Jean A. Hamilton

Provider encouragement of breast-feeding: evidence from a national survey.

Objective To examine the influence of provider encouragement on breast-feeding among women of different social and ethnic backgrounds in the United States. Methods A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone. The responses of the 1229 women interviewed were included in the analysis. Respondents were asked to recall whether their physicians or nurses had encouraged or discouraged them from breast-feeding. The effects of provider encouragement on breast-feeding initiation and duration were evaluated by multivariate logistic regression. The sample was then stratified to allow subset analyses by race and ethnicity, education, income class, age group, and marital status. Results More than one-third (34.4%) of respondents did not initiate breast-feeding. Three-fourths (73.2%) of women reported having been encouraged by their physicians or nurses to breast-feed; 74.6% of women who were encouraged initiated breast-feeding, compared with only 43.2% of those who were not encouraged (P < 0.001). Women who were encouraged to breast-feed were more than four times (relative risk 4.39; 95% confidence interval 2.96, 6.49) as likely to initiate breast-feeding as women who did not receive encouragement. The influence of provider encouragement was significant across all strata of the sample. In populations traditionally less likely to breast-feed, provider encouragement significantly increased breast-feeding initiation, by more than threefold among low-income, young, and less-educated women; by nearly fivefold among black women; and by nearly 11-fold among single women. Conclusion Provider encouragement significantly increases breast-feeding initiation among American women of all social and ethnic backgrounds.

Intrinsic enjoyment and boredom coping scales: validation with personality, evoked potential and attention measures

Abstract This paper reports the validation of brief, self-report measures of intrinsic enjoyment and boredom coping. Intrinsic enjoyment is characterized by intense involvement, interest and absorbed concentration; boredom coping is designed to reflect the disposition to restructure ones perceptions and participation in potentially boring activities so as to decrease boredom. Both traits are hypothesized to reflect the capacity for good attentional control across a variety of situations. Reliability was established by test-retest correlation and by an inter-item consistency measurement. Construct validity was established by comparison with previously-validated personality tests, real-life measures (such as Random Activities Experiential Sampling, which involves repeated self-report measures in daily life), as well as with laboratory measures of attention (including the averaged visual evoked potential (EP) and the Continuous Performance Test). Intrinsic enjoyment is significantly correlated with an independent measure of intrinsic involvement (low wish to be elsewhere in ones daily life), the affective experience of potency, self-reports of concentrating well with ease, high ego development, an internal locus of control, lack of boredom susceptibility and certain EP indices of attentional change and ‘cortical’ augmenting. Boredom coping is associated with a higher percent of time actually spent alone, high continuous performance task measures of attentional capacity, and low MMPI and Research Diagnostic Criteria indices of psychopathology.

D-Amphetamine in obsessive-compulsive disorder

In a double-blind rossover study, single doses of d-amphetamine and placebo were administered to 12 patients with severe chronic obsessive-compulsive disorder (OCD). Improvement of obsessional symptoms was significant on clinical ratings and was correlated with improved performance on an attention task. Changes were also significant for self-rated measures of activation and altered reality. The behavioral response to amphetamine was not statistically correlated with subsequent improvement during a 6-week clomipramine trial, although the direction of change was the same during both treatments for every patient studied.

Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder. Part II. What makes a "real" difference?

&NA; Five degree of change criteria used in previous research to confirm premenstrual syndrome/late luteal phase dysphoric disorder (PMS/LLPDD) based on daily ratings were examined to determine how well each differentiated between women claiming to experience severe symptoms and women with normal menstrual experience. Frequency and nature of stressful events and subjective perceptions of impairment were also examined. Ratings were evaluated in 31 women who met DSM III‐R criteria for a provisional diagnosis of LLPDD, and 34 women who reported no premenstrual symptomatology. Ratings for a sample of women taking oral contraceptives and a sample of men were also included for comparison purposes. Results indicated no differences between the groups in the frequency of stressful events. However, the PMS/LLPDD group rated their problems as more disturbing and evidenced a cyclical pattern in the occurrence of negative interpersonal interactions at work that was suggestive of some impaired functioning. None of the five change criteria differentiated the PMS/LLPDD group from the normally cycling No PMS group, and only one differentiated this group from the oral contraceptive No PMS group. This was true whether a liberal or conservative standard of confirmation was applied. The implications of these findings for using daily ratings to confirm PMS/LLPDD are discussed.

Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder. Part I. Effects of demand characteristics and expectations.

&NA; Daily symptom ratings were evaluated in 31 women who met DSM III‐R criteria for a diagnosis of Late Luteal Phase Dysphoric Disorder (LLPDD), and 34 women who reported no premenstrual symptomatology. Women in both groups were randomly assigned to be aware or unaware of the menstrual cycle focus of the study. Results revealed a consistent pattern of cyclic effects, with higher ratings in the mid‐luteal, premenstrual and menstrual phases for many symptoms. Ratings of women reporting severe symptoms were not affected by knowing the purpose of the study and were higher than ratings in the asymptomatic group for many symptoms relevant to the LLPDD diagnosis. Awareness of the study focus did increase cyclicity in the ratings of asymptomatic women aware of the study focus compared with those who were unaware, but these differences were small and most were not significant. The implications of these findings for research and clinical diagnosis of PMS/LLPDD are discussed.

Daily moods and symptoms: effects of awareness of study focus, gender, menstrual-cycle phase, and day of the week.

Evaluated changes in daily ratings of moods and symptoms in 30 normally cycling women and 23 men. Women were randomly assigned to two groups for manipulating awareness of the study focus (aware vs. unaware). Principal-components analysis revealed six factors (Dysphoric Moods, Well-being, Physical Symptoms, Personal Space, Food Cravings, Depression) that accounted for 70% of the variance in daily ratings. Repeated-measures analyses revealed cyclic variation on each factor and no significant differences between aware and unaware women during premenstrual or menstrual phases on any measure. Unaware women reported less well-being than men during the premenstrual phase but did not differ on any other measure. Aware women did not differ from men in premenstrual or menstrual ratings on any measure. The way these findings relate to retrospective symptom reports, menstrual attitudes, and changes in moods and symptoms across the week was examined.

Recurrent premenstrual decline in serum lithium concentration: Clinical correlates and treatment implications.

A 16-year-old female adolescent who met DSM-III criteria for bipolar disorder, mixed with psychotic features, showed a clinical response to lithium carbonate, but experienced repeated deterioration in function whenever she entered the premenstrual phase of her menstrual cycle. This exacerbation in her affective psychosis coincided with a progressive fall in serum lithium concentration despite a constant oral regimen with which the patient was compliant. If the oral dose was prophylactically increased during the patients luteal phase in order to compensate for the anticipated decline in serum concentration, and if the concentration could thereby be maintained at or above 1.1 mEq/L, then the premenstrual deterioration could be prevented.

Development of interest and enjoyment in adolescence. Part II. Boredom and psychopathology

Significant changes in both the capacity and the content of attention emerge during adolescence. Part II of this two-part article argues that a central task of adolescence is to utilize increased information-processing capacities in order to develop attentional habits which shape interests, provide enjoyment, and avoid boredom. Reports of chronic boredom or of extreme efforts to escape from boredom during adolescence may signify substantial difficulty in forming the attentional habits required for developing a separate identity. When adolescents are bored, they may resort to habits of attention and enjoyment which have deleterious personal, social, and ecological consequences. Further study of attention in adolescence may help to explore preventive educational approaches to the problem of boredom and of “pathological” solutions to boredom.

Problematic aspects of diagnosing premenstrual phase dysphoria: Recommendations for psychological research and practice.

A gender-specific psychiatric diagnosis, named after an aspect of normal menstrual cycle physiology («Late Luteal Phase» Dysphoric Disorder, or LLPD), is currently being considered for full diagnostic status in the upcoming catalog of psychiatric disorders, the DSM-IV. Psychologists have had surprisingly little voice in the ongoing debate about LLPD, despite the severe methodological difficulties involved in establishing reliability and validity for the proposed diagnosis. To stimulate research contributions by psychologists, we discuss the risks for over- and underdiagnosis, identify gaps in knowledge, and highlight specific empirical questions that required attention if the debate is to be informed by assessments with demonstrated and acceptable levels of reliability and validity

Premenstrual symptom changes and plasma β-endorphin/β-lipotropin throughout the menstrual cycle

Abstract The β-endorphin (BE) hypothesis of premenstrual symptomatology was assessed in 15 healthy, drug-free normally cycling women. Cycle-phase assignment was aided by measurement of basal body temperature and plasma progesterone. For the entire group, peripheral plasma BE concentrations by radioimmunoassay (with substantial β-lipotropin (BL) cross-reactivity) were generally unvarying across the menstrual cycle. High and low symptom subgroups were defined by retrospective and prospective daily self-reports of premenstrual changes. For the cycle studied, moderate to extreme symptom severity was defined according to premenstrual increases in impaired concentration, water retention and negative affect. No between-groups difference was observed for any cycle-phase for absolute values of β-endorphin (BE/BL). When difference scores were examined, there was a positive time-lag correlation between follicular-to-periovulatory changes in BE/BL and the subsequent luteal increase in impaired concentration over the periovulatory baseline (rs=0.82); considering the number of comparisons, however, the correlation fails to reach significance. The salience of various types of stressors on mood was assessed; there was a trend for “task-demands” to account for a greater percentage of negative attributions premenstrually compared to post-menstrually, for the entire group. The relative inconsistency in plasma BE/BL from cycle to cycle may be related in part, to the lack of stability in certain cycle characteristics from month to month. Future studies of BE/BL across the menstrual cycle may benefit from a demanding task in a provocative stress-paradigm.