself (the person behind the account, their partisanship, and number of followers) had little to no effect on respondents' decisions. Content moderation of harmful misinformation was a partisan issue: Across all four scenarios, Republicans were consistently less willing than Democrats or independents to remove posts or penalize the accounts that posted them. Our results can inform the design of transparent rules for content moderation of harmful misinformation.
Topics: Humans; Speech; Communication; Morals; Emotions; Politics; Social Media
PubMed: 36749721
DOI: 10.1073/pnas.2210666120 -
BMC Women's Health Dec 2021Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The identification of these challenges during...
BACKGROUND
Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The identification of these challenges during the treatment process is crucial to improve recipient mental health. Thus, the aim of this study was to gain an understanding of the experiences of oocyte recipient women.
METHODS
This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation.
RESULTS
Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial.
CONCLUSION
The results indicated that the process of treatment with donated oocyte is followed by the experiences of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women. Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The aim of this study was to gain an understanding of the experiences of oocyte recipient women. This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation. Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial. The results indicated that the process of treatment with donated oocyte is followed by experience of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women.
Topics: Adaptation, Psychological; Disclosure; Female; Humans; Oocyte Donation; Oocytes; Qualitative Research
PubMed: 34886829
DOI: 10.1186/s12905-021-01562-4 -
Medical Science Monitor : International... Jun 2015It is a struggle to identify the most adaptive coping strategies with disease-mediated stress. Here, we hypothesize that intensity of coping strategies, including...
BACKGROUND
It is a struggle to identify the most adaptive coping strategies with disease-mediated stress. Here, we hypothesize that intensity of coping strategies, including denial, in patients with end-stage renal disease (ESRD), varies with type of renal replacement therapy (RRT).
MATERIAL AND METHODS
We enrolled 60 in-center hemodialyzed patients (HD) and 55 patients treated with continuous ambulatory peritoneal dialysis (CAPD). We administered the Coping Inventory with Stressful Situation, Profile of Mood States, and Stroop Anxiety Inventory to measure patient coping strategies in the context of their ESRD. Denial defense mechanism was measured via the IBS-R/ED. The Nottingham Health Profile was used to evaluate self-perceived quality of life. Serum potassium, urea, creatinine, phosphorus, calcium, albumin, and hematocrit were utilized as the measurements of adequacy of dialysis.
RESULTS
HD patients had higher self-reported intensity of denial mechanism and avoidance-oriented strategies versus CAPD patients. Because a single strategy is almost never employed, we conducted cluster analysis. We identify 3 patterns of coping strategies using cluster analysis. "Repressors" employed denial and avoidance strategies and were predominant in HD. The second cluster consists of subjects employing predominantly task-oriented strategies with equal distribution among dialyzed patients. The third cluster encompassed a small group of patients who shared higher intensity of both denial and task-oriented strategies. Health-related outcome, anxiety, and mood profile were similar across all patients.
CONCLUSIONS
HD patients predominantly used "repressive" strategies. Patients on RRT utilized denial and avoidance-based strategies to achieve satisfactory outcome in terms of perceived quality of life. We conclude that these coping mechanisms that were previously thought to be inferior are beneficial to patient compliance with RRT.
Topics: Adaptation, Psychological; Adult; Affect; Aged; Albumins; Anxiety; Calcium; Cohort Studies; Creatinine; Cross-Sectional Studies; Denial, Psychological; Female; Hematocrit; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Phosphorus; Potassium; Quality of Life; Renal Dialysis; Statistics, Nonparametric; Urea
PubMed: 26094792
DOI: 10.12659/MSM.893331 -
The American Journal of Medicine Apr 2021
Topics: Brazil; COVID-19; Communication; Denial, Psychological; Humans; Periodicals as Topic; SARS-CoV-2
PubMed: 33561430
DOI: 10.1016/j.amjmed.2021.01.003 -
Children (Basel, Switzerland) Aug 2018Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight...
Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child's quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children's hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.
PubMed: 30200370
DOI: 10.3390/children5090120 -
Quality of Life Research : An... Mar 2019The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life...
PURPOSE
The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer.
METHODS
A consecutive sample of patients with localized prostate cancer (T1-3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death.
RESULTS
After controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time.
CONCLUSIONS
Higher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.
Topics: Adaptation, Psychological; Aged; Aged, 80 and over; Anger; Depression; Fatigue; Female; Humans; Life Change Events; Male; Middle Aged; Pain; Prognosis; Prostatic Neoplasms; Psychiatric Status Rating Scales; Quality of Life; Social Class; Stress, Psychological; Surveys and Questionnaires
PubMed: 30511254
DOI: 10.1007/s11136-018-2069-z -
Journal of Occupational Health Jan 2022We aimed to synthesize published literature on seafarers' mental health and wellbeing during the COVID-19 pandemic. (Review)
Review
OBJECTIVES
We aimed to synthesize published literature on seafarers' mental health and wellbeing during the COVID-19 pandemic.
METHODS
This scoping review searched four electronic databases for literature on the mental health and wellbeing of seafarers during the COVID-19 pandemic.
RESULTS
Fourteen studies were included in the review. Few reported on the prevalence of mental health conditions. Only one compared mental health data gathered during the pandemic to pre-pandemic matched samples, suggesting symptoms of depression and anxiety were greater during the pandemic. There was some evidence that mental health worsened with longer stays on board during the pandemic and being on board longer than expected. Crew exchange difficulties forced many participants to extend their contracts or delay repatriation, often with little information as to when they might get to go home, leading them to feel they had no control over their lives and causing concern about fatigue and the potential for accidents and injuries. Participants described other challenges such as denial of shore leave; concerns about finances and future employment; loneliness and isolation; fears of COVID-19 infection; limited access to essential supplies; and feeling unsupported by management.
CONCLUSIONS
Maritime organizations must understand how best to support their staff in the aftermath of the COVID-19 pandemic and in any other prolonged crises that may arise in the future. Recommendations include ensuring that staff feel valued by their organization; enhancing work-related autonomy; ensuring that communication is accurate, consistent, and timely; and using lessons learned from the COVID-19 pandemic to inform emergency preparedness policies.
Topics: Anxiety; COVID-19; Humans; Mental Health; Occupations; Pandemics
PubMed: 36134469
DOI: 10.1002/1348-9585.12361