Expression Of Emotional Distress Research Articles

Military psychological trauma: The contribution of EMDR

IntroductionThe treatment of psychological trauma is an integral part of the health care provided to military patients in Tunisia. For patients with PTSD several therapeutic options are proposed to patients as EMDR but there are various barriers to the use of EMDR . It seems that being patients consider the therapy which necessitate recognition and expression of emotional distress as a weakness. Added to that patients may be judged negatively by others and experiencing social rejection and isolation which limited the use of EMDR in a military setting.ObjectivesThe aim of this study is to study the contribution of the EMDR associated to pharmacological treatment in PTSD among military patients comparing to patients who received only medication .MethodsThe study was conducted since 2021 during ten months at the military hospital concerned two groups of patients with PTSD the first one composed of four military patients with PTSD who received 11 sessions of EMDR associated to medication and the second one four patients exposed to the same trauma under medication only. The evolution oftroubles were assessed using PCL-5 scale and medication compliance was assessed by psychometric scale MARS .Other data was gathered from medical files .ResultsThe first group of four military patients who were followed for PTSD since a year under pharmacological treatment presented sleep disorders with flaschbaks and nightmares , . The patients consulted for a depressive disorder and asocial isolation with feelings of insecurity about others. Psychiatrists proposed to associate 11 sessions of EMDR . At the end of sessions the evolution was interesting with regression of symptoms and remission comparing to the second group who presented relapses ten months later.ConclusionsTo improve symptoms of PTSD The use of EMDR is not systematic in a culture where emotional expression is restrictive in an environment that favors the intellect over the emotions. However EMDR can help the military patients with PTSD to link cognition to the emotions. PsychiatristS should propose this therapy as well as possible to patient with severe trauma to avoid relapse .Disclosure of InterestNone Declared

Affective communication with patients with limited health literacy in the palliative phase of COPD or lung cancer: Analysis of video-recorded consultations in outpatient care.

Affective communication in outpatient care is important, especially in the palliative phase. Appropriate responses by healthcare providers to emotional cues or concerns let patients express their feelings and enhance information recall and patient satisfaction. Patients with limited health literacy experience more barriers in health-related communication and information, which makes recognizing their cues and concerns even more relevant. This study explores emotional cues/concerns expressed by patients with limited health literacy and evaluates healthcare providers' responses to these utterances. Verona Coding Definitions of Emotional Sequences (VR-CoDES), a consensus-based system for coding patients' expression of emotional distress in medical consultations, was used in this exploratory observational study to analyse affective communication in video-recorded outpatient consultations. Consultations of 18 (10 female, 8 male) COPD or lung cancer patients (aged 70.3±6.8) with limited health literacy were recorded and analysed. Eight healthcare providers in four hospitals participated in the study. 101 cues and 11 concerns were observed, making 6.2 (SD = 4.2) cues or concerns per consultation. Healthcare provider responses were explicit in 56% and left scope for further disclosures in 58% of the cases. Patients with limited health literacy seem to express more cues or concerns than other patient populations. Healthcare providers responded roughly equally often in five different ways, but they shied away from further exploring the emotion disclosed in the cue/concern. Future research should elaborate on these exploratory observations, especially regarding why HCPs often only leave limited space for further disclosure of emotions in palliative care.

Detecting anxiety and depression among people with limited literacy living with chronic low back pain in Nigeria: adaptation and validation of the hospital anxiety and depression scale

BackgroundThe Hospital Anxiety and Depression Scale (HADS) is one of the most popular measures of anxiety and depression. The original HADS is mostly used in Nigeria precluding people with limited literacy. This study aimed to cross-culturally adapt and psychometrically test the HADS for rural and urban Nigerian Igbo populations with chronic low back pain (CLBP) who have limited literacy.MethodsThe HADS was forward translated, back translated, and appraised. Face and content validity was ensured by pre-testing the translated measure among a convenience sample of twelve rural Nigerian dwellers with CLBP. Reliability utilising Cronbach’s alpha, intraclass correlation coefficient, Bland–Altman plots and minimal detectable change were investigated amongst a convenience sample of 50 people living with CLBP in rural and urban Nigerian communities. Construct validity testing involving correlations between Igbo-HADS and Roland Morris Disability Questionnaire measuring self-reported back pain-specific disability, World Health Organisation Disability Assessment Schedule assessing generic self-reported disability, Fear Avoidance Beliefs Questionnaire measuring fear avoidance beliefs, and eleven-point box scale assessing pain intensity, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among a random sample of 200 adults with CLBP in rural Nigerian communities were conducted.ResultsIdioms and colloquialisms were difficult to adapt. Internal consistency was good (α = 0.78) and acceptable (α = 0.67) for anxiety and depression subscales respectively. Intraclass correlation coefficients were very good (ICC ≃ 0.8) for both subscales. Minimal detectable change was 6.23 and 5.06 for anxiety and depression subscales respectively. The Igbo-HADS and the anxiety subscale had strong correlations (≃ 0.7) with generic self-reported disability; moderate correlations (≃ 0.5–0.6) with pain intensity, self-reported back pain-specific disability, and fear avoidance beliefs. The depression subscale had the lowest correlations (≃ 0.3–0.4) with these outcomes. The EFA produced a two-factor structure with cross-loading of items. The CFA showed poor fit indices for the EFA structure, the original two-factor structure, and one-factor structure.ConclusionThe HADS may not be suitable for assessing anxiety and depression, or emotional distress in this population due to difficulty achieving cross-cultural equivalence with western idioms; and the expression of emotional distress through somatisation in this culture.

Masked Depression: Profile and Severity of Symptoms and Impulsivity in Patients with Generalized Anxiety Disorder

Major depressive disorder may remain underdiagnosed as it can be hidden behind somatic complaints or behavioral problems such as impulsivity, making other symptoms difficult to be recognized. The aim of the study was to determine the presence of depression in a sample of patients first-time diagnosed with generalized anxiety disorder that do not refer symptoms related to depression and to compare anxiety symptoms profile and impulsivity features between depressed and non-depressed patients. A total of 86 patients with DSM-IV diagnosis of GAD were recruited from the outpatient psychiatric services of the General Hospital of Comalcalco, Tabasco. Anxiety symptom severity and impulsivity were assessed with previously validated instruments. Depression was rated with the Hamilton Depression Rating Scale and the sample was categorized in depressed and non-depressed patients. More than half of the patients (54.7%) were identified as clinically depressed. These patients reported more severe anxiety symptomatology and more impulsivity than non-depressed patients; depressed patients also reported more somatic symptoms (e.g., gastrointestinal and hypochondriasis) which patients might identify as anxiety symptoms. In Latin-America, it is very common to use somatic symptoms as idioms of expression of emotional distress. Therefore, in patients with GAD with high levels of somatic complaints and impulsivity, depression should be evaluated.

Expressions of emotional distress in active duty military personnel with mild traumatic brain injury: A qualitative content analysis

ABSTRACTService members (SMs) who sustain traumatic brain injury (TBI) during deployment have increased risk for mental health issues. Mental health treatment can be challenging in military settings where treatment seeking is often stigmatized. Adequate care relies on accurate interpretations of SMs’ verbal accounts of distress, but little is known about how SMs, embedded in a culture that values resilience and self-reliance, relay emotional distress. We performed qualitative analyses of recordings from a telephone-based intervention with 25 SMs who sustained deployment-related mild TBI (mTBI) to elucidate thematic and dialectal patterns. Consistent with our expectations, SMs rarely used explicit depressive terms while discussing their emotional distress. More prevalent was language suggestive of an overarching theme of loss of control, whereby SMs’ stress, anxiety, and anger were often attributable to SMs’ perceptions that they had incomplete jurisdiction over their own lives. This study may help mental health providers improve engagements with SMs and Veterans, preventing misunderstandings and even improper diagnoses or referrals that could result from a strict reliance on the more customary expressions of distress.

Parent emotion regulation socializes children's adaptive physiological regulation.

Parenting practices play a major role in socializing children's developing regulatory abilities, but less is known about how parents' regulatory abilities relate to children's healthy functioning. This study examined whether parents' physiological and emotion regulation abilities corresponded to children's physiological and emotional responding to a structured laboratory-based disappointment task. Ninety-seven 3- to 7-year-olds (56 girls; M = 5.79 years) and one parent participated in a multi-method assessment of parents' and children's regulatory functioning. Direct (coaching children to use reappraisal) and indirect (resting physiology, dispositional use of reappraisal) aspects of parents' regulatory abilities were assessed. As expected, an adaptive pattern of parent regulatory abilities composed of higher resting respiratory sinus arrhythmia, use of reappraisal, and coaching reappraisal was associated with children's physiological reactivity after a disappointment indicative of more effective physiological calming in a recovery context (increased parasympathetic activation). In contrast, parents' regulatory abilities did not relate to changes in children's expressions of emotional distress.

The use of supportive communication when responding to older people\u2019s emotional distress in home care \u2013 An observational study

BackgroundResponding to older people’s distress by acknowledging or encouraging further discussion of emotions is central to supportive, person-centred communication, and may enhance home care outcomes and thereby promote healthy aging. This observational study describes nursing staff’s responses to older people’s emotional distress, and identify factors that encourage further emotional disclosure.MethodsAudio-recorded home care visits in Norway (n = 196), including 48 older people and 33 nursing staff, were analysed with the Verona Coding Definitions of Emotional Sequences, identifying expressions of emotional distress and subsequent provider responses. The inter-rater reliability (two coders), Cohen’s kappa, was >0.6. Sum categories of emotional distress were constructed: a) verbal and non-verbal expressions referring to emotion, b) references to unpleasant states/circumstances, and c) contextual hints of emotion. A binary variable was constructed based on the VR response codes, differentiating between emotion-focused responses and responses that distanced emotion. Fisher’s exact test was used to analyse group differences and determined variables included in a multivariate logistic regression analysis to identify factors promoting emotion-focused responses.ResultsOlder people’s expressions of emotional distress (n = 635) comprised 63 explicit concerns and 572 cues. Forty-eight per cent of nursing staff responses (n = 638) were emotion-focused. Emotion-focused responses were observed more frequently when nursing staff elicited the expression of emotional distress from the patients (54%) than when patients expressed their emotional distress on their own initiative (39%). Expressions with reference to emotion most often received emotion-focused responses (60%), whereas references to unpleasant states or circumstances and contextual hints of emotion most often received non-emotion-focused responses (59%). In a multivariate logistic model, nursing staff’s elicitation of the emotional expression (vs patients initiating it) and patients’ expression with a reference to an emotion (vs reference to unpleasant states or contextual hints) were both explanatory variables for emotion-focused responses.ConclusionsEmotion-focused responses were promoted when nursing staff elicited the emotional expression, and when the patient expression referred to an emotion. Staff responded most often by acknowledging the distress and using moderately person-centred supportive communication. More research is needed to establish generalizability of the findings and whether older people deem such responses supportive.

Conversion disorder in adolescents: A review and case report

IntroductionConversion disorder (CD) is an uncommon but highly disabling condition. Affected children and adolescents are often severely impaired and at risk of serious long-term physical and psychosocial complications. Despite the enormous personal suffering and health resource implications of CD, little research has been done.ObjectivesTo update our knowledge about CD in adolescents, with a comprehensive review of the literature with special focus in prevalence, psychosocial factors, diagnosis, treatment and outcome.AimsTo present the most relevant data of our review with a clinical illustration that provides a practical vision of this disorder.MethodsA systematic literature review was performed in MEDLINE, with particular interest in papers published in the last 10 years. Clinical illustration is provided by a case selected from an outpatient child and adolescent mental health service.ResultsFew reliable prevalence data are available; the range goes from 0.2 in a German study to 31% in non-western clinical settings. Diagnosis is based on a constellation of features and treatment should involve several heath care professionals. CD has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate even after recovery from conversion symptoms. Long clinical follow-up seems appropriate.ConclusionsThe expression of emotional distress in the form of physical complaints is common in children. Nevertheless, the most severe presentation of physical symptoms is not a common topic in literature. More research should be done to improve our understanding of this disabling disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.

How head and neck consultants manage patients' emotional distress during cancer follow-up consultations: a multilevel study.

Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant-reduced space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.

Sociological Scholarship on Gender Differences in Emotion and Emotional Well-Being in the United States: A Snapshot of the Field

This article provides a brief overview of scholarship on gender differences in emotion and emotional well-being among adults in the United States, highlighting major substantive findings, methodological innovations, and theoretical developments that have emerged in the sociologies of emotion and mental health. Sociological research consistently finds that men report more frequent positive and less frequent negative feelings than women as well as gender differences in both the experience and expression of emotional distress. Sociologists attribute these gendered patterns of emotion to the larger social, economic, and cultural context surrounding women and men. Overall, by identifying macro- and meso-level social causes of microlevel emotional processes, sociologists have made significant contributions to knowledge about gender differences in emotion and emotional well-being in the US.

Emotional Distress and Compassionate Responses in Palliative Care Decision-Making Consultations

Seriously ill hospitalized patients and their loved ones are frequently faced with complex treatment decisions laden with expressions of emotional distress during palliative care (PC) consultations. Little is known about these emotional expressions or the compassionate responses providers make and how common these are in PC decision-making conversations. To describe the types and frequency of emotional distress that patients and loved ones express and how providers respond to these emotions during PC decision-making consultations with seriously ill hospitalized patients. We used a quantitative descriptive approach to analyze 71 audio-recorded inpatient PC decision-making consultations for emotional distress and clinicians' responses to those emotions using reliable and established methods. A total of 69% of conversations contained at least one expression of emotional distress. The per-conversation frequency of expressions of emotional distress ranged from 1 to 10. Anxiety/fear were the most frequently encountered emotions (48.4%) followed by sadness (35.5%) and anger/frustration (16.1%). More than half of the emotions related to the patient's feelings (53.6%) and 41.9% were related to the loved ones' own emotions. The majority of emotions were moderate in intensity (65.8%) followed by strong (20.7%) and mild (13.5%). Clinicians responded to a majority of emotions with a compassionate response (75.7%) followed by those with medical content (21.9%) and very few were ignored (1.3%). Expressions of emotional distress are common during PC consultations and are usually met with compassionate responses by the clinician.

How Do Medical Students Respond to Emotional Cues and Concerns Expressed by Simulated Patients during OSCE Consultations? – A Multilevel Study

ObjectivesHow medical students handle negative emotions expressed by simulated patients during Objective Structured Clinical Examinations (OSCE) has not been fully investigated. We aim to explore (i) whether medical students respond differently to different types of patients’ emotional cues; and (2) possible effects of patients’ progressive disclosure of emotional cues on students’ responses.MethodsForty OSCE consultations were video recorded and coded for patients’ expressions of emotional distress and students’ responses using a validated behavioural coding scheme (the Verona Coding Definitions of Emotional Sequence). Logistic multilevel regression was adopted to model the probability of the occurrence of student reduce space response behaviour as a function of the number of patients’ expressions of emotional cues.ResultsWe found that medical students offered responses that differed to emotional cue types expressed by simulated patients. Students appeared to provide space to emotional cues when expressed in vague and unspecific words and reduce space to cues emphasizing physiological or cognitive correlates. We also found that medical students were less likely to explore patients’ emotional distress nearer the end of the consultation and when the duration of a patient speech turn got larger. Cumulative frequency of patients’ emotional cues also predicted students’ reduce space behaviour.Practical ImplicationsUnderstanding how medical students manage negative emotions has significant implications for training programme development focusing on emotion recognition skills and patient-centred communication approach. In addition, the statistical approaches adopted by this study will encourage researchers in healthcare communication to search for appropriate analytical techniques to test theoretical propositions.

A prospective study of family conferences (FCs) in a palliative care unit (PCU) at a comprehensive cancer center.

9127 Background: TheFC provides the family information and emotional support in the transition to end-of-life care. There are a few, mainly qualitative, studies of FCs in a palliative care setting. A retrospective report suggested increased emotional expression by family members when patients were not present in the FC. The purpose of our study was to determine the characteristics of FCs and the effect of patient participation on emotional expression by family members. Methods: A prospective study was conducted during 18-month period with140 consecutive FCs conducted by an interdisciplinary team (palliative care physician, social worker, and others). Data collected included demographics, discharge disposition, number of participants, caregiver characteristics, expressions of emotional distress, conflict with healthcare providers, and topics discussed. Descriptive statistics and frequencies were calculated. Analysis was performed using a chi-square test. Results: 70 patients (50%) were female, 64 (46%) white, 127 (91%) with solid tumors and a median age of 59. In 68/140 family meetings (49%), patients actively participated. The primary caregivers were predominantly female (66%), white (49%), and either the spouse or partner (59%). A median number of 4 family members and 4 healthcare providers attended the FCs with median duration of 1 hour and median of 2 days prior to discharge. Questions concerning advanced directives, symptoms anticipated at death and caregiver well-being were infrequent. Patients verbalized distress frequently, (73.1%). Primary caregivers emotional expression of verbal distress were high but not significantly affected by patient presence (82% vs 82%, P:NS); however, verbal expressions of emotional distress by family were more common when patients were absent (87%) than when present (73%), p = 0.037. Conclusions: There was a high frequency of expression of emotional distress by patients and family members. Patient participation was associated with decreased verbal emotional expression by family members but not the primary caregiver. Further studies are needed on the benefits of allocating additional time to meet with family members without patient presence during a FC.

From the Editors’ Desk: Challenging Problems, Challenging Patients

According to the World Health Organization, depression affects more than 120 million persons worldwide and is a significant cause of disability. In fact, as assessed by disability adjusted life years (or DALYs), depression now ranks 2nd for men and women in the 15–44 age group. Along with other mental and behavioral disorders, it is also one of the most common problems seen in primary care, and is a frequent accompaniment to many chronic illnesses. In this issue of JGIM, several papers examine depression and other mental/behavioral health disorders from a variety of perspectives. Sorkin et al. report on a study of the mental health needs and barriers to care among older Asian Americans in the US. They found that while expression of emotional distress and utilization of mental health services varied among the six Asian subgroups studied, several groups continue to underutilize care, possibly because of stigma and other cultural barriers. This study reminds us that our patients continue to confront more barriers to access quality care for mental and behavioral health conditions than for most of the other medical problems we manage. Access to care does not guarantee satisfactory outcomes. Prior research has shown that many patients with depression continue to have significant symptoms despite an adequate trial of antidepressant medication. How to manage patients with ‘treatment resistant depression’ has been an ongoing challenge for clinicians and researchers. Trivedi et al. report on a systematic review of psychotherapy for patients with treatment resistant depression to determine if the evidence supports the use of psychotherapy to augment or substitute for drug therapy. They conclude that while there is insufficient evidence to draw any firm conclusions, psychotherapy (primarily cognitive therapy) is likely underutilized by primary care providers and should be considered as an option for patients with treatment resistant depression. Also in this issue, a study by Bayliss et al. reminds us that primary care patients with depression usually also have other medical co-morbidities that complicate their care. In contrast with some prior research, they found that incident depression did not worsen clinical outcomes in a cohort of patients with diabetes. Patients with underlying mental disorders such as depression areoftenchallengingforphysicianstocareforandaremorelikely to be perceived as “difficult”. In this issue, Hinchey and Jackson present findings from a fascinating study that examined predictors and outcomes of difficult patient encounters in primary care. As they point out, most of the previous work in this area has focused on patient behavior. This study adds to our understanding of difficult encounters by more closely examining physician factors that are associated with difficult encounters and by looking at outcomes. They found that physicians with feweryearsofclinicalexperienceandthosethatratedloweronthe

Expressions of Emotional Distress by Seriously Ill Hospitalized Patients in Admission Encounters with Hospital-Based Physicians (701)

1.Discuss the frequency with which seriously ill hospitalized patients directly and indirectly verbally express negative emotion to physicians.2.Identify the most common topics about which seriously ill hospitalized patients express emotion.3.Describe the most common types of emotion that hospitalized patients express to physicians. Background. Research on how seriously ill patients express emotional distress to providers has focused on outpatients. Hospital admission may cause different and additional emotional distress. Research objectives. To describe how seriously ill patients express emotion to providers in the hospital. Methods. Cross-sectional observational study conducted on medical services at two hospitals within a university system between August 2008–March 2009. We recruited patients who were able to communicate verbally about their medical care and whose death or ICU transfer within the next year would not surprise their physician. Each patient's admission encounter with the attending hospital-based physician was audio-recorded. A codebook was iteratively developed, based on previous work, to identify instances where patients expressed negative emotion verbally, either directly, eg “I'm scared” or indirectly, eg “That's the hardest part.” Two coders independently coded 20% of encounters; kappa statistic for identification of expressions of emotion was 0.76, indicating substantial agreement. We categorized each expression by topic, and categorized direct expressions by type of emotion. Results. We audio-recorded 34 admission encounters (patient consent rate 66%). The median number of expressions of negative emotion per encounter was 2.5, range 0-15; 82% of encounters included at least one expression. Of 112 total expressions, 62% were indirect. Patients expressed emotion about the following topics: medical diagnoses and treatments (38%), symptoms and functional concerns (37%), the health care system (22%), social issues (15%), and death and dying (4%). In the direct expressions of emotion, anxiety was expressed most frequently (30%), followed by fear (21%), surprise (14%), depression (12%), and anger (5%). Conclusion. Expressions of emotion were of similar topic and type to those described in the outpatient setting. Compared to outpatient studies, we found a higher frequency of emotional expression, primarily in indirect expressions. Implications for research, policy, or practice. Expressions of emotion represent opportunities for hospital-based providers to provide emotional support.

Intrahousehold Disparities in Women and Men's Experiences of Water Insecurity and Emotional Distress in Urban Bolivia

This study is one of the first to examine the links connecting water insecurity, gender, and emotional distress. The article presents quantitative and qualitative analyses of interview data collected from randomly selected pairs of male and female household heads (n=48) living under the same household-level conditions of water insecurity., The results provide partial confirmation of past findings that women are more likely than men to be burdened with everyday water responsibilities. However, there were no significant differences between men's and women's experiences in household water emergencies (i.e., water shortages and last-ditch attempts to buy water) and reports on some measures of emotional distress (i.e., worry, annoyance, and anger with family members). The results suggest that intrahousehold gender disparities may be mitigated in times of severe water scarcity. The discussion raises questions about the comparability of men's and women's expressions of emotional distress.

Longitudinal examination of the associations between emotional dysregulation, coping responses to peer provocation, and victimisation in children

This study examined the role of emotional dysregulation and coping responses to peer provocation in predicting peer victimisation. Participants were 255 children aged 11–14 years who were assessed on two occasions at a 3-month interval. Cross-sectionally, gender was found to moderate the relationship between emotional dysregulation and victimisation. Girls who reported high levels of victimisation tended to experience problems in the emotional regulation of anger and greater use of internalising and aggressive coping strategies. Boys who reported high levels of victimisation were more likely to experience emotional dysregulation of sadness and reported greater use of internalising coping responses. Longitudinally, emotional dysregulation of anger, and coping responses to peer provocation that involve aggressive reactions or expressions of emotional distress, increased the risk of future victimisation in both genders. Preventive interventions should include training in emotional regulation and coping skills for children at risk of persistent victimisation.

Suicide Attempt and Sexual Risk Behavior: Relationship among Adolescents

The objective of this study was to examine the relationship between a history of suicide attempt and a range of current sexual risk behaviors in a large sample of sexually high-risk adolescents. Baseline data from 1,245 sexually active 15 to 21 year olds were collected as part of a multi-site, randomized trial of a brief HIV prevention program. Measures were collected using audio computer assisted self-interviews. Accounting for demographic, contextual, and substance use variables, a lifetime history of suicide attempt significantly added to multivariate regression models predicting sexual risk. Inconsistent condom users were almost twice as likely to have attempted suicide, and adolescents with an STI diagnosis were approximately twice as likely to have a history of suicide attempt. A history of suicidal behavior can be identified by clinicians and appears to be an important marker for sexual risk, which may represent an expression of emotional distress or a passive form of self-injury for suicidal adolescents.

Cultural interpretations of an emerging health problem: blood pressure in Dar es Salaam, Tanzania

This paper examines how a lower middle class community in an urban quarter of Dar es Salaam, Tanzania experiences the relatively new health problem of high blood pressure. Unlike previous research that focused on cultural risk factors or attempted to extract cultural models of hypertension, our study contributes to the growing body of literature that examines illness experience as a representation or embodiment of social suffering. The participants in this study use the local expressions ‘BP’ or ‘presha’ (from blood pressure) to refer to an illness that overlaps but is not synonymous with the biomedical conception of hypertension. The local concepts draw on biomedical notions of hypertension and, in addition, incorporate a range of afflictions into the symptomatology and aetiology that mirror their experiences of an increasingly harsh urban life. The concept of ‘BP’, therefore, is not bound to the body in a medical sense. As a broader and more complex syndrome, ‘BP’ is a somatic expression of emotional distress that links the body with the lived experience in this urban setting. Our approach of analysing cultural interpretations of ‘BP’ as an emerging health problem in this particular urban context calls for a more comprehensive response in diagnosis and treatment.