The effects of child temperament, maternal characteristics, and family circumstances on the maladjustment of school-age children.

Eighty-nine mothers with children between the ages of 8 and 11 years reported perceptions of their child's adjustment and temperament, and described concurrent family circumstances such as socioeconomic status, level of parental distress, major life events experienced, maternal hassles, and their own psychiatric symptoms. A conceptual model hypothesizing the direct and indirect effects of family circumstances, maternal characteristics, and child temperament on the maladjustment of school-age children was tested using causal modeling with residual analysis. Fifty-six percent of child externalizing behavior was directly explained by the negative reactivity and nonpersistence of the child's temperament, and maternal hassles. A total of 33% of the variance of internalizing behavior was explained by the direct effects of negative reactivity of the child's temperament and maternal hassles. For both externalizing and internalizing behavior, a total of 54% of the variance in maternal hassles was explained by three variables: maternal psychiatric symptoms contributed 34%, major life events added 15%, and the intensity of the mother's temperament added an additional 5%. These three variables have a direct effect on maternal hassles and together had an indirect effect of .24 on child externalizing behavior through maternal hassles. Likewise, they have a direct effect on maternal hassles and together had an indirect effect of .31 on child internalizing behavior through maternal hassles.

Private insurance coverage for the treatment of mental illness versus general medical care: a policy of inequity.

Private insurance coverage has historically been and continues to be discriminatory toward patients requiring treatment for mental illness and substance abuse disorders in comparison with those in need of general medical care. Factors contributing to this disparity include stigma, relatively low overt consumer demand for psychiatric care, lack of knowledge about psychiatric illness and treatment on the part of insurers, a historical reliance on public sector psychiatry, and the assumption that more liberal psychiatric benefits result in unnecessary and excessive use. Strategies aimed at eliminating discriminatory insurance practices against those in need of mental health care must be implemented. Recommended approaches include further research on the cost effectiveness of mental health care, public education regarding the nature of mental illness and its treatment, patient/family advocacy, and the marketing of services by mental health professionals.

The assessment and management of panic disorder.

Panic disorder affects approximately 1.5 percent of the general population in the United States, and individuals with this disorder are seen frequently in primary care settings. Recognition of panic disorder is complicated by the fact that patients tend to focus exclusively on the physical symptoms of the illness. Left untreated, patients with panic disorder suffer considerable impairment in functioning and are at increased risk for substance abuse, depression and suicide. This article provides clinicians with the information necessary to recognize and manage this illness. A detailed description of the disorder, including onset, course, complications, differential diagnosis and management, is presented in this article.

The impact of a staff support group on the work environment of a specialty unit.

The purpose of this study was to evaluate the impact of a staff support group led by a psychiatric liaison nurse on the work environment of a specialty unit. Before and at the completion of a series of 12 group meetings, participants completed two forms (real and ideal) of the Work Environment Scale (WES) that elicited their perceptions of the unit's work environment and their preferences for an ideal work environment. Initial findings were used to guide the content and process of the group intervention. Subjects real and ideal scores, as well as real-ideal discrepancies before and after intervention were compared using t tests. Statistically significant changes were found on the dimensions of clarity and control. Clinical observations showed a decrease in staff conflict and improvement in interpersonal communication.

The use of touch with the hospitalized psychiatric patient.

A descriptive study was designed to identify and describe the ways in which registered nurses use nonprocedural touch in the inpatient psychiatric setting. Natural setting observation and nurse interviews were used to examine the decision-making process and intentions of nurses who used touch. Twenty-five incidents of nonprocedural touch initiated by 13 registered nurses with 17 psychiatric patients were recorded over 27.5 hours of observations. Touch was primarily used by nurses in a discriminating manner and for specific reasons, and was correlated with numerous factors such as the patient's age and gender, and the nurse's feelings, beliefs, intuition, and personal style.