Promoting Healing and Restoring Trust: Policy Recommendations for Improving Behavioral Health Care for American Indian/Alaska Native Adolescents

American Indian/Alaska Native youth represent the strength and continued survival of many Nations and Tribes. However, they currently experience numerous health disparities and challenges, including the highest rate of suicide among 15–24 year-olds in the United States. Our comprehensive review of the literature on the mental health of AI/AN youth highlighted seven focal causes of behavioral health disparities: (1) high levels of violence and trauma exposure and traumatic loss, (2) past and current oppression, racism, and discrimination, (3) underfunded systems of care, (4) disregard for effective indigenous practices in service provision, policy, and funding, (5) overreliance on evidence-based practices, (6) lack of cultural competence among systems of care and providers, and (7) barriers to care. Seven policy recommendations that recognize the importance of moving beyond exclusive reliance on western models of care and that seek to foster transformation of individuals, families, communities, behavioral health service systems of care, and social structures are presented, supported, and discussed.     

Review Essay: Beyond the Fear of Intimacy

Can Love Last? The Fate of Romance Over Time by Stephen A. Mitchell (New York, NY: W.W. Norton, 2002, 224 pp.)

This article reflects on the importance of Mitchell's work in the United Kingdom, where notions of intimacy sit uneasily with psychoanalytic practice. The author argues that a reluctance to take up intimacy in the consulting room has a deleterious effect on intimate relations outside it. Drawing on her work with women, in particular, she posits that the erotic is still an undertheorized area of relational analysis. Although most orthodox theory has been jettisoned, new theory is necessary for an understanding of what the author observes to be a “false” erotic in many of her patients in whom the erotic is temporarily available but is unreliable as a desire and as a source of identity.     

Trajectories of Adjustment to Couple Relationship Separation

To test a stress‐diathesis model of adjustment to separation, the current study describes the trajectories of different aspects of separation adjustment in people formerly married or cohabiting, and moderators of those trajectories. A convenience sample of 303 recently separated individuals (169 women; 134 men) completed assessments of their emotional attachment to the former partner, loneliness, psychological distress, and coparenting conflict at two time points 6 months apart. Multilevel modeling of the overlapping multicohort design was used to estimate the trajectories of these different aspects of adjustment as a function of time since separation, marital status, gender, presence of children from the relationship, who initiated separation, social support, and anxious attachment. Attachment to the former partner, loneliness, and psychological distress were initially high but improved markedly across the 2 years after separation, but coparenting conflict was high and stable. Adjustment problems were similar in men and women, and in those formerly married or cohabiting, except that reported coparenting conflict was higher in men than women. Low social support and high anxious attachment predicted persistent attachment to the former partner, loneliness, and psychological distress. Coparenting conflict is a common, chronic problem for many separated individuals, and individuals with certain psychological vulnerabilities also experience chronic personal distress.     

Multiple Roles of Married Korean Women: Effect on Depression

This study was designed to examine relationships between roles of employed married women in Seoul, South Korea, perceptions of their work role, coping patterns, and levels of depression. The convenience sample contained 382 women, aged 25–55 years, who were living with their husbands and working at least 20 hr weekly. Participants completed five questionnaires: demographic, Center for Epidemiological Studies—Depression Scale, Index of Sex-Role Orientation, Role Sharing, and Coping Strategies. Multiple regression analysis revealed several statistically significant relationships. Higher levels of depression were found in women who perceived motherhood and career roles as incompatible, those who coped by working harder, and those who spent less time helping children with homework. Women who owned their houses had lower levels of depression.     

The Importance of Affective Beliefs and Attitudes in the Theory of Planned Behavior: Predicting Intention to Increase Physical Activity1

Standard theory of planned behavior (TPB) questions to elicit salient behavioral beliefs may elicit instrumental consequences of behavior, and overlook affective consequences. Two hundred thirteen English adults (35 to 75 years of age) completed a questionnaire that contained closed measures of TPB constructs, and open‐ended questions that asked not only about advantages and disadvantages, but also what respondents would like or enjoy and dislike or hate about being more physically active. Beliefs elicited by affective questions were associated more strongly with a closed affective attitude scale. Beliefs elicited by instrumental questions were associated more strongly with a closed instrumental attitude scale. Closed measures of the standard TPB variables explained 48% of the variance in intention to increase physical activity, while affective attitude explained an additional 11% of the variance. Applications of the TPB should consider affective and not just instrumental determinants of behavior.     

African-American clergy's perceptions of the leading health problems in their communities and their role in supporting parishioners' health

This article is a report on a survey of Southern California pastors to learn of their perceptions of the leading health problems in their congregations. Participants (N=41) identified stress, overweight, and obesity as the top three health indicators that effect the health of their congregations. Tobacco use and substance abuse were listed among the top five. From a list of health problems, pastors felt that from the pulpit they could impact parishioners responsible sexual behavior most. Pastors expressed their opinions about the reasons for certain maladies and addictions. The findings indicate room for improvement in building clergy's understanding of the nature of illness and addiction and in empowering them in their role of supporting healthy behaviors in the African-American community.     

COMPARISON OF DATA‐COLLECTION METHODS IN A BEHAVIORAL INTERVENTION PROGRAM FOR CHILDREN WITH PERVASIVE DEVELOPMENTAL DISORDERS: A REPLICATION

Cummings and Carr (2009) compared two methods of data collection in a behavioral intervention program for children with pervasive developmental disorders: collecting data on all trials versus only the first trial in a session. Results showed that basing a child's progress on first‐trial data resulted in identifying mastery‐level responding slightly sooner, whereas determining mastery based on all trials resulted in slightly better skill maintenance. In the current replication, no such differences in indication of mastery or maintenance were observed when data were collected on all trials or the first trial.     

Can We Eat Dog Without Dog Eating Us Commentary on Paper by Janine de Peyer

This paper examines a state of fear aroused in the analyst during a session. I suggest that the fear arose from the attempt to enter the patient's mental state—a state that was unfamiliar to the analyst. In entering what was essentially psychically foreign territory, I terrified myself with a version of the patient's experience.     

Aging, imagery, and the bizarreness effect

ABSTRACT This study examined the bizarre imagery effect in young and older adults, under incidental and intentional conditions. Intentionality was manipulated across experiments, with participants receiving an incidental free recall test in Experiment 1 and an intentional test in Experiment 2. This study also examined the relation between working memory resources and the bizarreness effect. In Experiment 1 young and older adults were presented with common and bizarre sentences; they later received an incidental recall test. There were no age differences in sensitivity to the bizarreness effect in Experiment 1 when ANOVAs were used to analyze the data. However, when the bizarreness effect was examined in terms of effect size, there was evidence that younger adults produced larger bizarreness effect sizes than younger adults. Experiment 2 further explored age differences in sensitivity to the bizarreness effect by presenting young and older adults with bizarre and common sentences under intentional learning conditions. Experiment 2 failed to yield age differences as a function of item type (bizarre vs. common). In addition, Experiment 2 failed to yield significant evidence that the bizarreness effect is modulated by working memory resources. The results of this study are most consistent with the distinctiveness account of the bizarreness effect.     

The Cypriot Community in the United Kingdom: Two Family Case Studies

The United Kingdom has the largest concentration of Cypriots outside Cyprus, equivalent to one-third of the island's population. The London Borough of Haringey has the largest concentration, 16% of its population being of Cypriot origin. Two cases are described of outreach work in an area lacking culturally appropriate services, where individuals suffer the stresses of being Cypriot in London, and the isolation and breakdown of communication within and between generations.