The clinician-investigator: unavoidable but manageable tension

The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine--specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions.     

The Assessment of Goal Commitment: A Measurement Model Meta-Analysis

Goals are central to current treatments of work motivation, and goal commitment is a critical construct in understanding the relationship between goals and performance. Inconsistency in the measurement of goal commitment hindered early research in this area but the nine-item, self-report scale developed by Hollenbeck, Williams, and Klein (1989b), and derivatives of that scale, have become the most commonly used measures of goal commitment. Despite this convergence, a few authors, based on small sample studies, have raised questions about the dimensionality of this measure. To address the conflicting recommendations in the literature regarding what items to use in assessing goal commitment, the current study combines the results of 17 independent samples and 2918 subjects to provide a more conclusive assessment by combining meta-analytic and multisample confirmatory factor analytic techniques. This effort reflects the first combined use of these techniques to test a measurement model and allowed for the creation of a database substantially larger than that of previously factor analyzed samples containing these scale items. By mitigating sampling error, the results clarified a number of debated issues that have arisen out of previous small sample factor analyses and revealed a five-item scale that is unidimensional and equivalent across measurement timing, goal origin, and task complexity. It is recommended that this five-item scale be used in future research assessing goal commitment. Copyright 2001 Academic Press.     

Depression and resilience mediate the relationship between traumatic life events and ill physical health: results from a population study

We set out to investigate the mediating roles of depression, resilience, smoking, and alcohol use, in the relationship between potentially traumatic life events and objective and subjective, physical and mental health in a single study. A face-to-face, population-based survey was conducted in Hong Kong (N = 1147). Information on health conditions and traumatic life events was obtained, and participants completed measures of subjective physical and mental health, depression, and resilience. Smoking and drinking were not significant mediators of the relationship between life events and both objective and subjective health. Depressive symptomatology was found to mediate the relationship between life threatening illness and subjective physical health, the relationship between abuse (physical and sexual) and subjective mental health, and the relationship between the death of a parent/partner and subjective mental health. Resilience was found to mediate the relationships between multiple traumatic life events and subjective physical and mental health. Our results indicate that psychological factors rather than biological are important mediators of the relationship between life events exposure and health. Our findings provide evidence that depressive symptomatology has a mediating role only in the case of specific potentially traumatic life events and that resilience is only a critical factor in the face of exposure to multiple traumatic events, rather than single events. Our results also indicate that behavioural factors, such as smoking and drinking, are not significant mediators of the relationship between life events and health.     

Differential Influence of Social Support in Emerging Adulthood Across Sources of Support and Profiles of Interpersonal and Non-Interpersonal Potentially Traumatic Experiences

Social support is protective against the negative effects of trauma, yet how these effects vary across sources of support and patterns of trauma exposure has not been examined. High co-occurrence exists among different types of trauma across domains and ages, yielding patterns of trauma exposure that may affect social support. This study identified profiles of potentially traumatic events (PTEs) experienced by 252 college students and examined the relationships between social support and mental health across these profiles. Five profiles emerged: “Non-Interpersonal Trauma Exposure,” “Adult Intimate Partner Violence,” “Poly-trauma Exposure,” “Low Trauma Exposure,” and “Childhood Family Violence.” The link between social support and adjustment differed across profiles. Family support was valuable for promoting resilience across patterns of PTEs. Friend and romantic partner support were related to lower mental health problems. Support from family and friends is particularly valuable in the context of adult intimate partner violence and childhood family violence.     

Relationship Education for Military Couples: Recommendations for Best Practice

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.