Faye A. Gary

Risk factors for femicide in abusive relationships: results from a multisite case control study.

OBJECTIVES This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrators access to a gun and previous threat with a weapon, perpetrators stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrators use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS There are identifiable risk factors for intimate partner femicides.

STIGMA: BARRIER TO MENTAL HEALTH CARE AMONG ETHNIC MINORITIES

This paper explicates the stigma of mental illness as it is experienced by four ethnic minority groups in the United States. Concerns about prejudice and discrimination among individuals who suffer burdens related to mental illness are delineated. It is proposed that ethnic minority groups, who already confront prejudice and discrimination because of their group affiliation, suffer double stigma when faced with the burdens of mental illness. The potency of the stigma of mental illness is one reason why some ethnic minority group members who would benefit from mental health services elect not to seek or adequately participate in treatment. The combination of stigma and membership in an ethnic minority group can impede treatment and well-being, creating preventable and treatable mortalities and morbidities. The article concludes with recommendations for research and health policy implications.

Barriers to detection, help-seeking, and service use for children with ADHD symptoms.

This study describes 4 help-seeking steps among children at high risk for attention deficit hyperactivity disorder (ADHD), and identifies barriers to ADHD symptom detection and treatment. Using a district-wide stratified random sample of 1615 elementary school students screened for ADHD risk, predictors of 4 help-seeking steps among a high-risk group (n=389) and parent-identified barriers to care among children with unmet need for ADHD care (n=91) were assessed. Study findings indicate that although 88% of children were recognized as having a problem, only 39% had been evaluated, 32% received an ADHD diagnosis, and 23% received current treatment. Older children and those with more severe behavior problems were more likely to be perceived by their parents as having a problem. Additionally, gender and ethnic disparities in the subsequent help-seeking process emerged. Boys had over 5 times the odds than girls of receiving an evaluation, an ADHD diagnosis, and treatment. Compared to African American youth, Caucasian children had twice the odds of taking these help-seeking steps. For those children with unmet need for ADHD care, poverty predicted lower treatment rates and was associated with the most pervasive barriers. The gap between parental problem recognition and seeking services suggests that thresholds for parental recognition of a child behavior problem and for seeking ADHD services may be different. Future research examining the help-seeking process for ADHD should include a qualitative component to explore the potential mechanisms for gender and ethnic differences.

Parental explanatory models of ADHD: gender and cultural variations.

This study describes parents’ explanatory models of Attention Deficit Hyperactivity Disorder (ADHD) and examines model variation by child characteristics. Children with ADHD (N = 182) were identified from a school district population of elementary school students. A reliable coding system was developed for parental responses obtained in ethnographic interviews in order to convert qualitative into numerical data for quantitative analysis. African-American parents were less likely to connect the school system to ADHD problem identification, expressed fewer worries about ADHD-related school problems, and voiced fewer preferences for school interventions than Caucasian parents, pointing to a potential disconnect with the school system. More African-American than Caucasian parents were unsure about potential causes of and treatments for ADHD, indicating a need for culturally appropriate parent education approaches.

Child Temperament, ADHD, and Caregiver Strain: Exploring Relationships in an Epidemiological Sample

OBJECTIVE To investigate the relationship between child-reported dimensions of temperament and attention-deficit/ hyperactivity disorder (ADHD), as well as other indicators of child psychopathology, including disruptive disorders, depression, and anxiety. It also examined whether difficult child temperament scores independently predicted caregiver strain. METHOD A school-district-wide, two-phase screening design (response rate 70% for phase 2) identified elementary school children at high risk for ADHD. Two hundred high-risk children and their parents completed standardized instruments to assess child temperament, diagnoses of disruptive disorders, childrens symptoms of anxiety and depression, and caregiver strain. Relationships were examined using analysis of variance, correlations, and multivariate prediction models, adjusting for child sociodemographic characteristics and psychopathology. All estimates were weighted for sampling design and differential participation. RESULTS Combined subtype ADHD was associated with lower scores on task orientation and higher scores on general activity level. Depressive symptoms correlated significantly with all but one difficult temperament dimension, in a pattern consistent with clinical symptoms of depression. Child temperament did not vary by ADHD treatment status. Among these high-risk children, maternal caregiver strain experiences were increased by male gender, inattention symptoms, and oppositional defiant disorder, but not by difficult temperament scores. CONCLUSION This study provides support for Graham and Stevensons hypothesis of continuity between specific temperament traits and certain child psychiatric disorders, namely ADHD and depressive disorders.

Could we have known? A qualitative analysis of data from women who survived an attempted homicide by an intimate partner

AbstractOBJECTIVE: To examine in-depth the lives of women whose partners attempted to kill them, and to identify patterns that may aid in the clinician’s ability to predict, prevent, or counsel about femicide or attempted femicide. DESIGN: Qualitative analysis of 30 in-depth interviews. SETTING: Six U.S. cities. PARTICIPANTS: Thirty women, aged 17–54 years, who survived an attempted homicide by an intimate partner. RESULTS: All but 2 of the participants had previously experienced physical violence, controlling behavior, or both from the partner who attempted to kill them. The intensity of the violence, control, and threats varied greatly, as did the number of risk factors measured by the Danger Assessment, defining a wide spectrum of prior abuse. Approximately half (14/30) of the participants did not recognize that their lives were in danger. Women often focused more on relationship problems involving money, alcohol, drugs, possessiveness, or infidelity, than on the risk to themselves from the violence. The majority of the attempts (22/30) happened around the time of a relationship change, but the relationship was often ending because of problems other than violence. CONCLUSIONS: Clinicians should not be falsely reassured by a woman’s sense of safety, by the lack of a history of severe violence, or by the presence of few classic risk factors for homicide. Efforts to reduce femicide risk that are targeted only at those women seeking help for violence-related problems may miss potential victims.

Exploring Help-Seeking for ADHD Symptoms: A Mixed-Methods Approach

Objective: Gender and race differences in treatment rates for attention‐deficit/hyperactivity disorder (ADHD) are well documented but poorly understood. Using a mixed‐methods approach, this study examines parental help‐seeking steps for elementary school students at high risk for ADHD. Methods: Parents of 259 students (male/female, African American/Caucasian) identified as being at high risk for ADHD completed diagnostic interviews and provided detailed accounts of help‐seeking activities since they first became concerned about their child. Help‐seeking steps (n=1,590) were analyzed using two methods: inductive analysis based on grounded theory, and deductive quantitative analysis of coded data derived from application of the network‐episode model, merged subsequently with demographic and other characteristics. Results: The inductive analysis revealed unique parental perceptions of their childrens sick role and of the agents of identification and intervention for each of the four groups. Deductive analysis showed significant variations by race and gender in consultation experiences, in the person or entity being consulted and in the transactions occurring in the consultation, and in illness careers. Conclusion: ADHD symptoms are interpreted as having different implications for the sick role and the intervention, dependent on a childs gender and race. Educational interventions need to address cultural stereotypes contributing to inequitable access to treatment.

General Classroom Teachers' Information and Perceptions of Attention Deficit Hyperactivity Disorder.

The authors used survey methods to examine three sources of teachers’ ADHD information—exposure to students with ADHD, self-study, and formal ADHD training—as well as perceived teacher confidence in instructional tasks for successful inclusion of students with ADHD and perceived barriers to such instruction. Participants represented a random sample of general elementary classroom teachers in five school districts in a southeastern state (N = 365). Almost all teachers had taught at least one student diagnosed with ADHD in the last 2 years. Virtually all teachers had read at least one article, and about 60% had read a book about ADHD. Half of the teachers had received some preservice ADHD training during their education, and three fourths had received inservice training after graduation, mostly of a brief nature. Of the teachers surveyed, 94% wanted more ADHD training. Teachers expressed lowest confidence in their ability to manage stress related to instructing students with ADHD. Class size and time requirements of special interventions were rated as the greatest barriers. General education teachers should receive preservice and inservice ADHD training, including skill-based teaching, and stress management. Smaller class size and the allocation of resources are essential to ensure high-quality student education.

Practice Guidelines and Parental ADHD Treatment Evaluations: Friends or Foes?

In this exploratory descriptive study, we used focus groups to examine parental evaluations of treatment approaches to attention-deficit/hyperactivity disorder (ADHD) and the congruence of these evaluations with professional practice guidelines. We paid particular attention to home-care strategies and to parental experiences and attitudes regarding medications for ADHD. Some home-care techniques were consistent with evidence-based behavioral principles, whereas others seemed to be based on popular myths, with little indication that they could improve the childs behavior. Indeed, some might actually add unnecessary stress to the parent-child relationship by introducing ineffective limitations (e.g., dietary restrictions). Parental accounts uniformly depicted stimulant use, the cornerstone of ADHD treatment in the United States, as a difficult treatment modality to consider and accept for their children. Study findings indicate that professional guidelines and parent ADHD treatment evaluations are only partially congruent, with the greatest discrepancy in the role assigned to stimulants. Increased provider-parent communication concerning medications might improve adherence and treatment outcomes.

Depression among southern rural African American women: A factor analysis of the Beck Depression Inventory-II

Background:This is the first reported study involving a factor analysis of the Beck Depression Inventory-II, which was administered to a sample of southern rural African American women. Objective:To determine the factor structure of the Beck Depression Inventory-II using data collected from southern rural African American women. Methods:Using a correlational, descriptive design, 206 southern rural African American women were invited to participate in a face-to-face interview that occurred in a variety of community-based settings. Results:The factor analysis of the Beck Depression Inventory-II resulted in a two-factor solution. Symptoms such as pessimism and worthlessness loaded high on the first factor (cognitive). The second factor explained somatic-affective symptoms of depression, with factor loadings high on tiredness and fatigue and loss of energy. Conclusions:The application of the Beck Depression Inventory-II among African American people would generate needed information about how depressive symptoms may be expressed among them. Knowledge gained from this study promises to be useful for developing appropriate research studies and population-specific treatment approaches for this group of women.