Behavioural problems of children with chronic physical illness and their siblings.

Children suffering from chronic physical illness are considered to be at increased risk for behavioural problems. There is also evidence that their siblings are at risk for behavioural problems. This study investigated parent-reported behavioural problems in chronically ill children and their siblings. There were significant positive correlations between the behaviour problem scores of the ill children and the scores of their siblings. Siblings older than the ill child had significantly higher behaviour problems scores of an internalizing nature than did the younger siblings. Sibling behaviour problem scores were similar to those of a comparison group of normal children and significantly different from those of a comparison group of psychiatrically referred children. Siblings of chronically ill children showed no greater likelihood of receiving scores in the clinical range of behaviour problems than children in the general population. Implications of the findings and suggestions for future research are discussed.

Behavioral problems of adolescents with chronic physical illness: a comparison of parent-report and self-report measures.

This study reports on the extent of behavior problems in Israeli adolescents suffering from chronic illness. A comparison was made between parent-reported and self-reported behavioral symptomatology using the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). 103 outpatients, aged 11-16 years, suffering from cystic fibrosis (CF), asthma, or hematological/oncological conditions were assessed. Healthy adolescents and adolescents referred for psychiatric assessment comprised the comparison groups. Parent- and self-reports were significantly positively correlated in each group (all chronically ill children r = .22; Healthy group r = .27; psychiatric group r = .50), but the correlations were particularly low (and non-significant) in younger adolescents with hematological/oncological conditions or HCF., pointing to the need for physicians to include parents' and adolescents' viewpoints in their assessments of these adolescents' psychosocial state. The mean number of parent-reported and self-reported behavior problems in the illness groups was no different from that of the Healthy group but significantly lower than that of the psychiatric group.

Utilization patterns of community mental health services by newly referred patients.

The present study compared the pattern of service utilization over a 1-year period, of 349 newly referred adult patients to the four community mental health clinics in Jerusalem. Treatment in these clinics is provided free of charge and there are no limits on length of treatment. Irrespective of patient diagnosis and clinic setting, the percentage of patients remaining in contact with the clinics declined sharply during the first 3 months, and after 6 months stabilized to around 25-40%. However, among patients with nonmajor psychiatric disorders, inter-clinic variation in compliance with treatment was observed. In clinics with a long-term psychotherapeutic orientation, a larger proportion of patients was referred to other services following intake, and a larger proportion of patients dropped out of treatment. In these clinics, more patients were placed on waiting lists before beginning treatment, and the drop-out rate among these patients was significantly higher than that of patients in treatment. The implications of these results for treatment policy in public services are discussed.

Adjustment problems among Soviet immigrants at risk, Part 2: Emotional distress among elderly Soviet immigrants during the Gulf War.

The nature and components of emotional distress under the threefold stress--old age, immigration and war--were studied in a group of 170 elderly Soviet immigrants in two settings--a mental health hotline for Soviet immigrants and an outreach project to immigrants deemed at risk. Most of the subjects reported distress during and following the war. Outreach subjects reported lower levels of distress determined by emotional factors and were much more concerned with objective problems related to immigration. In contrast, the predominant determinants of the hotline subjects' distress were emotional reactions related to the war. Among the emotional reactions, anxiety reactions were the most common symptom among women, while depressive reactions were more characteristic of men. Identified risk factors for emotional distress in men included prior experience with acute stress (Chernobyl accident) and living within an extended family. Academic education was identified as a resilience factor for women. No factors were identified that related to emotional distress combined with active help seeking behavior. This finding is particularly important in the context of primary and secondary prevention with Soviet immigrants.

Maternal and environmental characteristics as predictors of child behavior problems and cognitive competence.

Maternal and environmental characteristics as predictors of behavioral problems and cognitive competence in 505 Israeli kindergarten children were investigated. Events in closer temporal proximity to assessments of functioning appeared more predictive than those in early infancy. Findings support the need to include variables reflecting maternal characteristics in any prediction of child outcome and to consider the sex of the child in selection of variables.

Adjustment problems among Soviet immigrants at risk. Part I: Reaching out to members of the "1000 families" organization.

An outreach, preventive mental health project with Soviet immigrants implemented during and immediately following the Gulf War is described. One hundred and fifty immigrant families were visited by immigrant mental health professionals when the level and nature of their psychological distress was assessed. In the analyses of data, patterns of distress over time and factors which contributed to psychological distress were also examined. The main finding of the study concerned the subjects' well-being which was found to be marginally related to the Gulf War. Furthermore, no post-traumatic reactions could be discerned. Instead, immigration related factors, both emotional and objective, were correlated with the psychological distress of the subjects.

Long-term utilization of community mental health outpatient services in Jerusalem.

A survey of the long-term users of community mental health clinics in Jerusalem was conducted in 1986. The study population included all patients in regular contact for at least one year (789 patients). Data on clinical diagnosis, type of treatment and selected sociodemographic variables were extracted from the patient's file at the clinic. Long-term utilization rates were calculated for the different catchment areas and for different sociodemographic and diagnostic groups. It was found that for patients suffering from major psychiatric disorders (2/3 of the long-term users), the long-term utilization rates were similar across catchment areas, and higher in those socioeconomic groups that are also reported to have high true prevalence rates. On the other hand, for patients suffering from non major psychiatric disorders, the long-term utilization rates varied between clinics, reflecting local treatment policies, specifically the extent to which the clinics use psychotherapy as a treatment modality.