Persistent alterations in biological profiles in women with abuse histories: influence of premenstrual dysphoric disorder.

OBJECTIVE: To examine dysregulation in biological measures associated with histories of abuse in women and whether women with premenstrual dysphoric disorder (PMDD) differ in their dysregulation. DESIGN: Twenty-five women meeting prospective criteria for PMDD and 42 non-PMDD controls underwent structured interview to determine abuse histories and lifetime Axis I diagnoses, excluding those with current Axis I disorders or using medications. MAJOR OUTCOME MEASURES: Plasma cortisol and norepinephrine (NE), heart rate (HR), blood pressure (BP), and vascular resistance index (VRI) were assessed at rest and in response to mental stress. RESULTS: A greater proportion of PMDD women had prior abuse compared with non-PMDD women. Regardless of PMDD status, all abused women had lower plasma NE and higher HRs and tended to have lower plasma cortisol at rest and during stress. Abused women also reported more severe daily emotional and physical symptoms. Greater VRI and BP at rest and during stress were seen only in PMDD women with abuse. CONCLUSION: There is persistent dysregulation in stress-responsive systems in all abused women that cannot be accounted for by current psychiatric illness or medications, and PMDD women may be differentially more vulnerable to the impact of abuse on measures reflecting alpha-adrenergic receptor function.     

FACTORS THAT INFLUENCE DEPRESSIVE SYMPTOMS IN MOTHERS OF INFANT

This study explored the association between interpersonal factors and depressive symptoms in first-time mothers over the first two years of parenthood. An interpersonal style characterized by dependency, recollections of rejection in childhood, and current relationship characteristics was assessed in a nonclinical sample of 133 women. The final model explained 52% of the variance in depressive symptoms at 24 months. Controlling for initial symptom levels, interpersonal variables explained 24% of the outcome variance. The findings suggest that two interpersonal attributes, peer rejection in childhood and a dependent interpersonal style, are particularly important to our understanding of depressive symptomatology.     

The Interpretation of Anaphoric Noun Phrases Time Course, and Effects of Overspecificity

Two experiments investigated the interpretation of anaphoric noun phrases, and in particular those thatcould only be linked to their antecedents via knowledge-based inferences. The first experiment showed that much of the inferential processing was carried out as the anaphoric noun phrase was read, although there was some indication that inferential processing continued to the end of the clause. The second experiment attempted to establish why anaphoric noun phrases that are more specific than their antecedents cause problems. It showed that the difficulty did not lie in adding the extra information carried by the anaphor to the representation of the referent. Rather, we suggest, putting extra information in the anaphoric noun phrase disrupts the process of linking that noun phrase to its antecedent.     

The Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.     

The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.