Psychiatric treatment of children and adolescents in rural communities. Myths and realities.

Rural child and adolescent psychiatry offers many challenges, a varied and interesting practice, and the satisfaction of performing needed and important work in an environment in which one's presence is valued. The successful psychiatrist can expect to be an integrated and appreciated member of the community. The fit is not a good one for every practitioner, however. Not only are incomes lower, although the cost of living is low as well, but practitioners may find they have only exchanged urban stresses for rural pressures. The characteristics important for the child and adolescent psychiatrist are the same for rural and urban settings: flexibility, creativity and innovation, competence, self confidence, a good sense of boundaries, a good balance between personal and private life, supportive personal relationships, and a sense of humor. One must be a child advocate, have a willingness to give of one's self and one's time, and be down to earth, comfortable with oneself, and capable of self entertainment. Training programs with access to rural populations can introduce residents to rural child and adolescent psychiatry while supporting those who are already in practice. The authors hope that this article will promote a dialogue with psychiatrists considering relocation to a rural area and encourage training programs to prepare residents for rural practice.

Characteristics of families of children who refuse post-divorce visits.

Compared to 88 non-refusers, 12 children who refused post-divorce visits with their noncustodial parents were significantly more likely to be female, to be the oldest child at home, to be in special education, and to have at least one parent with evidence of psychopathology, particularly substance abuse, violence toward spouse, suicidal behavior, or psychosis. Most children in both groups lived primarily with their mothers.

Dimensions of prenatal anxiety and their influence on pregnancy outcome.

Wtih the use of perinatal data from a prospective study of 73 primigravid women and their newborn infants, we determined that prenatal anxiety is not a unitary construct, but that it is useful to consider the distinct concerns of pregnancy. From interviews with the pregnant women, three dimensions of anxiety were identified: (1) anxiety about the pregnancy and approaching birth, (2) anxiety about anticipated care of the child, and (3) psychiatric symptomatology. Correlations of the three anxiety dimensions with background and perinatal outcome variables reveal the strongest associations between anxiety about pregnancy and birth with maternal age, education, and preparation for childbirth. Anxieties about pregnancy and birth and about parenting are related to administration of anesthesia during childbirth and the motor maturity of the neonate. The findings thus give evidence that even in a medically uncomplicated population, emotional states of pregnancy are rooted in the woman's background and may have an impact on perinatal events and infant functioning.

Multidimensional sources of infant temperament.

Previous research on infant temperament has implicated a variety of prenatal and perinatal conditions, but most studies have investigated a single source of infant variability. This study examined the impact of several prenatal and perinatal factors on infant outcome according to a conceptual system of hypothetical models of influence. Seventy-five couples expecting their first child were recruited and interveiwed in the last trimester of pregnancy, providing demographic data and measures of the pregnancy experience and expectations of parenting. Childbirth information was obtained from hospital records, and infant behaviors were measured at three days of age by the Neonatal Behavioral Assessment Scale. Results indicate that the antecedent variables are themselves intercorrelated in that older, more highly educated, and financially secure couples are more likely to have a satisfying pregnancy and to be confident about childbirth and parenting than their young, more anxious counterparts. Two statistical methods--partial correlation and path analysis--were used to analyze relative relationships with infant behaviors. Results from both methods indicate that most of the antecedent variables (parental characteristics of age and socioeconomics, parental pregnancy orientation, and use of obstetric anesthesia) must be considered sources of infant behaviors. These findings thus demonstrate the imprecision of inferring a single causal pathway of parental or perinatal influence on infant temperament.

Local-regional anesthesia during childbirth: effect on newborn behaviors.

Administration of local-regional anesthesia during norgnal deliveries was correlated significantly with newborn behaviors as evaluated by the Brazelton neonatal assessment scale. Three days after birth, infants whose mothers received local-regional anesthesia were more irritable and motorically less mature than those infants whose mothers were not medicated.