1
Q
What are the two types of health behaviour?
A
- Health-impairing behaviours/habits e.g. smoking, eating a high-fat diet
- Health protective behaviour e.g. attending screenings
2
Q
Why is it important to study health behaviours?
A
- there is a relationship between health behaviours and life expectancy
- diseases and disabilities may cause behavioural dysfunction
- treatment schedules and procedures are influenced by behaviours
- lifestyle changes involve behaviours
3
Q
Describe locus of control
A
- the extent to which people believe they can control their lives
- internal (controlled by a force within themselves) vs external (controlled by outside forces e.g. luck)
- perceived control can be behavioural or cognitive
4
Q
Describe the self-efficacy model of health beliefs
A
- a person’s belief in their capability to exercise some measure of control over their own functioning and over environmental events
- two domains:
1) outcome expectancy - belief that a behaviour will lead to a favourable outcome
2) self-efficacy expectancy - belief that one can perform the behaviour properly
5
Q
The Health Belief Model says that people are more likely to adhere to treatment when they..
A
- view their physical problem as severe
- perceive themselves to be susceptible to further negative health effects if they fail to adhere
- consider the likelihood of treatment to be effective as high
- identify few barriers to adherence
- experience few rewards for failing to adhere
- encounter environmental cues supporting adherence
- believe that they can change
6
Q
Describe the components of the Health Belief Model
A
Individual perceptions:
- perceived susceptibility to illness affects the perceived threat of disease which in turn affects the likelihood of behavioural change
- perceived benefits vs barriers to behavioural change affect likelihood of behavioural change
Modifying factors:
- age, sex, ethnicity, SES, knowledge etc affect individual perceptions
- cues to action e.g. internal (symptoms) and external (education, media) affect individual perceptions
7
Q
Describe the theory of planned behaviour
A
Attitudes, social norms and perceived behavioural control all affect each other and their sum affects intentions and ultimately behaviour
8
Q
Describe the stages of change model
A
1) pre-contemplative
2) contemplative
3) determination
4) active change
5) maintenance
6) relapse
Can enter and leave cycle at any stage
9
Q
What are medically unexplained symptoms?
A
- physical symptoms not explained by organic disease causing distress and impairing function
- and for which there is positive evidence or a strong assumption that the symptoms are linked to psychological factors
- symptoms are produced by alternative mechanisms which are unconscious
10
Q
Define illness behaviour
A
- the ways in which given symptoms may be perceived, evaluated and acted (or not acted) upon
- adaptive or maladaptive behaviours associated with he adjustment to physical or mental illness
11
Q
Describe two maladaptive illness behaviours
A
1) illness denial - behaviours to avoid the stigma/inability to accept physical/mental disease
2) illness affirmation - behaviours which inappropriately affirm disease
12
Q
Describe the sick role (4 aspects)
A
1) exempts ill people from certain responsibilities
2) given people the right to seek help and care
3) obliges people to seek and co-operate with treatment
4) expects people to have a desire to recover
13
Q
Explain how the sick role can be maladaptive
A
- the sick role can be adaptive and help people to recover
- if someone continues in the sick role after their illness is over it becomes maladaptive
14
Q
How can MUS be identified clinically?
A
- symptom doesn’t fit with known disease models
- patient is unable to give a clear and precise description of the symptoms
- symptom/disability seem excessive in comparison to pathology
- temporal relationship to stressful life events
- patient attends frequently with different symptoms
- patient is overly anxious about the meaning of the symptoms and has strongly held beliefs about a disease process causing the symptoms
- patient complains of pain in various sites
15
Q
How should MUS be managed?
A
- good explanations
- symptom management
- promote self-efficacy
- initiate treatment for co-morbid mental health problem if present
- psychotherapies
16
Q
Give vulnerability factors for MUS
A
- genetics (small influence)
- familial transmission (through reinforcement and modelling, use of emotional currency)
- early insecure attachment
- cognitive process (tendency to over-interpret symptoms, catastrophise symptoms)
- central pain mechanisms affected by psychosocial factors
17
Q
What is the prevalence of MUS?
A
- 20% in general population
- 10-33% primary care presenting complaints diagnosed as MUS
- 20-50% new secondary care patients present with MUS
18
Q
What is addiction?
A
the continued repetition of a behaviour despite adverse consequences
19
Q
Outline features of a dependence syndrome
A
- salience: engaging in the behaviour takes higher priority than other behaviours which once had great value
- tolerence
- withdrawal symptoms (physiological)
- relief of withdrawal symptoms through engaging in behaviour
- compulsion to engage in the behaviour
- narrowing of repertoire: neglect of other interests
- reinstatement of behaviour following abstinence
20
Q
Explain the biaxial model of addiction
A
2 axis: dependence and problems, creates four categories:
- no significant problems or dependence e.g. social drinker
- high problems, low dependence e.g. binge drinker who gets into fights
- dependence with few problems e.g. methadone maintenance patient
- significant problems and dependence e.g. heroin user with criminal lifestyle
21
Q
What makes a substance more addictive?
A
- pleasure producing potency
- rapid onset of action
- short duration of action
- ability to produce tolerance and withdrawal
22
Q
What did the Adult Psychiatric Morbidity study find?
A
- 1/6 adults had a common mental disorder
- 1/5 women had a common mental disorder compared with around 1/8 men
- the gender gap in mental illness is most pronounced in young people
- every type of CMD was more common in people of working age
- 25% of people had a hazardous pattern of drinking
- the largest category of CMD was CMD-NOS
23
Q
People with neurotic disorders are most likely to be…
A
- female
- middle aged
- separated or divorced
- living alone or as a lone parent
24
Q
People with psychotic disorders are more likely to be…
A
- separated or divorced
- living alone
- in social class IV or V
- without higher levels of education
25
People with psychotic disorders are less likely to be..
- married
| - home owner occupiers
26
Discriminate between SE and SD
SD is used when talking about distributions and asking the question - how spread out is the data?
SE is used when talking about an estimate from a sample and asking the question - how accurate is the estimate?
27
What is the formula for SE of a sample mean?
se = SD/squareroot(n)
28
What is the formula for SE of a sample proportion?
SE = squareroot of p(1-p)/n
29
What are confidence intervals?
A range of values that probably contains the population mean or proportion
30
What are confidence limits?
Values that state the boundaries of the confidence interval
31
What are the four categories of typical grief reactions to loss?
- affective
- cognitive
- behavioural
- physiological/somatic
32
Give examples of typical affective grief reactions to loss
- depression, dispair, dejection, distress
- anxiety, fears, dread
- guilt, self-blame, self-accusation
- anger, hostility, irritability
- anhedonia
- loneliness
- yearning, longing, pining
- shock, numbness
33
Give examples of typical cognitive grief reactions to loss
- preoccupation with thoughts of deceased, intrusive rumination
- sense of presence of dead
- suppression, denial
- lowered self-esteem
- self-reproach
- helplessness, hopelessness
- suicidal ideation
- sense of unreality
- memory and concentration difficulties
34
Give examples of typical behavioural grief reactions to loss
- agitation, tenseness, restlessness
- fatigue
- overactivity
- searching
- weeping, sobbing, crying
- social withdrawal
35
Give examples of typical physiological/somatic grief reactions to loss
- loss of appetite
- sleep disturbance
- energy loss, exhaustion
- somatic complaints
- physical complaints similar to deceased
36
What did Stroebe et al (2007) show has a small but significant increase in incidence following a loss?
morbidity and mortality of the bereaved
37
How is grief different in different cultures?
- Balinese people exhibit grief for a very short amount of time
- in Egypt and Iran mourning can last for many years
- there are gender differences in grief reflected in Cantonese and Mandarin words for widow
38
What are the arguments around the idea that grief is universal?
- Stroebe and Stroebe concluded that crying is a universal grief response and that in no culture is grief treated with indifference
- Averill drew parallels with sexual feelings which are also universal but channeled by cultures into social rules
- Rosenblatt argued that most research is in English and from a Western perspective so it significantly underplays cultural differences
39
Does grief have a biological purpose?
Bowlby drew parallels between the distress of grief and the distress of a child who feels abandoned by their mother, concluding that the tendency for searching behaviour confers an evolutionary advantage in childhood in keeping family units together, thus naturally selecting this behaviour
40
Describe a stage model of grief
Numbing - few hours to a week
Yearning and searching - months or years
Disorganisation and despair
Greater or lesser degree of organisation
41
Outline a child's needs in relation to grief
A child needs:
- to know they are going to be cared for
- to know they did not cause the death
- clear info about the death, the causes and the circumstances
- to feel important and involved
- continued routine activity
- someone to listen to feelings, fantasies and questions
- something to help remember the dead person
42
What are the two family system types?
- closed system: rules are strict and constraining, there may be mistrust of others
- open system: enabling, look to each other for support
43
What is complicated grief?
- a cluster of symptoms such as anxious and depressive thoughts, painful memories, dreams about and preoccupation with the deceased etc
- no conclusive evidence of it being a pathological reality
- there is evidence for intrinsic and extrinsic factors complicating grief e.g. existing mental health conditions, guilt, financial difficulty, unemployment etc
44
Who recovers better from grief, emotionally secure or insecure individuals?
Emotionally secure individuals recover faster and more successfully than insecure people but this might be because they are more resilient.
45
Outline the process of producing stigma (Link and Phelan 2001)
- Labelling
- Stereotyping
- Othering
- Stigmatisation
- Discrimination
46
What are the types of stigma described by Goffman?
- Discreditable stigma
- Discrediting stigma
- Felt stigma
- Enacted stigma
- Courtesy stigma
47
What is discreditable stigma?
Keeping conditions hidden except to close friends and family etc
- e.g. HIV
48
What is discrediting stigma?
When a stigmatising condition cannot be hidden
| - e.g. using a wheelchair
49
What is felt stigma?
A sense of fear and shame due to one's condition
| e.g. someone with an STI visiting a clinic
50
What is enacted stigma?
Discrimination by others
| e.g. removing a person with SZ from a bus
51
What is courtesy stigma?
Stigma felt by someone who is with a person open to stigma
| e.g. parent of a child with autism
52
What does it mean to internalise stigma?
To absorb the social views of being lower status and this having an impact on personal beliefs and behaviours
53
What is covering, in relation to stigma?
- avoiding situations
- reducing visibility
- not disclosing
e. g. a blind person wearing sunglasses
- the condition is acknowledged and a 'solution' is sought
54
What is passing, in relation to stigma?
- passing oneself off without acknowledging symptoms (e.g. being 'normal')
- can still experience felt stigma
- may involve a high psychological cost in pretending to be something one is not
55
Which psychiatric diagnoses have gendered patterns?
Female:
- post-natal depression, post-partum psychosis, menopause
- anorexia nervosa, bulimia nervosa
- anxiety, depression, PTSD, dementia, depression in old age
Male:
- anti-social personality disorders, sex offences, substance misuse
No gender pattern:
- schizophrenia
- bipolar disorder
56
In regards to mental health, women are more likely to...
- be admitted to psychiatric hospitals
- receive a prescription for a psychotropic drug
- receive a diagnosis of depression
57
What are the potential reasons for women having more mental health diagnoses and treatment?
- women are more likely to be classified as suffering from depression
- women are more likely to seek help for emotional distress
- women are more likely to suffer from a mental disorder
58
What proportion of "successful" suicide attempts are made by men?
- 75% male
| - 25% female
59
What is the leading cause of death in men aged 20-34?
- Suicide
| - 24%
60
Who is most vulnerable to suicide? Why?
```
- men aged 30-59
Potential reasons:
- unemployment and economic hardship
- lack of close social and family relationships
- toxic masculinity
- personal crises e.g. divorce
```
61
Give examples of variations in mental health by ethnicity
- Chinese: low rates of mental illness
- Irish: highest rates of hospital admissions for depression and alcohol problems out of all ethnic minority groups in UK
- Black and African-Caribbean: more likely to be diagnosed with SZ, to receive "physical" treatments when in care, to have poorer outcomes after care
62
Describe the Minority Stress Model
1) Exposure to distal (external) stress
2) Increased exposure to proximal (internal) stress as a by-product of distal stress creates vigilance and negative feelings
3) Leads to adverse health issues
Model says stress is caused by the environment not by genetics e.g.
- lack of social support
- low SES
- prejudice and discrimination
Critique: correlational not causal
Phase I: H&S
flashcards
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