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Depression is associated with significantly higher healthcare costs in FFS Medicare recipients with diabetes mellitus and CHF. Only a small proportion of the increased costs are spent on mental health specialty care.

The aim was to understand the factors influencing informal disclosure of child sexual abuse experiences, taking account of dynamics operating prior to, during, and following disclosure. In-depth semi-structured interviews were conducted with 22 young people who experienced child sexual abuse and 14 parents. Grounded theory methodology informed the study. The key factors identified as influencing the disclosure process included being believed, being asked, shame/self-blame, concern for self and others, and peer influence. Many young people both wanted to tell and did not want to tell. Fear of not being believed; being asked questions about their well-being; feeling ashamed of what happened and blaming themselves for the abuse, for not telling, and for the consequences of disclosure; concern for how both disclosure and nondisclosure would impact on themselves and others; and being supported by and yet pressurized by peers to tell an adult, all illustrate the complex intrapersonal and interpersonal dynamics reflecting the conflict inherent in the disclosure process. These findings build on previous studies that emphasize the dialogic and interpersonal dynamics in the disclosure process. Both intrapersonal and interpersonal influencing factors need to be taken account of in designing interventions aimed at helping children tell. The importance of asking young people about their psychological well-being and the role of peer relationships are highlighted as key to how we can help young people tell.

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This study reports a grounded theory study of the process of how children tell of their experiences of child sexual abuse from the perspectives of young people and their parents. Individual interviews were conducted with 22 young people aged 8 to 18, and 14 parents. A theoretical model was developed that conceptualises the process of disclosure as one of containing the secret of child sexual abuse. Three key dynamics were identified: the active withholding of the secret on the part of the child, the experience of a 'pressure cooker effect' reflecting a conflict between the wish to tell and the wish to keep the secret, and the confiding itself which often occurs in the context of an intimacy being shared. Children's experiences of disclosure were multidetermined and suggest the need for multifaceted and multisystemic approaches to prevention and intervention. The need for the secret to be contained, individually and interpersonally in appropriate safeguarding and therapeutic contexts needs to be respected in helping children tell.

Maintenance lithium produces a highly significant reduction in relapses. The mirror-image studies had not been systematically analysed previously, and they support the effectiveness of lithium. We also failed to find sufficient evidence to prove that the lithium-withdrawal relapse phenomenon exists.

This article explores the processes through which dependence on opiates affects parenting capacity and family processes. The findings are based on in-depth interviews with 100 parents (50 drug-using [opiate dependent] and 50 non-drug using) living in Dublin. Qualitative analyses of semi-structured interviews suggest that opiate dependence has a specific impact on parenting processes and particularly on the physical and emotional availability of parents and on the capacity of parents to provide an emotionally consistent environment. Parenting behaviours were linked, based on parents' perspectives, to elements of the culture surrounding illicit drugs and their supply and acquisition, to drug treatment regimes and to the physiological and psychological effects of drugs. The implications for children's development and well-being, and for support of affected families, are considered.

Parents' values for their children and their beliefs about appropriate child-rearing practices contribute to the ways in which they try to shape their children's development. This paper examines the values and beliefs of 71 parents (37 mothers and 34 fathers) from two cities in the United States and Russia. Half of the families were middle class (determined by education and occupation criteria) and half were working class. The results revealed no cross-societal differences in value for self-direction in the children; perhaps reflecting the recent economic and ideological changes in Russia. In contrast, significant social class differences, for both mothers and fathers, were found in childrearing values and beliefs. Middle class parents in both societies were more likely to value self-direction and believe that children should have freedom in and around the home, whereas working class parents were more likely to believe that children should be expected to conform to rules. The results of this study underscore the role of within-society heterogeneity, as a function of social class, in parents' values and beliefs about child-rearing.