alexa Gender Differences to the Contextual Factors Questionnaire and Implications for General Practice | Open Access Journals
ISSN: 2329-9126
Journal of General Practice
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Gender Differences to the Contextual Factors Questionnaire and Implications for General Practice

Jean Francois Pelletier1,2*

1Department of Psychiatry, Yale University School of Medicine, USA

2Department of Psychiatry, University of Montreal, Canada

*Corresponding Author:
Jean Francois Pelletier
Assistant Clinical Professor, Department of Psychiatry
Yale University School of Medicine, USA
Tel: 514-251-4000
Email: [email protected]

Received date: March 17, 2017; Accepted date: March 27, 2017; Published date: April 04, 2017

Citation: Pelletier JF (2017) Gender Differences to the Contextual Factors Questionnaire and Implications for General Practice. J Gen Pract (Los Angel) 5:297. doi:10.4172/2329-9126.1000297

Copyright: © 2017 Pelletier JF. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of General Practice

Abstract

The purpose of this study was to contribute to the revision of the International Classification of Diseases (ICD-10) by exploring how mental health service users and their relatives conceive the influence of the contextual factors, as described in Chap. 21 of the ICD-10, on a) the onset of a mental or behavioral disorder; b) the resurgence of such a disorder; and c) the recovery process. In individual interviews, the 18 main categories of contextual factors proposed by the ICD-11 (beta draft) were discussed through the Contextual Factors Questionnaire (CFQ) by 28 participants who completed the CFQ individually.

This paper presents the results from a t-test that was performed on the data set to assess whether the means for two groups who completed the CFQ were statistically different from each other (p≤ 0.05). On one hand, we found significant differences between users and family members for A) Housing or the environment (p=0.01), and B) Personal finances (p=0.04); and for C) Water or nutrition (p=0.05) between male and female participants, on the other hand. In light of the fact that Social or cultural environments were considered to be the most influential of all 18 contextual factors by all aggregated participants, this suggests that male-female differences are related to social norms concerning gender, rather than discrete biological sex categories.

Keywords

Gender differences; Health status; Mental health

Background

Most of the people who would clinically be in need of care regarding mental health problems, do not consult for these reasons [1]. It is frequent, however, that they want to consult about socio-economic or psycho-social conditions that they associate to “problems” that interfere with their daily activities and responsibilities [2]. This project consisted of asking patients with a diagnosis of a mental or behavioral disorder, and their relatives, what is the influence of the contextual factors, if any, on either the onset of such a disorder, its resurgence, or on the recovery process.

These contextual factors influencing health status and contact with health services are gathered in Chap. 21 of the International Classification of Diseases (ICD-10th version). They are provided for occasions when circumstances other than a disease are recorded as "diagnoses" or "problems". As per the World Health Organization [3], this can arise when a person who may or may not be sick encounters the health services for some specific purpose, or to discuss a problem which in itself is not a disease or injury.

This can imply some circumstance or problem which influences the person's health status, circumstance or problem that needs to be borne in mind when the person is receiving care for some illness or injury.

Methods

The Community-based Participatory Research approach and methods of this project, which consisted in contributing to the revision of the WHO International Classification of Diseases, have been described in this Journal in a previous research paper. The reader can turn to this latter paper for more details on the background and methods of the study which is herein reported.

In brief, the contextual factors influencing health status and contact with health services are gathered in Chap. 21 of the International Classification of Diseases (ICD-10th version) [1,2]. They are provided for occasions when circumstances other than a disease are recorded as "diagnoses" or "problems".

Twenty-height users of mental health services and relatives of such persons (e.g. parents, friends, siblings) were recruited to take part in individual interviews [4]. Participants talked about the impact of the contextual factors either on a) the onset of a mental or behavioral disorder (Chap. 5 of ICD-10); b) the resurgence of such a disorder; and c) the recovery process. This paper reports the quantitative results for the participants who completed the Contextual Factors Questionnaire (CFQ) in preparation for the interviews. The 18 main categories of contextual factors proposed by the ICD-11 (beta draft) were assessed with this 18-item CFQ. Participants were invited to tell, on a 6-point Likert scale (1=no influence at all, 6=very influential), how influential these factors were, either for themselves (service users) or according to their relatives who discussed the influence of the contextual factors on their loved one’s condition [5]. For comparison among participants (see Pelletier, [2], for the IRB approved recruitment procedure and study design [1]), this 28 participants sample was divided twice in two sub-samples of: A) users (N=17) and relatives (N=11); and B) males (N=12) and females (N=16). Assuming symmetrical distribution between these independent sub-groups, two-tailed t-tests were performed with the Statistical Package for the Social Sciences software (SPSS, 24th version), to assess statistical differences among the subsamples [6,7].

Results

Using a significance level of 0.05, (Tables 1 and 2) respectively report the results for A) the user/relative grouping; and B) the male/ female grouping.

Item of the CFQ User (n=17) or relative (n=11) Mean SD Sig. 2-tailed Mean SD Sig. 2-tailed Mean SD Sig. 2-tailed Mean SD Sig. 2-tailed
Personal finances User 2.6 2.62 0.07 3.06 2.1 0.31 4 1.84 0.15 9.7 4.3 0.04*
Relative 0.9 1.7 2.18 2.4 2.9 2.02 6 4.17
Water or nutrition Relative 1.2 2.14   1.2 1.7 0.09 2.8 2.04 0.21 5.1 4.53 0.06
Housing or the environment User 3.5 2.15 0.00*** 3.35 1.8 0.01** 4.1 2.09 0.97 11 4.94 0.01**
Relative 0.6 1.57 1.36 2 4.1 2.07 6.1 3.96
Social, cultural environments User 3.8 2.35 0.15 4.12 2 0.11 4.7 1.27 0.87 12.6 4.11 0.11
Relative 2.6 2.02 2.82 2.1 4.7 1.27 10.1 3.56
Employment/unemployment User 3 2.15 0.02* 3.59 2.1 0.17 3.9 1.87 0.79 10.5 4.32 0.06
Relative 1.1 1.76 2.3 2.6 4.1 2.38 6.9 5.22
Education User 2.1 2.41 0.3 2.76 2.3 0.08 3.5 1.91 0.97 8.3 5.41 0.19
Relative 1.2 1.66 1.18 2 3.5 2.22 5.6 5.03
Social security welfare User 2.4 2.55 0.07 2.59 2.3 0.35 3.7 2.32 0.48 8.7 5.02 0.33
Relative 0.7 1.79 1.73 2.3 4.3 2.1 6.7 4.98
Judicial system User 0.9 1.83 0.13 1.76 2 0.12 1.6 1.94 0.39 4.2 5.23 0.12
Relative 0 0 0.64 1.4 0.9 2.07 1.6 2.25
Risk factors User 3.4 2.4 0.06 3.35 2.3 0.69 3.3 2.11 0.73 10.1 6 0.44
Relative 5 1.41 3.73 2.5 3 2.37 11.7 4.71
Interpersonal interactions User 2.8 2.25 0.39 3.35 1.9 0.58 4.2 1.78 0.4 10.3 4 0.42
Relative 3.6 2.38 3.8 2.2 4.7 1.42 11.7 5.31
Someone else’s behavior User 3.1 2.62 0.8 3.88 2.2 0.85 3.1 2.15 0.46 10 5.06 0.68
Relative 3.4 2.06 3.73 2 3.7 1.95 10.8 5.25
Someone else’s illness User 1.6 2.12 0.11 2.24 2.2 0.71 2.4 2.45 0.51 6.2 6.15 0.34
Relative 0.5 1.04 1.91 2.3 1.7 2.33 4.1 4.23
Loss or death of a close one User 2.6 2.24 0.21 2.47 2.1 0.38 3.4 2.12 0.08 8.4 5.51 0.21
Relative 1.4 2.46 3.2 1.9 1.9 1.79 5.9 4.23
Assault or harmful events User 2.6 2.62 0.62 2.76 2.6 0.52 2.9 2.47 0.4 8.2 6.03 0.75
Relative 3.1 2.33 3.4 2.1 2 2.6 7.6 4.76
Fear User 3.5 2.7 0.49 3.29 2.5 0.73 3.1 2.62 0.58 9.9 7.31 0.73
Relative 2.7 2.76 3.64 2.5 2.6 2.58 8.9 6.85
Impairments or restrictions User 2.2 2.54 0.95 1.88 2.2 0.57 2 2.37 0.45 6.1 5.56 0.85
Relative 2.3 2.45 2.4 2.3 2.7 2.16 6.6 5.91
Interventions User 1.5 2.15 0.22 2.47 2.4 0.52 4.9 1.48 0.46 8.9 3.68 0.51
Relative 0.6 1.12 3.1 2.4 4.5 1.97 7.9 4.51
Healthcare system User 1.8 2.33 0.25 2.76 2.3 0.7 4.7 1.73 0.89 9.2 4.4 0.51
Relative 0.8 1.93 3.1 2.1 4.6 2.02 8.1 4.35
Total User 45.5 26.2 0.11 53.9 19 0.23 63.1 18.6 0.47 161 50.2 0.14
Relative 30.9 15 44.8 19 57.2 24.2 131 48.1

Table 1: User-relative differences to the Contextual Factors Questionnaire (CFQ).

As per Table 1, the most significant difference for all dimensions combined (p=0.01) is between users and family members, and related to Housing or the environment (p=0.00 for onset, and p=0.01 for resurgence). Service users see this contextual factor to be more influential than family members do. This is also the case with Employment/unemployment (p=0.02 for onset), and for Personal finances (p=0.04 for all dimensions combined). In terms of malefemale differences (Table 2), the most significant difference is for Water or nutrition (p=0.00 and p=0.05, respectively for recovery, and for all dimensions combined) [8]. The male-female difference is also significant in terms of Education (p=0.05), whereas this difference is p=0.04 with respect to the Healthcare system [8,9]. It is with females that these two latter contextual factors are perceived to be more influential, respectively with regards to resurgence, and onset. Female participants also perceive Water or nutrition to be more influential than males do in terms of recovery and when all onset, resurgence, and recovery dimensions remain combined.

  Onset Resurgence Recovery All dimensions
Item of the CFQ Male (n=12) or female (n=16) Mean SD Sig. 2-tailed Mean SD Sig. 2-tailed Mean SD Sig. 2-tailed Mean SD Sig. 2-tailed
Personal finances Male 2.1 2.39 0.78 2.42 2.1 0.55 3.3 1.72 0.59 7.8 4.44 0.71
Female 1.8 2.51 2.94 2.4 3.8 2.15 8.5 4.74
Water or nutrition Male 1.6 2.39 0.8 1.42 1.4 0.14 2.2 2.25 0.00* 5.2 4.39 0.05*
Female 1.8 2.29 2.6 2.4 4.4 1.55 8.7 4.48
Housing or the environment Male 2.5 2.2 0.84 2.42 1.8 0.74 3.8 2.04 0.55 8.8 4.79 0.78
Female 2.3 2.6 2.69 2.4 4.3 2.09 9.3 5.5
Social, cultural environments Male 3.5 1.78 0.73 3.67 1.6 0.9 4.3 1.37 0.21 11.5 3.34 0.91
Female 3.2 2.64 3.56 2.5 4.9 1.12 11.7 4.59
Employment/unemployment Male 2.5 2.15 0.61 3.17 2.2 0.91 3.6 2.31 0.4 9.3 4.48 0.87
Female 2.1 2.27 3.07 2.5 4.3 1.79 8.9 5.38
Education Male 1 1.35 0.13 1.17 1.9 0.05* 2.8 2.17 0.13 5 4.59 0.06
Female 2.3 2.52 2.88 2.4 4 1.73 8.9 5.39
Social security welfare Male 1.3 2.26 0.35 1.42 2 0.1 3.8 2.22 0.77 6.4 3.2 0.18
Female 2.1 2.5 2.88 2.4 4 2.28 9 5.88
Judicial system Male 0.3 0.62 0.39 0.83 1.5 0.24 1.1 2.07 0.59 2.2 2.95 0.31
Female 0.8 1.88 1.69 2.1 1.5 1.97 3.9 5.29
Risk factors Male 3.9 2.02 0.81 3.33 2.2 0.75 3.1 1.98 0.85 10.3 4.33 0.76
Female 4.1 2.36 3.63 2.5 3.3 2.38 11 6.37
Interpersonal interactions Male 3.8 2.04 0.13 3.75 1.8 0.6 3.9 1.38 0.19 11.5 4.1 0.53
Female 2.5 2.37 3.33 2.2 4.8 1.77 10.4 4.88
Someone else’s behavior Male 3.4 1.83 0.7 3.25 1.9 0.22 2.8 2.08 0.25 9.5 5.02 0.47
Female 3.1 2.77 4.25 2.2 3.8 2.02 10.9 5.16
Someone else’s illness Male 0.9 1.44 0.58 2.58 2.2 0.34 1.9 2.15 0.72 5.4 4.31 0.96
Female 1.3 2.12 1.75 2.3 2.3 2.6 5.3 6.36
Loss or death of a close one Male 1.7 2.15 0.35 2.58 1.9 0.73 2.4 1.62 0.39 6.7 3.58 0.51
Female 2.5 2.5 2.87 2.2 3.1 2.42 8 6.08
Assault or harmful events Male 2.8 2.45 0.96 2.75 2.3 0.64 2 2.49 0.29 7.5 3.63 0.71
female 2.8 2.6 3.2 2.5 3.1 2.5 8.3 6.64
Fear Male 2.9 2.71 0.67 3.17 2.5 0.64 1.8 2.25 0.06 7.9 6.56 0.31
Female 3.4 2.75 3.63 2.6 3.7 2.58 10.7 7.32
Impairments or restrictions Male 2.4 2.31 0.77 2.25 2.3 0.72 1.9 2.39 0.5 6.4 4.66 0.92
Female 2.1 2.64 1.93 2.2 2.5 2.23 6.2 6.3
Interventions Male 0.6 1.08 0.14 1.83 2.1 0.09 4.6 1.93 0.66 7 3.41 0.08
Female 1.6 2.19 3.4 2.4 4.9 1.5 9.7 4.08
Healthcare system Male 0.5 1 0.04* 2.08 1.6 0.08 4.5 1.93 0.79 7.1 2.61 0.07
Female 2.2 2.62 3.53 2.4 4.7 1.78 10.1 4.97
Total Male 37.6 18.12 0.68 45.08 16.7 0.22 53.9 23.15 0.13 135.4 40.12 0.22
Female 41.4 27.02 54.31 21 65.9 17.74 159.5 56.3

Table 2: Male-female differences to the Contextual Factors Questionnaire (CFQ).

Thus, among all 18 contextual factors, as mentioned above, we found statistically significant differences between users and family members for A) Housing or the environment and B) Personal finances; and for C) Water or nutrition, this time in terms of male-female differences [10]. At the other end of the spectrum, the least statistically significant differences are for D). Someone else’s illness (p=0.96), E) Impairments or restrictions (p=0.92), and F) Social, cultural environments (p=0.91), each time in terms of male-female differences.

Discussion

Indeed, as previously reported [1], the Social or cultural environments factor is considered to be the most influential contextual factor for all onset, resurgence, and recovery dimensions combined. There seems also be a consensus that Impairments, limitations or restrictions (p=0.85 for user-relative; p=0.92 for male-female) and someone else’s illness (p=0.68 for user/relative; p=0.96 for male/ female) are the least influential, with the exception of the Judicial system.

This is the least influential for each dimension separately and therefore, for all dimensions combined, but with much sharper discrepancies between users and relatives (p=0.12), as well as between males and females (p=0.31).

Users consider their socio-economic status to be more influential than relatives do (e.g. finances, housing, and employment).

And in light of the fact that Social or cultural environments were considered to be the most influential of all 18 contextual factors by all aggregated participants, this suggests that male-female differences are related to social norms concerning gender, rather than discrete biological sex categories. In effect, sex typically refers to a set of biological attributes, whereas gender refers to socially constructed social roles [3]. Since gender influences how people perceive themselves, it also influences help-seeking intentions [4].

For instance, self-stigma is related to cultural and gender-role norms, the masculinity ideology and help-seeking intentions being known to be mediated by attitude and subjective norm [5], with the consequence that men are less likely than women to seek help for their mental health [6,7]. Moreover, symptoms of depression for men are often expressed through somatic symptoms like fatigue or sleep problems [8-15], for which people commonly show up in general practice.

Conclusion

These results highlight the relevance for primary care providers to assess the contextual factors that may be at play in the recovery process of their patients also with mental health needs. Further research will be needed to test the reliability and psychometric validity of the Contextual Factors Questionnaire (CFQ) when the WHO will have released the final ICD-11th version.

The actual CFQ beta-draft nevertheless proved to be useful. Results to such a survey, and doctor-patient discussion of these results, can be used in general practice to identify specific support needs and to provide gender-sensitive encouragement to diverse patients, for them to seek help and support, once the need for it is recognized.

Acknowledgement

This study was supported by grants from the Douglas Mental Health University Institute, the Montreal Mental Health University Institute, and the Quebec Mental Health University Institute, province of Quebec, Canada. This multi-site study was approved by the Institutional Review Board of the Montreal Mental Health University Institute.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Article Usage

  • Total views: 514
  • [From(publication date):
    April-2017 - Nov 22, 2017]
  • Breakdown by view type
  • HTML page views : 459
  • PDF downloads : 55
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords