Therapy of depressed and suicidal children

The author postulates that depression exists in adolescents, with the level of ego development producing varying clinical pictures. Therapy is based upon the psychoanalytic theory of personality development. Individual treatment is based on age and intelligence of patient, level of ego development, defenses utilized, attitude of parents, and community facilities available.     

Cynicism, hostility, and suicidal ideation in depressed outpatients

Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in relationship to measures of anger, aggression, hostility, cynicism, life events, and depression. There were no differences on measures of anger, aggression, hostility, and on most measures of severity of depression, but the suicidal group demonstrated more evidence of cynicism. Suicidal ideation is associated with cynicism but is unrelated to measures of hostility, anger, or aggression or to severity of depression in outpatients.     

Social problem-solving deficits and hopelessness, depression, and suicidal risk in college students and psychiatric inpatients

The Social Problem-Solving Inventory-Revised was used to examine the relations between problem-solving abilities and hopelessness, depression, and suicidal risk in three different samples: undergraduate college students, general psychiatric inpatients, and suicidal psychiatric inpatients. A similar pattern of results was found in both college students and psychiatric patients: a negative problem orientation was most highly correlated with all three criterion variables, followed by either a positive problem orientation or an avoidance problem-solving style. Rational problem-solving skills emerged as an important predictor variable in the suicidal psychiatric sample. Support was found for a prediction model of suicidal risk that includes problem-solving deficits and hopelessness, with partial support being found for including depression in the model as well.     

Social desirability: Its relevance to the measurement of hopelessness and suicidal behavior.

Replies to J. S. Nevid's (see record 1983-11675-001) comments on an article by the present authors (see record 1982-01443-001) examining the relationship between social desirability (SD), hopelessness, and reports of suicidal ideation/behavior. Further data on the relationship of SD, hopelessness, and prediction of future suicidal behavior collected from an inpatient psychiatric population (N?=?44) are analyzed. Results are similar to those obtained in the original study, thus strengthening confidence in those results. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, family environment, and adolescent suicidal behavior

OBJECTIVE: To assess the specific influence of family relationship difficulties, over and above the effect of depression, on the risk of adolescent suicidal behavior. METHOD: The study was based on the clinical data summaries, "item sheets," of children and adolescents who attended the Maudsley Hospital during the 1970s and 1980s. Two hundred eighty-four cases of suicidal behavior, defined as suicidal ideas, attempts, or threats (mean age 13.9 years, SD 2.6), were compared with 3,054 nonsuicidal controls, using stepwise logistic regression controlling for age and sex. RESULTS: The following variables were each independently associated with suicidal behavior: an operationally defined depressive syndrome, odds ratio (OR) = 4.4 (95% CI 3.1 to 6.3); family discord, OR = 1.5 (95% CI 1.1 to 2.0); disturbed mother-child relationship, OR = 1.5 (95% CI 1.1 to 2.0); and familial lack of warmth, OR = 1.6 (95% CI 1.1 to 2.3). Twenty-seven percent of the suicidal cases met operational criteria for depression. In a separate analysis of nondepressed cases (n = 198), female gender, OR = 2.4 (95% CI 1.7 to 3.2), and conduct symptoms, OR = 1.4 (95% CI 1.02 to 1.95), were independent risk factors for suicidal behavior. Among the depressed cases (n = 73), gender and conduct symptoms did not affect the risk of suicidal behavior. CONCLUSIONS: Although depression is the largest single risk factor for teenage suicidal behavior, family relationship difficulties make a significant independent contribution to this risk. Depression also interacts with gender, so that the excess risk of suicidal behavior in females is confined to nondepressed cases.     

Coping strategies in psychiatric clinical research.

Suggests that classical and elementary approaches to design and analysis of research frequently are based on expectations of the behavior of Ss and of measures of response that are unrealistic in the context of psychiatric clinical research. A broad range of strategies in sampling, measurement, design, execution, implementation, and analysis are examined, and specific strategies are suggested that tend to be successful in the real world of psychiatric clinical research. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symbiosis, empathy, suicidal behavior, and the family

This paper discusses the theoretical concept of symbiosis, as described by Mahler and her co-workers, and its clinical applications in suicidal situations. Symbiosis is defined as both a developmental phase characterized by a lack of differentiation between self and others and a relationship which is contingent upon the family and social network. A disturbed symbiosis is a major component in a suicide attempt. The destructive aspects of symbiosis are traced together with its relationship to empathy and the efforts to both restore and resolve a symbiotic conflict through suicidal behavior. In family therapy a repetition of older symbiotic relationships is frequently observed. These are repeated from one generation to the next in order to keep the old relationship alive. Finally, the practical implications of the concept of symbiosis for assessment and treatment are discussed.     

Hopelessness as a measure of suicidal intent in the depressed elderly.

Suicidal ideation in the elderly has been related to depression, changes in health, and anticipation of a limited future. The present study examined the Hopelessness Scale (HS) and its relation to these factors in a depressed geriatric population. A total of 120 elderly outpatients, who had applied to receive psychotherapy for depression, completed the HS, Beck Depression Inventory (BDI), health ratings, and the Schedule for Affective Disorder and Schizophrenia (SADS) at intake. The HS was found to be internally consistent, and a principal components analysis revealed three distinct factors that were related to hope, feelings of giving up, and future planning. The HS, BDI, and health ratings were predictive of suicidal ideation as measured by specific items in the SADS. The relation among suicidal ideation hopelessness, depression, and health perceptions for the depressed aged are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Levels of hopelessness in children and adolescents: A developmental perspective.

We investigated hopelessness at 3 age levels (8-, 12-, and 17-year-olds) in 210 children and adolescents from a community sample derived from public school listings of 4,810 children in a midwestern college town. The sample included 105 boys and 105 girls, and there were 70 subjects in each age group. The major finding was that children with high hopelessness scores are at greater risk not only for suicide and depression as revealed by the Child Assessment Schedule and the Birleson Depression Scale but also for overall psychopathology. This study suggests that hopelessness does not increase from preadolescence to adolescence in a general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies of counselors and school-age mothers.

61 13–21 yr old mothers and 28 26–60 yr old counselors rated the helpfulness of 6 coping strategies for each of 18 vignettes representing 4 types of stressful situations: criticism from others, offensive behavior of others, requests by others, and personal upset. Analysis revealed that school-age mothers preferred indirect coping strategies of avoiding the situation, changing the meaning of the event, and calming via distraction (strategies more highly associated with distress). Counselors perceived the direct coping strategies of assertion, negotiation, and demanding as more helpful. Differences in choice of coping strategy occurred within types of situation, between counselors and White and non-White mothers, and between counselors and high-distress mothers. Findings indicate that counselors must take careful assessments to determine the coping strategies appropriate for each client group. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and family functioning in families of depressed patients.

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patient's depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style, perceived uncertainty in illness, and distress in individuals with Parkinson's disease and their caregivers.

Examined the relationship of coping style and illness uncertainty to psychological distress in individuals with Parkinson's disease (PD) and their primary caregivers. Design: Correlational methods, within-group theory-driven hierarchical regression analyses, and transactional analyses. Ss were 44 dyads composed of individuals with PD and their caregivers. Main Outcome Measures: Hoehn and Yahr Clinical Disability Rating Scale, Instrumental Activities of Daily Living Scale, Symptom Distress Checklist-90—Revised, Mischel Uncertainty in Illness Scale-Community Form, and Revised Ways of Coping Checklist. Results: Emotion-focused coping was associated with higher levels of distress for persons with PD, whereas both emotion-focused coping and perceived uncertainty were associated with distress for the caregivers. Transactional analyses between patients and caregivers indicated that higher levels of patient problem-focused coping and perceived uncertainty in illness were associated with increased problems in caregiver distress. Adjustment to PD is influenced by several patient and caregiver variables. The results warrant consideration of a variety of clinical interventions involving patient and caregiver education about the disease and methods for managing the associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postoperative pain in children: Developmental and family influences on spontaneous coping strategies.

Examined children's and parents' reactions to postoperative pain, including stress appraisal and cognitive-behavioral coping processes from a developmental perspective. 30 younger children (aged 7–9 yrs) and 30 older children (aged 10–16 yrs) and their parents provided interview and psychometric data about pain and coping on the day following surgery. Observational data also was provided by nurses. All children described a variety of self-control strategies found to be helpful in managing postoperative pain. Older children were more likely to report using cognitive coping strategies, yet they reported lower overall self-efficacy. Coping strategy use, perceived self-efficacy, and frequency of catastrophizing thoughts were significantly predictive of children's pain, affective distress, and physical recovery. Parental anxiety was positively related to child anxiety, and inversely related to child self-efficacy and frequency of cognitive coping. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children.

The Hoplessness Scale for Children was developed and administered to 66 8–13 yr old children along with the Children's Depression Inventory, Bellevue Index of Depression, Depression Symptom Checklist, and the Self-Esteem Inventory. As predicted, Ss who scored high on the Hopelessness Scale showed significantly more severe depression and lower self-esteem than those who scored low on the scale. Ss who evinced suicidal attempt or ideation, independently assessed at intake diagnosis, showed greater hopelessness than Ss with no such intent. Suicidal intent was more consistently correlated with hopelessness than with depression, a finding parallel to results obtained with adults. Overall, findings suggest that negative expectations toward oneself and the future can be assessed in children and are related both to depression and suicidal intent. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents.

A family cognitive-behavioral preventive intervention for parents with a history of depression and their 9–15-year-old children was compared with a self-study written information condition in a randomized clinical trial (n = 111 families). Outcomes were assessed at postintervention (2 months), after completion of 4 monthly booster sessions (6 months), and at 12-month follow-up. Children were assessed by child reports on depressive symptoms, internalizing problems, and externalizing problems; by parent reports on internalizing and externalizing problems; and by child and parent reports on a standardized diagnostic interview. Parent depressive symptoms and parent episodes of major depression also were assessed. Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures. Implications for the prevention of adverse outcomes in children of depressed parents are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helplessness in children of depressed and nondepressed mothers.

Helpless behaviors in 5- to 7-year-old children of depressed and nondepressed mothers were assessed through direct observation, interviews, and teacher ratings. The affective tone the mothers set in a joint puzzle task and their tendency to encourage mastery or become intrusive when their children became frustrated at the task were also assessed. Although depressed mothers set a more negative affective tone than nondepressed mothers during solvable puzzles, there were few significant differences between the 2 groups of mothers and children. Still, mothers who were more negative and hostile and less able to encourage mastery in their children had children who exhibited more helpless behaviors in the puzzle task, who were less likely to endorse active problem-solving approaches to frustrating situations, and whose teachers rated the children as less competent and more prone to helpless behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a geriatric scale of hopelessness: Implications for counseling and intervention with the depressed elderly.

Evaluated hopelessness, depression, and self-esteem in 138 65–80 yr old subclinically depressed people drawn from community settings. In Phase 1, a factor analysis was performed on the contents of interviews with 60 Ss. Analysis yielded 4 distinct factors of geriatric hopelessness. In Phase 2, a geriatric hopelessness scale (included as a table) was developed on the basis of hopelessness themes suggested by factor analysis and was administered to 78 Ss. Results of this validity study show that Ss who scored high on the geriatric hopelessness scale had significantly higher depression and lower self-esteem scores than Ss who scored low on the scale. It is suggested that the same correlational patterns that exist in youth and adults between hopelessness and depression continue into old age. It is further suggested that identification of clients' latent themes of hopelessness would help counselors obtain more focused insight into clients' pessimism and negative outlooks and would provide the particular kind of encouragement and reinforcement needed. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of relatedness, depressive symptomatology, and perceived competence in maltreated children.

An attachment theory framework is applied toward understanding the emergence of depressive symptomatology and lower perceived competence in maltreated and nonmaltreated children. Hypotheses that maltreated children with nonoptimal patterns of relatedness evidence elevated depressive symptomatology and lower competence, whereas nonmaltreated children with optimal or adequate patterns of relatedness exhibit the least depressive symptomatology and higher competence, were confirmed. Additionally, differentiations between maltreated children with and without optimal or adequate patterns of relatedness emerged, suggesting that relatedness may mitigate against the adverse effects of maltreatment. Moreover, sexually abused children with confused patterns of relatedness evidenced clinically significant depressive symptomatology. Results are discussed with regard to mechanisms that contribute to adaptation or maladaptation in children with negative caregiving histories (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping profiles associated with psychiatric, physical health, work, and family problems.

Examined coping profiles of 11 samples (identified in the stress literature) with a total of 1,298 individuals experiencing psychiatric, physical health, work, or family problems. Comparisons were made in Ss with and without anxiety and depression to control for the effects of distress. Coping was similar for Ss in similar problem categories, but different for Ss in different categories. Psychiatric Ss made more use of avoidance and less use of social supports. Ss with physical health problems were among the most frequent users of social supports. Ss with a family problem were among the most frequent users of problem-focused coping and the least frequent users of self-blame. Ss with work stress were the most frequent users of self-blame. Results support the hypothesis that persons with psychopathology cope in maladaptive ways involving dysfunctional strategies that constitute the behavioral disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developmental psychopathology in children of depressed mothers.

It is suggested that the tripartite model by R. D. Parke et al (1988) of the ways that parents influence their child's social development might be used to organize the study of abnormal development in children of depressed mothers. Parents influence their child through dyadic interaction, coaching and teaching practices, and managing their child's social environment. Disruption in each of these areas has been associated with parental psychopathology and has been implicated in the development of deviant child outcomes. The components of a theoretical model of developmental psychopathology are outlined, as well as theoretical and methodological problems that have yet to be resolved. Issues of concern include the heterogeneity of maternal diagnoses; distinguishing among genetic, parenting, and environmental effects; matching the level of behavioral analysis with the question being answered; the heterogeneity of child outcomes; age-related effects; bidirectional influences; and the role of paternal psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)