The Epidemiology of Homicide followed by Suicide: A Systematic and Quantitative Review

This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide‐suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide‐suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide‐suicide and other homicide but there was modest but significant association between rates of suicide and homicide‐suicide. Homicide‐suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide‐suicide.     

Managing antidepressants in primary care: physicians' treatment modifications

To examine antidepressant management practices in primary care, patients (N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI-II), the Patient Health Questionnaire-9 (PHQ-9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.     

Relations Between PTSD and Distress Dimensions in an Indian Child/Adolescent Sample Following the 2008 Mumbai Terrorist Attacks

Posttraumatic stress disorder’s (PTSD) four-factor dysphoria model has substantial empirical support (reviewed in Elhai & Palmieri, Journal of Anxiety Disorders, 25, 849–854, 2011; Yufik & Simms, Journal of Abnormal Psychology, 119, 764–776, 2010). However, debatable is whether the model’s dysphoria factor adequately captures all of PTSD’s emotional distress (e.g., Marshall et al., Journal of Abnormal Psychology, 119(1), 126–135, 2010), which is relevant to understanding the assessment and psychopathology of PTSD. Thus, the present study assessed the factor-level relationship between PTSD and emotional distress in 818 children/adolescents attending school in the vicinity of the 2008 Mumbai terrorist attacks. The effective sample had a mean age of 12.85 years (SD?=?1.33), with the majority being male (n?=?435, 53.8 %). PTSD and emotional distress were measured by the UCLA PTSD Reaction Index (PTSD-RI) and Brief Symptom Inventory-18 (BSI-18) respectively. Confirmatory factor analyses (CFA) assessed the PTSD and BSI-18 model fit; Wald tests assessed hypothesized PTSD-distress latent-level relations; and invariance testing examined PTSD-distress parameter differences using age, gender and direct exposure as moderators. There were no moderating effects for the PTSD-distress structural parameters. BSI-18’s depression and somatization factors related more to PTSD’s dysphoria than PTSD’s avoidance factor. The results emphasize assessing for specificity and distress variance of PTSD factors on a continuum, rather than assuming dysphoria factor’s complete accountability for PTSD’s inherent distress. Additionally, PTSD’s dysphoria factor related more to BSI-18’s depression than BSI-18’s anxiety/somatization factors; this may explain PTSD’s comorbidity mechanism with depressive disorders.     

Evaluating the performance of departments of psychotherapy

Conceptual and practical issues which surround attempts at assessing the efficiency of psychotherapy departments are surveyed and the advantages and disadvantages associated with performance indicators reviewed. The issues of assessing efficiency in general and the selection of appropriate indicators at both national and local levels are discussed. It is concluded that it is possible to find indicators which reflect the value of a psychotherapeutic service to the community within which it is based, and that the identification of a generally agreed set of such parameters is a matter of priority.     

An Institution for Change: Developing a Family Day Unit

This paper describes the theory and structure of a day unit designed to intervene in the systems of families who present with severe or multiple problems to agencies attempting to help them, but who are difficult to engage in a therapeutic pact and unresponsive to attempts at outpatient therapy. An analysis of these families is offered in terms of the relations between internal and external boundaries and difficulties in making transitions in the daily contexts of life. The principles of the unit are described in terms of the creation of an artificial extended family, the intensification of sequence and patterns of interaction, and the making and traversing of boundaries. Particular attention is paid to the function of agency interventions in family patterns and to redefining the relationship between family and agencies.