Fear of flying treatment programs for passengers: an international review.

BACKGROUND: There are facilities established around the world for treating passenger flight anxiety, often as a joint activity of airlines and private entrepreneurs or mental health professionals. In the scientific and professional literature, there is little information about how these facilities operate and what the components of their treatment programs are. This paper is the first review to date to provide this information. METHOD: There were 212 airlines and treatment facilities approached for information on treatment programs for flying phobia, 43 of which were active in this field. Extensive information could be obtained from 15, which were the best known and well-developed. Information was collected both with a questionnaire and by meeting representatives from 15 international fear of flying treatment facilities that participated in the First International Conference on Fear of Flying (Feb. 1996). RESULTS: Fear of flying among passengers is a phenomenon with epidemic proportions, effecting roughly 10-40% of the adult population. All treatment programs share two basic elements, an information component and a test flight. The programs vary considerably in terms of treatment components. However, there is little available information on efficacy. CONCLUSIONS: To date there is a wide variety between facilities for the treatment for fear of flying in terms of methods and protocols used. Experts agree on the clear-cut need for standardization of a "best" minimum protocol for fear of flying treatment programs for which the main components where identified.

LEIPAD, an internationally applicable instrument to assess quality of life in the elderly.

A questionnaire to assess quality of life in the elderly was developed under the auspices of the European office of the World Health Organization. Stages in construction of the instrument, which was designed for international application, particularly at the primary level, are described. The latest version of the questionnaire is composed of 49 self-assessment item, 31 of which can be grouped into 7 subscales: Physical Function, Self-Care, Depression and Anxiety, Cognitive Functioning, Sexual Functioning, and Life Satisfaction. The remaining 18 items serve as moderators for assessing the influence of social desirability factors and personality characteristics on the individual scores for the 7 core instrument subscales. The questionnaire has been administered to 586 individuals aged 65 years and over recruited in communities in Italy (Padua and Brescia), the Netherlands (Leiden), and Finland (Helsinki). The main psychometric characteristics of the instrument, together with its concurrent validity with the Rotterdam Questionnaire, are illustrated.

Adolescents from one parent, stepparent and intact families: emotional problems and suicide attempts.

Data from a large community sample of adolescents were analysed to investigate the differences between adolescents living in intact families, one parent families and stepparent families with regard to emotional problems and suicidality. The results indicated that, in general, adolescents from one parent and stepparent families reported lower self-esteem, more symptoms of anxiety and loneliness, more depressed mood, more suicidal thoughts and more suicide attempts than children from intact families. Some differences between boys and girls were found. Boys from stepparent families had more emotional problems than boys from one parent families, whereas girls from one parent families had more such problems than girls from stepfamilies. Further, the lifetime prevalence rate of suicide attempts was much higher both for girls living in a one parent and stepparent family than for girls living in an intact family. For boys, living with a stepparent was related to a higher prevalence rate of suicide attempts, whereas living in a one parent family was not.

Child sexual abuse and emotional and behavioral problems in adolescence: gender differences.

OBJECTIVE: To compare sexually abused boys with sexually abused girls and with their non-sexually abused counterparts with regard to (1) the type of mental health problems they experience; and (2) the number and patterns of such problems. METHOD: The sample comprised 745 secondary school students, aged 12 to 19 years, with a self-reported history of sexual abuse (151 boys and 594 girls) and 745 matched students without such a history. Sexually abused and non-sexually abused boys and girls were compared with regard to four problem categories: emotional problems, aggressive/criminal behaviors, addiction-risk behaviors, and suicidality. RESULTS: A larger proportion of sexually abused adolescents than nonabused adolescents reported problems in the separate categories and in a combination of problem categories. Sexually abused boys had considerably more emotional and behavioral problems, including suicidality, than their female counterparts. There were differences between the specific combinations of problem categories reported by sexually abused girls and boys. These differences could not be attributed to the finding that sexually abused boys were more often the victim of concurrent physical abuse than sexually abused girls. CONCLUSIONS: The results suggest that although there was a strong association between being sexually abused and the existence of a multiple problem pattern in both sexes, the aftermath for boys might be even worse or more complex than for girls.

Perceived social support from family, school, and peers: relationship with emotional and behavioral problems among adolescents.

OBJECTIVE: To examine (1) the extent to which negative perceptions of support from family, school, and peers differ with regard to their impact on emotional and behavioral problems and (2) the extent to which negative perceptions of multiple social support systems are related to the presence of multiple emotional and behavioral problems in adolescence. METHOD: The sample comprised 476 high school students, aged 16 to 18 years: 119 without any emotional and behavioral problems, 119 with emotional problems only, 119 with behavioral problems only, and 119 with emotional and behavioral problems. Possible differences between the subgroups were tested with regard to the perceived social support from family, school, and peers, and with regard to the number of negatively perceived support systems. RESULTS: Whereas a negative perception of school was shown to be specifically related to behavioral problems and a negative perception of peers specifically to emotional problems, a negative perception of the family appeared to be strongly related both to emotional and behavioral dysfunction. A strong accumulating effect was found for multiple negatively perceived social environments. CONCLUSIONS: The results suggest a dominant role of negatively perceived family support. Therefore, to prevent emotional and behavioral problems in adolescence it is of paramount importance to identify families at risk at the earliest possible stage and to provide training and support for the parents involved.

[Epidemiology of suicide]. / Epidémiologie du suicide.

Epidemiology for suicide cannot give precise numbers: between 440,000 (WHO) and 818,000 persons in the world commit suicide each year. For Europe, suicides increased regularly to a maximum in 1982-84 (median = 17/100,000). Suicide victims tend to be younger. The author doubts that psychiatric causes can explain suicide and be the only factor of importance for prevention. Suicide of adolescents is only the visible tip of a general behavior learned since childhood. The suicidal "solution" (ideas, parasuicides, attempted suicides, and suicides) is probably a social phenomenon. Efficacious prevention requires a global societal approach. Programs of research and prevention in the Netherlands are presented.

Symptomatology, social support and social support seeking: long-term results of a prospective study among primary mental health care patients.

The long-term association between social support and symptomatology is studied. Social support variables were: experienced understanding, satisfaction, number of contacts, social support seeking and severity of interpersonal conflicts. Data were collected at the start of a short-term behavioural therapy (T1) and 6 (T2) and 18 months later (T3). In addition, a comparison is made between patients who had finished their therapy by the second measurement and those who were by that time still in therapy. A fine-grained analysis demonstrated that of all social support variables interpersonal problems were most strongly related to symptomatology, in particular to interpersonal sensitivity. The tendency to seek social support becomes associated with well-being in the long term. The best predictors of symptomatology at T3 were the initial severity of symptomatology, the change in severity of symptomatology between T1 and T2 and the severity of symptomatology at T2. The social support variables did not have any prognostic significance. All social support variables retained their high temporal stability. Results are translated into practical suggestions that might help maximize gains of short-term behavioural therapy within primary mental health care.

Psychosocial impact of bereavement after suicide and fatal traffic accident: a comparative two-country study.

This study examines the psychosocial problems of spouses bereaved as a consequence of unnatural causes of death (suicide and traffic fatality) in two countries, Slovenia (n = 53) and The Netherlands (n = 32). Structured interviews consisted of standardized measures for depression, substance use, social reactions, and acceptance and attribution of the loss. Although marked differences in sociodemographic background exist, bereaved subjects from both countries show more similarities than differences. Depressed symptomatology is slightly higher in the Slovene bereaved, but symptom patterns are almost identical. Core indicators of clinical depression, as well as reported substance use, are equally low in both countries, and gender and mode of death do not differ significantly. Social acceptance is more problematic in suicide bereaved, particularly in Slovenia. Methodological considerations of cross-cultural bereavement studies are discussed.

Adolescents' image of their suicide attempt.

OBJECTIVE: To inventory the reasons adolescents give for their perceptions of events, thoughts, and feelings in the last days and hours before and during the attempt. METHOD: A semistructured interview also included the administration of an instrument that contained the formulation of reasons. RESULTS: The most frequently mentioned reasons for attempting suicide concerned the cessation of (an unbearable) consciousness. The motivation most frequently named for "crossing the bridge" between thinking about and attempting suicide involved an escalation of frustration and tension. CONCLUSIONS: Special emphasis should be given to family relationships, relationships with peers and friends, frustration tolerance, and the way in which adolescents handle their problems.

Dying in dignity: the pros and cons of assisted suicide.

This paper describes the historical background and the current situation regarding the practice of assisted suicide in The Netherlands. It outlines and discusses what is considered to be the 'golden standard' of conduct for doctors and other health professionals in this area, it describes experiences with the application of this standard and discusses some of the major pitfalls involved. It also describes the results of several empirical studies on the attitudes of the general public, and the nature and magnitude of the practice of assisted suicide in the country. It is concluded that although perfect application of the 'Dutch Protocol' encourages and supports careful and responsible professional conduct regarding assisted suicide and provides satisfactory safeguards both for the patients involved, (potential) survivors and society as a whole, there are many cases where the desired perfection is far from feasible, hence assistance with suicide remains very hazardous. It is also concluded, however, that health care policy makers, as well as professionals, should confront the issue of assisted suicide, since, as the historical development in The Netherlands has shown, repression and denial implicates the worst of all possible scenarios, and does not contribute at all to the primordial goals of a humane health care system: the alleviation of suffering and the prevention of premature death.

Psychological distress, social support and social support seeking: a prospective study among primary mental health care patients.

This study addresses the time ordering of both quantitative and qualitative social support variables, social support seeking and psychological distress. Number of contacts, perceived understanding, satisfaction, severity of network conflicts, social support seeking and symptomatology were assessed at two points in time: at the start of a short term behavioural therapy (T1) and six months later (T2). Severity of symptomatology at T2 was best predicted by the severity of symptomatology at referral and by the change in interpersonal problems. Social support-seeking was at both measurements unrelated to symptomatology. The number of contacts, satisfaction, understanding and social support seeking demonstrated high temporal stability, in contrast to symptomatology and interpersonal problems. A more fine-grained analysis demonstrated that of all social support variables, interpersonal conflicts were most strongly related to symptomatology, especially to interpersonal sensitivity and depression. It is concluded that interventions aimed in particular at relieving interpersonal sensitivity and interpersonal stress and at fostering interpersonal effectiveness may prove to be critical in breaking vicious circles.

On the nature, magnitude, and causality of suicidal behaviors: an international perspective.

The central questions addressed in this paper are whether present generations of adolescents and adults worldwide are at greater risk of developing suicidal reactions than previous generations were and what the possible causal mechanisms involved are. On the basis of data from international and national data banks as well as an extensive review of the literature, it is concluded that a true increase in suicide mortality and morbidity has occurred over the larger part of this century among the White urban adolescent and young adult populations of North America and Europe, particularly among (young) males over the last three decades. Among the possible causal mechanisms identified are (1) the corresponding increase in the prevalence of depressive disorders; (2) the corresponding increase in the prevalence of substance (ab)use and substance abuse disorders, and a lowering of age of onset of (ab)use; (3) psychobiological changes, in particular the dramatic lowering of the age of puberty; (4) an increase in the number of social stressors with extensive consequences for youth; (5) changes in attitudes towards suicidal behaviors and the related increased availability of suicidal models.

The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

Social support, life events, and behavioral characteristics of psychologically distressed adolescents at high risk for attempting suicide.

Differences in social support, behavioral characteristics and life events between four groups of adolescents were investigated, one group consisting of suicide attempters and depressed adolescents showing problematic psychological scores and high risk for attempting suicide, and three other groups with lower risk and other (combinations of) psychological characteristics. The high-risk group distinguished itself from the psychologically most "normal" group by reporting less support and understanding from siblings and relations outside the family, more changes in living situation (life-time), more changes in caretaker and physical abuse during childhood, more changes in living situation and sexual abuse during adolescence, and more siblings leaving home during the preceding year. On a behavioral level, they reported consuming more alcohol and running away more often. The only exception to this was support and understanding from other relations: high-risk adolescents experienced more, especially in the last year. A possible explanation is that these subjects, due to the turmoil in their families, relied more on persons outside their families. Differences between the high-risk group and the other two groups are described in terms of the relation between the dependent variables and the psychological characteristics. Implications for assessments in emergency rooms is discussed.

Mode of death and kinship in bereavement: focusing on "who" rather than "how".

Although it is widely accepted that bereavement can result in health problems, little is still known about the factors that determine the impact of the loss on those left behind. The Leiden Bereavement Study attempted to address this problem, by examining the consequences of bereavement after suicide (N = 91), traffic accident (N = 93), and illness (N = 125) for first-degree family members. Seventy-three bereaved spouses, 68 parents, 86 siblings, and 82 adults who had lost a parent were interviewed in a longitudinal time-sample study. Multiple measures of physical, psychological, and social functioning, as well as details about the relationship and pre- and post-loss events, were obtained through in-depth structured interviews at 4 and 14 months after the loss. The results indicate that the influence of mode of death is small to absent for most aspects of psychosocial health. Post-traumatic stress symptoms were almost as common among the illness-bereaved group as they were among the unnatural death groups. The kinship relationship to the deceased played a prominent role in virtually all aspects of functioning, with parents (particularly mothers), widowers, and sisters of the deceased being more strongly affected than adult children, brothers, and widows. The characteristics of the relationship played a further important role in the level of problems after the loss. Early adaptation was highly predictive of longer-term adaptation. The implications of the findings for prevention and intervention are discussed.

Efficacy of rational-emotive therapy: a quantitative analysis.

Meta-analysis of 28 controlled studies on the efficacy of rational-emotive therapy (RET) showed RET to be superior to placebo and no treatment but equally effective in comparison with other types of treatment such as combination therapies and systematic desensitization. No support was found for the view that RET with a main or balanced emphasis on behavioral techniques is more efficacious than RET with a primarily or exclusively cognitive approach. However, given the heterogeneity of the set of studies and its relatively small sample size, interpretations of results have to be made with caution, particularly because evidence was found for a relationship between study characteristics and magnitude of effect size. For the sake of meta-analysis, outcome studies should be required to report at least the means and standard deviations for all experimental groups.

Two subtypes of adolescent suicide attempters. An empirical classification.

An empirical classification of 203 adolescent suicide attempters (mean age 17.3) was achieved using multiple correspondence analysis. The characteristics upon which the classification is based concern sociodemographic as well as psychological variables. Two groups are identified: the first is predominantly characterized by recent problematic behaviors, whereas the second group is primarily characterized by problematic circumstances. Analyzing related variables, the first group seems to have special clinical and preventive interest, because of its high risk for recidivism. The second group seems to have a satisfactory level of functioning.

The specificity of psychological characteristics of adolescent suicide attempters.

Using a semistructured interview, psychological characteristics were gathered from three groups of adolescents: 48 suicide attempters, 66 depressed, and 43 nondepressed adolescents who never attempted suicide. Various characteristics reported in literature discriminated the attempters from the normal group but not from the depressed group. These characteristics probably are not specific for adolescent suicide attempters. Even when a discriminant analysis was applied, the suicide attempters showed many similarities with the depressed adolescents, although both these groups could be separated from the normal group. Using follow-up data, the quadrants created by the axes appeared to have more implications for prevention than for the a priori group membership.

The epidemiology of suicide and parasuicide.

This article analyses secular trends in suicide and parasuicide and provides support for the hypothesis that a true increase in these phenomena has occurred since the early 1950s up to at least the early or mid-1980s among the adolescent and young adult populations of Europe and North America, particularly young men. One of the potential causal mechanisms for this development, increasing secular trends in and lowering of age of onset for depressive disorders, is examined. Although it is difficult to assess whether the earlier age of onset observed for depressive disorders is reflected in an increase of suicide mortality at a lower age, there is indirect evidence to suggest that this might be the case. Studies show that lifetime parasuicide prevalence rates for the general population do not exceed and sometimes even remain below the rates for adolescents. Assuming that recall of past episodes remains constant throughout the life span, one possible explanation for this finding is an earlier age of the first-ever parasuicidal act. Since parasuicide is an important precursor of suicide, a lowering of age for first-ever parasuicides can be expected to lower the age for suicides and increase the overall lifetime risk.