Faculty Bibliography

Few instruments exist for the assessment of adolescent mental health. In order to examine the appropriateness of the Mental Health Inventory (MHI) for use with adolescents, secondary analyses were conducted of the large subsample (n = 953) of adolescents who participated in the community-based Rand Health Insurance Study. The reliability and readability of the MHI were confirmed. Subscales reflecting Psychological Well-Being and Psychological Distress were derived. The MHI, with its adolescent norms, is recommended for the assessment of adolescent mental health, particularly in studies in which comparison to a nonpsychiatric, normative adolescent population is indicated.

A decade of research has shown that housing problems are the strongest predictors of the risk of homelessness among families. In a 1988 study conducted for the Human Resources Administration, we found that few families requesting shelter were plagued by serious drug abuse or mental health problems. Instead, they were faced with extremely difficult housing situations. Perhaps most telling, in a recent study of formerly homeless families judged to be at high risk of returning to shelter, the vast majority remained in their own apartments during their first year

Physicians' responses to AIDS at different career stages and in different specialties were studied by surveying house staff (N = 438), faculty (N = 363), and applicants (N = 487) at six residency programs in internal medicine and six in surgery. House staff had more negative outlooks than senior medical students and faculty, reporting greater fear of exposure to AIDS and greater unwillingness to treat AIDS patients. Surgeons were more negative than internists on these dimensions. For all groups, concern about possible negative educational consequences of treating AIDS patients was largely a function of their amount of contact with AIDS patients. Comparing willingness to treat AIDS and nine other conditions, AIDS consistently ranked low, along with Alzheimer's disease, alcoholism, and drug dependency. The findings have practical implications for hospitals and training programs. In addition, they raise issues concerning the impact of training on professional socialization, and call into question physicians' commitment to the professional norm of treating all patients regardless of provider self-interest, patient social characteristics, or medical uncertainty.

This study examines 253 newly hired home attendants to measure the degree to which employment-based health insurance can affect health status and utilization of health care services among a working poor population that has little experience with health insurance and may face other significant barriers to care. Physician contacts increased after benefits were received; attendants who had no coverage during the prior year experienced the greatest average increase. More attendants also reported using emergency rooms. Neither hospitalizations nor health status were affected. These findings indicate that insurance benefits may substantially improve access to care for many working poor persons, regardless of other barriers they may face.

In a study of the link between physical disability and social relationships among the elderly, questions about social network and social support evoked a surprisingly large number of group responses. People mentioned "my grandchildren," "the people in my building," "people at the senior center," and other groups in ways that suggested that the real unit of support was extraindividual and could not be accurately understood by reference to individual people within those groups. This paper describes the frequency of such responses and the circumstances under which they emerged. Definitions of social support and of social network should not be restricted to dyadic relationships between individuals; better understanding of social support processes would derive from consideration of the kinds of social support functions best offered by groups vs. individuals and consideration of differences in the ways in which support is derived from groups and individuals.

This article examines whether the psychological impact of different kinds of social supports varies according to who provides them. Data on 82 older adults' social relationships, measured as social provisions (Weiss, 1974), were used to evaluate whether the relationship between social provisions and emotional well-being varied when kin and, alternatively, nonkin, made the provisions. Findings showed that, although most social provisions were valuable regardless of their source, reassurance of worth was distinctly more beneficial when provided by nonkin than by kin, and reliable alliance, or instrumental assistance, was more strongly related to well-being when provided by kin than by nonkin. Analysis of social network structure showed that "multiplexity" was negatively related to well-being, and having duplicate providers for a given social provision was uniquely important in offsetting negative affect.