U.S. Cambodian refugees' use of complementary and alternative medicine for mental health problems

OBJECTIVE: This study examined U.S. Cambodian refugees' use of complementary and alternative medicine and Western sources of care for psychiatric problems. Analyses assessed the extent to which complementary and alternative medicine was used in the absence of Western mental health treatment and whether use of complementary and alternative medicine was associated with decreased use of Western services. METHODS: Face-to-face interviews were conducted with a representative sample drawn from the largest Cambodian refugee community in the United States. The sample included 339 persons who met criteria in the past 12 months for posttraumatic stress disorder, major depression, or alcohol use disorder. Respondents described contact with complementary and alternative medicine and Western service providers for psychological problems in the preceding 12 months. Bivariate and multivariate logistic regression analyses were used. RESULTS: Seventy-two percent of the sample sought Western mental health services, and 34% relied on complementary and alternative medicine in the past year. Seeking complementary and alternative medicine was strongly and positively associated with seeking Western services, contrary to the hypothesis that use of complementary and alternative medicine inhibits seeking Western mental health treatment. CONCLUSIONS: Only a small percentage of Cambodian refugees used complementary and alternative medicine exclusively (5%), and utilization of complementary and alternative medicine was positively associated with seeking Western sources of care for mental health problems. Complementary and alternative medicine use does not appear to be a significant barrier to mental health treatment in this population, contrary to the Surgeon General's conclusion that Asian Americans' use of alternative resources may inhibit their utilization of Western mental health care.     

Predictors of psychiatrist-reported treatment-compliance problems among patients in routine U.S. psychiatric care

Characteristics associated with psychiatrist-reported treatment-compliance problems were investigated using the 1999 Study of Psychiatric Patients and Treatments from the Practice Research Network of the American Psychiatric Institute for Research and Education (n=1,843). Logistic regression was used to study characteristics associated with compliance problems as perceived by treating psychiatrists. Among the 22 potential predictors of interest, all but three (age, gender, and problems with primary support group) were found to be significantly associated with treatment-compliance problems in bivariate analyses. A predictive model was developed consisting of eight independently significant predictors from diagnostic, clinical, psychosocial, and treatment-history domains. These predictors included substance use disorder diagnosis, medication side effects, moderate to severe psychotic symptoms, personality disorder diagnosis, economic problems, prior hospitalization, current Global Assessment of Functioning scale score, and duration of treatment with current psychiatrist. This predictive model correctly identified the presence or absence of treatment-compliance problems in 91% of patients in a sample randomly drawn from the dataset before model construction. These findings may be useful to clinicians, researchers, and program planners interested in addressing the important issue of treatment-compliance problems in psychiatric care settings.     

Maternal and environmental characteristics as predictors of child behavior problems and cognitive competence.

Maternal and environmental characteristics as predictors of behavioral problems and cognitive competence in 505 Israeli kindergarten children were investigated. Events in closer temporal proximity to assessments of functioning appeared more predictive than those in early infancy. Findings support the need to include variables reflecting maternal characteristics in any prediction of child outcome and to consider the sex of the child in selection of variables.     

Family characteristics of adolescents who display overt and covert behavior problems

The purpose of the present study was to examine and compare the families of young adolescents who demonstrated overt behavior problems, overt and covert behavior problems (i.e. versatile adolescents), and neither type of problem. From 176 nonclinic adolescents, a sample of 23 was selected based upon a teacher-completed measure. Interparental conflict, parental marital status, and mother-adolescent conflict were examined. The results indicated that families with a versatile adolescent were characterized by divorce as well as more interparental and mother-adolescent conflict than the other two groups. Assessment of and intervention for school-identified adolescents may need to include a focus on interparental conflict and parent-adolescent conflict.     

Child Health and Paediatrics in the U.S.S.R.

Observations on child health and paediatrics made during a three weeks' visit to the USSR are recorded. There are separate health services for children and their organization is outlined, as are the training and career structure of the many thousands of paediatricians employed. Provision for handicapped children is briefly discussed and a few comments are made on social aspects of child care.     

Assessing the reliability and validity of the Bermond-Vorst Alexithymia Questionnaire among U.S. Anglo and U.S. Hispanic samples

OBJECTIVE: The aim of this paper is to assess the psychometric properties of the Bermond-Vorst Alexithymia Questionnaire (BVAQ) in U.S. Anglo and U.S. Hispanic samples of college students. METHOD: One hundred ninety-four U.S. Hispanics and 304 U.S. Anglos participated in the study. In addition to completing the BVAQ, participants completed the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI), and the Eysenck Neuroticism Scale (ENS). RESULTS: BVAQ and TAS-20 subscales were correlated across groups. While the identifying and verbalizing composites of the BVAQ subscales were predictive of neuroticism and depression across groups in the expected direction, the fantasizing subscale of the BVAQ was negatively predictive of depression and neuroticism across groups. CONCLUSION: Given the unexpected findings associated with some of the BVAQ subscales, future research should explore the dimensionality of alexithymia.     

Development and results of social psychiatry in the U.S.S.R.

Summary All the most urgent problems of social and work resettlement of the psychiatrically disabled, as well as of prevention of disability and social readaptation, are emphasized in Soviet legislation as problems of national importance that have to be solved not only by the institutions of Health Security or of Social Assistance, but also by local executive committees, directors of factories, building undertakings, etc., in cooperation with the trades unions. These public organizations have to systematically study the reasons for morbidity and for disablement and help create the conditions for work resettlement in various institutions and places of work.Our experience shows clearly that success depends not only on legislation or on the organization of services for social readaptation, but also on the level of knowledge concerning clinical pathophysiology, and of psychological regularities in the development of remissions and in compensation for defect states.The gradual accumulation of knowledge in these fields increases the optimism and the efficiency of Soviet psychiatrists.

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Zusammenfassung Die dringlichen Probleme der sozialen und beruflichen Wiedereingliederung psychisch Behinderter sowie der Prävention seelischer Schäden und der sozialen Wiederanpassung werden innerhalb der sowjetischen Gesetzgebung als Fragen von nationaler Bedeutung angesehen; ihre Lösung erfolgt nicht nur durch die Einrichtungen des öffentlichen Gesundheits-und Sozialdienstes sondern auch durch die regionalen Behörden, Leiter von Industriebetrieben, Stadtplaner usw., und zwar in Zusammenarbeit mit den Gewerkschaften. Diese öffentlichen Dienste werden über die Ursachen psychiatrischer Morbidität und Behinderung laufend informiert und damit befähigt, in den unterschiedlichsten Institutionen und Industrie-Einrichtungen günstige Bedingungen für eine Wiedereingliederung zu schaffen.Aus unseren Erfahrungen geht deutlich hervor, daß der Erfolg auf diesem Gebiet nicht nur von der Gesetzgebung oder der Organisation des sozialen Dienstes abhängt, sondern auch vom Kenntnisstand im Hinblick auf die klinische Pathophysiologie und die psychologischen Gesetzlichkeiten der Remission und Kompensation psychischer Störungen.Die stetige Anhebung des Wissens in diesem Arbeitsbereich bedingt bei den sowjetischen Psychiatern einen wachsenden Optimismus und eine größere Wirksamkeit ihrer Bemühungen.

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Résumé Tous les problèmes les plus urgents de réintégration sociale et de rééducation au travail des handicapés mentaux, de même que les problèmes de prévention et de réadaption sociale, sont considérés dans la législation soviétique comme étant d'importance nationale; ces problèmes doivent être résolus non seulement par les institution de sécurité et d'assistance sociales, mais encore par des comités locaux, des directeurs d'usine, des chefs d'entreprise, etc., en collaboration avec les associations professionelles. Ces organisations publiques doivent étudier systématiquement les causes de morbidité et d'invalidité, et aider à créer des conditions de réadaptation au travail dans diverses institutions et cadres professionnels. Notre expérience montre clairement que le succès ne dépend pas seulement de la législation ou de l'organisation de services de réadaptation sociale, mais aussi du niveau des connaissances en pathophysiologie clinique et des lois psychologiques qui régissent le développement des rémissions et la compensation des états résiduels.La somme des connaissances obtenues progressivement dans ces domaines contribue à l'optimisme et à l'efficience des psychiatres soviétiques.

     

A systematic review and meta-analysis of the association of neighborhood ethnic-racial concentrations and adolescent behaviour problems in the U.S.

IntroductionEvidence suggesting a link between neighborhood ethnic-racial concentrations and adolescent behaviour problems in the U.S. is mixed, with some studies documenting negative and others positive associations. This work raises important questions about promoting and inhibiting effects of neighborhood environments characterized by high concentrations of ethnic-racial minority groups, including Asian Americans, Blacks or African Americans, and Latinos. We conducted a meta-analysis to examine 1) the magnitude, direction, and variability of the association between neighborhood ethnic-racial concentrations and adolescent behaviour problems, and 2) whether these associations varied by putative moderators.MethodsWe conducted a systematic search in PsycINFO, Web of Science, and PubMed as well as searching reference lists and relying on expert knowledge (285 initial records). We coded the records for theoretical and design elements.ResultsWe included 40 effect sizes from 17 records (24% unpublished) with N = 11,858. The average association between neighborhood ethnic-racial concentrations and adolescent behaviour problems was not significantly different from zero (r = −0.001, 95% CI -0.048, 0.046, p = .964, τ² = 0.006); there was a large percentage of systematic heterogeneity (I² = 77.1%), which was not explained by putative moderators.ConclusionsThere is substantial unexplained systematic heterogeneity in the association between neighborhood ethnic-racial concentrations and adolescents’ behaviour problems. There is heavy reliance on a small number of parent datasets in research on this topic, alongside critical reporting omissions. We offer recommendations to guide future work, in hopes of supporting culturally and developmentally informed policies and programs capable of addressing residential segregation.     

Resilience to mental health problems and the role of deployment status among U.S. Army Reserve and National Guard Soldiers

Purpose

Research suggests that interpersonal and intrapersonal resiliency factors protect against poor post-deployment mental health outcomes among Reserve/Guard soldiers who have been deployed. There is increasing awareness that never-deployed soldiers are also at risk. The purpose of this study was to examine the relationships between resiliency factors and a range of mental health outcomes among a sample of United States Army Reserve and National Guard (USAR/NG) soldiers who have and have not experienced deployment.

Methods

A subset of data was drawn from Operation: SAFETY (N = 360), an ongoing study examining the health and well-being of USAR/NG soldiers. We used a multivariate path analysis approach to examine the simultaneous effects of unit support, marital satisfaction, and psychological hardiness on the following mental health outcomes, concurrently: anger, anxiety, depression, and posttraumatic stress disorder (PTSD) symptomatology. We also examined interaction effects between resiliency factors and deployment status on mental health outcomes.

Results

Greater unit support (ps < 0.01), marital satisfaction (ps < 0.001), and psychological hardiness (ps < 0.001) were associated with less anger, anxiety, depression, and PTSD symptomatology. Psychological hardiness had significant interactions with deployment status on anxiety, depression, and PTSD, such that the protective effects of psychological hardiness were even stronger among never-deployed soldiers than previously deployed solders.

Conclusion

Resiliency factors can be targeted for intervention to prevent poor mental health outcomes among USAR/NG soldiers, regardless of deployment status. Further, psychological hardiness may be an even more important protective factor among soldiers who have never been deployed.

     

The co-occurrence of substance use and bullying behaviors among U.S. adolescents: Understanding demographic characteristics and social influences

This study examined the co-occurrence of subtypes of substance use and bullying behaviors using latent class analysis and evaluated latent class differences in demographic characteristics, peer and parental influences. Self-reported questionnaire data were collected from a nationally representative sample (N?=?7508) of 6-10th grade adolescents in the United States. Four latent classes were identified: the non-involved (57.7%), substance users (19.4%), bullies (17.5%), and substance-using bullies (5.4%). Older and Hispanic adolescents were more likely to be substance users and substance-using bullies, whereas younger and African American adolescents were more likely to be bullies. Females were more likely to be substance users, whereas males were more likely to be bullies and substance-using bullies. Spending more evenings with peers posed greater risks for substance use, bullying, and the co-occurrence of both problem behaviors. Paternal knowledge exerted protective effects over-and-above the effects of maternal knowledge. Implications for prevention and intervention efforts are discussed.     

Epidemiological study of mental illness in the U.S.S.R.

Summary Recent developments in psychiatric epidemiology in the Soviet Union are discussed. Some results of a survey of schizophrenic patients living in one particular district of Moscow are used to illustrate the value of the new techniques.

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Zusammenfassung Es werden die jüngsten Entwicklungen der psychiatrischen Epidemiologie der Sowjetunion diskutiert. Einige Ergebnisse einer Begutachtung schizophrener Patienten, die in einem besonderen Viertel von Moskau leben, wurden benutzt, um den Wert neuer Techniken zu illustrieren.

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Résumé L'auteur discute les progrès récents de l'épidémiologie en Union soviétique. Il se sert de quelques résultats d'une revue de malades schizophrènes vivant dans un district particulier de Moscou pour illustrer la valeur des nouvelles techniques.

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Based on a paper given at the Séminaire interrégional de l'Organisation Mondiale de la Santé sur l'hygiène mentale, Moscow, 1967.     

U.S.A., 13 years later

In October 1974, after living in Baltimore for 16 years, I went back to my home town, Belo Horizonte, in the State of Minas Gerais, Brazil. By then I was a citizen of the United States and a Board Certified Psychiatrist, and I wanted to bring back there some of what I had learned here. In 1987 I returned to the United States, and I want to set down my impressions of what has happened here since I left.