Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation

The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families’ psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.     

Depression at 3 Months Poststroke in the Elderly: Predictors and Indicators of Prevalence

The prevalence and determinants of depression in 79 elderly patients were assessed at 3 months poststroke. Predictor variables included gender, age, history of previous stroke, and hemispheric location of stroke. Indicator variables included two measures of physical functioning and seven aspects of cognitive functioning. Results indicated that 56% of patients had impairment in activities of daily living, and 39% reported clinically significant levels of depression. Prevalence of cognitive impairment ranged from 31% on a measure of basic cognitive functioning, through to 89% on a measure of complex attention. The results from a hierarchical multiple regression analysis showed that the combination of predictor and indicator variables explained 53% of the variance in depression scores. The three individual variables of history of previous stroke, physical functioning, and simple attention all made significant unique contributions to the variance in depression scores. The contribution of these findings to the ongoing debate concerning lesion location and poststroke depression is discussed.     

Testimony,Knowledge, and Epistemic Goals

Various considerations are adduced toshow that we require that a testifier know hertestimony. Such a requirement apparentlyimproves testimony. It is argued that the aimof improving testimony explains why we have anduse our concept of knowledge. If we were tointroduce a term of praise for testimony, usingit at first to praise testimony that apparentlyhelped us in our practical projects, it wouldcome to be used as we now use the word``know'.     

Exploring the long-term experience of vasomotor instability: A 5 year follow-up study of distress,perceived control and catastrophizing

Some women experience vasomotor instability for many years post-menopause, but little is known about their appraisals of this health problem, their levels of distress or their coping strategies, and whether these change over time. This study followed up a group of women over 5 years, to examine changes and consistencies in frequency of flushing, flush-related distress/ discomfort, control beliefs and catastrophic thoughts. A further aim was to examine the validity of previously developed measures of perceived control and catastrophizing against conceptually relevant standardized scales. A questionnaire of 20 women (average age 53 years) was carried out, with follow-up 5 years later. Measures of flush distress, flush frequency, perceived control over hot flushes, and catastrophic thoughts about flushing was compared at Time 1 and Time 2. Additionally, multidimensional health locus of control (MHLC) and depression (CES-D) scores were taken at follow-up. All measure showed improvements in well-being. Nevertheless, there were many individual consistencies in scores on most variables at Time 1 and 2. Flush distress at Time 2 was most related to catastrophic thinking, and was slightly elevated in more depressed women. Flush distress was completely unrelated to health locus of control. Psychological responses to hot flushes seem to improve over a 5-year period, yet women show some consistency in their appraisals of this mid-life health problem. Counsellors may find that cognitive re-framing strategies are helpful for alleviating flush distress in women who are continue to be distressed by chronic vasomotor instability, as distress is so closely related to catastrophic thinking.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

The Role of Attachment Styles and Interpersonal Problems in Suicide‐Related Behaviors

The relationships among adult attachment styles, interpersonal problems, and categories of suicide‐related behaviors (i.e., self‐harm, suicide attempts, and their co‐occurrence) were examined in a predominantly psychiatric sample (N = 406). Both anxious and avoidant attachment styles were associated with interpersonal problems. In turn, specific interpersonal problems differentially mediated the relations between attachment style and type of suicide‐related behaviors. These findings suggest the importance of distinguishing between these groups of behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.     

An analysis of response and time matching to reinforcement in concurrent ratio-interval schedules

Key pecks by six pigeons were reinforced on concurrent fixed-interval fixed-ratio schedules. The value of the fixed-interval was held constant at 4 min while the fixed-ratio varied from 25 to 450 responses. All of the pigeons responded on, with pecks reinforced under, both of the schedules over most of the concurrent pairings, and four of the six distributed responses between the schedules such that matching was obtained between the proportions of responses and reinforcements. Previous studies using concurrent variable-interval schedules have shown that when response-reinforcement matching occurs, a comparable match of time to reinforcement proportions is obtained. In the present study, time devoted to each response alternative was measured from the first response on that alternative to a subsequent response on the other alternative. Using that measure, large differences existed in the local rates of responding on the two schedules, and a time-reinforcement match was not produced. These results indicate that in a situation where response-reinforcement and time-reinforcement matching are incompatible, the measurement of response proportions is the better means of evaluating the effects of reinforcement.