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Disasters pose a documented risk to mental health, with a range of peri- and post-disaster factors (both pre-existing and disaster-precipitated) linked to adverse outcomes. Among these, increasing empirical attention is being paid to the relation between disasters and violence.
This study examined self-reported experiences of assault or violence victimisation among communities affected by high, medium, and low disaster severity following the 2009 bushfires in Victoria, Australia. The association between violence, mental health outcomes and alcohol misuse was also investigated.
Participants were 1016 adults from high-, medium- and low-affected communities, 3–4 years after an Australian bushfire disaster. Rates of reported violence were compared by areas of bushfire-affectedness. Logistic regression models were applied separately to men and women to assess the experience of violence in predicting general and fire-related post-traumatic stress disorder, depression and alcohol misuse.
Reports of experiencing violence were significantly higher among high bushfire-affected compared with low bushfire-affected regions. Analyses indicated the significant relationship between disaster-affectedness and violence was observed for women only, with rates of 1.0, 0 and 7.4% in low, medium and high bushfire-affected areas, respectively. Among women living in high bushfire-affected areas, negative change to income was associated with an increased likelihood of experiencing violence (odds ratio, 4.68). For women, post-disaster violence was associated with more severe post-traumatic stress disorder and depression symptoms.
Women residing within high bushfire-affected communities experienced the highest levels of violence. These post-disaster experiences of violence are associated with post-disaster changes to income and with post-traumatic stress disorder and depression symptoms among women. These findings have critical implications for the assessment of, and interventions for, women experiencing or at risk of violence post-disaster.
Changes in the organisation and delivery of psychiatric services are likely to increase the stigma of mental illness, reduce the role of the psychiatrist, and inhibit recruitment of the best medical students. The value of close integration with the district general hospital and medical school is stressed. The future of psychiatry will be in doubt if this is ignored.
At least one ethical committee is not prepared to approve open continuation studies of treatments for dementia. The author considers that such studies are an ethical necessity if patients are to give six months of their illness to trying out what may be placebo. The reasons for this conflict are discussed. In particular, it is suggested that such studies contribute real scientific information.
We thank Dr. A. Gauzzi and Dr. D. Pavuna for bringing to our attention their comments on our article “Ion beam sputter deposition of YBa2Cu3O7−δ,” as it gives us the opportunity to clear up some discrepancies, make more explicit some of the results, and correct unintended misunderstandings.
The shift of power from specialist services to the primary care teams has forced the former to examine the value of their hallowed traditions. In psychiatry, and geriatric medicine, the catchment area is a favoured restrictive practice, enabling demand to be regulated to suit the resources of each team. It is time to decide whether this is a practice to be defended and retained or whether, like many other restrictive practices, it is harmful to the consumer.
A Darwinian might question the role of sexual behavior in the elderly, pointing out that the purpose of any species was to increase its kind, and coitus beyond the menopause had little to contribute to this aim. If so, he would be mistaken, because the sexual act is not only penetration and fertilization, but is preceded by grooming, whose purpose in primates is to reinforce social bonds. As the human child takes at least 15 years to reach physical maturity, the survival of the last born will depend on this bond lasting until the mother is 65, and the male 70 (due to the need of the female to chose her mate on his status he is usually older by five years (OPCS, 1992)). The earlier death of the male (his expectation of life in the UK in 1988 was 72.4 compared to 78 for the female (OPCS, 1992)) might suggest that he plays a lesser role in child-rearing, or is not really adapted to monogamy (Reynolds & Kellett, 1991). The advantage to the species of prolonging life beyond this point is more controversial, though the elderly may stabilize society as carriers of the culture and provide support for their progeny in rearing their children. Either way, the preservation of the marriage bond can improve the quality of the couple's lives as they compensate for their declining abilities. Male carers of demented wives do better when the sexual contact is retained (Morris, Morris & Britton, 1988).
Forty-eight couples with a presenting problem of female sexual unresponsiveness were treated in a controlled study using a balanced factorial design. The factors varied in this design were medication (testosterone or placebo), treatment frequency (weekly or monthly sessions), and the number of therapists involved (one female or a male/female pair). All counselling was adapted from that described by Masters & Johnson (1970) and Heiman et al. (1976). Results were assessed before and after a 3-month treatment period, and again 6 months later. Contary to expectations from earlier work, there was no benefit attributable to testosterone or to the use two therapits; selfrating favoured weekly sessions with one therapist.