Psychiatric Hospital Treatment of Suicidal Children

ABSTRACT: Three phases of psychiatric hospital treatment of children, ages 6 to 12 years, admitted to the hospital because of suicidal threats or suicidal attempts are described. Suicidal behavior in young children must always be taken seriously. Although suicidal behavior usually ceases upon hospitalization, suicidal ideas may continue to be expressed in play and fantasy. In addition to individual and milieu therapy, treatment must also include concomitant assistance of the parents. The treatment procedures are illustrated by suicidal case examples of a depressed girl, an acting-out boy, and a psychotic boy.     

Interpersonal Psychotherapy—Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process

Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT–AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT–AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.     

The Role of Children's Neurophysiological Functioning in the Links Between Emotion-Parenting Behaviors and Child Anxiety Symptoms: A Biological Sensitivity to Context Framework

A plethora of data supports links between parenting behaviors and child anxiety, but few studies have examined factors that can contribute to variability in these relations. Adopting a biological sensitivity to context framework, this study explored the role of children's physiological stress reactivity in the links between emotion-parenting and child anxiety symptoms in a group of Chinese families. Sixty-one parent–child dyads (child M_age = 8.21 years, SD = 1.40, range = 6–12 years) participated in an acute stress protocol, from which children's physiological (cortisol and respiratory sinus arrhythmia) responses to a social speech task were recorded. Participants then completed questionnaires assessing parents’ emotion-parenting behaviors and children's anxiety symptoms. Results showed that the relation between supportive emotion-parenting and child anxiety was stronger in the context of greater child RSA suppression to acute stress, such that children higher in RSA suppression exhibited lower anxiety symptoms when supportive emotion-parenting was higher than when it was lower. Thus, these findings supported the biological sensitivity to context model. No significant moderation effect was detected for cortisol reactivity or recovery. Instead, exploratory mediation analyses showed that supportive emotion-parenting was negatively related to child anxiety via greater cortisol recovery. There was also a significant indirect path where unsupportive emotion-parenting was related to blunted cortisol recovery, which in turn was associated with higher child anxiety. The results highlight the importance of coaching parents to respond in supportive ways to children's emotional expressions, particularly in the context of greater child reactivity, to help buffer against childhood anxiety symptoms.     

Quantifying the Interplay of Semantics and Phonology During Failures of Word Retrieval by People With Aphasia Using a Multiplex Lexical Network

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways—(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia.     

Understanding and taking stock of positive emotion disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the “other side” of positive emotion, by describing and reviewing evidence supporting the emerging field of positive emotion disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.     

Women in advertisements in medical journals

To determine the images of women in picture advertisements, a stratified random sample of 32 medical journals, representing approximately 12% of medical journals published in the United States that are directed toward physicians in clinical practice, was subjected to content analysis. The sample consists of 209 different ads. The subjects of the ads included men, women, and children representing a variety of ethnic, racial, and socioeconomic groups. Notable, however, was the preponderance of Caucasian males pictured as physicians and the absence of women and people of color in this role. Women are pictured as 68.1% of consumers and men as 31.9%, a significant difference. Statistically significant differences also occur in the images of men and women as consumers. Most of the workers are men (68.2%), another significant difference. When women depicted are workers, they are secretaries and waitresses. Portrayals of women in medical advertisements continue to be stereotyped and outdated.     

Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.     

Salience Versus Proportional Reasoning: Rethinking the Mechanism Behind Graphical Display Effects

Two experiments examined predictions from two separate explanations for previously observed display effects for communicating low‐probability risks: foreground:background salience and proportional reasoning. According to foreground:background salience, people's risk perceptions are based on the relative salience of the foreground (number of people harmed) versus the background (number of people at risk), such that calling attention to the background makes the risk seem smaller. Conversely, the proportional reasoning explanation states that what matters is whether the respondent attends to the proportion, which conveys how small the risk is. In Experiment 1, we made the background more salient via color and bolding; in contrast to the foreground:background salience prediction, this manipulation did not influence participants' risk aversion. In Experiment 2, we separately manipulated whether the foreground and the background were displayed graphically or numerically. In keeping with the proportional reasoning hypothesis, there was an interaction whereby participants given formats that displayed the foreground and background in the same modality (graphs or numbers, thereby making the proportion easier to form) saw the probability as smaller and were less risk averse than participants given the information in different modalities. There was also a main effect of displaying the background graphically, providing some support for foreground:background salience. In total, this work suggests that the proportional reasoning account provides a good explanation of many display effects related to communicating low‐probability risks, although there is some role for foreground:background salience as well. Copyright © 2018 John Wiley & Sons, Ltd.     

Prediction of toddlers’ expressive language from maternal sensitivity and toddlers’ anger expressions: A developmental perspective

Despite evidence for the importance of individual differences in expressive language during toddlerhood in predicting later literacy skills, few researchers have examined individual and contextual factors related to language abilities across the toddler years. Furthermore, a gap remains in the literature about the extent to which the relations of negative emotions and parenting to language skills may differ for girls and boys. The purpose of this longitudinal study was to investigate the associations among maternal sensitivity, children's observed anger reactivity, and expressive language when children were 18 (T1; n = 247) and 30 (T2; n = 216) months. At each age, mothers reported on their toddlers’ expressive language, and mothers’ sensitive parenting behavior was observed during an unstructured free-play task. Toddlers’ anger expressions were observed during an emotion-eliciting task. Using path modeling, results showed few relations at T1. At T2, maternal sensitivity was negatively related to anger, and in turn, anger was associated with lower language skills. However, moderation analyses showed that these findings were significant for boys but not for girls. In addition, T1 maternal sensitivity and anger positively predicted expressive language longitudinally for both sexes. Findings suggest that the relations between maternal sensitivity, anger reactivity and expressive language may vary depending on the child's developmental stage and sex.