"Living with" the past: coping and patterns in families of Holocaust survivors

This exploratory study looks at how families of Holocaust survivors work through the traumatic past by considering the coping patterns adapted by family members. Life-story interviews (Rosenthal, 1993) with 57 individuals from 20 families, in which there were two to three generations, were used in order to learn about the significance they attach to the Holocaust past. The interviews were analyzed using Rosenthal's methods and Danieli's (1988) typology of post-war adaptation (victim families, fighter families, those who made it, and numb families). Results showed that in order to differentiate between the coping styles exhibited by the families, two new categories had to be added to Danieli's typology. These were entitled "life goes on" and "split families." It was concluded that survivor families exhibit heterogeneity in the ways in which they cope with the Holocaust past.     

Parents' Sense of "Entitlement" in Adoptive and Nonadoptive Families

The literature suggests that problems with developing a sense of entitlement are unique to adoptive families, but this assumption has not been examined empirically. In this study, a questionnaire was constructed to define operationally those characteristics associated with the construct of entitlement, and was administered to adoptive and nonadoptive families with children averaging 11.5 years in age who presented either for mental health service or were recruited as a comparison-control sample. Factor analysis yielded four factors on which the four groups of subjects were compared. Results indicated that problems with entitlement are not specific to adoptive families. Instead, differences in sense of entitlement occurred primarily between clinic and nonclinic control families, regardless of whether the target child had been adopted. Findings are discussed in terms of methodological shortcomings in the adoption research literature and how problems in entitlement may be associated with other family characteristics.     

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

This mixed method study examined factors associated with parents not attending their child’s mental health treatment after initially seeking help for their 2–5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71?% African American or multi-racial; 97.6?% low-income), 36 (29.3?%) never attended their child’s first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child’s first treatment session were more likely to live with more than four adults and children (p?=?.007) and have more depressive symptoms (p?=?.003). Median length of treatment delay was 80 days (IQR?=?55) for those who attended and 85 days (IQR?=?67.5) for those who did not attend their child’s first treatment session (p?=?.142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.     

Genealogic studies in genuine partial epilepsy

Clinical--electroencephalographic (EEG) investigation was performed in 12 families. In the study were included 12 epileptics with partial seizures in whom the katamnestic follow up from 2 to 6 years provided clinical, EEG and genetic data for the so called primary partial epilepsy 24 parents and 14 siblings. In four of the Children with epilepsy the seizures were of the "Rolandic" type; in 5--"psychomotor"; and in 3--hemiconvulsive. No data for structural brain lesion investigation were found. Rapid and long lasting therapeutic effect was achieved in all of the cases. The EEG showed focal paroxysmal activity in all of the diseased and in 11 of the siblings, in 5 of them were found epileptic seizures of the same type as in the probands. The possibilities of a genetic predisposition to development of an epileptogenic focus and its clinical Expression in members of the families in discussed.     

Similar-other support for men undergoing coronary artery bypass surgery.

This field experiment examined effects of a support intervention on the physical and mental health of coronary artery bypass graft (CABG) surgery patients. Control participants (N = 90) received usual hospital care; experimental participants (N = 100) also received visits from a "similar other" while in the hospital. Similar others were Veterans Administration veterans who had CABG surgery previously and were trained in simple supportive techniques. Outcomes were assessed prior to surgery and at 1, 6, and 12 months afterwards. Unexpectedly, the intervention generally had no effects on participants' well-being. Further analysis showed that participants who talked often with fellow cardiac patients in the hospital ("de facto similar others") experienced improvements in their physical and emotional well-being over time.     

A Randomized Controlled Trial of the Impact of a Family-Based Adolescent Depression Intervention on both Youth and Parent Mental Health Outcomes

This paper presents findings from a multi-centre, double-blind, randomized controlled trial that tested the hypothesis that parent and youth mental health improvements would be superior in a family-based intervention for adolescent depression (BEST MOOD) compared to a treatment-as-usual supportive parenting program (PAST). Eligible participants were families with a young person aged between 12 and 18 years who met diagnostic criteria for a depressive disorder (major, minor or dysthymic). Participating families (N = 64; 73.4% of youth were female) were recruited in Victoria, Australia and allocated to treatment condition using a block randomization procedure (parallel design) with two levels of blinding. This paper reports on the trial’s secondary outcomes on youth and parent mental health. General linear mixed models were used to examine the longitudinal effect of treatment group on outcome. Data were analyzed according to intention-to-treat; 31 families were analyzed in BEST MOOD, and 33 families in PAST. Parents in the BEST MOOD group experienced significantly greater reductions in stress and depressive symptoms than parents in the PAST group at 3-month follow-up. A greater reduction in parental anxiety was observed in the BEST MOOD group (d = 0.35) compared with PAST (d = 0.02), although the between-group difference was not significant. Both groups of youth showed similar levels of improvement in depressive symptoms at post-treatment (d = 0.83 and 0.80 respectively), which were largely sustained at a 3-month follow-up. The family-based BEST MOOD intervention appeared superior to treatment-as-usual (PAST) in demonstrating greater reductions in parental stress and depression. Both interventions produced large reductions in youth depressive symptoms.     

"Lesbians, gay men, and their parents": a critique of LaSala and the prevailing clinical "wisdom"

This article challenges the popular assumption that coming out to family of origin is important for lesbians and gay men's mental health and couple relationships. First, I present theory emphasizing the unique position of lesbians/gays in families of origin and the significance of "families of choice." Second, I review the quantitative research on social support received by lesbians/gays from family of origin, friends, and other social network sources. Third, I demonstrate how the dominant clinical opinion about coming out to family is based on an unwarranted use of theory developed for heterosexuals and on overgeneralization of findings from studies of white, upper-middle-class, North American lesbians/gays. Fourth, I propose five determinants of lesbian/gay persons' decisions to come out to family-of-origin members. Fifth, I argue that such decisions are constrained by "realistic" costs/benefits in various sociocultural niches rather than being a simple function of individuals' levels of differentiation. Lastly, I offer an expanded contextual stance for the family therapist working with lesbian/gay clients.     

Psychological factors and use of antiepileptic drugs: pilot work using an objective measure of adherence

Given the current emphasis on the "concordance" prescribing model, a study was designed to determine the influence of patients' beliefs about epilepsy, beliefs about medication and a range of neuroepilepsy variables on drug adherence among a sample of epilepsy patients. A special feature of the study was the use of a credible objective measure of drug adherence. Psychological health was also assessed. Thirty-seven patients were recruited from a local epilepsy clinic. Beliefs about epilepsy (illness representations), beliefs about epilepsy medication, anxiety, depression, neuroepilepsy status and adherence were all measured. Data were collected via clinical interview and questionnaire methods. Adherence with drug treatment was determined by an objective measure using low-dose phenobarbital as an indicator of adherence and, or, measurement of antiepileptic drug levels. Neither illness representations nor beliefs about epilepsy drugs were related to adherence. With the exception of time since last seizure, which was positively related to adherence, neuroepilepsy variables were unrelated to adherence. A number of significant associations between cognitive representations of epilepsy and mood were found.     

Memory deficits before and after temporal lobectomy: Effect of laterality and age of onset

Laterality and age of onset effects on semantic and figural memory were evaluated in 30 right-handed, left speech dominant (amobarbital test) patients with epilepsy before and after temporal lobectomy. There were no effects of focus on WAIS-R IQ scores. Early onset (less than or equal to 5 years) was associated with lower IQ and memory (WMS). Left Temporal (LT) patients showed worse semantic than figural memory preoperatively. Unexpectedly, early onset LT had marked postoperative decline of figural memory, whereas late onset LT patients showed the previously reported worsening of semantic memory. Right Temporal (RT) lobectomy patients, in contrast, improved in both semantic and figural memory regardless of age of onset. A "crowding effect" was suggested by the decline in figural memory following surgery in the early onset LT patients who remained stable or improved in semantic memory. Results indicate the need to incorporate age of onset of seizures into laterality models of memory function following unilateral temporal-hippocampal resection.     

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

Results of an Intervention for Individuals and Families with <Emphasis Type="Italic">BRCA</Emphasis> Mutations: A Model for Providing Medical Updates and Psychosocial Support Following Genetic Testing

Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.     

Anxiety and vulnerability in parents following the death of an infant

Empirical data on the subjectively reported anxiety reactions of 117 parents who lost an infant at birth or daring the first year of life are presented. From a retrospective survey conducted 1 to 4 years after the death it was evident that parents experienced a great deal of anxiety following the death of their child. Parents who experienced a sudden death in the home reported the strongest anxiety, but other parents who lost their child in hospital at birth or thereafter also experienced strong anxiety. The anxiety for surviving children and later-born children was extensive. In all areas mothers experienced more anxiety than fathers. More intense and longer grief in one's partner, the perceived lack of support from others, being older, and being a female were significantly correlated with anxiety. The results are interpreted as a confirmation that parents who lose their children experience a fundamental change in their beliefs about their family's future security. Better training of health personnel is required to secure an adequate follow up of families that lose a child.     

Neuropsychological profiles of adults who report "sudden remembering" of early childhood memories: implications for claims of sex abuse and alien visitation/abduction experiences.

Six adults, who had recently experienced sudden recall of preschool memories of sex abuse or alien abduction/visitation, were given complete neuropsychological assessments. All experiences "emerged" when hypnosis was utilized within a context of sex abuse or New Age religion and were followed by reduction in anxiety. As a group, these subjects displayed significant (T greater than 70) elevations of childhood imaginings, complex partial epileptic-like signs, and suggestibility. Neuropsychological data indicated right frontotemporal anomalies and reduced access to the right parietal lobe. MMPI profiles were normal. The results support the hypothesis that enhanced imagery due to temporal lobe lability within specific contexts can facilitate the creation of memories; they are strengthened further if there is also reduction in anxiety.     

A cross-validation of Paulson's discriminant function-derived scales for identifying "at risk" child-abusive parents

Paulson, Afifi, Chaleff, Liu, & Thomason (1975) developed a series of special subscales from the MMPI for identifying individuals who are at risk for child-abusive behavior. The initial results were highly encouraging, with the scales correctly identifying 93 to 100% of the subjects in their sample. Unfortunately, Paulson et al. (1975) failed to cross-validate their findings before publication. When the six scales were cross-validated on an independent sample from the population of child-abusing parents, significant shrinkage in the accuracy of prediction was found. The use of the special subscales for identifying "at risk" parents in prenatal clinics, pediatric clinics, pediatric clinics and mental health centers as originally suggested by Paulson and his colleagues is seriously questioned.     

Language after temporal or frontal lobe surgery in children with epilepsy

The purpose of this study was to compare language function in children undergoing temporal or frontal lobe surgery to control intractable epilepsy. Language measures (expressive vocabulary, receptive vocabulary, comprehension, reading, spelling, phonemic fluency, and category fluency) were administered to 9 children with frontal lobe epilepsy (mean age: 10.8 +/- 2.7 years) and 10 children with temporal lobe epilepsy (11.5 +/- 2.6 years). The results indicate that no differences exist, in language function, before and after surgery between children with frontal and temporal lobe epilepsy (all p > or = .05). Children with left hemisphere lesions had significantly lower scores than those with right on category fluency and comprehension, but laterality effects were not seen on the other measures. In both groups, language function was not significantly affected by surgery.     

Grandparents' psychological well-being after loss of contact with their grandchildren.

This study examined how loss of contact with grandchildren due to parental separation or divorce, family feud, or a sudden event, such as relocation, affected the emotional well-being of grandparents (N = 442). Using data from the Longitudinal Study of Generations, the depressive symptoms of grandparents were tracked over 15 years. Growth curve analysis was used to compare grandparents who had lost contact with their grandchildren with those who had not and to examine preloss to postloss change in depressive symptoms. Grandparents who lost contact with their grandchildren experienced a steeper increase in depressive symptoms as they aged compared with other grandparents. Depressive symptoms of grandparents who lost contact because of a sudden event increased up to 3 years following the loss but returned to equilibrium thereafter. The authors conclude that grandparents who lost contact with their grandchildren experienced a negative impact on their emotional health.     

Barriers to the management of patients with surgically remediable intractable epilepsy

It is estimated that only a small proportion of patients with surgically remediable intractable epilepsy receive surgical treatment. There are multiple reasons why this is the case. Patients with intractable epilepsy are sometimes severely disabled and disability can create barriers to getting recommended care. Patients with epilepsy are not well informed about their condition and the available treatments. The incidence of epilepsy is similar in minority populations, and surgically remediable epilepsy frequently presents in adolescence. Nevertheless, these vulnerable populations have specific barriers to receiving epilepsy care, which are often not addressed. In addition, despite scientific evidence for the benefits of the surgical treatment of epilepsy, many healthcare providers do not recommend or adequately discuss surgery with patients. Solutions to these barriers will require interventions that result in informed and capable patients who actively participate in their care and healthcare providers who practice culturally sensitive, recommended care.     

Dimensions of the severity of a health threat: the persuasive effects of visibility, time of onset, and rate of onset on young women's intentions to prevent osteoporosis

Examined the persuasive effects of information about different aspects of the severity of a health threat. The research participants were 170 young women who were at risk for osteoporosis because they neither consumed an adequate amount of calcium daily nor performed an adequate amount of weight-bearing exercise. A message describing osteoporosis as disfiguring and highly visible increased beliefs in its severity and strengthened intentions to adopt the communicator's recommended preventive responses. In addition, compared with control conditions, describing the threat as likely to occur in the near future, as opposed to the distant future, also strengthened intentions. Furthermore, motivation to prevent osteoporosis remained high regardless of whether subjects believed it might occur to them in the near or distant future if they believed it was highly visible or disfiguring. The rate of onset (sudden or gradual) had no effect on intentions. Several implications for preventive health psychology are discussed. First, health promotion campaigns should, whenever possible, emphasize the immediate onset of a health threat and any visible features. Second, in order to convince people a health threat can be severe, the sudden rate of onset should be emphasized whenever possible.     

Acceptance, avoidance, and ambiguity: conflicting social values about childhood disability

Advances in medical technology now permit children who need ventilator assistance to live at home rather than in hospitals or institutions. What does this ventilator-dependent life mean to children and their families? The impetus for this essay comes from a study of the moral experience of 12 Canadian families--parents, ventilator-dependent child, and well siblings. These families express great love for their children, take on enormous responsibilities for care, live with uncertainty, and attempt to create "normal" home environments. Nevertheless, they experience social isolation, sometimes even from their extended families and health care providers. Their lives are constrained in many ways. The challenges faced by parents of technology-dependent children raise questions of justice within society and within families.     

Adoption Counselors' Perspectives of Counseling Postadoptive Families

This study was conducted to explore the mental health needs of families who adopted from the state welfare system. Using consensual qualitative research, the authors examined the perspectives of 8 clinical mental health counselors who provided counseling services to postadoptive families. Findings represented by 5 domains and supported by 15 categories include the counselors' perspective of (a) strength of the current program, (b) families in crisis, (c) parents' construction of their child's problem, (d) programmatic limitations, and (e) systemic limitations.