David N. Cox

Violence risk assessment: Science and practice

Within the conceptual framework of the scientist-practitioner model, this paper describes how the science of risk assessment has progressed to a point where it can be of definite assistance to clinicians. Similarly, clinicians can be of marked help to researchers as they play a role in concept definition and as they design and carry out studies to determine the accuracy of their predictions. Risk assessments ought to be carried out in accord with state-of-the-discipline knowledge. Until fairly recently, it may have been argued that the state of knowledge did not provide any sort of reliable or trustworthy direction on violence risk assessment. This position seems no longer tenable. Topic areas discussed include violence and risk assessment generally, the actuarial-clinical prediction debate, the validity of violence risk assessments, predictors of violence, violence risk assessment schemes (empirically validated structured clinical decision-making), communication of risk assessment findings, and implications for training.

Psychological changes over the course of pregnancy: a study of attitudes toward the fetus/neonate.

Pregnant womens attitudes towards their fetus over the course of the pregnancy were studied in relation to physiological events of pregnancy, namely seeing the fetus via ultrasound and experiencing fetal movement. A consecutive series of primiparae (n = 129) was randomly assigned, at recruitment between 10 and 14 weeks menstrual age, to conditions of high (n = 67) or low (n = 62) feedback real time ultrasound. Thereafter, women were assessed at 16 and 32 weeks gestation, within 24 hours of delivery and by questionnaire at 3 months postpartum. On each occasion women completed attitude rating scales concerning their pregnancy and their fetus or neonate. These scales were subjected to principal components analysis and two main dimensions were derived for ratings of both attitudes towards the pregnancy and the fetus/neonate. No relationship was found between factor scores and ultrasound feedback condition, although scores on the fetal attachment dimension showed a significant linear increase over the pregnancy. Women reporting fetal movement at 16 weeks displayed significantly higher scores on the fetal-attachment dimension at all three assessment points. Multiple regression analyses were utilized to identify predictors of initial reactions to the neonate and attachment ratings at 3 months postpartum. At delivery, ratings of attachment to the neonate were related to drug requirements in labor and attachment ratings at 32 weeks. Reactions to the neonate at delivery and ratings of postpartum mood emerged as significant predictors of maternal attachment at 3 months postpartum. These results are discussed in the context of research attempting to establish the importance of postpartum bonding.

Psychosocial predictors of labor pain

&NA; The relationship between labor pain and concomitant psychological state, in terms of prenatal anxiety levels and post‐partum mood, has been studied. A consecutive series of primiparae (n = 129) was assessed at intervals over the course of their pregnancy and after delivery. State anxiety was measured at recruitment (10–14 weeks of pregnancy), 10 weeks, 32 weeks and at labor. Labor pain was assessed on the McGill Pain Questionnaire (MPQ) and visual analog rating scales. Pain ratings on the MPQ were found to be high when compared to other clinical pain groups. Drug use in labor emerged as the strongest predictor of pain ratings on the MPQ total, sensory and affective scales, accounting for 11, 9 and 7% of the variance respectively. Anxiety scores at 32 weeks accounted for a further 5% of the variance and emerged as the best predictor of MPQ evaluative scores and visual analog ratings. A significant association was found between pain ratings and ratings of post‐partum mood. Neither attendance at preparatory classes nor initial attitudes towards the neonate were related to pain scores.

The effects of ultrasound examination on maternal anxiety levels

A study has been conducted to assess the psychological effects of real-time ultrasound on the pregnant womans attitudes and anxiety levels. A consecutive series of primiparae, fulfilling the selection criteria of obstetrically “low risk,” was assigned at random to two conditions of ultrasound, namely, (a) high feedback (N=67), where the woman saw the moving fetus in utero;and (b) low feedback (N=62), where the monitor screen was not visible and no specific feedback was provided. A third group of women was assessed following a wait period in order to compare state anxiety levels among the three groups. Attitude assessments showed consistent preultra-sound-post-ultrasound change, with more uniformly positive attitudes displayed by the high-feedback group. No between-group differences in state anxiety emerged as a result of ultrasound compared with a wait control period. No differences emerged with respect to anticipatory anxiety measures. The results are considered in the context of evidence on the importance of psychological state on the course and outcome of pregnancy. It is suggested that the low-risk characteristics of this sample may have precluded effects on anxiety and it is concluded that the therapeutic potential of ultrasound warrants further study.

Cumulative concussion exposure in rugby players: Neurocognitive and symptomatic outcomes

A total of 111 rugby players underwent comprehensive testing to determine the impact of self-reported concussion exposure. Reliable estimates of concussion exposure were associated with an increase in postconcussion symptoms (PCS), but not diminished neurocognitive functioning. Importantly, the effects of concussion exposure on PCS varied as a function of player status. More specifically, extent of concussion exposure was associated with increased memory complaints and overall PCS endorsements in a dose-dependent manner for retired and older recreational players, but not for those who were younger and playing at more competitive levels. Future work should systematically evaluate the constituent participant factors that may influence differential concussion outcomes.

The referral decision scale

We examined the validity of the Referral Decision Scale (RDS), a test designed to screen for mental disorder in jail inmates, in a sample of 790 men admitted to an urban pretrial jail. Our results indicated that, in general, the RDS had excellent reliability and acceptable validity as a screening measure for serious mental disorder in jail settings, despite making a large number of false positive errors relative to both contemporaneous and subsequent assessments of mental disorder. Although the RDS is well suited for use in research, more information is needed before the test is used for clinical purposes. We discuss some potential problems with the use of the RDS in correctional systems.

Personality of paedophile club members

Abstract The EPQ and a lifestyle questionnaire were completed by 77 members of the Paedophile Information Exchange (PIE), a self-help club for men who are sexually attracted to children. Compared with control males the paedophiles were significantly introverted and high on P and N. Examination of individual items revealed that PIE members were more likely to be shy, sensitive, lonely, depressed and humourless, but they were not particularly troubled by guilt, obsessionality or worry about their looks. Individual variations within the paedophile sample were also found. Those who were high on P and low on E were interested in younger children and were less able to contemplate sex with adults. Paedophiles high on N were less happy about their sexual preference and were more likely to have sought treatment.

A survey of patient attitudes towards artificial insemination by donor

The psychological characteristics of a consecutive series (n = 58) of women attending an AID clinic have been examined. Women were assessed prior to treatment on a number of attitudinal and acceptability measures, as well as required to complete personality and martial adjustment inventories. At the time of each insemination, over 6 successive cycles, state anxiety was assessed. Following an interval of 6 months women were reassessed on an acceptability measure. The results showed generally positive attitudes at the outset. No systematic trends in anxiety were identified, with no differences between women becoming pregnant and those continuing in treatment. At follow-up women acknowledged the strain involved in timing the insemination to coincide with ovulation, with both pregnant and nonpregnant women attributing outcome to their psychological and emotional state at the time. The implications of these results are considered in terms of the characteristics of women requesting AID and the ways in which clinics can attend to the psychological states of the patients.

Social support for patients with prostate cancer: The effect of support groups

Abstract Questionnaires were administered to 234 patients with prostate cancer (142 attended support groups, 92 did not) to determine their sources of emotional, informational, and practical support and the relationship between their satisfaction with this support and their self-reports of coping and quality of life. Attenders were significantly more likely to cite other patients as sources of all three types of support. Furthermore, attenders cited fellow patients as their most helpful source of informational support, whereas nonattenders cited medical staff. Satisfaction with social support was significantly correlated with coping and quality of life. No significant differences were found between attenders and nonattenders regarding coping, quality of life, or satisfaction with the three types of support. The results are interpreted according to individual differences in how the patients satisfied their needs for support.

Relationship Between Body Image and Stimulant Use Among Canadian Adolescents

This study investigated the relationship between body image, dieting, disordered eating behaviors, and stimulant use in a sample of more than 30,000 British Columbian students. For both males and females, significant associations were found between stimulant use and body satisfaction, binging and purging, and efforts to lose weight.