Community interventions and effective prevention

The prevalence of pregnancy, substance abuse, violence, and delinquency among young people is unacceptably high. Interventions for preventing problems in large numbers of youth require more than individual psychological interventions. Successful interventions include the involvement of prevention practitioners and community residents in community-level interventions. The potential of community-level interventions is illustrated by a number of successful studies. However, more inclusive reviews and multisite comparisons show that although there have been successes, many interventions did not demonstrate results. The road to greater success includes prevention science and newer community-centered models of accountability and technical assistance systems for prevention.     

Suicide prevention for psychoanalytic institutes and societies

What follows are guidelines for rescue teams dedicated to suicide prevention for psychoanalytic institutes and societies. They provide a general orientation and presuppose intensive individual and organizational training by the rescue teams. Some general notes of caution: suicide prevention is a complex, delicate effort that requires specific training, experience, knowledge, patience, and courage. It is a well-known fact that drowning persons may resist rescue efforts, thereby posing the danger of drowning the rescuer along with themselves. Similarly, expect desperate, blind resistance to your efforts, particularly when the suicidal temptation is urgent and overwhelming.     

Suicide assessment and evaluation strategies: a primer for counselling psychologists

Suicide is a recognized national health risk in many countries. In order to effectively intervene in suicidal crises, it is important for mental health professionals to understand facts about suicidal behaviour, procedures for assessing an individual's risk of self-harm, and the evaluation of the lethality of a client's suicidal gestures. With updated knowledge and proper training, counselling psychologists can play a vital role in suicide prevention. This paper summarizes for counselling psychologists current statistics about suicide, general and specific risk factors for suicidality, and assessment tools used to evaluate suicidal risk.     

Suicide prevention in the psychiatric hospital

It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to severe depression. A treatment strategy that differentiated between regressive and progressive therapeutic measures was developed for patients admitted to a psychiatric hospital. Regressive, as opposed to progressive, treatment meant that the patient was temporarily relieved of virtually all responsibilities for self and others. Progressive measures were strictly avoided for all patients with symptoms of depression, regardless of the primary diagnosis. This strategy was tested on 5,149 inpatients and day patients over a period of 6.25 years and compared with 6,891 patients over the 15.75 years prior to this period. The suicide rate was 97 (per 100,000 admissions) compared with 319 in the previous period. The treatment method appears to be able to reduce the suicide rate. Although this result was achieved with hospital patients, it suggests that a regressive treatment method could be promising if developed for outpatient treatment as well.     

Deviant adolescent subcultures: assessment strategies and clinical interventions.

Alienation is a contributing factor in adolescents' participation in Satanism, the neo-Nazi skinhead movement, and violent street gangs. Many of their needs are met by gang and/or cult affiliation, including a sense of belonging, self-worth, companionship, and excitement. Emphasizing prevention may minimize deviant subculture involvement, but some adolescents require clinical intervention, ranging from a few outpatient sessions to lengthy inpatient hospitalization. Therapists must be knowledgeable about adolescents' involvement, empathic to their circumstances, and sophisticated in the approach to treatment.     

Suicide prevention in the genetic counseling context

Utilizing a case report, this paper explores psychosocial aspects of suicidal intent in a woman seeking prenatal diagnosis. Using knowledge and practice of appropriate assessment, referral, and intervention procedures, the therapy team of genetic counselor and psychotherapist facilitated successful identification and management of this potentially suicidal client. The main counseling goals for the genetic counselor are to assess the situation adequately, decrease the immediate danger, and, with supervision and/or consultation, stabilize the seriously suicidal person until that individual can be triaged to mental health or medical professionals for treatment. The prevalence of suicide issues in genetic counseling contexts is unknown and reports mentioning suicidal ideation unusual in the genetic counseling literature. Is this reported case a rarity among genetic counseling referrals? Systematically collected information on the prevalence and resolution of suicidal issues in genetic counseling contexts would be helpful for those setting curricula for genetic counseling training programs, standards for professional certification exams, and policy and procedures manuals for clinical units.     

The fight against stigma: an overview of stigma-reduction strategies and interventions

In many health conditions, people are severely affected by health-related stigma and discrimination. A literature review was conducted to identify stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. The review identified several levels at which interventions and strategies are being implemented. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, far less work has been done on assessing the effectiveness of stigma-reduction strategies. The effective strategies identified mainly concentrated on the individual and the community level. In order to reduce health-related stigma and discrimination significantly, single-level and single-target group approaches are not enough. What is required is a patient-centred approach, which starts with interventions targeting the intrapersonal level, to empower affected persons to assist in the development and implementation of stigma-reduction programmes at other levels.     

Adolescent pregnancy: contributing factors and strategies for prevention.

A questionnaire was administered to pregnant adolescents and adolescent mothers to assess both basic needs and factors that may have contributed to their becoming teen parents. Family background and composition, history of sexual abuse, vocational plans and aspirations, and self-esteem were examined. Results and implications for prevention programs and counseling are discussed.     

Suicide prevention for high-risk persons who refuse treatment.

A program was developed to exert a suicide prevention influence on high-risk persons who decline to enter the health care system. There were 3,006 patients admitted to a psychiatric in-patient service because of a depressive or suicidal state who were contacted to determine if the post-discharge plan was followed. Half of those who refused their treatment program were contacted by telephone or letter on a set schedule. The contact was limited to expressing interest in the person's well-being. Mortality in the contact group was compared with the no-contact subjects and with the subjects who had accepted treatment, after 1, 2, 3, and 4 years. Suicidal deaths were found to diverge progressively in the three groups, the treatment subjects showing the highest rates, the no-contact group coming next, and the contact subjects showing the lowest. The observed divergence between the contact and no-contact groups provides tentative evidence that a high-risk population for suicide can be identified and that a system-atic approach to reducing that risk can be applied.     

Malleability of weight-biased attitudes and beliefs: A meta-analysis of weight bias reduction interventions

Weight bias exists across many important life domains, necessitating interventions designed to reduce weight-biased attitudes and beliefs. Though the effectiveness of weight bias interventions has been questioned, to our knowledge no meta-analysis of these interventions has been conducted. This meta-analysis evaluated the impact of weight bias interventions on weight-biased attitudes and beliefs and explored potential moderators. Interventions were eligible if they used an adult sample and a validated measure of weight-biased attitudes, which resulted in the inclusion of 30 studies represented in 29 articles. A random effects approach using inverse weights resulted in a mean effect size estimate of g = −0.33 (lower scores indicate less weight bias) for both attitudes and beliefs. Intervention type, publication type, and population type were not significant moderators but demonstrated noteworthy trends. Results reveal a small, positive effect of weight bias interventions on weight-biased attitudes and beliefs and provide useful information for future interventions.     

Suicide prevention in the Pacific War (WW II).

During the war against Japan, there were two facets of an American program to prevent suicide among the Japanese. One was a research component in the Foreign Morale Analysis Division (FMAD), a subunit of the Office of War Information. The principal FMAD figure who did most of the research on Japanese suicide and ways to prevent suicide among the Japanese military was the anthropologist Ruth Benedict, assisted by her Japanese-American aide Robert Hashima. The second facet was the suicide prevention program itself, which was put into effect toward the end of the war in the battles of Saipan and Okinawa. This program of action was undertaken by American GIs. These unheralded activities in suicide prevention merit a place in the annals of suicide prevention programs.     

Adolescent pregnancy: implications for prevention strategies in educational settings

Over 1 million teenagers become pregnant each year in the U.S. The most alarming increases have occurred among adolescents who are younger than 15 years of age. Variables strongly associated with teen pregnancy include minority status, low socioeconomic status, low academic achievement and occupational aspirations, and growing up in a single- parent household. A majority of teenage pregnancies are unintended, and pregnancy is the largest contributor to school dropout rate for U.S. adolescent females. During pregnancy, adolescent mothers suffer higher rates of health complications, and after childbirth they receive less education, have more children, and are more likely to be dependent on welfare. Psychologists employed in educational settings are in a unique position to be involved in adolescent pregnancy prevention efforts, and schools are increasingly considered to be appropriate environments for this purpose. Progressive school-based family planning programs have been established by the St. Paul/Ramsey Medical Center in St. Paul, Minnesota, and by the Johns Hopkins University Medical Center in Baltimore, Maryland. Both programs emphasize the distribution of contraceptives. An increasing number of school programs focus their efforts on helping adolescents become more responsible in their approach to sexual relationships, though they do not distribute contraceptives. A number of innovative community-based programs have also been formed that utilize multiple strategies to provide positive alternatives to pregnancy. Before setting up teen pregnancy prevention programs, school psychologists should try to learn from the lessons offered by established programs. They should also consult with teachers, administrators, students, and parents, and they should decide what instructional approaches are appropriate for their own situations.     

Clinical interventions and prevention for Asian American children and families: Current status and needed research

The current status of clinical interventions and prevention for Asian American children and/or adolescents and their families was assessed through a review of the literature on conceptual frameworks, cultural variables and related issues, and empirical studies. Five proposed approaches to treatment or prevention were examined. Some factors that might account for the slow progress of treatment research in this area were also discussed. These included conceptual and methodological issues; the paucity of data on psychopathology in this population; their low service-utilization rates; and societal images, values, and needs. Some needed directions for future research are suggested.     

Physiological Reactions to a Suicide Film: Suicide Attempters,Suicide Ideators,and Nonsuicidal Patients

A film about two teenagers who commit suicide was shown to three groups of psychiatric inpatients: 17 who had attempted suicide, 20 who had expressed suicidal thoughts, and 10 who were not suicidal. Anxiety before and after the film was evaluated with psychometric (anxiety rating scale) and physiological tools (heart and respiration rate, blood pressure, electromyogram). Values noted before and after screening, and the degree of change in these values, were compared. In addition, psychomotor agitation was rated at several points during the film. Most results were negative. The suicide attempters had significantly lower postscreening heart rates and a significantly lesser change in heart and respiration rates than the other two groups. The suicide attempters revealed an increase in psychomotor agitation until the discovery of the suicide and a decrease thereafter, whereas the agitation of the nonsuicidal patients continued to increase from the start to the end of the film. The study suggests that on some parameters, suicide attempters reveal less anxiety than nonsuicidal psychiatric patients following exposure to a simulated suicide. The reaction of suicide ideators falls somewhere between the two groups.     

Homicide Followed by Suicide: A Comparison with Homicide and Suicide

Homicide‐suicides are a rare yet very serious form of lethal violence which mainly occurs in partnerships and families. The extent to which homicide‐suicide can be understood as being primarily a homicide or a suicide event, or rather a category of its own is examined. In total, 103 homicide‐suicides were compared to 3,203 homicides and 17,751 suicides. These are all events that took place in the Netherlands in the period 1992 to 2006. Logistic regression analyses show that homicide‐suicides significantly differ from both homicides and suicides with regard to sociodemographic and event characteristics. The findings suggest that homicide‐suicide might be considered as a distinct phenomenon from both homicide and suicide.