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Psychological distress of adolescents exposed to Hurricane Hugo.

To ascertain the effects of a natural disaster on adolescents, 1482 South Carolina high school students who were exposed to Hurricane Hugo were surveyed 1 year after the disaster. Subjects completed a self-administered questionnaire measuring Hugo exposure, nonviolent and violent life events, social support, self-efficacy, and psychological distress. Results showed that the students reported minimal exposure to the hurricane and psychological distress variables approximated national norms. As exposure increased, adolescents reported increased symptoms of psychological distress; i.e., anger, depression, anxiety, and global mental distress. Females and white students experienced higher levels of distress. In most cases, other stressful life events were at least as strong a predictor of psychological distress as was exposure to the hurricane. Self-efficacy and social support were protective.

Adolescent↗

Social capital and youth suicide risk factors in First Nations communities.

The paper presents a model of plausible mechanisms linking social capital to suicide risk factors among First Nations youth, informed by a study that explored the concept of social capital in First Nations communities, and by a study on mental health services in First Nations communities in Manitoba. The model incorporates several components of social capital. The plausible impact of social capital on protective and risk factors of suicide among youth is explored.

Adolescent↗

Promoting the social and emotional health of children: where to now?

In advanced industrial societies such as the UK, the burden of disease is shifting from physical to mental health problems--emotional and behavioural problems currently being the major cause of disability in children. Evidence concerning the role of parents in promoting children's social and emotional health, in conjunction with the benefits of supporting parents in this role, has focused attention on the need for greater clarity concerning the role of both parents and governments in supporting and protecting children's social and emotional health. This paper examines the evidence base concerning children's social and emotional development and suggests some steps that may be necessary to ensure the future promotion of children's social and emotional health.

Child↗

Social isolation, impulsivity and depression as predictors of aggression in a psychiatric inpatient population.

Aggressive behavior among psychiatric inpatients remains an issue of concern for staff, families and patients themselves. At the present time, studies examining prediction of aggression among psychiatric inpatients have focused mainly on diagnostic or demographic risk factors. Unfortunately little is known about specific social functioning and personality risk factors that may help identify specific individuals at risk for aggressive behavior. Given that many individuals who have engaged in violent criminal behavior have been observed to experience a combination of social isolation, depression and impulsiveness, it is possible that this same combination of traits may function as a predictor of aggression among psychiatric inpatients. The current study examines whether psychiatric inpatients with a combination of social isolation, depression and impulsivity are significantly more likely to become aggressive than other psychiatric inpatients without that combination of factors. Results indicated that impulsivity functioned as a positive predictor of aggression, whereas depression acted as a protective factor. Perceived social support did not appear to relate strongly to aggression. Further, physicians' ratings of hostility were more predictive of aggressive incidents than were self-reports of hostility. Clinical implications of these findings are discussed.

Adult↗

Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE.

OBJECTIVES: There is considerable evidence that social networks are strongly related to survival and other health outcomes. However, findings regarding the effect of social networks on disability outcomes have been inconsistent. This study examines this relationship with respect to the risk of developing disability and recovering from disability. METHODS: Data come from a community-based sample of the New Haven population aged 65 years and older, with nine annual interviews conducted between 1982 and 1991. Disability was measured by a 6-item index of activities of daily living (ADL), and a 3-item Rosow-Breslau index, with disability defined as impairment in one or more tasks on each measure. Social network variables were constructed for each of four domains of ties: children, relatives, friends, and a confidant, and a summary measure of total social networks. A Markov model was used to estimate one-year disability transitions averaged across all 8 intervals, after controlling for sociodemographic and health-related variables. RESULTS: Total social networks was associated with a significantly reduced risk of developing ADL disability (beta = -0.009, p < .01), and a significantly increased likelihood of ADL recovery (beta = 0.017, p < .01). Emotional and instrumental support did not affect the protective effect of social networks against disability, but partially accounted for their effect on enhanced recovery. Network variables related to relatives and friends were significantly associated with disability and recovery risks, but those related to children or a confidant were not. The associations with disability transitions as measured by the Rosow-Breslau index were generally smaller and nonsignificant. DISCUSSION: The findings lend further support for the role of social relationships in important health outcomes in old age. They suggest that being "embedded" in a social network of relatives and friends reduces risk for ADL disability, and enhances recovery from ADL disability.

Activities of Daily Living↗

[Caregivers of elderly with advanced cancer: vulnerable actors].

Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members provide meaningful care, especially during terminal illness. A literature review focused on the impact for families and the physical, psychological, social, and economic burden for family caregivers of seniors with advanced cancer, as well as related interventions. More studies are needed on family caregivers of elderly with advanced cancer in Brazil in order to develop programs to protect these important social actors.

Caregivers↗

The impact of a military air disaster on the health of assistance workers. A prospective study.

The worst peacetime disaster in United States Army history occurred on December 12, 1985 in Gander, Newfoundland. A charter airline carrying 248 soldiers home from peacekeeping duties in the Sinai Desert crashed after a refueling stop, killing all on board. After the crash, Army family assistance workers were appointed to help the surviving family members of each dead soldier. While substantial attention has been paid to the impact of sudden disasters on survivors and bereaved relatives, little is known about the health risks to those who perform helper roles. This study aimed to: a) identify the major stress areas for disaster family assistance workers; b) examine the relation between degree of exposure to these stressors and health; and c) locate risk factors, or resistance resources that might modulate any ill effects of exposure. A survey instrument assessed duration and intensity of family-helping activities and psychological well-being, psychiatric symptoms, major illness indicators, and social and personality variables at 6 months after the crash and again at the 1-year point for 131 family assistance officers. Results indicate a dose-response effect between exposure measured at time 1 and well-being, symptoms, and illness at time 2. Analysis of covariance findings also show that social supports (work supervisors, family, and friends) modulate the effects of exposure on symptoms and well-being. Social supports and the personality style of hardiness (or dispositional resilience) interact to modulate the effects of exposure on illness. These results demonstrate: a) a delayed negative impact of helper stress on family assistance workers, and b) a protective function of social supports and personality hardiness. Further research in this area should thus consider the potential influence of social/situational variables and personality dispositions in coping with disaster helper stress.

Accidents, Aviation↗

Brain-derived neurotrophic factor-5-HTTLPR gene interactions and environmental modifiers of depression in children.

BACKGROUND: Child abuse and genotype interact to contribute to risk for depression in children. This study examined gene-by-gene and gene-by-environment interactions. METHODS: The study included 196 children: 109 maltreated and 87 nonmaltreated comparison subjects. Measures of psychiatric symptomatology and social supports were obtained using standard research instruments, and serotonin transporter (5-HTTLPR) (locus SLC6A4) and brain-derived neurotrophic factor (BDNF) (variant val66met) genotypes were obtained from saliva-derived DNA specimens. Population structure was controlled by means of ancestral proportion scores computed based on genotypes of ancestry informative markers in the entire sample. RESULTS: There was a significant three-way interaction between BDNF genotype, 5-HTTLPR, and maltreatment history in predicting depression. Children with the met allele of the BDNF gene and two short alleles of 5-HTTLPR had the highest depression scores, but the vulnerability associated with these two genotypes was only evident in the maltreated children. A significant four-way interaction also emerged, with social supports found to further moderate risk for depression. CONCLUSIONS: To the best of our knowledge, this is the first investigation to demonstrate a gene-by-gene interaction conveying vulnerability to depression. The current data also show a protective effect of social supports in ameliorating genetic and environmental risk for psychopathology.

Adolescent↗

Beneficence re-examined: protective intervention in mental health.

Social workers have long reacted negatively to the idea of limiting client freedoms, seeing such activity as directly contrary to such central social work values as autonomy and self-determination. Nevertheless, practitioners often find themselves required to actively intervene in a protective manner when clients are unable to fend for themselves. Such interventions are increasingly a part of everyday practice as social workers respond to new mandates to provide services to disabled and vulnerable individuals. Because of these changing circumstances, the concept of beneficence and the process of protective treatment are currently being re-examined, especially in mental health. This article develops a conceptual model of protective intervention that can be used by clinical decision makers in a variety of situations. Case examples drawn from work with chronically mentally ill patients are used to illustrate the discussion.

Aged↗

Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project.

Recent findings suggest that a rich social network may decrease the risk of developing dementia. The authors hypothesized that such a protective effect may be due to social interaction and intellectual stimulation. To test this hypothesis, data from the 1987-1996 Kungsholmen Project, a longitudinal population-based study carried out in a central area of Stockholm, Sweden, were used to examine whether engagement in different activities 6.4 years before dementia diagnosis was related to a decreased incidence of dementia. Dementia cases were diagnosed by specialists according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria. After adjustment for age, sex, education, cognitive functioning, comorbidity, depressive symptoms, and physical functioning at the first examination, frequent (daily-weekly) engagement in mental, social, or productive activities was inversely related to dementia incidence. Adjusted relative risks for mental, social, and productive activities were 0.54 (95% confidence interval (CI): 0.34, 0.87), 0.58 (95% CI: 0.37, 0.91), and 0.58 (95% CI: 0.38, 0.91), respectively. Similar results were found when these three factors were analyzed together in the same model. Results suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly.

Aged↗

Significant others and fear of crime among the elderly.

The authors examine demographic, environmental, behavioral, and social psychological factors that affect fear of crime among the elderly. Using a structural equation model, relevant variables are examined. Confirming earlier studies, elderly women are found to be more fearful than other groups. Further, social isolation, type of housing, length of residence, and area of the city are all related to fear of crime in a predicted direction. The fearful individual expressed low satisfaction with the job being done by the police in providing protection from crime. Social interaction with neighbors and friends reduces the fear of crime among the elderly. Surprisingly, the more they socialize with their relatives, the more fear they express.

Aged↗

The attribution of somatization in schizophrenia patients: a naturalistic follow-up study.

BACKGROUND: Knowledge is limited concerning somatic symptoms that cannot be accounted for by detectable somatic illness among schizophrenia patients. This study aimed to explore the prevalence, correlates, and predictors of somatization among schizophrenia patients. METHOD: Initial data on all consecutively admitted adult patients with DSM-IV schizophrenia, schizoaffective disorder, major depressive disorder, or bipolar disorder were collected between August 1998 and August 2000. Standardized measures of psychopathology, somatization, emotional distress, adverse effects, insight, and stress process-related (psychosocial) variables were administered to 237 schizophrenia patients at admission and at least 12 months thereafter (N = 148). Partial correlation and multiple regression analyses were performed. RESULTS: The frequency of somatization, defined as the presentation of 5 or more medically unexplained somatic symptoms (Somatic Symptom Index-5), among the inpatient population (27%) did not change significantly after at least 12 months (30%; p =.61). Regression analysis showed that somatization scores were best predicted by the combination of scores for emotional distress attributed to psychopathology and side effects, expressed emotion, and insight. This combined model explains at least 40% of the variance in somatization scores. Self-esteem and social support showed negative association with somatization scores. Somatization scores were not associated with gender, age, education, age at onset, observed severity of psychopathology, subtype and duration of illness, number of admissions and treatment settings, or type and dose of antipsychotic agents. CONCLUSIONS: Somatization is a prevalent problem among schizophrenia patients and is associated with emotional distress attributed to psychopathology, side effects of antipsychotic agents, and family members' attitudes toward schizophrenia patients. This study suggests that insight, self-esteem, and social support may protect against somatization in schizophrenia patients.

Adult↗

The centre for the vulnerable child: a new model for the therapeutic provision for abused children and their families.

In the last decade in Scotland there has been a rise in the number of known cases of children and adolescents who have experienced sexual abuse and a rise in the number of cases entering treatment after detection. This is putting a considerable strain on existing child and adult mental health services. As part of the response to this problem a new service was set up in Fife, the Centre for the Vulnerable Child, to provide an integrated focus for therapy, in-service training, consultancy and research into the area of sexual abuse. The Centre has strong links with the local joint police and social work Child Protection Unit with which it shares premises. Early indications are that the service is dealing primarily with more severely abused children. An evaluation is underway to assess both user satisfaction and the impact of this new service on measurable health and social outcomes among sexually abused children and their families. Professionals who have referred patients and clients to the Centre are largely satisfied with its work and an instrument for seeking the views of referred children is under development.

Adolescent↗