Estimation of Error and Bias in Bayesian Monte Carlo Decision Analysis Using the Bootstrap

Bayesian Monte Carlo (BMC) decision analysis adopts a sampling procedure to estimate likelihoods and distributions of outcomes, and then uses that information to calculate the expected performance of alternative strategies, the value of information, and the value of including uncertainty. These decision analysis outputs are therefore subject to sample error. The standard error of each estimate and its bias, if any, can be estimated by the bootstrap procedure. The bootstrap operates by resampling (with replacement) from the original BMC sample, and redoing the decision analysis. Repeating this procedure yields a distribution of decision analysis outputs. The bootstrap approach to estimating the effect of sample error upon BMC analysis is illustrated with a simple value-of-information calculation along with an analysis of a proposed control structure for Lake Erie. The examples show that the outputs of BMC decision analysis can have high levels of sample error and bias.     

A qualitative study of intimate partner violence universal screening by family therapy interns: implications for practice, research, training, and supervision

Although a few family therapy researchers and clinicians have urged universal screening for intimate partner violence (IPV), how screening is implemented-and, in particular, client and therapist response to screening-is vaguely defined and largely untested. This qualitative study examined the dilemmas experienced by couples and family therapy interns when implementing universal screening for IPV in an outpatient clinic setting. Twenty-two graduate students in a COAMFTE-accredited program were interviewed using qualitative research methods grounded in phenomenology. Three domains, 7 main themes, and 26 subthemes were identified. The three domains that emerged in this study include (a) therapist practice of universal screening, (b) client response to universal screening, and (c) therapist response to universal screening. Implications for practice, research, training, and supervision are discussed.     

Mental health among college students: do those who need services know about and use them?

OBJECTIVE: The objective of this study was to examine connections between university students' mental health and their knowledge and use of campus mental health services. PARTICIPANTS AND METHODS: In March 2001, a sample of undergraduate students (N = 266) completed a Web-based questionnaire, providing information related to their mental health, knowledge of mental health services, and use of those services. RESULTS: Students who were mentally distressed were more likely to know about and use services; however, some students who reported to be mentally distressed either did not know about services or knew about services but did not use them. Living off campus, identifying as male, and having fewer years in college were related to less knowledge of campus mental health services. In addition, female sex and number of years in college were predictive of higher service use. CONCLUSIONS: With the high prevalence rates and severity of mental health problems, university mental health providers must continue to make strategic efforts to disseminate knowledge about mental health services to all students.     

Reciprocal Influence of Couple Dynamics and Eating Disorders

Little research has focused on the ways that eating disorder processes and adult couple dynamics influence one another. The purpose of this study was to investigate the reciprocal influence of couple dynamics and eating disorder illness and recovery processes. We conducted 51 interviews with 17 couples where one member identified as currently suffering or having recovered from an eating disorder. Using grounded theory analytical methods, findings include the systemic interplay of the eating disorder and relationship, both partners' perspectives on the eating disorder and its role in the relationship, the noneating disorder partner's impact on the eating disorder, and coping strategies for recovery as a couple. Clinical implications for supporting couples experiencing eating disorder illness and recovery are discussed.     

A Longitudinal Analysis of Parenting Practices,Couple Satisfaction,and Child Behavior Problems

This longitudinal study examined the relationship between couple relationship satisfaction, parenting practices, parent depression, and child problem behaviors. The study participants (n = 148) were part of a larger experimental study that examined the effectiveness of a brief family-centered intervention, the Family Check-Up model. Regression analysis results indicated that our proposed model accounted for 38% of the variance in child problem behavior at Time 2, with child problem behavior and couple relationship satisfaction at child age 2 years each accounting for a significant portion of the variance in child problem behavior at age 3. Couple relationship satisfaction directly predicted child behavior problems over time. Clinical and research implications are discussed.     

Aging in Asia: A cultural,socio-economical and historical perspective

Asia has about 60% of the world population and population aging is occurring more rapidly in Asia than in Western countries. The group aged 65 years and above will increase from 207 million in 2000 to 857 million in 2050, a staggering increase of 314%. The diversity in economic, demographic, religious, cultural and geo-political factors in Asia is unparalleled by any other continent, and is, in part, contributory to the rapid rise in population aging. By 2050, those under 15 years old will have shrunk from 30% in 2000 to 19%, while those aged 65 years and above will increase from 6% to 18%. In addition, the gender divide still persists with 100 elderly women to 70 elderly men. These projected demographic changes pose three major challenges: 1) how best to address the rising population of the group aged 65 years and above, 2) how to address the shrinking population of the young as well as the working adults, and 3) how to address the problems arising from the disproportionate increase in older women than men. From now to 2050, it will be expeditious for each country in Asia to look into ways of reversing the decline in total fertility rates (TFRs) and restore to replacement levels. If not, at least introduce measures to halt its free fall. Due to the complexity of factors that have influenced the fall in TFRs in Asia, it will be a daunting task to reverse this fall. There is no “single size fits all” solution to this complex problem. Research work in this short-term strategy in addressing the aging population is urgent. In the longer term, the East-West Centre have suggested four modalities, 1) establish policies and programmes that enhance traditional Asian systems of family support for the elderly; 2) introduce policy reform that encourages the elderly who are still capable of remaining in the work force; 3) create institutions and systems that support high levels of personal saving; and 4) formulate public programmes, including pension schemes and national healthcare systems. We need to work while there is time.     

Positive Adult Support and Depression Symptoms in Adolescent Females: The Partially Mediating Role of Eating Disturbances

This study examined linkages between depression symptoms (DEP) and positive adult support (PAS) in female adolescents and the partially mediating influence of eating disturbances (ED). Structural equation modeling was used to establish measurement models for each of the latent constructs, determine the relationships among the latent constructs, and examine the overall model fit of the data. The relationships among the latent constructs of ED, PAS, and DEP were tested using a mediation model. Results indicate that there is a significant, positive relationship between DEP and PAS and that ED are a partial mediator of this relationship. This study provides evidence for the importance of evaluating how ED can influence the trajectory of depression in the lives of adolescent females.     

A National Survey of Family Physicians: Perspectives on Collaboration With Marriage and Family Therapists

Recognizing the fit between family medicine and marriage and family therapy (MFT), members of both fields have made significant advances in collaborative health research and practice. To add to this work, we surveyed a nationwide random sample of 240 family physicians (FPs) and asked about their perspectives and experiences of collaboration with MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-related care, but their referral to and collaboration with MFTs were limited. Through responses to an open-ended question, we gained valuable information as to how MFTs could more effectively initiate collaboration with FPs.