Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

ObjectiveTo describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.MethodsRecords of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.Results22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.ConclusionsThe majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.     

Housing instability is as strong a predictor of poor health outcomes as level of danger in an abusive relationship: findings from the SHARE Study

Advocates, clinicians, policy makers, and survivors frequently cite intimate partner violence (IPV) as an immediate cause of or precursor to housing problems. Research has indicated an association between homelessness and IPV, yet few studies examine IPV and housing instability. Housing instability differs from homelessness, in that someone experiencing housing instability may currently have a place to live but faces difficulties with maintaining the residence. We present baseline findings from a longitudinal cohort study of 278 female IPV survivors with housing as a primary concern. Our analysis indicates the greater the number of housing instability risk factors (e.g., eviction notice, problems with landlord, moving multiple times), the more likely the abused woman reported symptoms consistent with PTSD (p < .001), depression (p < .001), reduced quality of life (p < .001), increased work/school absence (OR = 1.28, p < .004), and increased hospital/emergency department use (OR = 1.22, p < .001). These outcomes persist even when controlling for the level of danger in the abusive relationship and for survivors' drug and alcohol use. Importantly, both housing instability and danger level had stronger associations with negative health outcomes than other factors such as age, alcohol, and drug use; both make unique contributions to negative health outcomes and could contribute in different ways. Housing instability is an important and understudied social determinant of health for IPV survivors. These findings begin to address the literature gap on the relationship between housing instability, IPV, and survivors' health, employment, and utilization of medical care services.     

Victims of fraud: comparing victims of white collar and violent crime

Mental health professionals have focused attention on the psychiatric sequelae of criminal victimization. This article compares the experience of white collar and violent crime victims on several parameters including statistical risk of victimization and psychiatric outcome after victimization. Emphasis is given to data obtained from interviewing 77 victims of a fraudulent financial scheme.     

Does faith limit immorality? The politics of religion and corruption

Critically considering scholarship relating religiosity to ethical behaviour, we contend that religion is systematically related to levels of corruption, and that the nature of this relationship is contingent on the presence of democratic institutions. In democracies, where political institutions are designed to inhibit corrupt conduct, the morality provided by religion is related to attenuated corruption. Conversely, in systems lacking democratic institutions, moral behaviour is not tantamount to staying away from corrupt ways. Accordingly, in non-democratic contexts, religion would not be associated with decreased corruption. Time-series cross-sectional analyses of aggregate data for 129 countries for 12 years, as well as individual level analyses of data from the World Values Surveys, strongly corroborate the predictions of our theory. The correlation of religion with reduced corruption is conditional on the extent to which political institutions are democratic.     

The militant palestinian organizations and the Arab‐Israeli peace process

The current Arab‐Israeli peace negotiations have normalized frequent and open contacts between Israel and its neighbors. This new situation is primarily the result of Operation ‘Desert Storm’ and the Soviet Union's dissolution. Both events forced the Middle Eastern states and sub‐national organizations to re‐evaluate their perceptions of one another, as well as of the degree of support they might expect from their superpower patrons. This article begins by examining the ways in which these events have affected those countries and organizations which chose to participate in the peace process and finally focuses on the policies of the Palestinian national movement ‐ specifically the groups which are opposed to the negotiations and have vowed to undermine them. It argues that these groups seek to subvert any peace treaty which the talks may produce and that the moderate Palestinian leadership has proven incapable of controlling them. It concludes that unless this occurs, it will be impossible to implement any agreement.