The Struggle to Prevent and Evaluate: Application of Population Attributable Risk and Preventive Fraction to Suicide Prevention Researach

Population attributable risk (PAR) estimates have been used in suicide research to evaluate the impact of psychosocial and socioeconomic risk factors, including affective disorders, traumatic life events, and unemployment. A parallel concept of preventive fraction (PF), allowing for estimation of the impact of protective factors and effectiveness of preventive interventions, is practically unknown in suicidology. The study authors discuss the application of both concepts to suicide research and prevention, and review literature on the subject. Despite several methodological and conceptual limitations, both PAR and PF are valuable instruments to inform development and evaluation of suicide prevention programs.     

Coping with the exposure to torture

This paper describes approaches taken at the International Rehabilitation and Research Centre in Copenhagen to helping torture victims and their families cope with the exposure to and aftermath of torture.     

Many stimuli are frightening,but some are more frightening than others: The contributions of preparedness,dangerousness, and unpredictability to making a stimulus fearful

The nonrandom distribution of situational fears has been explained by evolutionary survival relevance of specific fears. Thirty-eight stimuli were taken from the literature on preparedness and were scored on fearfulness, objective dangerousness, and spatiotemporal unpredictability by three separate groups of students. The same items were scored on survival relevance by 15 biologists. Fearfulness of cues significantly correlated not only with survival relevance but also, and even more strongly, with dangerousness and unpredictability. While the fear/survival relevance association virtually disappeared when the unpredictability contribution was partialed out, the fear/unpredictability correlation was only marginally affected when controlling for survival relevance. This suggests that nonrandomness of feared stimuli may result from the spatiotemporal unpredictability that is attributed to these stimuli. The current practice of using snakes and spiders as phobia-relevant, and flowers and mushrooms as neutral, cues was not justified by the ratings of the 15 independent experts.This study was supported in part by a grant from the Dutch Organization for Fundamental Research (ZWO/Psychon, 560-268-001).     

No counterregulation after breaking the external restraint of children.

At the present, it is unknown how restraint and binge eating/counterregulation are exactly related. Earlier studies on this relationship suffer from two main shortcomings: the studies are all correlational in nature or could not rule out the contribution of confounding variables such as weight loss. The present study investigated whether a break of restraint is a sufficient condition for the occurrence of counterregulation by studying a restrained sample which is not liable to dieting practices and weight loss. The externally imposed restraint on children with regard to eating sweets was broken. However, after breaking their external restraint the children did not counterregulate. It is discussed whether restraint of food intake is really as important for binge eating as it is claimed to be or whether it is merely a consequence or an epiphenomenon of binge eating.     

Cue-exposure vs self-control in the treatment of binge eating: a pilot study.

From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS-US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. The present authors treated six obese bulimics with cue exposure and response prevention. Six other patients learned to avoid or escape the binge-related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the 1 yr follow-up. In contrast to the 100% binge-free subjects treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the subjects.     

Restrained eaters are rapidly habituating sensation seekers

Several authors have pointed to similarities between eating disorders and addictive behaviors. In earlier studies, addicts were found to score high on the Sensation Seeking Scale (SSS) and to habituate rapidly to neutral stimuli. In this study, we found experimental support for an addiction model of eating disorders: restrained eaters also scored significantly higher on the Sensation Seeking Scale and also habituated significantly quicker to a series of neutral stimuli than unrestrained eaters. No clear evidence was found for the hypothesis that restrained eaters score lower on measurements of anxiety. It is hypothesized that rapid habituation promotes sensation seeking, which may be manifested in excessive consumption of either drugs or food. Restraint may be a strategy to prevent negative consequences of sensation seeking and excessive consumption. The model is related to earlier experimental findings.     

Latent trait models and dichotomization of graded responses

This paper discusses thecompatibility of the polychotomous Rasch model with dichotomization of the response continuum. It is argued that in the case of graded responses, the response categories presented to the subject are essentially an arbitrary polychotomization of the response continuum, ranging for example from total rejection or disagreement to total acceptance or agreement of an item or statement. Because of this arbitrariness, the measurement outcome should be independent of the specific polychotomization applied, for example, presenting a specific multicategory response format should not affect the measurement outcome. When such is the case, the original polychotomous model is called compatible with dichotomization.A distinction is made between polychotomization or dichotomization before the fact, that is, in constructing the response format, and polycho- or dichotomization after the fact, for example in dichotomizing existing graded response data.It is shown that, at least in case of dichotomization after-the-fact, the polychotomous Rasch model is not compatible with dichotomization, unless a rather special condition of the model parameters is met. Insofar as it may be argued that dichotomization before the fact is not essentially different from dichotomization after the fact, the value of the unidimensional polychotomous Rasch model is consequently questionable. The impact of our conclusion on related models is also discussed.     

Divorce in the kibbutz: Past and present

In the kibbutz today, there are no ideological or economic barriers to prevent a couple from deciding to divorce. Both husband and wife are assured continued economic security and equal opportunities for co-parenting, thus reducing fears of disruption in the daily contact with the children. In spite of these favorable circumstances, marital breakups in the kibbutz are less frequent than in the larger cities in Israel. In recent years, however, at a time when a stronger and more intensive family life has gained legitimacy within the kibbutz structure, there is a marked tendency toward a rise in the rate of divorce. In this article we analyze the possible causes of the variations in the frequency of divorce within the kibbutz framework.The authors express appreciation to Esther Mivtzari, a psychologist on the staff of the Kibbutz Child and Family Clinic and a member of the religious kibbutz Ein-Tzurim, for assistance in gathering data on divorce in the religious kibbitzum.     

Personality characteristics of Divorce-Prone individuals: A preliminary clinical study

This study focuses on Divorce-Prone individuals and the question of why some persons fail in one marriage after another. The authors studied 12 individuals who had each been divorced two or more times. They found that the cases fell into one of three broad and overlapping groups. The groups have been called the Self-Involved Narcissists, the Compliant Depressed, and the Casualties of Life's Vicissitudes. The individuals and the groups demonstrate a different etiology, different treatment problems, and a very different prognosis.