Sleep complaints associated with wish to die after a suicide crisis-an exploratory study.

The present study explores whether sleep concerns are associated with wish to die throughout a 1-month time interval following a suicide crisis. Sixty-eight patients admitted to the emergency department of a general or psychiatric hospital were enrolled. Sleep difficulties were assessed using the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale, self-reported satisfaction with sleep and time in bed. Suicidal ideation was assessed through the presence of a wish to die at 1 month following a suicide crisis. Co-existing psychiatric diagnoses were assessed using the French version of the Mini International Neuropsychiatric Interview (MINI). Potential covariate factors such as personal and family history of suicidal behaviours and sociodemographic variables were accounted for. We found that wish to die was associated significantly with insomnia severity, low satisfaction with sleep and sleep duration 1 month after the suicide crisis, even after controlling for covariates. This exploratory study is limited by a small sample size, and results cannot be generalized to patients with psychotic disorders or alcohol use disorders. Also, other factors related potentially to suicidal ideation, such as depression severity, stressful events or levels of family support, were not accounted for. However, overall our study supports the assessment of sleep complaints as a potential indicator of suicide risk in the weeks that follow a suicide crisis.

Medical students' self-evaluations of their patient-centered cultural sensitivity: implications for cultural sensitivity/competence training.

The goals of this study were to (1) empirically assess the need for training in patient-centered culturally sensitive health care among medical students and (2) determine if training in such care needs to be customized to some degree based on individual or subgroup differences. Two hundred seventeen advanced (third- and fourth-year) medical students from 4 medical schools participated. Participants self-reported their current levels of engagement in patient-centered culturally sensitive health care using an online version of the Tucker-Culturally Sensitive Health Care Inventory Provider Form. Results indicated that participating advanced medical students gave self-ratings of engagement in patient-centered culturally sensitive health care that indicate high engagement in some but not all of the behaviors and attitudes that indicate this care. Additionally, their self-ratings differed in association with their gender, race/ethnicity, being fluent in a language other than English, and prior experience providing health care to racial/ethnic minority patients. Conclusions include that some medical students need training in patient-centered culturally sensitive health care, and this training ideally should be assessment-based and customized to address areas where there are low self-ratings of engagement in patient-centered culturally sensitive health care.

Family interaction patterns and their association with family support among women with breast cancer.

BACKGROUND: Family support often plays a major role in helping women accept, cope with, and recover from breast cancer, and yet its association with specific family interaction patterns among racially diverse women facing breast cancer has been insufficiently examined. OBJECTIVE: The aim of the study was to examine what specific family interaction patterns exist among diverse women with breast cancer and determine if these family interaction patterns are significantly associated with levels of perceived family support and family support satisfaction reported by these women. METHODS: Participants were 73 white women and 18 African American women with breast cancer. RESULTS: Three different family interaction patterns were identified (ie, cohesive-expressive, conflictual, and nonexpressive). Also, (a) the African American women in cohesive-expressive families versus conflictual families were more satisfied with their emotional family support, (b) the non-Hispanic white women in conflictual families versus nonexpressive families perceived that they received significantly more tangible family support, and (c) the non-Hispanic white women in cohesive-expressive families and those in conflictual families perceived that they received significantly more emotional support from their family members than did non-Hispanic white women in nonexpressive families. CONCLUSIONS: Three main family interaction patterns were found among African American and non-Hispanic white women with breast cancer, which were associated with levels of satisfaction with family support or perceived family support. IMPLICATIONS FOR PRACTICE: Findings from this study can be used to (a) more accurately assess the levels of satisfaction with family support experienced by diverse women with breast cancer and (b) implement family interventions to increase family support for these women.

Validation of a provider self-report inventory for measuring patient-centered cultural sensitivity in health care using a sample of medical students.

The paper describes the construction and initial evaluation of the new Tucker-Culturally Sensitive Health Care Inventory (T-CSHCI) Provider Form, which was developed to address the shortcomings of existing similar measures. Two hundred seventeen (217) 3rd and 4th year medical students completed the T-CSHCI-Provider Form. Factor analysis was used to identify non-overlapping items. The final solution produced five factors: patient-centeredness, interpersonal skills, disrespect/disempowerment, competence, and cultural knowledge/responsiveness. The five T-CSHCI-Provider Form factors/subscales proved to be reliable and were associated with related constructs as hypothesized. This study provides initial evidence that the T-CSHCI-Provider Form measures independent dimensions of patient-centered culturally sensitive health care as perceived by medical students. Recommendations for ways in which the T-CSHCI Provider Form can be used to guide culturally sensitive health care training are provided.

Assessments for measuring patient-centered cultural sensitivity in community-based primary care clinics.

OBJECTIVE: To develop and test the reliability of three race/ethnicity-specific forms of the pilot Tucker-Culturally Sensitive Health Care Inventory (T-CUSHCI) for use by patients at community-based primary care centers to evaluate the level of patient-centered cultural sensitivity perceived in the health care that they experience. METHODS: This research involved two studies using independent samples of primary care patients. In study 1, mostly low-income African-American, Hispanic and non-Hispanic white American patients (N=221) rated the importance of specific provider and office staff behaviors and attitudes, and center policies and physical environment characteristics that were earlier identified in previous focus groups as characteristics of patient-centered culturally sensitive healthcare. In study 2, three pilot race/ethnicity-specific T-CUSHCI patient forms were constructed from the items rated as at least important in study 1. Mostly low-income African-American and non-Hispanic white American patients (N=180) provided data to determine the reliability of the T-CUSHCI patient form for their racial/ethnic group. RESULTS: The pilot T-CUSHCI-African-American patient form and the pilot T-CUSHCI-non-Hispanic white American patient form were found to have Cronbach's alpha coefficients ranging from 0.71-0.96 and six-month test-retest and split-half reliabilities ranging from 0.92-0.99. CONCLUSION: The pilot T-CUSHCI patient forms (one each for African Americans, Hispanics and non-Hispanic whites) should be further tested using a national sample of patients. In the interim, these inventory forms can be used as clinical tools to obtain patient feedback for providing "individualized" patient-centered culturally sensitive healthcare.