This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted.Primary practice and the role of the primary care physician will likely assume increasing importance as health care reform proceeds through the 1990s and into the 21 st century. Likewise, because psychologists have assumed fundamental research, clinical servke, and training roles in primary health care settings, it can be anticipated that these roles will become paramount in shaping the delivery of primary care services in the future. As evidence of the growing interest in this topic, the American Psychological Association (APA) recently sponsored MARY BETH KENKEL served as action editor for this article.
Individuals with long-standing asthma may be at increased risk for depression and for learned helplessness deficits, specifically impaired problem solving, in response to environmental noncontingency. Results are discussed in terms of both learned helplessness theory and perseverative self-focus conceptualizations of depression. The implications for both short- and long-term management of pediatric asthma are also discussed.
Examined psychological adjustment in a college sample of older adolescents and young adults (n = 49) with histories of childhood asthma. A substantial number of subjects evidenced clinically significant levels of overall distress. In addition, greater perceived asthma uncertainty and increased stable attributions for negative events were significantly associated with poorer psychological adjustment after controlling for demographic and disease variables. Further analyses revealed a moderating influence of uncertainty on attribution-adjustment relationships. These findings provide initial support for a cognitive diathesis-stress view of adjustment in long-standing asthma. Results also support a growing body of evidence suggesting that the focus of efforts to enhance adjustment to asthma need to be expanded beyond childhood and early adolescence.
Utilizing a mixed methods approach located between constructivist-interpretivist and critical-ideological research paradigms (Ponterotto, 2005), the current study builds upon previous research (Pace et al., 2006) that investigated the cultural validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 in its use with American Indians. Thirty items from MMPI-2 scales F, 1, 6, 8, and 9 were identified via item analysis as reflecting significant differences in endorsement rates between an American Indian sample and the MMPI-2 normative group. Semistructured interviews focused on these 30 items were conducted with 13 American Indian participants from an Eastern Woodlands Nation in Oklahoma. Interviews were audio recorded, transcribed, and then coded for themes using a qualitative coding analysis. Nine themes emerged: core belief system, experiences of racism and discrimination, conflicting epistemologies, living in two worlds, community connectedness, responsibility and accountability to the community, traditional knowledge, stories as traditional knowledge, and language and historic loss. Results of the current study demonstrate how the MMPI-2 may pathologize Indigenous worldviews, knowledge, beliefs, and behaviors rather than accurately assess psychopathology. Implications for practice and future research are addressed.
This study investigated the normative validity of the MMPI-2 with two distinct American Indian tribes. Differences occurred on 8 of the 13 basic validity and clinical scales (F, 1, 4, 5, 6, 7, 8, 9) between the MMPI-2 norms and both tribal samples. Elevated MMPI-2 scores of American Indians may not only reflect the possibility of psychological distress spurred by historical oppression and present adversity, but also an expression of a divergent worldview. Considering the context of the historical and social production of knowledge about American Indians, it is argued that researchers and practitioners, when interpreting MMPI-2 results for American Indians, should seriously consider their interpretive points of reference, which may be impacted by dominant cultural belief systems.
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