Sunteți pe pagina 1din 148

Optimismul calea spre succes

17.05.2011 de Noni Calivita Las un raspuns

Zi de zi, nenumarati oameni se gandesc cu pesimism la viitorul lor si, din pacate, multi dintre ei nu beneficiaza de un mediu pozitiv sau de sprijin din partea semenilor. Dar tu faci parte dintr-o mare comunitate de oameni pozitivi, din familia CaliVita, si astfel te poti bucura de un sprijin deosebit in zilele in care simti ca optimismul ti s-a evaporat. Daca esti inconjurat de persoane pozitive si fericite si iti place ceea ce faci, inseamna nu doar ca duci o viata fericita, ci si ca esti mult mai eficient si poti trai mai mult. Studiile stiintifice au demonstrat ca persoanele care au o atitudine pozitiva, care pun pasiune in ceea ce fac si au vise de indeplinit traiesc cu 7-10 ani mai mult decat restul. Un alt beneficiu al optimismului este respectul de sine, care, la randul sau, te poate ajuta sa atingi succesul in tot ceea ce faci. Pentru a ne pastra o atitudine pozitiva trebuie sa evitam gandurile si sentimentele negative. Cei care isi pot schimba gandurile isi pot schimba si viata. In aceasta perioada dificila, oamenii au nevoie mai mult decat oricand de persoane optimiste, ca sa se poat atasa de ele si sa incerce sa-si imbunatateasca perspectiva de ansamblu asupra vietii. Voi, toti cei care aveti o atitudine pozitiva si sunteti optimisti, faceti un serviciu extraordinar semenilor vostri! Radiind optimism, ii ajutati sa isi salveze vietile, sperantele si visurile! Optimismul si sanatatea O serie de studii recente au demonstrat ca persoanele optimiste si cu o atitudine pozitiva prezinta un risc redus de aparitie a bolilor si ca sunt, in general, mai sanatoase decat restul. Optimismul poate fi, deci, folosit pentru prevenirea bolilor! Ca efect al gandurilor noastre, diferiti hormoni si substante chimice sunt eliberate in fluxul sanguin. Aceste substante ne pot influenta nivelul de energie, dispozitia si starea generala, avand astfel un impact important si asupra performantei noastre de la locul de munca si de acasa. Nu

exista niciun dubiu ca mintea si corpul sunt inseparabile: gandurile ne pot influenta organismul, si invers. De asemenea, aceasta inseamna ca ne putem modela cum dorim viata si viitorul. Secretul fericirii Accepta trecutul si inchide poarta acestuia. Traieste prezentul cu satisfactie. Indreapta-te spre viitor cu o atitudine pozitiva. Fa pasi concreti catre o viata mai sanatoasa si mai prospera. Sunt convins ca doar ce facem acum si in viitor conteaza! Nu trecutul ne determina viitorul, ci doar gandirea noastra pozitiva si pasii concreti pe care ii facem! Secretul succesului in afaceri Optimistii sunt deschisi la minte si la inima. Iar ceilalti vad si simt acest lucru si sunt atrasi de persoanele optimiste. Daca esti optimist, oamenii te vor considera atragator, iar aceasta calitate te va ajuta sa iti dezvolti afacerea CaliVita cu si mai multa eficienta si sa duci o viata de calitate. Atitudinea si comportamentul pozitiv te ajuta nu doar sa iti atingi scopurile personale, ci, in acelasi timp, te fac sa te simti foarte bine! Importanta dorintei de a invinge Astazi expertii considera ca succesul nu este doar rezultatul dorintei de a invinge, ci si al dispozitiei indispensabile de a face tot ce-ti sta in putinta pentru a-l atinge. Cei care isi doresc sa cunoasca succesul trec imediat la actiune si fac ceea ce e necesar pentru succes, daca e posibil chiar astazi! Optimistii duc o viata plina de speranta In orice situatie ne-am afla, trebuie sa incercam sa ne pastram gandirea pozitiva si sa ne modificam actiunile intr-un asemenea mod incat sa fim energici, sanatosi si plini de speranta. Unii spun ca oamenii care spera prea mult sunt naivi. Ei bine, cu riscul ca toti scepticii din lume sa ma considere naiv, eu tot imi voi trai viata cu speranta, optimism si cu inima deschisa! Imi place sa-i consider pe membrii nostri tot atatea faruri care emit o lumina pozitiva catre ceilalti. Cu multi ani in urma, am hotarat sa fiu o lumina calauzitoare pentru altii. Vreau sa schimb in bine vietile celorlalti si, astfel, sa traiesc chiar eu o viata mai fericita si mai prospera.

Gery G. Hargitai, Presedinte Calivita 0 inima vesela este un bun medicament,a scris un rege intelept al Israelului antic, cu circa 3000 de ani in urma (Proverbele 17:22). In prezent, medicii sunt de acord cu aceste cuvinte inteleple, inspirate de Dumnezeu. Insa multi dinlre noi poale ca nu sunt din fire veseli. Putini sunt cei care nu ajung coplesiti de presiunile vietii cotidiene ce genereaza dezamagire si ne fac sa fim pesimisti. Cu toate acestea, cercetari recente au dezvaluit ca, in pofida problemelor vietii, merita sa fim optimisti. Optimismul este definit drept atitudine a omului care priveste cu incredere viata si viitorul; tendinta de a vedea latura buna, favorabila a lucrurilor (Dictionarul explicativ al limbii romane). Cum reactioneaza o persoana optimista cand are un esec? Nu crede ca totul se termina aici. Aceasta nu inseamna ca refuza sa vada realitatea ci dimpotriva inseamna ca o accepta si analizeaza lucrurile. Apoi, daca situasia ii permite, ia masuri ca sa schimbe sau chiar sa imbunatateasca lucrurile. In schimb, o persoana pesimista se invinovateste adesea pentru necazurile ei. Ea se gandeste ca nu se mai poate remedia nimic si ca totul s-a intamplat pentru ca este incompetenta, ca nu arata bine ori ca nu face nimic bun. Ca urmare, se resemneaza si nu mai intreprinde nimic. Ne afecteaza optimismul sanatatea si bunas-tarea? Da! O echipa de specialisti de la Clinica Mayo din Rochester (Minnesota, SUA) a efectuat un studiu pe un lot de peste 800 de pacienti, timp de 30 de ani. Concluzia studiului? Persoanele optimiste au o sanatate mai buna si traiesc mult mai mult. De asemenea, cercetatorii au constatat ca optimistii fac fata mai bine stresului si sunt mai putin predispusi la depresie. Totusi, nu e deloc usor sa fii optimist intr-o lume in care problemele par sa se inmulteasca. Nu este surprinzator ca multora le e greu sa gandeasca pozitiv. Ce se poate face? Mai jos veti gasi cateva sugestii care v-ar putea fi utile. Desi buna dispozitie nu vindeca bolile, ea poate totusi contribuie la o sanatate mai buna si la o viata plina de satisfactii. Iata ce spune Biblia: Toate zilele celui nenorocit sunt rele, dar cel cu inima multumita are un ospat necurmat. Proverbele 15:15 Cateva sugestii pentru a fi mai optimisti

Cand iti vine in minte gandul ca nu te vei putea bucura de ceva sau ca nu vei reusi sa faci un anumit lucru, respingel imediat! Gandeste-te mai degraba ca vei avea succes Cauta sa gasesti placerea in ceea ce faci. Indiferent de munca pe care i efectuezi, straduieste-te sa gasesti acele aspecte legate de ea care iti aduc satisfactii. Alege-ti prietenii dintre cei care privesc viata cu optimism Cand poti schimba lucrueile, actioneaza. Dar cauta sa accepti situatiile pe care nu le poti schimba. Noteaza zilnic trei lucruri frumoase care ti s-au intamplat.

Studiile de psihologie pozitiva au aratat ca o atitudine pozitiva , impreuna cu o conceptie optimista si o gandire pozitiva au capacitatea de a ne ameliora sanatatea si a ne darui o mai mare fericire . Se pare ca , atunci cand ai o atitudine pozitiva fata de viata , ai mai mari sanse de a trai mai mult si mai bine , dar si de a te bucura intr-o mai mare masura de succes. Ce este atitudinea ? Atitudinea reprezinta o pozitionare mentala fata de un mod de gandire sau traire , sau o orientare personala catre credinta ta intima .O atitudine pozitiva este , asadar , tendinta generala de a fi optimist si increzator in realizarea sperantelor tale. Puterea gandirii pozitive O atitudine pozitiva si o gandire optimista aparute timpuriu in viata pot prezice o stare buna de sanatate si capacitatea de a trai intr-un mod fericit.Un studiu realizat la Universitatea din Harvard a aratat o corelatie stransa intre gandirea optimista a studentilor si sanatatea de care s-au bucurat mai tarziu, dupa varsta de 40 de ani. In cartea sa , Un abecedar in psihologia pozitiva , Christopher Petersen subliniaza ca optimismul are beneficii demonstrate , iar pesimismul ne incarca cu dificultati Optimismul a fost intotdeuna legat de o stare de spirit pozitiva si un bun moral , de perseverenta si capacitate de rezolvare eficienta a problemelor , de o cariera reusita in studiile universitare , atletism , armata si succes politic , popularitate , sanatate si chiar o viata mai lunga si eliberare de orice fel de trauma. Chiar daca ai fost pesimist si ai avut o gandire negativa de-a lungul unui mare interval de timp , niciodata nu este prea tarziu sa iti schimbi modul de gandire si sa te bucuri de beneficiile unei atitudini pozitive. Caracteristicile atitudinii pozitive si optimismului Optimistii cred ca sunt meniti sa intalneasca in viata numai lucruri bune si, din aceasta cazuza , lucrurile bune apar , in general , in calea lor.Daca , in schimb , li se intampla ceva rau , optimistii sunt inclinati sa creada ca acesta este doar un accident izolat , o anomalie sau ceva care le-a scapat de sub control ; optimistii sunt convinsi ca asa ceva nu se va mai intampla si ca lucrurile vor merge mai bine in viitor. Gandirea pozitiva necesita practica Daca esti o persoana ale caror prime ganduri despre intelesul unui lucru sau eveniment intamplat au o tenta negativa , ar trebui sa te incurajeze faptul ca primul pas catre o atitudine pozitiva si o gandire pozitiva consta in a-ti permite inca un gand despre lucrul sau evenimentul respectiv.Gandurile sunt sub controlul nostru.Modul tau pesimist de gandire reprezinta o obisnuinta , iar obisnuintele pot fi schimbate.

Atunci cand iti surprinzi un gand pesimist despre un eveniment din viata ta , mai intai trebuie sa evaluezi realitatea.In ce a constat evenimentul ? Care sunt faptele (si nu temerile tale interioar ) ? Intr-o urmatoare etapa , trebuie sa te gandesti la o explicatie alternativa a evenimentului si la evenimente viitoare.Atunci cand masina ta veche incepe subit sa scoata un zgmot suspect , te poti cufunda intr-o atitudine pesimista , gandindu-te la cat de scumpa va fi reparatia, sau poti apela la atitudinea optimista , spunandu-ti ca poate o mica reparatie va rezolva problema. Incearca sa urmezi acest tipar de gandire , repetandu-ti zilnic o afirmatie precum : Atunci cand am un gand negativ , trebuie sa evaluez faptele si sa ma gandesc la alternative pozitive care se conformeaza , de asemeni, faptelor. Daca practici sistemul de gandire pozitiva descris mai sus , in curand, acest tip de atitudine va incepe sa apara in tine in mod natural.La un moment , ai putea fi uimit de descoperirea ca , pur si simplu, incepi sa te simti mai bine prin inglobarea acestei atitudini pozitive. Va fi necesar , cu timpul, sa inveti sa folosesti afirmatiile pozitive , care iti pot intari atitudinea pozitiva. Mecanismul de dezvoltare personala ar putea fi exprimat prin urmatoarea formula : Gandire pozitiva + afirmatie pozitiva = atitudine pozitiva Afirmatiile pozitive si exersarea atitudinii O afirmatie este un declaratie, o intarire sau o afirmare a unei puternice credinte.Folosirea regulata a afirmatiilor pozitive consolideaza gandirea pozitiva si poate infrange efectele unei anterioare atitudini negative.Folosirea zilnica a afirmatiilor pozitive poate fi o eficienta cale de antrenament personal atunci cand structura generala a afirmatiei este bine inteleasa si utilizata. Ce este o buna afirmatie pozitiva ? Structura unei astfel de afirmatii este de o importanta vitala. Daca cuvintele folosite nu sunt potrivite , afirmatia poate avea un efect advers. Primul si cel mai important lucru care trebuie stiut despre o eficienta afirmatie este ca ea trebuie sa fie construita la persoana intai.Orice afirmatie pozitiva puternica incepe cu prenumele Eu. O a doua cerinta este una care le da batai de cap multor oameni : afirmatia trebuie sa fie la timpul prezent.In caz contrar , potentialul afirmatiei este cu mult diminuat.

Cu cateva exceptii , primele doua cuvinte ale afirmatiei trebuie sa fie Eu sunt.Cuvintele Eu sunt incorporeaza prima persoana si timpul prezent , conferind afirmatiei un puternic inceput.Un exemplu de afirmatie eficienta poate fi : Eu sunt o persoana pozitiva. In acest punct , multi oameni fac o mare greseala.Intrucat nu se comporta inca ca o persoana pozitiva , ei incearca sa evite timpul prezent , preferand o declaratie mai slaba , de genul : Voi incerca sa fiu o persoana mult mai pozitiva. Daca vei citi aceste doua exemple cu voce tare , vei simti imediat diferenta de energie si forta. Incarcatura emotionala si afirmatia puternica zilnica Oamenii insufletiti de sentimente pot ingloba cu o mai mare usurinta o afirmatie zilnica.Pasiunea emotionala de a atinge un obiectiv reprezinta o inepuizabila sursa de energie si furnizeaza hotarare in relizarea unui tel.Declaratia Eu sunt poate fi o afirmatie ferma si emotionala / pasionala. Declaratia de tipul Voi incerca este numai una a sperantei si a visului. Pentru a potenta o afirmatie pozitiva ii poti adauga o incarcatura emotionala sau afectiva , precum in urmatorul exemplu : Sunt mandru si fericit acum pentru ca sunt o persoana pozitiva. In crearea si folosirea unei afirmatii pozitive sunt implicate si alte aspecte , precum vizualizarea , modalitatea in care obisnuinta gandirii poate contrabalansa o eficienta afirmatie pozitiva , si constientizarea afirmatiilor accidentale. Copyright godessdiana88@yahoo.com . 2010 Repere : atitudine, forta, gandire, gandire pozitiva, personalitate, psihologie, putere

Cu totii avem zile mai bune si zile mai proaste, experiente in viata ce ne duc intr-o stare nu prea placuta, stare ce ne pune pe ganduri, cautand raspunsuri, neprimindu-le ajungem sa intram intr-o mica depresie, o stare in care nu te recunosti ca si persoana. Solutia este OPTIMISMUL! Stiu, usor de spus ve-ti spune, dar va voi da argumentele necesare pentru a gandi OPTIMIST. Comparand o persoana optimista cu una pesimista veti observa ca optimistul este binedispus chiar si in zilele in care ploua, pe cand pesimistul va avea o stare de somnolenta si nervozitatea. Daca stai sa o gandesti, de ce sa te stresezi? Optimistul este calm, psihicului lui lucreaza normal, pe cand cel al pesimistului este agitat, practic mai nesanatos.

A fost doar un exemplu pentru a introduce sanatatea in discutie, unul dintre subiectele relevante in a demonstra ca optimismul + sanatatea sunt in multe domenii cheia unui corp sanatos. Optimismul in Medicina Exemplul cel mai clar pe care il pot da sunteti/suntem noi ce cu siguranta odata in viata am fost bolnavi si ce faceam? Stateam in pat si ne vaitam, intram intr-o stare care facea ca boala sa treaca mai greu sau sa declanseze o alta boala. In schimb de ce nu ne-am baga in cap ca este doar o stare temporara, de ce nu am face un dus sau am manca vreun fruct? Fructele stim cu totii ca sunt bune, au vitamine si ca trebuie sa mancam minim 1 fruct pe zi pentru a o buna functionare a corpului nostru. Adevarul e ca desi un fruct nu face diferenta, faptul ca sti beneficiile unui fruct iti induc o stare de bine, optimista si te refaci mai rapid gandind mai lucid si cu dorinta de a fi bine. Optimismul in Sport Primul pas in a merge la sala este sa iti gasesti un partener, asa e firea omului, nu poate face lucrurile de unul singur si cauta un posibil sprijin. Sprijin care va fi defapt inversul decat te astepti, si anume ca atunci cand tu nu ai chef de sala, cel cu care mergi sa traga de tine ca sa mergeti. Nu va fi asa, posibil sa gasiti impreuna motive pentru care nu sa nu mergeti astazi si sa o lasati pe maine. Optimistul in sport se duce la sala de unul singur, antrenamentul e sfant si il pune pe primul loc chiar daca este invitat in oras de catre prieteni. Antrenamentele vor fi pe primul loc, optimistul vrea sa aiba rezultate care la final vor fi vizibile. El si-a antrenat creierul sa treaca peste limite si peste ispite, creierul gandind lucid si fiind sanatos de la oxigenarea sangelui, datorita sportului. Avand un creier sanatos va reactiona si corpul mai rapid si corect. Cel mai bun exemplu este Louis Amstrong, multiplul campion la ciclism care desi a aflat ca are cancer la testicule a continuat sa participe la concursurile de ciclism si chiar sa castige curse. Imi amintesc ca mi-a ramas in minte acest om deoarece o prietena mi-a spus care a fost raspunsul lui cand iarna impreuna cu echipa a incercat sa urce un munte, iar la o anumita altitudine cei din echipa i-au spus sa se opreasca ca nu va rezista pana sus. Raspunsul lui a fost Nu am fost pana acolo, nici macar nu stim daca putem. Haideti sa vedem. Si a reusit, gandind optimist si-a indeplinit telurile, teluri care daca nu ar exista, viata nu ar fi la fel de frumoasa. Optimismul in viata cotidiana Gandurile, toata ziua sunt prezente in mintea noastra, chiar va rog si acuma sa va ganditi la cum ar fi de nu am mai lasa energia negativa sa ne preocupe, ma refer la factori din exterior la care putem renunta voluntar. Exemplul cel mai bun sunt celebrele Stirile de

la ora 17:00 unde vedem atatea cazuri negativiste incat ne raman imprimate in minte si ne gandim la ele, le asociem personal, nu ne dorim sa se intample. Personal am renuntat sa ma uit la Stiri, ma focusez pe lucrurile intradevar importante si am grija de timpul meu sa nu fie irosit degeaba. Sunt enorm de multe variante in a inlocui Televizorul. Un alt exemplu sunt oamenii din jurul nostru. Omul din firea lui doreste sa se exteriorizeze, povestind apropiatilor ce ii mai apasa, unii asteptand sfaturi. Nu te implica prea mult, nu cauta solutii in locul lor pentru ca vor face tot cum vor ei. Mai bine incearca sa schimbi mentalitati si viziuni. Daca o prietena ti se plange ce a fost inselata, felicit-o ca a avut ocazia sa iasa dintr-o relatie in care jumatatea nu era potrivita. Raspunsul meu este cu siguranta satisfacator pentru cel ce il primeste, acceptul acesta creste mandria personala si automat optimismul in tine. Exemple sunt nenumarate, esentialul e in sanatate. Putem face ce vrem, putem ajunge unde dorii daca avem grija de corpul nostru, daca il alimentam cum trebuie si daca ii oferim suplimentele necesare dupa un efort fizic sau intelectual. Personal si fara vreo remarca comerciala va propun produse pe care le folosesc, nu neaparat brandul Calivita dar care aduc aceleasi beneficii corpului nostru:

Pentru cei ce vor sa slabeasca pot alege XShape Pastile de Slabit, bineinteles aceste pastile se recomanda a se lua facand un sport sau miscare zilnica. Pentru cei ce fac sport, recomand sa apeleze la aminoacizi, multivitamine in combinatie cu fructe zilnic, te vei ajuta enorm in pasii pentru indeplinirea scopurilor. Celebra Lecitina, pe care persoanele din ziua de astazi o iau gresit, atunci cand au nevoie sa sustina un examen sau vreun test. Este indicat sa se faca constant, tratament cu Lecitina, pentru o corecta functionare a creierului.

Inchei acest articol cu citate din sanatate pentru a constientiza cat de important este corpul nostru. Va multumesc si ne scriem curand. Fiti optimisti Cand vine vremea sa mananci corect si sa incepi sa faci exericitii, nu exista Voi incepe de maine. Maine este boala (V. L. Allineare) Sntatea este ca banii, niciodata nu vom avea o adevrat ideea de valoarea sa pn cnd o vom pierde. (Josh Billings) Cu siguranta sanatatea este mult mai valoroasa ca si banul deoarece sanatatea face banul (Samuel Johnson) O sanatatea proasta nu e din cauza ca nu aveti ci din cauza ca deja aveti ceva ce o face proasta. Sanatatea nu e ceva ce trebuie sa obti, e ceva de deti deja daca nu o deranjeaza altceva (Dean Ornish) Cei ce zic ca nu au timp sa faca exericitii pentru un corp mai sanatos cu siguranta mai tarziu vor avea timp pentru boala (Edward Stanley)

Sntatea este un cuvnt mare. Ea cuprinde nu numai corpul, ci mintea si spiritul ci si perspectiva unui om (James H. West)

Zi de zi, nenumarati oameni se gandesc cu pesimism la viitorul lor, si din pacate, multi dintre ei nu beneficiaza de un mediu pozitiv sau de sprijin din partea semenilor. Daca esti incurajat de persoane pozitive si fericite si iti place ceea ce faci, inseamna nu doar ca duci o viata fericita, ci ca esti mult mai eficient si poti trai mai mult. Studiile stiintifice au demonstrat ca persoanele, care au o atitudine pozitiva, care pun pasiune in ceea ce fac si au vise de indeplinit traiesc cu 8-10 ani mai mult decat restul. Un alt beneficiu al optimismului, este respectul de sine, care la randul sau, te poate ajuta sa atingi succesul in tot ceea ce vrei sa realizezi. Pentru a ne pastra o atitudine pozitiva, este important sa evitam gandurile si sentimentele negative. Cei care isi pot schimba gandurile isi pot schimba si viata. In aceasta perioada, poate putin mai dificila, oamenii au nevoie mai mult ca oricand, de persoane optimiste, de resurse pentru a trece la actiune astfel incat sa isi imbunatateasca perspectiva de ansamblu asupra vietii. Voi toti cei care cititi acest site, intuiesc ca aveti o atitudine pozitiva si sunteti optimisti, precum spune si Winston Churchill: Pesimistul vede dificultatea in fiecare oportuinitate; optimistul vede oportunitatea in fiecare dificultate. Optimismul si sanatatea. O serie de studii recente au demonstrat ca persoanele optimiste si cu o atitudine pozitiva prezinta un risc redus de aparitie a bolilor si sunt in general mai sanatoase decat restul. Ca efect al gandurilor noastre, diferiti hormoni sunt eliberati in fluxul sanguin. Aceste substante ne pot influenta nivelul de energie, dispozitia si starea de spirit generala, avand astfel un impact important si asupra performantei noastre de la locul de munca si de acasa. Nu exista nici un dubiu ca mintea si corpul sunt indispensabile: gandurile ne pot influenta organismul si invers. De asemenea, aceasta inseamna ca ne putem modela cum dorim viata si viitorul. Secretul Fericirii -Accepta trecutul si inchide poarta acestuia. -Traieste prezentul cu satisfactie. -Indreapta-te spre viitor cu o atitudine pozitiva. -Incepe sa faci pasi concreti catre o viata mai sanatoasa si mai prospera. Sunt convins ca deciziile de acum ne influenteaza viitorul. Nu trecutul ne determina viitorul, ci doar gandirea noastra pozitiva si pasii siguri pe care am hotarat sa ii facem.

Secretul Succesului in Afaceri. Optimistii sunt deschisi la noile oportunitati si vad partea plina a paharului. Iar ceilalti vad si simt acest lucru si sunt atrasi de persoanele optimiste si motivate. Daca esti optimist, din experienta iti spun ca oamenii te vor considera atargator, iar acesta calitate o poti folosi in afacerea ta. Atitudinea si comportamentul pozitiv te ajuta, nu doar sa iti atingi scopurile personale, ci in acelasi timp te fac sa te simti foarte bine. Importanta dorintei de a invinge. Astazi tot mai multi experti in domeniu, considera ca succesul nu este doar rezultatul dorintei de a invinge, ci al dispozitiei indispensabile, de a face tot ce iti sta in putinta pentru a-l atinge. Cei care isi doresc sa cunoasca succesul trec imediat la actiune, au o atitudine poztiva si sunt motivati. Doar persoanele cu o motivatie interna puternica si capacitatea de a lua decizii ferme si de a actiona catre telul care si l-au stabilit vor cunoaste succesul. Cu alte cuvinte daca gandurile noastre, reusesc sa ne activeze emotiile, nimic nu ne poate oprii sa trecem la actiune. Prin urmare, primul pas pe care trebuie sa il facem este sa avem o imagine cat mai clara, despre unde am vrea sa ajungem, in cat timp vrem sa realizam si cum va fi cand vom reusi sa ajungem unde ne-am propus.

Efectele crizei economice actuale asupra factorilor psihologici daunatori sanatatii CRIZA ECONOMIC MONDIAL o Eseu O r ice s chimbare n s ocietate are un mare impact as upra populaiei. To ate transformrile economice, politice sau sociale, au un impact psihologic n primulrnd asupra oamenilor. Tind s cred c aceast criz a aprut cu muli ani n urm,neavnd ns efectele majore pn n prezent. Mass-media a avut un rol determinantn a crea panic n interiorul societii. Din interese electorale, politice i comoditatepersonal, nesbuina cheltuielilor ncepe s ne ajung din urm. Nu putem s nemprumutm la nesfrit pentru a susine regii autonome neeficiente de ani buni, sauplata salariilor exagerate. ine de noi s avem nelepciunea s vedem c pn laurm interesul naional i colectiv trebuie s primeze demagogiei i incompetenei.nceputul crizei internaionale actuale l gsim n Statele Unite la finele anului2008, cnd a nceput aa-numita criza "subprime" ca urmare a scderii preurilor depe piaa imobiliar american. "Subprime" nseamna de fapt credite ipotecare cug r ad mare de ris c. P entru a putea acorda credite n condiii mai lejere, b n cile americane i externalizau o parte din mprumuturi prin securitizare (vindeau practicdatoriile oamenilor) ctre alte bnci sau fonduri care la rndul lor, le vindeau maidep arte. A tr a i de profit urile mari (date de ris cul mar e), mu l te dintre bn cil eimportante din lume au investit n aceste titluri. Cnd piaa imobiliar american s-aprbuit, iar oamenii nu au mai putut plti ratele, aceast criz nu a afectat numaibanca care a dat creditul, ci i toate celelal te in s titui i care au "comercia liz at" datoriile mprumutatului. De aici criza s-a extins n toat Europa, genernd o lipsacut de lichiditi i cderi locale la toate bursele din lume.Din ianuarie 2009 ncep s se simt efectele crizei economice n Romnia lanivelul populaiei, mai ales la nivelul populaiei active. Aceste efecte s-au

UNIVERSITATEA LUCIAN BLAGA DIN SIBIU FACULTATEA DE TIINE SPECIALIZAREA PSIHOLOGIE

DISCIPLINA ANALIZA COMPORTAMENTULUI ECONOMIC SI ELEMENTE DE TEORIA JOCULUI

CUPRINS

Efectul psihologic al crizei economice.................................................................3 Psihologia consumatorului- aspecte privind comportamentul consumatorului....5 Criza economic i consumatorul.........................................................................9

S vorbeti despre criz a devenit o normalitate. Ceea ce pn acum cteva luni prea doar o ameninare sau o exagerare acum face parte din aproape orice discuie i e neobinuit ca cineva s nu evalueze efectele crizei asupra lui sau a familiei sale. Toate dialogurile par s nceap cu criza economic.

I.

EFECTUL PSIHOLOGIC AL CRIZEI ECONOMICE a atras schimbri

fundamentale n comportamentul de consum att la nivel mondial, european ct i naional. In urma mai multor studii (printre care i studiul Deloitte privind tendinele de consum) s-a ajuns la ideea potrivit creia a luat natere un nou tip de consumator, care prefer produsele utile i durabile, care renun la achiziiile impulsive i analizeaz cu atenie deciziile de cumparare, cntrind preurile, calitatea i valoarea pe care o aduc produsele inovatoare. Criza economico-financiar s-a dovedit a fi o experien de nvatare pentru consumatori. In urma acestui studiu au rezultat urmtoarele: 1. 2. 3. 4. 5. 6. 7. 8. 78% dintre romni spun ca economia este n recesiune; 89% dintre romni considera ca reactia guvernului la criza financiara a fost neinspirata si slaba; 48% dintre romni cred ca economia se va redresa sau va ramne la fel, n 2010, n timp ce 45% cred ca situatia se va nrautati; 66% dintre romni cred ca declinul economic are un impact direct asupra situaiei lor financiare; Aproape un sfert dintre romni nu sunt interesati de situatia financiara a companiei n care lucreaza; 48% dintre romni cred n sigurana locului lor de munc n 2010; 59% dintre romni declar ca au mai putini bani pentru cheltuieli, fa de aceeai perioada anul trecut; 67% dintre romni au ncredere c situatia financiar a cminului lor se va mbunti sau va ramne la fel, n urmtoarele 12 luni;

9.

35% dintre romni spun ca dup ieirea din criz vor continua s cheltuie mai puin, n timp ce 46% spun c vor cheltui la fel; doar 19% si vor majora cheltuielile Comportamentul consumatorului romn n sezonul sarbatorilor de iarna 2009:

30% dintre consumatori intentioneaza sa cheltuie mai mult pe cadouri n acest an, fata de 28% - mai putin; 29% dintre consumatori intentioneaza sa cheltuie mai mult pe produse alimentare si bauturi n acest an, fata de 23% - mai putin; 52% dintre romni spun ca vor cheltui la fel de mult ca si anul trecut pentru activitati de divertisment; 28% dintre consumatorii romni cumpara cadouri pentru sfrsitul de an n avans, iar 23% - dupa sarbatori, pentru a beneficia de cele mai avantajoase preturi si a evita aglomeratia din magazine;

II. III. IV.

Criza a schimbat obisnuintele de consum ale romnilor, 45% declarnd ca si vor nfrna cheltuielile impulsive, iar 68% se vor orienta spre cadouri utile; Doua treimi dintre consumatori prefera produsele romnesti, tendinta care se accentueaza odata cu avansarea n vrsta; 68% dintre romni si vor face cumparaturile de srbtori n hipermarketuri; Utilizarea Internetului: Dou treimi dintre romni folosesc internetul pentru a cerceta piaa i a compara produse si preturi; Barbaii i persoanele cu vrste ntre 35 - 54 de ani sunt mai nclinai spre achiziiile online; Femeile i consumatorii mai n vrsta recurg la internet pentru cercetare i comparaii de preuri. Top 10 cadouri preferate de romni

Produse cosmetice / parfumuri (46%) mbrcminte / nclminte (44%) Bijuterii / ceasuri (36%) Obiecte de decor (35%)

Cri (35%) Bani ghea (33%) Laptop (32%) Bilete de cltorie (28%) Produse alimentare sau buturi Telefoane mobile (altele dect iPhone) (23%) Consumatorii europeni adopt o atitudine prudent. Printre noile tendine identificate n studiu se remarc utilizarea tot mai frecvent a internetului i a canalelor noi de media pentru a stabili cel mai bun pre; consumatorii prefer produse care respect principiile dezvoltrii sustenabile i ale comerului echitabil; de asemenea, mrcile proprii ale retailerilor cstig teren n defavoarea mrcilor naionale, datorit preului mai mic, care devine astfel pre de referin. In Romnia consumatorii sunt mai conservatori (oamenii, n general) i mentalitile se schimb greu i n mod diferit. Nu se observ mari diferene ntre consumatorul de dinainte de revoluie i cel de acum, cel de dup 20 de ani: romnii vor un stil de via modern dar cu valori tradiionale. Pentru a inelege comportamentul consumatorilor romni trebuie s fie ineles contextul socio-politic, dar mai ales psihologia consumatorului n general. PSIHOLOGIA CONSUMATORULUI ASPECTE PRIVIND

COMPORTAMENTUL CONSUMATORULUI Orice activitate economic trebuie s vizeze satisfacerea cerinelor efective i poteniale ale consumatorului, cu maximum de eficien. Cunoaterea nevoilor de consum, a cerinelor pieei necesit n primul rnd identificarea acestor cerine, urmrirea sistematic i chiar anticiparea lor pe baze ct posibil tiinifice, prin proiectarea si aplicarea unui instrumentar de investigare adecvat. In sens restrns, comportamentul consumatorului reflect conduita oamenilor n cazul cumprrii i/sau al consumatorului de bunuri materiale i de servicii.In sens larg,

el cuprinde intreaga conduita a utilizatorului final de bunuri materiale i nemateriale, indiferent de tipul acestora. Studiul comportamentului de consum este foarte important n dezvoltarea procesului de marketing i, n continuare, a celui de publicitate. Prin deciziile de cumprare, consumatorii determin vnzrile i, n ultim instan, profilul unei companii i, de aceea, orice activitate de marketing i comunicare trebuie programat i desfasurat n raport cu nevoile acestora. Astfel, analiza actului cumprrii, a conceptelor de cumprtor, consumator, comportament de cumprare, comportament de consum, a teoriilor fundamentale privind comportamentul consumatorului, factorii care influeneaz decizia de cumprare, precum i relaia dintre consumator i marc sunt elemente eseniale n nelegerea psihologiei reclamei i a consumatorului. Comportamentul consumatorului reprezint totalitatea actelor decizionale realizate la nivel individual sau de grup, legate direct de obinerea i utilizarea de bunuri i servicii, n vederea satisfacerii unor nevoi actuale sau viitoare, incluznd procesele decizionale care preced i determin aceste acte (Catoiu, 1996). Alte definiii consider comportamentul consumatorului ca fiind acele activiti observabile, alese pentru a maximiza satisfacia prin intermediul obinerii de bunuri i servicii(Kotler, 1999). Tipologia comportamentului consumatorului vizeaz, astfel, felul n care indivizii iau decizii cu privire la modul cum s i consume sau aloce anumite resurse de timp, bani, efort, implicare emoional pentru a achiziiona diverse produse sau servicii. Dintre dimensiunile ce definesc comportamentul de cumprare, cele mai importante sunt: motivele de cumprare sau necumprare; referinele cumprtorilor; inteniile de cumprare; obinuinele de cumprare; obiceiurile de consum; atitudinile cumprtorilor; imaginea mrcii(Kotler, 1999)

Maniera n care consumatorii abordeaz deciziile de cumprare cunoate o mare diversitate, ntruct reaciile acestora sunt determinate n foarte mare msur de problemele mediului ambiant n care i triesc viaa. Complexitatea deosebit a comportamentului consumatorului se explic i prin multitudinea factorilor care influeneaz direct sau indirect n ultim instan procesul decizional de cumprare i de consum. Toi specialitii recunosc, c n fapt, comportamentul consumatorului nu se poate explica, dect prin cunoaterea sistemului de factori ce acioneaz n strns legtur i intercondiionare reciproc, dar modul n care acioneaz i mai ales locul i rolul pe care acetia le au n sistem, sunt privite n mod diferit i de aceea ntlnim n literatura de specialitate diferite clasificri ale acestor factori. Intr-o ampla analiz pe care o face comportamentului consumatorului, Ph. Kotler pornete de la analiza factorilor care l influeneaz, grupai n: factori culturali, reprezentai de : cultura, subcultura i clasa social; factori sociali, care includ : grupuri de referin, familia, roluri i statusuri; factori personali, care se refer la : vrsta i stadiul din ciclul de via, ocupaia, stilul de via, circumstanele economice, personalitatea i prerea despre sine; factori psihologici, desemnai prin: motivaie, percepie, nvare, convingeri i atitudini. Factorii psihologici Dintre numeroasele variabile de natur psihologic cu influen major asupra comportamentului consumatorului evideniem: percepia, motivaia, nvarea i atitudinea. a. Percepia este un proces prin care individul recepioneaz, selecteaz, organizeaz i interpreteaz stimulii din mediul nconjurtor, conferindu-le o anumit semnificaie Este un proces complex, care depinde de caracterul stimulilor fizici, dar i de relaiile dintre stimuli i anumite condiii ce implic individul. Fiecare individ recepioneaz inputurile senzoriale din mediu (auz, vz, gust, miros, pipit) dac acestea se gsesc ntre nite limite care constituie pragul: absolut

(nivelul minim ce poate permite detectarea, senzitivitatea i diferenial (diferena minim care se poate detecta, de la un anumit nivel n sus. Consumatorul folosete informaiile astfel obinute pentru a alimenta refleciile sale i pentru a ajunge la o judecat asupra unui produs prelucrnd informaia n proces de reflecie controlat sau n procese semiautomate, care pot fi contiente sau nu. Aceast activitate perceptiv are cteva caracteristici deosebit de semnificative pentru specialistul de marketing:

percepia este selectiv, deci individul opereaz alegerea pentru stimuli, interpretndu-i doar pe aceia care se impun prin calitate (intensitate, diferen) i pe aceia care corespund unei stri de dezechilibru intern;

percepia este distorsionat, deformat de o serie de factori ca: similaritatea, impresia iniial, stereotipia; percepia este subiectiv, la aceiai stimuli ea va putea fi diferit de la un individ la altul. b. Motivaia este variabila care a polarizat interesul cercettorilor, fiind mult vreme considerat singura care intervine ntre stimuli i reacia cumprtorului, ntruct este uor de observat c orice act (cognitiv, afectiv, comportamental) are la baz n ultima instan un motiv, un impuls intern rezultat din interaciunea dialectic a coordonatelor sistemului. Motivele sunt tocmai mobilurile consumatorului care stau la baza comportamentului su. Referitor la adoptarea deciziilor economice privind perspectivele pieii este relevant cunoaterea elementelor motivaionale care predomin, dac predominante sunt cele generale, se poate face o prognoz asupra comportamentului consumatorului, dac predomin cele individuale ansa scade simitor. Specialitii apreciaz c motivaia de consum este constituit n cea mai mare parte din elemente ideatice i comportamentale specifice grupurilor sociale, cum ar fi: opinii, prejudeci i credine, obiceiuri i tradiii, modele socio-culturale de comportament, mod, etc. c. nvarea reflect o schimbare observabil sau inobservabil n comportamentul unui individ datorit acumulrii experienei, care conduce la o cretere a posibilitii ca un act s fie repetat.

d. Atitudinile i convingerile pe care oamenii le capt n timp ce nva i acioneaz au rezonan pentru cunoaterea mecanismului comportamental al individului. Convingerea este o cunoatere descriptiv pe care o persoan o are despre ceva. Convingerile contureaz n mintea oamenilor imaginea despre un produs, iar oamenii acioneaz conform convingerilor. Numai convingerile determinate au rol n luarea deciziei, adic o decizie important sau semnificativ n alegerea sau clasificare produselor, o decizie distinctiv (cum sunt diferenele percepute ntre mrci), o decizie frapant (care iese n relief, n eviden n mod deosebit). CRIZA ECONOMICA SI CONSUMATORUL Companiile tiu foarte bine c oamenii au, n continuare, bani, dar nu vor s-i cheltuie, de frica unor pierderi mari n viitor. Prin urmare, trebuie s gseasc punctul sensibil, prin care s-i determine s cumpere. Astfel marile companii au fcut apel la studii mari de marketing pentru a determina care este psihologia consumatorilor pe timp de criz. Consumatorii traverseaz o stare de insecuritate general, care se repercuteaz n planul ncrederii fa de branduri. Dezvoltarea tehnologic din ultimii ani contribuie la accentuarea strii de panic ntruct prediciile sumbre, vestile despre esecurile si cderile petrecute ntr-un anumit loc, ca efect al crizei economice globale, prolifereaz aproape instantaneu pe plan mondial. Cu ct teama este mai mare, cu att consumatorul si pondereaz si si organizeaz mai bine cheltuielile. El devine mai raional n ceea ce priveste decizia de cumprare si este mai atent la produs, la calitile intrinseci ale acestuia mai mult dect la partea emoional si aspiraional care nconjoar brandul. Petrece mai mult timp cutnd mrfuri durabile si este mai nclinat s amne achiziiile si s cumpere mai puin. Criza economic mondial a adus schimbri n comportamentul de consum, majoritatea oamenilor reuesc s se adapteze la noile condiii de pia, n timp ce o parte din populaie se declar n panic, devenind uneori isteric, fcnd tot posibilul s restrng cheltuielile marii consumatori dinainte de recesiune devin principalii clieni ai cabinetelor de psihologie datorit stresului cotidian i al fricii de a nu-i mai putea achita ratele, datoriile, creditele fa de bnci.

Consumatorii mari, adic patronii care au investit n tehnologie, imobile i afaceri sunt primii panicai. Omul de rnd, consumatorul obinuit fiind mai aproape de pragul de minim acesta cunoate foarte bine starea de a face economie, de a nu cheltui, de a nu cumpra dect dac este stric necesar. Alegerile se fac n funcie de pre poate mai mult ca niciodat. Se pune n balan raportul calitate pre, loialitatea cumprtorului se destram mult mai uor iar din toat transformarea asta au de ctigat doar acei vnztori / companii care se adapteaz cererii.

BIBLIOGRAFIE

1. Catoiu, Iacob, Comportamentul consumatorului, Ed. Uranus, Bucureti 2004. 2. Kotler, Philip, Managementul marketingului, Ed. Teora, Bucureti 2003. 3. Iliescu, Drago i Petre Dan, Psihologia reclamei i a consumatorului. Psihologia consumatorului, (vol. 1). Ed. Comunicare.ro.,Bucureti 2004. 4. Todoran, Dimitrie, Psihologia reclamei: studiu de psihologie economic Ed. Tritonic,2003.

5.https://www.deloitte.com/print/ro_RO/r o/informatii/comunicate-de-presa/pressrelease/ Care sunt efectele psihologice ale crizei financiare?


Criza financiara, o sintagma aproape la moda. Dar este realmente astfel? Pentru ca suntem bombardati cu informatii contradictorii care ne bulverseaza si ne descurajeaza, am invitat doi specialisti, un expert in finante si un psihoterapeut, sa explice ce se intampla, de fapt, la nivel individual si social.

< pagina anterioara pagina urmatoare > Pagina: 1 2 3

Cum percep romanii acest eveniment? Radu Craciun: Cred ca, multa vreme, oamenii au sperat ca aceasta criza ii va afecta pe altii sau alte tari. Exista o intarziere in ceea ce priveste constientizarea gravitatii problemelor cu care ne confruntam. Mai mult decat atat, Romania s-a bucurat in ultimii 7-8 ani de o crestere economica sustinuta, reflectata si in standardul de viata al populatiei. Este suficient sa ne uitam la cresterile de doua cifre inregistrate de salariul mediu net, vanzarile de automobile noi, numarul turistilor romani in strainatate etc. Din acest motiv, este foarte greu, psihic vorbind, ca dupa o perioada prelungita de crestere a bunastarii, sa accepti o rasturnare de situatie. Asta i-a facut pe multi sa perceapa ca pe un soc realitatea cu care ne confruntam azi. E o trezire foarte brusca. Acesta este un prim element care poate duce la o perceptie disproportionata a acestei crize. Al doilea element, cel putin la fel de important, este modul in care este tratat contextul economic actual de catre media. In momentul de fata, in presa exista un zgomot infernal in ce priveste criza. Este o situatie in care opiniile cu adevarat profesioniste, vocile rationale si echilibrate, nealiniate politic, nu se mai aud aproape deloc. Din pacate, tocmai opiniile cele mai nastrusnice si cele extreme sunt cele cautate, opiniile rezervate si echilibrate neavand suficient de multa sare si piper pentru a crea audienta. Acest bombardament mediatic mareste intr-un mod artificial stresul omului de rand si dezinformeaza. Bun. Pe langa asta, pripa cu care anumiti lideri politici creeaza asteptari pozitive, pentru ca ulterior sa se razgandeasca si sa-si contrazica afirmatiile initiale in legatura cu evaluarea situatiei economice... iata un plus de confuzie generala si perceptia ca lucrurile sunt scapate de sub control. Cand mediul ne pune in fata a ceva atat de... coplesitor si de stresant, care sunt modalitatile de adaptare? Valentin Popescu: Modalitatile de adaptare in situatii de criza cer o reevaluare a instrumentelor cu care am operat noi pana atunci. Este nevoie de un plus de atentie, de un plus de deschidere, de largire a notiunilor cu ajutorul carora intelegem realitatea. Avem nevoie de mai multa flexibilitate, o toleranta mai mare fata de necunoscut, de mobilizarea unei gandiri creative. Aceste elemente se inscriu in reactia matura; daca persoana a facut in timpul dezvoltarii ei aceste achizitii, atunci le poate folosi. Daca, insa, ii lipsesc aceste instrumente, ar fi nevoie de un demers sistematic si specializat, menit sa conduca la dobandirea acestor abilitati. Consilierea, coaching-ul, pot fi de folos. Ca psiholog, pot sa va spun ca acest eveniment readuce in prim plan si tema relatiei cu autoritatea. Pentru copilul mic, ea este reprezentata de adultii care il ingrijesc; pentru adult, aceste figuri ale autoritatii sunt inlocuite cu forme mai impersonale si mai

abstracte: grupuri de apartenenta, biserica, patronat, politie, justitie, guvern, presedinte etc... In perioade de criza, omul tinde sa caute sprijin si protectie in relatiile sale cu autoritatea, ceea ce se traduce prin cereri aparent materiale, dar care sunt expresia simbolica a unei nevoi de siguranta, a grijii, in cel mai matern sens. In perioadele de criza, individul tinde sa se intoarca spre trecut, spre ceva din istoria lui care l-a facut sa se simta protejat. In cultura romaneasca, marcata istoric de influenta sistemului paternalist-comunist, aceasta inseamna dezvoltarea unei dependente fata de forme de autoritate. Reflecta media corect lucrurile? Radu Craciun: Presa scrisa intr-o masura mult mai mare decat televiziunile, care, in momentul de fata par angajate doar intr-o cursa de senzational ieftin sau urmeaza o agenda politica. Valentin Popescu: Mai mereu o criza este perceputa subiectiv disproportionat, datorita efortului de adaptare pe care il solicita, precum si datorita elementului ei de noutate. Nesiguranta si lipsa unor repere cunoscute pe care situatia de criza le aduce, toate determina opinia grupului sa capete prioritate in raport cu opinia personala, zvonistica cunoscand o mai mare amplitudine intr-o astfel de perioada. Oamenii cauta febril informatii care i-ar putea orienta. De cealalta parte, media are nevoie de senzational. Rezultatul este o bombardare informationala cu date contradictorii care au un efect confuzant. Cred ca nimeni nu este ferit de influenta media. Ne putem proteja prin izolare informationala si intoarcerea catre bunul-simt personal. Starea de pesimism este direct proportionala cu dimensiunile crizei economice sau este mai adanca? Radu Craciun: Cred ca lumea incepe sa constientizeze seriozitatea situatiei. Pe de alta parte, ma uitam zilele acestea la o cercetare de piata care arata ca un procent mai mare de romani decat anul trecut se asteapta sa-si petreaca concediul in strainatate. Speranta moare ultima... Valentin Popescu: Da, vedem ca oamenii sunt deja afectati psihologic de aceasta criza. E necesara adoptarea unor schimbari pentru gestionarea situatiei. Mai vedem si neputinta de a face aceste schimbari datorita elementului de noutate pe care criza il aduce. Toate conduc la accentuarea stresului. Acesta se poate manifesta prin: neliniste, oboseala, tulburari de somn sau alimentare, dezvoltarea unor adictii.

CRIZA ECONOMICA ACTUALA CA FACTOR DE RISC PENTRU IMBOLNAVIRI PSIHICE

Schimbari aduse de a criza economica: instabilitatea de locuri de munca, reducerea venitului net pe familie, somajul saracia

Toate acestea sunt cauze de stres iar stresul duce la boli psihice anxietate depresie chiar suicid

Efectele crizei economice asupra sntii mintale


OMS Europa a publicat recent o brour cu privire la impactul crizei economice asupra sntii mintale. Documentul se refer la aspectele legate de sntate mintal, care sunt influentate de colapsul economic. OMS susine c trecerea la o societate bazat pe cunoatere subliniaz i mai mult importana sntii mintale pentru susinerea productivitii. Brour i propune s prezinte modul n care cunotinele actuale privind criza economic afecteaz sntatea mintal a populaiei i care aciuni ar putea fi puse n aplicare pentru a reduce impactul unei crize asupra bunstrii mintale a populaiei. OMS subliniaz n mod special avantajele de a investi n politicile sociale i aciunilor n domeniul sntii. Cu toate acestea, I-ntr-o criz economic, guvernele sunt mai multe sanse de a reduce la (mintal), cheltuielile pentru sntate i bunstare a unor presiuni de ctre comunitile financiare internaionale. n schimb, guvernele ar trebui s vizeze intervenii de protecie social pentru a rspunde nevoilor prioritare printre persoanele cele mai vulnerabile.

Aciunea este necesar n aceste domenii: 1. Active pe piaa forei de munc de programe menite s ajute oamenii menine sau rectiga de locuri de munc neutraliza efectele de sanatate mintala ale crizei. 2. Programele de sprijin familial a contracara efectele de sntate mintal. Este de o importan, deoarece tulburri psihice severe adesea incepe in adolescenta sau la maturitate tineri. 3. Control al preurilor i disponibilitatea de alcool reduce efectele duntoare asupra sntii mintale. 4. Primar de ingrijire pentru persoanele cu risc ridicat de probleme de sntate mintal imbunatateste accesibilitatea, i sprijin precum i previne efectele de sntate mintal. 5. Programe de reducere a datoriilor atenuare a efectelor crizei asupra sntii mintale. O parte din acest aciune include stigmatul abordarea de boal mintal, precum i investiiile n domeniul sntii mintale. Reformele de sntate mintal ar trebui s fie continuat, indepartandu-se de instituionalizare i se ndreapt spre ngrijire comunitate. n plus, universalismul n serviciile de sntate mintal ar trebui s fie asigurat. O bun sntate mintal n rndul populaiei contribuie la productivitate i prosperitate economic, fcndu-l un factor important pentru creterea economic.

Impactul crizei financiare i economice asupra sntii mintale a cetenilor i reacii din experi guvernamentali i alte de sntate mintal Rezultatele dintr-un mini-sondaj ad-hoc n rndul experilor n domeniul sntii mintale n statele membre Context i ntrebri Sondajul a fost realizat pentru a colecta informaii din partea experilor din statele membre la o mas rotund Evenimentul care va avea loc la Bruxelles la 27 aprilie 2009 privind "Reducerea psihosociale impactul crizei financiare i economice ". Evenimentul va fi gzduit de ctre comisarul Androulla Vassiliou. n scopul de a pregti acest eveniment, dou ntrebri au fost trimise la Guvern Experii de sntate mintal n capitale i la Attaches Sntii n reprezentanelor permanente: 1) Nu te observa n ara dumneavoastr cu privire la nivelul de sntate mintal i bunstare n

form populaiei, i care ar care iau? 2) n cazul n care rspunsul la ntrebarea 1 este "da", cum nu guvernul dumneavoastr i cum, probabil, alte actori n counmtry dumneavoastr act de a atenua impactul negativ sntatea mintal a crizei (Ar putea fi aceste activiti n valoare de evidenierea lor la Masa Rotund)? Rspunsurile Experi din unsprezece state membre au rspuns la ntrebri. Este prea devreme pentru a vedea un impact al crizei asupra sntii mintale i a bunstrii, dar ... Cei mai multi experti spun ca este prea devreme pentru a vedea consecinele crizei asupra sntii mintale i a binefiind n populaie. Cu toate acestea, experii din cteva state membre au raportat un anumit impact: Expertul din Republica Ceh a raportat "pn n prezent doar un impact minor". Acest lucru este numai rspuns care se refer la datele spital. Acesta nu respect o crestere de admitere, dar n rndul pacienilor unele "nervozitate i vigilen n ceea ce privete criza". Judectori Bulgaria c impactul observate n aceast ar este, pn n prezent, mai mici dect n "Occident". i observaii foarte concrete au venit din Letonia n cazul n care expertul a raportat: "(...) Un impact negativ al crizei asupra nivelului de sntate mintal este evident. Dar noi presupune c impactul real nu poate fi nc vzut complet ". n Letonia, o cretere cu 15% n sinucidere i un numr de 1,5 ori mai mare de via primul diagnostice de anumite afectiuni psihice a fost raportat pentru anul 2008, comparativ cu 2007 (a se vedea anex). Page 2 ... n acelai timp, exist sperana c de mult impactul crizei asupra sntii mintale i a bunstare a populaiei este doar o chestiune de timp Dei pe lng expertul de la Letonia numai cele din alte cteva state membre au reuit s deja observa un impact negativ a crizei financiare / economice asupra sntii mintale, muli dintre ei au fost foarte clare cu privire la faptul c ei se ateapt consequeneces astfel pe termen lung. Expert din Belgia a raportat c aceasta prevede c anumite statistici, de exemplu, pe sinuciderii i a depresiei, vor spori. Expertul finlandez a rspuns: "tim din experiena anterioar recesiunea c unele dintre consecintele pentru bunstarea populaiei veni n

pe termen lung ". Expertul din Olanda a exprimat bnuiala lui c "situaia economic poate avea un efect negativ (material si mental), privind anumite persoane (...). Facem cred c este doar o chestiune de timp. " Expert din Norvegia cu condiia reflecii despre mai multe dovezi care sugereaza modaliti de impact negativ asupra sntii a omajului (sperana de via redus, bolile cardiovasculare, anxietate i depresie, consumul de alcool), n timp ce impactul asupra sinuciderea ar rmn neclare (vezi anexa). Un cteva rspunsuri sa referit la impactul crizei asupra reabilitare: Expertul austriac menionat: "n perioadele anterioare de depresie economice am experimentat faptul c integrarea profesional este mult mai dificil pentru cei cu tulburri psihice. " n mod similar, rspunsul vine din Republica Ceh observate mai puine oportuniti pentru de locuri de munc cu jumtate de norm n programe de reabilitare profesional. Se poate presupune c astfel de consecine sunt legate de reducerile de finanare: Rspunsul a expertului finlandez a descris mecanismul n aceast ar n mod clar: "Situaia economic a multor municipaliti a slbit i au deja a nceput s taie costurile serviciilor de sntate i sociale n acelai mod ca n cursul ultima recesiune. Aceasta nseamn de exemplu, c municipalitile reduce cantitatea de resursele utilizate de promovare i prevenire, angaja personal mai puin pentru servicii, mri dimensiunea grupurilor n serviciile de ngrijire a copilului i colile i scderea de utilizare a preventive suplimentare beneficiu. Deoarece de promovare a sntii nu este obligatorie pentru municipaliti, este de obicei primul lucru pe care le va salva inch Chiar dac aceste schimbri ar putea fi mici, mpreun vor provoca o mulime de costurile ulterioare. " n ceea ce privete a doua ntrebare cu privire la msurile luate de guvernele sau a planurilor de aciuni pentru atenua consecinele psiho-sociale ale crizei, doar foarte puine iniiative au fost menionat: Pagina 3 Expert leton a raportat: "Ministerul Sntii al Republicii Letonia lucreaz la o aciune n punerea n aplicare Planul de strategie a "mbuntirea sntii mintale a populaiei n 2009-2014." Ideea de baz a acestui plan este de a dezvolta de ingrijire bazate pe comunitate de sntate mintal, pentru a mbunti calitatea de diagnosticare a tulburrilor mintale i ngrijirea pacienilor cu tulburri psihice (De exemplu, programe de educaie boli mintale pentru medicii generaliti), precum i, pentru a reduce stigmatizarea n societate (de exemplu, programe de educaie boal mintal pentru

cei care lucreaz ntr-un domeniul educaional i social). " Rspunsul provenind din Elveia, a anunat dorina de a solicita mai multe fonduri pentru reelelor transregionale. n Finlanda, Guvernul efectueaz o revizuire pe termen mediu. Se pune un accent mai mare privind economis, n general, i n special n asigurarea ocuprii forei de munc. n sntate i servicii sociale accentul este pus pe dezvoltarea serviciilor. De asemenea, Guvernul are un scop specific de a reduce problemele de sntate mintal n rndul populaiei de ctre de punere n aplicare noul plan de sntate mintal i abuz de substane. Concluziile anchetei de la: Sondajul a artat c, n acest stadiu, experi din statele membre, numai foarte puine (cu Letonia ca cele mai clare caz) nu au putut raporta un impact al crizei asupra sntii mintale i a fiind n populaie. Cu toate acestea, experi din mai multe state membre au exprimat punctul de vedere c un astfel de impact este doar o chestiune de timp. Consecinele negative asupra sntii diferite ale omajului au fost menionate, precum i impactul asupra copiilor i familiilor. Reduceri de buget de promovare a sntii i de formare profesional reabilitare au fost menionate. Pn n prezent, guvernele nu sunt prevznd rspunsuri la aceste ateptri. Cele mai active Statele membre par a fi Letonia i Finlanda, n cazul n care o aciune n planul de implementare (Letonia) i o revizuire intermediar (Finlanda) a crea un context n care aciunile de atenuare a mentale efect asupra sntii ale crizei pot fi integrate. n acelai timp, dac exist mai mult sau mai puin un consens c un impact negativ al crizei asupra sntii mintale i a bunstrii poate fi de asteptat in termen mai lung, ar trebui s fie momentul potrivit pentru a ncepe cu reflecii despre rspunsuri posibile. Page 4 Anexa 1: Rspuns de la Letonia (e-mail din 10.3.09 de ctre dna Agnese Rabovia, Agnese.Rabovica @ vm.gov.lv) prin prezenta v rugm s gsii mai jos rspunsurile la ntrebrile pe care le au indicat: 1) Nu te observa n ara dumneavoastr un impact negativ al crizei la nivel de mental form de sntate i a bunstrii n rndul populaiei, i care ar care iau? Semnele care ar putea dovedi impactul negativ al crizei asupra nivelului de sntate mintal n

populaie sunt numrul de cazuri de sinucidere, numrul de persoane care au fost diagnosticai de boal specifice dat mintale prima dintr-o via etc Numrul de cazuri de suicid n Letonia n 2008 a crescut cu 15% n comparaie cu 2007. Aa cum se arat n tabel, n 2008 numrul de boli (F41.2-F41.3) diagnosticat prima dat ntr-o via au crescut de 1,5 ori n comparaie cu anul 2006. Exist semne n societate c problema consumului de droguri este n cretere, prea. Date reprezint, c un impact negativ al crizei asupra nivelului de sntate mintal este evident. Dar noi presupunem c impactul real nu poate fi nc vzut complet. 2006 2007 2008 Diagnostica (ICD10) Total numr la 100 000 populaie Total numr la 100 000 populaie Total numr la 100 000 populaie F32.0-F32.9 189 8,26 180 7,9 189 8,3 F38.0-F38.8 4 0,17 1 0,04 4 0,17 F41.2-F41.3 53 2,31

61 2,68 77 3,38 F62.0 0 0 1 0,04 0 0 Sursa datelor: Statistic Sanitar i Medical Technologies Agenia de Stat 2) n cazul n care rspunsul la ntrebarea 1 este "da", cum nu guvernul dumneavoastr i cum, probabil, ali actori n ara dumneavoastr s acioneze pentru a atenua impactul negativ sntatea mintal a crizei (s-ar putea aceste activiti s fie n valoare de evidenierea lor la masa rotunda)? Ministerul Sntii al Republicii Letonia lucreaz la un plan de aciune de punere n aplicare Strategia "mbuntirea sntii mintale a populaiei n 2009-2014." Ideea principal a acest plan este de a dezvolta de ingrijire bazate pe comunitate de sntate mintal, mbuntirea calitii diagnostic de tulburri mintale i de ngrijire a pacienilor cu tulburri psihice (de exemplu, programe de educaie boli mintale pentru medicii generaliti), precum i, pentru a reduce stigmatizarea n societate (de exemplu, programe de educaie boli mintale pentru cei care lucreaz ntr-o domeniul educaional i social). Anexa 2: Rspuns din Finlanda (mesajul din 8 martie 2009 de prof. Eija Stengrd, eija.stengard @ thl.fi) V mulumesc pentru oportunitatea de a comentariu la aceast aspecte importante. Am discutat la ntrebrile cu mai muli experi n domeniu i am venit cu urmtoarele puncte la ntrebrile dumneavoastr. Page 5 1) Nu te observa n ara dumneavoastr un impact negativ al crizei la nivel de mental sntatea i bunstarea n rndul populaiei, i care, pentru c ar lua? Impactul negativ al crizei economice nu a crescut nc nevoia de mintale servicii de sntate. Cu toate acestea, tim din experiena de recesiune anterioare care unele dintre consecintele pentru bunstarea populaiei vin pe termen lung. Mai ales familiile cu copii mai avea nevoie de mai multe servicii de sprijin n viitor, pentru c situaia dificil i de lung durat economice va afecta abilitatile parentale dintre prini. Problemele de parinti va afecta bunstarea copiilor i

s-ar putea cauza probleme de exemplu, n coal. Chiar dac nu suntem n stare pentru a vedea consecinele pe de bine fiind populaie nc, exist modificri clare n structurile i resursele de servicii n municipaliti. Situaia economic a multor municipaliti a slbit i au au nceput deja s reduc costurile serviciilor de sntate i sociale, n acelai fel ca n timpul recesiunii trecut. Aceasta nseamn de exemplu, c municipalitile scderea cantitatea de resurse folosite pentru promovare i prevenire, angaja personal mai puin pentru servicii, mrii dimensiunea grupurilor n serviciile de ngrijire a copilului i colile i scderea utilizarea de beneficii suplimentare de prevenire. Deoarece de promovare a sntii nu este obligatorie pentru municipaliti, este de obicei primul lucru pe care le va salva inch Chiar dac aceste schimbri ar putea fi mici, mpreun vor provoca o mulime de costurile ulterioare. 2) Are guvernul dumneavoastr i cum, probabil, ali actori implicai n actul de ara dvs. pentru a reduce impactul negativ asupra sntii mentale criza? Guvernul tocmai a lansat lor la jumtatea perioadei revizuiasc politica (a se vedea ataamentul). Acolo, n prezent mai mult accentul pe economie, n general, i mai ales n asigurarea ocuparea forei de munc cu mai multe aciuni. n serviciile de sntate i sociale se pune accentul pe de dezvoltare a serviciilor (att structurile i activitile). Guvernul are, de asemenea, un obiectiv specific de a reduce problemele de sntate mintal n rndul populaiei de ctre de punere n aplicare noul plan de sntate mintal i abuz de substane. Exist, de asemenea, planuri de a promovarea dezvoltrii pozitive la copii i tineri. Anexa 3: Reflecii privind "omaj i de sntate" din Norvegia (mesaj din 10 Martie 2009 de domnul Thor Rogan, Thor.Rogan @ hod.dep.no) Criza financiar i de sntate mintal Vi HAR lite dokumentert kunnskap ei - barbati flgende HAR vi ftt fra FHI: omajul afisari disproporionat, n funcie de statutul social. Persoanele cu nivel sczut de educaie i venituri mici sunt afectate mai des dect persoanele cu venituri ridicate i n nvmntul superior. Aceasta este, de asemenea, n cazul n Norvegia. Exist o corelaie puternic i necondiionat ntre omaj i de sntate. n plus, este indiscutabil c omajul conduce la o presiune sporit asupra serviciilor de sntate primar, dup cum sa demonstrat n mai multe ri. omajul ucide-n special brbai de vrst medie. Sperana de via redus, independent de

cauza de deces, a fost gasit in Marea Britanie, Italia, Finlanda i Danemarca. Concluzii similare Page 6 pot fi gsite n studiile ajustate pentru faptul c bolnavilor cronici ntr-o msur mai mare tind care urmeaz s fie omeri, n comparaie cu cele care nu sunt bolnav n primul rnd. Potrivit unui britanic de studiu, chiar partenerii de sex feminin de brbai omeri sunt afectate negativ, i mor mai devreme dect brbaii care nu au fost afectate de omaj. Mai multe studii sublinia modul n care pe termen lung omajului poate fi mai daunatoare decat scurt timp omaj. n Norvegia, de nvecinate ar, Finlanda, a fost dovedit c riscul de a trece prea devreme crete paralel cu durata de omaj de la un pn la 12 luni. Numrul de decese cauzate de boli cardiovasculare crete datorit omajului n ambele Suedia, Danemarca, Finlanda, Marea Britanie, Scoia, ara Galilor, Germania, Frana, Australia, Canada i SUA. Majoritatea studiilor sunt ajustate pentru cele mai explicative alternative cauze. Potrivit constatrilor din Suedia, Germania, Frana i Canada, omajul crete riscul de infarct cerebral Chiar i simpla ameninare a impactului omajului. negativ asupra sntii. n Suedia, unul a constatat c riscul de a fi omeri crete bine-cunoscut factori de risc pentru bolile cardiovasculare, cum ar fi hipertensiunea arteriala, de nalt LDL colesterolului i trigliceridelor. Probleme cu somnul este nc o alt consecin, un indicator de stres crescnd riscul de o serie de suferine. Studiul n cauz a fost ajustat pentru alternative explicaii. Efectul a omajului privind sinuciderea nu este clar. O corelaie ntre dovedit omajului i suicid a fost gasit in Statele Unite, Canada, Frana i Australia. Cu toate acestea, n rile n curs similar cu Norvegia, n cazul n care exist o rat mai sczut de sinucidere i de binestabilit sistemele de securitate social, cum ar fi in Suedia, Germania i Japonia, nici o corelaie a fost nc gsit. n orice caz, ar putea fi util s se fac distincia ntre diferitele tipuri de sinucidere. De exemplu, ar putea fi faptul c rata de sinucidere n rndul persoanelor care nu au mintale tulburare, este mult mai receptiv la schimbrile n micrile ciclice, comparativ cu sinuciderea n rndurile oameni care au o tulburare mintal cunoscut. omajul mai multe cauze mentale tulburri, mai ales de anxietate si depresie. Acest lucru este adevrat n cazurile de Danemarca, Canada i SUA. Un studiu de douzeci de ani norvegian (Westin, Norum, Schlesselman, 1988) puncte n aceeai direcie. Dup cum am menionat anterior, soul de omeri, de asemenea, riscurile de a avea o tulburare mintal cel puin n-Canada

(Ajustate pentru diferentele de venituri i nivelul de educaie). Vom presupune c relaia ntre omaj i tulburri psihice este afectat de trei mecanisme. n primul rnd, locul de munc n cele 21 de st secol este una dintre sursele noastre cele mai importante pentru o via social i semnificativ, i ncrederea n sine. Dac suntem privai de munca noastr, aceast threathens sentimentul nostru de semnificativ existena i stima de sine, i ne ndeprteaz din viaa noastr social de zi cu zi. Primul care urmeaz s fie nstrinat, sunt cei care au avut cele mai multe dificulti n a intra pe piaa muncii, cei care au avut deja tulburri psihice. n vremuri de depresie, ei sunt marginalizai. Datorit aceluiai motive, pierderea sensului, ncredere n sine i o via social, omajul n sine reprezint o de risc n ceea ce privete problemele de anxietate n curs de dezvoltare, depresie i tulburri de somn. n plus, potrivit a studiilor efectuate de Institutul norvegian de Sntate Public, o criz economic reprezint un factor de risc independent pentru tulburri de sntate mintal. Americani si canadieni Studiile au tendina de a concluziona c omajul duce la spitalizare mai mult n domeniul sntii mintale grij pentru tulburri mentale grave (psihoza). Cu toate acestea, nu este sigur dac acest lucru, de asemenea, se aplic n cazul Norvegiei. Printre rile nordice, Norvegia rmne singura ar fr un registru operativ pacient, ceea ce face dificil pentru a rspunde la acest tip de ntrebare. Statistica de canadieni sugereaz c omajul afecteaz, de asemenea, politica de spitalizare n cadrul sistemul canadian de sanatate mintala. Page 7 n ceea ce privete omajul i consumul de alcool, exist dou preziceri relevante. O prezicere este c omajul duce la o scdere a consumului, deoarece oamenii sunt prost oprit, pentru c i omajul afisari adesea, cei care consuma cel mai putin pentru a ncepe cu. O alt predicie sugereaz contrariul, c omajul crete consumul de alcool, deoarece oamenii au dificulti de adaptare la situaia, i paralel cu aceasta, ei au, de asemenea mai mult timp liber. ntr-o ar bogat ca Norvegia, construit pe un sistem de sunet de securitate social, nu este puin probabil ca efectul acesta din urm respinge Fosta. Rmne de vzut. omajul afecteaz sntatea atat mentala cat si fizica. Att persoanele fizice i familiile sunt

n cauz, precum i a populaiei n general. Pentru societate n ansamblu, rata omajului este una dintre consecinele cele mai costisitoare deriv dintr-un depresie. Ce ar trebui s fie fcut n Pentru a evita omajul conduce la o cretere exploziv n suferin personal i de sntate cheltuieli? Exist trei modaliti de a continua: 1. Pstrai-le oameni angajai-da semnificativ de munc. Ministerul Finanelor poate fi considerat ca fiind cel mai important n for ceea ce privete promovarea sntii i prevenirea tulburrilor psihice. 2.The Muncii si Asistentei Sociale Administraia (NAV). 3. Municipalitilor. Anexa 4 (Mesajul din 25 martie de Dr. Elizabeta Radonic): AVIZ DE PE SCURT IMPACTUL psiho-sociale ale crizei economice CROAIA 2009 Stimati domni, Este foarte dificil de a da un aviz bazat pe dovezi cu privire la impactul psiho-social al globale Criza economic n Croaia, deoarece majoritatea indicatorilor relevani nu sunt nc disponibile. Prin urmare, acest aviz se bazeaz pe observaiile mele personale i a informaiilor. n primul rnd, se pare c criza economic afecteaz Croaia un pic mai ncet dect multe alte ri europene. Acest lucru ar putea fi parial din cauza la un impact mai mic asupra prima bancar sector care este, n general atribuite unor intervenii oportune i al Bncii Naionale croate (The CNB Guvernatorul Rohatinski a fost proclamat cel mai bun bancher central al Anului Global i Europa de ctre revista Banker bazat pe seria de aceste msuri). Totui, exist multe alte ameninri la adresa sectorului financiar s fie depit. Apoi, exist problema structurii al economiei croate, care este mai mult orientate pe servicii, aa mare pierdere de locuri de munc nu a fost nc s-a ntmplat. Observaii generale pn n prezent sunt c industria alimentar i a vnzrilor sunt cele mai afectate n Croaia. Vanzarile de autoturisme i de proprietate ratele au scazut. Exist, de asemenea mare ngrijorare cu privire la sezonului turistic viitor, care este la nivel naional importante n ceea ce privete solvabilitatea, precum i la nivel individual mai mult baza existenei financiare pentru persoanele n multe croat regiuni. Acest lucru ar putea fi un bun punct n text pentru a sublinia importana de implicaii culturale i de mentalitate, deoarece pentru muli oameni din Croaia este important s se menin la nivelul de personal

cheltuieli, mai degrab dect s fac investiii pe termen lung. Un bun exemplu ar putea fi faptul c de schiRata de acorduri de vnzare nu a sczut n acest sezon. omajul este n cretere ncet, dar rezultatele unui sondaj recent pe internet (de ctre un loc de munc relevant portal de pia), arat c 58% din cei care au rspuns se tem de consecinele pe care criza ar putea avea asupra lor de locuri de munc, 29% nu au o opinie, iar 13% nu se tem. Este interesan www.mentalhealthpromotion.net/resources/results-from-a-mini-ad-hoc-survey-amongmental-health-experts-in-member-states.pdf Sntatea psihologic nainte, n timpul i dup o criz economic: Rezultatele din Indonezia, 1993 - 2000 Jed Friedman, Banca Mondial Duncan Thomas, Universitatea Duke Aceasta cercetare a fost sustinuta in parte de NICHD subvenie HD040245 Introducere Din 1997 valut crizei asiatice, fr ndoial unul dintre evenimentele cele mai perturbator economiei mondiale n mai multe decenii, a provocat daune economice grave n mare parte de Est i Asia de Sud-Est. Nici o ar nu a fost mai afectate dect Indonezia. Dup mai multe decenii de cretere economic susinut, cu o inflaie sczut, un curs de schimb stabil i trei decenii ale preedintelui Suharto la putere, indonezieni societatea a fost sfiat de criz 1997. The Indonesian Rupiah sa prbuit, care se ncadreaz n jurul valorii de Rp din 2500 pe US $ la sfritul anului 1997 la Rp 15000 dolar SUA la mijlocul anului 1998. PIB-ul a sczut 12 la sut n 1998, iar economia nu a crescut din nou pn n 2000. Preuri pentru spiral cu inflaia n 1998, ajungnd la 80% n timp ce preurile la alimente au crescut cu 160%. Rsturnare economic a fost nsoit de tulburri politice. Presedintele Suharto a demisionat n urma protestelor stradale la nceputul anului 1998, care a prevestit schimbri istorice n cadrul sistemului de guvernare la nivel naional i local. Marea majoritate a majoritatea gospodriilor casnice indoneziene au luptat pentru a face fa att cu adversiti economice imediate, n care cu care se confrunt la debutul crizei, precum i incertitudinea enorm asupra lor economice, sociale, politice i futures. Condiii de via prin subliniaz crizei a avut un potenial substanial de taxare pe psihologice bunstarea populaiei. Acest proiect analizeaz probe i ncearc s identifice acele subgrupuri ale

populaie indonezian care au pltit cel mai mare pre din punct de vedere al lor psihologic i psihologic de sntate. Impactul crizei asupra bunstrii economice au fost departe de a fi uniform. Din multe puncte de criz a fost concentrat n zonele urbane i n gospodrii urbane defavorizate a dus greul crizei (Frankenberg et al, 1999;. Friedman i Levinsohn, 2002). Scade consumul pentru uz casnic i creteri n srcie rate au fost mult mai mare n mediul urban dect n cel rural. 1 In mare parte, acest lucru este o reflectare a creterii a preului relativ al produselor alimentare, n special orez, care au beneficiat productorii nete de produse alimentare i concomitent colapsul salariilor reale, care a avut o tax pe lucrtorilor urbane i rurale fr pmnt. Impactul economic a crizei, de asemenea, variat in mod dramatic n cele 27 de provincii indoneziene i numeroase grupuri de insula chiar n cadrul zonelor urbane i rurale (Levinsohn et al., 2003). Mai multe provincii urbanizate din Java, cum ar fi Jakarta i Java de Vest, a suferit cea mai mare contractiile ntruct efectele nocive ale crizei economice au fost substanial mai redus n aceste provincii, care a produs i exporturile de export legate de astfel de servicii ar fi turismul (n Bali, de exemplu), precum i producia de petrol, cherestea, i de pescuit (n Sumatra). Variaie ntre provincii i ntre zonele rurale i urbane este un aspect fundamental al economice din Indonezia criz i este important pentru nelegerea modului n care criza economic a afectat bunstarea psihologic. O serie de studii au descris efectele crizei asupra dimensiunile multiple ale economice bunstarea i sntatea fizic a populaiei indoneziene. Luate mpreun, aceste studii indic o 1 De uz casnic pe cap de locuitor a sczut cheltuielile cu 34% ntre gospodriile din mediul urban i 13% dintre gospodriile din mediul rural (Frankenberg et al, 1999.). Ratele srciei mai mult dect dublu n zonele urbane i a crescut cu aproximativ 50% n mediul rural (Suryahadi et al. 2000). Page 5 2 scdere dramatic, dar de scurt durat, n nivelul de trai al mai indonezieni care sugereaz o enorm rezistent populaiei, care a avut mari eforturi pentru a furtunii. 2 n contrast puternic, impactul crizei financiare asupra sntii psihice i mentale, nu a

fost explorate. Scopul acestui document este de a furniza dovezi empirice cu privire la msura n care colectorul revoltele i subliniaz asociate crizei Indonesian afectat starea de sntate psihologic a Indonezian populaiei i dac orice astfel de efecte au fost de lung durat. n acest sens, vom contribui noi dovezi privind costurile psiho-sociale de insecuritate economic n rile n curs de dezvoltare. Utilizarea datelor din Ancheta Viaa de familie Indonezia, vom urmri indicatorii de stres psihologic de la aceiai indivizi, care au fost evaluate pn la trei interviuri pe o perioad de nainte, n timpul i dup de la debutul crizei. Aceasta dovada este contrastat cu schimbri n starea general de sntate de la aceeai persoanelor fizice. Gsim exist creteri substanial mari i semnificative a prevalenei stres psihologic, att n rndul adulilor brbai i femei, dup declanarea crizei i aceast cretere a persist i dincolo de nceputul crizei. n timp ce efectele sunt vizibile n intervalul de vrst ntregul, exist o sugestie c adulii mai n vrst sunt ceva mai vulnerabile la stres ridicat. Gsim de asemenea, niveluri anxietate de sunt mai mari de la debutul crizei n rndul celor cu educaie mai puin. Impactul crizei este cea mai mare, de asemenea, printre fr pmnt din mediul rural i cei care locuiau n provincii, care a suferit cea mai mare taxare n ceea ce privete costurile economice ale crizei. De sntate n rile n curs de dezvoltare psihologic Dei este n general recunoscut faptul c sntatea psihologic este o component important a bunstrii individuale, exist dovezi limitate la un nivel de populaie n ceea ce privete prevalena de psihohandicap social n rile n curs de dezvoltare sau de variaia sa n aceste ri. Dincolo de direct consecine asupra bunstrii umane de sntate psihologic sraci, literatura de specialitate sugereaz c ar putea fi semnificativ costurile economice, att pentru individ i societate n general. Sarcina global a Bolilor Estimrile indic faptul c bolile neuro-psihiatrice cont pentru aproximativ 10% din povara total a bolii i prejudiciului (msurat n ani de via invaliditate ajustat), n rile cu venituri mici i medii i peste 12% din povara bolii n Asia de Est i Pacific. Aproximativ o treime din aceast povar bolilor este atribuit depresie. (Lopez et al. 2006). Alte contribuabili care duce la povara bolii la nivel mondial care sunt asociate cu sntatea psihologic includ schizofrenie, tulburare bipolara si abuzul de substante. 3

2 Studiile au descris impactul crizei asupra srciei, consumului i bogie, oferta de munc, salariile i ctigurilor salariale, colarizarea, sntatea fizic i sntate utilizarea de ngrijire (Frankenberg et al 1999;. Suryahadi et al 2000.; Frankenberg et al. 2003; Thomas et al. 2004; Strauss et al, 2004).. 3 Aa cum va fi discutat n detaliu mai trziu n hrtie, msurile noastre de sntate psihologice sunt concepute pentru a evalua global psiho-social bunstarea i manifestri specifice, nu de boli psihice. n timp ce majoritatea studiilor citate sunt mai multe clinice n natur i, prin urmare, msura clasificrile specifice de boal mintal n rezultatele noastre se refer la un Noiunea generalizate a sntii psihologice. Specifice de boli mentale, cum ar fi depresia bipolara sau generalizate tulburri de anxietate, sunt subsumate n aceast categorie general de stres psihologic sau de sntate psihic. Page 6 3 Studii n rile dezvoltate i n curs de dezvoltare, att sugera probleme psihologice de sanatate tind s fie mai raspandita in randul celor mai mici cu statut socio-economic, dei aceasta a fost o provocare pentru fixeze mecanismele cauzale care stau la baza acestor asociaii. Este posibil ca insecuritatea economic i srcia contribuie la sntatea psihologic sraci i, invers, dovezile sugereaz c oamenii care sufer de probleme de sntate psihologic tind s funcioneze mai puin bine n piaa forei de munc i la coal (Ettner et al 1997;. Dooley et al 2000, Kessler et al 1995..). Furnizorii de servicii de sntate de pe tot globul raporteaz c depresia i anxietatea sunt mai rspndite n rndul grupurilor mai mici educai (Goldberg i LeCrubier, 1995; Patel i Kleinman, 2003). Grupurilor mai srace i mai dezavantajate au de obicei puin sau nu acces la serviciile de ngrijire a sntii psihologice, n special n lumea n curs de dezvoltare, astfel potenial accentueaz relaia circular de srcie i boli mintale (Saraceno i Barbui, 1997). De cercetare emergente indic faptul c nu este neaprat srcia n sine, dar schimbari nefavorabile n sociosituaia economic, care sunt predictive de stres psihologic (Das et al., 2007). n cazul n care este corect, tranziii, dislocri i incertitudini cu care fac parte din viaa de zi cu zi pentru muli oameni care triesc n lumea de astzi n curs de dezvoltare sunt susceptibile de a transporta cu ei o povar crescute de psiho-sociale de sanatate

probleme. ntr-adevr, chiar ca sntatea fizic a unei populaii imbunatateste, la fel procesul de dezvoltare poate duce la patologii crescute sociale i psihologice ca societi suferi modificri pronunate astfel de precum urbanizarea rapid, care tind s slbeasc tradiionale obligaiuni sociale rurale (de zahr et al., 1991). Acesta a fost sugerat c cele mai nalte niveluri de patologii psihologice se gsesc n rile emergente din conflict, n cazul n care nivelurile de tulburare de stres post-traumatic (PTSD) sunt ridicate n rndul populaiei generale (Joop et al., 2001). Populaiilor din regiunile care au avut de la dezastru natural asemenea, sufer semnificativ primejdie mai mult din punct de vedere psihologic de depresie, somatizare, i anxietate (Wang et al, 2000.; Frankenberg et al, 2007.). Avnd n vedere aceste dovezi, este plauzibil s presupunem c dislocare economice grave poate avea efecte adverse asupra sntii n starea general de sntate i psihologice, n special. Tangcharoensathien et al. (2000) furnizeaz unele dovezi cu privire la consecinele imediate ale crizei financiar 1997, n Thailanda. Dei efectele globale asupra sntii fizice i psihice n acest eantion studiu de specialitate sunt mixt, prevalenta raportate de stres sever, idei suicidare, sentimentele i fr speran a crescut n mod substanial n rndul grupului de sub-de omeri. Criza thailandez nu a fost la fel de profund, de anvergur, de lung sau durabil, deoarece criza Indonezia i astfel impactul crizei Indonesian privind bunstarea psihologic din populaie ar fi putut fi mult mai rspndit. Ne ntoarcem acum pentru a evalua aceste probe. Datele Ancheta Indonezia Viaa Familiei (IFLS) este un continuu multi-scop-individuale, de uz casnici la nivel de comunitate sondaj longitudinal. Primul val de IFLS a fost pe campuri, n 1993 i colectate informaii cu privire la peste 30.000 de persoane care triesc n 7200 gospodrii. Proba iniial a acoperit 321 Reprezentantul comunitilor n 13 provincii i este de populaie care au reedina n aceste provincii, despre 83% din populaia naional. Respondenii acelai au fost re-intervievai n 1997 (IFLS2), cteva Page 7 4 luni nainte de nceperea crizei valutare din Indonezia, i din nou n 2000 (IFLS3). A 25% sub-

eantion de persoane fizice a fost re-intervievai n 1998 (IFLS2 +) pentru a msura impactul imediat al criza. 4 n plus fa de colectarea de informaii detaliate cu privire socio-economice i demografice caracteristici ale respondenilor i a familiilor lor, IFLS evalueaz bunstarea psihologic a acesteia respondeni folosind un instrument de interviu pe baz de anchet. Msurarea de sntate psihologic n aceast mod are o lung istorie n cadrul comunitii de cercetare de sntate mintal i mai multe instrumente anchetei, att pentru scopuri de diagnostic i screening-ul, au fost dezvoltate n ultimele decenii. Unele dintre aceste eforturi au a dus la evaluri extensive de diagnosticare, cum ar fi International Interviu compozit de diagnosticare (CIDI), care folosesc o baterie de un numr mic de ntrebri controlul de securitate care alimenteaz ntr-o mai extins subchestionar referitoare la patologii specifice psihologice. O evaluare psihologic alternativ de de sntate prin sondaj este scara de screening scurta de obicei, dezvoltat pentru a evalua la nivel de populaie prevalena n non-specifice stres psihologic. Un exemplu de astfel de scar pot fi gsite n Kessler et Al. (2002), care prezenta o metoda pentru dezvoltarea unui nou 10-ntrebare de screening la scar psihologic primejdie pentru Studiul National de Sanatate Interviu (SNIS). n timp ce aceste instrumente anchetei au fost dezvoltate pentru a studia populaiile din rile dezvoltate, o recente OMS consoriu (2000) folosind CIDI a realizat un studiu trans-naionale a prevalenei i a coreleaza de tulburare psihologic, inclusiv probe din Brazilia, Mexic, i Turcia. Ei au gsit c prevalenta tulburarilor, cum ar fi depresia sau anxietatea este larg rspndit n ntreaga lume. Dei este n general, dificil de a importa aceste instrumente anchetei cu ridicata intr-un cadru ar n curs de dezvoltare, multe cercetatorii au tradus i adaptat instrumentele n mod specific pentru contextul local. Recente la nivel local cu rdcini studii n curs de dezvoltare s-au gsit prevalenta de mai multe tulburri psihologice pentru a fi cat mai mare cum sau mai mari dect cele gsite n partea de vest. Almeida-Filho i alii (1997) gsii cele mai prevalena global modele de vrst i sex a DSM-III diagnostice psihiatrice n 3 centre urbane din Brazilia care urmeaz s fie similare cu

cele gasite in studiile epidemiologice SUA bazinul (pe baza rezultatelor citat la Robins i Regier, 1991). n mediul rural Etiopia prevalena morbiditatea psihiatric este destul de mare i la niveluri similare descoperite n ri din urbanizate, dezvoltate (Awas et al. 1999). Utilizarea instrumentelor dezvoltate la nivel local de screening, Abas i Broadhead (1997) si gasiti o depresie i anxietate prevalenta de 31% n rndul femeilor care triesc ntr-o Mahala Harare - o prevalen mai mare dect cea constatat pentru categoria demografic aceeai n Londra. n general, studiile n curs de dezvoltare bazate pe ar gsi c covariabilele de aceeai boal psihic i stres psihologic observate n rile dezvoltate - de gen feminin, cu venituri mici, varsta inaintata, si inferioara 4 Atenie considerabil a fost introdus pe minimizarea uzura n IFLS. n fiecare re-anchet, aproximativ 95% din gospodrii au fost re-contactat, minimiznd astfel se refer la date care pot aprea de la uzur selectiv. n jurul valorii de 10 15% din gospodriile casnice sa mutat din locul n care au fost intervievai n valul precedent i concertate efort a fost facut pentru a urmri aceste gospodrii in noua locatie. n plus, persoanele care au mutat n afara lor versiunea original IFLS de uz casnic au fost urmate. Aceasta a adaugat aproximativ 1.000 gospodrii la proba n 1997 i aproximativ 3.000 de gospodrii n anul 2000. Page 8 5 educaia - sunt, de asemenea, asociate cu tulburri psihice comun n rile cu venituri mici i medii (Patel et al 1999;. Patel i Kleinman, 2003). 5 Pentru a msura bunstarea psihologic, n Indonezia, IFLS a adoptat un studiu de screening scurt psihologic primejdie. Componenta de sntate psihologic a IFLS nu este destinat pentru a diagnostica un anumit boal psihic n sine, ci mai degrab pentru a evalua prevalena populaia de diferite simptome de psihologic primejdie. Aceste simptome sunt de obicei extrem de corelate cu forme specifice de psihologic boal. Special IFLS ntrebri psihologice de sntate sunt adaptate de la General Sanatate chestionar (GHQ) i ncercarea de a masura simptome de dou categorii de comune la nivel global tulburare psihiatric-depresie i anxietate (Goldberg, 1972). Apendicele Tabelul 1 prezint IFLS

ntrebri utilizate n acest studiu. Ei se concentreze pe sentimente generale de tristete sau anxietate, precum i specifice simptome de primejdie. 6 Aceste ntrebri au fost traduse i de back-traduse pentru a asigura exactitatea, astfel cum precum i testat extensiv n domeniu, n scopul de a asigura nelegerea ntre subiecte de studiu. Apendice Tabelul 1 include, de asemenea, o ntrebare cu privire la auto-perceput de starea general de sntate. Acest standard de sntate sondaj ntrebarea este o msur rezumat al sntii, care cuprinde domenii fizice i non-fizice ale binefiind. Acesta ofer un contrast cu care compara markeri noastre de psiho-social bunstarea mpotriva unui rezumat mai larg al sntii. n ceea ce privete punerea n aplicare a anchetei, ntrebrile psihologice de sntate au fost evaluate n ntregime n 1993 i 1998 valuri de anchet i de un subset de ntrebri au fost evaluate n valul 2000. (Subset este marcate cu un asterisc n figura apendicele 1). Pentru o mare parte din analiza urmtoare, vom exploata la panoul de natura datelor pentru a contrasta strii generale de sntate psihologic a fiecrui individ, la dou puncte n timp, 1993 i 2000 (anul 1998 rezultatele de la 25% sub-eantion va fi, de asemenea, utilizate). Aceast perioad de apte ani ntre paranteze crizei financiare, politice i sociale, care, dat fiind magnitudine, este probabil factorul dominant care stau la baza modificrilor n materie de sntate psihologic n aceast perioad. O Avantajul de a folosi 1993 pentru comparaie este faptul c estimrile noastre nu vor fi contaminate de impactul ateptrile n ceea ce privete o criz iminent. Psihologice primejdie, pre-si post-criz Vom ncepe cu o prezentare general a noastre psihologice bunstarea indicatori nainte i dup debutul de criz 1997. Tabelul 1 rapoarte prevalena global de stres psihologic n populaia de 5 Mai multe cercetari recente (Das et al., 2007) nu reuete s gseasc aceast relaie dintre care coincide sntate psihologic i low statut socio-economic n cinci ri n curs de dezvoltare, dei nu reproduce constatrile anterioare n ceea ce privete coreleaz demografice. 6 Cu privire la ntrebrile intreba despre o gam mai larg de simptome dect cea indicat de DSM-IV i, dei ntrebrile se refer la simptome de depresie i anxietate, prevalena a unui simptome simptom sau mai multe ntr-un

individuale nu sunt suficiente informaii pentru a produce un diagnostic (Bir i Frank, 2001). Desi studiile de validare cu SUA pe baza GHQ au ajuns la concluzia c, dac o grupare de simptome n cadrul unui individ este identificat, psihiatri sunt susceptibile de a pune un diagnostic (Goldberg, 1972), datele IFLS nu furnizeaz informaii de diagnostic i am interpreta msuri ca indicativ al generale bunstarea psihologic a populaiei. Page 9 6 adulii de vrst 20 i mai sus, la momentul de fiecare val al sondajului, mpreun cu procentul de respondeni raport care au fost n stare proast de sntate general. 7 Rapoartele de sus panoul de rezultate pentru brbai i panoul inferior pentru femei. Rapoartele din stnga mn panou estimeaz c se bazeaz pe rapoartele din toti respondentii din fiecare val al studiului. Estimrile sunt ponderate, astfel nct acestea sunt reprezentative pentru care stau la baza populaie. 8 Declanarea crizei 1997 a fost nsoit de o cretere dramatic n toate psihologice indicatori de primejdie msurat n IFLS. Pentru ambele barbati si femei, ntre 1993 i 1998, prevalena de primejdie aproape sa dublat, pentru fiecare indicator cu excepia unuia dificulti de adormire, care a crescut cu aproximativ De 50%. De exemplu, n 1993, aproximativ 12% din barbati au raportat senzaie de trist n prealabil patru sptmni; n 1998, aproape 30% dintre barbati au raportat senzaie de trist. Femeile au fost uor mai multe sanse sa se simta trist n 1993 (16%) i mult mai probabil sa se simta trist n 1998 (41%). Au fost chiar mai mare creteri proporionale n prevalena de anxietate care au crescut de trei pn la patru ori (de la o baz mai mic). Combinarea att markeri ntr-o Indicele identificarea celor care declara ca se simt fie trist sau anxietate, aproximativ unul din ase respondeni au raportat astfel de sentimente n 1993. n 1998, unul din trei barbati si aproape unul din fiecare dou femei au raportat aceste sentimente. n 1993, unul din cinci respondeni au avut tulburri de somn i pn n 1998 aceasta a afectat una din trei aduli. Prevalena de oboseal aproape sa dublat i temperament scurt, mai mult dect dublu. Pentru ambele brbai i femele, prevalena a durerii somatice raportate sa triplat de la aproximativ 20% pn la 60% dintre respondeni. Creterea frecvenei de probleme psihologice ntre 1993 i 1998 sugereaz o

cretere substanial n care stau la baza stres psihologic i emoional n aceast perioad, care, aa cum se arat n coloana a treia din tabel, au persistat i dup declanarea crizei. Exist doar o scdere mic n prevalena de stres psihologic ntre 1998 i 2000 att pentru brbai ct i femei. Acest lucru este persistena demn de remarcat, deoarece pn n 2000 economia Indonesian a nceput s recupereze i medie de uz casnic nivelurile de consum a avut deja a revenit la nivelurile de dinainte de criz din 1997. (Ravallion i Lokshin, 2007) n contrast cu creterea n probleme de ordin psihologic, auto-au raportat starea general de sntate schimbri foarte puin pe ntreaga perioad sapte ani. n jurul valorii de 11% dintre brbai i ntre 11 i 14% din femelele s-au rapoarte ca fiind n stare precar de sntate. Stabilitatea relativ a acestei msuri generale de sntate sugereaz c indicatorii psihologic primejdie a identifica o modificare ntr-o dimensiune diferit de sntate i a 7 Pentru uurina de expoziie, ne-am dichotomized stres psihologic i ntrebrile strii generale de sntate. Noi combina respondeni c raportul experiena unui anumit indicator de stres psihologic, fie de multe ori sau uneori, pe parcursul ultimelor patru sptmni. De asemenea, dac un respondent a raportat starea lor general de sntate ca fiind "oarecum nesntoase "sau" foarte nesntoase ", ne recode pentru a fi n" starea general de sntate proast ". O modalitate de msurare a sntii probleme cu datele anchetei este de a rspunsurilor agregate la mai multe ntrebri i de a crea un indice de sintez (a se vedea Das et al. viitoare, pentru un exemplu n materie de sntate psihologic). Vom prezenta rezultatele pentru dou domenii de psihologice probleme - senzaie de anxietate sau trist - i care sufer de dificultati de somn. Acestea sunt singurele ntrebri care sunt repetate n toate valurile sondajului trei. Rezultatele noastre sunt calitativ neschimbate dac vom combina toate cele ase ntrebri n un index i compara 1993 cu 1998 sau dac vom combina cele trei ntrebri comune n cadrul celor trei sondaje ntr-o index i compara 1993 cu 1998 i 2000. 8 Dimensiunile eantionului variaz n funcie de valurile din cauza designului anchetei. n 1993, un subeantion de aduli a fost intervievai n fiecare gospodrie. n 1998 i 2000, toi adulii au fost intervievai individual. Val 1998 a fost limitat la 25% sub-eantion de gospodrii pentru motive de cost. Pagina 10 7

bunstarea dect starea general de sntate i c criza a afectat difereniat aceste dimensiuni separate. n analiz ulterioar, rezultatele generale fizice strii de sntate va oferi o comparaie util cu indicatori de sntate psihologic i subliniaz impactul potenial unic al crizei asupra bunstarea psihologic. Analizele pn n prezent furnizeaz dovezi cu privire la prevalena problemelor de sntate n rndul populaiei. Aceasta este util de a explora tranziii n materie de sntate n aceast perioad, care necesit n urma acelai individ a lungul timpului. Panoul din dreapta din tabelul 1 rapoartelor prevalena unor probleme psihologice i sraci starea general de sntate n rndul respondenilor care au fost evaluate individual n ambele 1993 i 2000 i au fost la vrsta cel puin 20 n scenariul de referin 1993. Peste 80% din 1993, de asemenea, respondenii au fost intervievai n anul 2000. Comparnd ratele de prevalenta pentru populaie (n prima coloan), cu ratele pentru proba la panoul de de referin (n coloana a patra), ofera perspective n reprezentativitatea eantionului panoului. Pentru ambele masculi i femele, ratele de prevalen n 1993 sunt foarte similare n ntreaga coloane. Rate n anul 2000 sunt nu sunt direct comparabile n seciune transversal i panoul de probe, deoarece respondenii sunt apte ani mai mari n urm. Pentru indicatorii psihologic, tarifele sunt apropiate. Astfel, proba panoul de replici creterea n mare stres psihologic ntre 1993 i 2000, care a fost observat n seciune transversal eantion. n schimb, n proba de panou, o parte mai mare din respondeni se declar ca fiind n sntate precar n raport cu proba seciune transversal. Aceasta este n mare msur o reflectare faptul c sntatea proast se ridica cu vrsta i prevede o dovad n plus c efectele timp sunt minore n raport cu efectele de vrst, n cazul de general starea de sntate. Pentru a explora variaie n primejdie psihologice pe parcursul vieii, Figura 1 ofer nonestimrile parametrice a relaiei dintre raportare fie tristetea, fie anxietate i de vrst pentru brbai (n panoul superior) i femei (n panoul inferior). Relaiile sunt estimate separat pentru cele trei valuri de IFLS cu probele seciune transversal folosind ponderate la nivel local parcele mai lin puncte (Cleveland & Devlin, 1988). Prevalena de tristete sau anxietate variaz n funcie de vrst, dei puin cu rate de prevalen sunt mai mare n rndul brbailor tineri i mai mari n 1998 i 2000 i n rndul femeilor n vrst n 1998. Aceste modeste

diferenele de vrst sunt dwarfed de sus schimbare dramatic n acest profil ntregul ntre 1993 i 1998. La fiecare vrst, prevalena de tristete sau anxietate aproximativ sa dublat ntre 1993 i 1998 indic o cretere de profund n primejdie psihologice pentru aduli peste vrsta de distribuie ntregul. Estimrile pentru anii 1998 i 2000 sunt aproape de co-incident care indic persistena efectelor crizei asupra sntii psihologice n toate vrstele, chiar i pe msur ce economia indonezian au nceput s recupereze. Aceste rezultate n figura 1 stand in contrast cu cele din figura 2, care prezint aceeai nonparametri de analiz de data aceasta pentru starea general de sntate. Un gradient de vrst mai clar este uor de observat n Figura 2 - cum vrsta respondenilor care sunt mai multe sanse de a raporta sntate precar general. Acest rezultat, n conformitate cu literatura de specialitate mai empirice, scoate n eviden diferitele domenii de bunstare identificate de GHS, precum i cu ntrebri psihologice de sntate. O alt diferen se refer la schimbarea lipsa relativ n msura GHS n perioada 1993-2000. Nu pare s fie o cretere general de sntate proast a raportat n 1998 n Pagina 11 8 comparaie cu 1993, cu toate c nu o mai aproape de amploarea asistat de stres psihologic msuri. Cu toate acestea, o diferen a treia este un declin n GHS srace pentru respondenii de vrst mijlocie i mai mari ntre 1998 i 2000 n timp ce stres psihologic ramane la niveluri ridicate. nelegerea determinani de schimbare n msura GHS, n special aplatizare a gradientului vrsta cuprins ntre 1993 2000, se afl dincolo de punctul central al acestei lucrri. Ceea ce este clar este faptul c creterea general i durabil a populaiei stres psihologic nu este nsoit de schimbri n starea general de sntate a populaiei percepute. Tranziii individuale n stres psihologic i criza Am rndul su, alturi de o anchet de tranziiile de intrarea i la ieirea de stres psihologic exploatarea dimensiunea de observare repeta de date panel pentru a examina modificrile bunstrii aceiai indivizi, n timp. Tabelul 2 sintetizeaz rezultatele de tranziii ntre 1993 i 2000. Pentru fiecare msur de stres psihologic, procentul de persoane n fiecare din cele patru categorii de posibile este cotate la burs - cei care au raport de stres psihologic n ambele ani de anchet, cei care raporteaz nici o primejdie, n fie an, cei care tranziteaz n suferin psihic i cei care tranziteaz din primejdie.

Dup cum se poate observa n datele agregate, o parte considerabila de brbai i femei au trecut de n psihologic fiind n dificultate n aceast perioad. Cu toate acestea, peste jumtate din populaie - i, n unele cazuri, trei sferturi - nu a avut nici tranziii cu marea majoritate a acestor oameni nu de raportare pe care le simtit suferinta psihologica. O mic, dar semnificativ a populaiei sa mutat din senzaie aflate n dificultate n aceast perioad. De exemplu, printre cele 12% din barbatii care au simtit trist n 1993, mai mult de jumtate au nu se simt trist n anul 2000. Printre 17% dintre femeile care au simit trist, jumatate nu au simit trist n anul 2000. n acelai timp, timp, aproximativ 20% dintre brbai i 30% din femei nu sa mutat de la sentiment trist n 1993 la senzaie de trist n anul 2000. Motivele sunt n general similare pentru ceilali indicatori de bunstarea psihologic. 9 Femelele sunt mai susceptibile de a tranziiei la intrarea i ieirea din suferin i, n general, fraciunea de populaie care tranziiile n stres psihologic n aceast perioad este cuprins ntre 2 i 5 ori mai mare dect fraciunea care a trecut din primejdie. n contrast cu indicatorii psihologic, relativ puini oameni de tranziie n stare precar de sntate i n jurul valorii de dou treimi din cei care au fost n stare precar de sntate n anul 1993 raportul acestea nu sunt n sntate precar n anul 2000. Caracteristicile psihologice individuale i de primejdie Combinaia de msuri de bunstarea psihologic, mpreun cu demografice i sociocaracteristicile economice ale persoanelor fizice colectate n IFLS ntre 1993 i 2000, prevede unic oportuniti de a identifica acele grupuri sub-populatie care sunt la risc crescut de a suferi de 9 Motivele sunt, de asemenea, similare pentru tranziiile n 25% sub-eantion peste 1993 1998 perioad. Atunci cnd se uit la 1998 - 2000 perioad, persistena relativ de suferin, n contrast cu oricare 1993 - 2000 sau 1993 - 1998 perioad este clar. Raportul dintre persoanele de raportare primejdie, n anii 1998 i 2000 a vis de un vis de cele de tranzit care, din a unui stat aflate n dificultate este mai mare dect aceluiai raport calculate pentru perioadele n care durata crizei. Page 12 9 psihologic primejdie. Noi folosim de regresie multivariat pentru a identifica cele mai mare risc nainte i dup de la debutul crizei, precum i cei care sunt cel mai probabil, la tranzitia n sau n afara psihologic primejdie.

Ne concentrm pe rolul de vrst, educaie i religie (toate din care sunt msurate n 1993) n timp ce gen de control n modele. Nu toate modificrile ntre 1993 i 2000 pot fi atribuite din 1997 criz. We therefore also exploit the fact that the impact of the 1997 crisis differed dramatically across the Indonesian archipelago and relate differences in responses to the crisis to a measure of the magnitude of the crisis for the area in which each respondent was living in 1993. Specifically, we distinguish not only province of residence but also those living in urban areas, the rural landed and rural landless households because research on the crisis has demonstrated that the impact of the crisis differed substantially between those who were net food producers and those who were net food consumers. Under the plausible assumption that the crisis was unanticipated in 1993, the impact of location of residence in 1993 on psychological distress can be interpreted as capturing impacts that are unrelated to responses to the crisis. 10 Regression results are reported in Table 3 for three indicators of psychological distress, sadness, anxiety, and difficulty sleeping, and also for poor general health using the sample of respondents who were age 20 in 1993 and interviewed in both 1993 and 2000. Columns 1 and 2 in each block examine the correlates associated with psychological distress or poor health in 1993 and 2000, respectively. We report odds ratios from logistic regressions with the dependent variable being unity if the respondent reports being in poor psychological or physical health. Columns 3, 4 and 5 in each block report the results of the transition models which are estimated by multinomial logistic regression. We report risk ratios relative to not being in poor psychological or physical health in either 1993 or 2000. Standard errors take into account correlations of unobserved factors that are common within households. The table presents results for gender, age, education, and rural/urban location. Differences by province are summarized in Figure 2. 11 10

The data affords a broader set of socio-economic controls than those included in these parsimonious caietul de sarcini. We do not include measures of individual work (and therefore earnings) because they may be determined in part by contemporaneous psycho-social well-being (Ettner et al., 1997; Dooley et al., 2000) The same reasoning applies to measures of household resources such per capita expenditures, which is the combination of earnings (and other income) of each individual and the choice of living arrangements which may both influence and be influenced by psychological health. We assume the included socio-economic factors such as educational attainment, location of residence, and ownership of land are largely fixed before psychosocial well-being in 1993 is determinat. 11 Religion is an important characteristic that may condition the experience and reporting of psychological distress indicators and is also mostly fixed over the crisis period. Indeed the multivariate analysis finds important differences in reported psychological well-being across Indonesia's major religious groups Muslim, Christian, and Hindu. Este difficult to understand exactly how religion affects the interpretation and expression of states of psychological distress, and indeed this task is beyond the scope of this paper. Nevertheless we include religion in our multivariate framework because of the revealed influence on our psychological distress indicators. If we exclude religion from the analysis, the coefficients on the other covariates are largely unchanged with the exception of the Bali province coefficient, where the vast majority of Indonesian Hindus reside. Pagina 13 10 As noted above, gender plays an important role in both the prevalence and the transitions of psychological distress controlling other characteristics. Females are significantly more likely to report being sad, anxious, suffering from sleep difficulties and being in poor general health in either survey year than are males. In addition, females are significantly more likely to transit between states of poor psychological or physical health (in either direction) and to remain in poor health in both survey years than are males. To allow for differential response among the young and old, age is modeled as a linear spline

function with a knot at 50 years of age. The influence of age varies with the particular psychological distress indicator. For example, feelings of sadness do not appear to vary by age in either survey year, although the probability of transiting from not being sad to being sad is an increasing function of age for those aged 50 and over. Age is an important determinant of changes in anxiety, particularly the most common transition from not being anxious prior to the crisis to being anxious after the onset of the crisis. For this transition, the spline function indicates a U-shaped pattern where the probability of experiencing anxiety in 2000, given no anxiety in 1993, first declines and then increases with age. These results highlight an advantage of examining transitions in psychological well-being. As shown here, and in Figure 1, there is little evidence that age is associated with the risk of being sad or anxious before or after the onset of the crisis. However, older adults are slightly but significantly more likely to transition into either state after the onset of the crisis. In terms of the other well-being measures, both sleep difficulties and poor general physical health tend to increase with age and older adults are more likely to transition into suffering from sleep difficulties or poor health. Education, which is an indicator of socio-economic status, is measured by years of completed colarizare. Better educated adults are less likely to be sad both before and after the onset of the crisis with the latter effect being significant. The better educated are also less likely to transition into or out of feeling sad indicating that education tends to protect against swings in feelings of sadness. The pattern for sleep difficulties is essentially the same. The better educated are less likely to have difficulty sleeping after the onset of the crisis and they are less likely to experience a transition into or out of sleeping difficulties. The better educated tend to be in better general health in 1993 and 2000 and they are also less likely to experience a transition into or out of poor general health. The relationship between education and anxiety is different. In 1993, the association is not semnificative. By 2000, the better educated are less likely to feel anxious. Similarly, the better educated are significantly less likely to become anxious between 1993 and 2000 and they are significantly more likely

to transition from being anxious to not suffering from anxiety. Thus the crisis period witnessed a disproportionate increase in anxiety among the less educated. Studies discussed above suggest the most vulnerable groups during a crisis are the poorer and less educated groups. This is reflected in our evidence for anxiety which likely most closely reflects concerns about economic insecurity. Page 14 11 The last three rows of Table 3 investigate the relationship between health and sector of residence prior to the onset of the crisis. Rural dwellers who owned land in 1993 are the reference category. Ei are, on average, the group that was most protected from the deleterious impact of the crisis because they are net food producers and the relative price of foods rose dramatically during the crisis. Within the rural sector, the landless were substantially more vulnerable to the negative impact of the crisis since they relied on wage labor during a time when wages collapsed. This difference in crisis vulnerability is apparent in the increasing relative likelihood of sadness and/or anxiety for the rural landless. Before the crisis, the rural landless were neither more nor less likely to report feelings of sadness or anxiety than the rural landed. Post-crisis, the landless were significantly more likely to be sad or anxious and significantly more likely to transit into sadness or anxiety. The buffer of land assets most likely protected landed households from severe income shocks and increased psychological distress. Urban residents have a consistently higher likelihood to report sadness, anxiety, or sleep difficulties than landed rural residents before the crisis, and this is largely true after the crisis as well (with the possible exception of anxiety where urban residents still have a higher likelihood of anxious feelings, although the difference does not meet standard levels of significance). Urban residents are also more likely to transition across states of psychological distress and non-distress than their rural counterparts. Clearly, urban status influences the psychological distress indicators and constitutes an important conditioning variable, however the relative importance of urban residence in determining psychological health does not change over the crisis period, at least in relation to landed rural households.

Regional variations in psychological health transitions Besides education or landlessness, region is another variable that mediates the severity of crisis expunere. The previously cited studies that investigate the consequences of the crisis have noted large geographic variations in crisis indicators such as inflation or declines in real household resources. C literature highlights the important role of location within Indonesia in assessing the impact of the crisis on well-being. For example provinces on the island of Java as well as southern provinces in Sumatra were among the most affected while Bali, due to it's reliance on tourism, and provinces to the east, due to the importance of resource-intensive export industries, were comparatively less affected. The spatial pattern in the changes in psychological distress indicators largely reflects these geographic differences in crisis severity. The models reported in Table 3 include controls for province of residence in 1993 (results not shown). As expected given the previous discussion, there are pronounced differences in the psychological distress indicators by province of residence. This is the case even after controlling for education, religion, and urban/rural location. In order to provide a context for interpreting the differences in risk ratios for provinces based on the models in Table 3, we relate those effects to a measure of the impact of the financial crisis. Pagina 15 12 Results are reported in Figure 3 which relates the change in the estimated province effects between 1993 and 2000 to the proportional change in the average level of household per capita expenditure (PCE) at the province level between 1997 and 2000. The distress prevalence measure in Figure 3 is unity if the respondent reports being sad or anxious and the province effects are based on logistic regressions of the form reported in Table 3 except that the regressions are estimated separately for urban and rural households. 12 The results show a similar pattern for rural and urban areas although the relationship is more pronounced in urban areas. Moving from left to right on the X-axis indicates higher levels of positive change in PCE and, therefore, a more mild impact of the crisis. In urban areas, for the provinces included

in IFLS, Jakarta experienced a 15% decline in PCE between 1997 and 2000 whereas PCE rose in urban Bali. An increase in the Y-axis indicates an increase in sadness or anxiety. There is a positive relationship between crisis severity and change in relative prevalence of psychological distress. Among urban areas, Jakarta, West Java, and South Kalimantan experienced the largest declines in mean income and also exhibit the largest rise in relative prevalence of sadness or anxiety. On the other end of the spectrum, Bali fared relatively well over the crisis period and also posts one of the smallest increases in overall prevalence. This general relationship between crisis severity and change in prevalence is also apparent in the fitted regression line which has a significantly negative slope (in spite of our small sample size of 13) and an R-square statistic of 0.39. While the crisis affected the psychological health of many Indonesians, those that lived in cities most affected by crisis experienced the greatest increases in distress. Rural residents in areas most affected by crisis also experienced the greatest increases in psychological distress although the relationship is not as pronounced as that for urban residents, even after we exclude the outlier of rural Bali (where relative distress increased substantially even though mean household incomes increased by almost 25%). Rural Yogyakarta, West Java, and South Kalimantan experienced negative or zero mean income growth over the 1997-2000 period and also witnessed some of the largest increases in psychological distress. In contrast, North and West Sumatra, containing some of the fastest growing rural areas, experienced the smallest increases in relative distress. Overall the relationship between income growth and psychological distress is weaker in the rural areas than urban; indeed the slope of the rural fitted regression line is not significant at conventional levels. This is, in part, due to the fact that rural areas in general had not fared as poorly over the crisis period as urban areas had for the reasons discussed earlier. 13 12 The conclusions are unchanged if we look at the prevalence of sadness or anxiety separately, or pool urban and rural households .

13 Identical analysis investigating the covariation of GHS with provincial measures of crisis impact does not find any observable relationship. Pagina 16 13 Concluzii The 1997 financial crisis was the most disruptive socio-economic event to confront Indonesians for at least three or four decades, if not longer. The effects of the crisis were wide ranging. While some households prospered given the new opportunities afforded by rapid price changes, shifts in the structure of the economy and the political landscape, overall poverty increased and mean incomes fell. Acest studiu is the first to look at the Indonesian crisis impacts on psychological health and it does so using a high quality longitudinal socio-economic survey. We find that the severe economic dislocation and political uncertainty engendered by the crisis adversely impacted psychological health in the overall population. We document substantial increases in distress indicators at all ages and for either gender over the crisis period. In addition, the imprint of the crisis on psychological well-being can be seen in the relatively large increase in poor psychological health for those groups most adversely affected: the less educated, the rural landless, and residents in regions hit hardest by crisis. Our analysis has focused on characteristics such as age, gender, education, and location prior to the crisis in order to avoid the difficulties associated with interpreting correlations with characteristics that might respond to the crisis. Complications associated with co-determinacy arise in many studies of the relationship between psychological health and economic outcomes such as labor force participation or income. An additional important observation that emerges from this research concerns the persistence of psychological distress from the immediate post-crisis period in 1998 to the recovery period in 2000. De 2000, mean household consumption had already recovered to 1997 levels and the overall economy had returned to pre-crisis growth rates, however psychological distress remained at elevated levels. finding that psychological distress persists following an economic shock while income and consumption

recover suggests that psychological well-being is at least partially orthogonal to more standard measures of economic welfare. These standard measures include at least one common measure of subjective welfare: happiness. The burgeoning literature on the economics of happiness (see Layard (2005) and Kahneman and Krueger (2006) for reviews) commonly finds that an individual's happiness measure rapidly habituates to changes in income any change in happiness as a result of a change in income is temporary and happiness soon returns to the pre-change level. Clearly the findings here suggest, especially when considered alongside other recent work on the persistence of psychological health changes resulting from lifeevents (Das & Das, 2006; Stillman et al., 2006), that psychological health stands distinct from happiness and other common subjective measures and may represent an independent domain of individual welfare. This paper presents evidence that the internal life of the Indonesian population, as measured by psychological distress indicators, suffered over the crisis period. Indeed when judged by the duration of impact, population psychological health may have been one domain of welfare most affected by the crisis and its aftermath. Pagina 17 14 Referinte Abas, Melanie A., and Jeremy C. Broadhead. 1997. Depression and Anxiety Among Women in an Urban Setting in Zimbabwe. Psychological Medicine, 27:59-71. Almeida-Filho, Naomar, and others. 1997. Brazilian Multicentric Study of Psychiatric Morbidity: Methodological Features and Prevalence Estimates. British Journal of Psychiatry, 171: 524-529. Awas, M., D. Kebede, A. Alem. 1999. Major mental disorders in Butajira, southern Ethiopia. Acta Psychiatr Scand, 100:56-64. Bir, Anupa and Richard G. Frank. 2001. Mental Illness and the Labor Market in Developing Nations. Commission on Macroeconomics and Health Working Paper Number 6, WHO. Cleveland, William and Susan Devlin. 1988. Locally Weighted Regression: An Approach to Regression Analysis by Local Fitting. JASA 83:596-610.

Costello, EJ, SN Compton, G. Keeler, and A. Angold. 2003. Relationships Between Poverty and Psychopathology: A Natural Experiment. JAMA, 290(15):2023-2029. Das, J. and Das, V. 2006. Mental Health in Urban India: Patterns and Narratives. The World Bank. Processed. Das, Jishnu, Quy Toan Do, Jed Friedman, and David McKenzie. Mental Health Patterns and Consequence: Results from Survey Data in Five Developing Countries. 2007. Forthcoming Policy Research Working Paper Series. The World Bank. Das, Jishnu, Quy Toan Do, Jed Friedman, David McKenzie, and Kinnon Scott. Forthcoming. Poverty and Mental Health in Developing Countries: Revisiting the Relationship. Social Science and Medicine. Dooley, D., Prause, J., & Ham-Rowbottom, KA (2000). Underemployment and Depression: Longitudinal Relationships. Journal of Health and Social Behavior, 41(4), 421-436. Ettner, Susan L., Richard G. Frank, and Ronald C. Kessler. 1997. The Impact of Psychiatric Disorders on Labor Market Outcomes Industrial and Labor Relations Review, 51(1):64-81. Fadden, GP Bebbington, and L. Kuipers. 1987. The Burden of Care: The Impact of Functional Psychiatric Illness on the Patient's Family. British Journal of Psychiatry, 150: 285-292. Frankenberg, Elizabeth, Duncan Thomas, and Kathleen Beegle. 1999. The Real Costs of Indonesia's Economic Crisis: Preliminary Findings from the Indonesia Family Life Surveys. RAND Working Paper No. 99-04. Santa Monica, Calif. Frankenberg, Elizabeth, James P. Smith, and Duncan Thomas. 2003. Economic Shocks, Wealth, and Welfare. Journal of Human Resources, 38(2): 280-321. Frankenberg, Elizabeth, Jed Friedman, Thomas Gillespie, Duncan Thomas, and others. 2007. Mental Health in Sumatra after the Tsunami. Mimeo. Friedman, Jed and James Levinsohn. 2002. The Distributional Impacts of Indonesia's Financial Crisis on Household Welfare: A 'Rapid Response' Methodology. The World Bank Economic Review, 16(3): 397423. Pagina 18 15 Goldberg, D. 1972. The Detection of Psychiatric Illness by Questionnaire. London, Oxford University Apsai pe.

Goldberg, D. and Y. LeCrubier. 1995. Form and Frequency of Mental Disorders across Centres. n Mental Illness in General Health Care: An International Study, edited by TB Ustun and N. Sartorius, John Wiley and Sons publishers. Joop, TVM de Jong, et al. 2001. Lifetime Events and Posttraumatic Stress Disorder in 4 Postconflict Settings. JAMA, 286(5):555-562. Kessler, Ronald, Cindy Foster, William Saunders, and Paul Stang. 1995. Social Consequences of Psychiatric Disorders, I: Educational Attainment. American Journal of Psychiatry, 152(7):1026-1032. Kessler, R., G. Andrews, LJ Colpe, Hiripi E., and others. 2002. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32:959-976. Levinsohn, James, Steven Berry, and Jed Friedman. 2002. The Impacts of the Indonesian Economic Crisis: Price Changes and the Poor. In Managing Currency Crises in Emerging Markets , edited by Michael Dooley and Jeffrey A. Frankel, University of Chicago Press, Chicago. PP. 393428. Lopez, Alan D., Colin D. Mathers, Majid Ezzati, Dean T. Jamison, Christopher JL Murray. 2006. Global Burden of Disease and Risk Factors. Oxford University Press and World Bank. Patel, Vikram, Ricardo Araya, et al. 1999. Women, Poverty and Common Mental Disorders in Four Restructuring Societies. Social Science and Medicine 49: 1461-1471. Patel Vikram, and Michael Kleinman, 2003. Poverty and Common Mental Disorders in Developing Countries. Bulletin of the World Health Organization, 81(8): 609-615. Ravallion, Martin and Michael Lokshin. 2007. Lasting Local Impacts of an Economywide Crisis.Forthcoming, Economic Development and Cultural Change. Robins, L. and D. Regier. 1991. Psychiatric Disorders in America. The Free Press, New York. Saraceno, Benedetto and Corrado Barbui. 1997. Poverty and Mental Illness. Canadian Journal of Psychiatry. 42(3): 285-290. Stillman, S., D. McKenzie and J. Gibson. 2006. "Migration and Mental Health: Evidence from a Natural Experiment", BREAD Working Paper No. 123. Strauss, John, Kathleen Beegle, Agus Dwiyanto, and others. 2002. Indonesian Living Standards Three Years after the Crisis: Evidence from the Indonesia Family Life Survey. Manuscript.

Sugar, Jonathan, Arthur Kleinman, and Kristian Heggenhougen. 1991. Development's 'Downside': Social and Psychological Pathology in Countries Undergoing Social Change. Health Transitions Review, 1(2): 211-219. Suryahdi, Asep, Sudarno Sumarto, Yusuf Suharso, and Lant Pritchett. 2000. The Evolution of Poverty During the Crisis in Indonesia, 1996-1999. Policy Research Working Paper No. 2435. World Bank, Washington DC. Page 19 16 Tangcharoensathien, Viroj, et al. 2000. Health Impacts of Rapid Economic Changes in Thailand. Social Science and Medicine 51:789-807. Thomas, Duncan, Kathleen Beegle, Elizabeth Frankenberg, Bondan Sikoki, John Strauss,a nd Graciela Teruel. 2004. Education in a Crisis. Journal of Development Economics, 74(1): 53-85 Wang, Xiangdong, et al. 2000. Post-earthquake quality of life and psychological wellbeing: Longitudinal evaluation in a rural community sample in Northern China. Psychiatry and Clinical Neurosciences, 54:427-433. WHO International Consortium in Psychiatric Epidemiology. 2000. Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organization, 78(4):413426. riz de intervenie n Abuzului i neglijrii Charles E. Gentry 1994 Departamentul american de Sanatate si Servicii Umane Administraia pentru Copii i Familii Administrare pe copii, tineri, i Familii Centrul National de abuz i neglijare nelegerea de criz Introducere Definiia de criz Elemente de Crizele Fazele de criz Sentimente clienti pe timp de criza Efectele psihologice ale crizei Rezumat Introducere

Crizele de familie nu sunt evenimente neobinuite n domeniul proteciei copilului. Un copil de divulgarea sexuale molestare, naterea unui copil dependeni de droguri, descoperirea de dependen unui adolescent privind drogurile, o societii-mam arestare pentru comportament violent, ameninarea de evacuarea unei familii din locuine publice, sau un printe copleit cu nevoile unui copil ilustreaz doar cteva dintre crize cu care se confrunt familiile. Dei starea de criz este de scurta durata, n general, durata de 4 pana la 6 saptamani, aceasta este o perioad de familie sporit vulnerabilitate i dezechilibru care necesit un rspuns atent planificat. Aceast seciune ofer o prezentare general de criz, definiia acesteia, elemente, i faze. n plus, sentimentele i efectele psihologice de obicei, cu experien de ctre membrii de familie n criz, sunt prezentate pentru a crete gradului de contientizare a ramificatii de criz. Page 2 Definiia de criz "O criz", astfel cum sunt definite n Rezerv n criz de intervenie 2: Sourcebook Practitioner pentru Terapie Scurta, "este un suprat ntr-o stare de echilibru, un punct de cotitur critic duce la o mai bun sau mai ru, o ntrerupere sau ntr-o defalcare persoanei sau familiei model normal sau obinuit de funcionare. Suprat, sau dezechilibru, este, de obicei acut n sensul c este de origine recent. " 1 O criz constituie circumstane sau situaii care nu pot fi soluionate de ctre unul lui obinuite de rezolvare a problemelor de resurse. O criz este diferit de la o problem sau o situaie de urgen. n timp ce o problem poate crea stres i s fie dificil de rezolva, familie sau individual este capabil de a gsi o soluie. n consecin, o problema care poate fi soluionate de ctre o persoan sau o familie nu este o criz. Un caz de urgen este o necesitate brusc, presare, cum ar fi atunci cnd viaa cuiva este n pericol din cauza unui accident, o tentativ de suicid, sau violena n familie. Este nevoie de o atenie imediat de aplicare a legii, CPS, sau alte profesioniti instruii pentru a rspunde la viata in pericol evenimente. n cazul n care o situaie poate asteptati 24 de la 72 de ore pentru o de rspuns, fr a pune o persoan sau o familie in pericol, aceasta este o criz i nu o situaie de urgen. Elemente de Crizele Cele trei elemente de baz ale unei crize - o situaie stresant, dificulti n coping, precum i calendarul de de intervenie - interaciona i de a face fiecare criz unic. Stress-Producerea Situaii

Toat lumea experienele ori, apoi se simt suprat, dezamgit, sau epuizat. Atunci cnd astfel de sentimente sunt combinate cu anumite evenimente sau situaii de via, care conduce la tensiuni de montare si de stres. Exist cinci tipuri de situaii sau evenimente care pot produce stres i, la rndul su, s contribuie la o stare de criz: Situaii de familie - un abuz de anchet copilului, abuzul, o sarcina neplanificata, un dezertare-mam, un membru al familiei cu boli cronice, i lipsa de sprijin social sunt exemple de situaii de familie care pot crea stres si crize. Situaii economice - sua brusc sau cronic financiare este responsabil pentru multe crize de familie, cum ar fi pierderea locului de munc, unui furt de bani sau bunuri de uz casnic, cheltuieli medicale de nalt, ratat plile copil de sprijin, repunerea n posesie a unei masini, utilitati taie de la serviciu, bani "pierdute" pentru a jocuri de noroc sau de dependenta de droguri, i a srciei. Situaii de comunitate - violena vecintate, locuine inadecvate, lipsa de comunitate resurse, precum i programe educaionale inadecvate ilustra unele modaliti de comunitate pot contribuie la crize de familie. Evenimente semnificative Life - cele mai multe evenimente care vedere la fel de fericit, cum ar fi o cstorie, naterea unui copil, o promovare loc de munc, sau de pensionare, poate declana o criz ntr-o familie, o nscrierea copilului la coal, comportamente ale unui adolescent, un copil crescut de a prsi casa, debutul menopauzei, sau moartea unei persoane dragi poate fi, de asemenea, evenimente foarte stresante de viata. Elemente naturale - crize sunt create de dezastre, cum ar fi inundaii, uragane, incendii, i cutremure, sau chiar pe perioade prelungite de cldur i umiditate ridicat, sau sumbru sau excesiv de rece vreme. Pagina 3 Dificulti n Confruntarea Unui individ sau a unei familii de capacitatea de a face cu o situaie de criz este influenat de fizic i caracteristicilor comportamentale i atitudinile i convingerile lor. Chiar i familii cu viaa, n general, i fericit reele de sprijin pot fi coplesiti de evenimente stresante. De exemplu, sntate precar fizic, o nivelul sczut de energie cu caracter personal, un temperament prea sensibil, i de nencrederea n folosul comunitii Furnizorii seta scena pentru dificultatea de a face fa unei crize. Familii care s-au rezolvat problema, i n trecut, vor fi rapid pentru a beneficia de intervenie de criz. Cu

ncurajare, de sprijin, i un accent asupra procesului de soluionare a problemelor, ei vor face fa n curnd rectige lor competenelor i a stabiliza. De exemplu, un caz prevzut la CPS implicat neglijarea unui copil mic. Mama copilului a fost deprimat cu privire la ameninrile fostului ei so de o lupt custodie. Senzaie de fr speran despre o btlie juridic, mama a inceput sa vina si neglijarea copilului ei. Ca urmare a interveniei de criz, mama rapid a recptat sperana, garantate consilier juridic, i a dat seama c ea ar putea "s stea pn la ameninri." n o perioad de 3 sptmni, mama a fost n mod corespunztor prinilor copilului ei din nou i de a gsi bucurie n via. Prinii cu probleme cronice de Depasirea Multe familii n sistemul de CPS nu au experien n rezolvarea problemelor bine. Mai degrab, ele par s au dificulti continu n mai multe domenii ale vieii lor. Indicatorii de identificare celor dou tipuri de familii cei n situaii de criz acut i cele n criz cronic - sunt prezentate n exponat I . Nu este sarcina de a lucrtorilor de criz (de asemenea, cunoscut sub numele de interveniente de criz) pentru a "vindeca" orice disfuncie n cadrul "Cronic de criz" familii. n schimb, este mult mai critic s se concentreze pe una la patru subliniaz specifice care au creat imediate criz. Dac o familie se poate nva s se concentreze asupra i de a gsi soluii la un numr limitat de criz productoare de probleme, apoi membrii familiei va fi nvat cum s rezolve problema, i se vor simi mai mult control asupra destinului lor. Aa cum un client a spus: "Pana cand nu ma nvat s se concentreze asupra unui singur lucru la un moment dat, am simtit ca am fost o persoana rea pentru c nu am putut rezolva totul. Acum vd c am fost doar de funcionare de la un problem la alta i nu de fixare nimic. " Persoanele cu dificulti de adaptare cronice tind s fie mereu n situaii de stres i trebuie s fac fa cu mai multe probleme majore care au loc simultan, de exemplu, omaj, incapacitatea de a plti facturile, probleme cu plngeri proprietarul, dizarmonie marital, i vecintatea cu privire la copiii lor sau apariia a antierului. 2 Orice stres noi, cum ar fi utilitatile fiind deconectat, poate fi "pictura care a concediu din spate "a acestor familii. loc de a fi care s favorizeze reciproc, membrii familiei ncearc s plaseze vina. Argumentele sau violen ntre aduli poate duce la abuzul asupra copilului sau de neglijare sau invers. Abuz de substante, domeniul gasca adolescent, sau un adolescent fugar sau gravid poate indica faptul c Familia are probleme cronice de adaptare.

Dup ce familiile invata sa a rezolva probleme, ei au o noua speranta pentru viitor, oferindu-le energie pentru a adresa unele dintre antecedentelor la criza actual. Din nou, lucrtorii trebuie s se concentreze asupra crizei restabilirea familii de stabilitate i nva cum s rezolve problemele, mai degrab dect rezolvarea problemelor pentru ei. Cnd Criza ajuta familiile lucrtorilor n rezolvarea unei crize, familiile sunt, de asemenea, a contribuit la evitarea unor crize viitoare. Multe dintre aceste familii, cu toate acestea, trebuie s fie menionate la sntate mintal sau abuz de substane pentru consilieri Rezoluia de traume emotionale din trecut, cum ar fi abuz sexual in copilarie sau de tratare a dependenelor, depresia, si alte tulburari emotionale. Perioada de intervenie Dup cum sa menionat anterior, de obicei, crizele ultimii 4 la 6 sptmni, timp n care de rezolvare a problemelor este critic. A n timp util, rspunsul terapeutic este de natur s previn o defalcare sever n relaiile de familie i de a restabili adecvate de funcionare. Acesta este n acest moment c familia este cea mai deschis de intervenie. Prin intervenia ntr-o timp util i prin asistarea familiei n depirea situaiei de factori care au condus la criza, stabilizare este probabil s apar n cteva sptmni. Iniial, lucrtorul criza poate s rmn cu familia pentru cteva ore, dac este necesar. Deoarece situaia progreseaz sau devine mai intensa, timp n care lucrtorul criz cu familia este ajustat pentru a se potrivi situaiei. Deoarece reziliere este abordat, mai putine ore ar trebui s fie necesar. Pe parcursul procesului, criza lucrtorul ar trebui s fie disponibile n orice moment. Fazele de criz Atunci cnd indivizi sau familii se confrunt cu anumite niveluri de stres sau de combinaii de stres, crize apar. Aceste crizele sunt susceptibile de a avea o secven, sau o serie de faze, dup cum este descris mai jos. Dei prezentat ca apte faze distincte, fazele de criz se pot suprapune sau se ntreptrund. Page 4 Urmtoarea configuraie de faze crizei este adaptat i extins de la cele patru faze de centralizare Rezervai gsite n criz de intervenie 2: Sourcebook Practitioner pentru Terapie Scurt. 3 Faza I: Eveniment de precipitare - o neobinuit precipitare, neanticipate, stres, sau traumatice evenimentul are loc, provocnd o cretere iniial n anxietate. Individual i de familie s rspund cu familiar mecanismelor de soluionare a problemelor.

- Eveniment precipitant poate fi un raport de abuz sexual asupra copiilor sau a unei investigaii de ctre autoritile din legate de medicament activiti ntr-o familie. Un alt exemplu este un printe care i pierde un loc de munc. Senzaie de rnit i vulnerabile, mam poate deplasa lui sau a ei furie prin lezarea fizic un copil. La rndul su, nu exist un nou eveniment precipitant, un abuz de anchet copil cu potenialul su de a crea o familie criz. Faza II: Percepia - individuale sau de familie percepe evenimentul sau acuzaia ca semnificative i ca o ameninare la adresa obiectivelor individuale sau de familie, de securitate, sau legturile de afeciune. De exemplu, o familie poate percepe o plngere de abuz sau neglijare ca o ameninare la integritatea familiei i interpersonale de securitate (de exemplu, atunci cnd exist posibilitatea de a elimina un tat care a fost acuzat de sexual abuzeze adolescent su sau posibilitatea de a elimina un adolescent care sa comportat ntr-o manier beligerante). Faza III: Rspuns dezorganizat - sentimente nefamiliare de vulnerabilitate i neputin escalada ca comportamente, abiliti, sau resursele utilizate n trecut pentru a rezolva problemele eua. Familiei se ridic anxietate, i membrii s caute o soluie imediat i original la stres psihologic. - La rndul su, rspunsul familiei la criza de stres devine din ce n ce dezorganizate. Etapa IV: caut resurse noi i neobinuite - n ncercarea lor de a reduce tensiunea i rezolva durerea emotionala, membrii familiei ncep s implice i alte persoane. Deoarece fiecare familie membru are o perceptie diferita de ameninri i de care ar putea fi capabil de a ajuta, el sau ea poate cuta de validare pentru lui sau ei punctul de vedere att n interiorul ct i n afara familiei. Vecini, rude, si prietenii va oferi att asisten direct (locuinte, transport, alimente, bani, etc), i consultan ("suna la politie", "s fie mult mai supui i soul tu / tat se vor calma," "Concediu agresor", etc). Familia are nevoie de o lips de prejudeci, bine instruit lucrtor criz n timpul acestei faz, mai degrab dect consilieri contradictorii. - n timp ce familia se simte neajutorat, de intervenie de criz pot fi destul de eficient, deoarece familia este deschis pentru a ajuta la faptul c le ofer o oarecare protecie, de securitate, sau de sprijin. Compasiune, amestecat cu n mod corespunztor limitele firm, poate da un sentiment de familie sau de securitate protectedness. Acest lucru necesit lucrtorul criz pentru a asculta n mod activ la ceea ce spune c familia trebuie s devin stabil.

Faza V: O serie sau lant de evenimente - cele mai crize a pornit un lan de evenimente care pot crea nc o alt criz de familie. De exemplu, o criz poate ncepe cu un printe confrunta cu o induse de droguri schimbare de personalitate, devenind violent n familie, precum i cheltuielile privind chiria droguri. Dac crizelor de intervenie servicii nu sunt furnizate, evacuarea din locuine pot surveni, setarea off o alt criz. Faza VI: crizelor anterioare Devino legat de actuala criz - crize tind s stimuleze amintiri de evenimente traumatice trecute sau criz de pierdere a controlului. De exemplu, o mam care a Page 5 suprimat victimizare ei sexual de ctre tatl ei pot deveni extrem de contient de ea atunci cnd ei Prietenul n stare de ebrietate face avansuri sexuale fata de fiica ei. De asemenea, atunci cnd un copil este abuzat fizic de catre un parinte, celalalt parinte poate avea flashback-uri cu privire la btile n su sau ei copilrie. Faza VII: Mobilizarea de noi resurse, adaptare - aceast faz reprezint un punct de cotitur, atunci cnd tensiunea i lupta evolua n mobilizarea de resurse noi sau modaliti de adaptare. Acest poate aparea atunci cand o familie cu o istorie de abuz de substane particip la Alcoolicii Anonimi i AlReuniuni Anon, solicit locuine diferite sau de formare de locuri de munc, sau decide s asculte atunci cnd ai familiei Membrii vorbesc. - Deoarece nu exist posibilitatea ca o criz nerezolvate pot conduce la comportamente maladaptiv n continuare, cum ar fi combaterea vicios mai mult sau o dependen mai mare privind abuzul de substane, este treaba de criz lucrtorilor pentru a ajuta familiile caute i s pun n aplicare acceptabil de rezolvare a crizei strategii. Sentimente clienti pe timp de criza Howard i Libbie Parad descrie rspunsurile anxietate de oameni n criz, inclusiv ca "... supr n mncare, somn, vise, dragoste, senzaie, gndire, i de a face. "Ei cred c urmtorul text nou reacii emoionale de oameni n criz, astfel cum a descoperit de ctre Centrul pentru Problemele Benjamin Rush de Condiii de via, poate ajuta pe profesionitii s neleag mai bine i s lucreze cu crize: Nedumerire: sentimente noi i neobinuite. Pericol: Sentimente de tensiune, fric, i iminent sfarsit al lumii. Confuzie: Mintea este ncurcat i nu funcioneaz bine.

Impas: blocat Senzaie; fabric nimic. Disperare: Necesitatea de a face ceva, dar ce? Apatia: De ce s ncercai? Neajutorare: Aveti nevoie de cineva care s m ajute. Urgen: Aveti nevoie de ajutor acum. Disconfort: Senzaie de mizerabil, nedecontate agitat,. 4 Efectele psihologice ale crizei Dei diferenele n abilitile de coping, de stres productoare de situaii, precum i calendarul de intervenie face fiecare Criza unic, persoanele n situaii de criz experien unele frecvente efecte psihologice care afecteaz evaluarea i tratament. Formarea unei relaii de lucru cu prinii, atunci cnd rspunde la o criz cauzat de Page 6 rele tratamente aplicate copilului sau atunci cnd se ocup cu prinii n orice alt situaie de criz de cretere a copiilor, necesit anticipare a acestor efecte. n general, evenimentele criza produce probleme n ase domenii largi cum este descris mai jos. Astfel de probleme sunt temporare, cu toate acestea, nu i indicatori de boli psihice. O criz este tranzitorie, astfel cum sunt temporar Rspunsurile din partea membrilor familiei. Oricine poate avea o criz. Prin urmare, fiind n criz, nu este sinonim cu a fi bolnav psihic. Dezorganizat de gndire Oamenii din criz experien o dezorganizare n procesul de gndire lor. Ele pot trece cu vederea sau ignora detalii importante i distincii care au loc n mediul lor i pot avea probleme legate de idei, evenimente, i aciuni pentru a reciproc n mod logic. Acestea pot sari de la o idee la alta, n conversaie, astfel nct comunicarea este confuz si greu de urmarit. Ele nu pot observa sau poate avea Am uitat exact ceea ce sa ntmplat, sau cine ce a fcut cine. Detalii importante pot fi trecute cu vederea n evenimente de interpretare, cum ar fi un client care ofer informaii detaliate despre un incendiu casa, dar, n lipsa s spun c fratele ei a avut trei tarifele anterioare de incendiere. Temerile i dorinele pot fi confundate cu realitatea, manifest un sentiment general de confuzie. Unii oameni n situaii de criz dezvolta o cale minile, repetarea aceleai cuvinte, idei i comportamente care "a lucrat" in trecut, dar sunt inadecvate n curent situaie. Aceste persoane pot prea n imposibilitatea de a trece la idei noi, aciuni, sau comportament necesare pentru a

rezolva criza actual. Preocupare cu activiti nesemnificativ ntr-o ncercare de a combate procesele de gndire dezorganizat i anxietate, oamenii n criz, tind s devin foarte implicate n activiti nesemnificative sau neimportante, cum ar fi ngrijortor faptul c cineva va fi copleit cu aerul viciat prin pstrarea-o fereastr deschis. La vrf de criz, atunci, aceste persoane pot avea nevoie considerabil ajutor n concentrndu-se pe activitati importante, cum ar fi punerea n aplicare a paii pentru rezolvarea productiv criz. Exprimarea de ostilitate i distantarea emotionala Unii oameni n situaii de criz sunt att de suprat peste pierderea lor de control pe care acestea devin ostili fa de orice persoan care intervine n situaia. Ei resimt nevoia lor de ajutor, senzaie att suprat i vulnerabile. Alte crizelor oameni mers reacioneaz cu distanare emoional extrem i pasivitate, prnd a nu fi emotional implicate n situaia n cauz sau cu rezultatul acesteia. Pentru muncitorii de criz, problema nu este cum s dea directive, dar pentru a sublinia opiunile de manipulare a crizei i pentru a consolida punctele forte. Caracter impulsiv n timp ce unii oameni sunt imobilizai n situaii de criz, alii sunt destul de impulsiv, luarea de msuri imediate n rspuns la criza fr a ine seama de consecinele aciunii lor. Eecul lor de a evalua de adecvare a rspunsurilor lor, pot provoca crize n continuare, fcnd astfel o situaie deja complex chiar mai greu de rezolvat. Dependen Dependena de lucrtorul criza ntr-un moment de criz este un rspuns natural i poate fi necesar nainte de individuale pot relua independena. n cazurile de abuz i neglijare a copiilor, de protecie a copiilor poate solicita lucrtorului criz s fac pentru prini ceea ce majoritatea parintilor alte fac pentru ei nii. De exemplu, lucrtorul criza ar putea avea nevoie pentru a apela unui creditor sau a societii de utilitate sau ajut prinii n structurarea de baz de ngrijire a copilului. In timpul unei crize, percepia de putere a lucrtorului criza de autoritate sau pot avea un impact stabilizator pe un familie. O familie n criz este probabil s primeasc un obiectiv, abil, i autoritatea de tipul celor care tie cum s "te lucrurile "Oferte de ajutor din partea unui lucrtor n cauz, criza competente. par s se rspund la toate familiei dificulti.

Dup o scurt perioad de dependen, majoritatea familiilor sunt capabili s-i reia funcionarea independent. Pentru unele familiilor aflate n criz, cu toate acestea, dependenta poate persista. Trebuie s aib altcineva responsabil cu mrci aceste familii deosebit de sensibile la influena de la alii, fcndu-le mai vulnerabile. n lor nevoia de a gsi soluii, acestea nu pot fi n msur s discrimineze ntre ceea ce este benefic pentru ei i ce ar putea fi duntoare sau, n absena unui lucrtor criz competente, crora le ar trebui s asculte. 5 Ameninare la adresa identitii Identitatea este att o condiie interioar i un proces interacional. Atunci cnd un eveniment, cum ar fi un abuz asupra copilului Raportul, amenin un auto-concept i legturi de familie, are loc o criz. Deoarece de obicei coping metode eueaz, sentimentul de identitate personal este afectata, cauzand dezechilibru. 6 Unul dintre sentimentele anterioare de competen i de valoare poate parea complet pierdut. Page 7 Pentru a contracara o cobort auto-percepiei, un printe n criz i poate asuma o fatada de adecvare sau arogan, susinnd c nu este nevoie de ajutor. Sau, mam poate retrage din ofertele de ajutor. n ambele cazuri, este important s ne amintim c societatea-mam n criz este, probabil, foarte speriat, mai degrab dect "rezistent" sau "Nemotivat." Lucrtor Criza are posibilitatea de a stabili raportul de forte recunoscnd faptul c ajuta la restabilirea unui sentiment de buntate sau de valoare individuale. Lucrtor Criza nu poate accepta abuzul unui copil, dar nu recunosc punctele forte ale lui mam i familia lui. Rezumat n timpul o stare de criz, persoanelor i familiilor sunt de obicei destul de receptivi la intervenie. Anxietate produs de criza, impreuna cu realizarea ca strategiile din trecut i a face fata problemelor de rezolvare nu sunt de lucru, pinteni motivaia de a nva strategii noi. Dac nu este disponibil ajutor n aceast perioad critic de deschiderea spre schimbare, individual i de familie pot deveni total imobilizat sau s recurg la distructive sau comportamente maladaptiv. Prin urmare, este esenial ca CPS caseworkers identifica rapid situaiile de criz. n identificarea o situaie de criz, este important s se ia n considerare elementele sale contribuind: Ce situaii specifice

sau evenimente creeaz cele mai stres pentru individ i familia? Ce dificulti n a face fa sunt evident? n ce moment n timp este de intervenie au loc? Faza a crizei trebuie s fie, de asemenea, luate n considerare. Sentimente i comportamente care apar pe suprafaa bizare, pot fi, de fapt, caracteristic fazei de criz. Interpretare corect a fazei de criz este eseniale pentru intervenie corespunztoare. De exemplu, clienii ale cror crize sunt cronice sau mai multe pot solicita trimiteri la follow-up medicii care se pot adresa n continuare probleme care stau la baza. n cele din urm, este important s fie contieni de sentimentele oamenilor experien de obicei, n timpul strii de criz. O criz poate avea un impact devastator asupra simurilor cuiva i funcionarea psihologic. Cu toate acestea, acest impact este adesea de scurt durat atunci cnd este interpretat i tratate corect. Gol de intervenie de criz i pa www.buentrato.cl/pdf/est_inv/interv/ic_gentry.pdf Recenzie a unei cri Asoka Bandarage, femei, populaie i de criz global. Londra i New Jersey: Crile Zed, 1997. Aceasta este o bine scris, carte grijuliu, bine documentat i n timp util, care reunete numeroase informaii documentare a conexiunilor dintre globalizare economic, cretere economic i opresiunea reproductive a femeilor, dezastrul ecologic, declin la nivel mondial n nivelul de trai al oamenilor muncii, i utilizri ale ideologiilor malthusian i neo-malthusiene pentru a masca rdcinile capitaliste ale crizei. Este, totui, o carte contradictorie, una care, la mod, activiti din clasa de mijloc din SUA i din alte pri sunt susceptibile de a binevenite, pentru c surprinde lor principalele preocupri preuit cu auto-schimbare i spiritualitate bazat pe o sintez ntre surse intelectuale i religioase indigene i nonWestern . Stnga activiti i oameni de tiin marxist sociale, pe de alt parte, cel mai probabil vor gsi util descriptiv, dar teoretic problematic i politic frustrant. Punctele forte ale cartii sunt documentaia complet a crizei globale adncirea n aspectele multiple i efectele sale devastatoare sociale i ecologice (n special pe femei i copii), precum i dezvoltarea unei perspective feminista cu privire la natura libertii utile de reproducere pentru a contracara opiniile actuale, care subsuma drepturilor femeii n conformitate cu obiectivele de control al populaiei. Deficiene carte stem din natura idealist a analiza i soluia autorul propune. Autorul, de la bun nceput, c lumea are nevoie de o "schimbare de paradigma", adic un proces de transformare psiho-social de conducere de la nivelul actual "paradigma dominator", caracterizat prin violen, ecocrisis i inegalitatea, la "paradigma de parteneriat," caracterizate prin ecologie, pace i justiie (p. 3). n timp ce pacea, dreptatea i supravieuirea ecologice sunt goluri toat

lumea n stnga - indiferent de diferenele n angajamente politice i teoretic - ar sprijini, dezacordurile cu privire la modalitile de a le atinge sunt inevitabile i este n aceast privin, c aceast carte este probabil s se gseasc un mixt recepie. Prima parte este dedicat o expunere critic a teoriei lui Malthus "i analizele actuale malthusian i neo-malthusian a cauzelor demografic al srciei, degradarea mediului, instabilitatea politic i statutul femeilor, precum i o examinare aprofundat a bazelor politice de control al populaiei politici. Bandarage demoleaz argumentele lui Malthus care se bazeaz pe suprapopulrii pentru a explica problemele de orice i de toate social - dac la nivel local, naional sau global de analize - i postulat de control al populatiei, aa-numita "revoluie contraceptive," ca singura lor eficient i "tiinific" soluie. Analiza ei a neo-malthusiene sprijin pentru alegerile reproductiv a femeilor descopera nucleu sale coercitive; i anume de reducere a drepturilor femeii la drepturile de reproducere subsumate obiectivelor politicilor de control al populaiei concepute pentru a reduce fertilitatea celor sraci. Critica ei a ideologiei lui Malthus, care plaseaz controlul populatiei ca singura cale eficient la justiie social i dezvoltarea economic este fundamentul pentru critica de natura opresive de control al fertilitii n absena concomitente schimbrilor economice, politice i sociale care s conduc la femeile care nu mputernicirea numai ca ageni de reproducere, dar ca ageni politice i economice pe cont propriu. Analiza ei se aprinde implicaiile conservatoare de politici care s ia n considerare de planificare a familiei o condiie suficient pentru mbuntirea statutului femeilor i descoper de convergen ntre feministele liberale i susintorii de dreapta de control al populatiei fcut posibil de recurs a campaniilor concepute pentru a extinde femeilor "drepturile de reproducere "n izolare de la i ca un substitut pentru schimbare calitativ economice i politice. Discutarea ei a diferitelor metode de control al fertilitii mpins de ctre privat al statului, precum i ageniile internaionale sub pretextul de a extinde opiunile femeilor reproductiv i drepturile evideniaz msura n care femeile, n special femeile din Lumea a Treia, au fost supuse la abuzuri sterilizare, experimentare, anti- fertilitii "vaccinuri", i o varietate de metode destinate pur i simplu pentru a reduce fertilitatea lor sau de a produce sterilizare permanenta, fr mbuntiri substaniale n viaa lor. n aceste condiii, de planificare a familiei devine un mijloc de opresiune, pentru c priveaz sraci din poart copiii care ar putea grija de ei la btrnee i a cror munc ar putea crete nivelul de trai al familiilor lor. Pentru a accentul anistoric Malthus asupra populaiei (de exemplu, rata de cretere, dimensiunea, densitatea, structura, distribuia, etc), ca variabil independent, n orice explicaii i toate problemele sociale, economice i politice, Bandarage se opune, n partea a doua de carte, o analiz politico-economice care s ia n opinia sa, punctul de plecare lui Marx despre necesitatea de a examina populaiei istoric, deoarece fiecare modul de producie are legile ei a populaiei. n consecin, susine ea, problemele de astzi, trebuie s fie neleas ca efectele inegale dezvoltrii capitaliste globale, nu ca un rezultat al "legilor naturale a populaiei." Dezvoltarea implicaiile demografic al discuiei lui Marx cu privire la efectele acumulrii de capital, la cererea de for de munc ca rezultat producerea inevitabil de o armat de rezerv a forei de munc (Marx, 1974: 612-648), ani n urm am construit un cadru

teoretic marxist pentru analiza efectele acumulrii de capital i contradiciile capitaliste privind schimbri n structurile populaiei i a proceselor (Gimenez, 1977). A fost, prin urmare, foarte interesant pentru mine s vd de cercetare amnunit Bandarage, care mai multe documente ale relaiilor dintre capitalism i populaia postulat n care funcioneaz. Studii de Demografie i a populaiei sunt relativ nedezvoltate n scrierile marxist i neomarxiste, acesta este motivul pentru carte Bandarage este o contribuie binevenit n acest domeniu important al activitii teoretice i politice. Ei capitole referitoare la economia politic a srciei, mediul nconjurtor, violena i cu privire la factorii sociali structurale de la locul fertilitii acestor fenomene ferm n contextul relaiilor capitaliste de exploatare i maximizarea profitului. Dar, Bandarage subliniaz, capitalismul nu este singurul factor determinant al acestor fenomene: avertisment mpotriva "fundamentalismului marxist" i "reductionisms de clas", insist asupra Bandarage ar trebui s se uite la alte cauze de problemele lumii actuale, cum ar fi patriarhat sau dominaia de sex masculin, lcomie i sete pentru putere, rasism, imperialism, i motenirea tradiiilor occidentale filosofice i intelectuale caracterizate prin gndire liniar, fragmentat i undialectical, individualismul i o etic competitiv. n ciuda afirmaiilor sale despre importana istoricitii i economie politic i de respingere a malthusianism anistorice, teoretic, analiza Bandarage lui nu se bazeaz pe economie politic, ci pe fundatii anistorice i idealist. Economia politic devine o surs de a interveni variabilele socio-economice i politice (de exemplu, acumularea capitaliste, imperialismul, globalizarea, puterea transnaionale corporate, etc); greutatea explicativ al analizei se muta la factorii ideologici, psihologici i n cele din urm anistoric, cum ar fi de sex masculin inerente lcomia i dorina de dominaie asupra femeilor, natura i ali brbai. Prin urmare, ea a propune soluii n ultimul capitol, n care ea pune mai departe ideea c noi suntem n prezent funcioneaz ntr-un "paradigm dominator", caracterizat prin ignoran, ur, lcomie, antropocentrism, patriarhat, capitalismul, srcia, distrugerea mediului nconjurtor, etc loc , susine ea, ar trebui s fie angajai ntr-un proces de transformare psiho-sociale, individuale de auto-schimbare (pentru noi nu se poate schimba altii, p. 317) n vederea instituirii n cele din urm o "paradigm de parteneriat." Aceast paradigm este caracterizat ca o sintez de o varietate de tradiii intelectuale i spirituale, cum ar fi budismul, nativ american i alte nvturi indigene, ecologia profund, teoria cuantelor, ecofeminism, justiiei sociale, biologia evolutionista, bioregionalismul, i aa mai departe (p. 316) . Care stau la baza acestor paradigme antitetic este distincia ntre eco-feminista "feminin" (de exemplu, hranirea, ingrijirea, panice) i "masculin" (de exemplu, agresiv, predispus de rzboi, dominant) principii. Acest tip de brbai fa de femei i de natura problematic exonereaza n cele din urm claselor dominante i minimizeaz importana diviziunilor de clas n rndul populaiei masculine i feminine. "Parteneriat" paradigma este o negaie abstract sau undialectical a efectelor psihologice, culturale, sociale, economice, politice i intelectuale ale capitalismului. Rezult, la nivel individual de analiz, ntr-o etic a selftransformation care reflect preocuprile multora dintre aa-numitele "noi micri sociale" n rile capitaliste avansate i este probabil s fie foarte atrgtoare pentru mediu i superior de mijloc -clasa, activiti unic problem care, n timp ce implicat n luptele localizate n jurul valorii de feministe, ecologice,

drepturile de mediu, animale, pdurile tropicale, ecoturism i alte probleme, ntr-adevr, au nceput s-i exprime justificarea lor pentru aceste lupte n cadrele sau "discursuri", care combin n diverse elemente moduri preluate din tradiiile nativ americane si nonoccidentale religioase i filozofice. La nivel macro de analiz, alternativa este o dialectica idealist care transcende dualismele inerente n opinia lumea capitalist i forma de organizare socio-economice i politice de ctre postuleaz "conectare inerente" ntre subiect / obiect, om / non-umane, Nord / Sud, de capital / munc, natura / cultura, etc (p. 317). Dintr-un punct de vedere marxist, care stau la baza aceste conexiuni exist relaii materiale (de exemplu, nu relaiile pur intersubiective, dar relaiile mediat de relaia oamenilor de a mijloacelor de producie) de dominaie i exploatare, care nu pot fi depasite doar prin procese de schimbare individuale. Analiza Bandarage se bazeaz pe individualismul metodologic, pentru c presupune c schimbrile calitative structurale ar fi rezultatul final al schimbrilor n contiina persoanelor fizice i comportament, de la conducere un stil egocentric, consum, orientat de via spre simplitate, consumul comun de bunuri de folosin ndelungat, precum i gradul de contientizare a unitate cu ceilali i pmntul. Astfel de schimbri ".. ar elimina o mare parte din presiunile ecologice i sociale care sunt atribuite, n general la creterea populaiei de ctre malthusieni" (p. 330). Dar, n absena unor schimbri structurale n modul de producie, niveluri mai mici de drastic consumul n rndul pturilor mijlocii iluminat poate face abia o adncitur n starea de sntate a sistemului capitalist, ci, cei care mbriau "simplitate voluntar", "spiritualitate", "cohousing", "reciclare", forme alternative de constructii de case si asa mai departe au devenit o piata profitabila pentru cri, bun i serviciilor produse prin intermediul relaiilor capitaliste contribuind n acelai timp s consolideze convingerile lor n posibilitatea de schimbare prin transformarea individuale; la urma urmei, ei se confrunt cu ei nii n comunitile lor alternative. Exist o contradicie ntre o analiz c, n ciuda limitri, subliniaz rolul istoric a modurilor de producie i a capitalismului, n special, n determinarea srciei, oprimarea femeilor, deteriorarea mediului i violen i o concluzie care, lsnd deoparte aceste condiii materiale, susine c ceea ce are nevoie lumea este
"... n primul rnd o schimbare a inimii umane; din ignoranta ... lacomia ... i ur ... ... spre nelepciune, generozitate ... i compasiune. Este doar cu nelepciune i puternic angajament pe el parte de mai multe persoane i mai mult la baz Valorile de compasiune i generozitate c exploatarea i dominaie a ordinii lumii prezente pot fi traversate i ecocentric, alternative feministe, multiculturale i socialiste pot fi create. Solutii pentru criza global, inclusiv problema populaiei, trebuie s fie plasat ntr-un asemenea profund transformare in constiinta noastra si relatiile - o psiho-social revoluia "(p. 320).

Dar schimbarile in constiinta si relatiile presupun modificri n condiiile materiale, exist o legtur ntre sociale i revoluii psihologice care trebuie s fie explorat. Un astfel de studiu ar fi cel mai probabil aduce, ca un obiect de examinare critic, "afinitate electiv", pentru a mprumuta expresia lui Max Weber, ntre valorile care caracterizeaz "paradigma parteneriat", precum i condiiile materiale n care aderenilor lor n rile

capitaliste dezvoltate , n general, colegiu educai i relativ bogate, vii. De asemenea, sunt sceptic de analize care reproduc distincia ntre femei la fel de bun, moral, spiritual, sacru, Zeita, depozitar de virtute, i brbailor n rzboinici, lacom, violent, dominant, patriarhii care au femei oprimate i natur pe parcursul istorie. Barbatii, ca si femeile, sunt creaturi sociale, iar noi le facem un deserviciu att de reifying i imputarea puterea explicativ la efectele socio-psihologice ale inegalitii de gen secole i diviziunea muncii. Lumea va fi un loc mai bun n cazul n care condiiile materiale care au dus la trsturile lor curente sunt modificate, din punct de vedere teoretic marxist, procesele de auto-transformare individuale nu sunt suficiente. Va o nou cultur a asigura supravieuirea planetare dezvolta prin "ncorporare a dimensiunii sacre ale femininului prin dezvoltarea de noi arhetipuri i mituri culturale" (p. 340), sau prin eforturi pentru a schimba organizarea produciei i articulare ntre producie i reproducere, astfel nct ntreaga comunitate i asum responsabilitatea pentru tineri, persoanele n vrst i cei slabi? Aceasta i alte ntrebri similare, mi vin n minte atunci cnd citesc ultimul capitol din aceast carte i acesta este motivul pentru aceasta este, n cele din urm, un lucru contradictoriu dar fascinant. Cei care predau cursuri n studii populatiei va gsi primele apte capitole extrem de utile pentru ele conin o evaluare critic bine informat de malthusianism, n toate aspectele sale. Ele ar putea, totui, i n funcie de orientarea lor teoretic, gsi ultimul capitol interesant, dar n cele din urm dezamgitor. Alii s-ar putea gsi n ultimul capitol, cu declaraiile sale prescriptive despre modificrile pe care trebuie s se fac la toate nivelurile de organizare social i, mai presus de toate, n viaa personal, situaia cea mai buna si cea mai cuprinztoare despre ceea ce New Age, i circulaie spiritualitate este despre toate. Poate c ceea ce avem nevoie, ca noul mileniu ncepe, este o viziune a ceea ce viitorul ar putea fi ca i tipurile de moduri de a fi care ar fi necesar s se depun eforturi pentru dac vrem s construim o form uman de organizare social: cunoaterea schimbrile structurale necesare nu este suficient. Cri ca aceasta ar putea ajuta la stabilirea unui dialog productiv n rndul persoanelor care mprtesc obiective similare n ciuda diferenelor lor teoretice i politice i acesta este motivul pentru care, n ciuda criticilor mele anterioare, l-am bun venit ca o completare important a literaturii progresiste privind populaia i ca o surs de foarte important crezut perspective provocatoare. Referinte Gimenez, Martha E. 1977. "Populaia i capitalism." America Latin Perspective, Vol.. IV, nr 4 (toamna): 5-40. Marx, Karl. 1974. De capital, Vol.I. New York: Publishers International. www.colorado.edu/Sociology/gimenez/work/asoka.html http://www.colorado.edu/Sociology/gimenez/work/asoka.html

Urgente psihice: Grija pentru oameni n situaii de criz


PRET CURS: 24.00 dolari

ORE DE CONTACT: 3 Wild Iris Educaie Medical (CBRN Provider # 12300), este aprobat ca un furnizor de educaie continu pentru RNS, LVNs, si terapeutii respiratorii de ctre Consiliul de Nursing din California inregistrat. Wild Iris Educaie Medical, Inc este acreditat ca furnizor de educaie medical continu de Asistentilor Medicali american Credentialing Center Comisiei cu privire la acreditare. Planificatorii i autorii acestei activiti CE au divulgat fara relatii financiare relevante cu orice societilor comerciale referitoare la aceast activitate.

Acest curs de imprimare Luai de testare Spune-i unui prieten Bookmark / Adauga la Favorite Vezi de acreditare noastre Uita-te pentru Alte cursuri Obinei Instruciuni, Ajutor Ajutor pentru imprimare

Prin Persis Mary Hamilton, RN, CNS, MS, Edd Copyright 2007 Wild Iris Educaie Medical, Inc Toate drepturile rezervate.

Obiectivelor de nvare
La finalizarea acestui curs, v va fi capabil s:

Discutai despre caracteristicile crizelor n care acestea se aplic la situaii de urgen de psihiatrie. Explicai consideraii triaj pentru persoanele n situaie de criz. Identifice problemele juridice i etice de interes pentru ingrijitorii de oameni n criz. Rezumai ngrijirea persoanelor n situaii de criz cu starea de spirit legate de situaii de urgen. Explicai relaia de anxietate sa se teama n anxietate-forjat crize. Revizuirea de gestionare a furiei generate de violen. Descrie simptomele afiate de ctre oameni n situaii de criz cu tulburri consumul de substane. Discutai de intervenie de criz pentru bolnavi mental sever.

T cursul su discut situaii de urgen de psihiatrie din punctul de vedere al interveniei de criz. Acesta descrie evaluarea, diagnosticarea, planificarea, de intervenie, precum i evaluarea de ctre medicii de oameni n criz cu starea de spirit, anxietate, tulburri de furie, consumul de substane, i mental.

URGENE psihiatric, dup cum EVENIMENTE CRIZEI


Un caz de urgen de psihiatrie este un grup de condiiile n care capacitatea individului de a face fa este coplesita de detres respiratorie acut mentale i emoionale care rezult din factorii de stres situaionale i de maturizare. Clinicienii cel mai adesea se confrunt persoanele n situaie de criz n departamentele de urgen i pe linii de asisten telefonic de criz. Aceste persoane se confrunt cu tulburri severe de starea de spirit, gndire i comportament i necesit ngrijire imediat. De interes special sunt oameni n situaii de criz care sufer de tulburri de dispoziie, anxietate, furie, consumul de substane, i de boli mintale.

Caracteristicile de Crizele
Crizele sunt experimentate de oameni de toate varstele, culturile, precum i condiiile socio-economice, i nu poate fi legat de o tulburare mintal specific. Crizele incep cu un eveniment de precipitare i s intensifice n sentimente de fric i dezechilibru emoional. Deoarece oamenii in criza sunt att de inconfortabil, ei caut s rezolve problema ct mai curnd posibil, de obicei n mai puin de ase sptmni. In tot acest timp au devenit tot mai sensibil la influena altora i a nelege la aproape orice soluie, indiferent dac este sau nu remedia diminueaza necazurile lor sau mbuntete calitatea vieii lor (Aguilera, 1998).

SURSE
Dei crizele apar din mai multe surse diferite, cele mai multe persoanele care ii ingrijesc sunt de acord, exist cel puin dou cauze majore ale crizelor: maturizare i situaia. Crizele maturizare au de a face cu previzibile tranziiile experiena poporului, care trece de la o etap de dezvoltare uman la alta. Erik Erickson a identificat aceste etape n ceea ce privete sarcinile de dezvoltare ale copilariei, copilaria timpurie, precolari, de vrst colar, aduli adolesceni, tineri, aduli maturi, i la maturitate tarziu (1963). De exemplu, un copil este n curs de dezvoltare autonomie i stima de sine i poate avea un acces de furie temperament atunci cnd el nu obtine ceea ce vrea. Un adolescent este de nvare de identitate i intimitate i pot s prezinte un comportament sexual inadecvat fa de cineva de acelasi sex sau opus. Crizele situaionale sunt evenimente sau circumstane care amenin integritatea unei persoane fizice, sociale, psihologice i. Acestea pot proveni din corpul fizic, ca urmare a bolii, a prejudiciului, consumul de substane, sau stres emoional. Uneori, crizele

maturizare i situaionale s apar, n acelai timp i, ocazional, declaneaz o criz altul, compoziia problema. Un adolescent si fata sunt atrai unul de altul i s experimenteze cu intimitatea sexual. Atunci cnd perioada de fata lui menstrual are intarziere, ambele adolesceni sunt fora ntr-o stare de dezechilibru emoional, deoarece experiena att criza de dezvoltare a adolescenei i criza situaional de o potentiala sarcina. Aciunile pe care le ia pentru a rezolva criza le poate fora de traciune n nc o alt criz.

ETAPE
n 1965, Caplan observat c crizele se dezvolta in patru etape previzibile, dup cum urmeaz:

Iniial ameninare. Oamenii sunt confrunt cu o problem sau conflict. ntr-un efort de a reduce anxietatea lor, pe care le folosesc diferite mecanisme de aprare, cum ar fi compensarea (folosind efort suplimentar), raionalizare (raionamentul), i negare. n cazul n care problema este rezolvat, ameninarea dispare, i nu exist nici o criz. Continuarea ameninare devine o criz. Dac problema persist, oameni n situaii de criz devin din ce n ce nnebunit de durere i anxietatea lor creste la un nivel serios. In situatii de criza acum, acestea devin dezorganizate i au dificulti de gndire, de somn, i funcionarea. Ei initia proces-i-eroare eforturile pentru a rezolva problema i a restabili echilibrul emoional. Criz intensifica n panic. Atunci cnd proces-i-eroare de ncercri nu reuesc, anxietatea lor intensifica la niveluri severe i panic i persoana este imobilizat cu frica. Unii oameni n situaii de criz redefini problema, aceasta atac dintr-un unghi nou, i ncercai din nou s gseasc o soluie. Dezorganizare grave i asalt Dac problema nu este rezolvat i abiliti noi coping sunt ineficiente, anxietate poate coplei persoan i s conduc la dezorganizare grave, depresie, confuzie, violena mpotriva altora, sau comportament suicidar.. (Varcarolis et al., 2006)

FACTORI DE EGALIZARE
n activitatea sa seminale despre criza, Aquilera (1998) a remarcat faptul c echilibrul de oameni n criz este afectat n mod semnificativ de factori de echilibrare trei: percepia lor a unui eveniment, sistem de sprijin, i de mecanisme de coping.

Percepie a unui eveniment se refer la importana unei probleme de ctre persoana n criz i include lucruri cum ar fi sntatea, cariera, starea financiara, si reputatia. Sistem de sprijin se refer la resursele deinute de ctre persoana n criz, cum ar fi oamenii au ncredere care pot acorda sprijin i asisten ntr-o perioad de nevoie.

Mecanisme de coping sunt abilitati sau metode de oameni folosesc pentru a reduce anxietatea i de a rezolva probleme, cum ar fi raionamentul, meditatie, exercitii fizice, somn, i negare. (Aguilera, 1998)

SCENARIUL Petru, un adolescent, nu pentru a face echipa de fotbal. Lumea lui pare s se nruie ca el ncearc s fac fa att o criz maturizare i situaionale. Pentru a face se simt mai bine, Petru ia de automobile de familie, conduce la casa unui prieten, buturi alcoolice, i devine n stare de ebrietate. Pe drum spre cas, el accidente auto si sufera un prejudiciu grav. Comentariu Percepia lui Petru a evenimentului (care face echipa de fotbal) a fost cel mai important lucru n viaa lui. El a fost devastat atunci cnd el nu a primit pe echipa. n loc de asteptare pe un sistem de sprijin (familie sau prieteni, care ar putea impulsiona sentimentul de valoare), el a ncercat s se auto-medicate prin obtinerea stare de ebrietate. Acum, el se simte chiar mai ru despre el nsui. El ar fi putut alege mecanisme mai eficiente de adaptare cum ar fi raionamentul sau exercitarea. Familia i prietenii lui s-ar putea fi sugerat el iei pentru un sport diferite n care el ar putea excela.

REZOLUIE
Atunci cnd o criz este rezolvat i echilibru emoional restaurat, persoanele se confrunt din nou problemele de zi cu zi ale vieii. n mod ideal, ca urmare a unei crize, ei invata noi abilitati de adaptare, castiga o mai mare ncredere n sine, a mri sistemul lor de sprijin, i a ridica nivelul lor de funcionare. Scopul interveniei de criz este de a restabili nivelul de pre-criz de funcionare i, atunci cnd este posibil, se ridica la un nivel mai ridicat dect nainte de criz. O parte important a tuturor interveniilor de criz, indiferent dac au loc pe o linii de asisten telefonic sau ntr-o sesiune de consiliere, orientare este anticipate, prin care clienii s nvee cum s evite repetarea unui eveniment de criz.

Triajul Consideraii
Atunci cnd persoanele care sunt in primejdie apel unei linii telefonice sau mergei la un serviciu de urgen (ED), persoanele care ii ingrijesc a evalua persoana i problema, identifica eveniment precipitant, ia n considerare factorii care influeneaz, plan ce sunt necesare aciuni, s ia aceste aciuni, i s evalueze eficacitatea aciunilor. Triaj iniial consider c motive de siguran, provocri nemijlocirea, principiile etice, i aspecte juridice.

SIGURAN NGRIJORRI

Preocuparea cea mai urgent de ngrijire este de siguran a persoanelor n situaii de criz, precum i altele care pot fi n pericol. Clinicienii aduna informatii despre:

Prezena de arme, cuite, explozivi, sau alte dispozitive duntoare Ameninri cu violena la auto sau a altora de ctre persoana n criz Istoria duna sine sau a altora de ctre persoana n criz De intoxicare a persoanei n criz sau alte persoane, prin diferite substante Riscurile de mediu care ar putea complica intervenii (foc, vnt, ap, traume, gaze toxice, focuri de arm aleatoare)

Immediacy PROVOCRI
Iminena pericolului unei persoane n situaie de criz i alte persoane din apropiere este descris ca fiind fie emergente, de urgen, sau nonemergent (Antai-Otong, 2004).

Crize Emergent necesit o aciune imediat. Aceste situaii includ crize, cum ar fi sinucidere iminent, toxicitate de droguri, i comportamentul violent sau amenintor fa de ceilali. Dup efectuarea unei evaluri, intervine medicul de la o dat. Crize de urgen necesit atenie, dar nu sunt n pericol viaa de urgen. Aceste situaii includ comportament, cum ar fi gesturi suicidare, intoxicaie, gesturi bizare, i agitaie acut. Dupa ce a facut un examen fizic i de evaluare a strii mentale, asistentul ia msurile corespunztoare. Situaii Nonemergent nu necesit o atenie imediat, dar nu ar trebui ignorate. Aceste situaii includ lucruri cum ar fi uoare pn la moderate anxietate, ntrebri despre medicamente, precum i o nevoie de a vorbi despre probleme personale. Dup efectuarea unei evaluri iniiale, asistentul se refer la client la resurse adecvate pentru ngrijire.

PRINCIPII ETICE
Furnizorii de asisten medical respectarea standardelor etice de ngrijire, indiferent dac este sau nu un client este n criz. Aceste principii sunt bazate pe etica, ramura a filozofiei n cauz cu corectitudinea sau incorectitudinea ale comportamentului uman i buntatea sau rutatea a efectelor sale (Hamilton, 2006). Principiile etice sunt concepte fundamentale prin care oamenii iau decizii. Aceste principii s serveasc drept criterii fa de care oamenii comportamentul msur. Fluxul de Legile de la principiile etice i constau din norme cu privire la situaii specifice. Aceste norme sunt aplicate de ctre o autoritate, cu puterea de a vedea c acestea sunt respectate. Spre deosebire de legi, principii etice servi ca ghiduri generale de comportament. Cinci principii etice marca practica profesionitilor din domeniul sanitar: (1) respectul pentru viaa uman i demnitatea, (2) binefacere, (3) cinste, (4) justiie, i (5) autonomie.

Respectul pentru viaa uman i demnitatea este una dintre cele mai de baz de principii etice. Se afirm c "persoanele fizice trebuie s fie tratate ca fiine unice, egal cu fiecare individ alte. Justificare special este necesar pentru a interveni n scopul unui individ proprii, intimitate, i comportament" (Rawls, 1971). Atunci cnd se aplic n caz de urgene psihiatrice, respectul pentru viaa uman i demnitatea nseamn persoanele care ii ingrijesc:

Se abin de la abuz, hruire, discriminare sau Respect personalitatea, stilul de via, i sistemul de convingeri de clienti Demonstrai n vedere psihologic pentru fizic, i socio-economice i a bunstrii Straduiti-va pentru a susine viaa uman i demnitatea Respect i ncredere n dein toate informaiile cu caracter personal

Binefacerii nseamn a face bine pentru beneficiul altora. Dei unii scriitori binefacerii separate (face bine) de la nonmaleficence (nu face ru), Frankena (1973) sugereaz principiul etic al binefacerii este un continuum, de la un ru nu este neutru la pozitiv a face bine. La un minim, beneficien nseamn pstrarea competen profesional. n mod ideal, aceasta inseamna a actiona in moduri care sa demonstreze grija si ingrijire. Atunci cnd se aplic n caz de urgene psihiatrice, beneficien nseamn persoanele care ii ingrijesc:

D-empatie exacte, caldura nonpossessive, i autenticitate (Rogers, 1961) Se refer la clienii profesional i obiectiv n consultare cu alte clinicieni, urmai planuri de tratament D n vedere necondiionat pozitiv chiar i atunci cnd este necesar s se stabileasc limite, se aplic restricii fizice, sau micare limit (Carkhoff, 1977)

Onestitatea nseamn s fii sincer n cuvnt i fapt, chiar i atunci cnd trebuie s transmit sfaturi nedorite sau informaii despre o condiie sau tratament. Clinicienii trebuie s fie reinut la surs de informaii veridice, dar plin de compasiune, numai n cazul n care clientul este un copil minor sau un adult cu un tutore legal. Atunci cnd se aplic n caz de urgene psihiatrice, onestitate nseamn persoanele care ii ingrijesc:

Raportul cu precizie i s nregistreze date critice Locul de bunstare a clientilor de mai sus ctig personal sau profesional in promisiunile i s se supun unor contracte de Furnizarea de fapt, informaii tiinifice, relevante despre tratament, inclusiv beneficiile i riscurile

Justiie implic corectitudinea i egalitatea i necesit un tratament imparial de clienti. Ca i alte principii etice, justiia se bazeaz pe respectul pentru viaa uman i demnitatea. Imaginea istoric al justiiei este o femeie legat la ochi cu o scar, o problem de cntrire, pe baza unor elemente obiective i preceptele judiciare. Justiie nseamn c resursele limitate vor fi distribuite n mod egal, folosind aceleai criterii pentru toi. Atunci cnd se aplic n caz de urgene psihiatrice, justiie nseamn clinicieni:

Evaluarea toate nevoile clientilor "cu diligen egale si profesionalism Participa la nevoile clientilor, indiferent de ct de dificil personalitatea lor, complexe tulburri lor, sau comportamentul lor provocatoare Evaluarea i comunic informaii despre opiunile de tratament fr a aduce atingere

Autonomie nseamn respectarea dreptului de autodeterminare, independen, i libertate. n situaii de urgen psihiatrice, pentru a preveni clinicienii prejudiciu ar putea avea nevoie de a alege ntre aciunile care autonomie de sprijin (libertate), precum i cele care binefacerii de sprijin (de siguranta). Clinicienii ar putea fi necesar s limiteze clientilor, administra medicamente tranchilizante, sau de blocare-le n izolare mpotriva voinei lor. Legile care reglementeaz adresa de angajament involuntar dilemele etice create de acest conflict de principii etice. Cu excepia situaiilor definite din punct de vedere, atunci cnd sunt aplicate la situaii de urgen de psihiatrie, autonomia nseamn persoanele care ii ingrijesc: 1. Informeaz clienii despre opiunile de tratament i de riscurile i asigurai-v c ei neleg 2. Respectul i s accepte deciziile luate de ctre clienii cu privire la ngrijirea lor cu caracter personal 3. Punerea n aplicare i evaluarea interveniilor alese de clienti 4. inei n ncredere toate informaiile cu caracter personal, doar divulgarea atunci cnd clienii sau tutorii lor legali dea permisiunea

ASPECTE JURIDICE
n trecut, oamenii ar putea fi internat sub flimsiest de pretexte de ctre aproape oricine pentru aproape orice perioad de timp. Incredibil, a fost nevoie de aproape 200 de ani pentru al cincilea amendament la Constituia Statelor Unite care urmeaz s fie aplicat la oameni care sunt bolnavi mintal. Acest amendament spune c "Nici o persoan nu se ... poate fi lipsit de via, libertate, sau a proprietii, fr proces de drept." n Humphrey v. Cady, 1972, instana a recunoscut c angajamentul involuntar civile la un spital de boli mintale a fost o "reducere masiv a libertii" i a cerut "de protecie din cauza procesului." n ultimii ani, numrul i domeniul de aplicare al statului, federale, i legile cazul n care afecteaz tratamentul persoanelor cu tulburri psihice a crescut dramatic. De interes special pentru cei care au grij de persoane n situaie de criz sunt legile cu privire la drepturile civile, confidenialitatea, drepturile pacientului, deciziile de tratament, restriciile, izolare, i natere spital.
Drepturi civile

n conformitate cu legile federale i de stat, persoanele cu boli mintale sunt garantate de aceleai drepturi civile ca orice alt cetean n ar. Aceste legi s garanteze drepturile tuturor persoanelor la ngrijire umane, pentru a interaciona social, s depun plngere mpotriva altora, la vot, vorbesc, s intre n relaii contractuale, face cumprturi, s ndeplineasc cerinele pentru un permis de conducere, urmai practicile religioase, s participe la activiti juridice , i de cltorie n Statele Unite.
Confidenialitatea

n anul 2003, pentru a proteja viaa privat a persoanelor fizice, precum i confidenialitatea datelor pacientului, Congresul SUA a adoptat portabilitii de Asigurri de Sntate i Actul de responsabilitate (HIPAA). Acesta prevede c, fr acordul prealabil al pacienilor, dosarele medicale nu pot fi citite sau copiate. Dei actul de complic foarte mult stocarea i transmiterea de nregistrri i, n unele cazuri, ntrzieri tratamentul persoanelor n situaii de criz, el afirm dreptul la via privat i sprijin conceptul de respect pentru toate fiinele umane.
Drepturile pacientului

Cnd oamenii se limiteaz la o instalaie de asisten medical pentru tratament, acestea trebuie s fie ngrijii cu respect i demnitate. Nu mai pot autoritile le-a pus pe ecran ca animalele ntr-o grdin zoologic. Nici oamenii pot fi blocate pentru perioade de timp nedeterminat, fr asisten medical, astfel cum Luther Osborne este descris n povestea lui personal, Rachete Insanity (1939). Oamenii au dreptul s primeasc ngrijiri medicale i stomatologice, vizitatori distra, de a primi e-mail necenzurate, i s fie liber de medicatie excesiva, izolare, sau de constrngeri fizice. Persoanele fizice au dreptul de a refuza s participe la studii de cercetare sau de tratament experimental si nu pot fi discriminai pe baz de sex, vrst, religie, handicap, sau origine etnic. Dac oamenii nu vorbesc engleza sau se poate folosi doar limbajul semnelor, ele trebuie s aib acces la un interpret. Persoanele fizice nu pot fi obligai s lucreze pentru o facilitate de asisten medical fr plat. n cele din urm, oamenii au dreptul de a-i exprima nemulumirile, fr teama de pedeaps (Varcarolis et al., 2006).
Deciziile de tratament

Spitalizarea din Legea bolnavi psihici din 1964 impunea ca toi pacienii din spitalele publice au dreptul la tratament. nainte de acel moment, pacientii ar putea fi spitalizat timp de decenii fr tratament. De atunci, instanele au decis c clienii trebuie s fie ngrijii de personal calificat i suficient, ntr-un mediu uman, ca urmare a planurilor de ngrijire individualizate (programele interuniversitare de cooperare). n alte hotrri, instanele au decis c pacienii au dreptul de a refuza un tratament (de exemplu, terapia electrice convulsive [ECT] sau medicamente antipsihotice). n plus,

clienii au dreptul de a pregti o "directiv de ngrijire n avans" n cazul n care acestea ar trebui s devin incapabil.
Restricii i Izolarea

Cnd oamenii n situaii de criz devenit att de ntristat c acestea sunt un pericol pentru ei sau pentru alii, poate fi necesar pentru a le plasa n restricii sau pentru a le izola. Pentru c istoria este plin cu conturile de folosirea excesiv de restricii i izolare, legile actuale de stat i a deciziilor recente, instana afirm c cel puin msurile restrictive trebuie s fie utilizate. Restricii i izolare pot fi utilizate doar atunci cnd este absolut necesar i n rarele ocazii cnd o persoan n izolare criz a cererilor de a reduce stimulare senzorial. Dac aceste msuri sunt eseniale, un medic trebuie s le prescrie i specifica durata de timp n care pot fi folosite (de exemplu, 2 ore). Persoanele care ii ingrijesc trebuie s revizuiasc i s documenteze starea clientului la intervale specifice (de exemplu, la fiecare 15 minute). Aceste msuri pot fi reauthorized de ctre medic, dar restricii n acelai timp trebuie s fie urmat. n plus, restriciile i izolare nu pot fi utilizate pentru confortul personal sau s-i pedepseasc clienti (Simon, 2001).
Spitalul de natere

Admiterea la spital poate fi voluntara sau involuntara. Voluntar nseamn n care pacientul este n control i atunci cnd decide s intre n instalaia i cnd s plece. Dei unele state necesit pacienii s prezinte o notificare scris la spital, nainte ca acestea s pot prsi cele mai multe, nu. n plus, n majoritatea statelor un client poate iniia o procedur de instan solicit o descrcare de gestiune judiciar printr-un act de habeas corpus (un "drept la corp"). Habeas corpus ofer un mijloc constituional pentru a contesta detenia ilegal a persoanelor fizice. Angajament de urgen involuntar, numit de asemenea, angajamentul civile, de oameni n criz este controlat de statutul de stat specificnd condiiile n care oamenii pot avea loc mpotriva voinei lor. n general, admiterea involuntar este permis atunci cnd oamenii sunt un pericol pentru ele nsele, un pericol pentru alii, sau sunt n msur s ofere pentru nevoile umane de baz (de exemplu, sunt "grav handicap"). Multe state da ofieri de poliie, medici, i anumite autoriti de sntate mintal profesioniti pentru a spitalizarea astfel de oameni i s indice anumit perioad de timp (de multe ori 72 de ore) pe care le pot avea loc mpotriva voinei lor. Pe parcursul acestei perioade de timp, persoana trebuie s fie evaluate i un plan conceput pentru ngrijirea lor. Angajament civil pentru observare, de asemenea, numit temporar spitalizare involuntar, este pentru o perioad mai lung de timp dect spitalizare de urgen. Scopul

su principal este de observaie, diagnostic i tratament al persoanelor care au o boal psihic sau prezint un pericol pentru ei sau pentru alii. Durata de timp este specificat de statut i variaz semnificativ de la stat la stat. Cerere de acest tip de angajament poate fi fcut de ctre un tutore, membru de familie, medic, sau alt funcionar de sntate public i poate solicita un certificat afirme boal psihic. Angajament pe termen lung pentru internare involuntar este destinat s ofere clienilor asisten extins i tratament. Ca i n cazul clienilor care sufer de spitalizare observaionale involuntar, spitalizare prelungit involuntar poate avea loc numai printr-o aciune judiciar sau administrativ i de certificare medicale. Acest tip de spitalizare involuntare pot fi de 60-180 de zile sau, n anumite mprejurri, pentru o perioad nedeterminat de timp. Angajamentul ambulatoriu involuntar este o categorie relativ nou juridice de ingrijire, care a fost iniiat n 1990. Scopul su este de a oferi o alternativ la angajament involuntare staionar pe termen lung. Recent, statele au inceput sa utilizeze angajament ambulatoriu involuntar ca o msur preventiv pentru a indeparta situaii de urgen de psihiatrie i necesitatea pentru o instan a ordonat-angajament bolnavului. De obicei, angajamentul ambulatoriu involuntar este legat de primirea de bunuri i servicii oferite de ageniile de asisten social, inclusiv pensii de invaliditate i de locuine. Pentru a primi aceste beneficii, clienii trebuie s participe la planul de tratament (Chan, 2003). Doctrina alternativa cea mai puin restrictive, este un alt concept important, care se aplic pentru ingrijirea pacientilor. Aceast doctrin afirm c persoanele care ii ingrijesc trebuie s utilizeze cel mai puin mijloace restrictive pentru a atinge un scop specific. De exemplu, dac n patru puncte de blocare de ambele brae i ambele picioare este suficient pentru a proteja pacienii deranjat de auto-vtmare sau altele, ele nu trebuie s fie plasate n cinci puncte de blocare a taliei, ambele brae, i ambele picioare. Descrcarea de gestiune de la spital depinde de starea de clieni n momentul n care au fost admise. n general, cei care au intrat de bun voie au dreptul de a fi eliberate n mod voluntar cu excepia cazului n starea lor schimb n mod semnificativ in timpul spitalizarii lor. Unele state ofer o liberare condiionat de oameni care au fost admii n mod voluntar. O astfel de dispoziie permite medicilor sau administratorilor de a asigura un tratament n curs de desfurare pe o baza in ambulatoriu.

PROCESUL medical, precum i persoana n CRIZ

Evaluare
n cazul n care sigurana unei persoane n criz este asigurat, formal procesul de colectare a datelor incepe. Acesta este realizat n persoan sau prin telecomunicaii i ncepe cu un interviu de evaluare. Desigur, interviul este modificat pentru a se potrivi cu circumstanele, vrst, i capacitatea cognitiv a persoanei n criz.

Colectarea de date este mbuntit de informaiile colectate de la membri ai familiei, alti furnizori de asisten medical, precum i autoriti cum ar fi ofieri de poliie. Scopul este de a evalua starea mental i fizic a persoanei i a problemei. Specialitii pot gsi influeneaz (de echilibrare) factorii de crize un cadru util pentru un interviu de evaluare, n mod specific clientului (1) percepie a evenimentului, (2) sprijin situaionale, i abilitile (3) de adaptare.

Percepia a evenimentului. Ceva sa ntmplat pentru a crea o criz n viaa unei persoane, motivarea persoan s solicite ajutor de la un hotline criz sau ED. Prin obinerea de informaii despre eveniment precipitant, att persoanele care ii ingrijesc si persoanelor fizice n criz, o mai bun nelegere a problemei. ntrebrile la care medicii s-ar putea intreba despre un eveniment precipitant sunt: o Ce sa ntmplat de a te face att de suprat? o Cum te simti acum? o Cum acest eveniment afecteaz viaa ta? o Cum va afecta acest eveniment viitorul tau? o Ce trebuie fcut pentru a rezolva problema? Sprijin situaionale. Sistemul de sprijin al unui client include resursele disponibile pentru persoana n criz. Familia i prietenii, cluburile sociale, grupuri de biseric, i a reelelor de asociaii profesionale sunt toate sursele de sprijin. Atunci cnd aceste resurse nu sunt disponibile, persoanele care ii ingrijesc acioneze ca un sistem de sprijin temporar pentru client. Planul de ngrijire trebuie s includ identificarea unui sistem de sprijin. Unele ntrebri un clinician ar putea cere despre un sistem de sprijin sunt: o Cu cine vrei s vii? o Cnd te simi singur i copleit de via, care nu vorbesti cu? o Exist cineva n viaa ta care avei ncredere? o n trecut, n perioadele dificile, care ai vrut sa te ajute? o n cazul n care te duci la coal (s se nchine, s se distreze)? Competene coping n situaii de criz,. Este important s se evalueze nivelul persoanei de anxietate i metodele lor obinuite de adaptare. Unii oameni beau, unii mananca, unii dorm, i unele jocuri de noroc. Alii se implice n activitatea fizic, lucru mai greu, poti lupta, si sa vorbesti cu prietenii. Unii clinicieni ntrebri pot intreba despre coping competene sunt: o V-ai gndit la sinucidere sau altcineva? o Cum ti-ar merge despre a face acest lucru? o Ai ncercai s-l de data asta? Dac da, ceea ce a fost diferit de data asta? o Ce facei de obicei s se simt mai bine?

Examinarea strii mentale (MSE)


Examinarea strii mentale este utilizat pentru a evalua zonele critice de cunoatere i emoie. BVM, n psihiatrie, este "analog la examinarea fizic, n medicin general" (Varcarolis et al., 2006). Ingrijitorii folosi concluziile lor pentru a diagnostica nevoile nesatisfacute, identifica obiectivele dorite, i de a crea un plan de ngrijire. Dei o situaie

de urgen impune ca medicii s modifice examenul pentru a se potrivi situaiei, o MSE complet include urmtoarele elemente. INFORMAII PERSONALE

Vrst Sex Stare civila Religioase preferin Etnie Ocuparea forei de munc Regimul de via

NFIARE

Intretinere si rochie Igien Expresie faciala Inaltime, greutate, starea de nutriie Marcaje unice organism: cicatrici, tatuaje, piercing-uri Varsta referitoare la apariia

COMPORTAMENTUL

Miscarea corpului: excesiv sau reduse Circulaie ciudat: scanare, gesticulnd, echilibrul, mersul Micare anormal: tremors, dini clnneau Contactul cu ochii

DISCURSUL

Tarif: lent, rapid, normal Volum: tare, moale, normal Dezorganizat, rapid

AFECTA i starea de spirit


Afecteaz: plat, bland, animat, furios, retras, caz de contextul Mood: trist, labil, euforic

GNDIRE

Procesul de: zbor coerente, de idei, neologism, gndit blocarea, circumstantiality Coninut: iluzii, obsesii, ideations suicidare

PERTURBAIILOR Perceptual

Halucinaii: auditiv, vizual Iluzii: interpretri greite perceptuale

Cunoatere

Orientarea cu privire la timp, loc, persoan Nivelul de contiin: de alert, confuz, nnorat, ncremenit, incontient, n com Memorie: de la distan, recent, imediat Fondul de cunoatere Abstraciuni: performanta la testele care implic similitudini, proverbe Insight o problem Hotrrea

FIZIC STATUTUL DE EXAMINARE


Un examen fizic de baz este esenial la iniial n persoan interviu din cauza condiiilor medicale pot mima cele psihice i persoanele care sufer tulburri psihiatrice sunt mai multe sanse decat altele de a avea medicale, cognitive, sau tulburri legate de substan. Atunci cnd interviul este realizat prin telefon, medicul poate s ndemne apelantului pentru a obine o examinare fizica si persoana care trebuie s se refere la astfel de servicii. n cazul n care un examen fizic sugereaz persoan ntr-criza are o afectiune medicala sau se confrunt cu o reacie acut de droguri, clientul ar trebui s fie prevzute pentru tratament imediat. Un examen fizic minim include urmtoarele. Control medical

Msurarea de temperatur, puls, respiraii, a tensiunii arteriale (semne anormale vitale sugereaz o conditie de baza medicale sau legate de medicament) Revizuirea sistemelor organismului: cardiovasculare, gastro-intestinale, pulmonare, genito-urinar, musculo-scheletice, Integumentary, endocrine, i neurosenzoriale Nume de medicamente prescrise i nonprescribed Data i furnizor de examen fizic trecut Teste de laborator: hemoleucograma completa, alcool i nivelurile de zahr, panoul de tiroida, sumar de urina, hematocrit, hemoglobina, profil chimie, nivelurile de acid folic si tiamina, boli cu transmitere sexuala, hepatit, electrocardiogram, funciei hepatice i renale, toxicologie ecran de droguri, sarcin, dup caz (Antai- Otong, 2004)

Diagnostic
Dup evaluarea persoanei n criz, clinicienii pune un diagnostic tentativ, folosind una dintre cele trei sisteme majore de clasificare de diagnostic, toate din care identific

problema clientului sau nevoie nesatisfacuta, cauza probabil sau etiologia, i semne i simptome sau alte date de sprijin. Sistemele de clasificare sunt luate de la:

Clasificarea Internaional Statistic a Bolilor, Revizie nou, Modificare clinic (ICD-9-CM), publicat de Organizaia Mondial a Sntii (OMS) Manualul Diagnostic si Statistic al Mental Disorder-IV-TR (DSM-IV-TR), publicat de Asociatia Americana de Psihiatrie Nanda Diagnostice Nursing: Definiii i Clasificri 2005-2006 (NND), publicat de International Nanda

ICD-9-CM clasific sindroame att psihiatrice ct i medicale (clustere de simptome), folosind un numar si un cuvant sau o expresie, cum ar fi 295.30 Schizofrenie, paranoic, sau 577.1 pancreatit, cronic. Numrul de cod faciliteaz studii de cercetare, colectare de date demografice, precum i rambursarea de furnizori. DSM-IV-TR clasific tulburri psihice cu ajutorul cinci axe sau elemente:

Axa I: ICD-9-CM cod numrul i numele de tulburri psihiatrice, cum ar fi 309.81 tulburari de stres posttraumatic Axa II: ICD-9-CM numrul de cod i numele de o tulburare de personalitate sau de tipul de retard mintal, cum ar fi 301.6 tulburare de personalitate dependent i 317 retard mental uor Axa III: ICD-9-CM cod numrul i numele de condiie medical general, cum ar fi 530.3 stricturi esofagiene Axa IV: probleme psiho-sociale i de mediu care pot afecta diagnosticul, tratamentul i prognosticul de tulburare mintal, cum ar fi "o problem cu grupul de suport primar, mediul social, locuine, educaie i" Axa V: Evaluarea global a funcionrii scar folosind "100" pentru a indica "funcionarea superioar ntr-o gam larg" i "1" pentru a indica "pericolul persistent al rani grav sine sau a altora sau incapacitatea persistent a mentine igiena minime cu caracter personal", cum ar fi la 60 la 51 "simptome moderate sau dificultate moderat n funcionarea social, profesional, sau de coal." (APA, 2000).

NANDA describes "psychosocial responses or potential responses to health problems and life processes" (2005). A complete nursing diagnosis states a response to a health problem related to a medical or psychiatric disorder, as evidenced by signs and symptoms exhibited by the patient. For example, risk for suicide, related to depressed mood, as evidenced by dangerous behavior such as drinking and driving . Nurses make NANDA diagnoses and use them in the nursing care plans required by all accredited hospitals and agencies. Nurses must also be familiar with the other two diagnostic systems because healthcare organizations and government agencies use ICD9-CM and DSM-IV-TR codes to pay clinicians for professional services.

Planificare
When clinicians make an assessment of a person in crisis and diagnose the problem, they and the client decide what goals and outcomes are desirable and feasible. They then determine the process by which each outcome can be achieved. Naturally, outcomes depend on the setting and condition of the person in crisis. For a client who hears voices telling him to hurt himself, a NANDA diagnosis might be disturbed thought processes related to schizophrenia, paranoid type, as evidenced by persecutory hallucination . The outcome criteria might be to consistently refrain from doing what the voices command .

Intervention
Interventions are the actions caregivers take to achieve identified outcomes. Such actions are based on the clinical knowledge, judgment, and skill of the caregiver, how acceptable the intervention is to the person in crisis, and whether the action is feasible under the circumstances. When a person is a danger to self or others, as with a client who hears voices telling him to hurt himself, it may be necessary to call the authorities for "emergency involuntary commitment" whereby the individual is restrained and taken to a locked facility for evaluation and treatment. Emergency departments and telephone crisis centers often develop standardized procedures called clinical protocols to assist caregivers in giving more appropriate and effective emergency care to people in crisis. For example, when a victim of sexual assault comes to an ED, clinicians implement the rape protocol. The protocol will include such interventions as "provide emotional support and privacy, stay with the client, label and save all clothing, collect vaginal or rectal secretions, examine the victim's body for cuts and bruises, refer the person to a rape advocacy program, and document every aspect of care."

Evaluare
The effectiveness of an intervention is judged by its outcome. If outcome goals were met, the crisis was resolved, and the person in crisis was returned to a prior level of functioning, we can rightfully say the intervention was successful. Ideally, as a result of the intervention, individuals who have been in a crisis learn new coping skills, increase their social support network, and as a result are better equipped to overcome future disruptive events.

CRISIS-PRODUCING EMERGENCIES
Crisis-producing emergencies can be grouped into five categories: (1) mood-related (mania, depression, and suicide), (2) anxiety-wrought, (3) anger-generated, (4) substance use, and (5) mental illness. All of the conditions require immediate assessment and knowledgeable interventions from caring professionals.

MOOD-RELATED EMERGENCIES
All people experience a range of moods, from great joy to profound sadness, expressing these moods in an array of behaviors, from laughter and smiling to weeping and withdrawal. When moods become exaggerated at either end of the emotional spectrum they become disorders, limiting the ability of the person to function socially or occupationally. In their extremes, mood disorders produce the frenzy of mania and exhaustion and the melancholy of depression and suicide. When people experience mood disorders and seek help in EDs or on crisis hotlines, clinicians need to recognize typical symptoms, identify their cause, plan a course of action, implement the plan, and evaluate its effectiveness.

Manie
Manic episodes are periods of extreme elevation of mood when people feel expansive, energetic, grandiose, and, sometimes, irritable and ill-tempered. Typical behaviors of mania are:

Inflated self-esteem or grandiosity Decreased need for sleep (feels rested after only 3 hours of sleep) More talkative than usual or pressured to keep talking Subjective experience that thoughts are racing or flight of ideas Distractible, attention easily drawn to unimportant or irrelevant external stimuli Intense goal-directed activity, socially, sexually, and occupationally Hyperactive behaviors and symptoms occur in episodes of a week or more Excessive involvement in pleasurable activities with a high potential for painful consequences, such as unrestrained buying sprees, foolish business investments, and sexual indiscretions (DSM-IV-TR, 2000)

Hypomanic episodes last less than a week and are more moderate than manic episodes. The symptoms, though noticeable, are not severe enough to keep the person from functioning. During these times many individuals are exceptionally creative, productive, and focused, often becoming successful standup comedians, performers, inventors, and artists. As with people who experience manic episodes, those who experience hypomanic episodes commonly abuse substances.

ASSESSMENT

Caregivers assess the potential danger of these people in crisis to themselves and to others and their need for hospitalization. Often people experiencing a manic episode may not have eaten or slept for many days and have poor impulse control, resulting in harm to themselves and others. They may become exhausted to the point of death. Thus, clinicians need to assess the following:

Medical status, by performing a physical examination to determine if mania is primary or secondary to a medical condition or to substance disorder Other psychiatric conditions, such as anxiety disorder and schizoaffective disorder Understanding by the client and the family about bipolar disorder and their knowledge of prescribed medications, support groups, and organizations

DIAGNOSIS
Medical Diagnoses

Because depression often precedes and follows hypomanic and manic episodes, the disorder was once called manic-depression . Now, however, it is called bipolar disorder . Currently, the American Psychiatric Association identifies mania as a symptom in all of the following diagnoses:

Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar Disorder, Not Otherwise Specified (NOS) Mood Disorder due to a medical condition Substance-induced Mood Disorder Mood Disorder, NOS (DSM-IV-TR, 2000).

Nursing Diagnoses

Because clients exhibit constant and excessive motor activity, poor judgment, difficulty evaluating reality, probable dehydration, and lack of impulse control, the following NANDA diagnoses may be appropriate: risk for injury, risk for other-directed violence, risk for self-directed violence, risk for suicide, ineffective coping, defensive coping, ineffective coping, disturbed thought processes, impaired verbal communication, impaired social interaction, imbalanced nutrition, deficient fluid volume, self-care deficit, and disturbed sleep pattern (NANDA, 2005).

PLANIFICARE
The goal of care for clients in an acute manic episode is to prevent injury and instill hope for the future. Therefore, outcome criteria for the client are as follows:

Be well hydrated Maintain or obtain stable cardiac status

Maintain or obtain tissue integrity Get sufficient sleep and rest Demonstrate thought self-control Make no attempt at self harm (Moorhead, Johnson, & Maas, 2004)

INTERVENTION
To meet outcome criteria and ensure safety, medical stabilization, and external control, people in crisis manifesting manic symptoms need hospitalization. If they are not cooperative and are a danger to themselves or others, emergency involuntary commitment may be necessary. (See Legal Issues, above.) To gain their cooperation and communicate more effectively, clinicians:

Use short and concise statements and explanations Use a calm but firm approach Remain neutral, avoiding power struggles Coordinate care with other staff members to avoid manipulation

Medications such as antianxiety agents (anti-anxiolytics), antipsychotics, and antidepressants may be prescribed. Furthermore, mood stabilizers such as lithium and valproic acid are considered lifetime maintenance therapy for bipolar clients (Preston, O'Neal, & Talaga, 2005). Because the incidence of substance use disorders is exceptionally common with bipolar disorder, treatment for mood disorder and substance abuse should proceed at the same time when appropriate (APA, 2000).

EVALUATION
Caregivers achieve treatment goals when they meet outcome criteria, clients are safe, and families are informed of resources for ongoing assistance. If these goals were not met, caregivers need to analyze where they failed and make changes for the future.

Depression and Suicide


Depression is a "dis-ease" in a true sense of the word. Those who experience depression feel sad, joyless, empty, and that life is not worth living. This tragic condition is the fourth leading cause of disability in the United States and a major health problem of older adults. Depression is twice as common in women as it is in men and is not related to education, income, ethnicity, or marital status. Two-thirds of those who suffer from the disorder also suffer from anxiety. Typical symptoms of major depression are:

Depressed mood most of the time Lack of interest or pleasure in almost everything, most of the time Significant weight gain or loss when not dieting Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue and loss of energy

Feelings of worthlessness and inappropriate guilt Diminished concentration and indecisiveness Recurrent thoughts of suicide and death, but without a specific plan Morbid preoccupation with worthlessness and guilt Symptoms are not better accounted for by bereavement Clinically significant distress or impairment in social, occupation, and other areas of functioning (DSM-IV-TR, 2000)

Dysthymic episodes of depression means that sufferers have less severe symptoms than major depression. Even so, their symptoms occur over 2 or more years and cause significant distress in every area of life (DSM-IV-TR, 2000).

ASSESSMENT
Numerous screening tools have been devised to identify people who are depressed. However, in psychiatric emergency situations, there is little time for testing. Caregivers know that 10% to 15% of depressed persons eventually commit suicide (Dhossche, 2000). For this reason, clinicians in the ED take depression seriously and screen people in crisis for suicide ideation. They know that asking if someone has thought about committing suicide does not make them do it ! Direct questions to ask of people who are at risk for suicide are:

Have you ever felt that life was not worth living? Have you been thinking about death recently? Do you ever think about suicide? Have you ever attempted suicide? Do you have a plan for committing suicide? If so, what is that plan? (APA, 2003)

Areas of inquiry include the following:


Feelings: Helpless, worthless, hopeless, and anger, generated by profound helplessness Thought processes: Difficulty concentrating or making up one's mind Affect: Seeing the world through gray-colored glasses Communication and comprehension: Slow speech and understanding Delusional thinking: Believe false and denigrating things about the self (God wants me dead, I'm not worth anything, anyway) Typical behaviors: Poor personal hygiene, psychomotor agitation, weeping, substance abuse, changed sleep patterns, constipation, reduced sexual interest (Varcarolis et al., 2006)

Guidelines for assessing depressed clients include the following:

Always evaluate the client's risk of harm to self or others. In some cultures, there is a high correlation with anger, especially self-anger and suicide (Hamilton, 1997). A thorough medical and neurologic examination helps determine if the depression is primary or secondary to another disorder or to drugs. Evaluate whether the client is psychotic, has taken drugs or alcohol, has medical conditions, or has a history of psychiatric syndromes. Ask if the person has a history of depression. Assess support systems, family, significant others, and need for referral.

Guidelines for assessing suicidal clients include the following:


Assess risk factors, including history of suicide, degree of hopelessness and helplessness, and lethality of plan (gun, poison, hanging). If there is a history of suicide attempt, assess intent, lethality, and injury. Determine whether the client's age, medical condition, or psychiatric diagnosis puts the client at higher risk. Note whether a client's mood changes suddenly from sadness to a happier state. Often a decision to commit suicide gives a feeling of relief and calm. If the client is to be managed on an outpatient basis, assess social supports and knowledge of potential suicide signs.

DIAGNOSIS
Medical Diagnoses

The American Psychiatric Association (2000) recognizes three types of depressive disorders that do not have manic features (note that there is no medical diagnosis of "suicide risk"). The three types of depressive disorders are: 1. Major Depressive Disorder 2. Dysthemic Disorder 3. Depressive Disorder NOS (not otherwise specified)
Nursing Diagnoses

Because depressed individuals have many needs and may suffer from other psychological and physical disorders, numerous nursing diagnoses may be appropriate. However, risk for suicide is always considered. Other diagnoses may be: hopelessness, ineffective coping, social isolation, self-care deficit, ineffective coping, powerlessness, chronic low self-esteem, constipation, and sexual dysfunction.

PLANIFICARE
The planning of care for depressed individuals in crisis is based on the circumstances that bring them to emergency care. Outcome criteria for the nursing diagnosis risk for suicide

might be: Individuals will (1) value and nurture themselves and (2) refrain from hurting themselves. When depressed clients are judged to be a danger to themselves or others, clinicians must consider the need for emergency hospitalization.

INTERVENTION
There are three phases in the treatment and recovery of persons with major depression:

Acute phase (6 to 12 weeks). The goal of treatment is to reduce depressive symptoms and restore psychosocial and work function. Hospitalization during this phase may be necessary. Continuation phase (4 to 9 months). The goal of treatment is to prevent relapse with pharmacotherapy, education, and depression-specific psychotherapy. Maintenance phase (1 or more years). The goal of treatment is to prevent further episodes of depression.

Medical treatment for depression is either first-line or second-line. First-line treatment includes:

Selective serotonin reuptake inhibitors (SSRIs) Atypical antidepressants Cyclic antidepressants (eg, tricyclic antidepressants [TCAs])

Second line treatment includes: 1. Monoamine oxidase inhibitors (MAOIs) 2. Electroconvulsive therapy (ECT) Nursing interventions for severely depressed clients include providing food and fluids, suicide precautions, personal hygiene, supportive communication, and psychotherapy using cognitive-behavioral, psychodynamic, and interpersonal approaches. If a person is hospitalized because deemed at risk for suicide, staff implement Suicide Risk Precautions as follows:

Search client and belongings for harmful objects. Make sure visitors do not leave potentially harmful objects or gifts in client's room. Keep electric cords to minimal length. Hang-proof and jump-proof bathrooms. Provide plastic eating utensils. Do not assign client to private room. Lock utility rooms, kitchens, stairwells, windows, and offices. Conduct one-to-one nursing observations and interaction 24 hours a day.

EVALUATION

Treatment of depressed persons is considered successful if, after treatment, they are able to think clearly, behave appropriately, and express greater hope and self-esteem. For example, an individual who came to the ED considering suicide, now is able to state alternatives to suicide, explore thoughts and feelings that preceded those impulses, and function successfully in the environment.

ANXIETY-WROUGHT EMERGENCIES
In the United States, anxiety-wrought conditions are the most common of all disorders that cause people to seek help in EDs or through crisis hotlines (Anxiety Disorders Association of America, 2003). Consequently, clinicians need to understand anxiety and its many manifestations and be prepared to assess, diagnose, plan, intervene, and evaluate the effectiveness of their actions. Anxiety is a feeling of uncertainty and dread, resulting from real or imagined threats. Unlike fear , which is a reaction to a specific danger, anxiety is a vague apprehension that invades the "central core of the personality, eroding one's feeling of self-esteem and personal worth" (Varcarolis et al., 2006). Normal anxiety is a natural response to the demands of life. It provides energy to achieve goals and carry out the activities of daily living. It energizes people and helps them manage the usual demands of life, including such things as arriving for work on time, fulfilling commitments, and pursuing worthwhile goals. Acute anxiety , or state anxiety , is a sudden, intense feeling of fear, caused by an imminent threat to one's sense of security. It is the feeling new graduates experience as they sit for a licensing examination, singers experience as they walk to the microphone to audition for a leading role, and patients feel as they climb onto the dentist's chair. Chronic anxiety , or trait anxiety , is a long-lasting, fear-based condition that persists over many years. Children with this condition appear apprehensive and high-strung. Adults with the disorder experience unrelenting angst and may develop all manner of physical and emotional disorders such as insomnia or chronic fatigue syndrome. Anxiety disorders frequently occur with other psychiatric disorders, especially depression and substance abuse. Genetic, biological, psychological, and cultural factors all play a part in their development. Like other emotions, the intensity of anxiety varies with the situation, ranging from mild to panic. Mild anxiety actually improves performance, sharpens focus, increases attention, and helps people grasp information. However, as anxiety increases to moderate, the perceptual field narrows and people are less able to see, hear, and grasp information. They experience selective inattention and notice only a few things in the environment. The ability to think clearly lessens and the body responds with profuse perspiration, and rapid pulse and respirations.

As anxiety intensifies to severe, people feel dazed and confused, unable to solve problems or focus on more than one thing at a time. They may feel dizzy, have a sense of impending doom, and behave automatically. Panic is the most extreme level of anxiety. In this state, people lose touch with reality and are unable to process what is going on around them. They feel confused, behave erratically and impulsively, and experience false sensory perceptions.

ASSESSMENT
As with everyone who comes to an emergency facility for help, a physical examination and at least a modified mental status examination should be performed. Although all anxiety disorders are fear-based, the symptoms they display differ greatly, as described by The American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (2000): 1. Panic disorder: Sudden onset of extreme apprehension, with or without agoraphobia, a fear of being in a place from which escape is difficult or impossible. 2. Phobia: A persistent, irrational fear of a specific object, activity, or situation, leading to a desire to avoid certain objects. 3. Obsessive-compulsive disorder (OCD): Obsessions are repeated thoughts, impulses, and images. Compulsions are repeated ritualistic behaviors over which the sufferer has no control, even though the person knows they are excessive and unreasonable. 4. Generalized Anxiety Disorder (GAD): Excessive anxiety and worry about many different things for six months or more. Sufferers experience restlessness, poor concentration, irritability, tension, sleep disturbance, and fatigue. 5. Posttraumatic Stress Disorder (PTSD): Repeated re-experience of a highly traumatic event to which the person responds with intense fear, helplessness, or horror. These flashbacks may begin within three months or be delayed for years. The person avoids stimuli associated with the trauma, becomes hypervigilant, and experiences a feeling of detachment from others. 6. Acute Stress Disorder (ASD): Symptoms occur within one month of exposure to a highly traumatic event. The person displays three of the following dissociative symptoms: subjective sense of numbness, detachment, absence of emotional responsiveness, derealization, depersonalization, or loss of memory. ASD resolves within four weeks. 7. Substance-induced Anxiety Disorder: Symptoms of anxiety, panic attacks, obsessions, and compulsions develop with the use of a substance within a month of stopping use of the substance. 8. Anxiety due to medical condition: Symptoms of anxiety are a direct physiologic result of a medical condition such as hyperthyroidism, asthma, hypoglycemia, pulmonary embolism, and Parkinson's disease. Assessment guidelines for anxious individuals in crisis include the following:

Assess for potential self-harm, because people with high anxiety are more likely to become desperate and suicidal. Conduct a physical and neurologic examination to determine whether the anxiety is the cause or the result of substance use or a medical or psychiatric disorder. Assess for psychosocial and environmental problems that may be affecting the client, such as stressful relationships, recent loss of job, and economic pressures. Consider cultural differences that may affect the way a person exhibits anxiety.

DIAGNOSIS
Medical Diagnoses

The American Psychiatric Association (APA) recognizes eleven anxiety disorders, as follows: 1. Panic disorder without agoraphobia 2. Panic disorder with agoraphobia 3. Agoraphobia without history of panic disorder 4. Specific phobia 5. Social phobia 6. Tulburarea obsesiv-compulsiva 7. Tulburare de stres posttraumatic 8. Acute stress disorder 9. Tulburarea de anxietate generalizat 10. Anxiety disorder due to medical condition (state medical condition) 11. Substance-induced anxiety disorder (state substance) And, finally, anxiety disorder NOS (not otherwise specified).
Nursing Diagnoses

Although many anxiety disorders described by the APA differ markedly from one another, NANDA diagnoses may appear in all of the anxiety conditions. For example, ineffective coping, fatigue, anxiety, disturbed sleep pattern, and chronic low self-esteem are common to all of the anxiety disorders.

PLANIFICARE
People in crisis with anxiety disorders usually do not require hospitalization. However, clinicians encounter these people in homes, clinics, and acute and skilled nursing facilities. Caregivers encourage people with symptoms of anxiety to participate in planning their treatment. For example, if the nursing diagnosis is "self-control of anxiety," the outcome criteria might be: "client will monitor the intensity of anxiety and use relaxation and regular exercise to decrease anxiety."

MEDICAL INTERVENTIONS

Both psychotherapy and medications are used to treat anxiety disorders. In cognitive therapy, clients learn to recognize behaviors and take action to change them. Therapists teach cognitive restructuring or reframing (replacing irrational negative statements and beliefs with positive statements), relaxation to help reduce anxiety, systemic desensitization to overcome phobias, and thought-stopping to reduce obsessions. Medications prescribed for anxiety include antidepressants such as selective serotonin reuptake inhibitors (SSRIs), tricyclics, monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and anxiolytics such as benzodiazepines and nonbenzodiazepine, antihistamines, and anticonvulsants. Nursing interventions for anxious people include:

Teaching behavioral therapy techniques to reduce anxiety. Teaching relaxation techniques, cognitive reframing (changing negative thoughts to positive ones). Offering counseling, milieu therapy, self-care, and health teaching. Referral to appropriate community resources such as OCD support groups.

EVALUATION
The treatment of anxiety disorders is considered successful if symptoms of anxiety in clients are reduced and they are able to live a happier, less fearful life.

ANGER-GENERATED EMERGENCIES
Anger-generated emergencies that involve assault and battery are well-known to clinicians in EDs and crisis hotlines. In recent times, violence has become a serious public health issue, affecting individuals, families, and entire communities. For this reason it is essential that healthcare providers understand anger and aggression, recognize its signs and symptoms, plan appropriate interventions, and evaluate those interventions. The goal of such care is to ensure safety for everyone concerned. In his classic study of human emotions, Robert Plutchik (1991) identified anger as one of the primary emotions, an inborn response to the frustration of desire. The purpose of anger is to remove what is blocking fulfillment of human needs or wants. Aggression is the physical or verbal action people take to overcome obstacles that block their desires. As with other emotions, a stimulus event evokes a feeling and the feeling motivates the person to respond . The decision to express anger aggressively depends on many factors, including cultural influences, genetic predisposition, low serotonin levels, and brain abnormalities, especially in the limbic system. As with other crises, anger and aggression are mediated by three balancing factors: (1) the perception of an event, (2) the availability of a support system, and (3) coping mechanisms. On feeling angry, some people use aggression as their primary coping

mechanism. Such a response is common in disorders like substance abuse, mania, antisocial personality, and cognitive deficit.

ASSESSMENT
Because of the danger to themselves and others who may be nearby, it is important for clinicians to recognize common predictors of violence, including:

A history of recent acts of violence Intoxication with alcohol or drugs Possession of a potential weapon Situations that lead to violence: overcrowding, arbitrary rules, apparent favoritism Signs and symptoms of violence: hyperactivity, restlessness, clenched jaw, fierce facial expression, increasing tension, mumbling to self, clenched fist, profanity, loud voice, soft voice, argumentative, avoidance of eye contact, and intense eye contact

Guidelines caregivers can use to assess a client's anger and violence include:

History of violence Hyperactive, irritable, impulsive behavior Risk factors: wish or intent, plan to harm, means to carry out plan Demographic factors: male aged 14 to 24, low socioeconomic status, lack of support system, limited coping skills, frequent use of intimidation to meet needs Intolerance of limit-setting by authorities

Guidelines caregivers can use to assess their own response to anger : 1. Personal triggers, such as physical characteristics of clients or situations 2. Sense of personal competence in a situation of potential conflict 3. Ability to ask for assistance

DIAGNOSIS
Medical Diagnoses

Although impulse control and aggression are symptoms of many neurobiologic conditions, the American Psychiatric Association has identified only one discrete disorder in which aggressive episodes are not better accounted for by other mental disorders; it is Intermittent Explosive Disorder (APA, 2000).
Nursing Diagnoses

NANDA diagnoses for clients who display aggressive behavior include risk for selfdirected violence, risk for other-directed violence, aggression self-control, and ineffective coping.

PLANIFICARE
Without question, de-escalation of anger and prevention of violence is the primary outcome criteria for interventions with angry clients. Such planning takes into account resource availability and situations in which violence may occur, is occurring, or has occurred. In planning interventions, it is important to consider the stages of violence . These are the pre-assaultive stage , assaultive stage , and post-assaultive stage , when clients return to their usual disposition (Mason & Chandley, 1999).

INTERVENTION
Pre-assaultive stage interventions focus on de-escalation of anger and require that clinicians:

Analyze clients and their situation and reassure them of your concern and expectation that they will stay in control of themselves. Use de-escalating communication and remain calm and nonthreatening. Demonstrate respect for personal space of clients, giving them adequate space and decreasing intimidation. Sit if the client is sitting and stand if the client is standing. Interact with clients respectfully, in a low, nonthreatening voice, honestly verbalizing options. Encourage them to assume responsibility for the choices they make and acknowledge the difficulties they have in making choices. Use time wisely, giving adequate time for depressed or suicidal clients to consider options, but set limits with manipulative clients. Interact with clients in a quiet place that is in plain view of other caregivers. Secure personal safety: o Avoid dangling jewelry. o Alert other caregivers. o Eliminate hazards caused by furniture or other objects. o Stand to the side of clients, not directly in front of them in a threatening way. o If clients begin to escalate, provide feedback, assuring them they will be safe. o Avoid confrontation and "show of force" by security guards.

Assaultive stage interventions include application of restraints, administration of medication, and seclusion. These measures should be used only after alternative interventions have been tried (eg, verbal intervention, medication, decreased sensory stimulation). Restraints, medications, and seclusion are used only when clients present a clear and present danger to themselves or others, have been legally detained for involuntary treatment and escape risk, or when they request seclusion.

When physical restraint is necessary, a team of practiced staff members use management of assaultive behavior (MAB) . When restrained, physician-prescribed sedatives are administered and the client is placed in a quiet, secluded area. Post-assaultive stage interventions begin when the client has become calm. These measures include establishing rapport with the client, engaging in a therapeutic discussion of stressors, and teaching alternative coping behavior. When available, clients are referred to longer-term counseling and anger management group therapy.

EVALUATION
After an assault by a client, caregivers need time to regroup and regain a sense of personal safety, control, and security. They need time to debrief, to discuss what happened, what went right, what went wrong, and what they will do in future situations. All incidents of violence are reported and documented according to agency protocol.

SUBSTANCE-USE EMERGENCIES
We are a drug-oriented society, using substances of every kind to reduce pain, lessen anxiety, induce sleep, increase energy, restore health, create feelings of euphoria, and enhance alertness. At least two-thirds of the US adult population consume alcohol regularly and more than half of those with mental illnesses use or have used mindaltering substances (Smith-Dijulio, 2006). Because of the widespread use of substances, clinicians in EDs and on crisis hotlines must assess, diagnose, plan, intervene, and evaluate not only physical but also psychiatric disorders, including substances-use disorders. When more than one disorder presents, clients are described as suffering from dual diagnoses or co-morbid conditions . Some common dual diagnoses are:

Alcohol addiction and generalized anxiety disorder Cocaine addiction and major depression Polydrug addiction and schizophrenia Episodic polydrug abuse and borderline personality disorder (Negrete, 2003)

TERMINOLOGY Physical dependence: Physiologic adaptation to a drug, confirmed by the appearance of a signs and symptoms that occur if the drug is withheld. Psychological dependence (addiction): Compulsive and maladaptive dependence on various substances such as methamphetamine, cocaine, and tobacco. Polysubstance abuse: The simultaneous use of many legal and illegal mind-altering, addictive substances.

Substance abuse: The repeated use of mind-altering substances, resulting in a failure to meet obligations at home, work, or school. Substance use: The ingestion of a chemically active agent, such as legally prescribed medication, alcohol, tobacco, or illegally obtained drug. Tolerance: A condition in which people take progressively higher doses of a substance to achieve a desired effect; withdrawal symptoms appear when individuals stop taking the substance. Withdrawal syndrome: A group of symptoms that occur when a drug is discontinued or when its effect is counteracted by a specific antagonist.

ASSESSMENT
People in crisis often resort to mind-altering substances to dull their senses, lift their spirits, or in some way relieve their discomfort. When individuals come to a ED because they are suffering substance withdrawal symptoms or have taken a mind-altering drug and fear its effectsor have come for some other reason and exhibit bizarre behavior suggesting substance useclinicians interest themselves in the following:

History of substance abuse: What substance have you taken, how long ago, what symptoms? Have you had blackouts, overdoses, complications, recent accidents, head trauma? Do you have a family history of substance abuse? Medical history: What medical disorders do you have? What medicines do you take? Psychiatric history: Have you ever thought about ending your life or hurting yourself? Have you tried to end your life? When, and under what circumstances? Psychosocial issues: Do you have a family or friends? What do you do for a living? What do you do to make yourself feel happy? Have you had a crisis in your life recently?

When people do not know or will not tell caregivers what substance they have taken, clinicians look for typical signs of stimulants, depressants, inhalants, hallucinogens, intoxicants, opiates, and other drugs. Signs and symptoms of the most common are:

Central nervous system (CNS) stimulants (eg, cocaine, crack, amphetamines): Tachycardia, dilated pupils, elevated blood pressure, nausea and vomiting, insomnia, assaultive, grandiose, impaired judgment, impaired social and occupational functioning, euphoria, increased energy, severe to panic levels of anxiety, paranoia with delusions, visual, auditory, and tactile hallucinations Opiate intoxication (eg, opium, heroin, meperidine, morphine, codeine, fentanyl, methadone, hydromorphone): Constricted pupils, decreased respiration, drowsiness, decreased blood pressure, slurred speech, psychomotor retardation, initial euphoria followed by impaired judgment, attention, and memory

Hallucinogen intoxication (eg, lysergic acid diethylamine [LSD], mescaline, psilocybin): Pupil dilation, tachycardia, diaphoresis, palpitations, tremors, and elevated temperature, pulse, and respirations Phencyclidine piperidine (PCP) intoxication , or hallucinogens : Vertical or horizontal nystagmus, elevated blood pressure, pulse, temperature, ataxia, muscle rigidity, seizure, blank stare, chronic jerking, agitation repetitive movements, belligerence, impulsiveness, impaired judgment and functioning Inhalant intoxication (volatile solvents that vaporize at room temperature): Excitement, then drowsiness, agitation, and lack of self-control. Nitrates (room deodorizers): Enhanced sexual pleasure, euphoria Anesthetics (nitrous oxide): Giggling CNS depressants (eg. alcohol, benzodiazepines, barbiturates): Slurred speech; unsteady gait; drowsiness; decreased blood pressure; impaired judgment, memory, and occupational function; irritability; and aggressiveness Alcohol withdrawal: These signs usually develop within a few hours after the last drink, peaking sometime between 24 and 48 hours. The person becomes irritable, hyperalert, exhibits jerky movements called "shakes," and then symptoms gradually disappear. Complicated alcohol withdrawal with delirium tremens (DTs): occur 48 to 72 hours after the last drink. These include disorientation, agitation, tremors, anxiety, visual and tactile hallucinations, paranoid delusions, fluctuating levels of consciousness, hypertension, tachycardia, diaphoresis, fever (100F103F), and death, if untreated (Webb et al., 2000).

DIAGNOSIS
Medical Diagnoses

In the Diagnostic Criteria from DSM-IV-TR , the American Psychiatric Association lists a staggering number of substance-related disorders: 16 alcohol, 13 amphetamine, 4 caffeine, 9 cannabis, 13 cocaine, 11 inhalant, 11 hallucinogen, 3 nicotine, 12 opioid, 10 phencyclidine, 16 sedative, 1 polysubstance, and 15 other individual substance disorders (APA, 2000).
Nursing Diagnoses

Many nursing diagnoses are appropriate to substance abusers, indicating just how dysfunctional their lives may be. Some common diagnoses are: disturbed sleep pattern, ineffective health maintenance, imbalanced nutrition, deficient fluid volume, disturbed thought processes, hopelessness, nonadherence to healthcare regimen, anxiety, self-care deficit, ineffective coping, dysfunctional family processes, and risk for suicide (NANDA, 20052006).

PLANIFICARE
The goal of immediate care of substance-using individuals is to provide immediate, lifesaving measures, identify the drug or drugs the individual has taken, and give supportive

emotional care. The goal of long-term care is to encourage abstinence from substance abuse, meet physical and emotional needs, restore self-respect, and assist clients to establish a support system and become economically independent.

INTERVENTIONS
In the ED, interventions for a substance-abusing individual include identifying the specific drug or drugs they have taken, giving immediate life-saving care, providing food and fluid, and transporting clients to inpatient care or referring them to outpatient care. Sadly, many substance abusers are homeless and friendless and afflicted with serious comorbid conditions. Some communities provide shelter and drug treatment facilities, but people must agree to the rules and regulations of such facilities. Many refuse, preferring to live on the street until another crisis sends them back to an ED.

EVALUATION
Caregivers in EDs evaluate how well they have met the immediate needs of clients, even though they may find it difficult to remain sympathetic because these clients return to the ED again and again. Nonetheless, caregivers must strive to give every client "genuineness, accurate empathy, and nonpossessive warmth" (Rogers, 1961).

MENTAL ILLNESS EMERGENCIES


When precipitating events occur in the lives of people with mental illnesses they may become so distressed they seek help in an ED or through a crisis hotline. This is not surprising, since the coping skills of these individuals may be scarce and their support systems limited. Clinicians need to assess the signs and symptoms of such clients, diagnose their disorders, plan their care, intervene appropriately, and evaluate the effectiveness of these interventions. Some of the more common mental illnesses seen in EDs are:

Delirium (acute confusional state) : A disturbance of consciousness and change in ability to think that develops within a few hours or days. It is caused by numerous metabolic and toxic disorders and substances such as anticholinergic drugs and alcohol ((Beers & Berkow, 1999). Dissociative disorders: Disturbance of memory (amnesia) or confusion about personal identity; in dissociative fugue , person suddenly and unexpectedly travels away from home; in dissociative identity disorder , individual exhibits two or more distinct personalities (APA, 2000). Mania: Individual exhibits a period of expansive or irritable mood, lasting at least a week. The person is talkative, grandiose, sleeps very little, experiences flight of ideas, psychomotor agitation, and excessive involvement in pleasurable activities (APA, 2000). Panic disorders: Intense fear develops suddenly, reaching a peak within 10 minutes, with rapid heart rate, palpitations, sweating, tremor, shortness of breath,

feelings of being smothered or choked, fear of going crazy or dying, and dizziness. Symptoms gradually subside (APA, 2000). Posttraumatic stress disorder: An overwhelming traumatic event is reexperienced repeatedly, causing intense fear, helplessness, horror, and avoidance of stimuli associated with the trauma (Beers & Berkow, 1999). Schizophrenia: Loss of contact with reality with hallucinations (false perceptions), delusions (false ideas), illusions (false interpretations of real objects), abnormal thinking, flattened affect, diminished motivation, and disturbed work and social functioning (Beers & Berkow, 1999).

ASSESSMENT
When individuals with psychotic symptoms come to the ED, caregivers interview them and, when possible, interview relatives, associates, and other caregivers. Initial information may suggest the need for laboratory or other diagnostic studies. When clients have been hospitalized recently, those records may be available. If clients are agitated and assaultive, it may be necessary to restrain or seclude them for a limited period of time, as described in Legal Issues earlier in this course.

DIAGNOSIS
Clinicians consider carefully the signs, symptoms, history, medical record, and laboratory test results in diagnosing each client. They use standard medical reference codes found in the following.
Medical Diagnoses

The International Statistical Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), published by the World Health Organization The Diagnostic and Statistical Manual of Mental Disorder-IV-TR (DSM-IV-TR , published by the American Psychiatric Association

Nursing Diagnoses

The NANDA Nursing Diagnoses: Definitions and Classifications 20052006 (NND), published by NANDA International

PLANIFICARE
Individuals must have an individualized plan of care (IPC) that includes their immediate needs as well as ongoing needs. Many will require medications, some will need hospitalization, and most will need referral to outpatient care. The goal for all clients is stabilization and appropriate ongoing interventions.

INTERVENTIONS

Immediate interventions for individuals suffering from the disorders listed above are carried out in the ED. Ongoing interventions are provided by either the hospital staff or family members and other caregivers. When clients are returned home for ongoing care, it is essential that family members and other caregivers receive accurate information and a resource for ongoing help.

EVALUATION
As discussed earlier, clinicians evaluate the care they give clients, especially the care they give vulnerable clients. In a way, the arrival of a client in an ED constitutes a "precipitating event" of a potential crisis for the staff . The clinicians use their coping skills (experience, knowledge, and reasoning) and support system (professional colleagues) to meet the needs of clients. As a result, the potential crisis is resolved and staff go on about their work successfully.

REFERINE
Aguilera DC. (1998). Crisis Intervention: Theory and Methodology , 8th ed. St. Louis: Mosby. American Psychiatric Association (APA). (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry 160(11 Supplement). American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) , 4th ed. Washington, DC: Author. Anxiety Disorder Association of America. (2003). Statistics and Facts About Anxiety Disorders. Retrieved December 2006 from http://www.adaa.org/mediaroom/index.cfm. Antai-Otong D. (2004). Psychiatric Emergencies , 2nd ed. Eau Claire: PESI Healthcare. Beck AT, Rush AJ. (1995). Terapia cognitiv. In HI Kaplan and BJ Sadock (eds.), Comprehensive Textbook of Psychiatry , 6th ed., vol. 2. Baltimore: Williams & Wilkins. Beers MH, Berkow R (Eds.). (1999). Merck Manual of Diagnosis and Therapy , 17th ed. Whitehouse Station, NJ: Merck. Carkhoff RR. (1977). The Art of Helping , 2nd ed. Amherst, MA: Human Resource Development.

Chan C. (2003). Mandatory Outclient Treatment: Issues to Consider. Paper presented at the 153rd annual meeting of the American Psychiatric Association, Chicago. Collegiate Dictionary, 11th ed. (2006). Springfield: Merriam-Webster. Dhossche DM. (2000). Suicidal behavior in psychiatric emergency room patients. Southern Medical Journal 93(3). Compton WM. (2003). The role of psychiatric disorders in predicting drug dependence treatment outcomes. American Journal of Psychiatry 160(5):89095. Dubovsky, SL, Davies R, Dubovsky AN. (2004). Mood disorders. In RE Hales & SC Yudofsky (Eds.), Essentials of Clinical Psychiatry , 2nd ed. Washington, DC: American Psychiatric Association. Dochterman JM, Bulechek GM. (2004). Nursing Interventions Classification (NIC), 4th ed. St Louis: Mosby Elsevier. Erikson EH. (1963). Childhood and Society. New York: Norton. Franken WK. (1973). Ethics. Paramus, NJ: Prentice-Hall. Hamilton PM. (2006). Georgia: Ethics and Jurisprudence. Online continuing education course found at http://www.wildirismedical.com. Hamilton PM. (1997). Suicide in Micronesia: Causes and Interventions. Guam: University of Guam. Health Insurance Portability and Accountability Act (HIPAA). (2003). USC45C.FR 164.501. Humphrey v. Cady. (1972). US 504. Mason T, Chandley M. (1999). Management of Violence and Aggression. Philadelphia: Churchill Livingstone. Moorhead S, Johnson M, Mass M. (2004) Nursing Outcomes Classification (NOC), 3rd ed. St. Louis: Mosby. NANDA International. (2005). Nursing Diagnoses: Definitions and Classification, 20052006. Philadelphia: Author. National Institutes of Mental Health (NIMH). (2003). NIH News : Gene more than doubles risk of depression following life stresses. Negrete J. (2003). Clinical aspects of substance abuse in persons with schizophrenia. Canadian Journal of Psychiatry 48(1):1421.

Jamison KR. (1995). An Unquiet Mind. New York: Knopf. Osborne L. (1939). The Insanity Racket: A Story of One of the Worst Hell Holes in This Country. Oakland CA: Luther Osborne. Plutchik R. (1991). The Emotions , rev. ed. (Groundbreaking edition published in 1962.) Lanham, MD: University Press of America. Preston JD, O'Neal JH, Talaga MC. (2005). Handbook of Clinical Psycho-pharmacology for Therapists , 4th ed. Oakland CA: New Harbinger Publications. Rogers C. (1961). On Becoming a Person. Boston: Houghton-Mifflin. Seligman ME. (1973). Fall into hopelessness. Psychology Today 7:43. Simon RI. (2001). Concise Guide to Psychiatry and Law for Clinicians , 3rd ed. Washington, DC: American Psychiatric Press. Smith-Dijulio K. (2006). Care of the chemically imparted. In EM Varcarolis, VB Carson, Shoemaker NS. Foundations of Psychiatric Mental Health Nursing , 5th ed. St. Louis: Saunders-Elsevier. Varcarolis EM, Carson VB, Shoemaker NC. (2006). Foundations of Psychiatric Mental Health Nursing , 5th ed. St. Louis: Saunders-Elsevier. Webb JM, Carlton EF, Geehan DM. (2000). Delirium in the intensive care unit: Are we helping the patient? Critical Care Nursing Quarterly 22(4). http://www.nursingceu.com/courses/198/index_nceu.html

Urgente psihice: Grija pentru oameni n situaii de criz


Luai de testare
Lund testul nu te angajeaz s nregistrare sau de plat, dar trebuie s v nregistrai i s plteasc pentru a obine Certificatul de completare. Certificatul dvs. va fi livrat on-line imediat dup finalizarea procesului de nregistrare. Nu se percep taxe pentru cursuri gratuite de livrare i de certificatul de on-line. Trebuie s scor de 70% sau mai bun pentru a trece acest curs Selecionai unul rspuns pentru fiecare ntrebare, fcnd clic pe cercul de la stnga la alegere.. Pentru a modifica selecia, facei clic pe un cerc diferit. Nu sari peste nici o ntrebare.

Print ntrebri Test Ajutor pentru imprimare Du-te napoi la curs Arat cele Curs ntr-o New Window / Tab

1. O criz ncepe cu:


a. Emoional dezechilibru. b. Un eveniment de precipitare. c. Maturizare primejdie. d. Complicaii situaionale.

2. Metode de aptitudini sau oamenii folosesc pentru a rezolva probleme sunt:


a. Confruntarea mecanisme. b. Sisteme de sprijin. c. Egalizatoare criz. d. Motenit de talente.

3. Scopul interveniei de criz este de a:


a. Mrit sistemul de persoana de sprijin. b. Evitai se confrunt cu provocrile viitoare. c. Creterea numrului de factori de echilibrare. d. Restabilete nivelul pre-criz de funcionare.

4. O parte important a tuturor interveniilor crizei este:


a. Aflai mai multe despre nivelul de dezvoltare al unei persoane. b. ntrebare persoana despre ideaie sinucidere. c. Orientri anticipate pentru viitor. d. Acordarea n vedere necondiionat pozitiv.

5. Toate, dar una dintre urmtoarele situaii ar putea fi numit "non-emergente." Selectai unul care ar fi numit "emergente".

a. Doi oameni vin la ED cere ajutor pentru a rezolva un argument. b. O mam a unei linii telefonice i solicit solicit cu privire la efectele secundare ale unui medicament. c. Jane solicit o criz i linii de asisten telefonic recunoaste ca a luat doar o sticla de pastile durere. d. Jim vine la ED cere ajutor, mirosind a alcool, jignitoare cuvintele lui.

6. Atunci cnd clinicienii da oamenilor n criz nonpossessive caldura, empatie, i autenticitate, sunt expoziional care etice principiu?

a. Binefacere b. Justiie c. Onestitate d. Autonomie

7. Un act de habeas corpus ofer suport constituional pentru:


a. Un drept de a refuza tratamentul. b. Alternativ mai puin restrictiv. c. Un tip de spitalizare involuntare. d. O judiciare de descrcare de gestiune.

8. Toate, dar unul dintre urmtoarele sunt utilizate pe scar larg sisteme de diagnosticare in Statele Unite. Selectai una care nu este un sistem de diagnosticare.

a. Clasificarea Internaional Statistic a Bolilor b. Manualul Merck de Diagnostic si Tratament c. Manualul Diagnostic si Statistic de tulburri psihice d. Nanda Diagnostice Nursing: Definiii i Clasificri

9. Comparativ cu persoanele n episoadele maniacale, oameni n episoade hipomaniacale:


a. Nu mai au dormit pentru mai multe zile. b. Poate fi epuizat, pn la punctul de moarte. c. Au controlul impulsurilor mai srace. d. Plana controlul impulsurilor mai bun.

10. Procentul de oameni depresivi care se sinucid este:

a. 5% pn la 10%.

b. 10% la 15%. c. 15% la 20%. d. 20% la 25%.

11. Toate, dar unul dintre urmtoarele sunt faze de tratament i recuperare a persoanelor cu depresie major. Selectai faza incorecte:

a. Acute: Scopul tratamentului este de a reduce simptomele i de a restabili funcionarea. b. Continuarea: Scopul tratamentului este de a preveni recidiva cu diverse tratamente. c. n curs de desfurare: Scopul tratamentului este de a promova auto-testare prin mijloace de izolare. d. Intretinere: Scopul este de a preveni episoadele ulterioare de tristete si depresie.

12. Comparativ cu anxietate, teama este un:


a. Reinerii vagi care invadeaza de baz ale personalitii. b. Stima de sine scazuta asociate cu depresia cronic. c. Senzaie de dezamgire i incertitudine. d. Reacie la un risc specific.

13. Cognitive rencadrarea:


a. Cursuri predate clientilor de a inlocui gandurile negative cu unele pozitive. b. ncurajeaz clienii s se angajeze n activiti fizice, cum ar fi tamplarie. c. Este o noua tehnica pentru a ajuta clienii s se concentreze i s v relaxai. d. i nva pe oameni sa uite experienele nfricotoare copilrie.

14. Cnd a face cu un client furios, criteriul principal este rezultatul:


a. De-escaladarea de furie. b. Moderaia de ideaie sinucidere. c. De securitate pentru membrii personalului. d. Rezultatele exacte pstrarea.

15. Dup un episod assaultive, sesiunile de debriefing da timp personalului pentru:

a. Identificarea vinovat.

b. Stabilirea raport cu clienii. c. Rectiga un sentiment de siguran personal. d. A scrie un raport de administrare.

16. O condiie n care oamenii iau doze progresiv mai mari i prezint simptome de sevraj atunci cnd se opresc se numete:

a. Polysubstance abuz. b. Toleran. c. Dependen psihologic. d. Dependen fizic.

17. Un individ vine la ED chicotind i care acioneaz prostie. Ce prere avei substan suspect persoana care a luat?

a. Alcool b. Barbiturice c. Phencyclidine piperidin (PCP) d. De protoxid de azot

18. Un om este adus la ED de ctre un poliist, care raporteaz omul a fost gsit rtcind n mall. El are niciun element de identificare si nu stie numele sau adresa de domiciliu. Acest om ar putea fi sufer de ce boal mintal? a. Schizofrenie b. Tulburarea disociative c. Delir d. Tulburare de stres posttraumatic Criza din continentul american: Dezastrele si Sanatate Mintala din mediul rural Introducere (volumul 1) George W. Doherty, MS, LPC Cuvnt nainte de Thomas Mitchell, MS LPC Page 5 Criza din continentul american: Dezastre i Sntate Mintal n mediul rural Medii O Introducere (volumul 1)

Copyright (c) 2011 de ctre George W. Doherty. Toate drepturile rezervate. Biblioteca Congresului Catalogare-n-Publicarea de date Doherty, George W. (George William) Criza din continentul american: dezastre i de sntate mintal n mediul rural / George W. Doherty. v.; cm. Include referine bibliografice i index. Cuprins: v. 1. Introducere ISBN-13: 978-1-61599-075-7 (pbk.:. ALK hrtie) ISBN-10: 1-61599-075-5 (pbk.:. ALK hrtie) ISBN-13: 978-1-61599-076-4 (Hardcover:. ALK hrtie) ISBN-10: 1-61599-076-3 (Hardcover:. ALK hrtie) 1. De intervenie de criz (servicii de sntate mintal) - Statele Unite ale Americii. 2. Gestionarea situaiilor de urgen Statele Unite ale Americii. 3. Situaii de urgen psihice - Statele Unite ale Americii. I. titlu. [DNLM: 1. Intervenia de criz - Statele Unite ale Americii. 2. Planificarea n caz de catastrofe - Statele Unite ale Americii. 3. Serviciile de urgen, psihice - Statele Unite ale Americii. 4. Sntate rural - Statele Unite ale Americii. WM 401] RC480.6.D639 2011 362.2 '1 - dc22 2011000004 Rocky Mountain Regiunea de Sntate Mintal n caz de catastrofe Institutul este un 501 (c) 3 Nonprofit Organizaia. Aflai mai multe la www.RMRInstitute.org Rocky Mountain DMH Institutul de pres este o amprenta de: Vindecarea iubitor de pres Inc www.LHPress.com 5145 Pontiac Trail info@LHPress.com Ann Arbor, MI 48105 888-761-6268 Tollfree Statele Unite ale Americii Fax +1 734 663 6861 Page 6 Coninut Obiective ................................................. .................................................. ... iii Cuvnt nainte ................................................. .................................................. ..... v Capitolul 1 - Context i Prezentare ............................................ .................. 1 Conducerea unei ferme agricole i Crizele .............................................. ................................ 2 Stresul privind agricole i de pe Range .......................................... .................... 8 Variabilele de Sntate Mintal, stres, anxietate i Cross-Cultural din zonele rurale

de Vest Statele Unite ale Americii .............................................. ............................... 11 Stresul i a zonelor rurale .............................................. .................................... 15 Trauma rural ................................................ ............................................... 24 Suicid / Murder in zonele rurale ............................................ ......................... 33 Capitolul 2 - Cultura i ruralitate ............................................ ......................... 35 Competena cultural ................................................ .................................... 35 Populaii speciale n zonele rurale ............................................. .................. 37 Cultura rural i Etnii .............................................. ............................ 48 Valorile culturale n populaiilor rurale ............................................. .............. 50 Durerea: O scurt Cross-Cultural Perspective .......................................... ............ 54 Cross-Cultural Consiliere si Psihoterapie ............................................ . 57 Practica din mediul rural ................................................ ............................................... 63 Capitolul 3 - Sntatea mintal n caz de catastrofe n zonele rurale ......................................... 69 Context ................................................. ................................................. 69 Dezastrele tipice care afecteaz zonele rurale ............................................. ........... 70 Impactului dezastrelor n zonele rurale ............................................ ................... 75 Fazele de Consiliere crizei Rurale ............................................. .................... 77 Fazele de Disaster Recovery .............................................. ............................ 78 Fazele n caz de catastrofe care afecteaz criza Consiliere Rural ........................................ 84 De sntate mintal n caz de catastrofe n mediul rural ............................................ 92 Capitolul 4 - Impactul i de criz n caz de catastrofe n zonele rurale ................................... 95 Crizele ................................................. .................................................. ........ 95

Page 7 ii Criza din continentul american: Introducere Incidente critice i Intervenie criz ............................................. ......... 97 Consideraii suplimentare ................................................ ............................ 97 Unele Sentimente comune i comportamente ............................................. .......... 102 Percepia evenimentului .............................................. ................................. 108 BASIC-ID-ul ............................................... .................................................. .. 110 Concluzii ................................................. ............................................... 116 Capitolul 5 - Confruntarea cu provocrile ............................................ ................... 119 Provocrile cu care se confrunt rural Consiliere Criza ................... 120 Programe de consiliere pentru criz comunitii rurale ................................ 124 Servicii speciale comunitar ............................................... ........................ 130 Rural Consiliere Criza Proiectul Personal ............................................. ............. 132 Siguran i Securitate Personal .............................................. ............................... 134 Rural centre de sntate mintal .............................................. ........................ 137 Capitolul 6 - Concluzii: Cine sunt Medicii Tara? .................................... 143 Selecie a personalului n caz de catastrofe de Sntate Mintal ............................................. ........... 146 Populaia Demografie ................................................ ........................... 146 Personalitate ................................................. ................................................. 147 De calificri pentru profesionitii ............................................... ................... 148 Concluzie ................................................. ................................................ 150 Bibliografie ................................................. ................................................. 151 Resurse Materiale ................................................ ......................................... 181

n caz de catastrofe Referine Sntate Mintal i Resurselor ...................................... 181 Surse de Asisten i Informare ............................................. ........... 182 De stat i local ............................................... ............................................ 184 Organizaii de voluntariat ................................................ ............................. 185 Glosar de termeni ............................................... ....................................... 186 Despre autor ............................................... ............................................ 193 Despre Rocky Mountain n caz de catastrofe Regiunea Institutul de Sanatate Mintala ............. 197 Index ................................................. .................................................. ........... 201 Page 8 Obiective Dup finalizarea acestui curs, ar trebui s fie capabil s: Descriei modul n care dezastre afecteaza oamenii din mediul rural. Identificarea, explica i discuta cross-culturale considerente n mediul rural medii. Descriei serviciile de sntate mintal oferite de ctre specialitii n sntate mintal n zonele rurale. Identificarea modul n care comunitile rurale lucreze mpreun pentru a se pregti pentru rspuns i recuperarea de la incidente critice, de criz, i dezastre. Identificarea i descrie fundal i factorii care afecteaz ferm i fermele crize. Descriei i explicai factorii care afecteaz i provocarea de stres asupra fermelor i a ferme n vestul SUA i n alte medii rurale. Descriei i s identifice stres, anxietate, i trans-culturale variabile n mediul rural domenii. Identificarea problemelor asociate cu situatii trauma n zonele rurale. Descriei competen culturale i importana acesteia n mediul rural. Identificarea populaiilor de construcii prezente n zonele rurale. Explicai importana culturii rurale, etnie i valorile culturale n rspuns la incidente critice, de criz i dezastre n populaiile rurale. Explicai modul n care practic rural difer de la mediul urban. Descriei abordrile de sntate mintal n caz de dezastre din mediul rural. Identificarea tipuri de dezastre i a impactului acestora, care afecteaz zonele rurale. identifice i s descrie fazele de dezastru i modul n care acestea afecteaz mediul rural domenii.

Page 9 iv Criza din continentul american: Introducere Identificarea i descriei reele de sprijin i a resurselor n mediul rural medii disponibile pentru rspunsurile dezastru. Identificarea i descrie simptomele de traume psihologice. Explicai-BASIC ID-ul i modul n care aceast abordare multi-modal este folosit pentru a ajuta identifica zonele de interes pentru evaluare n urma dezastrelor i critic incident traume. Identificarea i descrie provocrile asociate cu sntatea mintal rspunsuri n zonele rurale i cum s le ndeplineasc. Identificarea i descrie rolurile de medici de ar i de sntate mintal din mediul rural profesioniti i al personalului auxiliar. Pagina 10 Prefa Cnd m-am rtcit afar, n cmpiile ridicat de Est Wyoming ca un nou btute profesionale de sntate mintal, am experimentat o perioad de oc cultural. Multe dintre serviciile necesare pentru persoanele fizice i familiile nu au fost de multe ori disponibile n mediul rural domeniu, am lucrat i, atunci cnd sunt disponibile, ar fi de multe ori insuficient. Oamenii din comunitilor agricole i fermele au propriul mod de a face cu vicisitudinile vieii i au mai multe sanse de a "cowboy up" dect s ia msuri pentru a rezolva probleme sau de a cauta ajutor la nevoie. Dup civa ani, angajatorul meu ma trimis s obin unele de formare n caz de dezastru de sntate mintal. L-am ntlnit George Doherty, la un curs de formare a avut loc n campusul de Universitatea din Wyoming. Rezultatul pentru mine a fost ntmpltoare, nu numai ca am avea accesul la resursele de instruire prin intermediul lui George n caz de catastrofe Rocky Mountain Regiunea Institutul de Sntate Mintal, dar a adugat posibilitatea de a nva cteva lucruri despre de sntate mintal din mediul rural i cum pentru a servi mai bine lui Wyoming rurale i agricole, orientate spre populaie. George a fost un practicant n mediul rural pentru mai muli ani dect el prefer s recunoasc i sa dezvoltat n mai multe perspective de servire din mediul rural populaii. Persoane din mediul rural din ntreaga lume sunt att similare i foarte diferite de la lor vecinii urban. Deseori realitile vieii rurale a crea o nevoie de a dezvolta competene n auto-suficien c, atunci cnd sunt combinate cu o atitudine de "individual-robust

dualismului, "pot face dificil pentru indivizi din mediul rural pentru a ajunge pentru ajutor atunci cnd justificat. Resursele sunt putine si de multe ori punct de vedere geografic separate prin sute de mile. Crizele n mediul rural nu poate fi de actualitate, n msura n care un anun similar criz ntr-un mediu urban ar fi. Ca urmare, n msura n a unui dezastru ar putea s nu devenit evident pentru mai multe zile. Orice rspuns care necesit servicii umane i sprijin material poate fi ntrziat, i mpiedicat de minime sau absente infrastructura, mpiedic i mai mult eforturile de recuperare. George Criza din continentul american: Dezastre i Sntate Mintal n mediul rural Medii a fost scris pentru un public larg de planificatori, sntate i mintal profesionitilor din domeniul sntii. n urmtoarele capitole se rezuma caracterul rural Pagina 11 vi Criza din continentul american: Introducere rezideni i provocrile vieii rurale, economia rural, provocrile vieii rurale, i un numr de pericole sau de catastrofe care au sau pot aprea n mediul rural. Georges dedic o seciune pentru a revizui vulnerabilitile unic la stres, precum i impactul crizei n mediul rural. El include clieni succint a componentelor de Managementul stresului critic de incident. Acesta concluzioneaz, cu o seciune privind pregtirea de criz i a personalului de asamblare adecvate pentru ocazii atunci cnd un concertate ca rspuns la criz este nevoie. Thomas Mitchell, MS LPC Vrf Wellness Center Torrington, Wyoming Page 12 1 Introducere n Crizele n mediul rural Domenii: Context i Prezentare O trecere n revist a literaturii de specialitate actuale relev o serie de studii publicate i articole care se ocup cu o larg seciune transversal a subiectelor privind intervenia de criz i domenii conexe (CISM, Trauma, dezastre), n mediul rural. Acestea includ CISM servicii n mediul rural (Seebold, 2003); servicii Telehealth (Dimmick, Burgiss, Robbins, negru, Jarnagin & Anders, 2003); stres n zonele rurale (Cowen, 2001); de intervenie sinucidere (Aoun & Johnson, 2001); rurale n vrst (Neese, Avraam, i Buckwalter, 1999; Snustad, Thompson-Heisterman, Neese & Abraham, 1993); rspunsuri n comunitile rurale n urma dezastrelor naturale (Sundet & Mermelstein, 1996); de aciune comunitar pentru brbai abuzive (Hanson & Whitman, 1995); litigii n practic din mediul rural (Bushy & Rauh, 1993); echipe de intervenie de criz din mediul rural (Silver & Goldstein, 1992); depresie copilrie (Cecchini, 1998); psihiatrie rurale n Camere la spital de urgenta (Morris, 1997); de intervenie n situaii de risc, cu adolesceni

(Rose-Gold, 1991); Orientare n coli mici (Dinkmeyer, 1990); aspecte culturale (Paulsen, 1988a; Paulsen, 1988b); rspunsurile minitrilor rurale, la dezastre naturale (Echterling, Bradfield, Wylie, 1988); crizei agricole (Mermelstein, 1987; Thompson & McCubbin, 1987; Hargrove, 1986); de prevenire a abuzului sexual din mediul rural (Johnson, 1987); pe termen scurt, interveniile cu familii i copii n urma tornade (McRee, Corder, Deitz, Silverstein, et al, 1985-1986.); Dezastre n cantiti mici comunitilor (Farberow, 1985); de intervenie de criz, n colile din mediul rural (Wise & Smead, 1985; Harper, 1984; Beare, 1981); formare psihiatrie din mediul rural (Bassuk & Cote, 1983); utilizarea a personalului auxiliar la populaiile rurale (Shybut, 1982; Marshall, 1971); de lucru cu familiile din mediul rural (Anderson, 1976); i abordri de droguri Pagina 13 2 Criza din continentul american: Introducere prevenire i tratament n zonele rurale (Bourne, 1974). O cutare literatura de specialitate a relevat un total de 37 de articole publicate pe aceste subiecte din 1974. Dei acest lucru este, probabil, nu include toate lucrrile efectuate pe de intervenie de criz n zonele rurale, aceasta nu sugereaz o lips de diseminare a acestor informaii pentru sntatea mintal i legate de profesioniti. Paulsen (1988) au discutat despre criza economic care afecteaz mediul rural Americii, n ceea ce privete impactul acesteia asupra individului i comunitii sale. Ea a subliniat trei teme: (1) comunitile rurale sunt ntr-o stare de criz cronic, (2) Persoanele din mediul rural sunt membrii unei culturi distinct unic, i (3) criza din mediul rural justific un numr unic de rspuns de la specialitii n sntate mintal. Toate aceste trei oferi perspective n crizelor din mediul rural i toate cele trei merit un studiu mai aprofundat. Harper (1984) au discutat de intervenie de criz i tehnici de management n mediul rural sau zone izolate, cu accent pe mediul rural Alaska, i a sugerat linii directoare pentru succes intervenii care a subliniat importana nelegerii culturale diferite, ences. Acestea sunt consideraii importante n majoritatea zonelor rurale din Statele Unite ca zonele rurale tind s urmeze tradiiile culturale mai mult dect n mediul urban, n general. Liniile telefonice de criz sunt o metod care a fost folosit att n mediul rural i urban domenii. Shybut (1978) a constatat c underutilization, n special de brbai i de ctre n vrst de ambele sexe, a fost problema iniial pe un telefon de intervenie de criz servicii utilizate ntr-o zon rural. Forme Telecounseling i alte tipuri de consiliere, inclusiv consiliere online pe internet, sunt zone care prezint un potenial mare pentru a acoperi geografice zonele comune n partea de vest rural. n ultimii 20 de ani, a existat o criz n comunitile de fermieri mai multe

faa a agriculturii n ar sa schimbat. Multe ferme de familie au fost pierdute sau vndute cu stres nsoitor pe cei implicai. Hargrove (1986) a examinat mit din comunitile rurale unire n condiii de stres, i sugereaz clinice i activitile comunitii de lucrtori n domeniul sntii mintale n timpul crizelor agricole. n articolul su, el a susinut c un model pentru intelegerea omului rspuns la dezastre naturale este utile pentru nelegerea ca rspuns la astfel de crize. El a oferit recomandri n nivel de comunitate i a sugerat c modelul clinice / avocat dezvoltat de ctre G. B. Melton (1983; a se vedea, de asemenea, PA, Vol. 61:. 9256) ofer o perspectiv util de la care s funcioneze. Conducerea unei ferme agricole i Crizele Abordri de tratament pentru astfel de crize varia. De exemplu, Jurich & Russell (1987) evaluate 15 familii agricole care a fost supus tratamentului de la Kansas State University Page 14 Context i Prezentare 3 Centrul de Familie, folosind un model de adaptare la stres de familie dezvoltat de HI McCubbin et al. (A se vedea nregistrare 1981-30250-001). Intervenii majore sunt incluse rencadrarea, mobilizarea resurselor, i folosind mijloace indirecte de mai puin de intervenie. Subiectii (Ss) au aratat o crestere mai mare a bunstrii la trei luni dect a fcut o eantionul general al clientilor. Cu toate acestea, nivelul de stres nu s-au redus la fel de mult ca satisfacie eantionul general, i viaa a fost mai mic la follow-up dect generale populaie. Thompson & McCubbin (1987) sublinia unele resurse materiale disponibile pentru a ajuta la educatori, consilieri, i alii pentru a sprijini familiile din mediul rural n situaii de criz i pentru a facilita luarea deciziilor, cu raz lung de planificare, i rezolvarea problemelor. Programe de consiliere, ateliere de lucru, publicaii, grupuri de suport pentru a face fa pentru stres, i computerizat ajutoarele decizie sunt revizuite. ntr-o alt abordare, Paulsen (1988) afirm c crizele din mediul rural a crea numere noi persoanelor din mediul rural care au nevoie de asisten n care acestea s fac fa stresului de dislocarea economic i dificultile copleitoare care apar dup pierderea unui ferm sau de afaceri. Ea discut individuale de tip familial,, i aspecte de tratament comunitate n contextul tematic al unei culturi n criz. O familie urban-regional pe baza agenie de servicii, Agricultorii ajutnd agricultorii, este prezentat ca un exemplu de sisteme de ca rspuns la criza din mediul rural. Tratamentul propus implic o mai multe niveluri rspuns la nivel comunitar, care include de auto-ajutorare grupuri de suport, de instruciuni de adaptare

coping competene, i schimbul de informaii n comunitile rurale. Profe-sntate mintal sntii sunt contestate n continuare nelegerea lor a crizelor din mediul rural i s adopte strategii mai flexibile de tratament care s cuprind un sistem de rspuns de mai multe niveluri. In timpurile actuale de criz, la nivel naional i internaional, cu un nivel crescut de stres, anxietate i ngrijorare cu privire la terorism, este esenial faptul c sntatea mintal profesionitii din mediul rural s devin contieni de cercetri recente, formare i abordri de intervenie de criz, traumatologie, oboseal compasiune, mentale dezastru de sntate, critic de management al stresului incident, stres post-traumatic, i domenii conexe. Waterfield (1986) a acoperit divizat n cretere economic i cultural ntre mediul rural urbane i America. n Conflict cartea sa i Crizele din Rurale America, sa adresat multe dintre problemele majore impact asupra zonelor rurale. Acestea includ aspecte cum ar fi: "Rural-urban rzboaie" peste de utilizare a terenurilor, controlul apei, politica de produse alimentare ieftine, comer, utilizarea substanelor chimice i pesticide, drepturile animalelor, prejudecile n zonele urbane dominate de mass-media, corupiei n marketing i distribuie produse alimentare, ceea ce se ntmpl n ara, i care sunt cele mai mari moieri. Waterfield sugereaz c America rural cota de avuiei naionale este n declin i c America este cea mai bun speran din lume pentru rezolvarea problemele de foametei i srciei rurale. Pagina 15 4 Criza din continentul american: Introducere Printr-o pe termen lung (1982-1989) studiu de familii agricole 156 in Dodge County, Georgia, Barlett (1993) discut daunele de la un deceniu de criz, i ofer un privire critic la tendinele n agricultura american, impactul lor asupra comunitii rurale vitalitatea, i a efectelor legislaiei agricole federale. Acesta a fost un studiu de ferme familiale in Dodge County, Georgia. Acesta a examinat factorii sociali i economici care determina succesul n agricultur astzi. Bartlett, un profesor de antropologie la Emory Universitatea, prezint o istorie agrar de Dodge Judeean i modificrile sale i transformrile din timpuri de frontier prin prezent. Perioada cheie de ei Studiul a fost deceniul boom-and-bust din 1980, cnd naiunea a fost n strnsoarea a unei crize agricole. Folosind datele obinute din interviuri i observaii personale de 124 mici i scar medie familii agricole, Bartlett descrie n detaliu strategiile de adaptare i abordri de gestionare a celor care au fost determinate s rmn n agricultur i cei care au plecat. Ea exploreaz istoriile de familie, aspiraiile personale, i atitudini despre agricultura ca un trai. Ei interviuri cu femei agricole dezvluie o varietate de

definiii rolul i relaiile ntre soi, care permite familiilor agricole s rmn intacte. Perioada de dup criz i impactul acesteia asupra marimea fermei, conservarea resurselor, i stil de management ofer perspective pentru supravieuire agricole familiale n alte comuniti. Psihologie rural a foarte puine studii majore n ceea ce privete practica n mediul rural medii i mici comuniti. Practicanii se confrunt cu unele foarte diferite problemele de la colegii lor mai urbane. Practic din mediul rural prezint importante nc provocatoare probleme de psihologie, mai ales n America de Nord i distribuiei internaionale a populaiei, nivelul de nevoia de servicii psihologice n mediul rural, disponibilitatea limitat a serviciilor din mediul rural, i migraia din mediul rural rezideni n centrele urbane. Probleme directe de servicii includ necesitatea de a gzdui o mare varietate de dificulti de sntate mintal, probleme legate de client i de confidenialitate limitele, i provocri practice. Aspecte indirecte de servicii include mai mare nevoie pentru diverse activitati profesionale, inclusiv activitatea de colaborare cu profesioniti avnd n diferite orientri i convingeri, program de dezvoltare i evaluare, precum i efectuarea de cercetri cu mentori puine sau colaboratori la egal la egal. De formare profesional i problemele de dezvoltare includ lipsa de cursuri de specialitate relevante i destinaii de plasare, i aspecte, cum ar fi personal posibiliti limitate pentru recreere i cultur, i lipsa de intimitate. Psihologie va trebui s abordeze mai bine aceste probleme complexe n cazul n care rezidenii zonelor rurale sunt de a primi un tratament echitabil i servicii (Barbopoulos & Clark, 2003). Pagina 16 Context i Prezentare 5 Preocuprile recente n agricultur au cauzat oamenii s aruncm o privire la cazul n care acestora vine de la produsele alimentare. Criza din industria carnii, ca urmare a preocuprilor incadrand boala vacii nebune i, n preocuprile Orientul ndeprtat, despre "gripa aviara", n pui contribui la factorii de stres, nu numai n rndul publicului larg, dar, de asemenea, printre agricultori i fermierii care se strduiesc s menin populaia hrnite. Criza agricole din SUA in anii 1980 reorientat atenia la nivel naional cu privire la situaia de zonele rurale. Datele indic faptul c, n raport cu zonele urbane, rurale America sufer de pe urma sarcina dubl a (a) un nivel ridicat de srcie, persoanele cu handicap, precum i depreciere, i (b)

necorespunztoare de sntate i servicii umane. Wagenfeld (1988) a introdus un numr special a Jurnalului de Psihologie comuniti rurale, care a prezentat un raport de stare pe problemele de sntate mintal n zonele rurale, n aceast perioad. Subiecte discutate inclus ecologie sociale de servicii de stationar de sanatate mintala, rspunsul centre comunitare de sntate mintal la criza agricole, de sntate mintal inovatoare servicii, abordri de politic la mbuntirea serviciilor de sntate mintal, i o cercetare Ordinea de zi a comunitii rurale psihologie. Ramirez-Ferrero (2002) provocri interpretri ale restructurrii n curs de sectorul agricol american ca pur si simplu un fenomen economic cu consecine psihologice. Ramirez-Ferrero susine c agricultorii de sex masculin "rspunsurile la Criza a fermelor financiare nu sunt strict psihologic, individual, sau idiosincratic, dar culturale. Aciunilor subiecilor si credintele sunt o consecin a unei multitudini de discursurile culturale. Acesta este sensul lor social-construite de sine sau subiectivitate (meditrol aferente prin procese culturale de putere), care determin ce cele pe care le interiorizeze, ia n considerare, i s acioneze asupra. Rural nord-vest Oklahoma a servit ca loc de aceast studiu. Studiul a fost realizat cu familiile agricole si a inclus colectarea de via istoriile de la 13 Cupluri, periodice participant-observare la o ferm, nestructurate i interviuri structurate cu profesionitii din domeniul sntii, precum i de cercetare focus grup. Acest Studiul ncorporat poveti de agricultori "vieii, n special cele de criz, pentru a nelege noiuni locale de gen, rudenie, terenuri, stiluri agricole, goluri familiale i agricole, precum i comunitate. Poveti de informatori "de viata sunt prezentate n contextul mai larg de discuiilor cu privire la istoria de nord-vest Oklahoma, economie agricol, proceselor corporative, i cea capitalist, i cretinism a nelege sociale de construcie a emoiei de mndrie, o emoie, care este critic n nelegerea brbailor rspunsuri la criza agricole. Ramirez-Ferrero sugereaz c emoiile sunt mediate cultural, gnduri ntruchipat care sunt n mod necesar de evaluare, i provocri, prin urmare, o nelegere comun a emoiilor ca biologice i fenomene psihologice. Deoarece fundamentul patriarhale de cretere Pagina 17 6 Criza din continentul american: Introducere comunitilor este erodat de valorile industriale, barbatii se confrunta cu devalorizarea idei culturale care au susinut subiectivitate lor, n special, sentimentul de mndrie. Aceast devalorizare, la rndul su, conduce pe oameni la aciuni i inaciuni care sunt adesea negative, distructive, i tragic. Stein (1984) a explorat etosul cultural i psihodinamica care stau la baza dualitate n caracterul Vestul Mijlociu / sud-vest american de sex masculin, care este ncapsulat

n imaginea de statornicie, agricultorul sedentar i c a aventuros vagabond cowboy-att, n rzboi cu unul pe altul, n aceeai persoan. Aceast dualitate este considerat n primul rnd n contextul Oklahoma de grau-agricole i de vite fermele familii, dar este, de fapt, o variatie pe o Midwestern regional / Southwestern US identitate. Stein susine c calitile psihologic primitiv atribuit i alocate la Midwest directorul / Southwest de ctre grup mai mare naionale pstra caracterul instabil regional masculin "strnit" i, prin urmare, disponibil pentru restul naiunii att ca exemplu negativ si pozitiv surs pentru nostalgie naionale n vigoare, i ca suport pentru politic "conservatorism" i internaionale militarismului. Ca lucrurile se schimb n zonele rurale, nevoia de servicii sociale adecvate, de asemenea, schimbri. Martinez-Brawley & Blundall (1991) a intervievat 44 familii agricole n Iowa si Pennsylvania cu privire la credintele si atitudinile cu privire la necesitatea i servicii sociale. Familii n Iowa au fost grav afectate de o criz agricol i au fost mai probabil sa fi avut contact cu serviciile sociale organizate. Solicita asistenta a aprut mai acceptabil din Iowa dect n Pennsylvania. Printre familiile, acolo was a sense that success and failure had little to do with deservingness. perception that the world is unfair was overwhelming in Iowa. Families did not view themselves as needing special help as a class of people; yet they did voice concerns about not being understood by outside systems. Services that were found to be the least acceptable in both Iowa and Pennsylvania were those closely associated with depression indicators (eg problems with spouse, increased dependency on school, feelings of anxiety or isolation). Schulman & Armstrong (1990) analyzed interview data from statewide surveys of 670 farm operators, collected during a period of economic and ecological crisis, to examine relationships among perceived stress, social support, and survival in agriculture. While the level of perceived stress had no relationship with survival, social support had a significant impact on both social psychological and behavioral dimensions of survival in agriculture. Perceived social support increased plans to remain in agriculture and increased the probability of a person continuing farming. Pagina 18 Background and Overview 7 Using data from a statewide survey of 725 North Carolina that farm operators collected during a period of economic and ecological crisis in 1986, Schulman & Armstrong (1989) analyzed the relationships between perceived social psychological distress, social support, and demographic, farm structure, and socioeconomic characteristics. Younger operators showed higher distress levels, and age and social support interacted so that social support lowered distress levels more for younger than for older operators. Results also suggested that total family income had a curvilinear relationship with perceived distress. Low and high income farm operators manifested higher levels of distress than middle income operators. Rezultate have implications for policy intervention and farm crisis support programs. Cook, John R. & Tyler (1989) examined the attitudes of 34 North Dakota farm

couples toward receiving help for a personal problem. Statistical significances (Ss) were assigned to groups according to the level of financial coping with respect to the possible loss of their farm (stable, declining, and out of business). Ss who were out of business or declining were more open to receiving help from educational sources than Ss whose farms were stable. Female Ss were open to receiving help regardless of their level of financial coping while their husbands were as receptive to help only at times of financial crisis. Ss showed reluctance in making use of outside resources of any kind. Leaving the Farm or Ranch Early on, Lamarche (1960) suggested that rural crises are created by the movement to the city, especially on the part of the young, and abandonment of the land. Rapid social evolution without any preparation can have undesirable psychological effects. In the 1980s, there was a high level of interest in retirement of farmers because of an aging farm population and concern that the farm crisis may have disrupted succession patterns. Keating & Munro (1989) described the process of exit from farm businesses of a group of older farmers and determined the relationship between goals of family succession and behaviors in the exit phase. A sequence of exit from work, management, and ownership was found. Farmers (aged 50+ yrs), who value continuity, were most likely to involve sons in management of the operaie. Keating & Munro suggested that programs for two-generation farm families may be useful in the early part of the exit phase while estate planning information and programs may be more appropriate to those in the latter part of procesul. Page 19 8 Crisis In The American Heartland: Introduction Stress on the Farm and on the Range Carson, Araquistain, & Ide (1994) examined the relationship between potential family vulnerability factors (stressors and strains), manifestations of maladaptation (family discord and distress), family strengths (hardiness), and measures of bonadaptation (quality of life) as reported by 188 men and women representing 100 Idaho farm and ranch families. Ss completed a battery of tests, including the Farm/Ranch Stress Scale, a demographic questionnaire, and four measures from the Family Invulnerability Test. Family strains and stressors unique to farming and ranching were positively associated with family discord and distress but negatively associated with hardiness and quality of life. Greater family hardiness, as reported by both wives and husbands, was positively correlated with their perceptions of family's quality of life. Plunkett, Henry , & Knaub (1999) studied 77 adolescents in farm and ranch families to examine the relationship of demographic variables, family stressor events, and family coping strategies to adolescent adaptation. Results indicated that adolescent age and family transitions were positively related to individual stress. Males reported less family stress than did females. Seeking spiritual support was negatively related to family stress, while the perceived impact of the farm crisis was positively related to family stress. Family support was positively related, and family

substance use issues were negatively related, to adolescent satisfaction with family via. Swisher, Elder, & Lorenz (1998) examined how the occupation of farming structures the stress experiences of individuals through the timing and placement of aciuni. They showed how occupations have effects that spillover into family and friendship relationships. The sample came from the Iowa Youth and Families Project, a longitudinal study of siblings and parents in the aftermath of the farm crisis of the 1980s, and included 424 married couples who had one child in the 7th grade and another child within four years of age of the first child. Results show that farming affects both exposure and vulnerability to stressors. Specifically, farm men are more exposed to financial and job-related stressors, while less prone to marital conflict, than non-farmers. Given the importance of cohesion in farm family operations, farm men are more vulnerable to such conflict when it occurs. However, farm men are unaffected, if not consoled, by knowledge of undesirable events in the lives of their friends. It was concluded that farm men use downward social comparisons to cope with the high levels of uncertainty characteristic of Page 20 Background and Overview 9 farming in the aftermath of the 1980s' farm crisis. The lives of rural families who suffered economic hardship and economic pressure caused many to face difficult choices in response to hardship. Multiple adjustments created significant pain for many of these families. This was evidenced by the extreme emotional distress among families who lost a farm as a result of the crisis. Rettig, Danes, & Bauer (1991) describes a resource exchange theory that outlines the dimensions of life quality and presents a multidimensional scale measure of personal evaluations of family life quality based on this theory. The scale includes items representing love, status, services, information, goods, and money resources received from the family. It is suggested that receipt of these resources satisfied personal needs for (1) love and affection, (2) respect and esteem, (3) comfort and assistance, (4) shared meaning, (5) personal things, and (6) money for personal use. Van Hook (1990) interviewed 49 adolescents (mean age 16.8 yrs) during the farm crisis. In 66% of the families, there was an increase in parental work responsibilities outside the family farm or business. Family tensions increased in response to the economic uncertainties and change in family roles. The farm crisis was an anxious time for Ss, who described major gaps in family and community information systems. Feelings of personal responsibility for family economic problems were found in 63% of the Ss. The determination of Ss to prepare to cope with an uncertain and unfair world may involve the shift from farming to other occupations. Increased levels of anxiety, depression, and suicide attempts make this a high-risk population during difficult times. Cecil (1998) describes the development and implementation of Stress: Country Style , an Illinois program designed as a response to stress problems among farm families created by an economic downturn. The program involved a crisis line, outreach counseling, and community education about stress. The relationship between the program and community mental health centers is also addressed.

Successes and failures of the program are considered. Walker & Walker (1998) studied the self-reported incidence of stress-related symptoms in 476 male and 341 female farmers, and 70 male and 39 female urban residents. Close to 50% of the farmers reported the frequent to constant occurrence of the symptoms of trouble relaxing, loss of temper, and fatigue; over 30% reported similar occurrence rates for 6 additional symptoms. Self-reported symptom rates were significantly higher in farm women than in farm men, higher in younger farmers, higher in mixed farming operations, and higher in farmers who were holding off-farm employment. Symptom scores were significantly higher in the Pagina 21 10 Crisis In The American Heartland: Introduction farmers compared with the urban Ss. Scores on five symptoms distinguished farm and urban Ss. Walker & Walker suggest that the chronic stress associated with the farm financial crisis may have caused a high self-reported incidence of symptoms among farmers. Loeb & Dvorak (1987) discuss the high level of stress experienced by many of today's farm families. They suggest that health professionals should be aware of the current situation to deal effectively with the farm family as a unit. Therapists must be well-versed in farm family dynamics before they can understand the impact of external factors. The following topics are of importance: the economics of farming, the farm family (husband, wife, in-laws, adult children), communication in farm families, and health issues. Loeb & Dvorak conclude that there is no end in sight to the farm crisis and that many more families will need support from trained experts in the future. Hargrove (1986) examined the myth of rural communities uniting under stress and suggests clinical and community activities for mental health workers during farm crises. A model for understanding human reaction to natural disasters is useful for understanding response, recovery and community cohesiveness following such crises. Hargrove suggests that the clinical/advocate model developed by GB Melton (1983; see also PA, Vol. 61:9256) provides a useful perspective from which s funcioneze. Olson & Schellenberg (1986) examined stressors in farm environments, using data from questionnaire surveys of general, familial, and extrafamilial farm stressors. General stressors include problems such as machinery breakdown and harvests, while familial stressors involve role incongruence and conflict. discussion of extra-familial stressors emphasizes financial stressors and farm financial crises. Olson & Schellenberg suggest that financial stressors are becoming more intense relative to familial factors because of farm crises. They consider directions for community psychology in terms of four types of programs aimed at preventing or alleviating farm financial stress: General education/socialization Individual skill training Development of supportive social agencies Political action They also note the importance of a multiple program approach emphasizing

early detection of farm financial stress. Pagina 22 Background and Overview 11 Farmer (1986) suggests that farmers who have failed in the farm crisis of the 1980s blame themselves, although even top producers and managers had been afectate. The prevalence of depression is not surprising considering the severity of the losses, the prolonged nature of the stress, and the minimal control farmers have in overcoming their problems. Participation in farm support groups may be effective for families working through a fairly predictable grief cycle involving denial, anxiety, guilt, anger, hostility, confusion, and depression. Internal and external threats could soon squeeze some ranch and farm families out of business. To assist ranch families with these threats and with amiably transferring the operation to the next generation, Zimmerman (1984) offers a six-step Consensus Management Model that combines strategic planning with psychoeducation/family therapy. A pilot test with an intergenerational ranch family indicated improvements in family functioning, including reduced stress and depression, and improved self-esteem and family coping levels. Mental Health, Stress, Anxiety, and Cross-Cultural Variables in Rural Areas of the Western United States There has been increasing interest worldwide in recent years in the development of comprehensive mental health programs. In a pluralistic society like the United States, successful intervention will quite often depend on how well the therapist knows and understands the client's cultural or ethnic group. Rural areas of the western United States add still another dimension with sometimes large geographical areas populated with diverse ethnic and cultural groups. The American west has been portrayed in song, story, speech, myth, legend, and films. From the classic tales of Mark Twain to the legends of Butch Cassidy to Native Americans to films about western women, schoolmarms, and prostitutes to the major epic dramas of United States history, the American west has held a fascination for people from many cultures. The west, though, has a reality of its proprii. The myths and legends were created, but the reality doesn't always fit the or even the general concept of what the west may be like.myth or legend modern west is changing as man seeks to use and/or change the environment. The physical aspects of our environment are a large part of an individual's experien. They have an impact on the individual and the amount of stress and anxiety experienced. One aspect of the physical environment, ie population Pagina 23 12 Crisis In The American Heartland: Introduction density, appears to have negative effects on feelings of personal security and on affiliative and other social responses to individuals or groups. There has been relatively little research on crowding which has focused on individual and cross-cultural differences. Evans (1978) found evidence that young children may be more adversely affected by crowding than older persons. Cu toate acestea,

this may only be indicative of western cultures. Children in Kung society (Draper, 1974) apparently do not suffer any ill effects from crowding. Studies of crowding in Chicago (Galle, Gove, and MacPherson, 1972) support the hypothesis that pathology tends to increase as the population density increases. This relationship appears to work the other way in the Netherlands (Levy and Herzog, 1974). ntr-un study done in Hong Kong, no adverse effects were found as the result of high population density (Mitchell, 1971). The environment is the source of many stressors which can initiate a variety of reactions. These reactions may range from endocrine secretions to such things as complicated appraisals and evaluations of the sources. These reactions to stressors may be physiological (Selye, 1956) and/or psychological (Lazarus, Opton, & Tomita, 1966). Few investigators have attempted to study all aspects of the stress process simultaneously. Stressful responses can be evoked by the changes and challenges that one experiences in daily life. They can be caused by the disruption of one's habits (eg unpredictable noise or crowding). Malfunctioning of social systems which place may deprivation, losses, and culturally-governed mores obstacles in one's path also contribute to stressful responses. Stressors may be intrusive, physical, and universally threatening (eg natural disasters). Others may be more culturally determined, less universal, and more psychosocial in nature. Aiello and Thompson (1980) found that varying intensities of crowding and proximities in spatial invasion are specific to cultural norms and meanings. The obvious lack of relative crowding and the presence of generous open space in western rural areas would seem to offer escape from the stressors generally associated with urban areas. The lessening of noise factors, crowding, and other variables associated with stress production would seem to enhance the quality of via. In fact, these have been some of the traditional reasons why people have sought out rural areas for rest, relaxation, and vacations. Ranchers and farmers have tended to form small close communities which have supported their way of life and provided for mutual support. Depending on their cultural heritage, they have developed and maintained values and attitudes Pagina 24 Background and Overview 13 congruent with their way of life. Other groups (eg Mexican Americans) have been generally successful in preserving their cultural heritages while attempting to adapt and adjust to changes in the United States' society. Others (eg Native American groups) have maintained their culture in varying degrees and, in many cases, in relative isolation from the mainstream of the US society. Much of the history of the United States is concerned with the westward expansion of a civilization that had its beginnings on the eastern shores of the North American continent. The Spaniards were the first men of European origins to penetrate the vast regions between the Rocky Mountains and the Pacific Ocean. Ca late as the 1820s, very little exploring had been done in the far west. In many cases, the terrain was found to be rough and rugged, and resources were scarce in the beginning. Communities were separated by great distances and travel was difficult,

at best, by today's standards (Hulse, 1990). Today, in many areas of the western United States, rural towns and communities may be separated by as much as 100 miles or more. Many of these towns are farm and ranch centers or mining towns. There is often a shortage of physicians, psychiatrists, and psychologists, as well as other mental health related services and trained personnel. An increase in population in a number of areas within the past 1520 years has placed a tremendous strain on many local resources. The need for effective community counseling programs in rural areas of the western United States has been increasing. This is, at least partially, due to stressors placed on old timers and newcomers alike. The rapid growth in some areas is exacerbated by rapidly fluctuating economic changes. As more people enter an area, they tend to overwhelm old timers who, quite often, are left bewildered and lost in a community which once was theirs. Newcomers have difficulties dealing with scarce or nonexistent services and resources as well as a lack of adequate housing. Tensions develop over these areas as well as from a clash of values. There is a need for adequate and effective community counseling centers to address these problem domenii. Human services in any community cover a broad area. In addition to mental health services, such services may include law enforcement, legal services, social services, public health, recreation, youth services, local government, educational services, and services for senior citizens. These services have generally been provided informally or through institutions. When rapid community growth occurs, the size of the local population may increase at a rate which causes people's problems to increase tremendously with a resultant strain on existing community resources. Page 25 14 Crisis In The American Heartland: Introduction In areas of rapid development, there tends to be a rapidly developing shortage of adequate and reasonably-priced housing. Rentals become high and crowding develops (Uhlmann, Doherty, and Hill, 1977). Recreation presents other problems. Citizens of rural communities in the west have traditionally engaged in recreational activities such as camping, fishing, and hunting. Newcomers tend to have a different set of interests (eg bowling alleys, theaters, swimming pools, and handball courts). Communities which can't provide these types of activities may find newcomers taking advantage of more easily available diversions such as drinking, gambling, and prostitution (Uhlmann, 1977). Uhlmann (1977) pointed out a number of significant problem areas in her analysis of the delivery of human services in Wyoming boom towns. A review of her report points out the potential sources of stress and other mental health related problems encountered in western rural communities experiencing rapid growth. Ea found that mental health problems in rapidly developing communities include an increased incidence of depression among women and a rising rate of alcoholism among males. She also found an increase in family crises and that children and adolescents are at risk for an increased incidence of behavior disorders and social maladjustments. Newly arrived young adults (1826) were found to face problems as a result of few, if any, solid interpersonal relationships. They frequently became

involved in drug and alcohol abuse. Uhlmann found that public assistance through social services was drastically reduced and that there was frequently a lack of adequate medical personnel. She found that schools experienced difficulties as a result of a rapid growth in student population. At the high school level, the dropout rate tended to increase as young people were attracted and drawn off by employment opportunities in the area. Uhlmann suggested that law enforcement personnel in rapidly developing communities may have to deal with problems they have not encountered before and may be hampered by inadequate training, low salaries, and a high turnover of personnel. Poor and/or inadequate facilities (eg jails, juvenile detention, and foster homes) were seen as making the job of law enforcement more difficult. Uhlmann has also suggested that local governments in small rural communities may not have the administrative structure necessary to deal with the new and critical demands placed on them by a rapidly growing population. In the past, rural communities in the western United States were frequently characterized by a large population of senior citizens. Uhlmann suggests this occurred because young people left the community to seek better employment Pagina 26 Background and Overview 15 n alt parte. However, it seems that when a rapid increase in population due to development occurs, this process is partially reversed. Senior citizens may be forced to leave the community due to a rising cost of living. Such a process of demographic change was observed in three Wyoming communities (Uhlmann, Kimble, and Throgmorton, 1976; Uhlmann, Doherty, and Hill, 1977). Other problems associated with rapid population growth include a sense of a decreasing quality of life. Rapid growth brings rapid change. Many impacted communities have stressed decline and loss. The negative effects such accounts point out usually include: a speeded-up pace of life, congestion and overcrowding, inflation in prices, fear of change in life style for present residents, lack of activities and sense of belonging for newcomer families, alcoholism and mental health problems ( HUD Program Guide , 1976). Increased incidents of severe depressions and alienation of both old-timers and newcomers may result in we-they conflicts. Traditional agencies and persons who have dealt with the above problem areas may not even exist in such communities. Many of these small rural communities have long been used to everyone taking care of themselves. Existing agencies may find their caseloads overwhelming. Communities which are impacted need help in defining future problems, predicting the magnitude of such problems, and designing and implementing programs and mechanisms to alleviate the problems. Uhlmann (1977) suggested that most of these problems develop because communities don't have the time to develop financial resource bases and local attitudinal support for needed services. She also suggested that problems occur due to the changing composition of local populations. She pointed out that all of the factors reviewed above bring about increased demands for human services in impacted communities. Stress and Rural Areas

Stress in rural areas is often overlooked due to smaller populations. De exemplu, Nevada has a history of boom and bust dating back to the middle of the nineteenth century (Hulse, 1990). As a state, it has managed to grow and expand its interests. Although geographically rugged and sparsely populated, it has maintained a rich culture and a pluralistic society. Basque sheepherders in the north, cattle ranchers, miners, Mexican Americans, Chinese Americans, Japanese Americans, Shoshone, Washo, and Paiute Indians, and many other groups add to the color and richness of Nevada culture. Pagina 27 16 Crisis In The American Heartland: Introduction Over the years, an expanded effort has been made to develop and maintain mental health services in rural areas (Doherty, 1984). Fluctuations in the economy have stressful effects on the small rural communities. Growth and decline of communities have a psychological impact on those directly affected. Oameni experience this stress and anxiety differently, depending on a number of factors. One method of studying perceived stress and anxiety is to use a self-report indicator such as Spielberger's (1970) State-Trait Anxiety Inventory (STAI). Spielberger (1970) states that Trait anxiety tends to be relatively stable and indicates a tendency to respond to situations perceived as threatening with elevations on the State scale. McClelland & Atkinson (2000) suggest that trait anxiety has the characteristics of a class of constructs which they term motives. They define these as dispositions which remain latent until they are activated by cues in different situations. Campbell (See Spielberger & Bale, 1970) calls these acquired behavioral dispositions. According to him, they involve residues of past experiences which tend to predispose individuals to view the world in a particular cale. They also tend to predispose an individual to manifest what he calls object consistent response tendencies. In other words, trait anxiety is like potential energy. It suggests differences between people in the disposition to respond to stressful situations with varying amounts of state anxiety (Spielberger & Bale, 1970). Persons with high levels of trait anxiety tend to be more likely to respond with an increase in state anxiety intensity in situations that hold a threat to their self-esteem (Spielberger & Bale, 1970). Whether persons who differ in trait anxiety differ in a similar way for state anxiety depends on the extent to which they perceive a specific situation as threatening or dangerous. This is strongly influenced by their past experiences. Attitudes toward the sources of stress tend to mediate the responses. If an individual or a group believes that a stressor will cause no permanent harm, the response will probably be less extreme than if the danger poses the threat of lasting harm. Psychologically, the perceptions of control, social support, and other characteristics of individuals exposed to stressors will affect their evaluation of different stressors. Perceived control can be a powerful mediator of stress. That is, it can provide the individual, or group, with a sense of being able to cope more effectively. Adequate needs assessments, community planning, and allocation of available human resources can help prevent and alleviate potential problems and stressors

associated with rapidly growing rural communities. Such activities can give Page 28 Background and Overview 17 communities perceived and actual control over their futures and can contribute to the well-being and mental health of the whole community. Changing Roles In a longitudinal study, using preferences for living near family and in the local community obtained in the 8th and 11th grades, Elder, King, & Conger (1996) modeled the social and developmental pathways by which adolescents approach decisions to leave home and settle in other parts of the country. Data come from 351 two-parent families in the Iowa Youth and Family Project, launched in 1989 to investigate the economic stresses and family consequences of the farm crisis. Lack of socioeconomic opportunity; relatively weak and declining ties to parents, kin, and the religious community, and strong educational prospects emerged as strong sources of a declining preference for living near family and in the local community among boys and girls. Whether coupled with family attachments or not, plans to settle elsewhere after education were linked to more elevated feelings of depression and unhappiness about life. Conger, Elder, & Lorenz (1994) examined the plight of several hundred rural families who lived through the years of economic hardship in the mid-1980s. participants in the Iowa Youth and Families Project included farmers, people from small towns, and those who lost farms and other businesses as a result of the farm crisis. Conger et al traced the influence of economic hardship on the emotions, behavior, and relationships of parents, children, siblings, husbands, and wives. Ei interviewed four members in each of 451 rural families. All of the families in the study included a seventh-grade adolescent, when they were interviewed in 1989. n addition to this target adolescent, both parents of the seventh-grader and a sibling within four years of age participated in the study. They were particularly concerned with the quality of social relationships, both within and outside the family, that might affect the various linkages in their theoretical model of family economic stres. Cook & Heppner (1997) investigated the role of coping strategies, perceived control, and problem-solving appraisal in farmers' career transition processes. sample, examined previously by PP Heppner et al (1991), included 79 male and female farmers (aged 39.2 and 41.6, respectively) who were participating in career transition workshops. Relationships among the three variables and an outcome variable, depressive symptomatology, were examined. Significant correlations were found between problem-solving appraisal and all other variables in this study. Page 29 18 Crisis In The American Heartland: Introduction Coping strategies were found to be related to depressive symptomatology. ntr-un regression equation, only coping strategies contributed significantly, and no significant interaction was found between coping strategies and perceived control as hypothesized.

McInnes (2000) focused on the complex dynamics related to the family farm and their effect on the rural couple's relationship. The typical relationship examined was where the man is from a farming background and the woman from the city, or, if originally from the land, has lived or studied away from the district and been independent. The challenge for the counselor is to work with the two levels the couple bring: The couple's 'individual' story The larger context, including the man's family of origin, the family farm, the rural community, and the rural crisis nationally. A case study of the typical couple's process and outcome in counseling was furnizate. It was concluded that the traditional stories about men, women, and relationships that once ordered the lives of couples on the land are no longer valid in times of enormous social and political change. In life course theory, the principle of human agency states that individuals construct their own life course through the choices and actions they take within the constraints and opportunities of history and social circumstances. Elder & Russell (2000) explore the implications of this principle, drawing upon three other principles of life course study: The location of individual lives in historical time and place. The differential timing of lives through events and experiences. Linked lives. They focus on two historical periods in which adolescence was shaped by the agency of young people and their opportunities and constraints: the Great Depression of the 1930s, and the Great Farm Crisis and rural decline of the 1980s and 1990s. The resulting portrait is documented by research on lives in changing times over three decades. Within these historical eras, Elder & Russell view the agency of youth in terms defined by specific historical times and places. World War II played a major role in structuring pathways out of Depression disadvantage. Fifty years later, migration to urban areas of economic prosperity provided a general escape route for youth in the disadvantaged rural Midwest of the US. In each era, Pagina 30 Background and Overview 19 societal changes left their mark on the expression of human agency in youth's negotiation of adolescence. Conger, Rueter, & Conger (2000) present research from the Iowa Youth and Families Project (IYFP), a longitudinal study of Iowa families who were living in small towns and on farms during the farm crisis of the 1980s. The research was designed to assess how the macrosocial change and economic upheaval that occurred across the US during the 1980s influenced family functioning and the wellbeing of parents and their children. It describes the empirical and theoretical foundations for the Family Stress Model. The sections that follow summarize findings from the IYFP and other studies relevant to the various processes and mechanisms proposed in the Family Stress Model. They also consider research on hypothesized protective mechanisms or dimensions of vulnerability that may moderate the causal linkages proposed in the theoretical model. After reviewing the

possible applied significance of this work, they close with a discussion of conclusions that can be drawn from the research conducted thus far and the implications of these findings for future investigations of family economic stress. In another example, the crisis in the farming industry in the Netherlands has had far-reaching negative consequences for the well-being of farm-families. Bazat pe identity-theory, Gorgievski-Duijvesteijn (1999) hypothesized that job-involvement (the psychological importance of the professional role) would intensify the negative relationship between role-relevant stressors and well-being. Specifically, 107 Dutch, self-employed dairy farm-couples (mean age 52 yrs for husbands and 49 yrs for wives) participated in a study that examined whether job-involvement exacerbates the negative effects of three role-relevant stressors (potential threats to business continuity, restrictions on autonomy as a self-employed person, and financial problems) on two indicators of well-being (job-related worrying and mental health complaints). Gender differences were also explored. Results show partial support for the hypotheses derived from identity-theory in that job-involvement only exacerbates the positive relationship between financial problems and job-related worrying for both spouses. No other moderating effects of job-involvement were gsite. Although husbands were more involved in farming than wives, the direct effect of the three role-relevant stressors on the two indicators of well-being were similar for both spouses. During economic downturns, traditional gender allocations of labor have been considered to vary more than in prosperous times. While most studies have examined the division of labor in the household or in paid employment, Lobao & Pagina 31 20 Crisis In The American Heartland: Introduction Meyer (1995) examined it where both intersect, in family-owned and familyoperated enterprises in the farm sector of the 1980s. This context, combining crisis conditions and the agency of economic actors, should be related to greater flexibility in labor allocations, leading to the feminization of farming. However, a contrasting perspective argues for rigidity of gender roles in farming. Lobao & Meyer use data from a twelve-state midwestern sample and a more detailed Ohio studiu. The results failed to support the flexibility thesis. The rigidity of production roles was further translated into different factors related to women's and men's stres. DeFrain & Schroff (1991) examined how city life and country life differences influence parents in their efforts to rear children as well as endeavor to paint a more realistic picture of rural life. They begin with a section on the impact of urbanization on fathers and mothers in the United States, discussing the pluralistic nature of the city, the increased leisure of urban youth as compared to rural youth, the power of the youth peer group in urban areas, the impersonality and anonymity of the city, the pervasive nature of the urban mass media, and the urban ghetto. They focus on the positive aspects of urbanization: the advantages urban organization offers families and the relative affluence of the city compared to the ar. They discuss special problems of rural fathers and mothers in the United States, including the dramatic decline in the farm population, the most recent wave

of the continuing farm crisis, agricultural fundamentalism, resettlement, the impact of urbanization on farm parents and their children, the fact that the farm parents often find themselves preparing their children for an urban-industrial world that they themselves do not fully understand, the difficult realities of the rural economy today, and rural social class barriers farm families face. Willson (1928) deals with the education of farm children and the relation of education to the migration of farmers to non-farming occupations. It is based upon original research of the author for Western North Dakota (N. Dak. Agr. Exper. Sta. Bull. 214, 1928) during the agricultural depression of 19201926. The data show that improved agricultural conditions and better financial returns from farming result in improved educational facilities and increased grade and high school attendance by farm children. A decrease in the number of farms did not operate to deprive the children of grade school education. The amount of high school education is decreased as distance from secondary schools and the proportion of foreign-bornespecially the Russianswithin the community are increased. percentage of farm children in high schools is increasing. The percentage of farm Pagina 32 Background and Overview 21 children entering non-farming occupations increased directly with the amount of education they received. A point demonstrated in this study is the relationship between the ability to survive the agricultural crisis and type of family organization. The married individuals, who had children, survived the depression best of all. Some Different Approaches Peeks (1989) posits that school counselors must be ready to work with children of farm families in crisis to direct solutions to the presenting problems and provide the family with hope for the future. She notes that the problem of the student from a farm family can be viewed as a metaphor (mirroring the parents' own fears about the future and feelings of hopelessness) and a form of protection (diverting parental attention toward a solvable problem). Mermelstein & Sundet (1998) focused on the decision criteria that influenced 118 directors of rural community mental health centers (CMHCs) as to whether to adopt innovative programming with regard to the crisis among farmers. Cinci criteria were postulated as independent variables: Compatibility with the director's values Relative advantage Observability Feasibility Trial-ability of the innovation The dependent variables were the amount and type of farm crisis programming and the date of introduction into the Community Mental Health Center (CMHC). Findings demonstrate the widespread failure of CMHCs to respond effectively to mental health concerns arising from massive environmental stress. Impediments to innovation appear to be a real or perceived paucity of resources and a mentality favoring existing programs. Peeks (1989) reviewed the transitions faced by adults from farm families whose

farms have failed in the agriculture crisis, including career transition, relocating, a redefined lifestyle, and refocusing on future goals. Students' school problems are discussed as behavioral metaphors for the family's crisis, and a school-based strategy for counselors to help students, whose problems are related to the family transitions, is described. Six strategic interventions are presented for solving student problems by inviting the parents to school and focusing on positive problemsolving. Pagina 33 22 Crisis In The American Heartland: Introduction Paulsen (1988) asserts that the rural crisis is creating new numbers of rural individuals who are in need of assistance as they cope with the stress of economic dislocation and the overwhelming difficulties that occur after the loss of a farm or de afaceri. Individual, family, and community treatment aspects are discussed within the thematic context of a culture in crisis. An urban-based regional family service agency, Farmers Helping Farmers, is presented as an example of a system's response to the rural crisis. The proposed treatment involves a multilevel community response that includes self-help support groups, instruction of adaptive coping skills, and sharing information in rural communities. Mental health professionals are challenged to further their understanding of the rural crisis and to adopt more flexible treatment strategies to encompass a multilevel system's response. Jurich & Russell (1987) evaluated 15 farm families, who underwent therapy at the Kansas State University Family Center, using a model of family adaptation to stress by HI McCubbin et al (see record 1981-30250-001). Major interventions included reframing, mobilizing resources, and utilizing less indirect means of intervention. Ss showed a greater increase in well-being at three months than did a general sample of clients. However, stress levels were not lowered as much as the general sample and life satisfaction was lower at follow-up than the general populaie. Davis-Brown & Salamon (1987) argue that families' responses to the loss of their farm due to the agricultural crisis depend on whether shared agricultural goals originate primarily from financial or familial motivations. Salamon's (1985) farm management style types are combined with a family stress model by McCubbin and Patterson (1983) to develop a framework for identifying contrasting capabilities and definitions possessed by families holding divergent agricultural goals. O instrument based on the application of stress concepts to farm family research is presented for use in counseling families who lose their farms. Rosenblatt (1990) offers testimony from 42 adults in 24 Minnesota farm couples that were caught in the farm crisis. They speak of how they struggled economically, what they understood and felt about their economic situation, and how their relationships within the family and outside of it were affected by the economic dificulti. The purpose was to go beneath the statistics, to record people's experiences, feelings, and reflections in their own words, and to understand what happened to them as individuals and families. That understanding has implications for policy, service delivery, and community action. Extensive face-to-face interviews were carried out in 1986 by three graduate students in the Department of Family

Pagina 34 Background and Overview 23 Social Science at the University of Minnesota. Telephone follow-up interviews were carried out in the latter half of 1987 and early part of 1988 with adults in 23 of the 24 households. Interviews were wide-ranging but focused mainly on the history of the farm operation, what happened in family and community relationships as economic difficulties developed, problems with lenders and creditors, and personal feelings and reflections as things happened. People were also asked to fill out a checklist of feelings, personal reactions, and aspects of family relationships that might be influenced by the crisis. Ferguson & Engels (1989) discussed the 1980s farm crisis that had large numbers of farmers and their families abandoning farming due to new and frequently unmanageable economic realities. Selected issues were discussed with regard to farmers who: Were then working and living on family farms Were being or had been forced to pursue other occupations Ferguson & Engels note that farmers are at a geographical disadvantage for receiving mental health and career counseling services, and most traditional support services are centered in keeping farmers in agriculture. Counselors and state and national counseling organizations need to consider pro bono and sponsored approaches for working with farm families. Farmers might benefit from modification of programs aimed at adult education, career development, retirement, and separation and grief. Van Hook (1987) used the ABCX family-crisis model developed by Hill (1949) to identify needs and design intervention strategies while long-term solutions to the crisis are being developed. Basic to the model is the concept that each event has not only an external reality but an internally experienced reality as well. Van Hook suggested that focusing on the family unit strengthens both individual and family resurse. Because many farm families have considerable strengths, relatively small intervention efforts may be needed to enable them to mobilize for survival. Telecounseling Counseling by telephone further lends itself well to disaster and traumatic response. Because victims may be overwhelmed by immediate on-site counselor response and may need time to grieve or otherwise react, providing the means to follow up by telephone at one's convenience as needed has strong appeal. A system of referral through such methods as distributing business-sized cards at the site with Pagina 35 24 Crisis In The American Heartland: Introduction an 800 number to call when needed and in which the client initiates the process is both responsive and unobtrusive. Despite all the challenges involved, a counselor-staffed telephone-response system to disaster and trauma offers supports long after the crisis. Astfel de telecounseling offers them support immediately, when the victim is in crisis, conveniently, and anonymously. It cuts through distance, class, appearances, and

resistances to therapy. It is a lifeline to engaging the victim at any point. Telephone counseling additionally presents itself well to disaster and traumatic response since victims may initially be overwhelmed by their experiences and be resistant to using treatment; yet may later need to access counseling services. Through telephone contact, this can be done in a non-threatening way as their grieving and symptoms unfold. As a result, telephone counseling is both responsive to the victim and can be an effective point of access to the therapeutic process. To summarize, it is important that the mental health profession be aware of the socially, economically, community-wide, and on factors involved in rural crises other related variables. Providing appropriate responses, approaches, methods, and programs that are individualized for communities and individuals is important in these times of change and increased levels of stress. Rural Trauma Background and the Problems Within one year, in the early 1990s, a small rural American town experienced a series of traumatic events. A number of individuals put in much time and effort toward a crisis plan, known as the Trauma Intervention Plan , which ultimately failed. Taplitz-Levy (2002) explored the factors that added to and detracted from the success of the specific school-based collaborative intervention and research proiect. The attitudes of crisis team members toward the crisis plans, collaborative work, and research were examined using a series of qualitative research methods. Through qualitative analysis of the data, results show that the Trauma Intervention Plan was hindered by poor communication, a lack of trust, and poor historical relationships between the school team and the out-of-school consultants. TaplitzLevy's study gives compelling reasons for school personnel and local community mental health staff to develop positive relationships. In June 1981, southeastern Kentucky experienced serious and widespread flooding. In May 1984, a storm system brought tornadoes, strong winds, and Page 36 Background and Overview 25 severe, extensive flooding to this same area. Norris, Phifer, & Kaniasty (1994) studied the psychosocial impact of these events. Their study had three features that hold particular promise for increasing what we know about the effects of disaster: The study's prospective and longitudinal design Its consideration of both individual and collective aspects of disaster expunere Its focus on older people (age 55 or older) This study addressed the following questions: What impact did these two floods have upon the mental, physical, and social functioning of the rural Appalachian victims? Were these individuals able to take these events in stride or did they present a serious challenge to their ability to cope? Did these floods leave a lasting impact on the mental and physical well- being of these individuals or did they only result in relatively minor and short-lived emotional upset?

Were some people more affected than others? Were these communities able to rally around their members or were they shattered and split apart? In September 1991, in the small rural town of Hamlet, NC, a fryer exploded at a chicken processing plant, killing 25 employees and injuring many more. Acest disaster stirred national attention, influenced state law and inspection policies, and profoundly affected the entire community. Derosa (1995) examined the relationship between PTSD and the survivors' subjective experiences of the trauma, their search for meaning, and their perceptions of self, of others, and of the world around them. They attempted to capture the survivors' experiences of themes such as rage, grief, and a belief in a benevolent world, in conjunction with clinical diagnosis of PTSD (using the SCID interview) in order to assess the buffering or exacerbating influence of the subjective experience. Seventy-eight subjects included the plant's employees, relatives of employees, rescue personnel, and relatives of fire/rescue personnel. Ei examined several categories of variables: Unresolved trauma themes 'Pre-fire' variables including neuroticism History of traumatic experiences Pagina 37 26 Crisis In The American Heartland: Introduction Previous psychiatric treatment Peri-traumatic variables including dissociation injury, and , fear of level of exposure to the fire Types of social support Demographics The most robust variables contributing to lifetime diagnosis of PTSD after the fire were having lower socio-economic status, being female, feeling little social support, fearing death/injury, and dissociating during the fire. The only significant contribution to the model for chronic PTSD was the number of unresolved trauma themes. The degree to which the trauma themes remained maladaptive varied by the severity of diagnosis. Exploratory cluster analyses of patterns of unresolved themes among survivors and their families suggested that in addition to the number of unresolved themes, the pattern of thematic resolution is associated with diagnosis. In 1992, El Salvador ended a twelve-year civil war which caused tremendous social upheaval. Approximately 50,000 civilians were killed, 500,000 displaced, and 750,000 to one million left the country (Lundgren and Lang, 1994). impact of the violence left many survivors with traumatic emotional problems. Oakes (1998) studied three rural communities in El Salvador. She examined the emotional reactions of eighty respondents to war, analyzing the data from the point of view of respondents. Respondents included those who had only indirect war experiences, those who experienced occasional traumatic events during the war, and those who lived in a war zone and had continuous and extreme experiences during the war. Respondents reacted to everyday events, violence, and war with an escalating pattern of emotions. This pattern began with worries often connected to

everyday events, then fears often related to violence, and then to emotional states including ataques de nervios and affliction, and finally to sadness caused by loss. Some physical reactions related specifically to war, such as jumping at noise; while others, such as headaches, were experienced by all, regardless of the amount or type of war experience. Past war experiences often affected how respondents reacted emotionally to everyday events in the present, especially when those events were linked to danger or violence. Respondents who had only indirect exposure to war reacted to present and future events only occasionally and mildly through the standpoint of past events in war, while individuals who had prolonged and extreme war experiences reacted to present and future events much more intensely and regularly through the viewpoint of war. In an additional analysis of a small group Pagina 38 Background and Overview 27 of respondents who had lived through extreme warfare, Oakes reported that they had few emotional reactions to normal events that they did not relate to war. Ea suggested that the sum of many people's emotional reactions, therefore, may cause such configurations of people to have reactions to events that are not based on present reality. Since 1994, lethal violence toward people suspected of witchcraft has escalated in rural communities in South Africa. Hundreds of older people believed to be witches have been burned to death and thousands, who escaped death, have taken refuge in government established camps. Hill (2000) examined a group counseling approach that promotes sustainable reconciliation with traumatized individuals in communities divided by violence due to witchcraft persecution. Specifically, Hill examined a single case sample of a group counseling session aimed at reconciliation. Fifteen group members included individuals from conflictual parties from geographic areas in South Africa where there are witch burnings. Beyond the 15 group members, 11 other participants rated the group session and its potential for fostering sustainable reconciliation. These 11 individuals were divided into two groups: American student raters (N = 3) South African observers (N = 8). This study was constructed as a 10-step process of data gathering and a constant comparison (Strauss & Corbin, 1994) of data categorized by all participants. As defined by Glaser and Strauss (1967), the Grounded Theory methodology allowed for an emergence of common themes across raters that could be related to theories for sustainable reconciliation, trauma counseling, group process, and witchcraft persecution. The results of this study suggest that sustainable peace is possible using the reconciliation group counseling approach. With these specific types of groups, special consideration must be given to leadership style, building safety, and including the entire community that has been affected by witch persecution. However, according to participants, reconciliation groups will fail if the fundamental reasons for the violence continue to go unattended (eg, poverty, unemployment, etc). Such fundamental issues perpetuate feelings of fear and hopelessness in community members, which fosters an unstable

mediu. These results suggest that therapists must understand the context of such violence, attend to the trauma symptoms of individuals, and perhaps play a supportive role in the group. The South African observers suggested that successive Pagina 39 28 Crisis In The American Heartland: Introduction counseling groups, with public admittance of behavior and retribution for losses, would be necessary before sustainable peace could be possible. The above studies have identified variables, approaches, and interventions, and make suggestions for a variety of events that produced trauma in rural areas. following section presents results of studies involving the effects of various traumaproducing events on children, parents, and families. Baden (1998) discusses how newspapers seem to be telling us that every cornfield is threatened by a Dairy Queen restaurant. This media barrage about the crisis of our shrinking farmland is traced to the 1979 publication of Where Have All the Farmlands Gone? by the National Agricultural Lands (NALS) Study. The NALS report, to which eleven federal agencies contributed, argued that land-use planning and control must be employed to protect valuable farmland from urban sprawl. Baden's edited book, a collection of essays by a distinguished group of economists including Theodore W. Schulz, Julian L. Simon, and Pierre Crosson, takes issue with the belief that croplands need governmental protection. n opposition, the collection as a whole supports two theses: Shrinking farm acreage is not a serious problem Individual choices by landowners in a market setting result in better organized land use than would governmental land-use planning and regulation Throughout, large parts of the developing world's rural livelihoods are in crisis (Bernstein, Crow, and Johnson, 1992). Even in those parts of the third world where there has been growth of food output, that growth has rarely been translated into a commensurate expansion of livelihoods. Bernstein et al (1992) examined how people in developing countries survive and how their lives have been affected by the great changes since the World War II. They examined the diverse human implications of rural change, the various crises of rural livelihoods which arise from change, and the survival strategies of individuals and households. They describe the great processes of agrarian transformation which have fundamentally altered rural livelihoods in developing countries, identifying some of the dilemmas for public action which arise from agrarian transformation and the crises of rural livelihoods. The contributors draw on a range of disciplinary approaches to the subject including anthropology, sociology, economics, political economy, agricultural science, and development studies. Pagina 40 Background and Overview 29 Not only does the culture of rurality have differences from urban areas, but rural cross-cultural differences are also important in understanding and providing appropriate responses and services to residents of rural environments. Mai departe

attention and study of these areas as well as the awareness of what is already known is needed to inform mental health and other professionals working in these domenii. Domestic Violence Domestic violence and poverty are interwoven. Poverty makes it difficult to deal with domestic violence and undermines financial stability and possible strategies for effective change. Significant numbers of low-income women in the rural western US are battered, and the violence they experience can make their climb out of poverty impossible. Poverty, in turn, makes it more difficult to end domestic violence and heal its effects. Without long-term financial stability, reducing the risk of physical violence does not make battered women and their children safe. While focusing on physically separating the battered woman and her children from the abusive partner, most criminal justice interventions overlook basic needs: a roof over their heads, food on their table, or available health care. Partner violence is a serious mental and physical health concern leading to debilitating physical injury in women. Significant psychological sequelae are associated with battering. However, only recent investigations have begun to delineate the different types of psychological distress. The diagnosis of Posttraumatic Stress Disorder (PTSD) has been useful in characterizing the symptoms associated with victims of severe trauma. The DSM-IV criteria for PTSD include reexperiencing trauma, avoidance responses, and heightened arousal. Given the characteristics shared between battered women and other victims of violent crime, Presty (1996) predicted that battered women develop primary features of PTSD. The second hypothesis was that other women would meet DSM-IV criteria for Acute Stress Disorder (ASD). She also performed exploratory analyses to examine relationships between the frequency and severity of abuse and diagnostic categories. The results confirmed the two hypotheses. First, 65.6% of the sample was PTSD positive, with 5% meeting criteria for ASD. Other anxiety disorders accounted for 13.1%. The prevalence rate of Major Depressive Disorder (MDD) was 70.5%. comorbidity of depression with PTSD was 84.6%. Physical abuse significantly predicted PTSD development, explaining 11.4% of the total variance. Verbal abuse significantly predicted MDD. Dissociation was predicted by both verbal and Pagina 41 30 Crisis In The American Heartland: Introduction physical abuse. Exploratory cluster analysis revealed three typologies of battered women: Cluster 1 reflected young, poorly educated women, who experienced the greatest physical and sexual abuse. They had the highest levels of PTSD, moderate depression, and the poorest level of functioning. Cluster 2 women were the oldest, had the most children, and had the longest relationship duration. They experienced more verbal than physical abuse, and had the highest degree of depression, with modest PTSD severity. Cluster 3 reflected the youngest, most educated group, with the least number of children, and shortest relationship duration.

Wendt, Taylor, & Kennedy (2002) provide a critique of the Australian research into rural domestic violence. Research to date has focused on the factors that keep rural women trapped in violent relationships. While this research has been useful in developing policy to address rural domestic violence, it has not yet provided information about women's understandings of their rural contexts. Research into domestic violence is moving toward acknowledging and recognizing the complexities and differences between people's experiences. Wendt et al suggest that it is time to explore the differences between various rural regions and to move away from the assumption that there is one rural culture. They suggest that a move towards feminist post-structural perspectives has strengths in that it enables a focus on the meanings of rural cultures from the perspectives of women, who experience, and men, who perpetrate domestic violence. If these meanings become apparent, it may enable local solutions to be implemented and contribute knowledge and new ideas. Although it has been suggested frequently that certain aspects of rural culture present barriers to women escaping domestic violence, research has not yet focused on how rural culture affects women's experiences. Wendt & Cheers (2002) report a study that explored how 14 rural women experiencing domestic violence perceived local cultural beliefs and values, the extent to which they had internalized these, and how they believed rural culture affected them in their situations. Components of their local rural cultures that they identified as impacting on their experiences of domestic violence included: belief in the sanctity and permanence of marriage, the importance and privacy of the nuclear family, Christian doctrine, and preservation of intergenerational property transfer. Each woman's story shows that, while rural culture gave them strength to endure the violence, it also created internal conflicts Pagina 42 Background and Overview 31 between wanting to escape and the cultural beliefs and values that they had internalized. Also, they were afraid of community reactions in case they left. Consequently, they did not disclose their violent situation and persevered in them far longer than they thought they would have in a different cultural context. Youth Violence Slovak (2000, 2001, 2002) addressed gaps in the youth violence literature by exploring the types and levels of children's exposure to violence in a rural setting. She also examined the psychological trauma associated with exposure to violence. Her initial study (Slovak, 2000) was a secondary data analysis which utilized the rural sample (N=549) from a larger study. The larger study had conducted a 45 minute questionnaire with students in grades 3 through 8. The questionnaire was designed to tap into children's present and past exposure to violence as a victim and witness across the home, school, and neighborhood. This questionnaire also assessed children's trauma symptoms. Slovak found that children in the rural sample were exposed to high amounts of violence as both a victim and witness within and prior to the past year. n general, more boys reported being victims or witnesses to an at-least-sometimes violent event within the past year compared to girls, except for the act of being touched in a private place. In addition, more students in the lower grades reported being the

victims and witnesses of violent acts compared to students in upper grades. Studeni reported that home was the place where they were most likely to be victims of violence, with the school being the next most likely place to be victimized, at least sometimes. The neighborhood was reported as the least likely place for students to be victims of violence, at least sometimes within the past year. Students reported a different trend for witnessing violence. They reported that school was the most likely place to witness violence, with the neighborhood being second. The home was the site reported as the least likely place to witness violence, at least sometimes within the past year. Slovak also found that exposure to violence variables explained a significant amount of variance in anxiety, anger, dissociation, depression, PTSD, and total trauma score above demographic variables. This is consistent with the literature examining the association of trauma and exposure to violence. These findings can be utilized to inform policy, practice, and research conducted in rural areas. In addition, the documentation of children's exposure to violence in a rural setting can help banish the stereotype that rural communities are safe havens from violence. Pagina 43 32 Crisis In The American Heartland: Introduction Peltzer (1999) identified exposure to experiences such as violence and the consequences for health in children in a rural South African community. stratified random sample included 68 (46%) boys and 80 (54%) girls in the age range of 616 years. Their ethnicity was Northern Sotho. The interviews included the Children's Posttraumatic Stress Disorder Inventory and the Reporting Questionnaire for Children. They grouped experiences into either traumatic or other events. 99 (67%) had directly or vicariously experienced a traumatic event which included witnessing someone killed or seriously injured, a serious accident, a violent or very unexpected death or suicide of a loved one, sexual abuse or rape of a relative or friend, violent crime, child abuse, and other life-threatening situations. Scores on the Children's Posttraumatic Stress Disorder Inventory of 17 (8.4%) fulfilled the criterion for posttraumatic stress disorder (PTSD). 71% had more than one score and 53% had more than four scores on the Reporting Questionnaire for Children. Posttraumatic stress symptoms were significantly related to age and experiences such as those mentioned above. Gun Violence Slovak and Singer (2001) compared rural youth (Grades 3-8) exposed to gun violence and rural youth not exposed to gun violence on a number of variables: anger, anxiety, dissociation, depression, posttraumatic stress, total trauma, violent behavior, parental monitoring, and levels of violence in the home, school, and comunitate. One-fourth (25%) of the 549 subjects reported having been exposed to gun violence at least once. Youth exposed to gun violence reported significantly more anger, dissociation, posttraumatic stress, and total trauma. In addition, youth exposed to the violence of guns reported significantly higher levels of violent behaviors and exposure to violence in other settings and also reported lower levels of parental monitoring. This study contributed to the growing body of literature addressing the stereotype that rural communities are not immune to the violence of

firearms. This stereotype can act as a barrier to mental health practice, research, and policy issues in rural communities. Slovak (2002) investigated the relationship between access to firearms and parental monitoring on rural youths' exposure to gun violence and examined the effect of gun violence exposure on the mental health of these youths, She administered a survey to 162 students (mean age 14.3 years) who participated in a student assistance program that provided in-school support groups for students in grades 6 through 12. Her results show that a substantial number were exposed to Pagina 44 Background and Overview 33 gun violence and exposure was significantly related to firearm access and parental monitoring. Furthermore, gun violence exposure was significantly associated with trauma among the youths. Implications for mental health workers include advising high-risk clients and their families on gun removal and safe storage practices. Suicide/Murder in Rural Areas Suicide can occur as a response to increased perceived stress and can also be a response to a severe loss. Treatments for suicidal ideation in rural areas are very limited. Dimmick, Burgiss, & Robbins (2003) assessed the impact of a suicide intervention program from a consumer perspective. Self-administered questionnaires were distributed to consumers who had been referred to a suicide intervention counselor in the two-year period of the program in rural southwest Western Australia. 35 patients completed and returned the questionnaire. Three-quarters of respondents were positive about their experience with the service, with half of the respondents no longer having thoughts of suicide and only 20% of all respondents reporting having attempted deliberate self-harm post-counseling. Reported suicidal ideation and attempted self-harm were much higher in the dissatisfied group. Dissatisfaction of respondents stemmed from the history of their treatment and the hassle created by the many systems for them to access care. However, the overall outcome of this study is that, from the consumers' perspective, a high-intensity approach to suicide intervention resolved or improved the presenting problem and their ability to deal with it. Ragland & Berman (1990-1991) examined the relationship between the farm economic crisis and farmer suicide rates, using data from 15 states in the US from 1980 to 1985. Suicide frequencies for farmers and two control occupations (forestry and transportation workers) were obtained. The 1980 US Census occupational population data were used to convert these frequencies into suicide rates. Sinucidere rates for farmers were greater than rates for transportation workers (truck drivers), but no different from rates for forestry workers. A significant positive correlation between the declining farm economy and increasing state suicide rates was also gsite. Page 45 Crisis In T Disas In R George

Rural practice presents important yet challenging issues for psychology, especially given uneven population distribution, high levels of need, limited availability of rural services, and ongoing migration to urban centers. It is critical that mental health professionals and first responders in rural areas become aware of recent research, training and approaches to crisis intervention, traumatology, compassion fatigue, disaster mental health, critical incident stress management, post-traumatic stress and related areas in rural environments. Critical issues facing rural areas include: Physical issues such as land, air, and water resources, cheap food policy, chemicals and pesticides, animal rights, corruption in food marketing and distribution, and land appropriation for energy development. Quality of life issues such as rural America's declining share of national wealth, problems of hunger, education, and rural poverty among rural populations of farmers and ranchers. Direct service issues include the need to accommodate a wide variety of mental health difficulties, client privacy and boundaries, and practical challenges. Indirect service issues include the greater need for diverse professional activities, collabor ative work with professionals having different orientations and beliefs, program development and evaluation, and conducting research with few mentors or peer collaborators. Professional training and development issues include lack of specialized relevant courses and placements. Personal issues include limited opportunities for recreation, culture, and lack of privacy. Geo R ge W . Face el rty , M S ,L P C Crisis I nT h eA

m eri c an H e AR T l and Disast er s & Ment al H e alt hI nR ural E n vironment s : An Introduction (V olume 1) RMR DMHIP Rocky Mountain Region Disaster Sntate Mintal Institute Press