101
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Kopacz MS, Connery AL, Bishop TM, Bryan CJ, Drescher KD, Currier JM, Pigeon WR. Moral injury: A new challenge for complementary and alternative medicine. Complement Ther Med 2016; 24:29-33. [DOI: 10.1016/j.ctim.2015.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 08/03/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
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102
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Bryan CJ, Griffith JE, Pace BT, Hinkson K, Bryan AO, Clemans TA, Imel ZE. Combat Exposure and Risk for Suicidal Thoughts and Behaviors Among Military Personnel and Veterans: A Systematic Review and Meta-Analysis. Suicide Life Threat Behav 2015; 45:633-649. [PMID: 29889337 DOI: 10.1111/sltb.12163] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
Due to seemingly mixed empirical results, questions persist about the possible role of deployments and combat exposure. We conducted a narrative review and meta-analysis of 22 published studies to integrate findings regarding the relationship of deployment-related predictors (i.e., deployment, deployment to a combat zone, combat experience, and exposure to specific combat events) with suicide-related outcomes (i.e., suicide ideation, attempt, and death). Across all predictors and outcomes, the combined effect was small and positive, r = .08 [0.04, 0.13], and marked by significant heterogeneity, I2 = 99.9%, Q(21)=4880.16, p < .0001, corresponding to a 25% increased risk for suicide-related outcomes among those who have deployed. Studies examining the relationship between exposure to killing and atrocities (k = 5) showed the largest combined effect, r = .12 [0.08, 0.17], and less heterogeneity, I2 = 84.4%, Q(4)=34.96, p < .0001, corresponding to a 43% increased risk for suicide-related outcomes among those exposed to killing or atrocity. Implications for theory, research, and clinical practice are discussed.
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Affiliation(s)
- Craig J Bryan
- The University of Utah, Salt Lake City, UT.,National Center for Veterans Studies, Salt Lake City, UT
| | | | | | | | | | | | - Zac E Imel
- The University of Utah, Salt Lake City, UT
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103
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Raji CA, Willeumier K, Taylor D, Tarzwell R, Newberg A, Henderson TA, Amen DG. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population. Brain Imaging Behav 2015; 9:527-34. [PMID: 25917871 PMCID: PMC4575682 DOI: 10.1007/s11682-015-9385-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PTSD and TBI are two common conditions in veteran populations that can be difficult to distinguish clinically. The default mode network (DMN) is abnormal in a multitude of neurological and psychiatric disorders. We hypothesize that brain perfusion SPECT can be applied to diagnostically separate PTSD from TBI reliably in a veteran cohort using DMN regions. A group of 196 veterans (36 with PTSD, 115 with TBI, 45 with PTSD/TBI) were selected from a large multi-site population cohort of individuals with psychiatric disease. Inclusion criteria were peacetime or wartime veterans regardless of branch of service and included those for whom the traumatic brain injury was not service related. SPECT imaging was performed on this group both at rest and during a concentration task. These measures, as well as the baseline-concentration difference, were then inputted from DMN regions into separate binary logistic regression models controlling for age, gender, race, clinic site, co-morbid psychiatric diseases, TBI severity, whether or not the TBI was service related, and branch of armed service. Predicted probabilities were then inputted into a receiver operating characteristic analysis to compute sensitivity, specificity, and accuracy. Compared to PSTD, persons with TBI were older, male, and had higher rates of bipolar and major depressive disorder (p < 0.05). Baseline quantitative regions with SPECT separated PTSD from TBI in the veterans with 92 % sensitivity, 85 % specificity, and 94 % accuracy. With concentration scans, there was 85 % sensitivity, 83 % specificity and 89 % accuracy. Baseline-concentration (the difference metric between the two scans) scans were 85 % sensitivity, 80 % specificity, and 87 % accuracy. In separating TBI from PTSD/TBI visual readings of baseline scans had 85 % sensitivity, 81 % specificity, and 83 % accuracy. Concentration scans had 80 % sensitivity, 65 % specificity, and 79 % accuracy. Baseline-concentration scans had 82 % sensitivity, 69 % specificity, and 81 % accuracy. For separating PTSD from PTSD/TBI baseline scans had 87 % sensitivity, 83 % specificity, and 92 % accuracy. Concentration scans had 91 % sensitivity, 76 % specificity, and 88 % accuracy. Baseline-concentration scans had 84 % sensitivity, 64 % specificity, and 85 % accuracy. This study demonstrates the ability to separate PTSD and TBI from each other in a veteran population using functional neuroimaging.
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Affiliation(s)
- Cyrus A Raji
- Department of Radiology, UCLA Medical Center, 757 Westwood Blvd, Los Angeles, CA, 90095, USA.
| | | | - Derek Taylor
- Department of Research, Amen Clinics, Inc, Costa Mesa, CA, USA
| | - Robert Tarzwell
- Faculty of Medicine, Department of Psychiatry, University of British Columbia School of Medicine and Clinical Director of Research for Mental Health, Lions Gate Hospital, Vancouver, BC, Canada
| | - Andrew Newberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Theodore A Henderson
- The Synaptic Space and The International Society of Applied Neuroimaging, Denver, CO, USA
| | - Daniel G Amen
- Department of Research, Amen Clinics, Inc, Costa Mesa, CA, USA
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104
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Maguen S, Madden E, Cohen BE, Bertenthal D, Neylan TC, Seal KH. Suicide risk in Iraq and Afghanistan veterans with mental health problems in VA care. J Psychiatr Res 2015; 68:120-4. [PMID: 26228410 DOI: 10.1016/j.jpsychires.2015.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/11/2015] [Accepted: 06/18/2015] [Indexed: 11/19/2022]
Abstract
Suicide rates among U.S. military personnel and veterans are a public health concern, and those with mental health conditions are at particular risk. We examined demographic, military, temporal, and diagnostic associations with suicidality in veterans. We conducted a population-based, retrospective cohort study of all Iraq and Afghanistan war veterans who screened positive for posttraumatic stress disorder (PTSD) and/or depression, received a suicide risk assessment, and endorsed hopelessness about the present or future after their last deployment and between January 1, 2010 and June 29, 2014 (N = 45,741). We used bivariate and multivariate logistic regression analyses to examine variables associated with having endorsed suicidal thoughts and a plan. Multiple factors were associated with suicidality outcomes, including longer time from last deployment to screening (proxy for time to seeking VA care), an alcohol use disorder diagnosis, further distance from VA (rurality), and being active duty during military service. Hispanic veterans were at decreased risk of having suicidal ideation and a plan, compared to their white counterparts. In high-risk veterans, some of the strongest associations with suicidality were with modifiable risk factors, including time to VA care and alcohol use disorder diagnoses. Promising avenues for suicide prevention efforts can include early engagement/intervention strategies with a focus on amelioration of high-risk drinking.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, USA.
| | - Erin Madden
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| | - Beth E Cohen
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, USA.
| | - Daniel Bertenthal
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; Mental Illness Research, Education & Clinical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| | - Thomas C Neylan
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, USA; Mental Illness Research, Education & Clinical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| | - Karen H Seal
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, San Francisco, USA.
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105
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Nazarov A, Jetly R, McNeely H, Kiang M, Lanius R, McKinnon MC. Role of morality in the experience of guilt and shame within the armed forces. Acta Psychiatr Scand 2015; 132:4-19. [PMID: 25737392 DOI: 10.1111/acps.12406] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces. METHOD A search of the literature pertaining to guilt, shame and morality within military samples was conducted. RESULTS Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-traumatic stress disorder (PTSD). No studies have explored moral judgment in conjunction with assessments of guilt or moral injury. CONCLUSION These findings have important implications for the prevention and treatment of PTSD-related symptoms in military samples. By measuring moral judgment prior to deployment, it may be possible to predict the likelihood of incurring moral injuries and the development of associated symptoms. Early intervention programmes aimed at ameliorating guilt and shame are required to prevent the long-term development of deployment-related psychological distress.
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Affiliation(s)
- A Nazarov
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - R Jetly
- Department of National Defence, Government of Canada, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - H McNeely
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - M Kiang
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - R Lanius
- Department of Psychiatry, University of Western Ontario, London, ON, Canada
| | - M C McKinnon
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
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106
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Bryan CJ, Bryan AO, Clemans TA. The association of military and premilitary sexual trauma with risk for suicide ideation, plans, and attempts. Psychiatry Res 2015; 227:246-52. [PMID: 25863823 DOI: 10.1016/j.psychres.2015.01.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 01/05/2015] [Accepted: 01/10/2015] [Indexed: 10/23/2022]
Abstract
Military sexual trauma is a strong predictor of psychiatric disorders and negative health outcomes among military personnel and veterans, but little is known about its relationship with suicide risk. The current study investigates the association of military sexual trauma with suicide risk among 464 U.S. military personnel and veterans enrolled in college classes. Results indicate that premilitary sexual assault was associated with significantly increased risk for later suicide ideation, plans, and attempts during military service. Unwanted sexual experiences occurring during military service was associated with significantly increased risk for suicide ideation and suicide plans for male participants. When considered simultaneously, premilitary sexual trauma showed relatively stronger associations with suicide risk among women whereas military sexual trauma showed relatively stronger associations with suicide risk among men. Results suggest differences in the relation of sexual trauma to suicide risk among male and female military personnel and veterans.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, The University of Utah, 260 S. Central Campus Dr., Room 205, Salt Lake City, Utah, USA.
| | - AnnaBelle O Bryan
- National Center for Veterans Studies, The University of Utah, 260 S. Central Campus Dr., Room 205, Salt Lake City, Utah, USA
| | - Tracy A Clemans
- National Center for Veterans Studies, The University of Utah, 260 S. Central Campus Dr., Room 205, Salt Lake City, Utah, USA
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107
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Bryan CJ, Roberge E, Bryan AO, Ray-Sannerud B, Morrow CE, Etienne N. Guilt as a Mediator of the Relationship Between Depression and Posttraumatic Stress With Suicide Ideation in Two Samples of Military Personnel and Veterans. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.2.143] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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108
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Abstract
This study examined the association between cognitive flexibility and variables that may be associated with treatment outcome for 579 veterans seeking Veterans Health Administration treatment for posttraumatic stress disorder (PTSD) secondary to combat or sexual trauma. Factors associated with severity of PTSD (level of PTSD symptoms and guilt cognitions) and with PTSD prognosis (posttraumatic growth and optimistic expectations for the future) were examined. Regression analyses revealed that cognitive flexibility was associated with lower levels of PTSD symptoms and fewer guilt cognitions. Cognitive flexibility was positively associated with posttraumatic growth and optimistic expectations for the future, even when controlling for PTSD severity. These results suggest that interventions designed to increase cognitive flexibility in veterans may be a worthwhile adjunct to treatment for PTSD as we continue efforts to improve treatment outcomes.
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109
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Ansell EB, Wright AGC, Markowitz JC, Sanislow CA, Hopwood CJ, Zanarini MC, Yen S, Pinto A, McGlashan TH, Grilo CM. Personality disorder risk factors for suicide attempts over 10 years of follow-up. Personal Disord 2015; 6:161-7. [PMID: 25705977 DOI: 10.1037/per0000089] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying personality disorder (PD) risk factors for suicide attempts is an important consideration for research and clinical care alike. However, most prior research has focused on single PDs or categorical PD diagnoses without considering unique influences of different PDs or of severity (sum) of PD criteria on the risk for suicide-related outcomes. This has usually been done with cross-sectional or retrospective assessment methods. Rarely are dimensional models of PDs examined in longitudinal, naturalistic prospective designs. In addition, it is important to consider divergent risk factors in predicting the risk of ever making a suicide attempt versus the risk of making an increasing number of attempts within the same model. This study examined 431 participants who were followed for 10 years in the Collaborative Longitudinal Personality Disorders Study. Baseline assessments of personality disorder criteria were summed as dimensional counts of personality pathology and examined as predictors of suicide attempts reported at annual interviews throughout the 10-year follow-up period. We used univariate and multivariate zero-inflated Poisson regression models to simultaneously evaluate PD risk factors for ever attempting suicide and for increasing numbers of attempts among attempters. Consistent with prior research, borderline PD was uniquely associated with ever attempting. However, only narcissistic PD was uniquely associated with an increasing number of attempts. These findings highlight the relevance of both borderline and narcissistic personality pathology as unique contributors to suicide-related outcomes.
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Affiliation(s)
- Emily B Ansell
- Department of Psychiatry, Yale University School of Medicine
| | | | - John C Markowitz
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | | | | | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Anthony Pinto
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
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110
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Vanderploeg RD, Nazem S, Brenner LA, Belanger HG, Donnell AJ, Scott SG. Suicidal Ideation among Florida National Guard Members: Combat Deployment and Non-Deployment Risk and Protective Factors. Arch Suicide Res 2015; 19:453-71. [PMID: 25517207 DOI: 10.1080/13811118.2014.957454] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined relationships among risk/protective factors and suicidal ideation (SI) in deployed and non-deployed National Guard members, particularly examining for possible differential effects of deployment on SI. A total of 3,098 Florida National Guard members completed an anonymous online survey that assessed variables associated with SI including demographics, current psychiatric diagnoses, and pre-, during, and post-deployment experiences. Those deployed had significantly higher rates of SI (5.5%) than those not deployed (3.0%; p < .001). In multivariate analyses, among those not deployed, SI was significantly associated with major depressive disorder (p < .001), posttraumatic stress disorder (PTSD) (p < .001), prior psychological trauma (p < .01), and heavy/hazardous alcohol consumption (p < .05). In contrast, in the deployed, only PTSD (p < .001) and deployment-related mild traumatic brain injury (p < .05) were independently associated with SI. Risk and protective factors differed by deployment status in National Guard members suggesting the possible need for cohort-specific treatment targets to minimize SI.
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111
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van Minnen A, Zoellner LA, Harned MS, Mills K. Changes in comorbid conditions after prolonged exposure for PTSD: a literature review. Curr Psychiatry Rep 2015; 17:549. [PMID: 25736701 PMCID: PMC4348535 DOI: 10.1007/s11920-015-0549-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prolonged exposure (PE) is an effective psychological treatment for patients who suffer from PTSD. The majority of PTSD patients have comorbid psychiatric disorders, and some clinicians are hesitant to use PE with comorbid patients because they believe that comorbid conditions may worsen during PE. In this article, we reviewed the evidence for this question: what are the effects of PE on comorbid symptoms and associated symptomatic features? We reviewed findings from 18 randomized controlled trials of PE that assessed the most common comorbid conditions (major depression, anxiety disorders, substance use disorders, personality disorders, and psychotic disorders) and additional symptomatic features (suicidality, dissociation, negative cognitions, negative emotions, and general health and work/social functioning). Although systematic research is not available for all comorbid populations, the existing research indicates that comorbid disorders and additional symptomatic features either decline along with the PTSD symptoms or do not change as a result of PE. Therefore, among the populations that have been studied to date, there is no empirical basis for excluding PTSD patients from PE due to fear of increases in comorbid conditions or additional symptomatic features. Limitations of the existing research and recommendations for future research are also discussed.
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Affiliation(s)
- Agnes van Minnen
- Behavioural Science Institute, Radboud University Nijmegen, NijCare, Pro Persona, Tarweweg 2, 6524 AM, Nijmegen, The Netherlands,
| | - Lori A. Zoellner
- Department of Psychology, University of Washington, Seattle, WA USA
| | | | - Katherine Mills
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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112
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Farnsworth JK, Drescher KD, Nieuwsma JA, Walser RB, Currier JM. The Role of Moral Emotions in Military Trauma: Implications for the Study and Treatment of Moral Injury. REVIEW OF GENERAL PSYCHOLOGY 2014. [DOI: 10.1037/gpr0000018] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Moral injury, a term coined to represent the potential negative outcomes following transgression of deeply held moral values and beliefs, has recently gained increased recognition as a major concern among military service members exposed to trauma. However, working definitions of moral injury have not yet fully clarified the mechanisms whereby violations of conscience result in these outcomes or their co-occurrence with posttraumatic stress disorder (PTSD). In this paper, advances from the field of moral psychology are used to integrate cognitive, affective, and social dimensions of the emerging moral injury construct, while also pointing to new possibilities for clinical intervention. After reviewing the salience of moral injury for military and veteran populations, the presence of negative moral emotions (e.g., guilt, anger, disgust) are examined within the context of trauma and military-related PTSD. Next, social functionalist accounts of moral emotions are used to explain the development of moral injury and are linked to potential etiologies of PTSD that emphasize both fear and nonfear emotions. Finally, the clinical importance of positive moral emotions for existing and emerging trauma-focused interventions is discussed. Future directions for research and clinical interventions are identified highlighting the importance of utilizing community support.
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Affiliation(s)
| | - Kent D. Drescher
- National Center for PTSD, Menlo Park, California; and The Pathway Home, Yountville, California
| | - Jason A. Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; and Duke University Medical Center, Durham, North Carolina
| | - Robyn B. Walser
- National Center for PTSD; and Department of Psychology, University of California, Berkeley
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113
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Kopacz MS, Silver E, Bossarte RM. A Position Article for Applying Spirituality to Suicide Prevention. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2014. [DOI: 10.1080/19349637.2014.896856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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114
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Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: an evaluation of the Suicide Cognitions Scale. J Affect Disord 2014; 159:15-22. [PMID: 24679384 DOI: 10.1016/j.jad.2014.02.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/04/2014] [Accepted: 02/07/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Newer approaches for understanding suicidal behavior suggest the assessment of suicide-specific beliefs and cognitions may improve the detection and prediction of suicidal thoughts and behaviors. The Suicide Cognitions Scale (SCS) was developed to measure suicide-specific beliefs, but it has not been tested in a military setting. METHODS Data were analyzed from two separate studies conducted at three military mental health clinics (one U.S. Army, two U.S. Air Force). Participants included 175 active duty Army personnel with acute suicidal ideation and/or a recent suicide attempt referred for a treatment study (Sample 1) and 151 active duty Air Force personnel receiving routine outpatient mental health care (Sample 2). In both samples, participants completed self-report measures and clinician-administered interviews. Follow-up suicide attempts were assessed via clinician-administered interview for Sample 1. Statistical analyses included confirmatory factor analysis, between-group comparisons by history of suicidality, and generalized regression modeling. RESULTS Two latent factors were confirmed for the SCS: Unloveability and Unbearability. Each demonstrated good internal consistency, convergent validity, and divergent validity. Both scales significantly predicted current suicidal ideation (βs >0.316, ps <0.002) and significantly differentiated suicide attempts from nonsuicidal self-injury and control groups (F(6, 286)=9.801, p<0.001). Both scales significantly predicted future suicide attempts (AORs>1.07, ps <0.050) better than other risk factors. LIMITATIONS Self-report methodology, small sample sizes, predominantly male samples. CONCLUSIONS The SCS is a reliable and valid measure that predicts suicidal ideation and suicide attempts among military personnel better than other well-established risk factors.
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115
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The sequelae of our millennial war. J Nerv Ment Dis 2014; 202:88-90. [PMID: 24469518 DOI: 10.1097/nmd.0000000000000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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116
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Fernando I, Cohen M. Case formulation and management using pattern-based formulation (PBF) methodology: clinical case 1. Australas Psychiatry 2014; 22:32-40. [PMID: 24288380 DOI: 10.1177/1039856213511674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A tool for psychiatric case formulation known as pattern-based formulation (PBF) has been recently introduced. This paper presents an application of this methodology in formulating and managing complex clinical cases. METHOD The symptomatology of the clinical presentation has been parsed into individual clinical phenomena and interpreted by selecting explanatory models. RESULTS The clinical presentation demonstrates how PBF has been used as a clinical tool to guide clinicians' thinking, that takes a structured approach to manage multiple issues using a broad range of management strategies. In doing so, the paper also introduces a number of patterns related to the observed clinical phenomena that can be re-used as explanatory models when formulating other clinical cases. CONCLUSION It is expected that this paper will assist clinicians, and particularly trainees, to better understand PBF methodology and apply it to improve their formulation skills.
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Affiliation(s)
- Irosh Fernando
- Staff Specialist Psychiatrist, Hunter New England Area Health Service, The Mater Hospital, Waratah, NSW, and; PhD Candidate, School of Electrical Engineering & Computer Science, University of Newcastle, Callaghan, NSW, and; Conjoint Lecturer, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
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117
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Steenkamp MM, Nash WP, Lebowitz L, Litz BT. How Best to Treat Deployment-Related Guilt and Shame: Commentary on Smith, Duax, and Rauch (2013). COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2013.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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118
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Bryan CJ, Elder WB, McNaughton-Cassill M, Osman A, Hernandez AM, Allison S. Meaning in life, emotional distress, suicidal ideation, and life functioning in an active duty military sample. JOURNAL OF POSITIVE PSYCHOLOGY 2013. [DOI: 10.1080/17439760.2013.823557] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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119
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Pulcu E, Zahn R, Elliott R. The role of self-blaming moral emotions in major depression and their impact on social-economical decision making. Front Psychol 2013; 4:310. [PMID: 23750148 PMCID: PMC3670430 DOI: 10.3389/fpsyg.2013.00310] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/14/2013] [Indexed: 12/13/2022] Open
Abstract
People with major depressive disorder (MDD) are more prone to experiencing moral emotions related to self-blame, such as guilt and shame. DSM-IV-TR recognizes excessive or inappropriate guilt as one of the core symptoms of current MDD, whereas excessive shame is not part of the criteria for MDD. However, previous studies specifically assessing shame suggested its involvement in MDD. In the first part of this review, we will consider literature discussing the role of self-blaming moral emotions in MDD. These self-blaming moral emotions have been purported to influence people when they make social and financial decisions in cognitive studies, particularly those using neuroeconomical paradigms. Such paradigms aim to predict social behavior in activities of daily living, by using important resource tangibles (especially money) in laboratory conditions. Previous literature suggests that guilt promotes altruistic behavior via acting out reparative tendencies, whereas shame reduces altruism by means of increasing social and interpersonal distance. In the second part of this review, we will discuss the potential influence of self-blaming moral emotions on overt behavior in MDD, reviewing clinical and experimental studies in social and financial decision-making, in which guilt, and shame were manipulated. This is not a well-established area in the depression literature, however in this opinion paper we will argue that studies of moral emotions and their impact on behavioral decision-making are of potential importance in the clinical field, by linking specific symptoms of a disorder to a behavioral outcome which may lead to stratification of clinical diagnoses in the future.
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Affiliation(s)
- Erdem Pulcu
- Neuroscience and Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, The University of Manchester , Manchester , UK
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120
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Guilt is more strongly associated with suicidal ideation among military personnel with direct combat exposure. J Affect Disord 2013; 148:37-41. [PMID: 23232420 DOI: 10.1016/j.jad.2012.11.044] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/07/2012] [Accepted: 11/20/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Suicide rates in the U.S. military have been rising rapidly in the past decade. Research suggests guilt is a significant predictor of suicidal ideation among military personnel, and may be especially pronounced among those who have been exposure to combat-related traumas. The current study explored the interactive effect of direct combat exposure and guilt on suicidal ideation in a clinical sample of military personnel. METHODS Ninety-seven active duty U.S. Air Force personnel receiving outpatient mental health treatment at two military clinics completed self-report symptom measures of guilt, depression, hopelessness, perceived burdensomeness, posttraumatic stress disorder, and suicidal ideation. RESULTS Generalized multiple regression analyses indicated a significant interaction of guilt and direct combat exposure (B=.124, SE=.053, p=.020), suggesting a stronger relationship of guilt with suicidal ideation among participants who had direct combat exposure as compared to those who had not. The interactions of direct combat exposure with depression (B=.004, SE=.040, p=.926), PTSD symptoms (B=.016, SE=.018, p=.382), perceived burdensomeness (B=.159, SE=.152, p=.300) and hopelessness (B=.069, SE=.036, p=.057) were nonsignificant. CONCLUSIONS Although guilt is associated with more severe suicidal ideation in general among military personnel, it is especially pronounced among those who have had direct combat exposure.
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