BACKGROUND
Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples.

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Health Care Contacts in the Year Before Suicide Death

Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers making a quit attempt. Positive psychotherapy can both increase positive affect (PA) and decrease NA and, therefore, may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a positive psychotherapy for smoking cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in PA at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of the participants (31.6%) sustained smoking abstinence for six months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.

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Positive psychotherapy for smoking cessation: Treatment development, feasibility, and preliminary results

The main procedure used by clinicians to determine whether an individual may be at risk of suicidal behaviors is the suicide risk assessment (SRA). The purpose of the SRA is to identify risk and protective factors that then provide the data for the formulation of suicide risk. The suicide risk formulation (SRF) assigns a level of suicide risk that ideally leads to triage and treatment deemed appropriate for that level of risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.

Suicide risk assessment and risk formulation part I: a focus on suicide ideation in assessing suicide risk.

Suicide exposures and bereavement among American adults: Evidence from the 2016 General Social Survey.

The Differentiation of Self Inventory—Revised (DSI-R; Skowron & Schmitt, 2003, “Assessing interpersonal fusion: Reliability and validity of a new DSI fusion with others subscale,” Journal of Marital and Family Therapy, 29, 209 –222) assesses a central construct of Murray Bowen’s Family Systems Theory. Differentiation of self (DoS) consists of both intra- and interpersonal dimensions, or the capacities for affect regulation and negotiating relational separateness and togetherness. In this study we examined the internal and external structure of the DSI-R with a sample of 749 university students. Confirmatory factor analysis supported a three-factor, first-order solution and offered evidence for a two-dimensional higher-order structure of DoS. The three factors exhibited acceptable reliability and demonstrated theoretically consistent associations with parentification and mental health symptoms. The results confirm the use of the DSI-R as a psychometrically sound measure of DoS. Implications for future research and clinical practice are addressed.

http://guru.louisville.edu/parentification/uploads/1/8/9/9/18990327/Jankowski,%20P.%20and%20Hooper,%20L.%20M.--differentiation%202012.pdf

Differentiation of Self: A Validation Study of the Bowen Theory Construct

Existing research indicates that parentification can result in positive and negative outcomes for individuals; however, little is known about the mechanisms that account for the variability. This study tested a theoretical model of the relation between parentification tasks and mental health symptoms, with perceived unfairness and differentiation of self (DoS) as mediators. The results supported the proposed model in a sample of 783 college students. A significant total indirect effect existed between the latent construct of parentification and that of mental health symptoms. Significant specific indirect effects were observed between parentification and mental health symptoms with perceived unfairness as a mediator; between parentification and DoS with perceived unfairness as a mediator and between perceived unfairness and mental health symptoms mediated by DoS. Implications for clinical work with adult clients who have experienced parentification in their family of origin are addressed.

Parentification and mental health symptoms: mediator effects of perceived unfairness and differentiation of self

Despite the ubiquitous nature of parentification, few instruments allow for the empirical study of the roles, responsibilities, and processes that undergird this construct. To fill this need, the researchers developed and refined a new instrument, the Parentification Inventory (PI; Hooper, 2009). A sample of 847 college students was split into two random, non-overlapping samples. For these initial survey development and cross-validation studies, the factor structure and psychometric properties of the PI were examined. To assess the PI's reliability, the researchers conducted an exploratory factor analysis (Study 1) using the first sub-sample of 431 students (mean age = 20.86, SD = 3.55). The researchers used the results to refine the PI and conducted a subsequent confirmatory factor analysis (Study 2) using the second, non-overlapping sample of 416 students (mean age = 20.89, SD = 3.83). The best fitting and most parsimonious model resulted in 22 items that cohered into three unique, replicable factors th...

http://guru.louisville.edu/parentification/uploads/1/8/9/9/18990327/hooper-l.-m.-doehler-k.-wallace-s.-a.-hannah-n.-j.-2011.-the-parentification-inventory-development-validation-and-cross-validation.pdf

The Parentification Inventory: Development, Validation, and Cross-Validation

Primary care physicians play a significant role in depression care, suicide assessment, and suicide prevention. However, little is known about what factors relate to and predict quality of depression care (assessment, diagnosis, and treatment), including suicide assessment. The authors explored the extent to which select patient and physician factors increase the probability of one element of quality of care: namely, intention to conduct suicide assessment. Data were collected from 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying major depression with moderate levels of severity. The authors examined which patient factors and physician factors increase the likelihood of physicians’ intention to conduct a suicide assessment. Data from the study revealed that physician-participants inquired about suicide 36% of the time. A random effects logistic model indicated that several factors were predictive of physicians’ intention to conduct a suicide assessment: patient’s comorbidity status (odds ratio (OR) = 0.61; 95% confidence interval (CI) = 0.37–1.00), physicians’ age (OR = 0.67; 95% CI = 0.49–0.92), physicians’ race (OR = 1.84; 95% CI = 1.08–3.13), and how depressed the physician perceived the virtual patient to be (OR = 0.58; 95% CI = 0.39–0.87). A substantial number of primary care physicians in this study indicated they would not assess for suicide, even though most physicians perceived the virtual patient to be depressed or very depressed. Further study is needed to establish factors that may be modified and targeted to increase the likelihood of physicians’ providing one element of quality of care—suicide assessment—for depressed patients.

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Predictors of Primary Care Physicians' Self-reported Intention to Conduct Suicide Risk Assessments

In this pilot study, we examined the relationship between health factors, sociodemographic factors, and body mass index (BMI) across two generations (n = 41 parent-child pairs). Generation 1 study variables included parent- and family-focused characteristics and health variables, the Generation 2 variables included child demographic factors, and the outcome variable was youths’ physical health (operationalized as BMI). Regression models revealed that Generation 1 variables, taken together, accounted for 26% of the variance in youth BMI. However, only the parent’s mental health symptoms (i.e., depression symptoms) made a unique contribution to the variance in youth BMI. Logistic regression analysis revealed that the youths’ race and age—but no other demographic factor—were significantly related to youth BMI-for-age. Our findings suggest that youth race, age, and parent mental health are each associated with youth physical health (i.e., BMI), confirming previous study findings that parental factors and demographic factors should be considered when exploring youth health outcomes.

Associations Among Body Mass Index, Depression, and Family Factors Across Two Generations

Studies have long shown that some patients receive less than optimal care for depression in primary care settings. However, few studies have uncovered factors that predict and explain this deficiency. The authors administered a survey to 408 primary care physicians. They examined how physicians' attitudes (eg, feeling positively or negatively about treating depression in their patients), physicians' beliefs (eg, beliefs about what their patients think and prefer in terms of depression care), and demographic characteristics (independent variables) predicted optimal depression care (dependent variable). Using logistical regression analyses, they identified differences in treatment decisions between family and internal medicine physicians. Physicians' specialty and race (family physicians and white physicians were more likely to prescribe a medication) were unique determinants of whether the physician treated depression by prescribing medication; physicians' specialty and race (family physicians and nonwhite physicians were more likely to provide office-based counseling) were unique determinants of whether the physician treated depression by providing office-based counseling; physicians' beliefs about depression care and physician age were unique statistically significant determinants of whether the physician treated depression by providing a referral to a mental health specialist. These findings help clarify how physicians' specialty and beliefs about depression care influence treatment. In addition, the results in this study suggest that there are differences between family and internal medicine physicians in terms of their practice patterns and beliefs in types of treatment that patients would be willing to receive. Implications for future research on primary care depression treatment are discussed. Language: en

https://journals.sagepub.com/doi/pdf/10.1177/2150131910387647

Natalie J. Hannah

Papers

Parentification and mental health symptoms: mediator effects of perceived unfairness and differentiation of self

The Parentification Inventory: Development, Validation, and Cross-Validation

Predictors of Primary Care Physicians' Self-reported Intention to Conduct Suicide Risk Assessments

Associations Among Body Mass Index, Depression, and Family Factors Across Two Generations

Family medicine and internal medicine physicians' attitudes and beliefs about depression: implications for treatment decisions.