Raymond B. Flannery

Sense of coherence, life stress, and psychological distress: A prospective methodological inquiry

Antonovsky (1987) has proposed the Sense of Coherence (SOC) as a global perceptual predisposition in responding to life stress. Composed of comprehensibility, manageability, and meaningfulness, this construct has been associated with more adaptive coping in previous cross-sectional studies. This prospective study (N = 95) investigated the association of SOC (assessed by Antonovskys measure) with life stress and symptoms. SOC was correlated negatively with life stress and symptoms and appeared to mitigate the impact of life stress. SOC was not found to be a buffer variable. Implications of these findings are presented, as are methodological issues that concern Antonovskys measure.

Validating Antonovsky's Sense of Coherence Scale.

This study empirically supported Antonovskys predictions that a persons Sense of Coherence is implicated in coping with life stresses and psychological distress. Sense of Coherence scales accounted for as much variance in criterion measures of Life Events stressors, Depression, and Anxiety as did traditional locus of control and social support predictor measures. Sense of Coherence scales emerged as useful additions for studies of personality characteristics implicated in personal reactions to distressing life events.

Critical Incident Stress Management (CISM): a statistical review of the literature

Crisis intervention has emerged over the last 50 years as a proven method for the provision of urgent psychological support in the wake of a critical incident or traumatic event. The history of crisis intervention is replete with singular, time-limited interventions. As crisis intervention has evolved, more sophisticated multicomponent crisis intervention systems have emerged. As they have appeared in the extant empirically-based literature, their results have proven promising. A previously published paper narratively reviewed the Critical Incident Stress Management (CISM) model of multicomponent crisis intervention. The purpose of this paper was to offer a statistical review of CISM as an integrated multicomponent crisis intervention system. Using the methodology of meta-analysis, a review of eight CISM investigations revealed a Cohens d of 3.11. A fail-safe number of 792 was similarly obtained.

Social support, life stress, and psychological distress: An empirical assessment.

Previous social support research had demonstrated the presence of either main (network) or buffering (interaction) effects as factors that mitigated the impact of life stress. To date, two studies have assessed both types of social supports in the same subjects at the same time. One study found a main effect, and both studies reported buffering effects. The present study (N = 74) extended this type of inquiry with a more comprehensive assessment of both social support resources that addressed previous methodological limitations. This study found buffering effects, but no main network effect. Possible explanations for these findings are discussed.

Characteristics of Staff Victims of Pschiatric Patient Assaults: 15-Year Analysis of the Assaulted Staff Action Program (ASAP)

Psychiatric patient assaults on staff victims are a worldwide occupational hazard. This paper reports on a 15-year study of the characteristics of staff victims of patient assaults and a crisis intervention procedure to ameliorate the aftermath of theses incidents. The debate on the efficacy of early interventions is outlined and the present 15-year findings are presented, findings demonstrating remarkable consistency in victim characteristics over time. The crisis intervention procedures were associated with sharp declines in disrupted victim functioning. The validity of the study’s findings are noted and the implications for enhanced risk management training and staff victim crisis intervention procedures are discussed.

Characteristics of assaultive psychiatric patients: fifteen-year analysis of the Assaulted Staff Action Program (ASAP)

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.

Ethnicity as a factor in the expression of pain

Abstract Ethnicity is often assumed to play a role in response to pain, and previous studies have tended to support this general concept. To assess the impact of learned ethnic attitudes to ward pain, the authors surveyed 75 women who had just delivered a baby and had an episiotomy. Interviewers administered self–assessment measures and made behavioral observations. No significant difference in pain response to the episiotomy was found among the five ethnic groups–Black, Italian, Jewish, Irish, and Anglo-Saxon Protestant patients.

Patients' threats expanded definition of assault

Most studies of patient assaults against staff operationally define violence as episodes of unwanted physical or sexual contact. This study empirically assessed a broader range of patient violence by including verbal and nonverbal threats in addition to sexual and physical assaults. Preliminary data from a statewide survey suggested that patient threats were frequent events. Data from a team of staff assaulted by patients in one hospital suggested that some verbal threats produced as much psychological distress for staff victims as did some physical assaults. These findings suggest the need to consider including threats in future studies of patient assaults.

Characteristics of patient and staff victims of assaults in community residences by previously nonviolent psychiatric inpatients.

There currently exists a large body of empirical research examining patient assaults in inpatient psychiatric facilities. These studies have focused primarily on staff and have found younger, male mental health workers with lower levels of formal education and experience as well as nurses involved in restraint procedures to be most at risk. However, despite the increased utilization of community-based services, little attention has been directed toward patient assaults on patients and staff in community settings, particularly residential services. This study began to respond to this need by examining patient assaults toward other patients and staff in community residences during the first twelve months post-discharge for a group of newly discharged patients who were not violent as inpatients. This study found female patients and staff to be at greater risk for assault than male patients. Lack of experience by staff was also a risk factor. The clinical, administrative, and research implications of these findings are discussed.

Linking substance abuse and serious mental illness service delivery systems: initiating a statewide collaborative.

In the past, persons with serious mental illness and substance abuse often found themselves in parallel systems of care that inadequately addressed their needs. Recent advances have seen the development of an integrated approach to care for these disorders in both the public and private sectors. While some state departments of mental health have developed integrated systems of care for public sector patients, no department appears to have developed such a system for both public and private clients, and there appears to be no published journal report of a model to induce cooperation by all stakeholders. This article outlines a two-step approach by the Massachusetts Department of Mental Health to foster stakeholder cooperation in designing an integrated system of care for both public and private clients with co-occurring disorders.