The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.     

Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction. The authors thank the National Institute of Mental Health for their financial support (MH43248, MH42357) for this project, Dorothy Gano for word processing and editorial assistance, and Gitry Heydebrand, Melissa Dannelet, Betty Tempelhoff, Ruth Smith, and Laeeq Ahmad for assisting in the interviews of clients. We are also appreciative of the cooperation given to us by the staffs of Malcolm Bliss Mental Health Center, St. Patrick's Center, the Community Advocacy and Support Alliance Program, and the St. Louisemergency shelters. Finally, we thank all of the participants in this study; we hope that their homelessness has now ended. (The conclusions presented in this paper are the sole responsibility of the authors and do not necessarily reflect official National Institute for Mental Health policy.)     

The total workload of male and female white collar workers as related to age, occupational level, and number of children

A questionnaire assessing various aspects of paid as well as unpaid forms of productive activity was mailed to stratified samples of male and female white collar workers, approximately matched for educational and occupational level. Data from 501 men and 679 women employed full time revealed traditional gender differences in terms of main responsibility for household duties, child care etc. In keeping with this, women reported higher levels of work overload, stress and conflict than men, which increased significantly with the number of children at home. The various stress indices reached a peak between the ages of 35 and 39. Men reported more autonomy in their paid work whereas women reported more control at home. Men and women at the upper managerial levels reported more control over their total work situation and less conflict between demands.     

A spanish translation and validation of the daily stress inventory and a comparison of the level of stress experienced by three culturally distinct hispanic groups

Two studies were conducted, the first to establish a valid Spanish version of the Daily Stress Inventory (DSI). A second study was conducted using the bilingual version of the DSI to assess differences in the level of stress experienced by three selected Hispanic groups: (a) very Hispanic/Hispanic-oriented bicultural, (b) true bicultural, and (c) Anglo-oriented bicultural/very Anglicized as determined by the adapted version of the Acculturation Rating Scale for Mexican Americans (ARSMA). It was expected that stress levels would be highest for the least acculturated group. The results of the first study indicate that the Bilingual DSI scores are highly correlated with the scores of the original DSI when both instruments are responded to simultaneously by fully bilingual individuals. In Study 2, the initial data analyses showed no difference in the level of stress reported by Hispanics at different levels of acculturation as measured by the ARSMA. When a median-split method was employed, differences in the DSI I/E measures between the two groups were significant, suggesting that acculturation level may be related to stress level.     

Primary and secondary reflection in existential family therapy

The author uses Gabriel Marcel's topology of primary and secondary thought to clarify and outline the process of reflection in Existential Family Therapy. Clinical material is used to illustrate the differences between primary and secondary reflection during the practice of Existential Family Therapy.     

Families and family therapy in Germany

The author describes some of the effects of decades of life under a dictatorship for East Germans and the effects on family life and family therapy of changes following the recent reunification of Germany. A case example illustrates some intergenerational family problems associated with the changes. Contrasts are drawn between East and West Germany and family therapy's present stage of development is depicted in both parts of the reunified country. Germany has approximately 10,000 trained family therapists, a minority of whom work in private practice. The largest amount of family and couples therapy is performed in agencies.Portions of this material were first presented in a poster session at the American Association for Marriage and Family Therapy annual conference in Miami Beach, 1992.     

Long term marriages in Sweden: And some comparisons with similar couples in the United States

This international, five-country long term marriages study of couples who have been married, or unmarried and cohabiting, for 20 years or longer is designed to study, among other things, marital satisfaction. This first report of the Swedish part of the study reports on a Swedish version of the self-rating Dyadic Adjustment Scale (DAS) used to investigate self-rated marital satisfaction. The couples describe high marital satisfaction and a high sense of coherence (SOC) compared to other groups. Contrary to other studies, no differences were found between men and women regarding SOC. The differences between them, that describe high relative to low marital satisfaction, pertain to matters of recreation, sex, life philosophy, time spent together, and frequency of quarrels. The men reported greater marital satisfaction than the women.     

Circular definitions,circular explanations,and infinite regresses

This paper discusses some of the ways in which circular definitions and circular explanations entail or fail to entail infinite regresses. And since not all infinite regresses are vicious, a few criteria of viciousness are examined in order to determine when the entailment of a regress refutes a circular definition or a circular explanation.I would like to thank Professors Robert Tully, Howard Sobel, and Derek Allen for their constructive comments.     

‘community psychology and politics’ by David Smail

Demystification, eschewing roles that disempower others and enhancing accessibility to the tools of knowledge, are consistent with the aims of community and applied social psychology. Although a focus on psychological empowerment can be a distraction from the need for actual power, it can also enhance it. Psychologists who avoid victim blaming and individual causal attribution biases can contribute to the discourse about social change. This requires both a reinterpretation of the known facts, and a reframing of social analysis. Social scientists and professionals are today's theologians and priests. Our power lies in our legitimation as interpreters of social reality. Teaching the psychology of empowerment, participative decision making and informed consent can influence the powerful as well as the powerless.