Feasibility of validating survey self-reports of mental health service use

Survey respondents may inaccurately report mental health service utilization for motivational and cognitive reasons. There is little evidence on accuracy of self-reports of mental health service use, and this evidence suggests that respondents tend to underreport inpatient utilization. This study addressed the question of self-report accuracy by comparing survey data from a large probability sample to data from computerized records of publicly funded mental health services. Few inaccuracies in self-reporting were detected. However, despite the use of data bases that were unusually appropriate for verifying self-reports, several problems limited the feasibility of validation. Suggestions are offered for increasing the feasibility of validation in future studies.     

GENDER DIFFERENCES IN DEPRESSIVE SYMPTOMS

Large community studies of depressive symptomatology provide mixed evidence concerning gender differences. The present paper investigates the effect of the high skewness typically present in distributions of depressive symptom scores on findings of a gender difference in depression. Because of this skewness, a few extreme scores among women (or in any subgroup) can produce a significant between-groups difference in untransformed scores even when the two groups' distributions are otherwise similar. Data from a community survey ( n = 1316) are consistent with this hypothesis. The data also suggest that gender increases depression scores indirectly, rather than directly, for the few women scoring in the extreme upper tail of the distribution. It is concluded that the gender difference in depressive symptoms lacks robustness, and that when it does occur, the effect of gender on depression can be understood as ndirect, i.e., as mediated by gender differences in rate of employment, job status, education, and income.     

TEACHING SAFETY SKILLS TO HIGH SCHOOL STUDENTS WITH MODERATE DISABILITIES

Teaching students with disabilities to respond appropriately to potentially dangerous situations is a useful skill that has received little research attention. This investigation taught 3 students with moderate mental retardation to remove and discard broken materials (plates, glasses) safely from (a) a sink containing dishwater, (b) a countertop, and (c) a floor. A 4th student was instructed on the sink task only. A multicomponent treatment package was used to teach the skills. Simulated materials were used initially and were replaced with broken plates and glasses. A multiple probe design was used to evaluate the effectiveness of the treatment package. The results indicated that the treatment package was effective in teaching the skills. Data were collected 1 week and 1 month following the completion of training, and indicated mixed results. No student was injured during any phase of training. Issues pertinent to teaching safety skills to students with moderate disabilities are discussed.     

A biopsychosocial model for treating infertility

With approximately one out of six married couples experiencing infertility, having a basic knowledge of infertility is important to marriage and family therapists. This paper presents important themes that infertile couples often struggle with and stresses the importance of having a biological, psychological, and social understanding of infertility. In addition, the paper suggests possible interventions that family therapists can use in helping infertile couples.     

Developmental sequences in the age of onset of disruptive child behaviors

Retrospective and prospective reports of the onset of disruptive child behaviors were analyzed in a sample of clinic-referred boys. The younger boys (ages 7–9 years), compared with the older boys (ages 10–12 years), showed the highest level of disruptive behavior and, judging from mothers' reports, had the fastest progression of onsets from less serious to more serious problem behaviors. Despite some overlap, developmental sequences in problem behavior within the domains of hyperactivity/inattention, oppositional behavior, and conduct problems were similar across the two age groups. This was also the case for developmental sequences of overt or confrontive problem behaviors and covert or concealing conduct problems. Sequences of the onset of oppositional behavior and conduct problems were validated through prospective data, based on the information from mothers, teachers, and boys themselves. The implications of the findings are discussed for the formulation of developmental pathways of behavior and the analysis of causal factors.     

Testing visual short-term memory: Simultaneous versus sequential presentations

Two experiments testing immediate ordered recall are presented; in these experiments, subjects engaged in repetitive speech (“articulatory suppression”) during a visual presentation in order to prevent auditory recoding of the stimuli. In both experiments, a simultaneous presentation produced results that suggested the use of visual short-term memory, whereas a sequential presentation did not. In Experiment 1, visual confusion errors occurred more often than would be expected by chance for a simultaneous presentation but not for a sequential presentation. In Experiment 2, recall from visual short-term memory was expected to suffer more when subjects wrote a prefix than when they spoke a prefix; this effect occurred for a simultaneous presentation but not for a sequential presentation. These results suggest that existence of a visual short term store that retains a simultaneous presentation but not a sequential presentation.     

The process of cognitive therapy: The first dysfunctional thought changes less than the last one

An observant cognitive therapy patient reported that the first dysfunctional thought elicited and treated in homework sessions was more resistant to change than later distorted thoughts. To determine whether this was due to the fact that this thought was elicited first, or to the fact that it was treated first, systematic data were collected from 9 patients in 48 sessions of cognitive therapy. In half of these sessions, dysfunctional thoughts were treated in the order they were elicited; in half of the sessions, they were treated in the reverse order. Results showed that the first dysfunctional thought elicited changed least; there was no effect of order of treatment. Several possible explanations of this finding are offered.     

A new quantitative approach to the assessment of stages of vigilance as defined by spatiotemporal EEG patterning

Electroencephalographically oriented research on vigilance needs valid measures for assessing the level of vigilance between wakefulness and sleep. When studying different psychologically, psychopathologically, and pharmacologically induced states, special attention has to be paid to minor alterations of the level of vigilance which are reflected, essentially, in topographical changes of alpha-activity (Stage A). Since vigilance is a dynamic process, brief fluctuations in the range of a few seconds must also be recorded. In our opinion existing methods of quantification do not fully meet these demands. We have, therefore, developed a relatively simple procedure which can be characterized as an attempt quantitatively to reconstruct visually, i.e., spatiotemporally defined patterns of vigilance. The usefulness of this method, which also has certain limitations, has been demonstrated in psychopharmacological studies.     

A strategic assessment of deliberate self-harm

This paper describes how patients are interviewed in the context of a general hospital after they have been involved in an episode of self-harm. The interview schedule is structured upon the principles of brief therapy, and uses the 'neutral' approach of the Milan Team (Weakland 1974; Palazzoli et al. 1980). The schedule provides information for referring on and has proved to be 'therapeutic' in itself. The method of interviewing has been used in other hospital contexts with families where a member has been referred 'in a crisis' threatening, or indicating suicidal behaviour. It is suggested that the identification of who is involved systemically is of paramount importance, and that this may not involve 'the family' but significant others in the social network. The important systemic involvement of the general practitioner is recognized.