Problems in families of male Vietnam veterans with posttraumatic stress disorder.

Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed.     

Common sense representations of schizophrenia in patients and their relatives

This study tests whether the same dimensions that have been shown to be relevant to cognitive understanding of physical health problems may also be applied validly to severe mental health problems such as schizophrenia. 22 people with a diagnosis of schizophrenia, and 18 of their relatives, were asked open-ended questions about their understanding of schizophrenia. The responses were recorded and were sorted into common sense dimensions. Construct validity for the use of the dimensions assessed by the most recently updated Illness Perception Questionnaire (IPQ-R) was examined. The results suggest that the dimensions of the IPQ-R are present in people's understanding of schizophrenia. Copyright © 2005 John Wiley & Sons, Ltd     

Interrogation and interview: strategies for obtaining clinical data

During assessment of 55 outpatients, we recorded the numbers and kind of health problems noted during an open-ended interview and during an `interrogation' based on a structured questionnaire. The combined strategies (interviews and questionnaires) identified a total of 269 problems which were clinically important (i.e. needed medical attention). One hundred and ninety-eight of these problems (74 per cent) were identified by the open-ended interview. Thirtyeight (14 per cent) were identified only by the interview, 71 (26 per cent) only by the questionnaire. We observed that few of the problems detected only by questionnaire were acted upon and that they were therefore only marginally important; most of the problems noted only during interview did lead to further medical action and so were unequivocally of clinical importance. Our data suggest that an open-ended interview, undertaken with the intention of identifying all the patient's health problems, detects those problems well. The routine addition of a lengthy interrogation adds little and is therefore unnecessary.     

Dear Elizabeth: The Diary of a Survivor of Sexual Abuse (Book)

Examined two marital variables (marital dissatisfaction and overt marital conflict) and two parenting variables (rejection and inept discipline) as predictors 6 9 oppositional behavior problems in 50 school-age boys. It was hypothesized that the combination of these marital and parenting variables would provide an effective prediction of child oppositional behavior. The results revealed that the effects of marital dissatisfaction on child oppositional behavior were mediated by paternal rejection. Similarly, overt marital conflict had an effect on child oppositionality through disruptive effects on discipline practices by mothers. The findings are discussed in relation to various etiological models that have attempted to explain the link between marital variables, parenting characteristics, and children's adjustment.     

Positive parenting as a mediator of the relations between parental psychological distress and mental health problems of parentally bereaved children.

This study investigated a positive parenting composite of multiple measures of warmth and consistent discipline as a mediator of the relations between surviving parents' psychological distress and parentally bereaved children's mental health problems using both cross-sectional and prospective longitudinal models. The study included 214 bereaved children ages 7 to 16 and their surviving parent or current caregiver. A multirater, multimethod measurement model of positive parenting was developed. Although the mediational model was supported by analysis of the cross-sectional data, it was not supported in the 3-wave longitudinal model. However, the longitudinal model did find a significant path from positive parenting at Wave 2 to child mental health problems 11 months later at Wave 3, controlling for stability in child mental health problems. Implications for understanding the development of mental health problems of parentally bereaved children are discussed.     

The relation between common sleep problems and emotional and behavioral problems among 2- and 3-year-olds in the context of known risk factors for psychopathology

The contribution of sleep problems to emotional and behavioral problems among young children within the context of known risk factors for psychopathology was examined. Data on 2- and 3-year-olds, representative of Canadian children without a chronic illness, from three cross-sectional cohorts of the Canadian National Longitudinal Study of Child and Youth were analysed ( n  = 2996, 2822, and 3050). The person most knowledgeable (PMK), usually the mother, provided information about her child, herself, and her family. Predictors included: child health status and temperament; parenting and PMK depressive symptomatology; family demographics (e.g., marital status, income) and functioning. Child sleep problems included night waking and bedtime resistance. Both internalizing/emotional (i.e., anxiety) and externalizing/behavioral problems (i.e., hyperactivity, aggression) were examined. Adjusting for other known risk factors, child sleep problems accounted for a small, but significant, independent proportion of the variance in internalizing and externalizing problems. Structural equation models examining the pathways linking risk factors to sleep problems and emotional and behavioral problems were a good fit of the data. Results were replicated on two additional cross-sectional samples. The relation between sleep problems and emotional and behavioral problems is independent of other commonly identified risk factors. Among young children, sleep problems are as strong a correlate of child emotional and behavioral problems as PMK depressive symptomatology, a well-established risk factor for child psychopathology. Adverse parenting and PMK symptomatology, along with difficult temperament all contribute to both sleep problems and emotional and behavioral problems. Children's sleep problems appear to exacerbate emotional and behavioral problems.     

An Analysis of Stakeholder Views on Children's Mental Health Services

The purpose was to examine the perspectives of mental health stakeholders as a means to guide the adaptation of evidence-based treatments. The Mental Health System Ecological (MHSE) model was used to organize therapist, administrator, and parent perspectives gathered using qualitative methods. The MHSE model posits the influences of client-level, provider-level, intervention-specific, service delivery, organizational, and service system characteristics on implementation. Focus groups and interviews were conducted with community mental health stakeholders and included parents, therapists, and administrators (N = 21). Participants included 11 primarily Caucasian (90.48%) female participants, ranging in ages between 31 and 57 years. Data were analyzed according to the MHSE model. Frequency counts were tabulated for each theme and stakeholder group differences were determined using the Mann-Whitney test. Stakeholder groups mentioned needs at each level of the MHSE model. Stakeholder group differences most notably emerged with child and family themes, which included complexity of mental health issues, parenting differences, and family stressors. Stakeholders identified challenges for optimal mental health services for children across multiple levels of an ecological model. Implications of the findings are discussed, including the continued relevance of adapting mental health interventions by increasing their flexible application across multiple target problems and the promise of partnership approaches.     

The impact of the changing health care environment on the health and well-being of faculty at four medical schools.

PURPOSE: Increased pressure for clinical and research productivity and decreased control over the work environment have been reported to have adverse impacts on academic faculty in limited studies. The authors examined whether work-related stressors in academic medicine negatively affected the physical and mental health, as well as life and job satisfaction, of academic medical school faculty. METHOD: A 136-item self-administered anonymous questionnaire modified from a small 1984 study was distributed to 3,519 academic faculty at four U.S. medical schools following institutional review board approval at each school. Validated scales measuring depression, anxiety, work strain, and job and life satisfaction; a checklist of common physical and mental health symptoms; and questions about the impact of institutional financial stability, colleague attrition, and other work-related perceptions were used. Responses were analyzed by sex, academic rank, age, marital status, faculty discipline, and medical school. RESULTS: Responses were received from 1,951 full-time academic physicians and basic science faculty, a 54.3% response rate. Twenty percent of faculty, almost equal by sex, had significant levels of depressive symptoms, with higher levels in younger faculty. Perception of financial instability was associated with greater levels of work strain, depression, and anxiety. Significant numbers of faculty acknowledged that work-related strain negatively affected their mental health and job satisfaction, but not life satisfaction or physical health. Specialties were differentially affected. CONCLUSIONS: High levels of depression, anxiety, and job dissatisfaction-especially in younger faculty-raise concerns about the well-being of academic faculty and its impact on trainees and patient care. Increased awareness of these stressors should guide faculty support and development programs to ensure productive, stable faculty.     

The Patient Perspective Survey (PPS): a new tool to improve consultation outcome and patient involvement in general practice patients with complex health problems. Psychometric testing and development of a final version

The Patient Perspective Survey (PPS) is designed to enhance consultation outcome and patient participation among general practice patients with complex health problems. This article presents the final version of the survey. This version is more condensed, tested for psychometric and clinical properties, and with increased emphasis on coping. The development and testing was performed in two phases with two groups of GPs and patients. Indications for use and criteria for rejection of items were defined, based on comprehensive data analysis and clinical judgement. The number of items was reduced to 38 items. The majority of diagnoses were related to psychosocial or musculoskeletal disorders. For the survey's main dimensions (psychological and somatic items, everyday life situation and coping) sound psychometric properties were identified. Seven open-ended questions were found useful for obtaining important new information and stimulating processes, often related to coping aspects. The revised 38-item PPS represents a condensed and final version, with increased focus on coping, and sound psychometric properties.     

父母婚姻质量、教养行为与女生外化问题的关系

目的:考察父母婚姻质量、教养行为和女生外化问题的关系。方法:采用中国科学院心理研究所全国青少年心理健康数据库中2008年的横断数据,对其中3718名11到19岁的在校女生数据进行分析;外化问题由女生报告,婚姻质量和教养行为由家长报告。结果:①婚姻质量、教养行为和外化问题两两之间存在显著相关。②监控、说理和严厉管教这三种教养行为在婚姻质量和外化问题之间均发挥着部分中介作用。结论:在婚姻质量对子女外化问题的关系中,教养行为起中介作用。     

Impact of spouses' sleep problems on partners

STUDY OBJECTIVES: To analyze relationships between spouses' sleep problems and their partners' physical health, mental health, well-being, social involvement, and marital quality in a sample of older persons. DESIGN: The Alameda County Study is a population-based longitudinal study focusing on behavioral factors associated with health and mortality. SETTING: Participants completed questionnaires for the sixth wave of data collection (1999). PARTICIPANTS: 405 couples (810 husbands and wives aged 51 to 94 years). MEASUREMENTS AND RESULTS: Participants were asked how often they had experienced difficulty falling asleep, waking up in the middle of the night, and waking up very early in the morning over the past month. Response sets ranged from "never" to "often." Scores were summed. Analyses included multivariate statistical models using generalized estimating equations to adjust for paired data as well as partner age, sex, chronic conditions, financial problems, and own sleep problems. Although partners' associations with negative outcomes were stronger for their own sleep problems, spouses' sleep problems were associated with partners' poor health, depressed mood, poor mental health, unhappiness, low optimism, feeling left out, not satisfied with relationships, and unhappy marriage, even after adjusting for the partners' sleep problems. We found no sex differences in associations between spouses' sleep problems and partners' outcomes. CONCLUSIONS: Although data are cross-sectional, findings suggest that spouses' sleep problems negatively impact partners' health and well-being. Our analyses emphasize the importance of treating sleep problems to promote the health and well-being of both affected individuals and their partners.     

Words about body and soul: Social representations relating to health and illness

The purpose was to examine a sample of Stockholm residents' social representations of their physical and mental health and ill-health. Four open-ended questions were answered by 1240 people between 18-80 years. A thematic analysis revealed nine aspects of health: physical, lifestyle, psychological, social, recreational, work and study, treatment, other and multifactorial aspects. Some cross-cutting themes were described to have an impact on health: empowerment, health-conscious lifestyle, life balance and life perspective. A key result is the interdependence between physical and mental health that was described by the respondents.     

博士研究生心理健康状况与社会支持、应对方式的关系研究

目的了解在校博士研究生的心理健康状况及其与社会支持、应对方式的关系。方法采用随机抽样的方法对辽宁省3所具有博士学位专业授予权学校的博士研究生进行问卷调查。结果①博士生心理问题的检出率为39.3%,博士生在强迫、焦虑、恐怖、精神病性及心理健康总均分上明显高于全国常模(t1=4.13、P1<0.01,t2=3.38、P2<0.01,t3=2.39、P3<0.05,t4=3.40、P4<0.01,t5=2.20、P5<0.05),在人际敏感因子的得分低于全国常模(t=2.57、P<0.01);②博士研究生的心理健康状况在性别、年级、婚姻状况方面不存在明显差异(P>0.05),而在工作情况、学习方式上存在显著的差异(P<0.05);③客观支持、支持利用度、消极应对方式可共同解释博士生心理健康18.6%的变异。结论博士研究生的心理健康状况不容乐观,社会支持和应对方式是预测博士研究生心理健康的重要因素。     

Psychological distress of fathers attending an Australian early parenting service for early parenting difficulties

Background: Early parenting centres are in a unique position to identify and provide support to fathers experiencing mental health difficulties. However, the extent to which fathers attending these services experience mental health difficulties is not known. This study aimed to assess fathers' mental health, identify specific clinical profiles based on the severity and pattern of self‐reported symptoms of depression, stress, anxiety, and fatigue and identify factors associated with poorer mental health. Methods: Participants were 144 fathers admitted to a residential programme. Socio‐demographic information and symptoms of depression, anxiety, stress, and fatigue were collected using standardised instruments. Results: The proportion of fathers reporting distress in the clinical ranges for stress, anxiety, and depression were 17%, 6%, and 9%, respectively. Latent class analysis identified two distinct groups or clinical profiles of fathers, representing mild (84%) and high distress (16%). Poor physical health, severity of child's sleep disruption, low socio‐economic position, and poor self‐care were associated with high distress. Conclusions: Fathers attending early parenting services are at risk of experiencing significant levels of distress, anxiety, stress, and fatigue. Early Parenting Services can play a critical role in screening and identifying fathers experiencing poor mental health and link them into appropriate mental health support.     

'They think they can talk to nurses': practice nurses' views of their roles in caring for mental health problems.

BACKGROUND: Primary care teams have been encouraged to develop the care they provide to patients with mental health problems, and a greater role for practice nurses has been advocated. However, little is known about practice nurses' current level of involvement or their perceived strengths and limitations in caring for patients' mental health problems. AIM: To describe practice nurses' current experiences of caring for patients with mental health problems and to explore their perceptions about enlarging this role. METHOD: Pilot interviews were carried out with a purposeful sample of practice nurses to design a postal questionnaire, which was then sent to 635 practice nurses identified from family health services authority lists in six health authorities in the north-east of England. RESULTS: Completed questionnaires were returned by 445 (70%) practice nurses. Most nurses (83%) reported that they commonly saw patients with a range of mental health problems arising indirectly or directly in consultations. Many practice nurses (52%) lacked any formal mental health training and identified a broad range of training needs. A majority (80%) of responders had concerns about their abilities to address mental health problems effectively, given their existing workloads. However, most (61%) were keen to expand their role in mental health care if appropriate support and training were forthcoming. CONCLUSION: There is considerable potential for practice nurses to realize a greater and more effective role in the care of mental health problems in primary care. Developing practice nurses' contribution will require further training and support.     

Financial problems and health complaints among farm couples: results of a 10-year follow-up study

Over a 10-year period, this survey study of 91 Dutch dairy farm couples investigated both causal and reversed causal relationships between couples' financial problems and husbands' and wives' mental and physical health complaints, as well as crossover effects of mental and physical health complaints between spouses. These relationships were tested simultaneously using structural equation modeling analyses. Results showed that financial problems were not predictive of health complaints for either spouse but that husbands' health complaints did predict both couples' financial problems and wives' health complaints 10 years later. These findings emphasize the importance of mental and physical health as resources for both the business and the family. For wives, these effects were not found, which may reflect the different positions of husbands and wives at the farm and, hence, the different ways they allocate their resources.     

Spillover of Marital Interactions and Parenting Stress in Families of Children With Autism Spectrum Disorder

Few disorders appear to be more challenging for parents than autism spectrum disorder (ASD). Little is known about the extent to which parenting stress experienced by parents of children with ASD affects or is affected by marital quality. We examined daily spillover between level of parenting stress and marital interactions in a sample of 176 married couples (89.4% Caucasian, non-Hispanic) who have a child with ASD (5–12 years of age, 85% male) via a 14-day daily diary approach. On each day of the daily diary, parents individually reported on 8 positive and 8 negative marital interactions and their level of parenting stress. Dyadic multilevel modeling analyses using hierarchical linear modeling were conducted to examine same-day and lagged-effect associations between number of positive and negative marital interactions and level of parenting stress. Having a day with a higher number of negative marital interactions was associated with a higher level of parenting stress for both mothers and fathers of children with ASD. Having a day with fewer positive marital interactions was associated with having a more stressful parenting day for mothers of children with ASD. Same-day spillover was moderated by parent gender and the functioning of the child with ASD. Spillover flowed bidirectionally for mothers of children with ASD. Helping parents of children with ASD find ways to engage in positive marital interactions on stressful parenting days and avoid having negative affect, tension, and behaviors stemming from negative marital interactions spill into parenting experiences are important intervention targets.     

Parenting Stress and Child Adjustment: Some Old Hypotheses and New Questions

Individual differences in parenting stress, experienced by most parents as those aversive feelings that are associated with the demands of the parenting role, have been shown to be an important aspect of parent, child, and family functioning. A definition of parenting stress is provided, along with its application to more general stress models. Three implicit hypotheses in much of the past research on parenting stress and behavior are evaluated: (a) parenting stress is causally related to poor parenting, (b) poor parenting is causally related to problems in child adjustment, and (c) parenting behavior mediates the associations between parenting stress and child adjustment. In addition, three questions for future research regarding within-family and within-Individual variation in parenting stress are raised: (a) Is parenting stress genetically influenced? (b) Do mothers and fathers show similar or different levels of parenting stress? (c) Is parenting stress “child specific” within families?     

Marital relationship, occupational life, and subjective well-being of married people

This research investigated mental health of marreid people in relation to their marital relationship, occupational life, and household income. A questionnaire was administered to husbands and wives, either in middle age or child-rearing years, to measure their degree of satisfaction in marital relationship, occupational life, household income, and subjective well-being. Results showed that satisfaction in workplace for men, and additionally satisfaction in marital relationship of men in child-rearing years, strongly predicted their subjective well-being. As for women, however, the strong association with subjective well-being was found for satisfaction in marital relationship, for those who were unemployed or employed part-time. The association was strongest for those who were in child-rearing years. Satisfaction in workplace was as important as satisfaction in marital relationship for women who were employed full-time. These findings suggested that satisfaction gained from what a person concentrated most of his/her energy on, explained his/her subjective well-being very well.