In sickness and in health

The British Journal of Health Psychology and Psychology, Health and Medicine both made their debut in February 1996, each asserting intellectual occupancy of a hitherto vacant nook. As such, they join the early issues of other new journals that treat the emerging discipline of health psychology in its interdisciplinary context, all making claims to a coverage of psychology applied to health and illness throughout life. In due course, this shared approach is likely to give way before policy choices and particular editorial flair; specialisations will doubtless emerge and, probably, a hierarchy of journals of varied renown and professional acceptability will appear.

To differentiate between the declared editorial principles of the two newcomers is not easy. The aim of the BJHP is "to provide a forum for high-quality research relating to health and illness", and it clearly has a strong position owing to its publication by the increasingly powerful British Psychological Society.

Its objectives extend to all areas of health psychology, once again with stress being laid on life-span coverage, "ranging from experimental and clinical research on aetiology and the management of acute and chronic illness, responses to ill-health, screening and medical procedures, to research on health behaviour and psychological aspects of prevention".

PHM may be regarded as a symbol as well as a product of the evolution of health psychology; it aims "at a clear niche", which is further identified as an interdisciplinary challenge whereby health, particularly psychological health, is to be discussed as an independent construct. This is an apt challenge indeed for health psychologists, since a major question for their independent and evolving discipline is the precise location of "health". A further editorial aim is "to allow for both an in-depth exploration of theory and applied work within medicine but outside of it as well. Such a statement may be construed as perpetuating the deviation that exists between developing health psychology as an academic discipline and simply applying psychology to health-related issues. For me, the independence of the former is a sine qua non for the systematic practice of the latter.

The early issues of both journals carry material on health and illness-related topics, all contributed by research workers and practitioners of international repute. The BJHP has articles on the development and validation of new measures, the application of health psychology theories to health-related matters and the effectiveness of cognitive-behavioural therapies to various health/illness issues. A variety of research methods and design are used. A range of topics are discussed, but if there is a main focus, it is "individual health psychology", with the studies described done in a variety, and sometimes a combination, of hospital, home and community settings. One contribution of considerable interest and import reports on the development and reliability of the health anxiety questionnaire based on cognitive-behavioural theory of anxiety. The development and validation of new measures is always welcome and this is one area in which health psychologists can really show their strength. The authors state that the proportion of cases in which physical illness is not identified by physicians and surgeons can be as high as 84 per cent, a figure to be seen against the claim that an increasing interest in health anxiety is a "relatively neglected area of research". Despite the evident importance, "effective treatment approaches are only in the relatively early stages of development".

There are reports ranging from a comprehensive review of the psychological effects of vertically acquired HIV infection in infants and children to the development of items for the World Health Organisation quality of life assessment related to health in Britain. The study had the additional objective of contributing to an international pool of items to provide cross-cultural measures; focus groups were used by a team of workers from different countries.

PHM offers original descriptions of research on health and illness-related topics. An interesting review paper on "Coping, social support and chronic disease: a research agenda", highlights the failure to identify coping strategies that may be helpful in adapting to adverse conditions. The article discusses how the use of such strategies could be encouraged and emphasises the need to pay greater attention to the role of beliefs and illness cognitions as determinants of coping.

One issue attempts to strike a balance between illness and health-related issues. Another paper deals with obstacles to the provision of psychological support in paediatric oncology and one offers a measurement model of physician empathy, with cross-sectional analysis. In this study, the interpersonal reactivity index (published in an appendix) was identified as suitable for assessing sympathy and empathy in physicians and college undergraduates. Notwithstanding the small sample, the authors offer a precise methodology that has not hitherto been available for measuring the sympathy and empathy constructs.

The editor of PHM clearly attempts to maintain a balance between health-service evaluation and illness-related (cancer, HIV and so on) phenomena. With regard to investigative methods, a bias is evident towards surveys, cross-sectional designs and the use of self-report questionnaires. If the editor's assertion that health psychology is an independent discipline is to be sustained, articles on experimental applied health psychology must be encouraged, particularly within the duly defined life-span perspective. A special issue for this purpose, with a guest editor, is tentatively recommended here. If fine tuning of the material does not take place, there is no reason to suppose that PHM could not continue to be a creditable journal, but with an international set of contributors reporting on topics in health psychology rather than dealing with health psychology per se. Undoubtedly one of the problems of health psychology remains its "location".

It is clear that both PHMand BJHP try to achieve their aims by striving for balance in their selection between the development of new theories, the testing of existing theories and the development and validation of (new) measurements. The BJHP, however, appears to be less driven to report on topics in health psychology as distinct from treating health psychology as an evolving entity. It attempts a balance between the testing of theories in health psychology, developing new measurements, and evaluating the effect of different interventions.

But neither journal reports on experimental applied health psychology, despite the important role this plays in the development of health psychology as an independent discipline. Both journals lean towards illness rather than towards health, but this may be due more to sources of funding and the compelling interests of the majority of investigators. Promoting health by treating illness, communicating effectively, rehabilitation and improving the quality of life are all undoubtedly within the scope of health psychology. Yet abundant treatment of these important matters expose the lacunae. The relevance of psychology in promoting health by preventing illness, investigating healthy people and reporting on relevant experimental applied psychology are so far only low key in both journals. Without such a revision of emphasis, the evolution of health psychology as an independent discipline and its intrinsic value will remain in question.

Elvidina Adamson-Macedo is senior lecturer in health psychology, University of Wolverhampton.