A family-based mental health program of recovery from state terror in Kosova

Family processes of communication, mutual support, and sustenance of cultural values can play vital roles in recovery from psychological and material damage in societies afflicted by terror. This is particularly the case when a campaign of terror has specifically targeted family life and its traditions, when the culture is one whose identity has been centered in its families, and when public mental health resources have been scarce. At the end of the 1999 war in Kosova, the Kosovar Family Professional Educational Collaborative (KFPEC) was initiated to counter mental health sequelae of war in Kosova. This initiative focused upon the recovery and strengthening of Kosovar families, rather than the psychiatric treatment of individuals for post-traumatic symptoms. Findings and outcomes from this project may usefully inform the design of other international public mental health initiatives.     

The impact of mental health evidence on support for capital punishment: are defendants labeled psychopathic considered more deserving of death?

Controversy surrounds the use of the Hare Psychopathy Checklist--Revised (Hare, 1991, 2003) in capital murder cases, where it has been introduced to support prosecution claims that a defendant represents a "continuing threat to society". Although widely presumed to have a prejudicial impact (e.g., American Psychological Association, 2004), little is known about how the lay public reacts to data derived from ostensibly stigmatizing assessment instruments such as the PCL-R. The present study examined the effect of psychopathy data on layperson attitudes by having 203 undergraduates review a capital murder case where the results of the defendant's psychological evaluation were experimentally manipulated. When expert testimony described the defendant as psychopathic, a much larger percentage of participants supported a death sentence (60%) than when testimony indicated that he was psychotic (30%) or not mentally disordered (38%). Interestingly, participant ratings of how psychopathic they perceived the defendant to be--regardless of the testimony condition to which they had been assigned--also predicted support for a death sentence. Given the limited probative value of the PCL-R in capital cases and the prejudicial nature of the effects noted in this study, we recommend that forensic examiners avoid using it in these trials.     

The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients

The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment group (n = 25) resolved their suicidality significantly more quickly than TAU patients (n = 30). CAMS was also significantly associated with decreased medical health care utilization in the 6 months after the start of suicide-related mental health treatment. These results provide promising preliminary support for the effectiveness of CAMS and a foundation for prospective research.     

An evaluation of the Psychache Scale on an offender population

This study examined the generalizability of a self-report measure of psychache to an offender population. The factor structure, construct validity, and criterion validity of the Psychache Scale was assessed on 136 male prison inmates. The results showed the Psychache Scale has a single underlying factor structure and to be strongly associated with measures of depression and hopelessness and moderately associated with psychiatric symptoms and the criterion variable of a history of prior suicide attempts. The variables of depression, hopelessness, and psychiatric symptoms all contributed unique variance to psychache. Discussion centers on psychache's theoretical application to the prediction of suicide.     

Perceptions concerning college student suicide: data from four universities

The issue of suicide, including prevention, intervention, and postvention, continues to be a problem on college campuses. For this study, data concerning a variety of issues related to college student suicide were collected from 1,865 students at four different universities. Incidence, risk factors, and potential solutions are described, as well as implications for mental health professionals in university settings.     

High-lethality status in patients with borderline personality disorder

Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.     

Evaluating the efficiency and community safety goals of the Broward County Mental Health Court

Mental health courts have developed as one response to persons with mental illness who are involved with the criminal justice system. This study investigated the efficiency and safety goals of one such court in Broward County, FL. Mental health court (MHC) clients spent significantly fewer days in jail for the index arrest associated with study enrollment than a comparison group. MHC clients had similar survival time to re-arrest up to one year after study enrollment. MHC clients did not significantly differ from the comparison group in self-reported aggressive acts over an 8 month follow-up period, while they did self-report significantly fewer acts of violence than the comparison group at the 8 month follow-up. These findings suggest that some of the benefits associated with the MHC reported in prior studies were not achieved at the expense of efficiency and safety.     

Selective Mutism in Children: Comparison to Youths With and Without Anxiety Disorders

Fifteen children with selective mutism (SM), 15 children with anxiety disorders (AD) without selective mutism, and 15 children without anxiety disorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All children with SM received a diagnosis of social anxiety disorder and 53% received a diagnosis for an additional anxiety disorder. In addition, the SM and AD groups differed substantially from controls with respect to parent- and teacher-rated internalizing behavior problems. No differences among the groups were found with respect to parent-and teacher-reported externalizing behavior problems. The results are consistent with prior research emphasizing the association between selective mutism and anxiety disorders, and suggest that selective mutism may be conceptualized, assessed, and treated as an anxiety-related problem.     

Field reliability of comprehensive system scoring in an adolescent inpatient sample

The extent to which the Comprehensive System for the Rorschach is reliably scored has been a topic of some controversy. Although several studies have concluded it can be scored reliably in research settings, little is known about its reliability in field settings. This study evaluated the reliability of both response-level codes and protocol-level scores among 84 adolescent psychiatric inpatients in a clinical setting. Rorschachs were originally administered and scored for clinical purposes. Among response codes, 87% demonstrated acceptable reliability(> .60), and most coefficients exceeded .80. Results were similar for protocol-level scores, with only one score demonstrating less than adequate reliability. The findings are consistent with previous evidence, indicating reliable scoring is possible even in field settings.     

The<Emphasis Type="Italic">remember</Emphasis> response: Subject to bias,graded, and not a process-pure indicator of recollection

Recognition memory judgments have long been assumed to depend on the contributions of two underlying processes: recollection and familiarity. We measured recollection with receiver-operating characteristic (ROC) data and remember-know judgments. Under standard remember-know instructions, the two estimates of recollection diverged. When subjects were told they might need to justify theirremember responses to the experimenter, the two estimates were more likely to agree. The data support the conclusion thatremember responses are generally based on a continuous underlying process but that specific task instructions can produce data that appear consistent with a high-threshold recollective process. Models based on signal detection theory provide a better account of these data than does the dual-process model (Yonelinas, 1994) or process-pure interpretations.