Suicide Attempts by Adolescent Latinas: An Exploratory Study of Individual and Family Correlates

Epidemiological data show high rates of suicide attempts among adolescent Latinas. Few studies have addressed the psychosocial, cultural and family correlates of suicide attempts among this age group of a rapidly growing population. The authors studied 31 adolescent Hispanic females who were receiving mental health services; 14 girls had attempted suicide in the previous five years and 17 had never attempted suicide. The two groups of girls did not differ significantly with respect to demographic profiles, levels of depression, family type, acculturation, or self-esteem. However, as hypothesized, the mutuality between girls and their mothers was lower among suicide attempters. Maladaptive coping skills of withdrawal and wishful thinking were more commonly used by attempters, and non-attempters used emotional regulation and problem-solving more frequently. Findings are discussed within the context of the empirical and theoretical literature and implications for practice are considered.     

Non-ignorable missing covariate data in survival analysis: a case-study of an International Breast Cancer Study Group trial

Summary.  Non-ignorable missing data, a serious problem in both clinical trials and observational studies, can lead to biased inferences. Quality-of-life measures have become increasingly popular in clinical trials. However, these measures are often incompletely observed, and investigators may suspect that missing quality-of-life data are likely to be non-ignorable. Although several recent references have addressed missing covariates in survival analysis, they all required the assumption that missingness is at random or that all covariates are discrete. We present a method for estimating the parameters in the Cox proportional hazards model when missing covariates may be non-ignorable and continuous or discrete. Our method is useful in reducing the bias and improving efficiency in the presence of missing data. The methodology clearly specifies assumptions about the missing data mechanism and, through sensitivity analysis, helps investigators to understand the potential effect of missing data on study results.     

Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

Real nonparametric regression using complex wavelets

Summary.  Wavelet shrinkage is an effective nonparametric regression technique, especially when the underlying curve has irregular features such as spikes or discontinuities. The basic idea is simple: take the discrete wavelet transform of data consisting of a signal corrupted by noise; shrink or remove the wavelet coefficients to remove the noise; then invert the discrete wavelet transform to form an estimate of the true underlying curve. Various researchers have proposed increasingly sophisticated methods of doing this by using real-valued wavelets. Complex-valued wavelets exist but are rarely used. We propose two new complex-valued wavelet shrinkage techniques: one based on multiwavelet style shrinkage and the other using Bayesian methods. Extensive simulations show that our methods almost always give significantly more accurate estimates than methods based on real-valued wavelets. Further, our multiwavelet style shrinkage method is both simpler and dramatically faster than its competitors. To understand the excellent performance of this method we present a new risk bound on its hard thresholded coefficients.     

Child Behaviour Management Programs Avoiding Parental Drop-Out

Maintaining parental commitment to home-based child behaviour modification programs is difficult when parents are convinced their child's ‘misbehaviour’ is evidence of personal rejection. This paper suggests an approach which combines behaviour modification techniques with systemic ideas to overcome this potential cause of parental drop-out.     

Struggles with Time: the careers of parents with adult sons and daughters with learning disabilities

The experiences of parents with adult offspring with learning disability and the meanings their parental careers have for them, has been the subject of very little empirical research. In this paper we describe and examine some of the features that gave shape and meaning to the day to day lives of parents of 33 co-resident adults with learning disabilities. Their accounts of their situations revealed that 'time' was a factor of some importance. Participants suggested that socialisation into the parental role was one that continued over the life course. In addition, they also felt that the services they received were based upon an inadequate and too narrow an understanding of how they experienced 'time'. The data reveal that both 'over time' and 'in time', parents struggled to maintain a set of aspirations for a typical life. The data show that for many parents there was a slow accommodation to the constraints of service provision and, as a result, their needs for service support became less extensive.     

The Vitalizing and the Revitalizing Experience of Reliability: The place of touch in psychotherapy

A particular psychotherapeutic procedure described by the authors as The Vitalizing and the Revitalizing Experience of Reliability, is used as an adjunct to enhance the effectiveness of the treatment. Characteristically, it is a nonmanipulative, nonseductive procedure used during particular stressful times with certain patients—adults as well as children—to facilitate a confirmation of the self as separate from others. It should also instill in the patient a feeling of increased safety and reliability as well as promoting basic trust in self and others with the ultimate goal of reintegration of a fragmented ego. Such an adjunct can take various forms. The one described here is a highly controversial one, physical touch. Two clinical examples are given which emphasize transferential and countertransferential considerations. The paper describes the delicate balance between discipline and flexibility required by the therapist.This paper was presented to the Psychoanalytic Psychologists of Long Island, 1985 and to the New York State Society of Clinical Social Work Psychotherapists, Nassau County Chapter, 1985.     

Freud's “Anna O.”: Social work's Bertha Pappenheim

The story of Anna O. has loomed large in psychoanalytic history, but few social workers know that the young woman, who was so influential in the development of Freud's thinking, became a pioneer social worker in Germany. The story of the transformation of the troubled young woman, who was actually Joseph Breuer's patient, is the focus of this paper. In addition, some of the facts of the case are discussed as social constructions. Anna O./ Bertha Pappenheim participated in the creation of the talking cure and eventually went on to be a leading feminist, developer of social programs for women, and social reformer.