Suicide in rural communities

The public image of rural areas being characterized by social stability, integration, and supportive interpersonal networks has been challenged with recent evidence showing a large increase in the suicide rate in these areas. Increases have been reported for a number of European countries, including Sweden, Denmark, Scotland, and Ireland. This paper reviews the evidence relating to those groups at risk of suicide. The group at most risk of committing suicide in rural areas is males between the ages of 25 and 60, who are unemployed and live alone, and who have a history of psychological disturbance. These findings are discussed in relation to the psychological implications of socio-economic changes brought about by changes in the Common Agriculture Policy of the European Community.     

Culturally grounded strategies for suicide and alcohol risk prevention delivered by rural Alaska Native communities: A dynamic wait-listed design evaluation of the Qungasvik intervention

We examined the effectiveness of the Qungasvik (Tools for Life) intervention in enhancing protective factors as a universal suicide and alcohol prevention strategy for young people ages 12−18 living in highly affected rural Alaska Native communities. Four communities were assigned to immediate intervention or to a dynamic wait list. Outcomes were analyzed for 239 young people at four time points over two years of community intervention. Outcomes assessed two ultimate variable protective factors buffering suicide and alcohol risk, and three intermediate variable protective factors at the individual, family, and community level. Dose dependent intervention effects were associated with growth in ultimate but not intermediate variables. This evaluation of the Qungasvik intervention provides support for the effectiveness of its Indigenous strategies for suicide and alcohol misuse prevention in this rural Alaska Native setting. Though findings did not provide support for a theory of change where growth in ultimate variables is occasioned through effects on intermediate variables, research designs focused on young people who enter intervention at lower levels of preexisting protection hold promise for better understanding of intervention change processes. The Qungasvik intervention is responsive to an acute public health need for effective rural Alaska Native suicide and alcohol risk prevention strategies.     

Toward a framework for defining and resolving ethical issues in the protection of communities involved in primary prevention projects

Ethical issues flow from and are embedded in contexts of practice. Contexts of practice refer to the diverse social settings where interventions occur. Primary prevention activities require new professional roles in these diverse social settings. These new roles engage the professional in new activities, which in turn allow new ethical issues to arise. This article takes an ecological perspective on ethical issues arising from the enactment of new preventive roles intended to affect groups or communities. Within this perspective, the concepts of context and culture take on special conceptual significance. Four ecological assumptions about preventive interventions intended to affect groups or communities are offered as a means of framing ethical issues in such interventions. Finally, several approaches to developing ecological knowledge about the contexts of practice are presented as ways of furthering our ability to conceptualize and cope with ethical issues in preventive interventions intended to affect groups or communities.     

Support systems of elders in rural communities

The social network concept can be used to guide the extension of the mental health clinician's role to the practice of prevention on the local level. A model of such work is described which builds on clinical skills in collaborative consultation with formal and informal social support networks in a community. The model is illustrated and expanded through a case example of a project in a rural New England town to address issues of stress and support for frail elders. Focusing on the social network of such elders, consultations were developed to address the needs of middle generation caregivers, natural helpers, organized community associations, general community attitudes toward aging, and the ability of the community to secure and use outside resources. Issues of community entry through natural sponsorship are reviewed and the overall process of community empowerment is emphasized as a guiding principle in work with social networks.     

The practice of psychology in rural communities: potential ethical dilemmas

The practice of psychology in rural areas offers unique challenges for psychologists as they try to provide optimal care, often with a minimum of resources. Psychologists are frequently required to be creative and flexible in order to provide effective services to a wide range of clients. However, these unique challenges often confront psychologists with ethical dilemmas and problems for which their urban-based training has not prepared them. The author examines how certain characteristics of rural communities may lead to specific ethical dilemmas. By being a part of a small community, psychologists will inevitably face multiple relationship dilemmas. Confidentiality is harder to maintain in a small town, particularly with its informal information-sharing network. To provide services to meet community needs, with a limited number of referral options, psychologists typically need to be generalists. This may lead to concerns about scope of practice, training, and experience with diverse populations. Psychologists also face other competency issues, such as a lack of supervision and consultation resources. Other concerns addressed include the psychologist's personal life, and the blurring of professional and personal roles. Suggestions are made for coping with each of these ethical issues, although more quantitative research and discussion are needed on the practice of psychology in rural areas.     

A cervical cancer prevention programme in rural Mexico: addressing women and their context

This article reports on the development and administration of a programme in seven rural villages in the Mexican state of Oaxaca to address high rates of cervical cancer. The rationale and strategy are described on which the programme is based. The development and administration of the programme (to 1513 women) is presented, aimed at enabling women to take better care of themselves. Various additional activities that were added in the course of the programme in order to facilitate contextual factors are also described, including community campaigning, programmes with men and the training of health personnel. Effectiveness was evaluated in terms of both process and impact indices, showing high rates of attendance at programme sessions by enrolled women, an increase in knowledge and a substantial increase in the number of preventive diagnostic tests. The final section reflects on both the achievements, and the scope and the limitations of the programme. Copyright © 2005 John Wiley & Sons, Ltd.     

Dream appreciation group: A model of stress prevention for medical students

This paper describes a pilot study in stress prevention for medical students, utilizing Montegue Ullman's process in a dream appreciation group. Relevant literature on the use of dreams in a group is reviewed. In this model, group dynamics and interaction are not analyzed, rather the dream holds center stage. The technique of working with dreams in a group is described, and selected vignettes are presented to document the process. This study suggests that in the presence of a supportive group atmosphere, unconscious conflicts can be alleviated or resolved so as to enhance medical students' evolving personal and professional identity.This paper is based on a presentation at the thirty-first winter meeting of the American Academy of Psychoanalysis, Scottsdale, Arizona, December 11, 1987.     

A systematic review of primary prevention strategies for sexual violence perpetration

This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates (Foshee et al., 2004); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003).     

Teleconsultation: The use of technology to improve evidence-based practices in rural communities

Problem-solving consultation in schools has been found to be an effective method of service delivery to support teachers who are struggling to address student social–emotional behavioral (SEB) concerns. Despite its benefits, a number of barriers (e.g., lack of time and limited access to trained professionals) restrict the use of consultation within schools, especially in rural settings. The purpose of the study was to examine the impact of teleconsultation designed to improve behavior support to students living in rural communities. Both student outcomes and teacher perceptions were evaluated. Results indicated that (a) student disruptive behaviors improved through the implementation of an individualized behavior support plan developed through teleconsultation, and (b) teachers found the teleconsultation experience acceptable and feasible. As the demands placed on psychologists and the quality of videoconferencing continue to increase, teleconsultation is becoming a viable option for service delivery within rural school settings.     

Sickle cell disease: primary stroke prevention

Stroke is an important and common complication of sickle cell disease (SCD), affecting children as well as adults. Clinically evident stroke, usually brain infarction, is usually associated with stenosis or occlusion of the intracranial arteries of the Circle of Willis, sometimes with formation of moyamoya (a Japanese word for "hazy" or "like a puff of smoke" that describes the appearance of a abnormal microvasculature on angiography believed secondary to internal carotid artery stenosis or occlusion and the resultant extensive collateralization). Several types of intracranial hemorrhage are observed but usually in older children and adults. Cerebrovascular diseases restricted to small vessels may go unrecognized but is associated with cognitive and learning problems. Prevention of recurrent stroke has been accomplished with chronic blood transfusion. A primary prevention strategy for clinical stroke, based on the Stroke Prevention in Sickle Cell Anemia Trial, has been tested in a randomized clinical trial. Over 2,000 young children with SCD were screened with transcranial Doppler ultrasound (TCD) to detect elevated blood flow velocity indicative of vessel disease and high risk of future stroke. Those randomized to standard care (no transfusion) had a 10%/year risk of stroke, which was reduced >90% with chronic transfusion. This approach is the only primary stroke prevention strategy so far tested in SCD in a randomized controlled trial. Silent lesions on magnetic resonance imaging are associated with an approximately 1.5%/year risk of clinical stroke and a trial is now starting in children with these lesions who do not meet Stroke Prevention in Sickle Cell Anemia Trial criteria for transfusion based on TCD. A controlled trial, based on intervention for nocturnal hypoxemia, is also underway. Hydroxyurea, bone marrow transplantation, antiplatelet, and antithrombotic agents may work but have not been tested in primary prevention in a systematic way. If early and repeated, TCD screening of children, as recommended by National Heart Lung and Blood Institute and the American Stroke Association, were implemented broadly the incidence of new strokes could be greatly reduced in these children.     

A brief history of primary prevention in the twentieth century: 1908 to 1980

While primary prevention is a much talked about and debated topic in contemporary psychology, it has a considerable history. This paper critically traces primary prevention, philosophy and practice, in the 20th century. Beginning with the mental hygiene movement (1908-1960), the paper progresses to examine the child guidance movement (1920-1955), the eugenics movement (1860-1955), the initial era of federal involvement (1930s, 1940s) as well as significant research, events, and legislation in the decades between 1950 and 1980. The paper concludes with a synopsis of the major themes revealed by the review and suggestions for future efforts in prevention.     

The role of primary prevention in mental health services: A review and critique

Community psychology in the West has had a growing impact on mental health service provision. One facet of this development has been the advocacy of an increased focus on the primary prevention of mental illness. This paper reviews both theoretical and practical work in this area in order to assess the current role and relevance of primary preventive interventions. There is a discussion of primary prevention's historical and theoretical contexts, of its conceptualisations and definitions, of criticisms of its relevance and efficacy, and of examples of its practice. It is argued that primary prevention is inappropriately marginalised in current service provision and that there is a need to engage in the long-term planning and evaluation of primary preventive interventions in order to facilitate their fuller incorporation into national and local policies on mental health.     

Emancipatory education versus school-based prevention in African American communities

Schools have become strategic settings for the work of community psychologists. In a review of 177 primary prevention programs for children and adolescents, Durlak and Wells (1997) found that 129 (72.9%) were based in schools. The literature in community psychology describes many school-based prevention programs targeting problems such as substance abuse, school maladjustment, delinquency, and violence (e.g. C. A. Mason, A. M. Cauce, L. Robinson & G. W. Harper, 1999). A large number of these programs are based in schools in African American communities and include social–cognitive, decision making, affective education, and other skills-building modules along with direct instruction. In this paper, it is argued that ideas from emancipatory education (e.g. Freire, 1998) and African-centered education (e.g. H. Madhubuti & S. Madhubuti, 1994; M. J. Shujaa, 1995) should guide school-based interventions in communities of people of African descent. There is an extensive and distinguished history of emancipatory schools and school-based programs in African American communities. Included in this history are the freedom schools during reconstruction, the SNCC Freedom Schools, the Liberation Schools of the Black Panther Party, the Malcolm X Academy in Detroit, Sankofa Shule in Lansing, the Institute for Positive Education/New Concept Development Center in Chicago, the Benjamin E. Mays Institute in Hartford, and the schools affiliated with the Council of Independent Black Institutions (CIBI) to name just a few. This paper will first provide a brief, critical review of the role of schools and social oppression. Second, primary prevention programs in communities of people of African descent will be examined, questioning some of the dominant methods and assumptions. Next, underlying assumptions about relationships between African identity, educational success, and healthy outcomes for young people will be addressed. This will be followed by a discussion of African-centered emancipatory education, focusing specifically on the role of students as agents of social change and the importance of critical reflection on African cultural resources. The Benjamin E. Mays Institute will be presented as an example of how ideas from an African-centered emancipatory approach to education have been incorporated within a school serving a community of people of African descent in Hartford, Connecticut.     

Stereotypes of stutterers and nonstutterers in three rural communities in Newfoundland

The existence of a negative stereotype of stutterers among residents of three small, rural communities in Newfoundland, Canada was investigated. Members of these communities (n = 106) completed a 25-item semantic differential scale developed by Woods and Williams (1976) which asked them to rate a hypothetical adult male stutterer and nonstutterer. Results indicated that community members perceived hypothetical stutterers in a negative manner in comparison to nonstutterers, despite the fact that 85% of the respondents reported knowing stutterers and 39% reported being related to stutterers. It is suggested the negative stuttering stereotype exists because nonstutterers generalize state to trait anxiety, and because of the nature of the stuttering moment itself. Since this study and previous studies appear to show that the stereotype is not modified by exposure to stutterers, familial relationships, and/or educational background, further research is needed to determine what, if any factor, can modify the pervasive negative stereotype.     

Counselling and primary prevention

Counsellors and counselling services are frequently involved in primary prevention work. Increasingly these services are required to help immediately after major disasters, an implicit assumption being made that normal social support networks will be unable to cope. A review of the literature suggests extensive participation of counsellors in primary prevention activities despite difficulties in definition, training and funding, and evidence that some interventions may be ineffective or harmful. It is suggested that counsellors providing primary prevention services should be aware of the complex practice and philosophy issues surrounding such efforts, and should be rigorous in assessing the real effects of primary prevention activity.