"Why Are we Giving up on my Brother?"-The Unmet Needs of the Adolescent Facing End-of-Life Care in a Sibling.

Adolescence is a challenging time at baseline, and a sibling receiving end-of-life care can alter an adolescent's life irrevocably. It is imperative for the medical team to understand the unique needs and perspectives of such an adolescent sibling. This in turn facilitates the anticipation of an adolescent's grief response, and allows for parents to be appropriately guided. However, more can be done to evaluate the needs of adolescent siblings and improve their support. This can be through establishing a validated needs-based questionnaire, empowering families and the multidisciplinary team to engage siblings, and diverting resources toward culturally sensitive support groups for siblings with critical illness. A framework to involve key players in the adolescent's circle is presented.

Assessing long-term effects of trauma: diagnosing symptoms of avoidance and numbing.

OBJECTIVE: This study compared the discovery of posttraumatic stress disorder (PTSD) symptoms by means of the Structured Clinical Interview for DSM-III-R (SCID) with a semistructured, psychodynamic clinical interview in a long-term follow-up of the survivors of the Buffalo Creek (W.Va.) flood. METHOD: Videotaped semistructured, psychodynamic clinical interviews of a small group of survivors (N=6) were compared with the results obtained in a prior group-level SCID investigation. RESULTS: Seventy-two percent of the total PTSD symptoms for the subjects studied were elicited exclusively by the psychodynamic clinical interview. PTSD cluster C symptoms of avoidance and numbing of general responsiveness were especially sensitive to discovery by this method. CONCLUSIONS: The psychodynamic clinical interview should be included in the design of studies that seek to investigate long-term effects of trauma, which are especially likely to be manifest in negative symptoms and subtle character change.

The comorbidity of post-traumatic stress disorder and suicidality in Vietnam veterans.

Vietnam veterans (N = 232) recruited from three sources were assessed for suicidal thinking and behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression. Findings support the notion that suicidal thoughts are prevalent in this group, with veterans in psychotherapy reporting a greater likelihood of such symptoms (82.6%) than veterans in the community (35.7%) or those seeking assistance through a veteran's outreach center (66.7%). Thoughts of ending one's life and a previous suicide attempt were significantly correlated with a diagnosis of PTSD (r = .53, p < .001; and r = .33, p < .001, respectively). Veterans with a diagnosis of PTSD and depression or dysthymia were also more likely to report suicidal thinking and behaviors than veterans with only one of the diagnoses.

Children of disaster in the second decade: a 17-year follow-up of Buffalo Creek survivors.

OBJECTIVE: To conduct a long-term follow-up of child survivors of a devastating human-caused disaster. METHOD: Child survivors (2-15) of the Buffalo Creek dam collapse, first evaluated in 1974, 2 years postdisaster, were reevaluated 17 years postdisaster when they were adults. Of the original 207 children, 99 were located and reevaluated using ratings on the Psychiatric Evaluation Form, the Impact of Event Scale, and the SCL-90 and lifetime and current diagnoses from the Structured Clinical Interview for DSM-III-R. RESULTS: Ratings of psychiatric symptoms at the two points in time showed significant decreases in overall severity ratings and in anxiety, belligerence, somatic concerns, and agitation. A few symptoms, not present in the child sample, increased over time (substance abuse, suicidal ideation). The current rate of disaster-related post-traumatic stress disorder (PTSD) was 7%, down from a postflood rate of 32%. There were no differences by age group in current psychological status; however, women evidenced more PTSD-related symptoms than did men. All current PTSD cases were women. Comparisons with similar subjects from a nonexposed community showed no differences. CONCLUSIONS: The findings indicated that the children studied, although having shown earlier effects, had "recovered" from the event by the time of long-term follow-up.

Portraits of survival. A twenty-year follow-up of the children of Buffalo Creek.

This study is a follow-up of the children of Buffalo Creek "hollow" who survived the dam collapse and flood of 1972. It was conceived as a complement to the 1988 NIMH-funded follow-up investigation of the children of Buffalo Creek conducted by the University of Cincinnati Traumatic Stress Study Center. That 1988 study utilized standardized methodology to assess levels of psychopathology present among those who were children at the time of the 1972 flood. Among the original child subjects, results demonstrated that the rates of both posttraumatic stress disorder (PTSD) and levels of other psychopathology had sharply declined as the children moved to adulthood. Several questions remained unanswered: the long-term meaning which the flood had in the survivors' lives and its impact on their adaptation as they progressed through the subsequent stages of emotional development. For these reasons, we, as psychoanalytic investigators who had been members of the original clinical assessment team, planned an interview of child and adolescent survivors as a follow-up to our interviews in 1974 with a particular focus on meaning and adaptation.

Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample.

Research has indicated significant comorbid psychopathology with chronic posttraumatic stress disorder (PTSD) in samples of war veterans. The present paper examines the issue of comorbidity in a disaster sample to learn whether findings from veterans generalized to this event. A total of 193 subjects exposed to the Buffalo Creek dam collapse of 1972 were examined 14 years later using diagnoses derived from the Structured Clinical Interview for DSM-III (SCID). Past and present PTSD was found in a significant portion of the sample. Major depression was the next most common diagnosis and was highly related to PTSD. Anxiety disorders were also common. The overlap with other diagnoses was quite similar to that found in a sample of Vietnam veterans we studied earlier, except that the disaster sample had fewer dysthymic disorders, substance abusers, and antisocial personality disorders. Possible explanations for comorbidity in chronic PTSD were discussed and it was suggested that the morphology of PTSD may be quite stable in at least some other nonveteran trauma populations.

Children and disaster: age, gender, and parental effects on PTSD symptoms.

Psychiatric reports of 179 children aged 2 to 15 who were exposed to the Buffalo Creek dam collapse in 1972 were rated for post-traumatic stress disorder (PTSD) symptoms 2 years after the disaster. Age and gender effects and the impact of the level of exposure and parental functioning were examined according to a conceptual model addressing factors contributing to adaptation to a traumatic event. Results showed fewer PTSD symptoms in the youngest age group and higher symptom levels for girls than boys. Approximately 37% of the children were given a "probable" diagnosis of PTSD. Multiple regression analysis showed that life threat, gender, parental psychopathology, and an irritable and/or depressed family atmosphere all contributed to the prediction of PTSD symptomatology in the children.

Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans.

This study examined the contribution of premilitary, military, and postmilitary risk factors to posttraumatic stress disorder (PTSD) and other postwar diagnoses in a sample of Vietnam veterans. PTSD was explained primarily by war stressors, including threat to life and exposure to grotesque death, but premilitary and postmilitary factors also contributed to the likelihood of a current diagnosis of PTSD. Panic disorder was also highly predicted by war experiences, whereas prewar functioning played a stronger role in several non-PTSD diagnoses. The study supported the notion that PTSD is specifically linked to intense stressors. Mechanisms for interactions among risk factors are discussed.

Buffalo Creek survivors in the second decade: stability of stress symptoms.

A follow-up study of 120 adult survivors of the Buffalo Creek dam collapse of 1972 showed group changes 14 years after the event. Decreased symptoms were noted in all areas, although significant psychopathology remained in about one-quarter of the survivors. A small group with delayed onset of symptoms was identified.

Multiple diagnosis in posttraumatic stress disorder. The role of war stressors.

Prior studies have shown that posttraumatic stress disorder (PTSD) in Vietnam veterans is associated with various aspects of war stressors and that other diagnoses often co-occur with PTSD in this population. The present report examines the prediction of other diagnoses, in combination with PTSD, from a variety of war stressor experiences in a broad sample of veterans recruited from clinical and nonclinical sources. The results show that PTSD with panic disorder is better explained by war stressors than other diagnostic combinations and that high-risk assignments and exposure to grotesque deaths were more salient than other stressor experiences in accounting for different diagnostic combinations. Implications of the findings for PTSD's placement in the DSM-III-R and for psychological and pharmacological treatments were discussed.

Empathy and outcome in brief focal dynamic therapy.

In an attempt to test the hypothesis that therapist empathy is an important variable in successful dynamic therapy, the authors collected outcome measures and empathy ratings in the brief focal dynamic therapy of 59 patients. There was no significant agreement among patients, therapists, and clinical supervisors when they used the same scale to rate therapist empathy for the same sessions. Only the patients' ratings correlated significantly with some of the outcome measures, and they added modest but statistically significant predictive variance on multiple regression analysis. The authors discuss the implications of these findings for the traditional mode of supervision of dynamic therapy.

Posttraumatic stress disorder. Toward DSM-IV.

This report raises conceptual issues about the validity of the posttraumatic stress disorder diagnosis as described in DSM-III. The helpfulness of DSM-III is acknowledged, but gaps in that classification are noted. These are organized into three areas: the etiology of the disorder, its natural history, and diagnostic specificity. Suggestions are made for conceptualizing these issues and for research that needs to be undertaken to help resolve them. The authors urge more theoretical and empirical attention to these important issues in the upcoming years, so that later diagnostic descriptions and understandings will be more precise.

Learning during group dynamics training: the effects of silent versus traditional training formats.

According to practicing group psychotherapists, the two most valued components of training for group psychotherapy are: (1) the opportunity to conduct a therapy group under supervision, and (2) participation in experiential training (Dies 1974). It is no wonder, then, that a large spectrum of experiential training models has emerged (Lakin, Lieberman, and Whitaker 1969). What is learned from the various models relates to the milieu, the leader, and the group composition (Stone and Green 1978), and in part depends on the particular training format. In contrast to descriptions of training, however, is the relatively limited formal evaluation of the learning which occurs in these programs. This paper will focus on an evaluation of the learning which took place during the group dynamics component of group psychotherapy training. The effect on learning of variations in format in which the leader is either silent or explicates group processes was tested.