Coping with war captivity: the role of attachment style

The current study examines the implication of attachment style in both immediate coping and long-term adjustment of prisoners of war (POWs). 164-ex-POWs and 184 matched controls filled out a battery of questionnaires, 18 years after the war. They were questioned about their subjective experience of captivity, current mental health status, and characteristic attachment style. Secure individuals, who reported lower levels of suffering, less helplessness and more active coping during captivity, exhibited better long-term adjustment. Avoidant ex-POWs, who reported helplessness and hostility, and ambivalent individuals, who felt abandoned and vulnerable, reported long-term maladjustment. The role of attachment style as a stress-moderating resource is discussed. © 1998 John Wiley & Sons, Ltd.     

The Practice of Suicide Assessment and Management by Marriage and Family Therapists

Abstract

Over 90% of mental health providers encounter suicidal clients. However, the majority of marriage and family therapists (MFTs) are not exposed to suicide-specific trainings within their clinical coursework. Due to the lack of consistent training protocols for suicide assessment and management among MFTs, this qualitative study identified common MFT responses to suicidal clients, including assessment of risk severity and intervention modalities. Responses were then compared to best practices for suicidal clients. Participants inconsistently adhered to best practices identified in the larger field of mental health, revealing the need for increased MFT training on suicide to ensure appropriate and effective care.     

Longitudinal patterns of risk for depression in dementia caregivers: objective and subjective primary stress as predictors

The present study examined how patterns of risk for depression over 1 year in 188 dementia caregivers (consistently asymptomatic, n = 88; consistently symptomatic, n = 40; changing risk, n = 60) could be predicted by objective (behavior problems of the relative) and subjective (role captivity and overload) primary stress. Results reveal that all primary stressors differentiated caregivers who remained at low levels of symptomatology over the course of 1 year from those who were at risk for experiencing a depressive disorder. In addition, caregivers' subjective experience of role captivity predicted the chronicity of risk. Findings extend prior caregiving research on patterns of depressive symptomatology by highlighting the relationship between subjective primary stressors and stability and change in caregivers' mental health.     

Mental health treatment need among pregnant and postpartum women/girls entering substance abuse treatment

Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.     

Adjustment of Siblings of Children with Mental Health Problems: Behaviour, Self-Concept, Quality of Life and Family Functioning

This study examined the adjustment of siblings of children with mental health problems. The participants had brothers or sisters receiving treatment at a Child and Adolescent Mental Health Service within the Hunter New England Health Service, New South Wales, Australia. Seventy-five siblings completed questionnaires on their self-concept, quality of life and family functioning. Their carers completed questionnaires on the sibling’s behaviours, family demographics and family functioning. The diagnosis and severity of disability of index children were attained from the treating clinician. The study revealed the siblings had significantly higher rates of psychopathology, poorer quality of life and lived in more dysfunctional families than normally developing children. Regression modelling predicted variables related to the three main behaviour scales of the Child Behaviour Checklist (CBCL). Family functioning, family communication and the extreme ends of family cohesion and balance, were the most significant contributors to regression model. The sibling self-concept domains of global self-worth, athletic competence and behavioural conduct, contributed to the model. Additionally, a smaller family size was associated with more internalising behaviour disorders in the siblings. The diagnosis and severity of mental health problem of the index child and other family demographic factors did not impact on the sibling’s behavioural functioning. This study highlights that siblings of children with mental health difficulties are a group vulnerable to adjustment difficulties regardless of the index child’s diagnosis or the severity of impairment. Overall, family functioning had a greater impact on the siblings than other factors.     

Pathways to Problems – The Evolution of 'Pathology'

This paper describes a qualitative research study which compared accounts from interviews with families where difficulties had evolved into serious problems with those where an escalation into pathology has been avoided. These accounts confirm that family life is commonly seen to be problematic and stressful, particularly during transitional stages. Specifically, it appears that it is not simply the severity of the initial stresses and problems that distinguishes families, but the meanings that these evoke and the corresponding patterns of responses, especially the 'attempted solutions' that are set in motion. These responses, fuelled by external interventions, can launch families along pathological pathways. It is suggested that the meanings ascribed to difficulties and the ensuing responses are predominantly shaped and constrained by three factors: the dominant societally shared discourses of mental health and distress; the emotional resources and attachments of family members; and systemic interpersonal processes. Some therapeutic implications, especially the importance of assisting families to resist pathologizing processes are indicated.     

African American Pastors on Mental Health,Coping, and Help Seeking

Within the Black Church, there remains much that is unknown about pastoral motivations, beliefs, and attitudes about mental health. The purpose of this study was to investigate pastors' responses to parishioners dealing with mental health issues, including perspectives on counseling services and coping strategies. According to this study's findings, African American pastors often are the first line of support for parishioners' mental health and recognizing adaptive and maladaptive forms of coping.     

The relationship between spirituality and depressive symptom severity,psychosocial functioning impairment,and quality of life: examining the impact of age,gender, and ethnic differences

Research has documented the contribution of spirituality on overall health and mental health among college students. However, very few studies have explored the impact of cultural and ethnic differences on the effect of spirituality on mental health outcomes in this population. The aims of this study were to examine the relationships among spirituality, depressive symptom severity, psychosocial functioning impairment, and quality of life in a large multi-ethnic sample of college students and explore the impact of age, gender, and ethnicity on these relationships. The sample consisted of Latino, African-American, Caucasian, and Caribbean/West Indian college students. Findings indicated that spirituality, believing in God's presence, age, gender, and ethnicity were significantly related to depressive symptoms. These factors were also associated with impairment in psychosocial functioning and quality of life related to depression.     

Homelessness Is Traumatic: Abuse,Victimization, and Trauma Histories of Homeless Men

Homelessness is traumatic, and trauma-informed care is an emerging best practice. Using structured interviews with day shelter clients (N = 152), this study examined trauma among homeless men. The PTSD Checklist (PCL–C) was used to assess for posttraumatic stress disorder (PTSD). Participants’ pattern of PCL–C responses suggested that 23% to 30% screened positive for PTSD. Those with positive PTSD screens had been homeless longer and were more likely to have met time criteria for chronic homelessness. They were significantly more likely to be veterans and to report violent attacks, abuse histories, and mental health problems. Importantly, only 69% of those with positive PTSD screens acknowledged current mental health problems. These individuals were much less likely to report mental health counseling in the prior year.     

心理健康的测量与评估:大学生与成人及住院病人的纵向横向研究

对国内有关大学生心理问题比一般成人更严重的研究结论提出了质疑。使用总量4268人的样本,应用自编的心理健康评定量表(PHS)进行了纵向与横向研究。研究发现,大学生人群与一般成人同期相比,心理问题并非更严重。5项分量表中3项(抑郁、焦虑、躯体化)成人却明显比大学生人群要高,另外两项(强迫和精神病性)二者没有显著差异。但是,10年后的大学生与10年前的大学生在所有分量表上均见非常显著的差异,说明10年的变迁中,大学生的心理问题有非常明显的增长趋势,日见复杂化,虽然不能说比成人更严重,但是也足够引起我们的高度重视。将不同人群样本的数据按心理障碍严重性进行排列,依次是:住院精神障碍患者、成人、大学生。     

A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault

The effectiveness of psychological treatments for PTSD is likely to be enhanced by improved understanding of the factors involved in maintaining the disorder. Ehlers and Clark [A cognitive model of persistent posttraumatic stem disorder Behav. Res. Ther. 38 (2000) 319-345] recently proposed a cognitive model of maintenance. The current study aimed to investigate several cognitive factors highlighted in Ehlers and Clark's model using a prospective design. Fifty-seven victims of physical or sexual assault participated in the study. Cognitive factors were assessed within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault sequelae (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity. These findings support the cognitive model of PTSD proposed by Ehlers and Clark and suggest that effective treatment will need to address these cognitive factors.     

Asthma severity, child security, and child internalizing: using story stem techniques to assess the meaning children give to family and disease-specific events

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children's perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children's feelings of security and mental health. Furthermore, given the difficulty in assessing young children's perceptions, this study helps demonstrate the potential of story stem techniques in assessing children's appraisals of illness threat and management in the family.     

Early environment, emotions, responses to stress, and health

A harsh early family environment is related to mental and physical health in adulthood. An important question is why family environment in childhood is associated with these outcomes so long after its initial occurrence. We describe a program of research that evaluates a model linking these variables to each other. Specifically, we hypothesize that low social competence and negative emotional states may mediate relations between a harsh early family environment and physiological/neuroendocrine responses to stress, as well as long-term health outcomes. We report evidence that the model characterizes self-rated health, cortisol responses to stress, and, in males only, elevated cardiovascular responses to stress. We discuss how the social context of early life (such as SES) may affect the family environment in ways that precipitate adverse health consequences. Perspectives on comorbidities in physical and mental health are discussed.     

Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault.

Cognitive factors hypothesised to influence the development and maintenance of PTSD were investigated. 92 assault victims completed questionnaires assessing a range of cognitive variables. Factors relating to onset of PTSD were investigated by comparing victims who did and who did not suffer PTSD. Factors relating to maintenance of PTSD were investigated by comparing victims who had recovered from PTSD with victims who had persistent PTSD. Cognitive factors associated with both onset and maintenance of PTSD were: appraisal of aspects of the assault itself (mental defeat, mental confusion, appraisal of emotions); appraisal of the sequelae of the assault (appraisal of symptoms, perceived negative responses of others, permanent change); dysfunctional strategies (avoidance/safety seeking) and global beliefs impacted by assault. Cognitive factors that were associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between the cognitive variables and PTSD remained significant when variations in perceived and objective assault severity were statistically controlled. The cognitive factors identified in the study may contribute to PTSD directly, by generating a sense of ongoing threat, or indirectly, by motivating cognitive and behavioural strategies that prevent recovery, or by affecting the nature of the traumatic memory.     

Adolescent males' view on the use of mental health counseling services

This study investigated adolescent males' view on mental health counseling. Additionally, participants were asked if they had ever used mental health counseling services, if they expected to use such services in the future, and what types of services/activities would constitute a successful counseling experience. The participants' responses indicated that they associated mental health counseling with mental illness and pathology. Eighty-eight percent of the participants reported having never used mental health counseling services. Surprisingly, 69% reported a willingness to use mental health counseling services for life's concerns. Finally, the participants identified a preference for action-oriented counseling strategies. Implications for mental health counseling practice are discussed.     

Mental Health Problems of Displaced War-Affected Adolescents in Northern Uganda: Patterns of Agreement Between Self and Caregiver Assessment

We evaluate caregiver and adolescent concordance on adolescent mental health severity in war-affected Northern Uganda. Data were collected from 628 caregiver-adolescent dyads in two internally displaced persons’ camps. Internalizing and externalizing-type mental health problems were assessed using locally-developed scales. To evaluate concordance, mean caregiver and adolescent scores on each scale were compared using Pearson’s correlation coefficients and within-pair-differences were compared by subtracting caregiver from adolescent responses and using t tests to assess whether these differed from 0. Mental heath problem type and youth/caregiver gender and age were investigated as potential indicators of group differences. Adolescents consistently rated their problems as more severe for internalizing problems and less severe for externalizing problems compared with caregivers. Mothers’ reports exhibited better concordance for internalizing problems while fathers’ and other caregivers’ exhibited better concordance of externalizing problems. Results suggest researchers and program implementers need to be aware of respondent differences when planning studies and services.     

Crying wolf? Australian adolescents’ perceptions of the ambiguity of visible indicators of mental health and authenticity of mental illness

Young people’s perspectives about mental health concepts shape both their interactions with sufferers of mental illness and their actions related to their own mental health. The current study employed a cross-sectional qualitative design to explore how adolescents (aged 12–18 years) speak about mental health and illness in order to gain insight into young people’s perceptions and experiences and contribute to shaping approaches to policy and practice. When discussing mental health concepts and appropriate behaviours toward sufferers of mental illness, adolescents conveyed a sense of acceptance and understanding of the potential complexity and severity of mental health problems. In contrast, when discussing mental health in the context of their own lives, a stronger sense of scepticism was conveyed, with students expressing difficulty with the lack of visible markers of mental health and confusion determining authenticity in the mental health states conveyed by their peers. Interestingly, adolescents interviewed commonly conveyed the notion that young people may exaggerate or “fake” a mental illness for personal gain. Adolescent perceptions of mental health and illness hold practical implications for policy and school-based programs aimed at improving mental health knowledge, attitudes and behaviours among youth.     

Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy.

OBJECTIVE: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. DESIGN: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. MAIN OUTCOME MEASURES: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. RESULTS: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. CONCLUSIONS: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation.     

Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers

A stress and coping model was used to study predictors of individual differences in caregiver adaptation. A total of 54 family caregivers of elderly dementia patients completed interviews and questionnaires assessing the severity of patient impairment and caregiving stressors; caregiver appraisals, coping responses, and social support and activity; and caregiver outcomes, including depression, life satisfaction, and self-rated health. Correlational and regression analyses supported the utility of the stress and coping model. Appraisal, coping responses, and social support and activity were significant predictors of caregiver outcome, even when severity of caregiving stressors was statistically controlled. The importance of a multidimensional approach to assessing caregiver outcomes was supported by regression analyses indicating that each caregiver outcome was predicted by different patterns of stressors, appraisal, coping, and social support and activity. Results are discussed in terms of a stress and coping model of caregiving, and clinical implications for work with caregiving families.     

A suicide in an online mental health support group: reactions of the group members, administrative responses, and recommendations.

Suicides in online mental health support groups are inevitable. This case report of such a suicide describes the responses of the group members and the moderator and makes recommendations. Members of a large, public, mental health message board supported each other, and the moderator, a mental health professional, managed the milieu. A member joined in February 2001 and killed herself in April 2002. The initial response of the members was grief. The moderator attempted to minimize suicide contagion by not making any special announcements and to facilitate mourning by starting a memorial thread. There were no reports of self-injury in response to the suicide, and the online ventilation of grief may in fact have had some preventative effect. One member went to the funeral, and gradually, the group moved on. The moderator later implemented a memorial page. The responses of online groups to suicide may, like those of real-life groups, have resuscitation, rehabilitation, and renewal phases. Diffusion of dependency, a searchable archive, and threaded, asynchronous discussion may facilitate mourning, but anonymity may increase vulnerability to false reports. A thread started in memory of a deceased member may function like a virtual memorial service. A memorial page may function like a virtual cemetery. Preliminary recommendations can be made regarding suicide prevention and responding to suicide in moderated online mental health support groups.