Gender differences in adolescent depression.

Depression in adolescents is more common in girls; this gender disparity becomes more apparent during the teen years when girls have close to twice the rate of depression compared with boys. Vulnerability-stress models help explain these differences, and a tendency toward rumination may play a role both in the development and continuation of depressive symptoms. Psychiatric nursing interventions must focus on reappraisal of relationships, challenging rumination, and promoting autonomy.

Update on early intervention in schizophrenia.

Early intervention is a popular idea for helping people with schizophrenia. There are two major approaches: intervening when the first symptoms of psychosis are expressed during adolescence and treating individuals at high risk during adolescence before psychotic symptoms become apparent. The risks and benefits of each approach are discussed.

Reducing HIV risk among people with serious mental illness.

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.

Catchers in the rye: treatment foster parents as a system of care.

PROBLEM: Similar to the children in J. D. Salinger's novel, The Catcher in the Rye, youth in foster care face the specter of "going over the cliff." METHODS: The empirical basis for "treatment foster care" is reviewed, concluding that treatment foster care is both a clinically and cost-effective form of community-based treatment. FINDINGS: Treatment foster parents prevent the fall of foster youth into the chasm of school failure, involvement with juvenile justice, and dependent living as adults. CONCLUSION: Treatment foster care is an evidence-based approach that is less restrictive and offers troubled youth an opportunity to engage and grow within a family setting.

Triple jeopardy for HIV: substance using Severely Mentally Ill Adults.

Severely Mentally Ill (SMI) adults have disproportionately high HIV seroprevalence rates. Abuse of alcohol and other substances (AOD) and lifetime exposure to trauma by others are particularly potent risk factors, which, in combination with psychiatric disabilities, create triple jeopardy for HIV infection. This study examined the predictive utility of demographic characteristics; history of physical, emotional, or sexual abuse; extent of drug and alcohol abuse; knowledge about HIV/AIDS; sexual self-efficacy; and condom attitudes toward explaining the variance in a composite of HIV high-risk behavior among 188 SMI women and 158 SMI men. History of sexual abuse, engaging in sexual activities while high on substances, and lower cannabis use were the most significant predictors of HIV sexual risk behaviors. Given the triple jeopardy for HIV risk in this population, a triple barreled approach that simultaneously addresses multiple health risks within an integrated treatment setting is warranted.

Integrated HIV care: HIV risk outcomes of pregnant substance abusers.

Identifying contextual factors that may influence the effects of HIV risk-reduction strategies aimed at inner-city, minority female populations may be critical to interrupting the alarming trends in seroprevalence in the United States, especially among pregnant women with substance use-related problems. The objective of this Phase I, NIDA-funded project was to determine which contextual and cognitive factors were most predictive of HIV outcomes in this population. Eighty-one HIV-negative women were enrolled in a maternal addiction program with a cognitive-behavioral HIV risk-reduction component. Measures were administered between 1996 and 1998, one week post-admission, and follow-up assessments were conducted on 69 participants at 6 months post-discharge Paired t-tests were conducted to assess changes in sex risk behaviors, HIV/AIDS-related knowledge, and HIV risk-related attitudes/behaviors. Hierarchical regression analyses were conducted to investigate the relationship between attitudes/knowledge with contextual variables. At six months follow-up, there were significant increases in favorable condom attitudes (t = 3.36, p = .01) and in factual knowledge regarding HIV (t = 3.20, p = .01), with a significant decrease in the number of sexual partners (t = 2.21, p = .05). Hierarchical regression analysis revealed that the strongest predictors of the number of partners--a key outcome variable--were alcohol use, intentions to engage in safer sex behaviors, psychiatric symptoms, and a history of physical abuse (F[11, 57] = 6.58, p < .001). This study also reinforces the strategic importance of utilizing substance user treatment programs as crucial vehicles for integrating HIV risk-reduction strategies. Additionally, it will further guide the design of effective procedures to test the feasibility of an integrated HIV risk-reduction intervention for a larger randomized controlled study. The study's limitations are noted.

International adoption as a natural experiment.

International adoption research has been called a natural experiment by many child development researchers. How do studies of severe early deprivation inform us about risk factors experienced by many of these children and their impact on developmental outcomes? Three longitudinal studies conducted by British and American researchers in the 1990s are reviewed. Each year, over 20,000 children are adopted from overseas, and a significant number are now entering adolescence; the impact of their prenatal risk factors, early institutionalization, and ameliorative postadoptive environments is also reviewed. The feasibility of generalizing findings to other children in foster care is also addressed.

Family history as a tool for psychiatric nurses.

In the current age of genomic health care, family history is an essential tool for health assessment, especially for those with chronic mental illness. Three methods of family history assessment (genograms, ecomaps, and pedigree analysis) are described and illustrated. Examples from the family history literature demonstrate each method's usefulness. These approaches improve both consumers' and psychiatric nurses' abilities to comprehend overall health status as well as risks at the individual, family, and community levels.

Context and common ground: cultural adaptation of an intervention for minority HIV infected individuals.

Understanding social contextual mediators of risk in HIV/AIDS prevention and promoting cultural adaptation of clinical interventions have evolved from new priorities set forth by the National Institutes of Health (NIH) on ecological validity and translational research (NIH, 2001). Thus, emphasis is placed on linguistically and culturally translating promising interventions "for and with" new populations to serve the realities of the particular group. The purpose of this paper is to describe the process involved in developing culturally sensitive interventions to strengthen the ecological validity of a cognitive behavioral stress management (CBSM) intervention for HIV+ individuals.

The black cloud over the Sunshine State: health disparities in south Florida.

Florida, the "Sunshine State", is paradise for international tourists and has been adopted as seasonal or permanent home by many wealthy individuals and celebrities. However, Florida is not paradise for the growing number of residents who suffer from poverty, health problems, and a lack of access to health care and social services. The purpose of this paper is to present data on health care problems and disparities throughout the state of Florida and in select south Florida counties. Flaskerud and Winslow (1998) have provided a framework which can be used to analyze disparities in resource availability, relative risk, and health status indicators and suggests areas in which nursing and other health professionals can ethically intervene through research, practice, and political action.