RESUMEN
OBJECTIVES: To describe the trajectory of, and examine factors affecting, intimate partner violence (IPV) and IPV-specific healthcare seeking among Japanese women over the life course. STUDY DESIGN: Life course study. METHOD: One hundred and one women, aged 24-80 years, who had a lifetime history of IPV were interviewed in the Tokyo metropolitan area, Japan in 2005 and 2006. Life course data were collected according to the life history calendar method. Hierarchical linear modelling was used to examine IPV-specific healthcare seeking over the life course. RESULTS: Injury, formal or informal help seeking, public assistance, worse self-rated health status and smoking significantly increased the likelihood of IPV-specific healthcare seeking over the life course. There are significant cohort effects on healthcare seeking. The results suggest that women who experience IPV may seek healthcare services not only immediately after the first occurrence of IPV, but also later in life. CONCLUSIONS: IPV is not always associated with immediate healthcare seeking. In particular, sexual IPV is not significantly associated with healthcare seeking. Pursuing formal and informal help is associated with healthcare seeking.
Asunto(s)
Mujeres Maltratadas/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Maltrato Conyugal/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Mujeres Maltratadas/estadística & datos numéricos , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Investigación Cualitativa , Tokio , Adulto JovenRESUMEN
OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.
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Bisexualidad/psicología , Conductas Relacionadas con la Salud , Homosexualidad Femenina/psicología , Tamizaje Masivo/estadística & datos numéricos , Neoplasias/prevención & control , Adolescente , Adulto , Recolección de Datos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Mamografía/estadística & datos numéricos , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos/epidemiología , Frotis Vaginal/estadística & datos numéricosRESUMEN
Satisfaction data have recently returned to popularity, as an outcome measure in managed behavioral healthcare systems. However, there are few examples of management uses of such data. We collected data 12 months after participants had completed a supported education program, concerning their retrospective satisfaction and the barriers, needs, and personal difficulties currently experienced in their attempts to pursue post-secondary education or training. Data on follow-up supportive contacts were also obtained. Results supported participants' continuing satisfaction, and identified particular information items which were endorsed as most helpful. However, the data indicated that personal difficulties presented obstacles to many and that a majority of participants had current needs for financial aid, tutoring, job placements, support groups, and transportation. Following completion of the supported education program, many participants had continuing contacts in support of their educational plans. The amount of contact was generally low, however. In the future, supported education programs need to build in mechanisms to ensure students receive ongoing support for education, since this support was found to positively and significantly affect individuals' enrolling in college or training.
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Comportamiento del Consumidor , Escolaridad , Apoyo Social , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVE: This study evaluated the Michigan Farmers' Market Nutrition Program in one Michigan county to determine its effect on fruit and vegetable consumption behavior. SUBJECTS/SETTING: Subjects were selected from WIC and Community Action Agency populations: 564 low income women completed the pretest; 455 completed the posttest. Attrition rate was 19.3%. INTERVENTION: Subjects were assigned to one of 4 interventions: education about the use, storage and nutritional value of fruits and vegetables, distribution of farmers' market coupons, both education and coupons, or no intervention. DESIGN: Education-only and coupon and education groups were randomly assigned; clinic appointment timing determined assignment to no-intervention and coupon-only groups. MAIN OUTCOME MEASURES: A self-administered questionnaire before and after intervention measured attitudes about fruit and vegetable consumption and intake of fruits and vegetables. WIC records documented redemption of coupons. STATISTICAL ANALYSES: Data analysis included 2-way multivariate analysis of covariance, univariate analysis of covariance, logistic regression, and covariance structure modeling. RESULTS: Both the education interventions and the coupon interventions had positive effects. Coupons had a direct effect on increasing fruit and vegetable consumption behavior but no effect on attitudes. Education had a direct effect on attitudes and seemed to exert an effect on consumption behavior through attitudes. The maximum impact of the intervention was achieved through a combination of education and coupons. APPLICATIONS: This study demonstrated that a low-income population may be more likely to increase its fruit and vegetable consumption behavior when incentives such as coupons improve affordability.
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Ingestión de Alimentos , Frutas , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Pobreza , Verduras , Análisis de Varianza , Educación , Femenino , Manipulación de Alimentos , Frutas/economía , Humanos , Michigan , Motivación , Evaluación de Resultado en la Atención de Salud , Pobreza/economía , Factores Socioeconómicos , Encuestas y Cuestionarios , Verduras/economíaRESUMEN
Causes of hypertension that are amenable to surgical treatment constitute a very small but potentially important segment of the hypertensive population. These causes (which constitute frequently asked questions for medical students) include coarctation of the aorta, aldosterone and corticosteroid-producing tumors of the adrenal glands, lesions producing decreased renal blood flow, and pheochromocytoma. This latter tumor is quite uncommon, with a frequency of roughly one per million, but often produces dramatic hypertensive episodes. Due to its rarity, physicians in practice may not consider the diagnosis and appropriately evaluate the patient. We present the case histories of three patients with pheochromocytoma who demonstrate important features of this disease. Diagnostic evaluation and principles of treatment will be discussed.
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Neoplasias de las Glándulas Suprarrenales/complicaciones , Hipertensión/etiología , Feocromocitoma/complicaciones , Adolescente , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Femenino , Humanos , Hipertensión/cirugía , Masculino , Persona de Mediana Edad , Feocromocitoma/diagnóstico , Feocromocitoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Individuals with a severe mental illness now have greater opportunities to pursue normal adult roles, including parenting. The research reported involved 379 women carrying out parenting responsibilities, recruited from the public mental health system in an urban area. The sample displayed great heterogeneity in educational levels, number of children, number of fathers for their children, and family living arrangements, except that most women were very poor. These women faced many significant stresses: living alone with their children, significant child behavior problems, and financial worries. Still, most of the women endorsed the significance of motherhood in their lives. Inattention by most mental health providers to parenting issues leaves many important needs unmet and is likely to have adverse consequences for these women and their children. Implications for psychosocial rehabilitation practice are discussed.
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Estilo de Vida , Trastornos Mentales/rehabilitación , Madres/psicología , Estrés Psicológico/psicología , Adolescente , Adulto , Femenino , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Calidad de Vida/psicología , Características de la Residencia , Factores SocioeconómicosRESUMEN
OBJECTIVE: The study sought to identify characteristics of participants in a supported education program that were related to a successful outcome. Supported education programs provide rehabilitation and support services to help people attain postsecondary education. METHODS: A total of 147 persons who completed such a program were interviewed six or 12 months later, or at both times, to determine whether they were involved in productive activity, which was defined as engaging in either college or vocational education or in paid employment. Variables examined as predictors of productive activity were demographic characteristics; education and work background; social support; self-perceptions related to self-esteem, empowerment, quality of life, and school self-efficacy; and illness-related variables, including diagnosis, symptoms, and length of illness. RESULTS: Multivariate logistic regression identified the strongest predictor as productive activity at baseline. Marital status was the only significant demographic variable in the model; single participants were less likely to be engaged in productive activity. For participants who reported more frequent contact with their social network, the likelihood of engagement in productive activity was higher, and for those who reported more encouragement for education from their network, the likelihood was lower. A lower level of adjustment in the financial domain decreased the likelihood of productive activity, and a higher level of problems with housework increased the likelihood. No illness-related variable or self-perception was a significant predictor. CONCLUSIONS: Factors related to a successful outcome from a supported education program for persons with severe mental illness are also likely to be important factors for nondisabled populations. Among those with mental illness, social support is a key factor in attaining educational and vocational goals.
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Educación , Empleos Subvencionados , Trastornos Mentales/rehabilitación , Apoyo Social , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Autoimagen , Índice de Severidad de la Enfermedad , Ajuste Social , Resultado del TratamientoRESUMEN
Mental health services have generally ignored the parenting needs of women with serious mental illness. This chapter identifies the parenting risks and strengths that these women display, as well as the opportunities available to psychologists to play a key role in improving mother and child outcomes.
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Trastornos Mentales/psicología , Madres/psicología , Femenino , Humanos , Conducta Materna/psicología , Trastornos Mentales/terapia , Servicios de Salud Mental/provisión & distribución , Relaciones Madre-Hijo , Responsabilidad ParentalRESUMEN
Recent innovations to improve employment rates among persons with psychiatric disabilities include "hybrid case management/employment services." Project WINS was a research/demonstration project which integrated specialized vocational services into case management teams. In this report, client outcomes of WINS involvement are evaluated, using a quasiexperimental, longitudinal design. On almost all the work-related variables, participants in the immediate and delayed treatment conditions displayed better outcomes than those in the control condition, as did individuals receiving moderate or substantial service versus no/ minimal services. To address possible selection bias due to the quasiexperimental nature of the design, further analyses used baseline differences across conditions and participation levels as covariates. Results of multivariate analyses showed some anomalous findings regarding significant positive effects for the delayed, but not the immediate treatment condition versus the no-treatment control group. However, in similar analyses involving participation level as the independent variable, a moderate or substantial amount of service increased the odds of working by almost five times and also positively affected three other work-related variables. While limitations of this quasiexperimental design are noted, the results appear promising enough to support replications of WINS.
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Manejo de Caso/estadística & datos numéricos , Empleo/estadística & datos numéricos , Trastornos Mentales/rehabilitación , Grupo de Atención al Paciente/organización & administración , Rehabilitación Vocacional/métodos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Michigan , Evaluación de Resultado en la Atención de SaludRESUMEN
Coping is a critical theoretical concept believed to be a mediator for successful outcomes produced through a variety of different social work interventions. This article describes an approach used to measure coping with stressors and was designed specifically for an intervention, the Michigan Supported Education Research Project, aimed at providing support for people with psychiatric disabilities to pursue college or vocational education. Hypothetical scenarios were developed that matched the content of material covered in the program. Open-ended responses were elicited from program participants as part of an in-person interview. Key findings included a participation effect on the number of positive coping strategies of participants and a significant relationship among some coping strategies and later outcomes. Implications for social work practice and research are identified.
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Adaptación Psicológica , Educación , Trastornos Mentales/rehabilitación , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asistencia Social en Psiquiatría , Encuestas y CuestionariosRESUMEN
Many individuals with serious mental illnesses have co-occurring drug and alcohol problems. The research reported in this article examined an integrated inpatient mental illness-chemical dependency program and compared it with standard inpatient psychiatric treatment for two groups: those demonstrating high change from baseline to two-months postdischarge and those with negative or no change. Univariate analyses revealed significant differences in the change groups on baseline personal-clinical characteristics and on aspects of their social and physical environments. The results have implications for improving mental health practice by better predicting patients who will optimally benefit from inpatient treatment.
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Trastornos Mentales/terapia , Evaluación de Resultado en la Atención de Salud , Trastornos Relacionados con Sustancias/terapia , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Comorbilidad , Femenino , Humanos , Pacientes Internos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Estudios Longitudinales , Masculino , Trastornos Mentales/epidemiología , Alta del Paciente , Valor Predictivo de las Pruebas , Psicometría , Índice de Severidad de la Enfermedad , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
An intensive community-based advocacy intervention was designed and evaluated by randomly assigning 278 battered women to an experimental or control condition. Participants were interviewed 6 times over a period of 2 years. Retention rate averaged 95% over the 2 years. The 10-week postshelter intervention involved providing trained advocates to work 1-on-1 with women, helping generate and access the community resources they needed to reduce their risk of future violence from their abusive partners. Women who worked with advocates experienced less violence over time, reported higher quality of life and social support, and had less difficulty obtaining community resources. More than twice as many women receiving advocacy services experienced no violence across the 2 years postintervention compared with women who did not receive such services.
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Mujeres Maltratadas/educación , Redes Comunitarias/organización & administración , Violencia Doméstica/prevención & control , Servicio Social/métodos , Adolescente , Adulto , Mujeres Maltratadas/psicología , Defensa del Consumidor , Depresión/psicología , Violencia Doméstica/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Relaciones Interpersonales , Michigan , Persona de Mediana Edad , Calidad de Vida , Recurrencia , Ajuste Social , Apoyo Social , Voluntarios/educaciónRESUMEN
In recent years post-secondary education has been recognized as a viable option in the psychosocial rehabilitation of individuals with mental illness. This study reports the first evidence of effectiveness of a supported education demonstration project which used an experimental design to compare the effects of different model types. A total of 397 participants were assigned to one of three conditions: group, classroom, and individual (control). At graduation from the program significant differences in program participation rates were found; group members participated most, followed by classroom participants, then those assigned to the individual condition. Also, immediate, intermediate, and long term outcomes were examined. On four immediate outcomes (motivation, satisfaction, enjoyment, and learning) significant participation effects were found (high participants scoring highest, followed by moderate participants, and then non-participants). On two intermediate outcome (empowerment and school efficacy) condition differences were found (classroom scoring highest followed by group, then individual). Although no condition differences were found on behavioral outcomes, the percentage of individuals enrolled in school or vocational education was more than twice that reported at baseline. Overall, the results demonstrated success in engaging participants, affecting self-perceptions, and increasing enrollment in post-secondary education.
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Educación Especial/normas , Trastornos Mentales/psicología , Apoyo Social , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rehabilitación VocacionalRESUMEN
We examined the effects of intimate violence on the physical and psychological health of women over time. Changes in levels of physical and psychological abuse, injuries, physical health symptoms, anxiety, and depression were assessed three times: immediately after exit from a domestic violence program and at 81/2- and 141/2-month follow-ups. Analyses showed a significant decline in abuse, physical health symptoms, anxiety, and depression over time. Longitudinal structural equation modeling demonstrated that ongoing abuse was significantly related to increased physical and psychological health problems from one time period to the next, even when prior levels of physical and psychological health were controlled. Within each time interval, the effects of abuse on physical symptoms appeared to be mediated through anxiety and depression; although this relationship was replicated at several time points, the mediation was not verified across time, probably because measurement intervals were too long to reflect the underlying causal sequence. Although injuries were the direct result of abuse, injuries showed no significant effect on physical symptoms, anxiety, or depression. Implications for intervention and future research are discussed.
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Mujeres Maltratadas/psicología , Salud Mental , Salud de la Mujer , Adulto , Ansiedad , Defensa del Consumidor , Demografía , Depresión , Violencia Doméstica , Femenino , Estudios de Seguimiento , Humanos , Modelos Psicológicos , Modelos Estadísticos , Investigación , Heridas y Lesiones/psicologíaRESUMEN
Incidents of domestic violence are frequently not reported to police (e.g., Johnson, 1990; Langan & Innes, 1986; Roy, 1977), and people commonly assume that women's reasons for not calling about violence by a current or former partner are intrapersonal (e.g., shame, embarrassment, love). However, few researchers have asked battered women themselves about the frequency of their police contacts and their reasons for not calling the police. In this study, participants were recruited from a battered women's shelter and asked about their experiences with the police over the prior 6 months. Two thirds of the sample had had contact with the police during that time, but most did not have as much contact with the police as they had needed. Women gave multiple reasons for not calling the police; these reasons frequently included situational barriers, such as being physically prevented from using the telephone and/or being threatened with more violence. Only 3% of the sample reported that shame, embarrassment, or love were their sole reasons for not calling the police. Underreporting was related to previous (negative) experience with the police, as well as to the level of violence experienced. The practical implications of these findings are discussed.
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Mujeres Maltratadas/psicología , Motivación , Policia/estadística & datos numéricos , Maltrato Conyugal/prevención & control , Maltrato Conyugal/psicología , Adulto , Comportamiento del Consumidor , Miedo , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Amor , Evaluación de Necesidades , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Vergüenza , Maltrato Conyugal/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Rape victims have many emergency medical needs, yet there has been very little research examining whether victims are receiving desired assistance. In this study, 147 rape victim advocates were interviewed about their most recent case in which a victim has sought treatment in an emergency room (ER). The results of this study indicated that there is some inconsistency in which services victims receive and that many women did not obtain the resources they wanted. Some forms of assistance were not provided to victims due to lack of resources in their communities (e.g., follow-up medical care). Other services were not offered due to problems in the implementation of available services (e.g., the morning-after pill [ethinyl estradiol-norgestrel] to prevent pregnancy). This research also examined how characteristics of the hospitals, the assaults themselves, and the victims impacted whether women would receive desired help. These findings indicated that women who were treated in hospitals affiliated with the Catholic church; those who were raped by their friends, dating partners, or husbands; those who experienced multiple forms of forced penetration (vaginal rape and anal rape, oral rape, or rape by an object); women of Color; and victims who did not present a sympathetic demeanor in the ER were less likely to receive several forms of assistance, such as treatment of physical injuries, arranging follow-up medical care, information and treatment for sexually transmitted diseases, information on the risk of pregnancy, the morning-after pill, and information on the physical and psychological health effects of sexual assault. Victims who were taken to hospitals that had coordinated response teams (e.g., Sexual Assault Response Teams) to work with survivors were more likely to receive some forms of treatment (e.g., information on the physical and psychological health effects of sexual assault). Implications for future research and policy initiatives in women's health are discussed.
Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Servicios Médicos de Urgencia/normas , Defensa del Paciente/estadística & datos numéricos , Violación , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Víctimas de Crimen/clasificación , Víctimas de Crimen/psicología , Estudios Transversales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Funciones de Verosimilitud , Modelos Logísticos , Persona de Mediana Edad , Violación/psicología , Muestreo , Estados UnidosRESUMEN
OBJECTIVE: Supported education programs provide assistance, preparation, and support to individuals with psychiatric disabilities who desire to pursue postsecondary education. To determine the extent to which "typical" clients with severe mental illness can participate in a supported education program, the study examined characteristics of participants in a large supported education program. METHODS: Baseline interviews with participants in a supported education program in the metropolitan Detroit area gathered demographic data, as well as information about school, work, and psychiatric history; social adjustment and support; psychiatric symptoms; and self-perceptions in the areas of school efficacy and self-esteem. Cluster analysis used five variables (sex, age, educational attainment, work background, and symptoms) to produce a client typology. RESULTS: Five clusters emerged: well-functioning young men, young aspiring women, young dependent men, well-functioning but unemployed participants, and distressed unemployed participants. The clusters also differed on a large number of variables not used in the cluster analysis. However, members of all clusters had similar rates of program participation and first-semester attendance. Overall, the supported education participants were younger, better educated, and higher functioning than subjects in general samples of persons with severe mental illness. Although many participants had significant problems with symptoms, social adjustment, and substance abuse, they were able to remain active program participants. CONCLUSIONS: The results indicate that supported education is a feasible alternative for many individuals to meet goals for educational advancement, personal development, and better jobs.
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Trastornos Mentales/rehabilitación , Rehabilitación Vocacional , Educación Vocacional , Adolescente , Adulto , Anciano , Curriculum , Evaluación Educacional , Empleos Subvencionados , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Michigan , Persona de Mediana Edad , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Using data from a CSP-funded research demonstration project designed to expand vocational services offered by case management teams serving people with serious mental illness, this paper examines the issues created by employing consumers as peer support specialists for the project. Roles and benefits of these positions are analyzed. Challenges experienced by specialists created by serving peers, the structure of the position, the mental health system and the community, and personal issues are analyzed using data from focus groups and the project's management information system. Implications for consumer role definition, supports for role effectiveness, and the structuring of these types of positions are discussed.
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Participación de la Comunidad , Personal de Salud , Adulto , Empleo , Femenino , Personal de Salud/educación , Humanos , Masculino , Trastornos Mentales/rehabilitación , Servicios de Salud Mental/organización & administración , Rehabilitación Vocacional , Recursos HumanosRESUMEN
Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking.
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Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Servicios Comunitarios de Salud Mental/normas , Personas con Mala Vivienda/psicología , Trastornos Mentales/psicología , Adulto , Servicios Comunitarios de Salud Mental/organización & administración , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tratamiento DomiciliarioRESUMEN
Sexual abuse in day-care centers is a phenomenon of increasing concern, both in terms of its prevalence and its serious effects on child victims. Legal intervention in this area is problematic because criminal investigations are usually beset with difficulties: Characteristics of children and of the abuse situation affect disclosure rates and credibility. Research on children as witnesses is amassing; however, so far, little systematic analysis has been conducted on multi-victim child sexual abuse cases. The present study concerns a case of sexual abuse in a day-care center with over 100 alleged victims. Criteria derived from Statement Validity Analysis (SVA) protocols were applied to aggregate record review data to assess the veritability of the abuse allegations. Individual children's abuse disclosures were also analyzed, vis-à-vis characteristics of the children (age, gender, recency of attendance) and of the investigation (agency doing the interview, number of interviews, use of anatomically detailed dolls). The use of SVA criteria supported the veritability of allegations in this day-care abuse case. Even acknowledging the limitations of archival data collected for other purposes, the aggregate data analysis reflected consistency, logical structure, and spontaneity; however, little evidence of accommodation was found. Multivariate comparison of disclosing and nondisclosing children found an unexpected inverse relationship of disclosure with age, as well as positive associations with number of interviews and use of dolls. Alternative interpretations of these results are discussed.