Psychiatric assessment of the suicidal terminally ill.

Terminally ill patients who refuse life-supporting treatments and express a wish to die are often viewed in the same light as suicidal patients who are medically well. Terminally ill patients who are depressed should be treated with antidepressants, but if the wish to die persists, it should be respected.

Loss items on the Schedule of Recent Events (SRE): duration of psychotherapy.

High scores on the Schedule of Recent Events (SRE; Holmes & Rahe, 1967) have been correlated with a high number of subsequent visits for medical or psychological intervention. This study examined the relationship between psychotherapy visits and endorsement of loss items on the SRE. Items that correlated significantly with length or duration of psychotherapy were: divorce (p less than .005); death of a close family member (p less than .07); fired at work (p less than .001); and a son or daughter leaving home (p less than .07). Additional variables are predetermined by the therapist and the clinical setting, so that the observed correlation between high SRE scores and subsequent psychotherapy should be validated in other settings.

Women's self-reported responses to abortion.

The legalization of abortion in many states has allowed an alternative for women with unplanned or unwanted pregnancies who do not wish to deliver and raise their children or to place them for adoption. Of 158 women asked to recall their responses to the experience, 21% reported psychosocial satisfaction at the time of abortion, and 45% reported satisfaction several months later; over half reported an improved outlook on life, and nearly half found abortion preferable to other alternatives for future unplanned pregnancies. It may prove important to make counseling or therapy available to about 10% of women who report negative responses (guilt and confusion) to the abortion.

PIP: Women members of a pre-paid health plan who had had therapeutic abortions during 3 years answered a questionnaire by mail on their reactions to the abortion experience. The procedure took 20 minutes, under general anesthesia, with a 36-hour hospital stay. 178 subjects submitted usable questionnaires. These included a wide range of ages, marital status, religious backgrounds, education and socioeconomic status. Most had abortions over 1.5 years before. Over 50% felt relieved after their abortions. Only 21% recalled feeling satisfaction at the time, but 45% were satisfied at the time of the survey. Nervousness, guilt or confusion were cited by 6, 14 and 11%. Over 50% reported an improved outlook on life after the abortion. Negative responses were reported by 9-12% for several items such as tension, anxiety, energy level and sleep problems and 17% for depression. 49% said that they would have another abortion in the event of a future unplanned pregnancy, compared to 25% who would keep the baby, 0% who would place it for adoption and 23% who did not know. The observation that some women recounted distress at the time of abortion suggests that counseling or psychotherapy should be provided to those in need.

Psychosocial factors influencing American men and women in their decision for sterilization.

A self-administered questionnaire was answered by nearly 300 surgically sterilized men and over 200 such women 6 weeks after their surgery. Nearly half of these Americans were from large families. More women than men reported a history of medical, gynecologic, or psychiatric problems; one half had been pregnant four or more times; one third reported recent pregnancy. Most sterilized people reported an unsatisfactory contraceptive history. Despite that women had more complications from the procedure than men, improved psychosocial adjustment between 6 weeks before and 6 weeks after sterilization was reported by more women than men.

Evaluating psychosocial stress: preliminary report on a brief and convenient instrument for health professionals.

The Heimler Scale of Social Functioning (HSSF) is an effective instrument for evaluating psychosocial stress and dysfunction. When tested, the HSSF clearly differentiated between two different patient groups: those who had scheduled initial appointments for outpatient psychotherapy and those who were participating in a multiphasic health examination. Both groups were composed of members of the same prepaid health plan, utilizing the same medical center, and were comparable to each other in all respects except age. This scale has excellent potential for use as a screening instrument by primary care physicians in clinics and medical centers, psychotherapists in various clinical settings, and psychiatric professionals in outpatients services.

Utilization of medical services by psychiatric patients.

The relationship between medical and psychiatric utilization of services was examined in a two-year study of two groups of psychiatric patients: high users of psychiatric services (more than ten visits in one year) and low users of psychiatric services (ten or fewer visits in one year). The high-utilization group made more than 60 per cent of the total psychiatric visits in the two-year period, but only 21 per cent of the total medical visits. However, patients in this group increased their utilization of medical services when psychiatric utilization was reduced, raising the question of whether high-utilization patients tend to substitute medical visits for psychiatric visits. In contrast, patients in the low-utilization group were able to hold their medical utilization constant when they reduced psychiatric utilization. Analysis of factors influencing utilization patterns might allow illness behavior in patients to be predetermined and lead to better and more cost-effective health care.