Family Characteristics and Posttraumatic Stress Disorder: A Follow-Up of Israeli Combat Stress Reaction Casualties

This study assessed the role of family status and family relationships in the course of combat-related posttraumatic stress disorder (PTSD). The sample consisted of 382 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War. Results showed that one year after the war married soldiers had higher rates of PTSD than did unmarried soldiers. Furthermore, higher rates of PTSD were associated with low expressiveness, low cohesiveness, and high conflict in the casualties' families. Theoretical, methodological, and clinical implications are discussed.     

Preschoolers with Asthma: Narratives of Family Functioning Predict Behavior Problems

This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.     

Capturing Children's Response to Parental Conflict and Making Use of It

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full-text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ).
The aim of our study is to examine the interface between children's physiological changes and the specificities of parental conflict, and to develop a procedure in which such information can be shared with the family for therapeutic change. Children from 20 families were exposed to parental conflict discussion (CD) while their arousals were measured through skin conductance and heart rate sensors. It was found that regardless of the subject of the argument, 80% of the time they were complaining about each other. Likewise, 80% of the time the children were responding to the parents' own interpersonal tension, including moments of silence. The protocol established for the study, consisting of CD and debriefing, was found to be a powerful tool in moving parents toward conflict resolution.     

Quality adjusted survival analysis: A neglected application of the quality of well-being scale

Abstract

Background In survival analysis, those who are alive are statistically coded as 1.0 while those who are dead are coded as 0.0. Since everyone who remains alive is given the same score, a person confined to bed with an irreversible coma is alive and is counted the same as someone who is active and asymtomatic. The Quality of Well-being (QWB) scale defines levels of wellness on the continuum between death and optimum function and integrates morbidity and mortality into the same number. This paper demonstrates the effect of including mortality in QWB estimates for male adults with HIV infection.

Method This study involves follow-up of a cohort of 386 male adults participating in the San Diego HIV Neurobehavioral Research Center (HNRC). Patients were evaluated using the QWB at enrollment and at six month intervals. All patients were classified into three stages of HIV disease according to the Center for Disease Control (CDC) classification: CDC IV (symptomatic HIV disease), CDC II or III (asymptomatic infection) and uninfected male controls.

Results QWB scores were calculated with and without mortality included for men in each CDC class who completed a one year (N = 148) or two year follow-up (N = 60). At each evaluation, there were significant differences among CDC classes and inclusion of deaths increased the variance accounted for by CDC class at each evaluation.

Conclusions HIV infection has significant impacts upon both morbidity and mortality. Survival analysis captures only the mortality dimension, while quality adjusted survival analysis using the QWB includes both dimensions. We propose quality adjusted survival analysis as a more sensitive method for assessing outcome in HIV disease and other health conditions.     

The effects of stressor predictability on lymphocyte proliferation in humans

Abstract

To demonstrate the effects of predictable and unpredictable stressors on immune function, 36 male subjects were randomly assigned to complete ten trials of either a predictable or unpredictable cold pressor task or a non-stressful warm pressor control task. The predictable and no-stressor groups were given information about the duration of each pressor trial and a countdown of seconds passed from beginning to end of each trial. The unpredictable stressor group received no information. Self-report, cardiovascular, and biochemical measures were taken throughout the tasks in order to ascertain the effectiveness of the predictability and stressor manipulations. Lymphocyte proliferation to concanavalin A (Con A) and pokeweed mitogen (PWM) were measured before, during and after the tasks. Lymphocyte proliferation to Con A (10/μg/ml) was significantly reduced only in response to the unpredictable stressor suggesting that predictability buffered the effect of the stressor on immune function. Proliferation to PWM followed a similar pattern but was not statistically significant. Blood pressure responses were negatively correlated with proliferation values suggesting that stressor predictability may attenuate stress-associated immune decreases by reducing sympathetic arousal.     

Cultural Specificity in Patterns of Mental Illness and Health: A Slovak-American Case Study

Mental illness and mental health are conceptualized as dynamic opposites o/a single, underlying psycho-cultural process. An illustrative case history of a Slovak-American family with a schizophrenic member is presented.