Karen L. Weihs

Psychological distress and help seeking in rural America.

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.

Natural disaster and depression: A prospective investigation of reactions to the 1993 Midwest Floods

A statewide sample of 1735 Iowa residents, approximately half of whom were victims of the 1993 Midwest Floods, participated in interviews 1 year prior to, and 30 to 90 days after, the disaster. Employing a rigorous methodology including both control-group comparisons and predisaster assessments, we performed a systematic evaluation of the disasters impact. Overall, the disaster led to true but small rises in depressive symptoms and diagnoses 60–90 days postflood. The disaster–psychopathology effect was not moderated by predisaster depressive symptoms or diagnostically defined depression; rather, predisaster symptoms and diagnoses uniquely contributed to increases in postdisaster distress. However, increases in symptoms as a function of flood impact were slightly greater among respondents with the lowest incomes and among residents living in small rural communities, as opposed to on farms or in cities. Implications for individual- and community-level disaster response are discussed.

Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer

OBJECTIVE To assess whether negative affectivity and restriction of emotions predict survival time with recurrent breast cancer. METHODS Thirty-two patients with recurrent breast cancer, diagnosed 6-19 months earlier and stabilized using surgical, medical and/or radiation therapies, were enrolled. Cox regression survival analyses, including initial severity of metastases (RR=4.3 [1.3-14.3]; p=0.02), were used to explore the association of psychological variables with survival. RESULTS Low chronic anxiety in the context of low emotional constraint predicted low mortality (RR 0.07 [0.01-0.52]; p=0.007). However, patients with low chronic anxiety scores but with high constraint had higher mortality (RR=3.7 [1.2-11.5; p=0.02). High chronic anxiety, with or without high constraint, also predicted earlier death, as did high control of feelings. CONCLUSION An integrated model of negative affectivity in the context of restriction of emotions appears to strengthen the prediction of survival based on severity of breast cancer metastases.

Continuation phase treatment with bupropion SR effectively decreases the risk for relapse of depression

BACKGROUND This was the first controlled continuation phase study (up to 1-year total treatment) to evaluate the safety and efficacy of bupropion SR for decreasing the risk for relapse of depression in patients who responded to bupropion SR. METHODS Patients with recurrent major depression were treated with bupropion SR 300 mg/day during an 8-week open-label phase. Responders (based on Clinical Global Impressions Scale for Improvement of Illness scores) entered a randomized, double-blind phase where they received bupropion SR 300 mg/day or placebo for up to 44 weeks. After randomization, relapse was defined as the point at which the investigator intervened by withdrawing the patient from the study to treat depression. RESULTS Four hundred twenty-three patients were randomized. A statistically significant difference in favor of bupropion SR over placebo was seen in the time to treatment intervention for depression when survival curves were compared (log-rank test, p =.003). Statistically significant separation between bupropion SR and placebo began at double-blind week 12 (p <.05). Adverse events in bupropion SR-treated patients accounted for 9% and 4% of discontinuations from the open-label and double-blind phases, respectively. CONCLUSIONS Bupropion SR was shown to be effective and well tolerated in decreasing the risk for relapse of depression for up to 44 weeks.

Freud's antiquities

Upon entry to the Freud Museum in London, one is struck by the enormous collection of antiquities (figurines, busts, statues) on display from ancient Egypt, Greece, Rome and other cultures. Freud was fascinated with ancient civilisations and collected these objects throughout his career. He believed that bringing pathogenic unconscious mental contents into the light of conscious awareness was a process akin to recovering ‘buried treasures’ (Freud, 1937). In fact, his office was arranged so that from his chair, positioned at the head of the couch, he could view and contemplate these antiquities during psychoanalytic sessions (see Figure 1; Engelman, 1998). The parallel between unearthed buried treasures and making the unconscious conscious during psychoanalysis, while an important advance and extremely useful at the time, creates a misimpression about the nature of the unconscious. Modern psychological research has demonstrated that fantasies and their motivational properties do not reside in the unconscious fully formed waiting to be unveiled when the forces of repression are overcome (Schimek, 1975). While the hypothesised unconscious mental contents may be fully formed in the therapist’s mind, they most commonly exist in the patient in an undifferentiated form consisting of sensori-motor schemes that are pre-ideational and pre-verbal (Schimek, 1975). The Boston Change Process Study Group, for example, has concluded that conflict and defense are higher level abstractions that are derived from, and do not underlie, the implicit level of lived interaction (Boston Change Process Study Group, 2007). Viewing unconscious mental contents as ‘buried treasures’ implies that the therapist can know with certainty something about the patient that the patient does not know. Becoming consciously aware of unconscious mental contents is instead a creative, interactive process (Stern, 1983), the outcome of which cannot be known in advance by the analyst. Failure to appreciate this reality can potentially lead to distorted constructions or threats to the

Systems-oriented Counseling

When a factory worker complains to his/her family physician of a sore throat, back pain, and irritability at home, the physician can choose to work up the sore throat and the back pain, using a straightforward biomedical approach. Alternatively, in addition to biomedical problems, the clinician can consider broader diagnoses such as job stress, marital discord, and depression. When a patient with well-controlled chronic heart failure presents with trouble sleeping and crying spells, without dyspnea, ankle edema, or chest pain, the physician can reassure the patient that his/her chronic disease is under control and leave it at that, or he/she can address the way these symptoms are part of more generalized distress in the patient’s life.