Prosociality should be a public health priority

Kubzansky, L.D., Epel, E.S. & Davidson, R.J. 

Nat Hum Behav (2023).

https://doi.org/10.1038/s41562-023-01717-3

Standfirst:

Hopelessness and despair threaten health and longevity. We urgently need strategies to counteract these effects and improve population health. Prosociality contributes to better mental and physical health for individuals, and for the communities in which they live. We propose that prosociality should be a public health priority.

Comment:

The COVID-19 pandemic produced high levels of stress, loneliness, and mental health problems, magnifying global trends in health disparities.1 Hopelessness and despair are growing problems particularly in the U.S. The sharp increase in rates of poor mental health is problematic in its own right, but poor mental health also contributes to greater morbidity and mortality. Without action, we will see steep declines in global population health and related costs to society. An approach that is “more of the same” is insufficient to stem the cascading effects of emotional ill-being. Something new is desperately needed.

To this point, recent work called on the discipline of psychiatry to contribute more meaningfully to the deaths of despair framework (i.e., conceptualizing rises in suicide, drug poisoning and alcoholic liver disease as due to misery of difficult social and economic circumstances).2 Recognizing that simply expanding mental health services cannot address the problem, the authors noted the importance of population-level prevention and targeting macro-level causes for intervention. This requires identifying upstream factors causally related to these deaths. However, factors explaining population health trends are poorly delineated and focus on risks and deficits (e.g., adverse childhood experiences, unemployment). A ‘deficit-based’ approach has limits as the absence of a risk factor does not inevitably indicate presence of a protective asset; we also need an ‘assetbased’ approach to understanding more comprehensively the forces that shape good health and buffer harmful effects of stress and adversity.

A pdf is here.

My take:

Prosociality refers to positive behaviors and beliefs that benefit others. It is a broad concept that encompasses many different qualities, such as altruism, trust, reciprocity, compassion, and empathy.

Research has shown that prosociality has a number of benefits for both individuals and communities. For individuals, prosociality can lead to improved mental and physical health, greater life satisfaction, and stronger social relationships. For communities, prosociality can lead to increased trust and cooperation, reduced crime rates, and improved overall well-being.

The authors of the article argue that prosociality should be a public health priority. They point out that prosociality can help to address a number of major public health challenges, such as loneliness, social isolation, and mental illness. They also argue that prosociality can help to build stronger communities and create a more just and equitable society.

Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies

Joel, S., Eastwick, P. W., et al. (2020).

PNAS of the United States of America,

117(32), 19061–19071.

https://doi.org/10.1073/pnas.1917036117

Abstract

Given the powerful implications of relationship quality for health and well-being, a central mission of relationship science is explaining why some romantic relationships thrive more than others. This large-scale project used machine learning (i.e., Random Forests) to 1) quantify the extent to which relationship quality is predictable and 2) identify which constructs reliably predict relationship quality. Across 43 dyadic longitudinal datasets from 29 laboratories, the top relationship-specific predictors of relationship quality were perceived-partner commitment, appreciation, sexual satisfaction, perceived-partner satisfaction, and conflict. The top individual-difference predictors were life satisfaction, negative affect, depression, attachment avoidance, and attachment anxiety. Overall, relationship-specific variables predicted up to 45% of variance at baseline, and up to 18% of variance at the end of each study. Individual differences also performed well (21% and 12%, respectively). Actor-reported variables (i.e., own relationship-specific and individual-difference variables) predicted two to four times more variance than partner-reported variables (i.e., the partner’s ratings on those variables). Importantly, individual differences and partner reports had no predictive effects beyond actor-reported relationship-specific variables alone. These findings imply that the sum of all individual differences and partner experiences exert their influence on relationship quality via a person’s own relationship-specific experiences, and effects due to moderation by individual differences and moderation by partner-reports may be quite small. Finally, relationship-quality change (i.e., increases or decreases in relationship quality over the course of a study) was largely unpredictable from any combination of self-report variables. This collective effort should guide future models of relationships.

Significance

What predicts how happy people are with their romantic relationships? Relationship science—an interdisciplinary field spanning psychology, sociology, economics, family studies, and communication—has identified hundreds of variables that purportedly shape romantic relationship quality. The current project used machine learning to directly quantify and compare the predictive power of many such variables among 11,196 romantic couples. People’s own judgments about the relationship itself—such as how satisfied and committed they perceived their partners to be, and how appreciative they felt toward their partners—explained approximately 45% of their current satisfaction. The partner’s judgments did not add information, nor did either person’s personalities or traits. Furthermore, none of these variables could predict whose relationship quality would increase versus decrease over time.

Conclusion

From a public interest standpoint, this study provides provisional answers to the perennial question “What predicts how satisfied and committed I will be with my relationship partner?” Experiencing negative affect, depression, or insecure attachment are surely relationship risk factors. But if people nevertheless manage to establish a relationship characterized by appreciation, sexual satisfaction, and a lack of conflict—and they perceive their partner to be committed and responsive—those individual risk factors may matter little. That is, relationship quality is predictable from a variety of constructs, but some matter more than others, and the most proximal predictors are features that characterize a person’s perception of the relationship itself.

Psychological health profiles of Canadian psychotherapists: A wake up call on psychotherapists’ mental health

Laverdière, O., Kealy, D., Ogrodniczuk, J. S., & Morin, A. J. S.
(2018) Canadian Psychology/Psychologie canadienne, 59(4), 315-322.
http://dx.doi.org/10.1037/cap0000159

Abstract

The mental health of psychotherapists represents a key determinant of their ability to deliver optimal psychological services. However, this important topic is seldom the focus of empirical investigations. The objectives of the current study were twofold. First, the study aimed to assess subjective ratings of mental health in a broad sample of Canadian psychotherapists. Second, this study aimed to identify profiles of psychotherapists according to their scores on a series of mental health indicators. A total of 240 psychotherapists participated in the survey. Results indicated that 20% of psychotherapists were emotionally exhausted and 10% were in a state of significant psychological distress. Latent profile analyses revealed 4 profiles of psychotherapists that differed on their level of mental health: highly symptomatic (12%), at risk (35%), well adapted (40%), and high functioning (12%). Characteristics of the profiles are discussed, as well as potential implications of our findings for practice, trainee selection, and future research on psychotherapists’ mental health.

Here is part of the Discussion:

Considering that 12% of the psychotherapists were highly symptomatic and that an additional 35% could be considered at risk for significant mental health problems, the present findings raise troubling questions. Were these psychotherapists adequately prepared to help clients? From the perspective of attachment theory, the psychotherapist functions as an attachment figure for the client (Mallinckrodt, 2010); clients require their psychotherapists to provide a secure attachment base that allows for the exploration of negative thoughts and feelings, as well as for the alleviation of distress (Slade, 2016). A psychotherapist who is preoccupied with his or her own personal distress may find it very difficult to play this role efficiently and may at least implicitly bring some maladaptive features to the clinical encounter, thus depriving the client of the possibility of experiencing a secure attachment in the context of the therapeutic relationship. Moreover, regardless of the potential attachment implications, clients prefer experiencing a secure relationship with an emotionally responsive psychotherapist (Swift & Callahan, 2010). More precisely, Swift and Callahan (2010) found that clients were, to some extent, willing to forego empirically supported interventions in favour of a satisfactory relationship with the therapist, empathy from the therapist, and greater level of therapist experience. The present results cast a reasonable doubt on the ability of extenuated psychotherapists, and more so psychologically ill therapists, to present themselves in a positive light to the client in order to build strong therapeutic relationships with them.

Burnout in mental health providers

Practice Research and Policy Staff
American Psychological Association Practice Organization
Originally published January 25, 2018

Burnout commonly affects individuals involved in the direct care of others, including mental health practitioners. Burnout consists of three components: emotional exhaustion, depersonalization of clients and feelings of ineffectiveness or lack of personal accomplishment (Maslach, Jackson & Lieter, 1997). Emotional exhaustion may include feeling overextended, being unable to feel compassion for clients and feeling unable to meet workplace demands. Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel a negative sense of personal and/or career worth.

Studies estimate that anywhere between 21 percent and 61 percent of mental health practitioners experience signs of burnout (Morse et al., 2012). Burnout has been associated with workplace climate, caseload size and severity of client symptoms (Acker, 2011; Craig & Sprang, 2010; Thompson et al., 2014). In contrast, studies examining burnout prevention have found that smaller caseloads, less paperwork and more flexibility at work are associated with lower rates of burnout (Lent & Schwartz, 2012). Burnout results in negative outcomes for both practitioners and their clients. Symptoms of burnout are not solely psychological; burnout has also been linked to physical ailments such as headaches and gastrointestinal problems (Kim et al., 2011).

The following studies examine correlates and predictors of burnout in mental health care providers. The first study investigates burnout amongst practitioners working on posttraumatic stress disorder clinical teams in Veterans Affairs (VA) health care settings. The second study examines correlates of burnout in sexual minority practitioners, and the third study investigates the impact of personality on burnout. Finally, the fourth study examines factors that may prevent burnout.

The information is here.

When Are Doctors Too Old to Practice?

By Lucette Lagnado
The Wall Street Journal
Originally posted June 24, 2017

Here is an excerpt:

Testing older physicians for mental and physical ability is growing more common. Nearly a fourth of physicians in America are 65 or older, and 40% of these are actively involved in patient care, according to the American Medical Association. Experts at the AMA have suggested that they be screened lest they pose a risk to patients. An AMA working group is considering guidelines.

Concern over older physicians' mental states--and whether it is safe for them to care for patients--has prompted a number of institutions, from Stanford Health Care in Palo Alto, Calif., to Driscoll Children's Hospital in Corpus Christi, Texas, to the University of Virginia Health System, to adopt age-related physician policies in recent years. The goal is to spot problems, in particular signs of cognitive decline or dementia.

Now, as more institutions like Cooper embrace the measures, they are roiling some older doctors and raising questions of fairness, scientific validity--and ageism.

"It is not for the faint of heart, this policy," said Ann Weinacker, 66, the former chief of staff at the hospital and professor of medicine at Stanford University who has overseen the controversial efforts to implement age-related screening at Stanford hospital.

A group of doctors has been battling Stanford's age-based physician policies for the past five years, contending they are demeaning and discriminatory. The older doctors got the medical staff to scrap a mental-competency exam aimed at testing for cognitive impairment. Most, like Frank Stockdale, an 81-year-old breast-cancer specialist, refused to take it.

The article is here.