Michael Feldstein

MEASURING CHILDREN'S COPING

Using a transactional model of stress and coping, a measure of childrens coping is offered and applied in a semi-structured interview in which specific coping styles are assessed. Data from 176 school-age children yielded findings on age and gender differences along with other preliminary suggestions of the validity of the instrument.

Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care.

Psychosocial problems and symptoms of emotional distress play a prominent role in patients reporting to primary care settings. Interpersonal counseling (IPC) was developed as a brief psychosocial intervention for patients with stress and distress to be administered by nurse practitioners in a primary care setting. The results of a pilot study indicate more rapid reduction of symptoms and improvement in emotional sysmptoms and psychosocial functioning in the IPC group than in a comparison group with initially elevated scores on the General Health Questionnaire. The priorities for further testing are discussed, and possible implications for service delivery are explored.

REPORTING PRACTICES OF PSYCHIATRISTS WHO KNEW OF SEXUAL MISCONDUCT BY COLLEAGUES

Of 1423 psychiatrists responding to a national survey, 65% reported treating patients who had been sexually involved with previous therapists. Respondents saw these prior involvements as harmful in 87% of cases but reported the sexual abuse in only 8% of cases. The majority, however, favored mandatory reporting of such incidents. The problem of underreporting and the need for effective management of sexual abuse cases are discussed.

The validity of pap smear parameters as predictors of endometrial pathology in menopausal women

Cytopathologists recognize that certain Pap smear findings are suspicious for endometrial pathology in menopausal women. To study their prognostic importance in the directed cervical smear, six parameters were used to evaluate smears for evidence of an endometrial lesion: the presence of (1) histiocytes, (2) multinucleated histiocytes, (3) nonspecific inflammation, (4) bleeding, (5) elevated squamous cell maturation index, and (6) the degree of cytologic atypicality of endometrial glandular cells, expressed as a ‘score’ from 0 to 6. Clinical pathologic correlation of 102 women with these parameters was undertaken. A multivariable statistical analysis determined which of these six parameters was most predictive of an endometrial lesion. Cytologically ‘scored’ endometrial glandular cells was the only parameter predictive of endometrial pathology. Its emergence as the sole prognostic cervical Pap smear parameter for endometrial pathology has not been previously reported. This predictive value was consistent even with control for bleeding history and age. Appropriate interpretation of abnormal Pap smear findings contributes substantial diagnostic information in the evaluation of the endometrium.

Preliminary Findings on a New Instrument to Measure Cohesion in Group Psychotherapy

ABSTRACTThis article describes the development of a new process scale to measure cohesiveness in group psychotherapy. This scale, The Harvard Community Health Plan Group Cohesiveness Scale (HCHP-GCS), can be used by trained clinical raters viewing half-hour videotaped segments of psychotherapy groups. Early evidence indicates that these ratings can be made in a reliable manner and that there appears to be a strong relationship between ratings of cohesion and patient ratings of outcome in the group.

Multiple daily fractionated radiation therapy and misonidazole in the management of malignant astrocytoma. A preliminary report

Various attempts have been made to improve the effectiveness of radiation in the treatment of cerebral malignant astrocytomas. A trend favoring multiple daily fractionated (MDF) radiation therapy over conventional single daily fractionated (CF) radiation therapy was identified in our previous study. In order to assess the effect of MDF with and without misonidazole, a province‐wide prospective randomized trial was initiated in January 1981. By March 1984, 124 patients with histologically verified grade III and IV astrocytomas were randomized to CF (5800 cGy/6 weeks/30 fractions) MDF (6141 cGy/4.5 weeks/69 fractions at 89 cGy every 3–4 hours, three times a day) and MDF in combination with misonidazole (1.25 g/m2 three times weekly for the first 3 weeks). Thirty‐eight patients were randomized to CF, 43 patients to MDF, and 43 patients to MDF and misonidazole. At the preliminary assessment in July 1984, the median survival time was 27 weeks for the CF group, 39 weeks for the MDF group and 49 weeks for MDF and misonidazole group. The 1‐year actuarial survival rate from surgery was 20% for CF group, 41% for MDF group, and 45% for MDF and misonidazole group. There is a statistically significant difference (P < 0.001) between the CF and MDF group. However, the addition of misonidazole does not significantly alter survival.

Comparative Outcome in Time-Limited Individual and Group Psychotherapy

ABSTRACTIn this randomized clinical trial, we compared time-limited group psychotherapy and time-limited individual psychotherapy. Ninety-eight nonpsychotic psychiatric outpatients participated. There were five therapists, all highly experienced with brief therapies. Significant improvement and maintenance of improvement occurred in both treatments. Although both treatments were quite beneficial on a number of our subjective measures, there was a clear preference by patients for the individual therapy. Recommendations are offered for improving the acceptability of group treatment approaches.

Perceptions of control, competence, and contingency as influences on the stress-behavior symptom relation in school-age children.

Analyzed data from 154 school-age children and their mothers to examine the relations between stress, perceived competence and contingency, and behavior symptoms. Analyses focused on the relative merits of unidimensional vs multidimensional measures of control in predicting symptoms. The stress of undesirable life events and behavior symptoms were related in the expected direction. Multiple regression models with R2 ranging from .11 to .14 (all ps less than .0002) included significant main effects for stress, competence, and control. Analyses supported the relative superiority of the multidimensional measure of control. Models containing main effects and interaction terms were of equivalent magnitudes in accounting for variance in symptom scores. Findings support the idea of perceived control as a moderator of the stress-illness relation and are consistent with earlier suggestions that simple main effects models may be the most useful in examining these relations.

Assessment of psychological morbidity in primary care: Explorations with the general health questionnaire

The 30-item version of the General Health Questionnaire (GHQ) was completed by 1649 new adult enrollees in a Health Maintenance Organization (HMO). Factor analysis of responses disclosed six factors (Anxiety/Strain, Confidence, Depression, Energy, Social Function, and Insomnia) and a strong tendency for items of similar wording (positive phrasing) to cluster together. Elevations of GHQ scores, especially when persistent over two administrations of the GHQ separated by 7 months, were strongly associated with the probability of both mental health and non-mental health care within 12 months of enrollment. Anxiety/Strain, Depression, and Social Function scores were associated with the probability of use; Confidence and Energy factors were not. Once in care a members rate of use of service was relatively independent of the response pattern to the GHQ at enrollment.

Stressful experiences, temperament, and social support: Impact on children's behavior symptoms

Abstract A long tradition of research has documented an important set of relationships between stressful life events and mental health. Recent understandings of these relationships have emphasized the importance of moderating variables such as temperament and social support. Most recently, developmental aspects of this relationship are being explored and described with an aim of identifying stress and illness relationships over the life course of children and families. This paper is a report from a longitudinal study of stress and illness in a sample of 166 families with school-age children. Recent analyses have yielded several series of multiple regression models which document the expected relationships between stress and behavior symptoms and which, in separate models, provide evidence for both main effects and moderating influences of temperament and social support on these relationships (Wertlieb, Weigel, & Feldstein, 1987; Wertlieb, Weigel, Springer, & Feldstein, 1987). To better understand the stress mediation process, this study simultaneously considers multiple moderators and tests the hypothesis proposed by Lerner and East (1984) that “not only does temperament moderate other intraindividual moderators of stress reactions, but it interacts … with key contextual moderators such as social support”. (p. 158) A main-effects multiple regression model with R 2 = .32 ( p Implications for the research agenda in stress and mental health are discussed. Opportunities and cautions associated with application of stress research findings to the design and evaluation of mental health prevention and intervention services are noted.