Suicide compared to other causes of mortality in physicians

Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results about cause-specific mortality such as suicide. In this study, we compared all-cause and cause-specific mortality in a sample of physicians to the age-gender matched general U.S. population from 1948 through 1998. We also compared the mortality experience across medical specialties. The risk of all-cause mortality was 56% lower than expected in men, and 26% lower in women, compared to the general population. Standardized mortality ratios (SMRs) were markedly lower for diseases strongly linked to smoking, e.g., cardiovascular diseases, respiratory diseases, and lung cancer. Suicide was the only cause of death where risk was greater than the general population. Overall, we found that physicians are at substantially lower risk of dying compared to the general population for all causes of death except suicide. The findings for suicide are strikingly different than other causes of death and should provide impetus for new research on the mental health of physicians.     

The imaginer and the imagined

A transference of the imaginer and the imagined, arising from largely unconscious fantasies of the way parent and child interact to construct a view of reality, is present in all analyses. For narcissistic patients, primitive fantasies of the imaginer and imagined form an enduring organization, and the enactment of these fantasies in transference and countertransference distorts the way analyst and patient construct meaning. Clinical material demonstrates the deepening that occurs when these fantasies are interpreted.     

Multisystemic therapy for young offenders: families' experiences of therapeutic processes and outcomes

Multisystemic Therapy (MST) has been found to be effective in reducing youth antisocial behavior, but little is known about the process and impact of MST from the perspective of families themselves. This qualitative study explored parents' and young people's experiences of MST, focusing on aspects of the intervention that promoted or limited change. Thirty-seven semistructured interviews were conducted with a consecutive sample of 21 families (21 parent interviews, 16 young people) who had participated in a randomized controlled trial of MST for young offenders in the United Kingdom. Thematic analysis yielded 10 themes, organized into two domains: (a) engagement in MST and initial processes of change captures the central importance of the therapeutic relationship and the MST engagement model in families' positive experiences of MST; and (b) outcomes are complex reflects the range of positive outcomes reported (notably increased parental confidence and skills, improved family relationships, a return to education, and greater reflection and aspiration on the part of the young person) and mixed behavior outcomes. Even when the young person had reoffended, respondents indicated a range of other benefits for the family. The findings support the MST theory of change as well as point to some outcomes not usually measured in MST outcome studies. They also suggest some adaptations that may increase the impact of the intervention, including more attention to the influence of deviant peers, and ongoing support for families struggling to maintain strategies beyond the prescribed treatment period.     

The Hispanic Stress Inventory--Adolescent Version: a culturally informed psychosocial assessment

A 2-phase study was conducted to develop a culturally informed measure of psychosocial stress for adolescents: the Hispanic Stress Inventory--Adolescent Version (HSI-A). Phase 1 involved item development through the collection of open-ended focus group interview data (n = 170) from a heterogeneous sample of Hispanic youths residing in the southwest and northeast United States. In Phase 2, we examined the psychometric properties of the HSI-A (n = 1,651), which involved the use of factor analytic procedures to determine the underlying scale structure of the HSI-A for foreign-born and U.S.-born participants in an aggregated analytic approach. An 8-factor solution was established, with factors that include Family Economic Stress, Acculturation-Gap Stress, Culture and Educational Stress, Immigration-Related Stress, Discrimination Stress, Family Immigration Stress, Community and Gang-Related Stress, and Family and Drug-Related Stress. Concurrent, related validity estimates were calculated to determine relations between HSI-A and other measures of child psychopathology and behavioral and emotional disturbances. HSI-A total stress appraisal scores were significantly correlated with both the Children's Depression Inventory and the Youth Self Report (p < .001). Reliability estimates for the HSI-A were conducted, and they yielded high reliability coefficients for most factor subscales, with the HSI-A total stress appraisal score reliability alpha at .92.     

Negative triangles: simple geometric shapes convey emotional valence

It has been suggested that downward pointing triangles convey negative valence, perhaps because they mimic an underlying primitive feature present in negative facial expressions (Larson, Aronoff, and Stearns, 2007). Here, we test this proposition using a flanker interference paradigm in which participants indicated the valence of a central face target, presented between two adjacent distracters. Experiment 1 showed that, compared with face flankers, downward pointing triangles had little influence on responses to face targets. However, in Experiment 2, when attentional competition was increased between target and flankers, downward pointing triangles slowed responses to positively valenced face targets, and speeded them to negatively valenced targets, consistent with valence-based flanker compatibility effects. These findings provide converging evidence that simple geometric shapes may convey emotional valence.     

SUBSTANCE-ABUSING MOTHERS IN RESIDENTIAL TREATMENT WITH THEIR BABIES: IMPORTANCE OF PRE- AND POSTNATAL MATERNAL REFLECTIVE FUNCTIONING

A residential treatment program has been developed specifically for substance-abusing pregnant and parenting women in Finland, focusing on simultaneously supporting maternal abstinence from substances and the mother-baby relationship. The aims of the study are to explore maternal pre- and postnatal reflective functioning and its association with background factors, maternal exposure to trauma, and psychiatric symptoms, postnatal interaction, child development, and later child foster care placement. Participants were 34 mother-baby pairs living in three residential program units during the pre- to postnatal period. We employed self-report questionnaires on background, trauma history, and psychiatric symptoms (Brief Symptom Inventory: L.R. Derogatis, 1993; Edinburgh Postnatal Depression Scale: J.L. Cox, J.M. Holden, & R. Sagovsky, 1987; Traumatic Antecedents Questionnaire: B. Van der Kolk, 2003), videotaped mother-child interactions coded for sensitivity, control, and unresponsiveness (Care Index for Infants and Toddlers: P. Crittenden, 2003); a standardized test of child development (Bayley Scales of Infant Development-II: N. Bayley, 1993); and semistructured interviews for maternal reflective functioning (Pregnancy Interview: A. Slade, E. Bernbach, J. Grienenberger, D.W. Levy, & A. Locker, 2002; Parent Development Interview: A. Slade et al., 2005). Pre- and postnatal maternal reflective functioning (RF) was on average low, but varied considerably across participants. Average RF increased significantly during the intervention. Increase in RF level was found to be associated with type of abused substance and maternal trauma history. Mothers who showed lower postnatal RF levels relapsed to substance use more often after completing a residential treatment period, and their children were more likely to be placed in foster care. The intensive focus on maternal RF is an important direction in the development of efficacious treatment for this very high risk population.     

Attachment‐based intervention for substance‐using mothers: A preliminary test of the proposed mechanisms of change

Although randomized controlled trials examining the efficacy of attachment‐based interventions have been increasing in recent years, adequate measurement of treatment integrity, integrity–outcome associations, and mechanisms of change has been rare. The aim of this investigation was to conduct a rigorous test of proposed mechanisms of change in the Mothers and Toddlers Program (MTP) treatment model, a 12‐session, attachment‐based individual therapy for substance‐using mothers of children birth to 3 years of age. The MTP aims to improve maternal reflective functioning (RF) and representation quality (RQ) to bring about second‐order change in maternal caregiving behavior. Following guidelines from M.K. Nock ( 2007 ), it was hypothesized that (a) therapist adherence to unique MTP treatment components would uniquely predict improvement in RF and RQ and that (b) improvement in RF and RQ would function as unique mechanisms of change (when compared with other potential mechanisms—reduction in depression and increase in abstinence from drug use) in the improvement of caregiving behavior. Findings supported each hypothesis, confirming the proposed mechanisms of the treatment model. However, improvement in maternal depression also uniquely predicted improvement in caregiving behavior. Results underscore the potential value of attachment‐based parenting interventions for improving mother–child relations and the importance of providing these interventions in clinic settings where mothers have access to comprehensive care (e.g., psychiatric services).     

The effect of cognitive behavior therapy on decision making in adolescents who self-harm: a pilot study

Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also investigated whether improvement in decision making following treatment was linked to self-harm cessation. Adolescent self-harmers receiving CBT (n = 24) or no treatment (n = 9) and healthy controls (n = 22) were longitudinally compared on the Iowa gambling task (IGT). Significant IGT improvements were only observed for adolescents who self-harm following CBT. CBT may benefit adolescent self-harmers and generate decision-making improvements.