Mental health in complex emergencies.

Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scientific evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies.

Violent and aggressive behaviors in youth: a mental health and prevention perspective.

Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.

Psychiatry behind the walls: mental health services in jails and prisons.

Throughout his professional career, Karl Menninger emphasized the importance of understanding criminal behavior and societal responses to such behavior. He focused on the need for more humane approaches within the criminal justice system. This article focuses on the current needs and anticipated directions for psychiatric services in prisons and jails, including comprehensive systems approaches that can facilitate better treatment and decrease repeat offenses. With the growing number of individuals being incarcerated in jails and prisons, and with higher percentages needing mental health services, it is important that effective mental health services be designed and implemented. Services should provide quality interventions and treatments for the inmates, must take into account and be respectful of the security needs of the facility, and must deal sensitively and thoughtfully with the stresses and factors that contribute to burnout among the professional staff and security officials. In this way, we can achieve part of Karl Menninger's dictum to provide better care for those who are unfortunate enough to have their behavior result in their being incarcerated in jails and prisons.

Training older adults to work as psychiatric case management aides.

Adults who were age 55 and over were trained to work as case management aides for individuals with serious and persistent mental illness. The training program was a cooperative effort of several state, academic, and private agencies in the New Orleans area, including the department of psychiatry at a state university medical center, the State Office of Mental Health, a consortium of colleges and universities providing educational opportunities for older adults, and the American Association of Retired Persons. The program curriculum included ten weeks of classroom instruction and a four-month field practicum. Of the 14 participants in the initial group of trainees, 13 sought and received employment as case aides. At follow-up three months after employment, supervisors of the case aides rated their job performance as excellent.

Barriers to human immunodeficiency virus related risk reduction among male street prostitutes.

Two hundred eleven male street prostitutes between the ages of 18 and 51 years were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). Economic, social, and emotional barriers to the reduction of HIV-related risk behavior were examined within the context of several concepts present in the Health Belief Model (HBM). Three lifestyle factors were found to function as barriers to engaging in risk reduction behavior. Subjects who were more economically dependent on prostitution, perceived less control over the hustling encounter, and reported increased pleasure from sexual activity with their customers were more likely to engage in risk-taking behavior. Prostitutes' perception of the severity of HIV infection was not significantly associated with their risk behavior. Unexpected findings indicated that increases in perceived susceptibility to HIV and perceived benefit of condom use for HIV prevention were significantly related to increased risk-taking behavior. Practical applications of findings in the design and implementation of future HIV-related preventive health education programs are discussed.

PIP: A survey of male street prostitutes in New Orleans, Louisiana, on the social, economic, and psychological barriers to human immunodeficiency virus (HIV)-related risk reduction behaviors has significant implications for the design of health education programs. The 211 subjects, ages 18-51 years, were tested for HIV antibodies and interviewed through use of a semi-structured schedule aimed at eliciting data on life-style and based on the Health Belief Model. 37 (17.5%) of study subjects were HIV-positive. HIV risk behavior was measured on the basis of participation in anal-genital and oral-genital sex, sexual orientation, and syphilis serostatus. High-risk behavior was found to be significantly positively associated with economic dependence on hustling, enjoyment of sex with tricks, and perceived control over hustling, negatively with frequency and quantity of substance abuse. These variables accounted for 6%, 3%, 4% and 4%, respectively, of the total variance in risk behavior. 96% of male prostitutes identified HIV as a serious condition; however, risk-taking behavior was found to increase with increased levels of perceived susceptibility to HIV infection. Finally, risk-taking behaviors increased along with increased in perceptions of the availability and efficacy of condoms. These findings suggest that health education efforts based on promoting HIV infection as a serious condition or emphasizing the effectiveness of condom use will be ineffective without attention to the social context of population groups at greatest risk of HIV infection. Measures most likely to reduce HIV-taking behaviors among male prostitutes are, according to these findings, elimination of the economic incentive for engaging in unsafe sex through the provision of alternative income sources, empowering male prostitutes to exert control over the hustling situation, and promotion of achievement of sexual pleasure through safe sex.

Sexual behavior patterns of customers of male street prostitutes.

Information about male customers of male prostitutes, including sociodemographic and life-style characteristics, sexual and drug use behaviors, and knowledge about HIV infection were collected from a convenience sample of 211 male street prostitutes and a convenience sample of 15 male customers as part of a feasibility study. Data from these two groups indicate that despite knowledge of HIV infection and its transmission, customers engage in high-risk sexual and drug use behaviors with prostitutes. Because there is a high HIV infection rate within the male prostitute sample (175/1000) and because these customers for the most part describe themselves as bisexual or heterosexual, it is likely that male customers of male prostitutes serve as a vector of transmission of HIV infection to their other partners including the heterosexual population.

PIP: A sample of 211 adult male street prostitutes and a sample of 15 male customers of male prostitutes were recruited from the Greater New Orleans metropolitan area at the Louisiana State University Medical Center. The prostitutes were tested for HIV using the enzyme-linked immunosorbent assay and the Western Blot. Sociodemographic characteristics, sexual behavior patterns, drug use patterns, knowledge of safer sex, safe drug practices, and HIV transmission data were obtained by interviews. The prostitutes were equally distributed across age 25 and age 25 and IV vs. non-IV drug use. 105 were White, and 196 were Black. Educational level ranged from completion of Grade 1 to college. The customers include 8 Blacks and 7 Whites with an age range of 19-49 years. 7 had never been married, 4 were currently married, and 4 were either separated or divorced. The prostitutes were positive that at least 40% of their customers were married at the time of their encounters. 8 of the customers were bisexual. 6 saw themselves as heterosexual, while 1 identified himself as homosexual. 99% of the prostitutes indicated that they perform oral-genital sex with their customers. When the customer was the insertive partner, the prostitutes states that 46% wore a condom. When the prostitute was the insertive partner in anal sex, 67% of their customers did not request use of a condom. Almost 30% of the prostitutes perceived that customers solicited them for high-risk sexual acts. 8 of the customers reported that they never wore a condom. The other 7 customers said that they never work them with their regular sexual partner(s). 57% of the prostitutes reported using alcohol and drugs with their customer. Among IV drug-using prostitutes, 28% injected drugs and shared needles with their customers. Customers exhibited an accurate knowledge of AIDS, modes of HIV transmission, and safer sex practices, 11 customers said that they had been tested previously for antibodies to HIV. One indicated that he was HIV seropositive, 9 said that they were negative, and 1 subject had not yet received his test results.

Psychological characteristics of a sample of male street prostitutes.

Two hundred and eleven male street prostitutes were interviewed and administered the SCL 90-R psychological symptom checklist. When compared to nonpatient normals, male prostitutes exhibited significantly higher levels of psychopathology. However, when compared to adult psychiatric outpatients, male prostitutes exhibited significantly less psychopathology on all symptom dimensions of the SCL 90-R except paranoid ideation. The male prostitutes' elevated scores on the psychological symptom checklist may reflect their response to an often dangerous and chaotic environment. However, it is as likely that their psychological functioning leads them to this particular milieu.

Adolescent and older mothers' interaction patterns with their six-month-old infants.

Children of adolescent mothers suffer more physical, intellectual, and emotional difficulties than do other children. In order to gain a better understanding of the differences, the interaction patterns of adolescent mothers and non-adolescent mothers interacting with their young infants were compared. One hundred adolescent mothers and 29 married primiparous non-adolescent mothers were observed interacting with their six-month-old infants during a feeding episode and a play episode. All of the mothers had a high school education or less. During feeding, the adolescent mothers demonstrated less expressiveness, less positive attitude, less delight, less positive regard, fewer vocalizations, and a lower quality of vocalizations than non-adolescent mothers. During play, the adolescent mothers demonstrated less inventiveness, less patience, and less positive attitude than the non-adolescent mothers. These results extend and strengthen what is known about adolescent mothers patterns of interaction with their young infants.

The male street prostitute: a vector for transmission of HIV infection into the heterosexual world.

Two hundred and eleven New Orleans male street prostitutes were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). The subjects' lifestyle characteristics and their sex and drug use practices were evaluated to determine the prostitutes' potential to function as a vector for transmission of HIV into populations with currently low infection rates. Information about the customers of the male prostitutes was also obtained from the sample. The period prevalence of HIV in the sample was 175/1000. Many of the male prostitutes reported having wives or girlfriends, some of whom were prostitutes themselves. The prostitutes perceived a majority of their male customers to be heterosexual or bisexual (indicating sexual contact with women as well as men), many (39%) were thought to be married. Results from the study support the argument that male prostitutes serve as a bridge of HIV infection into populations with currently low infection rates through contact with both non-customer sexual partners and customers and thus indirectly to spouses and sexual partners of these individuals.

Effects of cesarean delivery on parental depression, marital adjustment, and mother-infant interaction.

To further our understanding of the effects of cesarean delivery on maternal and paternal depression, marital adjustment, and mother-infant interaction during perinatal and three-month postpartum feeding, data were prospectively collected on 80 primiparous married women and their infants, and 76 of their husbands. There were 56 vaginal deliveries and 24 cesarean section deliveries. Data were collected by interview at the latter part of the second trimester and three months post-partum by examination of the mothers' and infants' medical records, and by observation of mother-infant feedings at two days and three months postpartum. The infants' birthweight, weeks of gestation, and Apgar scores at five minutes, maternal age at delivery, and maternal and child health index risk scores were not significantly different between the two groups. Mothers who had cesarean delivery had significantly higher labor index risk scores than those with vaginal birth. The mothers and fathers were not significantly different on levels of depression or marital adjustment prenatally or at three months postpartum. There were no significant differences in mother-infant behaviors during the feedings observed. That we found no differences after cesarean and vaginal delivery would support the theory that mothers respond to infants' behavioral repertoire and not to the mode of delivery.

Evaluation and management of premenstrual syndrome in clinical psychiatric practice.

Premenstrual syndrome, a long-recognized entity, has been the subject of increased interest in recent years. Many women, perhaps a majority, experience some premenstrual symptoms; a minority have severe symptoms. The authors explore possible links to psychiatric disorders, outline general evaluation and management approaches, and discuss specific implications for the treatment of psychiatric patients who have a menstrually related component to their symptoms. It is hoped that a continuing understanding of this complex area may further our conceptualization and treatment of both premenstrual symptoms and psychiatric disorders.

Relationships between prenatal medical and nutritional measures, pregnancy outcome, and early infant development in an urban poverty setting. I. The role of nutritional intake.

Repeated nutritional assessments were made on 118 low-income women who registered at an urban hospital clinic prior to the twenty-eighth week of pregnancy and then on 122 comparable women who were provided with protein-mineral supplementation. Demographic and background information were obtained. Medical assessments were carried out throughout pregnancy, labor, delivery, and the postpartum period. The infants were assessed both medically and with Brazelton Neonatal Behavioral Assessment Scales. In spite of their low-income status, the subjects did not appear nutritionally deprived. Few significant relationships were obtained between maternal nutritional intake and measures of maternal or infant medical status or infant psychological status. A limited number of consistent relationships were obtained when the supplemented and nonsupplemented groups were compared. Although consistent infant medical and psychological benefits were not noted, mothers in the supplemented group developed fewer parameters of pre-eclampsia and had fewer complications during labor and delivery.