Recent investigations have elucidated the influence of the Strong Black Woman (SBW) Schema on the mental health and treatment seeking behaviors of Black women in the United States. However, the SBW schematic characteristics that produce depression have yet to be identified. The current study fills this void in the literature through a quantitative examination of how characteristics of the SBW Schema relate to depressive symptomology. Analyses were based on 194 participants, including college students (n = 98) and community members (n = 96), ranging in age from 18 to 82 years-old (M = 37.53, SD = 19.88). As hypothesized, various manifestations of self-silencing were found to significantly mediate the relationship between the perceived obligation to manifest strength (a SBW characteristic) and depressive symptomatology. The present study advances the idea that depressive symptoms are related to endorsement of the SBW Schema and highlights selfsilencing as a mechanism by which this relationship occurs. These results offer evidence and clarification of the impact of the SBW Schema on Black women's mental health and identify specific points of intervention for mental health practitioners conducting therapeutic work with Black women. We provide recommendations for future research to avoid pathologizing strength and we discuss the implications and potential benefits of integrating a Womanist theoretical perspective into counseling for Black women, a population that has historically underutilized mental health resources.

The overall rate of major perioperative and postoperative adverse events in women undergoing colpocleisis is low; however, concomitant hysterectomy is associated with longer operative times and higher blood loss.

Objective: Mental health (MH) presentations to ED are increasing in children and adolescents. Little is known about patients with severe acute behavioural disturbance (ABD). We set out to describe patients with ABD severe enough to trigger an acute crisis team response in ED (termed 'Code Grey') and how they differ from other MH patients. Methods: Retrospective electronic medical record review of all ED patients with MH discharge codes at a tertiary children's hospital. We assessed the epidemiology and management of patients who triggered acute crisis team interventions (Code Grey) as proxy for severe ABD. We calculated the odds ratios (ORs with 95% confidence intervals) of key demographic factors compared to other MH patients. Results: During 2018, there were 85 347 ED presentations of which 1695 (2.0%) were related to MH diagnoses; 84 MH patients had 141 MH presentations triggering 204 Code Greys (26 patients triggered 59% of Code Greys). These patients had higher triage acuity (OR 12.6 [8.3-19.0]), stayed longer in ED (>12 h OR 8.2 [5.1-13.1]) and were more likely to be admitted (OR 2.0 [1.4-3.0]) compared with non-Code Grey MH presentations. Patients were physically (19.2%), mechanically (31.9%) or chemically restrained (37.6%). Eight different medication approaches were used as either a single agent or a combination of oral and/or intramuscular agents. Conclusions: Children and adolescents with severe ABD differ from other MH presentations and often require physical or chemical restraint. Anticipatory management plans may be valuable for repeat presenters.

RSCP and RCSP are effective, efficient, and safe procedures.

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