The themes expressed in suicide calls to a telephone help line.

BACKGROUND: Little is known about the suicidal ideation of callers to telephone help lines even though these services are in the front line of suicide prevention efforts. Where thematic data are collected by telephone counseling agencies, it is rarely clear how the categories were constructed and the measurement properties of the instruments are rarely reported. METHODS: The call sheets kept by counselors on 409 suicide calls were content-analyzed, resulting in a reliable checklist comprising nine major themes. The prevalence of these themes within the sample was then determined and age and gender differences in the themes expressed by first-time callers (n = 189) were examined using logistic regression analysis. RESULTS: Almost equal numbers of male and female calls were received and the nine themes were mentioned a total of 981 times. Among first-time callers, males under 35 years were around 75% more likely to refer to relationship breakdown in their calls than were same-age females. Male callers were also around twice as likely to refer to material hardship. Females were four times more likely to refer to being the victim of abuse and nearly 60% more likely to refer to interpersonal and family problems. CONCLUSION: The vast majority of suicide callers expressed dissatisfaction with the quality of their intimate relationships, which suggests that the promotion of intimacy and coping strategies for relationship breakdown are central to the primary prevention of suicide.

Emotional expressiveness and the quality of life of patients with schizophrenia.

BACKGROUND: The present research aims to study the association between emotional expressiveness of primary care-givers and quality of life of patients with schizophrenia. METHOD: The data for the present study were collected from 174 purposively selected patients with schizophrenia and their primary care-givers. The Quality of Life Interview (QOLI) (Lehman 1988) was used to collect information related to the quality of life of patients. The care-givers' emotional expressiveness was assessed using three questions on home environment from Disability Assessment Schedule (WHO/DAS) (WHO 1988). RESULTS: Three components of emotional expressiveness were included in the present research, namely, emotional involvement, control and attitude of rejection. Among these three components, emotional involvement of key care-givers was found to have a significant association with quality of life of schizophrenia patients. CONCLUSION: Based on this result, the present study argues that emotional involvement of key care-givers needs careful attention while planning psychosocial rehabilitation programmes aimed at enhancing the quality of life of schizophrenia patients.

The predictors of unsuccessful transition to foster care.

The placement movements of 235 children entering foster care over a 12-month period were followed up 4 months after referral into care. Baseline and follow-up measures of the 170 children who were still in care at follow-up were also compared. Results indicated that adolescents with mental health or behavioural problems were the least likely to achieve placement stability or to display improved psychological adjustment in care. In fact, unsatisfactory transition to foster care was found to be so prevalent among these children that conventional foster family care should be considered unsuitable for them. The paper concludes that there is an urgent need for a wider range of alternative care options for the adolescent population.

Relative misery and youth suicide.

OBJECTIVE: To test the 'absolute misery hypothesis' that suicide rates are a proxy measure of psychological maladjustment within the general population of young people. METHOD: Study I regressed World Health Organization statistics on youth suicide rates on measures of adolescent adjustment across seven countries. Study II analysed the results of a Canadian survey involving 2,111 children from 31 schools in grades seven to 12 (ages 11-20 years, mean = 15.5, SD = 1.7). The survey contained measures of suicidality, depressed affect and social comparison. RESULTS: Study I found that male suicide was much more likely in psychologically well-adjusted countries than in less well-adjusted countries. Although not statistically significant in a sample of this size (n = 7), correlation analysis suggested that the relationship between suicide and adjustment was in the opposite direction for females. Study II found that suicidality in boys was not associated with depressed affect on its own, or with social comparison on its own, but was associated with the combination of depressed affect and negative social comparison. By contrast, suicidality in girls was significantly associated both with absolute and comparative levels of unhappiness. CONCLUSIONS: A new, 'relative misery hypothesis' is proposed to account for these results. Under this hypothesis, the disposition of vulnerable young men towards suicide is influenced by their affective state relative to others. When those around them are perceived to be better off than they are, the predisposition of young men to suicide is increased. By contrast, female suicide is predicted to be less influenced by young women's relative state, and more by their absolute level of unhappiness. The primary implication of the relative misery hypothesis is that the prevention of young male suicide in particular is likely to require methods that discourage vulnerable individuals from making negative social comparisons.

The drinker's children.

There is no doubt that growing up in a home where one or both parents misuse alcohol is undesirable. However, it is far less certain that this predicament is responsible for psychological damage to the child in the long term. This paper reviews the literature on the psychological effects on children of parental alcohol misuse and concludes that research needs to move beyond crude comparisons between alcohol-affected and nonalcohol-affected homes to a search for the precise mechanism(s) responsible for mediating any statistical associations between parental drinking and psychological deficits in children.

The relative importance of factors which influence order of injecting with a shared needle and syringe.

Injecting drug users (IDUs) in Adelaide, South Australia, rated the likelihood of first use of a shared needle and syringe by persons who have characteristics which have previously been suggested as influencing order of injecting. This enabled the relative importance of these factors to be assessed. It was found that those who supply their own drug and injecting equipment have the greatest likelihood of using first, but it is also somewhat advantageous if one is able to promote one's needs, has recently been tested for HIV or is at home when the opportunity to inject arises. Older IDUs and regular users may be slightly advantaged, as may those who inject others and those who were denied first use the last time sharing occurred. A model for predicting order of use is proposed.

Coping with a partner who drinks too much: does anything work?

This paper reports on a multiple regression study in which the efficacy of positive and negative coping responses adopted by the partners of "heavy drinkers" were compared under conditions of drinker intoxication and sobriety. Results indicated that only one combination of response type and drinker state was associated with higher levels of partner well-being: positive responses when the drinker is sober. Moreover, even this coping pattern accounted for relatively little variance in partner well-being scores. It is concluded that programs which aim to improve the quality of partner's lives should not generalize about desirable coping behaviours but should take account of situational and individual difference variables.

Unilateral interventions for women living with heavy drinkers.

Despite the fact that unilateral therapy is often the only treatment option for women living with heavy drinkers, very few structured programs have been developed for this client group. Moreover, the programs that do exist lack empirical support (as in the case of Al-Anon) or have as their highest priority promoting change in the drinker. This article looks at unilateral therapy for women partners of heavy drinkers and concludes that although a number of promising developments have occurred in recent years, more research is needed on the benefits to the women themselves.

Deciding to risk it: toward a multivariate model of unsafe injecting behavior.

This paper reports on a set of studies which sought to explain why Australian injecting drug users (IDUs) continue to share injecting equipment despite the provision of needles and syringes, drug treatment, education programs, and HIV testing. A range of situational and psychological factors were implicated in risk-taking, and these are integrated into a theoretical model which reflects the decision-making processes that occur when IDUs decide to take a risk.

The Drinker's Partner Distress Scale: an instrument for measuring the distress caused by drinkers to their partners.

Although it is generally accepted that the spouses of excessive drinkers experience a range of problems as a result of their partner's alcohol consumption, there have been few attempts at measuring the hardship experienced. Previous attempts have counted only the number of categories of hardship experienced over the previous year and not taken into account the frequency with which these occur or the degree of inconvenience suffered. The Drinker's Partner Distress Scale (DPDS) is proposed as a measure which overcomes these limitations. Two dimensions of alcohol-induced problems are measured; depression and marital discord. Both subscales demonstrated internal consistency, and predictions of convergent and discriminant validity were supported in relation to both subscales.

The 'pressures to change' approach to working with the partners of heavy drinkers.

The 'Pressures to Change' approach to working with the partners of drinkers is a structured procedure for promoting change in resistant drinkers. In this study 22 women and one man were randomly allocated to two treatment conditions and one no-treatment waiting list control condition in an experimental evaluation of the procedure. Group 1 was treated individually and Group 2 was treated as a group. Almost two-thirds of the drinking partners of clients in treatment made a significant move towards change, compared with none of the drinkers in the waiting list control condition.

Working with resistant drug abusers.

Despite the social turmoil created by drug abusers who are resistant to treatment, very little has been done to develop techniques for working with them. This article identifies some of the more promising approaches in the literature. Among these are individualized and objective feedback on the social and physiological effects of drug consumption. Expert advice to quit and the deliberate manipulation of environmental contingencies by workers can also be effective, as can partner interventions such as reciprocity marriage counseling and reinforcement training. Resistant drug abusers are of particular interest to social workers, who frequently encounter drug addiction in the context of some other, often more pressing, social crisis such as domestic violence or homelessness.

The effects of alcohol abuse on children and the partner's capacity to initiate change.

This paper identifies the social, psychological and cognitive effects of parental alcohol abuse on children across the lifecycle. While the evidence regarding cognitive effects is mixed, there is ample evidence of negative effects on a range of developmental outcomes. Recent advances in unilateral partner interventions open up one avenue for ameliorating this damage even when the drinker is resistant to change.

Predictors of unsafe injecting drug use.

This paper reports on the incidence of unsafe injecting and the factors which influence this practice in a sample of 1245 Sydney injecting drug users (IDUs). Using a needle and syringe after someone else at some time in the last six months was reported in 41.6% of the sample. Taking into account those who claimed always to clean used needles with virucidal methods, 32.9% had placed themselves at risk of HIV infection from shared needles in the six months prior to interview.Seven factors were predictive of unsafe behaviour. These were (a) the amount spent per week on drugs, (b) the number of times a single needle was used prior to disposal, (c) having shared with a person who is now HIV infected, (d) having a regular sexual partner, (e) the proportion of times high, stoned or drunk when injecting, (f) being part of a group that injects together and (g) having been in prison.

Injecting drug users and HIV/AIDS: risk behaviours and risk perception.

This paper reports on the incidence of risk taking behaviours, and the relationship between risk perception and risk behaviours in a sample of 1245 Sydney injecting drug users (IDUs). Almost all respondents reported engaging in behaviours that placed them at risk of HIV infection: 32.9% through unsafe injecting, 84.4% because of unsafe sexual behaviour and 89.2% because of either injecting or sexual behaviour. Injecting and sexual behaviour were poorly correlated. This study also found that risk perception is unrelated to injecting or sexual behaviours, previous history of sexually transmitted diseases, a range of demographic characteristics including age and gender, and the number of times tested for HIV. Social policy and prevention programs should aim to change unsafe injecting and sexual behaviours directly, rather than attempting to achieve change indirectly by changing risk perception.

The Situational Confidence Questionnaire (Heroin).

This paper describes the derivation of a 22-item Situational Confidence Questionnaire for heroin users [SCQ (Heroin)]. Results revealed the SCQ (Heroin) to be an internally consistent scale with an acceptable level of test-retest reliability. Construct and discriminant validation were demonstrated through moderately significant correlations of all subscales with the short form of the Beck Depression Inventory. Factor analysis revealed a three-factor structure which could be labeled: coping with or enhancing arousal states, casual or occasional usage, and coping with negative emotions.

Microcomputers and prevention of drug abuse.

In recent years, the psychological treatment of drug addiction has been dominated by an emphasis on learning theory and an interest in minimal and self-administered treatment. The computer provides the consummate medium for bringing these components together. This paper reports on two computer-assisted learning programs, one for the prevention of relapse in former heroin users and the other for the promotion of controlled drinking in early-stage problem drinkers. The need for this type of technology is supported by mounting evidence that drug and alcohol misusers prefer self-help to psychotherapy and that most addicts who manage to overcome their addiction do so on their own.

Computer-assisted drug prevention.

Although the psychological treatment of addiction is premised on the notion that addictive behavior is learned behavior, addiction workers have been slow to exploit the capacity of the computer to promote new learning. The best computer-assisted learning programs are fully adaptive; their design anticipates the responses a user can make, classifies them, and provides feedback for each. This paper reports on two recent attempts to achieve this level of sophistication in computer-assisted drug prevention. One program seeks to prevent heroin relapse among currently abstinent prisoners, and the other promotes controlled drinking in alcohol abusers. Given the fact that most drug users can be expected to opt for self-help materials over the offer of formal therapy, and that most (licit) drug users who solve their addiction problems do so without recourse to professional help anyway, the use of computer-assisted drug prevention programs like these provides an important new direction in substance abuse treatment.