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Using qualitative methods to develop contextually relevant measures and preventive interventions: an illustration.

Qualitative methods were used to develop a contextually relevant quantitative measure of parenting stress and inform the design of family-focused interventions aimed at preventing adolescent mental and behavioral health problems. The study focused on the experiences of low-income one- and two-parent families representing three ethnic groups (Mexican, African, and European Americans) living in low-income neighborhoods in a large Southwestern city. This report describes the place of this study in a broader program of prevention research, the qualitative methods and data analysis procedures employed, and how the results were used to develop a new measure of parenting stress and inform future program design. The report also includes reflective comments on the methods used and lessons gained.

Adolescent↗

Studying the dynamics of problem behavior across multiple time scales: prospects and challenges.

As a commentary on the Special Issue, this paper discusses recent advances in the study of change across several time scales. It points out the importance of specifying time scales and putative patterns of change when characterizing problem behavior over developmental time scales. Methods for studying risk and protective mechanisms through observation of social interaction are also discussed as a way to study influences that operate in real time. Methods for studying episode-level interaction patterns that result from such real-time influences are also discussed, along with ways to integrate these with longitudinal assessments to study the effects of social interaction on problem behavior across developmental time scales.

Behavioral Research↗

Prediction of inpatient violence.

OBJECTIVE: An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given. METHOD: To date, the published data do not allow a systematic meta-analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence. RESULTS: Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts. CONCLUSION: The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.

Humans↗

A model of aggression in psychiatric hospitals.

OBJECTIVE: Research of the determinants of inpatient aggression indicates that certain environmental hospital variables play a role in triggering aggression in psychiatric hospitals. Yet, how patient, staff and ward variables interact in eliciting aggression is not well understood. METHOD: On the basis of earlier findings, a model was proposed in which psychopathology and distorted cognitions of the patient are combined with environmental and communicational stressors that are specific for psychiatric wards. RESULTS: The proposed model elucidates how certain patient, staff and ward characteristics may interact in causing aggression. The model also emphasizes that repeated inpatient aggression may be the result of a vicious circle, i.e. inpatient violence is often followed by an increase in environmental and/or communication stress on the patient, thereby heightening the risk of a repeated outburst of violence. CONCLUSION: Although tentative, the model may shed light on the mechanisms that lead to (repeated) violence.

Aggression↗

Bullying in the school environment: an injury risk factor?

OBJECTIVE: To describe a research project assessing the role of bullying at school as an injury trigger and the modification effect of the socio-economic environment of the victims. Preliminary results are also presented. METHOD: A case-crossover and a case-referent design were combined. The study base consisted of all children aged 10-15 years residing in the Stockholm county in 2000-02. Cases were recruited at the county's children hospital and interviewed shortly after the injury, using a specially designed questionnaire. RESULTS: Preliminary analyses (261 interviews) reveal that about two injured children out of 10 reported having been bullied during the school term. Also, one out of 10 had been bullied shortly enough before the injury for bullying to be considered as a trigger. The circumstances of occurrence of those injuries varied. CONCLUSION: Bullying, apart from being frequent in the school environment, is quite likely to act as an injury trigger.

Adolescent↗

Dental anxiety in relation to mental health and personality factors. A longitudinal study of middle-aged and elderly women.

Little is known about the longitudinal course of dental anxiety in relation to age, mental health and personality factors. In 1968 69 a representative sample of 778 women aged 38 to 54 yr took part in a psychiatric examination. Three hundred and ten were followed up in 1992-93. A phobia questionnaire, including assessment of dental fear, and the Eysenck Personality Inventory were distributed to the participants at both occasions. High dental fear was reported by 16.8% of the women at baseline and was associated with a higher number of other phobias, a higher level of neuroticism, more psychiatric impairment, more social disability due to phobic disorder, and a higher anxiety level. Among women who reported high dental fear in 1968 69 (n=36), 64% remitted and 36% remained fearful. Among women with low dental fear in 1968 69 (n = 274), 5% reported high dental fear in 1992-93. Chronicity was associated with higher neuroticism, lower extraversion, and more psychiatric impairment at base-line. Remission was associated with higher extraversion at baseline. Dental anxiety increased or decreased over time in concert with the number of other fears.

Adult↗

Predicting adolescent peer problems and antisocial activities: the relative roles of aggression and dysregulation.

This study examined the relative roles of aggression and other dysregulated behaviors in the prediction of adolescent peer problems and antisocial behavior. The social adjustment of 145 boys studied first in Grades 3-6 was assessed again 4 years later in Grades 7-10. At each time, peer ratings of aggressive, hyperactive-disruptive, withdrawn, and irritable-inattentive behaviors were collected. Aggression and withdrawal showed stability and were linked to peer difficulties in elementary school and in adolescence, but these behaviors indicated significant risk for adolescent rejection, victimization, and antisocial activity primarily when accompanied by irritable-inattentive behaviors. Results are discussed in terms of the potential role that difficulties regulating negative affect may play in the genesis of the particular constellation of irritable-inattentive behaviors studied here and the developmental significance of aggressive or withdrawn problem profiles that are or are not accompanied by these behavioral indicators of dysregulation.

Adolescent↗

Analogue observational methods in the assessment of social functioning in adults.

This article provides a clinically oriented overview of analogue observational methods used in the assessment of problematic social functioning, specifically skill deficits and social anxiety. This article emphasizes role-play assessment methods, the predominant method used in clinical settings. An examination of the psychometric characteristics of analogue assessment methods is presented, followed by a review of procedural and structural considerations that may impact the quality of assessment data. Of special concern are the potential impacts of instructional variables, structured versus ideographic role-played situations, confederate characteristics and behavior, molar and molecular levels of assessment, self-ratings versus clinician ratings of functioning, and physical attractiveness. Finally, published and empirically evaluated analogue observation tests are critically reviewed with an emphasis on features that may impact their utility in clinical practice.

Adult↗

Are multiracial adolescents at greater risk? Comparisons of rates, patterns, and correlates of substance use and violence between monoracial and multiracial adolescents.

Rates and patterns of substance use and violent behaviors among multiracial adolescents were examined and compared with 3 monoracial groups, European, African, and Asian Americans. The relationships between ethnic identity and the subjective experience of racial discrimination, substance use, and violent behavior were also examined. The authors found multiracial adolescents reporting higher rates of problem behaviors. Several significant relationships between ethnic identity and racial discrimination were found with these problem behaviors.

Adolescent↗

Relations between neighborhood factors, parenting behaviors, peer deviance, and delinquency among serious juvenile offenders.

The present study examined relations among neighborhood structural and social characteristics, parenting practices, peer group affiliations, and delinquency among a group of serious adolescent offenders. The sample of 14-18-year-old boys (N=488) was composed primarily of economically disadvantaged, ethnic-minority youth living in urban communities. The results indicate that weak neighborhood social organization is indirectly related to delinquency through its associations with parenting behavior and peer deviance and that a focus on just 1 of these microsystems can lead to oversimplified models of risk for juvenile offending. The authors also find that community social ties may confer both pro- and antisocial influences to youth, and they advocate for a broad conceptualization of neighborhood social processes as these relate to developmental risk for youth living in disadvantaged communities.

Adolescent↗

When syndromal similarity obscures functional dissimilarity: distinctive evoked environments of externalizing and mixed syndrome boys.

This research examined how syndromal approaches to assessment can obscure differences between children in the quality of their social interactions. Mixed boys (high for externalizing and internalizing problems) showed heterogeneity in the responses they evoked from others: For one subgroup, aggression and withdrawal evoked aversive responses from others, and even prosocial behavior evoked hostile peer responses; for the other, aggression and withdrawal evoked positive peer responses. Externalizing boys also showed heterogeneity in the patterning of their evoked responses. Within-group heterogeneity was not explained by boys' syndrome scores but was linked to their reactions to specific antecedent events. The results illustrate how a contextualized analysis of behavior can reveal distinctive social interactional patterns that underlie similar overall rates of problem behaviors.

Adolescent↗