Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

Damage compounded: disparities, distrust, and disparate impact in end-of-life conflict resolution policies

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience.     

Longitudinal Gender Differences in Objectified Body Consciousness and Weight-Related Attitudes and Behaviors: Cultural and Developmental Contexts in the Transition from College

Longitudinal analysis of objectified body consciousness, body esteem, self-acceptance, and weight-related attitudes and behaviors in young adults (115 women and 49 men), who were undergraduates in 1993, tested hypotheses developed from theory on the social construction of gendered bodies and the developmental contexts of the post-college transition. Gender differences in body surveillance, body shame, and body esteem and the relationships between these persisted, whereas the relationship between body esteem and self-acceptance decreased for women and was similar to men at Wave 2. For both women and men, body surveillance and body shame decreased and body esteem increased over time, even though BMI also increased. Men wanted to lose weight at levels similar to women at Wave 2 and were equally likely to exercise to control weight, but they were less likely than women to diet. These results fit both cohort and age-related changes models of body experience for women and men.     

The empirical study of teenage work: A behavioral code for the assessment of adolescent job environments

Policy recommendations that adolescents supplement their experience in school with experience in the workplace have been made in the absence of objective data on the nature of most adolescents' activity on the job. This paper presents a coding system for chronicling a variety of microbehaviors in sequence, as they occur, in adolescent job environments. Three elements of each of approximately 100 behaviors performed by a targeted teenage worker are recorded by an on-site observer who enters appropriate code numbers into a portable event recorder: (1) the social context of the behavior; (2) the character of the behavior; and (3) the duration and concomitants of the behavior, when appropriate. Each of 97 working teenagers was observed continuously over a two hour period on the job. Interobserver agreement on the coding of worker behaviors and the social contexts in which they occurred averaged .86 and .97, respectively. In addition to its applicability in research on the effects of working on adolescent development, information obtained using the code can be helpful in the evaluation of youth employment programs, the vocational counseling of adolescents, and the validation of subjective worker reports of job attributes.     

Sexual preference,feminism, and women's perceptions of their parents

In an attempt to clarify the relation between parental variables, sexual preference, and sex-role attitudes, three groups of women were studied: lesbian feminists, heterosexual feminists, and heterosexual traditional women. The women were asked about their perceptions of their parents when they were in high school. The groups differed more from each other with respect to their perceptions of their fathers than their mothers. The perceived attitudes of the father were much more important in differentiating lesbian feminists from heterosexuals than in differentiating heterosexual feminists from heterosexual traditionals. Both the heterosexual groups (feminist and traditionals) reported having a more affectionate and involved father who also encouraged them more in the expression of anger than the lesbian feminists reported. The results suggest women's father relationships must not be obscured in research and support Johnson's hypothesis that the father relationship is more central than the mother relationship in sex typing and especially in the specifically sexual aspects of sex typing.     

Disturbances of consciousness in dementia with Lewy bodies associated with alteration in nicotinic receptor binding in the temporal cortex

Disturbances of consciousness, including fluctuations in attention and awareness, are a common and clinically important symptom in dementia with Lewy bodies (DLB). In the present study we investigate potential mechanisms of such disturbances of consciousness (DOC) in a clinicopathological study evaluating specific components of the cholinergic system. [3H]Epibatidine binding to the high-affinity nicotinic receptor in the temporal cortex (Brodmann's areas 20 and 36) differentiated DLB cases with and without DOC, being 62-66% higher in those with DOC (F=4.5,p=.025). The were no differences between DLB patients with or without DOC in 125I-labeled alpha-bungaratoxin binding to the low-affinity nicotinic receptor, [3H]pirenzepine binding to the muscarinic M1 receptor, or in choline acetyltransferase activity. These findings provide support for the hypothesis that cholinergic activity is an important neural correlate if consciousness and suggest a mechanism of DOC in DLB involving alterations in the nicotinic receptor, composed of predominantly alpha4 and beta2 subunits.     

The 'open circle' in counsellor education and training: Rationale and criticisms

The apparently simple open circle is described and five elements of a rationale are discussed: that it acts as a 'buffer'; contributes efficiently towards developing trust; highlights aspects of self-disclosure; enhances awareness of emotions, biases etc; and, most subtly, provides practice of feeling sympathetic but not 'rescuing'. In the final section, four criticisms of the open circle are countered: that it is pointless; artificial; taxing; and insensitive.     

Research and Theory Religion and Spirituality in Coping With Stress

Relations among and between religion, spirituality, and the ability to cope with stress were examined using a sample of 115 graduate students in counseling. Religion and spirituality positively correlated with coping with stress. Counseling students who expressed spirituality through religious beliefs had greater spiritual health and immunity to stressful situations than counseling students who identified themselves as spiritual but not religious. Counseling students with a religious/spiritual affiliation indicated more discomfort counseling clients hostile to religion compared with counseling students with a spiritual‐only affiliation. The results have implications for preparing counseling students to work with clients with religious/spiritual issues.     

The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.