Prologue: Introduction and Overview to Special Volume

Abstract

The editors provide an overview of the obstacles that prevent us from ending child abuse in the United States and briefly summarize the various articles in this volume that address these obstacles from multiple points of view.     

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.     

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.     

Is IQ in Childhood Associated with Suicidal Thoughts and Attempts? Findings from The Mater University Study of Pregnancy and Its Outcomes

This study explores associations of IQ at age 14 with adult symptoms of suicidal thoughts and attempts at age 21. Analysis was based on the Mater University Study of Pregnancy and its outcomes, an Australian prospective birth cohort study started in Brisbane Australia in 1981. We assessed associations with suicide thoughts, plans, and attempts. We used two measures of IQ: the Raven's Standard Progressive Matrices and the Wide Range Achievement Test. In multivariable analyses, there was an inverse association between Raven's IQ and suicide thoughts, plans, and attempts, but no strong evidence of an association between the WRAT3 and the three suicidal items. Specific aspects of intelligence may be associated with suicidal thoughts, plans, and attempts.     

Distinguishing Between Subgroups of Adolescents Who Self‐Harm

The differences in factors associated with subgroups of adolescents in the continuum of deliberate self‐harm (DSH) phenomena were investigated. In an anonymous self‐report survey of 6,020 adolescents aged 15 and 16 years, 3.2% of adolescents (5.3% females, 1.3% males) reported DSH with intent to die, 2.8% (4.3% females; 1.5% males) reported DSH without intent to die, and 15% (22.4% females; 8.5% males) reported thoughts of DSH without acts. Regression analysis indicated considerable overlap in vulnerability factors along the spectrum of DSH thoughts and acts. A uniquely distinct relationship was found between DSH of a friend and DSH without intent to die on one hand and DSH of a family member with DSH with intent to die on the other. Results indicate that familial and nonfamilial social influences on DSH behavior may be important in designing prevention programs and that educational programs for the promotion of psychological well‐being may be helpful for adolescents at any point along the spectrum of DSH that was examined.     

The Interrelations of Agency,Depression, and Suicidal Ideation Among Older Adults

The high rates of suicide among older men are cause for concern, and have prompted the investigation of factors that might explain these elevated rates. The current research examined whether the gender role construct agency was associated with depression and suicidal ideation among older adults. The results, based on self‐report data from a sample of older Australian men (n = 69) and women (n = 90), indicated that depression mediated the relation between agency and suicidal ideation. In addition, for older men only, agency moderated the depression‐suicidal ideation relation. The results suggest that older adults, and particularly men, with low levels of agency should be the targets for interventions aimed at increasing levels of agency and improving mental health.     

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.