A six-item predictive scale for parasuicide repetition was retested on a second sample of Italian parasuicides. All the patients firstever admitted after a deliberate self-harm to the psychiatric department of a general hospital during the period April 1973-March 1976 were interviewed and followed-up after an interval of 1 year. The scale showed the same predictive power found in the first sample (1970-73) and gave a range of probability of repetition within 1 year of 15% at a score of 0 up to 44.8% at the scores 3, 4, 5, and 6. Moreover it discriminated between repeaters and non-repeaters at a significant level. Only two items (diagnosis of sociopathy and change of domicile in the last year) of the five items which discriminated repeaters from non-repeaters in the first study were still significantly associated with repetition, while four additional items (previous in-patient psychiatric treatment; previous parasuicide resulting in hospital admission; unemployment; criminal record) appeared as new discriminating factors. In spite of these changes the rate of repetition remained constant over the years at around 26%.

A six-point prodictive scale for parasuicide repetition developed by Buglass and Horton (1974a) was tested on a group of patients admitted for parasuicide to a psychiatric ward of one of the city hospitals of Verona. The scale gave a range of probability of repetition within 12 months of 15 per cent at a score of o up to 45-5 per cent at the scores 3, 4, 5 and 6. Moreover the scale discriminated significantly between repeaters and non-repeaters. Items significantly associated with repetition in the Italian sample, which are not represented by the six-point scale were: previous parasuicide not admitted to hospital, violence received, alcohol taken at time of act, less than one year at the present address.

Chronic illness in a child requires successful organisational and emotional adjustment of the child and the family. The way in which the child and the family adapt to the illness will affect their psychological well-being and their quality of life. This review summarizes recent research findings on the relationship between illness factors, individual and family functioning, coping strategies and psychosocial adjustment. The findings are presented within the framework of three complementary theoretical models: the family developmental approach; the psychosocial typology of illnesses; and the process model of stress and coping. These models are useful for a better understanding of the complex interactions between illness, family and coping and offer to the professionals engaged in the care of chronically sick children, guidelines for assessment and the development of intervention programs. The review starts with examining the impact of chronic illness on the psychosocial adjustment of the sick child, his/her siblings and parents. Then psychosocial Stressors and risk factors in terms of illness and family related characteristics are discussed. Coping resources and strategies are presented which have been shown to be related to child and parental adjustment; and finally, successful intervention programs are described.

ResumenLa enfermedad crónica en un niño requiere un ajuste organizativo y emocional acertado del niño y la familia. La manera de adaptarse del niño y la familia a la enfermedad afectará a su bienestar psicológico y a su calidad de vida. Esta revisión resume hallazgos de investigación recientes sobre la relación entre factores de enfermedad, funcionamiento individual y familiar, estrategias de afrontamiento y ajuste psicosocial. Los hallazgos se presentan dentro del marco de tres modelos teóricos complementarios: el enfoque evolutivo familiar, la tipología psicosocial de enfermedades y el modelo de proceso de estrés y afrontamiento. Estos modelos son útiles para una comprensión mejor de las complejas interacciones entre enfermedad, familia y afrontamiento, y ofrecen a los profesionales que participan en la asistencia de niños enfermos crónicos directrices para la evaluación y el desarrollo de programas de intervención. La revisión empieza examinando las repercusiones de la enfermedad crónica sobre el ajuste psicosocial del niño enfermo, sus hermanos y parientes. Luego, se discuten factores que producen estrés psicosocial y factores de riesgo desde el punto de vista de las características relacionadas con la enfermedad y con la familia. Se presentan recursos y estrategias de afrontamiento que se han mostrado relacionados con el ajuste infantil y de los padres, y por último se describen programas de intervención que tienen éxito.

The way in which the family copes with and adapts to illness of one of its members has a strong impact on the physical and psychosocial well-being of all members and on the shape and duration of the clinical course of the illness itself. The family doctor therefore should be able to evaluate the families' adaptation to illness and to promote successful coping strategies where necessary. This review illustrates how the family doctor's evaluation of the illness impact on family functioning is facilitated by a family developmental approach and by the use of a psychosocial classification scheme of illnesses.