Beverley Raphael

Posttraumatic stress disorder in response to HIV infection

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Who Helps the Helpers? The Effects of a Disaster on the Rescue Workers

There is virtually no literature detailing the effects of a disaster on the rescue workers. This paper reports the results of a questionnaire survey conducted one month after the Granville rail disaster on ninety-five of the personnel involved in the rescue work and a follow-up on thirteen of them one year later. Seventy-seven of the ninety-five found the experience stressful; in particular, the feelings of helplessness engendered by the disaster, the magnitude of the destruction, the sight and smell of mutilated bodies, the anguish of relatives, and the need to work under pressure were items highlighted by the respondents. While only about 20 percent experienced specific psychological sequelae as a result of the disaster (depression, anxiety, insomnia), approximately 70 percent of the helpers showed evidence of being temporarily strained (half of them being over this by the end of one week). Thirty-five percent felt more positive about their own lives as a result of their involvement. The utility of debriefing sessions to assist workers to come to terms with and assimilate their experiences is discussed.

Primary Prevention: Fact or Fiction

This paper is a review of studies oriented to the primary prevention of psychiatric disorder. Difficulties in this field are noted, including current aetiological concepts, outcome measures, techniques and processes, methodological problems, humanitarian and ethical issues and the role of social processes. Studies in several different areas of primary prevention are described. These include projects directed towards parenting processes, vulnerable children, crisis intervention, psychosomatic variables, biological factors, mental health education and community processes. Resistances to preventive work are outlined. It is concluded that much work in this field represents a ‘call’ for prevention; that diffuse interventions for diffuse population groups to achieve diffuse outcomes may not lead to demonstrable effects in prevention. Specific interventions directed towards high risk populations to achieve specific preventive goals have shown that primary prevention may be accomplished in some areas.

A Primary Prevention Action Programme: Psychiatric Involvement following a Major Rail Disaster

A primary prevention program implemented immediately following a major rail disaster is described. Because of the high mortality, services were oriented towards the provisions of preventive counselling for bereaved families as well as support for the injured. Emergency counselling services were provided at the City Morque. Subsequently, coordinating consultative and educative programmes were instituted in the affected health region. Counselling bereaved families was continued through appropriate specialised community services. High-risk groups of bereaved were delineated and special emphasis given to individual care of these persons. Recommendations are made concerning the relevance of such a programme to the personal disasters of life.

Correlates of Pregnancy and Sexual Experience in Australian Adolescents

In 1983 a longitudinal study was commenced in the Hunter Region of New South Wales to investigate the development of adolescent psychosocial morbidity. This paper reports analyses based on data obtained during the screening phase of that project, in which 2157 adolescents completed a Social and Emotional Development questionnaire. Those surveyed comprised approximately 25% of the 14-16 year olds in the region.Adolescents were allocated to 1 of 3 groups on the basis of their sexual experience: no sexual experience (26%), minor sexual experience (such as petting, 47%), and major sexual experience (sexual intercourse on at least one occasion, 27%). Overall, 31% of the males and 24% of the females were in the major sexual experience group; 1 in 15 of the females in this group (n = 17) reported that she had been pregnant. Just over half (52%) of the girls in the major sexual experience group had used contraceptives, compared with 42% of the boys.A series of hierarchical discriminant analyses were undertaken to...

Squibb Academic Address. Personal disaster.

The term ‘personal disaster’ will be used in the paper to describe intensely distressing, possibly catastrophic personal experience. Such experience may be perceived as disastrous by the individual because of its shock, its intensity, or perhaps even its chronicity when the circumstances of distress continue unchangingly and cannot be altered. The quest to name and quantify the personal disasters of human existence has led to a proliferation of scales listing, measuring and scoring a wide range of life crises or events. Yet when personal disaster occurs it is known and recognised by all who are involved. Life will be changed by it in major and significant ways. The person involved will always remember and know it, as it becomes incorporated into his psychic structure and life with many consequences often negative, sometimes positive.

Measuring Psychological Adjustment to HIV Infection

Aims: A modified version of the Mental Adjustment to Cancer Scale (The Mental Adjustment to HIV Scale-MAHIVS) was used to evaluate patterns of psychological adjustment in response to HIV infection. Methods: A sample of 164 HIV positive homosexual/bisexual men were recruited across three Australian centers (79 asymptomatic (CDC II/III) and 85 symptomatic HIV infection (CDC IV)). Factor analysis of the MAHIVS was conducted and the predictive validity of the MAHIVS was investigated using the General Health Questionnaire, while The Diagnostic Interview Schedule was used to assess current and lifetime psychiatric disorder. Other measures of adjustment/coping were used to investigate the construct validity of the MAHIVS (neuroticism, locus of control, defense style). Results: Factor analysis of the MAHIVS detected four factors: Hopelessness, Fighting Spirit/Self Efficacy, Personal Control, and Minimization. Hopelessness and Fighting Spirit factors exhibited acceptable levels of internal consistency and validity, with significant correlations detected with psychological symptoms and significant association with other measures of psychological adjustment and personality. Fighting Spirit emerged as a potential indicator of psychological resilience, whereas Hopelessness was significantly associated with psychological symptoms and current major depression (but not past depression). Conclusions: The findings indicate the validity of the MAHIVS and support the presence of common themes in the psychological adaptation to life-threatening illness that can be detected across disease categories and groups.

Psychiatry ‘At the Coal-Face’:

The practice of psychiatry confronts the individual clinician, as well as the administrator with responsibility for psychiatry services, with many dilemmas. Who needs psychiatric services, what do they need and who can provide them? There has been criticism that the clinician in private psychiatric practice provides for the upper class and well-to-do, and perhaps especially for fellow professionals. Yet any such claims must be balanced by the provision of public sector mental health services for, more than in any other specialist discipline, psychiatrists work in public facilities to provide care for those without ready access to private health care systems. Thus, according to our manpower estimates, more than fifty per cent of members of the Royal Australian and New Zealand College of Psychiatrists are so employed. Nevertheless, it behoves us to consider if indeed, either as individuals or as a profession, we provide for the most needy individuals with mental health problems. Do we have individual professional codes to guide us for their care, and have policies of our health care systems been developed to meet their needs? If we do not, then this is an important issue for us to address both as individuals and as a College, for it is the core of our professioal role as psychiatrists. It is useful to consider what may be the greatest need in terms of mental health problems in terms of psychic distress and suffering and how we should address this need. This, I have chosen to call psychiatry ‘at the coal-face’, at the dirty, tough, difficult edge of existence, where battles of survival are fought and lost and mental health must encompass these realities. This title is of symbolic significance as well, because many of the problems and issues I will outline are condensed in

POST-HYSTERECTOMY ADAPTATION: A REVIEW AND REPORT OF TWO FOLLOW-UP STUDIES

Hysterectomy, its indications and its consequences for later health, have been prominent topics in recent psychiatric, gynaecological and lay literature. This study describes the results of two recent surveys, one of 216 women less than 45 years old who had a hysterectomy for non-malignant conditions at a major Sydney hospital. These women were interviewed on the seventh to tenth postoperative day. One hundred and ninety-four were then followed up by questionnaire 13 months later. In a later study carried out at a hospital on the outskirts of Sydney, 100 out of 146 women responded to a follow-up questionnaire approximately one year after their operations. These studies and their relevance to recent similar studies are discussed in terms of post-hysterectomy adaptation and prognostic factors associated with poor psychiatric outcome.

Congenital developmental disability‐‐The first 18 months: Parental perceptions and early intervention

This paper reports data based on interviews with parents of congenitally developmentally disabled infants, including parental perceptions and reactions to professional services. The role of early support programmes is also examined and its relation to parental perceptions. Overall, family distress scores on interview showed a significant relationship (r = 0.64, p#lt0.001) to family grief scores on an unresolved grief inventory reported in an earlier paper (Nicholas & Lewin, 1986). Results also suggest that early intervention programmes extend the social network of the family and provide parents with skills to manage their baby. In so doing, such programmes may ameliorate the intensity of the parental grief response.