Victoria H. Raveis

Suicidal ideation in adolescence: Depression, substance use, and other risk factors

The interrelationships of depression and suicide with adolescent drug use, delinquency, eating disorders, and the risk factors for these different problems were investigated among 597 9th and 11th graders in an urban high school. There is a strong association of drug use with suicidal ideation among girls, and a stronger relationship with attempts among girls and boys. Suicidal youths are ill-adjusted and display a lack of attachment and commitment to family and school. Causal models indicate that poor interpersonal interactions with parents, absence of peer interactions, and life events lead to depression, which in turn leads to suicidal ideation. Depressive symptoms are the strongest predictors of suicidal ideation. Among females, depression predicts drug involvement, and in turn, drug use increases suicidal ideation. Drug use is only one class of problem behaviors that constitutes a risk factor for suicidal behavior in adolescence. Delinquency and eating disorders also have direct effects on suicidal ideation beyond those of depressive affect. As for drug involvement, these problem behaviors are more predictive of suicidal behavior among girls than boys. Similarity and specificity of the predictors for problem behaviors within and between the sexes are discussed. Although young women use drugs to handle feelings of depression, drug use appears ineffective in the long run in relieving these depressive feelings. Understanding the dynamics of suicidal ideation in adolescence has important public health implications, since ideation is a strong predictor of attempts, especially among females.

Caregiver burden and unmet patient needs

Four‐hundred eighty‐three patients with cancer and their informal caregivers were studied. Patients reported on met and unmet needs in personal care activities (bathing and dressing), instrumental activities (heavy and light housekeeping, cooking, shopping), transportation (medical and general), and home health care (health/treatment assistance). A minority (18.9%) experienced an unmet need. Hierarchical logistic regression was used to identify significant predictors of any unmet need. Patients were more likely to report any unmet needs when their illness/treatment resulted in restricted activity days, when their financial resources were reduced enough for them to apply for Medicaid or Public Assistance, or when their caregivers were not their spouses. Although in general, the likelihood of an unmet need decreased as the number of domains of assistance provided by the caregiver increased, if that care was associated with a high level of burden, the odds of a patient reporting an unmet need actually increased.

Psychological well-being of gay men with AIDS: Contribution of positve and negative illness-related network interactions to depressive mood

While the positive functions of social network interactions in ameliorating the effects of life stress are widely documented and acknowledged, a growing body of research investigations has demonstrated that social relationships can concurrently be a source of stress and that actions intended to be supportive may instead be experienced as psychologically disturbing. Data from a study of the social support experiences of gay men diagnosed with AIDS were examined to determine the contribution to the mens depressive mood of positive and negative network interactions (n = 83). Although the results are consistent with the social support literature regarding the beneficial effect of positive network interactions for seriously-ill individuals, the findings also indicate that negative illness-related network interactions are associated with decreases in depressive mood, as indicated by scores on the Center for Epidemiological Studies of Depression Scale (CES-D). The findings also demonstrate the additive effects of positive and negative network interactions and clearly point out the value of investigating the complexity and multiple functions of social interactions.

Illness-Related Support and Negative Network Interactions: Effects on HIV-Infected Men's Depressive Symptomatology

Data collected as part of a psychosocial study of gay and bisexual mens experiences of living with HIV infection as a chronic illness were examined to investigate the psychological impact of the perceived availability of illness-related support and negative illness-related network interactions in a sample of men from this population. The sample was comprised of 144 HIV-infected non-Hispanic white, African American, and Puerto Rican men living in the New York City metropolitan area. Analyses found evidence of a conjoint (interactive) effect between perceived support and negative network interactions. There was no evidence of either perceived availability of illness-related network support buffering or negative illness-related network interactions amplifying the effect of HIV/AIDS-related physical symptomatology on depressive symptomatology.

CORRELATES OF CHANGE IN DEPRESSIVE SYMPTOMATOLOGY AMONG GAY MEN WITH AIDS

Longitudinal data from a sample of gay men living with AIDS (N = 128) were used to assess the relationship of change in various individual and situational correlates with change in depression. Results of regression analyses suggest that changes in physical symptomatology, in the number of bed days, and in the perceived sufficiency of social support are significantly correlated with concurrent change in depressive symptomatology. There was no evidence of change in the perceived sufficiency of social support buffering or amplifying the relationship of change in physical symptomatology with change in depression. The findings illustrate the need for the use of panel data (i.e., repeated assessments of the same individuals) and the assessment of change in both distress and its correlates among individuals living with AIDS.

Psychological and psychosocial adjustment of HIV-infected gay/bisexual men: Disease stage comparisons

The association between HIV disease progression (asymptomatic, symptomatic, AIDS) and mental health and psychosocial adjustment was examined among 144 men living in the New York City metropolitan area who had sex with men. While mean levels of mental health reported by the men did not differ by disease stage, mean levels of psychosocial adjustment did, with asymptomatic participants reporting significantly higher levels of adjustment on average, than those with AIDS. The data indicated that gay and bisexual men with HIV or AIDS were at risk of intrapsychic distress throughout the disease course, but the likelihood of problematic adjustment associated with their social interactions appeared to increase with the progression of the disease. The data also revealed that the men reported relatively high levels of psychological symptomatology and low levels of psychosocial adjustment compared to normative general population samples, and lower levels of psychosocial adjustment compared with some samples of individuals having other acute or chronic conditions. The implications of these findings for community psychologists are discussed.