Understanding managed care: practice implications for NPs.

Highly effective nurse practitioners in managed care settings may understand the basic concept of managed care without appreciating how the context of managed care impacts their practice. This article discusses the concept of managed care within the context of 4 managed care strategies. In developing this paper, our goals were first, to describe contracts, incentives, management, and medical necessity as managed care strategies and second, to discuss some of the ways these strategies can significantly impact nurse practitioner practice. Illustrative practice examples are used to suggest that those nurse practitioners who understand managed care, both as a theoretical concept and as a context for practice, may find that they are better able to develop innovative ways to meet the needs of their patients.

A two-factor model of the Depression Coping Questionnaire.

The original 11 factors reported for the 29-item Depression Coping Questionnaire (DCQ) unnecessarily limits its potential usefulness as a clinically interpretable self-report measure. Therefore, the goal of this study was to reduce the number of DCQ factors to equal the number of core dimensions of depression coping addressed by the measure. Study participants (N = 668) completed the original 29-item DCQ and the Center for Epidemiological Studies-Depression (CES-D) scale. The total sample was then split into two equal randomized subsamples. Using a factor loading value cutoff of .40, an initial LISREL exploratory factor analysis produced a 22-item, three-dimension model of positive (10 items), negative (8 items), and substance/sexual (4 items) depression coping behaviors. Because both the negative and substance/sexual dimensions addressed detrimental dimensions of depression coping, these factors were intercorrelated, however, the negative dimension accounted for greater variance. Consequently, given the stated goal of this study the model was then restricted to two core dimensions of positive and negative depression coping. Using the second split-half subsample, a LISREL confirmatory factor analysis produced a 17-item, two-factor model. One negative item (daydreaming) failed to maintain a loading value of .40 or higher and was deleted. The Goodness-of-Fit index for the 17-item, two-factor DCQ was .87 and the Root Mean Square Residual was .08. DCQ alpha coefficients were acceptable at .82 (positive) and .74 (negative). Significant CES-D subgroup differences and correlations were observed.

Personal and social illness demands related to depression.

Negative personal and social illness demands related to depression may first become stable and then persistent. Persistent illness demands may be a factor in the development of depression-related functioning impairment. The purpose of this study was to explore the premise of stable or persistent illness demands related to depression. The Demands of Illness Inventory (DOII) Personal Meaning and Social Relationships subscales and standard measures of depression, stress, and support were completed by adults with a history of repeated treatment for depression. Adults currently and recently treated for depression completed the illness demands and depression measures 3 times in 8 weeks. The DOII subscales showed adequate internal consistency and construct validity. High depression was associated with more intense and higher numbers of illness demands, but illness demands related to depression showed stability despite current/recent treatment.

Rapid improvement in the defense style of depressed women and men.

The purpose of this study was to determine whether the defense style of hospitalized depressed adults improved over the course of treatment. Thirty-one inpatients (24 women and 7 men) with an admitting diagnosis of major depression completed the 40-item Defense Style Questionnaire and the 20-item Center for Epidemiologic Studies-Depression Scale. Participants completed the Defense Style Questionnaire and the Center for Epidemiologic Studies-Depression Scale within 48 hours after admission and within 24 hours before or after discharge. The average admission and discharge Center for Epidemiologic Studies-Depression Scale ratings (+/-SD) were 41.93+/-9.93 and 26.45+/-12.19, respectively. The average hospital length of stay was 7.1+/-2.8 days. Two-tailed t-test comparisons of the Defense Style Questionnaire admission and discharge ratings showed significantly higher discharge mature ratings, significantly lower discharge immature ratings, and stable neurotic ratings. We concluded that for some depressed women and men, improvement in defense style can occur within days after the initiation of standard inpatient treatment.

Depressed mood and self-esteem in young Asian, black, and white women in America.

During the last two decades, investigators have explored the relationship between women's life conditions and their mental health. Some have related women's socially disadvantaged status, or their socialization to a traditional feminine role, to depression and low self-esteem. Others have emphasized the consequences of women's roles, or the balance of social demands and resources, on their well-being. More recently, feminist scholars have proposed a developmental account of depression. We tested a model comparing the effects of personal resources, social demands and resources, socialization, and women's roles, on self-esteem and depressed mood in young adult Asian, Black, and White women in America. Women who resided in middle-income and racially mixed neighborhoods were interviewed in their homes. Personal resources were indicated by education and income and social resources by unconflicted network size as measured by Barrera's (1981) Arizona Social Support Interview Schedule. Social demands were assessed by conflicted network size as measured by the Barrera scale and by the Positive Life Events and Negative Life Events scales from Norbeck's (1984) revision of the Sarason Life Events Scale. Women's roles included employment, parenting, and partnership with an adult (e.g., marriage). Self-esteem was assessed with the Rosenberg Self Esteem Scale (Rosenberg, 1965) and depressed mood with the Center for Epidemiologic Studies Depression scale (Radloff, 1977). Although models for Asian, Black, and White women differed, social network and social demands as well as personal resources were common to each group as predictors of self-esteem and depression.