Sleep Symptoms as a Partial Mediator Between Combat Stressors and Other Mental Health Symptoms in Iraq War Veterans

Sleep symptoms are a prominent feature of mental health disorders like PTSD and depression. However, it is unknown whether sleep symptoms mediate the relationship between combat stress and these disorders. We examined the mediating role of sleep symptoms on the relationship between combat stress and PTSD; and the relationship between combat stress and depression using data from 576 Army veterans of the Iraq War surveyed in 2004. Correlational analyses revealed that when insomnia was included in the model, the correlation between combat stressors and other depression symptoms decreased by 65%; and when nightmares were included in the model, the correlation between combat stressors and other PTSD symptoms decreased by 69%. We replicated these analyses using individual items assessing PTSD and depression and found that the insomnia and nightmare items had the largest and second largest mediation effect between combat stressors and PTSD and depression symptoms. Our result support the theory that sleep symptoms contribute to the development and/or maintenance of other mental health symptoms and that early treatment of sleep symptoms may mitigate the other mental health consequences of combat stress.     

Studies on Interfaith Relations: Latest Input for Authority Management Review (AMR) in Malaysia

Malaysia is a multi-religious society with 28.3 million people. The country had succeeded in managing religious diversity for almost fifty-seven years. This includes the promotion of interfaith relationships granted under the right to religious freedom, which is protected by the State. There are, however, emerging interfaith challenges, including conversion from one faith to another and reversion back to the original faith, these types of challenges appearing especially in the early millennium. This article reviews the ten latest research studies on interfaith issues in Malaysia and identifies useful themes for authority in exercising management review. Using the content analysis method, this study found that there are several important managerial aspects to be taken into serious consideration, including setting clear parameters for freedom of religion in Malaysia, clear procedures for managing religious conflict, managing faith with respect, and effectively promoting media advocacy. The findings also give insights on the development of interfaith studies in Malaysia.     

A biopsychosocial model for treating infertility

With approximately one out of six married couples experiencing infertility, having a basic knowledge of infertility is important to marriage and family therapists. This paper presents important themes that infertile couples often struggle with and stresses the importance of having a biological, psychological, and social understanding of infertility. In addition, the paper suggests possible interventions that family therapists can use in helping infertile couples.     

Divorce in the kibbutz: Past and present

In the kibbutz today, there are no ideological or economic barriers to prevent a couple from deciding to divorce. Both husband and wife are assured continued economic security and equal opportunities for co-parenting, thus reducing fears of disruption in the daily contact with the children. In spite of these favorable circumstances, marital breakups in the kibbutz are less frequent than in the larger cities in Israel. In recent years, however, at a time when a stronger and more intensive family life has gained legitimacy within the kibbutz structure, there is a marked tendency toward a rise in the rate of divorce. In this article we analyze the possible causes of the variations in the frequency of divorce within the kibbutz framework.The authors express appreciation to Esther Mivtzari, a psychologist on the staff of the Kibbutz Child and Family Clinic and a member of the religious kibbutz Ein-Tzurim, for assistance in gathering data on divorce in the religious kibbitzum.     

A benevolent conceptualization of marital power: The case of depression

Treatment of the depressed client with low self-esteem, external locus of control, and an absent spouse often is frustrating due to the limitations of modifying the social context. An approach to the problem using a systemic view which is based on examining the notion of power and examining the problems in their context is presented. Interventions which sidestep the temptation of emphasizing self-esteem of the client and, instead, utilize client strengths and interactional dynamics within the marriage are presented.     

The client: Therapist's partner or therapist's opponent? thoughts on the question of power and cooperation in therapy

The difference in process and outcome of two therapies conducted by the author with families having a psychotic adolescent is considered. Attention is paid to the fact that in one case the client was regarded theoretically as an opponent and in the other as a partner. It is concluded that the contention thatthe therapist must decide whether to be influential or cooperative arises from a logical confusion by failing to recognize that therapy cannot be anything other than cooperation.Originally published as part of a special issue on the power metaphor guestedited by Klaus G. Deissler inZeitschrift fur systemische Therapie (1986),4, 253–257. Translated by S. Awodey.     

The Shattered Microcosm: Imperatives for Improved Family Therapy in Africa in the 21st Century

This paper provides an in-depth socio-political analysis of the basis for the limits of family therapy in Africa in the last 40 years. The goal is to make more visible the economic, social, political, and cultural factors that have combined to complicate and frustrate our macro-environments of practice. The conclusion is that family therapy in Africa cannot achieve any meaningful progress in the present millenium unless the structures of underdevelopment under which we live and work are dismantled and in their place the important preconditions for successful practice of modern family therapy are entrenched. The list of imperatives to be addressed is offered to suggest the direction along which we must move if we are to effect this adaptation.     

Moving Beyond Self‐Report: Implicit Associations about Death/Life Prospectively Predict Suicidal Behavior among Veterans

Reliance on self‐report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6‐month follow‐up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15–3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.     

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression,Suicidal Ideation,and Suicidal Behavior in High‐Risk Adolescents

The relationship between hopelessness and depression in predicting suicide‐related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2‐ to 4‐year period. In multivariate regressions controlling for depression, suicidal ideation, and negative‐expectation hopelessness, positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.     

A Review of “Trauma and Human Existence: Autobiographical,Psychoanalytic and Philosophical Reflections”

Abstract

The author sets out to locate Bion's model of the mind within the developmental history of psychoanalysis, from Freud to Klein to Bion, using biographical material and clinical case examples, to illustrate Bion's concepts of container/contained, his understanding and use of projective identification, his extension of the use of the countertransference, and his differentiation between the psychotic and non-psychotic aspects of the mind. Links, and attacks against linking are discussed, as well as Bion's thoughts about learning versus knowing, being versus becoming and his emphasis on the essential importance of the development of the capacity to think.