Examination of the Hamilton Scales in Assessment of Anxious Older Adults: A Replication and Extension

This study examined the original and reconstructed Hamilton scales in the assessment of anxiety and depression in a sample of older adults diagnosed with GAD (n = 82). Internal consistency of all scales appeared adequate. Results indicated improved construct validity with the reconstructed scales, which demonstrated reduced shared variance. However, construct validity examined through intercorrelations of the Hamilton scales with self-report measures of anxiety and depression was generally poor. Discriminant function analysis indicated that the reconstructed scales might have some clinical utility in differentiation of patients with and without coexistent depressive diagnosis (67% correct classification). In addition, two items from the Hamilton rating scale for depression (Work and Activities; Hopelessness) correctly classified patients with and without depression at a similar level as the Hamilton scale total scores (64–65% correct classification). These results suggest that the Work and Activities, and Hopelessness items may provide clinicians with useful screening questions for depression in anxious older adults.     

Anxiety Disorders Among Older Primary Care Patients

Data from the 1997 National Ambulatory Medical Care Survey (NAMCS) were accessed to obtain information about naturalistic patterns of recognition, service utilization, and treatment for late-life anxiety in primary care. The NAMCS is a national probability sample survey of office visits to non-Federal, U.S. physicians engaged in patient care. The survey was conducted by the Division of Health Care Statistics, National Center for Health Statistics, and Centers for Disease Control and Prevention (CDC). Data are now in the public domain. For the current report, all cases indicating office visits for patients age 60 and older were selected (n = 7,687). Anxiety disorders were assigned for 1.3% (n = 99) of these visits, with anxiety disorder NOS the most frequent diagnosis. For 20.2% of these visits (n = 20), a coexistent depressive disorder also was diagnosed. Depression without coexistent anxiety was diagnosed for 2.3% of all visits (n = 176). These figures suggest that late-life anxiety may often go unrecognized and may be more difficult to detect than depression. Nevertheless, other data indicate that appropriate pharmacological treatment and mental health services or referrals are often provided when anxiety or depression is recognized. However, visits wherein these disorders are recognized require increased physician time, and significant proportions of patients in some groups may still not receive appropriate mental health care. Results are discussed in terms of the nature of usual care for late-life anxiety and the needs for future research.     

How Many People Are Exposed to Suicide? Not Six

It has long been stated that six people are left behind following every suicide. Despite a lack of empirical evidence, this has been extensively cited for over 30 years. Using data from a random‐digit dial survey, a more accurate number of people exposed to each suicide is calculated. A sample of 1,736 adults included 812 lifetime suicide‐exposed respondents who reported age and number of exposures. Each suicide resulted in 135 people exposed (knew the person). Each suicide affects a large circle of people, who may be in need of clinician services or support following exposure.     

Suicide Risk Among Wounded U.S. Service Members

The association between suicide and combat injuries sustained during the wars in Iraq and Afghanistan was examined. A retrospective population‐based cohort design was conducted using official military records to identify combat injuries (October 7, 2001, to December 31, 2007). Those who were injured during combat had higher crude suicide rates than those who deployed and were not injured (incidence rate ratio [IRR] = 1.50; confidence interval [CI] = 1.06, 2.12), or never deployed (IRR = 1.46; CI = 1.04, 2.06). After adjusting for demographics, these findings were no longer statistically significant. Although our data did not support an elevated suicide risk among wounded service members, additional research is needed to examine the impact of injury severity.     

Remembering Early Childhood: How Much, How, and Why (or Why Not)

In this article, we consider recent research on three questions about people's memories for their early childhood: whether childhood amnesia is a real phenomenon, whether implicit memories survive when explicit memories do not, and why early episodic memories are sketchy. The research leads us to form three conclusions. First, we argue that childhood amnesia is a real phenomenon, as long as the term is defined clearly. Specifically, people are able to recall parts of their lives from the period between ages 2 and 5 years, but they recall less from that period than from other periods. Second, we conclude that implicit memories from early childhood may be evident even when explicit memories are not, a finding that suggests early experience may affect behavior in ways that people do not consciously recognize. Third, we argue that although young children are well known to be wonderfully efficient learners of semantic information, they have difficulty in either encoding or retrieving the interlinked aspects of events that lend them their autobiographical character. Although more evidence is needed, the relative lack of episodic memories of early childhood may be linked to maturation of prefrontal cortex.     

"Feminism Lite?" Feminist Identification, Speaker Appearance, and Perceptions of Feminist and Antifeminist Messengers

Drawing on a communications model of persuasion ( Hovland, Janis, & Kelley, 1953 ), this study examined the effect of target appearance on feminists' and nonfeminists' perceptions of a speaker delivering a feminist or an antifeminist message. One hundred three college women watched one of four videotaped speeches that varied by content (profeminist vs. antifeminist) and target appearance ("feminine" vs. "masculine"). Self-identified feminists responded more favorably to a profeminist message when it was presented by a feminine than a masculine-appearing speaker and expressed less feminist attitudes after viewing a masculine-appearing feminist speaker. Nonfeminists' evaluations did not vary as a function of speaker appearance or message content. Implications for the communication of feminist ideology are discussed.     

"Learning to live with what you can't rise above": control beliefs, symptom control, and adjustment to tinnitus.

The relations between 3 types of perceived control, symptom severity, and 2 adaptational outcomes, depressive symptoms and psychological well-being, were examined in a sample of 319 people with tinnitus. Consistent with previous studies of control and adjustment to chronic health conditions, general health and symptom control were associated with better psychological adjustment, and retrospective control was associated with worse psychological adjustment. Only symptom control emerged as a significant moderator in the symptom severity-adjustment relationship, such that stronger beliefs in one's ability to control symptoms were most strongly associated with better adjustment among those with more severe tinnitus symptoms. These findings were consistent with coping perspectives and cognitive adaptation theory and suggest that symptom-related perceptions of control may be an effective coping resource to nurture in chronic health contexts with severe symptoms.     

Vitalizing the group--and me

Emotional liveliness in a psychotherapy group can take various forms. Maintaining this liveliness can be a challenging task in a group, particularly when both the patients and the therapist face deeply rooted inhibitions, including fears about competition, being judged, and being destructive. The author of this paper, a candidate and group member in a postdoctoral group psychotherapy training program, recounts some of her experiences as the leader of a newly formed and developing group, particularly as they relate to her efforts to become and remain a "libidinal" (i.e., life or vital force) leader, despite the impact of the group members' and her own anxieties. Clinical anecdotes and insights about the author's own growth, both personally and professionally, as they relate to establishing and maintaining vitality are presented.