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This chapter outlines the ways in which depression and other mental health issues influence adherence and health-behavior change. Patient adherence and health-behavior change are defined and described. Common mental health issues including depression and anxiety are described as well as the prevalence of nonadherence to treatment for these conditions. Next, comorbidity of physical and mental health issues are discussed, such as depression co-occurring with various chronic diseases, providing evidence of the effects of mental health on adherence and health-behavior change. The mechanisms for the relationship of mental health to adherence and health-behavior change are discussed through the framework of the information-motivation-strategy model, with adherence being affected due to cognitive factors, motivational factors, and resource-related factors. The chapter concludes with a discussion of what health-care professionals can do to address and reduce this barrier to adherence and health-behavior change.

The clinical settings in which physicians and other healthcare providers must apply their scientific knowledge and technical expertise are diverse and require further adaptive capacities on their part. Thus, the science and the art, although often opposed, are in fact complementary and together define excellence in practice in which the art is not, as stated by Saunders, merely part of the medical humanities but it is integral to medicine as an applied science. This essay addresses those dimensions of medical talk described as the “art” of the medical encounter, how these impact the quality of information gathering and provision, and how, in turn, this influences patients’ understanding and recall. The notion of the “art of information exchange” is reframed as a “medical dialogue” using communication skills and dimensions not traditionally thought of when referring to the “art” of medical information exchange.

Nonadherence represents a significant challenge not only to personal health and well-being but also to the health-care system as a whole. The Information-Motivation-Strategy model, which forms the organizational framework for this volume, provides a simple yet comprehensive heuristic for addressing the significant and complex problem of nonadherence, emphasizing within each component the vital role of communication between the clinician and patient.

This chapter focuses on how communication is affected when, in addition to the physician and the patient, there is another individual present during the interaction. Although it is difficult to estimate the frequency with which triadic (three-person) encounters take place, they occur in a variety of medical situations, including pediatric, obstetric, geriatric, and oncology visits, visits in which an interpreter is present, visits in which health-care professional trainees participate, and a myriad of inpatient situations. Although estimates of the frequency of accompaniment to medical visits vary from study to study, we hypothesize that over the next decade there will be many more encounters in which a third person is present. This is likely to occur because of the rapid growth of the aging of the population (where there is frequent accompaniment in geriatric visits), the greater recognition of medical errors (and the potential role that accompanying third parties may play in reducing errors), the increasing size of the immigrant population that will need translating services, and the consumerist approach to health care. Of note, in recent empirical research, we have observed tetradic (four-person) and pentadic (five-person) medical visits. In this chapter, we briefly review the theoretical basis for understanding multiparty medical encounters (i.e., visits in which more than two interactive participants are present) and examine triadic interactions in four clinical areas: pediatric care, oncologic care, encounters with interpreters present, and geriatric care. We also provide an excerpt of a transcript from a visit to explore interactions in which more than three persons are present. An agenda for future research is suggested.

Volumes of research and countless models have examined how people decide to make a health-behavior change. This chapter is focused on what happens after the decision to change is made. Do people maintain the changes they initiate? In other words, how do people commit to the new healthier behavioral choice? Often, the factors that push a person to make the change may be the same factors that help the person maintain the change. We discuss how, in fact, there may be a paradoxical inverse relationship. A number of theories are examined and applied to behavior maintenance. These include borrowing from both the commitment literature with Rusbult’s Investment Model of Commitment, as well as the health-behavior-change literature, such as the Theory of Planned Behavior, the Health Belief Model, and the Transtheoretical Model. We also examine the concepts of approach and avoidance motivation and goal orientation. Discussion of these models and future directions conclude this chapter.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are prevalent disorders that exhibit a high rate of co-occurrence. Furthermore, these disorders have been shown to be associated with each other, suggesting that the presence of one disorder increases risk for the other disorder. In this chapter, we discuss relevant theories that attempt to explain why SAD and MDD are related. We propose that the available evidence provides support for conceptualizing the comorbidity of SAD and MDD as resulting from a shared underlying vulnerability. There is evidence that this underlying vulnerability is genetic in nature and related to trait-like constructs such as positive and negative affect. We also discuss the possibility that the underlying vulnerability may confer tendencies toward certain patterns of thinking. Finally, we discuss theories that propose additional causal pathways between the disorders such as direct pathways from one disorder to the other. We advocate for a psychoevolutionary conceptualization that links the findings on the underlying cognitions to the shared relation of lower positive affect and the findings on peer victimization. We suggest that, in addition to a shared underlying vulnerability, the symptoms of social anxiety and depression may function as a part of a behavior trap in which attempts to cope with perceived social exclusion lead to even higher levels of social anxiety and depression. Finally, we make recommendations for the best methods for assessing SAD and MDD as well as suggestions for treating individuals with both disorders.

This chapter examines the relation between personality disorder (PD) and depression, disorders that are commonly comorbid in clinical and community populations. This comorbidity presents both clinical and conceptual challenges. In anticipation of the upcoming introduction of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5), we review research on the associations of depression with both PD and traits in order to help bridge the current and future literatures. Issues distinguishing PD and depression are reviewed, including conceptual concerns, the nature of the associations between depression and PD and traits, and current evidence on associations between depression and PD and chief personality trait dimensions. Data are presented from an ongoing study examining associations between depressive symptoms, maladaptive-range personality, and psychosocial functioning using proposed DSM-5 criteria for depression and PD trait domains and facets. Depressive disorders exhibit large associations with negative affect and more moderate links with positive affect and conscientiousness/disinhibition, though there appear to be even more differentiated patterns of associations at the facet level. However, our understanding of the processes responsible for the associations of PD and depression is still limited. Despite this lack of clarity, the links between depression and PD and traits have important clinical implications for assessment and treatment of both disorders. Assessment approaches and challenges are discussed, as well as the implications of co-occurring PD and traits for the treatment of depressive disorders. Finally, future research directions are summarized.

Diagnosis of personality disorder (PD) in older adults is clinically difficult. In DSM-5, no specific provisions for the diagnosis in later life have been included. This omission makes it difficult not only to come to accurate commonly accepted diagnoses but distorts the accuracy of the epidemiological studies of PD in older adults which are reviewed in this chapter. Personality essentially remains stable over the lifespan although the expression of underlying personality dynamics becomes less dramatic with ageing. The somewhat different phenomenology of PD in old age is examined. Personality is interactive with the capacity to adapt to the challenges of ageing and affects both the psychology and physiology of adaptation. Five key developmental tasks of early life that affect the older person’s adaptation are presented together with examination of how understanding and evaluation of these elements is key to effective treatment. A clinical case vignette illustrates how PD can lead to rupture of the therapeutic relationship and the need for specific techniques of intervention to heal it.

New and intricate technologies are commonplace in medical care today, but the key to good health-care outcomes is how that care is delivered. Research evidence strongly supports the importance of effective communication in the process of delivering medical care, as well as patient-centered approaches to help individuals maintain healthy behaviors and adhere to recommended treatments. Both communication and patient engagement have strong and significant effects on health and quality of life. This chapter briefly reviews several theoretical approaches to health behavior; introduces a broad yet simple three-component model for improving adherence and health behavior change; and prefaces the chapters that comprise the present volume in the context of this three-part model, around which the volume is structured.

As discussed in previous chapters, adherence to the recommended treatment regime is central to achieving successful medical outcome in most medical conditions. This section examines factors that motivate patients to follow treatment recommendations and, in particular, the significance of their beliefs about health and illness.

This essay describes health literacy as the range of skills that individuals need to optimally function in the healthcare setting, as well as the interplay between these literacy skills and the literacy-related demands and expectations of an increasingly complex healthcare environment. The connection between limited health literacy and health outcomes is reviewed, with an emphasis on how limited health literacy contributes to health disparities. The essay introduces the concept of bidirectional communication to frame the discussion about challenges associated with interactive communication in the medical setting, then describes strategies for effective communication, including the use of “universal precautions” or plain language for all as a means of effectively communicating information to patients, the importance of avoiding jargon, and the central role of ensuring comprehension. Finally, the chapter introduces newer areas of interest including numeracy and medication safety.

Although palliative and hospice care services are increasingly available, many adults and children still die without this kind of support or receive it only in the last few days of life, as many patients, family members, and clinicians equate the initiation of these services with loss of hope. This chapter presents a model of how hopeful patterns of thinking and a balance of positive and negative affect may facilitate a regoaling process in which individuals transition from cure-seeking goals to other personally meaningful goals that are attainable at the end of life or while living with a serious chronic illness. Understanding different forms of hopeful thinking, goals, and self-concepts among dying patients and their families can help clinicians provide support through this difficult experience and achieve better quality of life and symptom management for patients and better quality of life and long-term adjustment for family members.

Students hold many misconceptions about issues related to sexuality, thus it is important to include a course in human sexuality in the undergraduate psychology curriculum. Through this course, instructors have the opportunity to encourage students to be critical thinkers about sexually relevant information as well as to teach them to locate and evaluate information they need for themselves. Given the sensitivity of the course content, there are special considerations instructors should keep in mind to create a safe learning space for all. This chapter argues for the inclusion of human sexuality in the psychology major, describes the typical structure of the course, discusses some general tips for teaching the course, and presents some innovative assignments that are especially useful.

This essay examines issues relevant to the accurate assessment of patient adherence to recommendations for health behavior change and/or the management of medical conditions, including long-term chronic diseases. Both conceptual and methodological issues are discussed. The importance of accurate assessment in both clinical practice and research is examined, as well as the consequences of conceptual and measurement biases. The role of assessments of current adherence in predicting future behavior is examined, as is the essential distinction between assessing adherence as a behavior and assessing the predictors and consequences of adherence. The potential challenges of various approaches to assessing adherence accurately are examined, focusing particularly on self-report; measurement scales for adherence are presented; and innovative techniques are discussed for assessing adherence using technologically based formats. Effective communication is emphasized as the most important and salient element relevant to adherence assessment, linking patient adherence assessment with effective communication in the clinical setting.

Health-care activities rely on the acquisition, portrayal, and analysis of diagnostic and therapeutic information as an integral part of patient care. As a service provided by multiple participants, the communication of information is embedded in nearly every aspect of health care. There is much talk of communication as an issue that needs to be improved. This is often because other issues such as equipment research and development and government policy are outside care providers’ immediate range of influence. A good deal of the discussion about communication is uninformed by any real understanding of communication as a field. It is also based on certain presumptions such as more data equal greater understanding, or completeness (rather than salience) equates to quality, or changing the medium (e.g., from face-to-face to e-mail) does not affect message. In fact, changes to communication may not yield direct benefits because other stronger forces such as economic, social, organizational, and legal influences make health care what it is. This chapter invites attention to the nature of the health care work setting, the communication of information through verbal exchanges and artifacts, and efforts that have the potential to improve team communication and care.

Although adolescence is the healthiest period in the lifespan, significant health threats are present that require intervention. In this chapter we first provide an overview of developmental transitions during adolescence to provide an important context for understanding health in this period. This is followed by a review of health status and the main threats to health experienced in adolescence, noting that the majority are associated with behaviors. We then discuss in more detail the research and issues related to interventions to prevent or treat four selected health threats: (a) alcohol and illicit substance use, (b) sexual activity, (c) obesity, and (d) diabetes. These health threats illustrate the range of intervention research conducted with adolescents. We end by providing a broader perspective on adolescent health and propose that the development of social and emotional competences is important for optimizing health broadly in adolescence.

Adherence to medication is an intriguing and complex behavior. It is a multifaceted construct that is influenced by a range of factors. The problem of nonadherence remains a challenge for health-care professionals and patients. In the literature, age has been inconsistently associated with poor adherence, and there is no strong evidence that it is more prevalent in the older population. However, older age presents a multitude of potential risk factors for nonadherence, which may result in poor health outcomes, lower quality of life, and increased health-care costs. Many studies investigating adherence are limited by a lack of commonality in terms of how adherence is measured, the definition of an older person, and the range of disease states that have been examined. To date, efforts to explain and improve patient adherence have been disappointing and ineffective. Various strategies have been proposed; however, most evidence appears to advocate interventions that include components of a medication review with the aim of simplifying the drug regimen. Once-daily scheduling of drug administration may offer a pragmatic approach to optimizing drug therapy in some conditions. The use of fixed-dose combinations and forgiving drugs (which have a prescribed dosage interval that is 50% or less the duration of drug action) have also been proposed. Optimal adherence should be viewed as a means of achieving a satisfactory therapeutic outcome and not as an end in itself.

Depression is common in older adults and prevalence rates tend to increase with age, female sex, reduction in severity of symptoms, and greater restriction in living arrangements. Unfortunately, late-life depression often goes under-recognized potentially due to differential presentation across the lifespan. Late-life depression is caused by a combination of biological (genetic predisposition and comorbid medical illnesses), psychological (comorbid psychiatric disorders, maladaptive cognitions, and lack of engagement in pleasant events), and social factors (life strain, poor social support, and negative life events). However, many older adults evade late-life depression despite experiencing such risk factors, which in turn provides evidence for potential protective factors (resources, psychological strategies, and meaningful engagement). Fortunately, evidence-based pharmacotherapies (tricyclic anti-depressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors) and psychotherapies (cognitive-behavioural, behavioural, problem-solving, reminiscence, brief psychodynamic, and cognitive bibliotherapy) have been identified to ameliorate symptoms of late-life depression.

Lesbian, gay, bisexual, and transgender (LGBT) older adults are patients in geriatric healthcare settings yet are often invisible to providers. LGBT older adults remain vulnerable to providers’ assumptions and biases. Understandably, most LGBT older adults are fearful of healthcare providers and some have experienced mistreatment from providers over the course of their lives. This chapter is written to prepare psychologists and all other healthcare professionals to become more effective in their interactions and interventions with LGBT older adults. Components of the chapter include providing basic information about the historical, sociocultural, legal, and psychosocial dimensions in the lives of LGBT older adults while also recognizing the many domains of diversity inherent within this community. Specific suggestions are offered for ways in which healthcare providers might become more welcoming to LGBT older adults across a range of integrated healthcare settings for older adults.

Loneliness in old age is a very popular issue in the media although it is frequently looked at through the lens of prejudice and myth. There is no doubt that loneliness is a serious problem for older people and that, considering its association with adverse health outcomes, both from a mental and physical point of view, increased attention should be paid to this topic. The main findings about loneliness are: (1) it is a common subjective experience; (2) it is a negative condition for human beings; (3) the prevalence of loneliness is higher in southern European countries compared to northern European countries; (4) loneliness is more prevalent in young and older cohorts than in middle-aged adults; (5) loneliness is associated with several variables although the direction of the association, as cause or consequences, is far from clear; (6) most probably, personal and contextual variables have a bidirectional relationship. In this chapter we review the multiple variables associated with loneliness as well the diversity of possible consequences. Although there is abundant literature on loneliness, a deeper and more systematic knowledge of it will help to develop and implement more specific interventions to deal with the problem. The types of intervention that have been reported appear to be relatively inefficient and probably the subject must be addressed by innovative strategies from both a social as well as a psychological perspective.