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Schafer KM, Melia R, Joiner T. Risk and protective correlates of suicidality in the military health and well-being project. J Affect Disord 2024; 363:258-268. [PMID: 39033824 DOI: 10.1016/j.jad.2024.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/26/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans.
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Affiliation(s)
- Katherine Musacchio Schafer
- Tennessee Valley Healthcare System, United States of America; Vanderbilt University Medical Center, United States of America.
| | - Ruth Melia
- Florida State University, United States of America; University of Limerick, United States of America
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2
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Bond AE, Houtsma C, Shapiro ME, Bandel SL, Moceri-Brooks J, Anestis MD. Female military service members and veterans: Understanding treatment seeking behavior and previous suicide risk among suicide decedents. DEATH STUDIES 2024:1-8. [PMID: 38912977 DOI: 10.1080/07481187.2024.2370468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
To examine the differences in treatment seeking behaviors, previous suicidal thoughts, previous suicide attempts, and disclosure of suicidal thoughts among female service members (SM)/Veteran suicide decedents who used a firearm and those who used another method. Data was acquired from the National Violent Death Reporting System which is maintained and monitored by the Center for Disease Control and Prevention. Data included in the present study were from suicide deaths that occurred between 2003-2018. Female SM/Veterans who died by firearm suicide had lower proportions of current mental health or substance use treatment, lifetime mental health or substance use treatment, and previous suicide attempts compared to those who used another method. Female SM/Veterans who die by firearm suicide are less likely to encounter mental health services than those who use another method. Conversations on secure firearm storage need to occur outside of the health care setting.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Claire Houtsma
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary E Shapiro
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- School of Public Health, Rutgers University, New Brunswick, USA
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3
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Piña-Watson B, Suarez Bonilla G, Manzo G, Gonzalez IM. Examining associations between value-behavior discrepancy guilt, anxiety, and suicide risk for Mexican descent college students: Resilience through self-compassion. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37855815 DOI: 10.1080/07448481.2023.2253916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/25/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE The present study examines self-compassion (SC) as a potential protective factor in the relationship between value-behavior discrepancy guilt (VBDG) and the mental health outcomes of anxiety and suicide risk in a sample of Mexican-descent college students. METHOD Participants consisted of 810 college students of Mexican descent. Students were recruited through a psychology participant pool and completed an online survey. Two regression analyses examined the direct effect of VBDG on anxiety symptoms and suicide risk with SC as a moderator. RESULTS Results indicated that high levels of SC were protective in the relationship between VBDG and mental health outcomes. On the other hand, lower levels of SC put one at risk for increased anxiety symptoms and higher suicide risk when they experience VBDG. CONCLUSION The study shows the need to develop interventions that cultivate a high sense of SC in Mexican-descent college students.
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Affiliation(s)
- Brandy Piña-Watson
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Gisel Suarez Bonilla
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Gabriela Manzo
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Iliana M Gonzalez
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
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4
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O'Garo KGN, Koenig HG. Spiritually Integrated Cognitive Processing Therapy for Moral Injury in the Setting of PTSD: Initial Evidence of Therapeutic Efficacy. J Nerv Ment Dis 2023; 211:656-663. [PMID: 37381149 DOI: 10.1097/nmd.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
ABSTRACT After defining the syndrome of moral injury (MI), reviewing its relationship to posttraumatic stress disorder (PTSD), and examining its psychological consequences and impact on functioning, we describe a new psychotherapeutic treatment for MI called spiritually integrated cognitive processing therapy (SICPT). SICPT builds on cognitive processing therapy (CPT), a commonly used trauma-focused treatment for PTSD. To our knowledge, SICPT is the first one-on-one individualized psychotherapeutic treatment that integrates a person's spiritual and religious beliefs into the treatment for MI, using the latter to work through and process the psychological, spiritual, and religious symptoms of this condition. Here, we describe the initial results obtained from a single-group experimental study examining the treatment of three patients with significant symptoms of both MI and PTSD. Given the effects of SICPT on reducing both MI and PTSD symptoms, we have decided to report these early results before study completion to alert the scientific community about this potentially effective new treatment.
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Affiliation(s)
- Keisha-Gaye N O'Garo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Diekmann C, Issels L, Alliger-Horn C, Rau H, Fischer C, Thiel T, Willmund G, Zimmermann P. Traumatized German soldiers with moral injury - value-based cognitive-behavioral group therapy to treat war-related shame. Front Psychiatry 2023; 14:1173466. [PMID: 37533887 PMCID: PMC10390695 DOI: 10.3389/fpsyt.2023.1173466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction During deployment, soldiers are confronted with potentially morally injurious events. In many cases, these events violate their personal values and belief systems, resulting in feelings of anger, alienation, guilt, and shame. The psychological distress caused by such transgressions is defined as moral injury. It remains unclear to date, which therapeutic interventions are most appropriate for addressing this specific psychological condition. This study examines the effectiveness of value-based cognitive-behavioral group therapy combining elements of cognitive-behavioral therapy, acceptance and commitment therapy, spiritual care, and adaptive disclosure therapy. Materials and methods This controlled study uses the Compass of Shame Scale to assess symptom severity among participants both before and after a three-week inpatient group therapy regimen for moral injury. An intervention group (n = 45) was compared to a waiting-list control group (n = 40). A one-way between subjects ANOVA was conducted to determine the differences between the two measurement points in the intervention group compared to the control group. A positive ethics vote from the Humboldt University Berlin (Charité) was available (No.EA1/092/15). Results A significant difference was found on the shame-associated maladaptive strategies subscales of attack self (F (1, 83) = 5.942, p = 0.017, Cohen's f = 0,27), withdrawal (F (1, 83) = 8.263, p = 0.005, Cohen's f = 0,32), and attack others (F (1, 83) = 10.552, p = 0.002, Cohen's f = 0,36) of the Compass of Shame Scale between the intervention group and the control group at the p < 0.05 level in the pre- and post-treatment (t1-t2) comparison. Conclusion This study suggests that the special therapeutic focus in cognitive-behavioral group therapy can alter shame-based maladaptive coping behaviors in response to war-related moral injury. This study provides further evidence that therapeutic approaches - through fostering a reconciliatory, compassionate, and forgiving approach toward oneself and others - target the underlying mechanisms of moral injury. Therefore, value-based cognitive-behavioral interventions should be considered as a standard element of trauma care in a military setting. Future studies should further examine such interventions in randomized control trials. It would also be particularly valuable for future studies to include a follow-up time point.
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Affiliation(s)
- Caroline Diekmann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Hospital Berlin, Berlin, Germany
- Charité - Berlin University of Medicine, Humboldt University of Berlin, Berlin, Germany
| | - Leonie Issels
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Hospital Berlin, Berlin, Germany
| | - Christina Alliger-Horn
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Hospital Berlin, Berlin, Germany
| | - Heinrich Rau
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Hospital Berlin, Berlin, Germany
| | | | - Thomas Thiel
- Military Chaplaincy Central Office, Berlin, Germany
| | - Gerd Willmund
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Hospital Berlin, Berlin, Germany
| | - Peter Zimmermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Hospital Berlin, Berlin, Germany
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6
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Szeto EH, Ammendola E, Starkey A, Hay J, McClung JG, Bryan CJ. Differences in Guilt, Shame, Self-Anger, and Suicide Cognitions Based on Recent Suicide Ideation and Lifetime Suicide Attempt History. J Nerv Ment Dis 2023; 211:226-232. [PMID: 36166283 DOI: 10.1097/nmd.0000000000001592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Suicide risk factors such as hopelessness and psychiatric disorders can predict suicide ideation (SI) but cannot distinguish between those with SI and those who attempt suicide (SA). The fluid vulnerability theory of suicide posits that a person's activation of the suicidal mode is predicated on one's predisposition, triggers, and baseline/acute risks. This study compared guilt, shame, self-anger, and suicidal beliefs based on recent SI and lifetime SA. In a total of 2222 primary care patients in this cross-sectional, observational study reported no recent SI or lifetime SA (SI-SA-), 161 reported recent SI only (SI-SA+), 145 reported lifetime SA only (SI+SA-), and 56 reported both recent SI and lifetime SA (SI+SA+). Kruskal-Wallis test showed that the four risk factors were the highest for SI+SA+, followed by SI+SA-, then SI-SA+, and lastly SI-SA-. The study shows that risk factors may be worse in those with recent SI than those with SA history.
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Affiliation(s)
- Edwin H Szeto
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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7
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Olgiati P, Fanelli G, Serretti A. Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder. Int Clin Psychopharmacol 2023:00004850-990000000-00051. [PMID: 36853754 DOI: 10.1097/yic.0000000000000461] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Suicidal ideation (SI) is a risk factor for suicidal behaviour. To ascertain the clinical correlates and prognostic impact of severe SI, we analysed 249 outpatients with major depressive disorder (MDD) and suicidal thoughts included in the COmbining Medications to Enhance Depression outcome (CO-MED) trial. Patients with severe SI (36%) were younger at disease onset (P = 0.0033), more severely depressed (P = 0.0029), had more lifetime suicidal behaviour (P < 0.0001) and psychiatric comorbidities (panic disorder: P = 0.0025; post-traumatic stress disorder: P = 0.0216), and a history of childhood maltreatment (neglect: P = 0.0054; emotional abuse: P = 0.0230; physical abuse: P = 0.0076; sexual abuse: P = 0.0016) than those experiencing low-moderate SI. After controlling for depression score, severe SI was positively correlated with lifetime suicidal behaviour (OR [95% CI]: 1.26 [1.12-1.41]), panic disorder (1.05 [1.00-1.12]), and childhood maltreatment (neglect: 1.93 [1.13-3.30]; physical abuse: 2.00 [1.11-3.69]; sexual abuse: 2.13 [1.17-3.88]), and inversely correlated with age of onset (0.97 [0.95-0.99]) and sleep-onset insomnia (0.76 [0.61-0.96]). Finally, the occurrence of serious lifetime suicidal behaviour was predicted by SI severity (2.18 [1.11-4.27]), bipolar score (1.36 [1.02-1.81]), and childhood sexual abuse (2.35 [1.09-5.05]). These results emphasise the importance of assessing childhood maltreatment and bipolar liability in MDD to estimate suicidal behaviour risk.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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8
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Houle SA, Inhaber J, Jetly R, Ashbaugh AR. Negative cognition in the context of suicidality after exposure to military-related potentially morally injurious events. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of events that deeply transgress a person’s core moral beliefs and values. Such events are reportedly common in the military context, and strong associations have been demonstrated between exposure to potentially morally injurious events (PMIEs) and suicidality. This study explored differences in negative cognitions between treatment-seeking Canadian Armed Forces members and Veterans with and without current suicidal thoughts and behaviours (STBs), all of whom reported current distress in response to a PMIE. Those exhibiting STBs reported stronger negative beliefs about the self. Scores for event-related guilt cognitions and self-blame were similar across individuals with and without STBs. Individuals reporting STBs also displayed higher depression and symptoms of posttraumatic stress disorder. The results suggest that severity of mental health symptoms and negative self-evaluations may be most pertinent in their association with suicidality in the MI context. Results remain preliminary, however, and additional research is needed to properly examine how event and self-related evaluations affect suicidality after PMIEs.
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Affiliation(s)
| | - Joseph Inhaber
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rakesh Jetly
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
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9
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Chou PH, Wang SC, Wu CS, Ito M. Trauma-related guilt as a mediator between post-traumatic stress disorder and suicidal ideation. Front Psychiatry 2023; 14:1131733. [PMID: 37056401 PMCID: PMC10086326 DOI: 10.3389/fpsyt.2023.1131733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 04/15/2023] Open
Abstract
Background As a mental health issue, suicide is a growing global concern, with patients who have post-traumatic stress disorder (PTSD) being at particularly high risk. This study aimed to investigate whether the link between PTSD and suicidal ideation is mediated by trauma-related guilt. Methods Data were obtained from Wave 1, Time 1 (November 2016), and Time 2 (March 2017) of the National Survey for Stress and Health (NSSH) in Japan. The NSSH is an online longitudinal survey conducted on Japan's national population aged 18 years and older. The cumulative response rate of the survey was 66.7% at Time 2. A total of 1,005 patients with PTSD were included for analyses. The severity of PTSD symptoms was assessed with PTSD DSM-5 Checklist, and the trauma-related guilt were assessed using the two subscales (hindsight-bias/responsibility and global guilt scale) of the trauma-related guilt inventory (TRGI). Suicidal ideation was evaluated using the suicidal ideation attributes scale (SIDAS). Pearson's correlation was used to investigate the associations among PTSD symptoms, TRGI scores, and SIDAS scores. Causal mediation analysis was applied to evaluate the causal relationship between PTSD, trauma-related guilt, and suicidal ideation. Results Pearson's correlation did not show patients' age, gender, and household income significantly associated with SIDAS scores. On the other hand, severities of PTSD symptoms (r = 0.361, p < 0.001) and trauma-related guilt (r = 0.235, p < 0.001) were positively associated with SIDAS scores. After adjusting for age, gender, and household income, the mediation analysis revealed that trauma-related guilt significantly mediates the effects of PTSD symptoms on suicidal ideation. Conclusion Our results implied that trauma-related guilt may represent a critical link between PTSD and suicidal ideation, which may be a noteworthy target for therapeutic intervention.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan
- *Correspondence: Po-Han Chou, ;
| | - Shao-Cheng Wang
- Department of Psychiatry, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Chi-Shin Wu,
| | - Masaya Ito
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Hsinchu, Miaoli, Taiwan
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10
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Novilla LK, Broadbent E, Leavitt B, Crandall A. Examining relationships between positive and adverse childhood experiences with physical and mental health indicators in a low-income adult sample. CHILD ABUSE & NEGLECT 2022; 134:105902. [PMID: 36201942 DOI: 10.1016/j.chiabu.2022.105902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/06/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Emerging research on positive and adverse childhood experiences (PCEs and ACEs) indicates that both may be important to adult health, but little is understood about the pathways through which childhood experiences affect adult health. OBJECTIVE The aims of this study were to 1) examine how shame may mediate the relationship between childhood experiences and health, and 2) whether PCEs moderated the relationship between ACEs, shame, and adult health. PARTICIPANTS AND SETTING The sample consisted of 206 low-income adults ages 18-55 who were living in a community in the Intermountain West. METHODS Participants were recruited at a local food bank and community center where various services for low-income residents were offered. Each participant completed a 15-20-minute survey. The data were analyzed using a structural equation modeling (SEM) framework. RESULTS Shame mediated the relationship between both ACEs and PCEs with depression in the expected direction. Among participants with low-to-moderate PCEs, ACEs were directly associated with shame and tobacco usage. Among participants with high PCEs, ACEs were not associated with shame, depression, nor stress, and the relationship between ACEs and tobacco usage was attenuated. CONCLUSION Shame may be an important pathway through which childhood experiences affect adult health. Additionally, promoting high levels of PCEs may mitigate the negative effects of early adversity on adult health.
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11
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Xu Z, Zhu R, Zhang S, Zhang S, Liang Z, Mai X, Liu C. Mortality salience enhances neural activities related to guilt and shame when recalling the past. Cereb Cortex 2022; 32:5145-5162. [PMID: 35102376 DOI: 10.1093/cercor/bhac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 12/27/2022] Open
Abstract
Mortality salience (MS) influences cognition and behavior. However, its effect on emotion (especially moral emotions) and the underlying neural correlates are unclear. We investigated how MS priming modulated guilt and shame in a later recall task using functional magnetic resonance imaging. The behavioral results indicated that MS increased self-reported guilt but not shame. The neural results showed that MS strengthened neural activities related to the psychological processes of guilt and shame. Specifically, for both guilt and shame, MS increased activation in a region associated with self-referential processing (ventral medial prefrontal cortex). For guilt but not shame, MS increased the activation of regions associated with cognitive control (orbitofrontal cortex) and emotion processing (amygdala). For shame but not guilt, MS decreased brain functional connectivity related to self-referential processing. A direct comparison showed that MS more strongly decreased a functional connectivity related to self-referential processing in the shame than in the guilt condition. Additionally, the activation of insula during MS priming was partly predictive of neural activities related to guilt and shame in the subsequent recall task. Our study sheds light on the psychological and neural mechanisms of MS effects on moral emotions and provides theoretical insights for enriching terror management theory.
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Affiliation(s)
- Zhenhua Xu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
| | - Ruida Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China.,Business School, Beijing Normal University, Beijing 100875, China
| | - Shen Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
| | - Sihui Zhang
- Department of General Adult Psychiatry, Heidelberg University, Heidelberg 69115, Germany
| | - Zilu Liang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
| | - Xiaoqin Mai
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Chao Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing 100875, China
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12
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Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
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Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
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13
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Kelley ML, Strowger M, Chentsova VO, Bravo AJ, Gaylord SA, Burgin EE, Vinci C, Ayers KL, Agha E. Mindfulness to Manage Moral Injury: Rationale and development of a live online 7-week group intervention for veterans with moral injury. Contemp Clin Trials Commun 2022; 30:101011. [PMID: 36340697 PMCID: PMC9626875 DOI: 10.1016/j.conctc.2022.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/27/2022] [Accepted: 10/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Military service puts service members at risk for moral injury. Moral injury is an array of symptoms (e.g., guilt, shame, anger) that develop from events that violate or transgress one's moral code. Objective We describe adaption of in-person mindfulness training program, Mindfulness to Manage Chronic Pain (MMCP), to address symptoms of moral injury to be delivered live via the web. We discuss how we will assess benchmarks (i.e., recruitment, credibility and acceptability, completion rates, and adherence) of the Mindfulness to Manage Moral Injury (MMMI) program. Methods Aim 1: To develop and then adapt the MMCP program based on feedback from experts and veterans who took part in Study 1. Aim 2: To develop an equally intensive facilitator-led online Educational Support (ES) program to serve as a comparison intervention and conduct a run-through of each program with 20 veterans (10 MMMI; 10 ES). Aim 3: To conduct a small-scale randomized controlled trial (N = 42 veterans; 21 MMMI; 21 ES) in which we will collect pre-post-test and weekly benchmark data for both refined intervention arms. Results Study 1 and 2 are completed. Data collection for Study 3 will be completed in 2022. Conclusion MMMI is designed to provide a live facilitated mindfulness program to address symptoms of moral injury. If Study 3 demonstrates good benchmarks, with additional large-scale testing, MMMI may be a promising treatment that can reach veterans who may not seek traditional VAMC care and/or who prefer a web-based program.
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Affiliation(s)
- Michelle L. Kelley
- Old Dominion University, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
- Corresponding author. Department of Psychology, Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA.
| | - Megan Strowger
- Old Dominion University, Old Dominion University, Norfolk, VA, USA
| | | | - Adrian J. Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E. Burgin
- School Psychology and Counselor Education, William & Mary, Williamsburg, VA, USA
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth L. Ayers
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Erum Agha
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Kip A, Diele J, Holling H, Morina N. The relationship of trauma-related guilt with PTSD symptoms in adult trauma survivors: a meta-analysis. Psychol Med 2022; 52:2201-2211. [PMID: 35781354 PMCID: PMC9527673 DOI: 10.1017/s0033291722001866] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a severe condition that is associated with trauma-related guilt. We aimed at providing a comprehensive quantitative systematic review on the relationship between trauma-related guilt and adult PTSD. Database searches in Medline, PsycINFO, PTSDpubs and Web of Knowledge resulted in the inclusion of 163 eligible studies with a total of 35 020 trauma survivors. The studies reported on 157 cross-sectional and 19 longitudinal data points. Overall, we included 135 studies not included in previous meta-analyses. Random-effect models yielded a moderate cross-sectional correlation (r = 0.38, 95% CI 0.35-0.42, p < 0.001, I2 = 90.3%) and a small to moderate predictive correlation (r = 0.21, 95% CI 0.13-0.29, p < 0.001, I2 = 66.7%). The association appeared to be stable over time and was robust to sensitivity analyses. All symptom clusters significantly correlated with guilt. No effects were found for military v. civilian populations or clinical v. non-clinical samples. Effects were smaller for high-quality studies and larger for instruments based on DSM-5. Further significant moderators were type of guilt measure and trauma type. The largest association was found among participants reporting war-related trauma (r = 0.44, 95% CI 0.36-0.51) and the smallest among survivors of motor-vehicle accidents (r = 0.18, 95% CI 0.02-0.33). The results underpin the role of trauma-related guilt in the onset and maintenance of PTSD symptoms, which have important clinical implications. Future studies should further explore the change interactions of guilt and PTSD symptoms.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | - Judith Diele
- Institute of Psychology, University of Münster, Münster, Germany
| | - Heinz Holling
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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15
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Schwartz G, Halperin E, Levi-Belz Y. Moral Injury and Suicide Ideation Among Combat Veterans: The Role of Trauma-Related Shame and Collective Hatred. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP13952-NP13977. [PMID: 33858258 DOI: 10.1177/08862605211007932] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as a significant stressful combat event that may lead to mental health problems, including suicide ideation (SI). Several studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SI. However, the contribution of social-emotional factors has yet to be examined. In the current study, we examined the association between PMIE-Self and SI among combat veterans and explored the mediating role of trauma-related shame and the moderation role of collective hatred in this association. A volunteer sample of 336 Israeli combat veterans was recruited, completing self-report questionnaires in a cross-sectional study. Results indicated that PMIE-Self was positively associated with SI, and trauma-related shame mediated this association. Moreover, collective hatred moderated both their direct (PMIE-SI) and indirect (PMIE-Shame-SI) association. Notably, collective hatred had an inverse role for each of the associations. Thus, collective hatred was found to comprise both a risk and a protective factor for SI following PMIE-Self. The current findings highlight the crucial contribution of trauma-related shame and collective hatred to the association between moral injury and suicidality. Moreover, the findings demonstrate that even years after their military service release, combat veterans exposed to PMIEs may still feel consumed by painful memories and maintain premonitions of a foreshortened future. Furthermore, the findings help to better understand the dynamics of collective hatred and the challenge of modifying it.
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16
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Wang W, Li N, Yuan Y, Wu X, Lan X. Longitudinal relationships between guilt and suicide risk among adolescents in a postdisaster context: Mediating roles of rumination and posttraumatic stress disorder. Suicide Life Threat Behav 2022; 52:773-781. [PMID: 35355309 DOI: 10.1111/sltb.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/20/2021] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyze the pathways and mechanisms underlying the impact of guilt on suicide risk using a well-controlled longitudinal study, we examined the mediating roles of intrusive rumination, deliberate rumination, and posttraumatic stress disorder (PTSD) in this association. METHOD Four hundred and eight adolescent survivors (Mage = 14.05 years) were assessed using self-report questionnaires three and a half years and four and a half years after the Ya'an earthquake. The self-report questionnaires included the Trauma Exposures Questionnaire, the Interpersonal Guilt Questionnaire, the Event-Related Rumination Inventory, the PTSD Checklist for the DSM-5, and the Child Behavior Problems Questionnaire. RESULTS The results indicated that guilt had a direct and positive effect on suicide risk. Intrusive rumination and PTSD mediated the relationship between guilt and suicide risk. Guilt could increase deliberate rumination, but deliberate rumination did not significantly predict PTSD and suicide risk. CONCLUSION Negative postdisaster emotions, such as guilt, can enhance the combined effects of cognition and psychological disorders on suicide risk. Guilt affects suicide risk indirectly through intrusive rumination and PTSD but not through deliberate rumination.
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Affiliation(s)
- Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Nan Li
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yue Yuan
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xiaoyu Lan
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
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17
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Muziki JD, Uwera T, Niyonsenga J, Nshimiyimana A, Sebatukura SG, Mutabaruka J. A qualitative analysis of negative feelings among incarcerated filicide mothers in Rwanda. BMC Psychiatry 2022; 22:432. [PMID: 35761308 PMCID: PMC9235198 DOI: 10.1186/s12888-022-04081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most of the research on filicide mothers suggests that they experience negative feelings before they kill their child. However, little is known about whether these negative feelings can be expressed after one-year post-offense among incarcerated filicide mothers with no history of psychiatric problems. In this study, we aimed to conduct a qualitative analysis to (a) understand negative feelings evolving from negative emotions such as anger, guilt, shame, depression, and anxiety among filicide mothers incarcerated in Nyarugenge Prison in Rwanda, (b) identify the impact of experienced negative feelings on their personal wellbeing, and (c) explore their coping strategies. METHODS This study adopted a phenomenology research design and face-to-face in-depth interviews to explore the problem among twenty filicide mothers selected from Nyarugenge prison. Data were audio recorded, transcribed verbatim, organized, and analysed by using ATLAS.ti 8 Windows. RESULTS Anxious and depressed participants experienced both physical and emotional negative feelings. Social withdrawal and cognitive problems were expressed by anxious participants, while avoidance behaviours were particularly experienced by depressed participants. Intolerance created anger, while self-blame, regret, and acute stress created guilt. In addition, avoidance behaviours and poor self-judgment emerged from shame. Participants felt disconnected from their community and worried about a variety of issues because of their negative feelings. To cope with negative feelings, participants reported that they used abnormal defense, surrender and support from community resources. DISCUSSION Our findings highlight the overall negative feelings of incarcerated filicide mothers, which can guide mental health professionals and different stakeholders to respond with appropriate interventions.
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Affiliation(s)
- Jean d’Amour Muziki
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Thaoussi Uwera
- grid.10818.300000 0004 0620 2260Department of Health Informatics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Japhet Niyonsenga
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.10818.300000 0004 0620 2260Mental Health & Behavior Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Augustin Nshimiyimana
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Siméon Gitimbwa Sebatukura
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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18
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Schuler MS, Wong EC, Ramchand R. Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions. Drug Alcohol Depend 2022; 235:109461. [PMID: 35487079 DOI: 10.1016/j.drugalcdep.2022.109461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Rates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors. METHODS Data on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup). RESULTS HED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2-3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force. CONCLUSION Service branch differences were not fully explained by variation in demographics and deployment/combat experiences.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA.
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
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19
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Norman S. Trauma-Informed Guilt Reduction Therapy: Overview of the Treatment and Research. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:115-125. [PMID: 35531442 PMCID: PMC9068861 DOI: 10.1007/s40501-022-00261-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 12/16/2022]
Abstract
Purpose of Review The purpose of this review is to describe Trauma-Informed Guilt Reduction Therapy (TrIGR), the Non-Adaptive Guilt and Shame (NAGS) model that underlies TrIGR, and the research supporting the use of TrIGR to treat the guilt and shame components of moral injury. TriGR is a 6-session individual psychotherapy that helps clients consider their role in the traumatic event and find constructive ways to express important values, so that they no longer need to express values by suffering through guilt and shame. Recent Findings A recently completed randomized controlled trial of TrIGR versus supportive care therapy included 144 post-9/11 veterans. TriGR showed greater reductions in trauma-related guilt, PTSD symptoms, and depression symptoms. Participants in TrIGR had greater likelihood of losing their PTSD diagnosis and showing clinical meaningful change in PTSD and depression symptoms. Mean attendance was high; 5.3 out of 6 sessions. Summary TrIGR is efficacious in reducing guilt that is common to moral injury as well as PTSD and depression symptoms among combat veterans. The next steps in the program of research to develop and evaluate TrIGR are studies with diverse trauma types and populations as well as relative effectiveness studies comparing TrIGR to other evidence-based treatments for moral injury and PTSD.
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Affiliation(s)
- Sonya Norman
- Executive Division, National Center for PTSD, White River Junction, VT USA
- Department of Psychiatry, San Diego School of Medicine, University of California, San Diego, CA USA
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, MC 116B, CA 92161 San Diego, USA
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20
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Whalen DJ, Hennefield L, Elsayed NM, Tillman R, Barch DM, Luby JL. Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence. J Am Acad Child Adolesc Psychiatry 2022; 61:676-685. [PMID: 34506928 PMCID: PMC8898992 DOI: 10.1016/j.jaac.2021.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/15/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Suicidal thoughts and behaviors (STBs) represent a significant and escalating public health concern in youth. Evidence that STBs can emerge in the preschool years suggests that some pathways leading to clinically significant STBs begin early in life. METHOD This prospective longitudinal study examined the developmental trajectories of STBs in children from ages 3 to 17, oversampled for preschool-onset depression. RESULTS Three unique trajectories of STBs across childhood and adolescence were identified: low class (n = 273) characterized by low rates of STBs, early-persistent class (n = 21) characterized by steadily increasing STBs, and late-onset class (n = 21) characterized by low rates of STBs through age 10 followed by a dramatic increase from ages 11 to 14 years. Preschool measures of depression symptoms, externalizing symptoms, impulsivity, and lower income relative to needs were associated with both high-risk STB classes. Both high-risk STB classes reported greater functional impairment, more externalizing symptoms, and more cumulative stressful life events in adolescence relative to the low class; the late-onset class also reported poorer academic functioning relative to both the early-persistent and low classes. CONCLUSION A significant minority of this prospectively followed group of preschool children evidenced STBs by and/or after age 10. Although relatively rare before age 10, approximately half of the children who experienced STBs in adolescence first exhibited STBs in early childhood and comprised a trajectory suggesting increasing STBs. In contrast, approximately half of children first exhibited STBs in early adolescence. Early screening and identification of at-risk youth during both preschool and late childhood is important for early intervention regarding STBs.
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Affiliation(s)
- Diana J Whalen
- Washington University School of Medicine in St. Louis, Missouri.
| | | | | | - Rebecca Tillman
- Washington University School of Medicine in St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine in St. Louis, Missouri; Washington University in St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine in St. Louis, Missouri
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21
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Norman SB, Capone C, Panza KE, Haller M, Davis BC, Schnurr PP, Shea MT, Browne K, Norman GJ, Lang AJ, Kline AC, Golshan S, Allard CB, Angkaw A. A clinical trial comparing trauma-informed guilt reduction therapy (TrIGR), a brief intervention for trauma-related guilt, to supportive care therapy. Depress Anxiety 2022; 39:262-273. [PMID: 35075738 DOI: 10.1002/da.23244] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Trauma-related guilt is common, associated with posttraumatic mental health problems, and can persist after posttraumatic stress disorder (PTSD) treatment. We compared the efficacy of two six-session psychotherapies, Trauma-Informed Guilt Reduction (TrIGR) and Supportive Care Therapy (SCT), for reducing trauma-related guilt. TrIGR helps patients accurately appraise their role in the trauma and re-engage in values. In SCT, patients guide session content. METHODS A total of 184 veterans seeking VA mental health services were enrolled across two sites; 145 veterans (mean age: 39.2 [8.1]; 92.4% male; 84.8% with PTSD) who endorsed guilt related to a traumatic event that occurred during a post 9/11 Iraq or Afghanistan deployment were randomized and assessed at baseline, posttreatment, 3- and 6-month follow-up. RESULTS Linear mixed models using intent-to-treat analyses showed guilt decreased in both conditions with a greater decrease for TrIGR (treatment × time, -0.22; F 1, 455.2 = 18.49, p = .001; d = 0.92) than supportive therapy. PTSD and depressive symptoms showed the same pattern. TrIGR had significantly higher likelihood of PTSD treatment response (67% vs. 40%), loss of PTSD diagnosis (50% vs. 14%), and meaningful change in depression (54% vs. 27%) than supportive therapy. Psychological distress and trait shame improved in both conditions. Quality of life did not change. CONCLUSIONS Targeting guilt appears to be an effective means for reducing posttraumatic symptoms and distress.
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Affiliation(s)
- Sonya B Norman
- Executive Division, National Center for PTSD, Hartford, Vermont, USA.,Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Christy Capone
- Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Kaitlyn E Panza
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Moira Haller
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Brittany C Davis
- Department of Mental Health, James A. Haley Veterans Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, Hartford, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - M Tracie Shea
- Department of Mental Health, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Kendall Browne
- Department of Research, Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gregory J Norman
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ariel J Lang
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Clinical Research Division, VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexander C Kline
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Shahrokh Golshan
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Carolyn B Allard
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Clinical Psychology, California School of Professional Psychology at Alliant International University, San Diego, California, USA
| | - Abigail Angkaw
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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22
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Kudinova A, Brick LA, Barthelemy C, MacPherson HA, Jenkins G, DeYoung L, Gilbert A, Radoeva P, Kim K, Armey M, Dickstein D. Sex and age moderate the trajectory of guilt among children and adolescents with and without recent suicidal ideation. Cogn Emot 2022; 36:512-526. [PMID: 35077324 PMCID: PMC9156530 DOI: 10.1080/02699931.2022.2029359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We aimed to examine whether the trajectories of ecologically derived guilt differ among a transdiagnostic sample of youth with and without recent suicidal ideation and whether sex and age moderated this association. We assessed guilt 3 times a day over a 2-week period via ecological momentary assessment (EMA) technology in 102 children recruited from the community, outpatient, and inpatient settings. The average age of children was 10.95 y.o. (SD = 2.26, range 8-16) and the majority were male (54.9%) and White (76.5%). We found that the real-world guilt during a two-week EMA period was higher among youth with greater suicidal ideation severity in the past six months. Moreover, there was a significant moderating effect of sex and age on this association, such that the association between suicidal ideation severity and guilt was particularly strong among females compared to males and youth who were 10 years old or older. The findings were maintained when we adjusted for the relevant demographic and clinical characteristics, including age, minority status, parental income, EMA response rate, and current internalising symptoms. These preliminary findings highlight the clinical relevance of assessing and targeting feelings of guilt in the day-to-day lives of youth, particularly for females and older youth.
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Affiliation(s)
- Anastacia Kudinova
- Bradley Hospital, Providence, RI, USA
- Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Leslie A. Brick
- Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine Barthelemy
- PediMIND Program at McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard University Medical School, Boston, MA, USA
| | | | - Gracie Jenkins
- PediMIND Program at McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard University Medical School, Boston, MA, USA
| | - Lena DeYoung
- PediMIND Program at McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard University Medical School, Boston, MA, USA
| | - Anna Gilbert
- Bradley Hospital, Providence, RI, USA
- Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Petya Radoeva
- Bradley Hospital, Providence, RI, USA
- Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kerri Kim
- Bradley Hospital, Providence, RI, USA
- Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Armey
- Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel Dickstein
- PediMIND Program at McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard University Medical School, Boston, MA, USA
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23
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McQuaid RJ, Nikolitch K, Vandeloo KL, Burhunduli P, Phillips JL. Sex Differences in Determinants of Suicide Risk Preceding Psychiatric Admission: An Electronic Medical Record Study. Front Psychiatry 2022; 13:892225. [PMID: 35711595 PMCID: PMC9196272 DOI: 10.3389/fpsyt.2022.892225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Individuals requiring inpatient psychiatric care represent a group at higher risk of progressing toward suicide attempt. Using electronic medical record (EMR) data collected from psychiatric inpatient admissions, the objective of this study was to identify sex differences in risk factors for suicide plans and/or attempts within the 30 days preceding hospital admission. METHODS Resident Assessment Instrument for Mental Health (RAI-MH) intake data were obtained for patients admitted to a Canadian tertiary-care hospital deemed a "threat or danger to self" during a 10-year period (2008-2018). Data was extracted for individuals categorized into three groups: non-suicidal (N = 568), presence of suicide plan (N = 178), and presence of suspected suicide attempt (N = 124) in the 30 days prior to hospital admission. Multivariate logistic regression models were used to examine determinants of suicide risk. RESULTS Across all models, diagnosis of depression was the strongest predictor of suicide plan and/or attempt (OR = 5.54, 95% CI = 3.71-8.27, p < 0.001). Comparing clinical symptoms between suicidal and non-suicidal groups at the time of admission, the largest effect sizes were found for hopelessness (p < 0.001, η2 = 0.11), and guilt or shame (p < 0.001, η2 = 0.09). Female sex was identified as a significant factor for elevated suicidal risk (OR = 1.56, 95% CI = 1.01-2.21, p = 0.01), thus we stratified the regression model by sex to identify specific risk factors for suicide plan and/or attempt for males and females. Among males, having no confidant (OR = 2.13, 95% CI = 1.19-3.80, p = 0.01), presence of recent stressors (OR = 1.95, 95% CI = 1.16-3.29, p = 0.01), and participation in social activities (OR = 1.67, 95% CI = 1.02-2.71, p = 0.04) were important predictors, while among females, younger age (OR = 0.96, 95% CI = 0.94-0.97, p < 0.001) increased odds of suicide plan and/or attempt. CONCLUSION EMR-derived findings highlight different psychosocial and clinical determinants for males and females associated with suicide plan or attempt prior to psychiatric admission. Identifying precipitating factors that elevate imminent suicide risk may inform suicide prevention efforts for psychiatric inpatients.
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Affiliation(s)
- Robyn J McQuaid
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Neuroscience, Carleton University, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Katerina Nikolitch
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Katie L Vandeloo
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Patricia Burhunduli
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer L Phillips
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Neuroscience, Carleton University, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
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Fischer IC, Norman SB, Feder A, Feingold JH, Peccoralo L, Ripp J, Pietrzak RH. Downstream consequences of moral distress in COVID-19 frontline healthcare workers: Longitudinal associations with moral injury-related guilt. Gen Hosp Psychiatry 2022; 79:158-161. [PMID: 36403350 PMCID: PMC9664834 DOI: 10.1016/j.genhosppsych.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the longitudinal associations between dimensions of COVID-19 pandemic-related moral distress (MD) and moral injury (MI)-related guilt in a large sample of frontline COVID-19 healthcare workers (FHCWs). METHODS Data from a diverse occupational cohort of 786 COVID-19 FHCWs were collected during the initial peak of the COVID-19 pandemic in New York City and again 7 months later. Baseline MD and MI-related guilt at follow-up were assessed in three domains: family-, work-, and infection-related. Social support was evaluated as a potential moderator of associations between MD and MI-related guilt. RESULTS A total of 66.8% of FHCWs reported moderate-or-greater levels of MI-related guilt, the most prevalent of which were family (59.9%) or work-related (29.4%). MD was robustly predictive of guilt in a domain-specific manner. Further, among FHCWs with high levels of work-related MD, those with greater perceptions of supervisor support were less likely to develop work-related guilt 7 months later. DISCUSSION MD was found to be highly prevalent in FHCWs during the initial wave of the COVID-19 pandemic and was linked to the development of MI-related guilt over time. Prevention and early intervention efforts to mitigate MD and bolster supervisor support may help reduce risk for MI-related guilt in this population.
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Affiliation(s)
- Ian C. Fischer
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Corresponding author at: US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
| | - Sonya B. Norman
- US Department of Veterans Affairs National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, USA,Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H. Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert H. Pietrzak
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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25
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Brémault-Phillips S, Cherwick T, Smith-MacDonald LA, Huh J, Vermetten E. Forgiveness: A Key Component of Healing From Moral Injury? Front Psychiatry 2022; 13:906945. [PMID: 35911220 PMCID: PMC9328408 DOI: 10.3389/fpsyt.2022.906945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Service members and veterans can be exposed to potentially traumatic and morally injurious experiences (PMIEs) including participating in, witnessing, or failing to prevent an act(s) that transgresses their core beliefs. Violation of one's deeply held morals and values can be profoundly distressing and shatter one's sense of self at the deepest level. Relationships with self, others, the world, and for some, the Sacred, can also be fractured. Post-Traumatic Stress Disorder (PTSD) and/or Moral Injury (MI) can result. Left unresolved, MI can leave individuals struggling with guilt, shame, cognitive dissonance, and negative self-attributions. A holistic approach that addresses the psychological and spiritual harm associated with MI is warranted. We wonder if forgiveness can help individuals struggling with MI to address the harm caused by actions or inactions, release negative emotions, and mend relationships. Commonly used by Spiritual/Religious (S/R) Leaders, forgiveness practices are increasingly being explored by Mental Health Professionals as a complement to evidence-based treatment approaches. This article provides case examples that illustrate the use of forgiveness practices that promote recovery and identifies programs used in clinical practice that incorporate forgiveness. Research is yet needed to better understand the importance of forgiveness in the treatment and healing of PTSD and/or MI. This requires an interdisciplinary discourse between Mental Health Professionals and S/R Leaders working in the field of MI. Such engagement and integrated use of forgiveness practices may yield improved outcomes not only for service members and veterans, but for all those struggling as a result of PTSD and/or MI.
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Affiliation(s)
- Suzette Brémault-Phillips
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,HiMARC, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Terry Cherwick
- Royal Canadian Chaplain Service, Department of National Defence, Edmonton, AB, Canada
| | - Lorraine Alison Smith-MacDonald
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,HiMARC, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - John Huh
- Royal Canadian Chaplain Service, Department of National Defence, Edmonton, AB, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
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26
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Lin YC, Wee JY, Marks RB, O'Connell KL, Hassler ME, Law KC. Shame-proneness and suicidal ideation: The roles of depressive and anger rumination. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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27
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Ollivier F, Soubelet A, Duhem S, Thümmler S. Shame and guilt in the suicidality related to traumatic events: A systematic literature review. Front Psychiatry 2022; 13:951632. [PMID: 36276326 PMCID: PMC9581050 DOI: 10.3389/fpsyt.2022.951632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Shame and guilt are involved in suicidality and in post-traumatic stress disorder. However, few studies have explored the implication of those emotions in the suicidality of patients exposed to traumatic events. OBJECTIVE The objective of this literature review was to examine the implication of shame and guilt in the suicidality of individuals who have experienced potentially traumatic events or been diagnosed with post-traumatic stress disorder. These two emotions are part of post-traumatic stress disorder and suicidality. Moreover, when individuals perceive that their coping strategies are inadequate, they may view suicide as a relief from suffering. METHOD This review was conducted according to PRISMA method. We used combinations of search words for traumatization, suicide ideation and behavior and shame and guilt to search for empirical studies in common databases in psychology and medicine. RESULTS Among 137 identified articles, 9 full texts were retained. Results suggest that shame and guilt were involved in all aspects of suicidality in patients who had experienced traumatic events or been diagnosed with post-traumatic stress disorder. The degree of shame and guilt differed with the type of traumatic event, notably affecting individuals who had experienced military combat, physical or sexual abuse, or emotional or physical neglect. CONCLUSION Shame and guilt are implicated in suicide's risk. Future research is now needed to determine whether greater attention to these two emotions would enhance our understanding and anticipation of suicidal behavior in those who have experienced a potentially traumatic event or been diagnosed with post-traumatic stress disorder.
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Affiliation(s)
| | - Andréa Soubelet
- CoBTek, FRIS, Université Côte d'Azur, Nice, France.,Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | - Stéphane Duhem
- Service de Psychiatrie, CRP HdF, CHU Lille, Lille, France.,Department of Psychiatry, CHU Lille, Lille, France.,F2RSM Fédération Régionale de Recherche en Santé Mentale et Psychiatrie, Lille, France.,Inserm, Centre d'Investigation Clinique, CHU Lille, Lille, France
| | - Susanne Thümmler
- CoBTek, FRIS, Université Côte d'Azur, Nice, France.,Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
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28
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Kovnick MO, Young Y, Tran N, Teerawichitchainan B, Tran TK, Korinek K. The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:526-544. [PMID: 34622692 PMCID: PMC8633195 DOI: 10.1177/00221465211039239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Most Vietnamese young adults who experienced the American War were exposed to war-related violence, which can exert a lifelong impact. We analyze survey data collected among northern and central Vietnamese older adults in the 2018 Vietnam Health and Aging Study (N = 2,447) to examine the association between various war traumas, psychological distress, and suicidal ideation. Informed by life course and stress process perspectives, we use structural equation models with multiple mediators to analyze the relationship between mental health outcomes and five types of wartime stress exposure: loss of family and friends, witnessing death, malevolent living conditions, life threat, and moral injury. Our findings reveal enduring mental health impacts of war among survivors. Wartime stress exposure's influence on mental health is mediated by recent comorbidities and stressful life events. Loss of family members, witnessing death, and malevolent living conditions during war are particularly salient risks for psychological distress.
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Affiliation(s)
| | | | - Nhung Tran
- University of Utah, Salt Lake City, UT, USA
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29
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Norman SB, Feingold JH, Kaye‐Kauderer H, Kaplan CA, Hurtado A, Kachadourian L, Feder A, Murrough JW, Charney D, Southwick SM, Ripp J, Peccoralo L, Pietrzak RH. Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety 2021; 38:1007-1017. [PMID: 34293236 PMCID: PMC8426909 DOI: 10.1002/da.23205] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/21/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties. METHOD Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample. RESULTS The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes. CONCLUSION Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.
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Affiliation(s)
- Sonya B. Norman
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA,Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Jordyn H. Feingold
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Halley Kaye‐Kauderer
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carly A. Kaplan
- Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alicia Hurtado
- Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Lorig Kachadourian
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA,Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Adriana Feder
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - James W. Murrough
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Dennis Charney
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Steven M. Southwick
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA
| | - Jonathan Ripp
- Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Lauren Peccoralo
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Robert H. Pietrzak
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA,Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA,Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
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30
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Koenig HG, Al Zaben F. Moral Injury: An Increasingly Recognized and Widespread Syndrome. JOURNAL OF RELIGION AND HEALTH 2021; 60:2989-3011. [PMID: 34245433 PMCID: PMC8270769 DOI: 10.1007/s10943-021-01328-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 05/05/2023]
Abstract
Moral injury (MI), originally discussed in relationship to transgressing moral beliefs and values during wartime among military personnel, has expanded beyond this context to include similar emotions experienced by healthcare professionals, first responders, and others experiencing moral emotions resulting from actions taken or observations made during traumatic events or circumstances. In this article, we review the history, definition, measurement, prevalence, distinctiveness, psychological consequences, manifestations (in and outside of military settings), and correlates of MI in different settings. We also review secular psychological treatments, spiritually integrated therapies, and pastoral care approaches (specific for clergy and chaplains) used to treat MI and the evidence documenting their efficacy. Finally, we examine directions for future research needed to fill the many gaps in our knowledge about MI, how it develops, and how to help those suffering from it.
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Affiliation(s)
- Harold G Koenig
- Departments of Psychiatry and Medicine, Duke University Health System, Durham, NC, 27705, USA.
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
- School of Public Health, Ningxia Medical University, Yinchuan, People's Republic of China.
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Psychiatry, Duke University Medical Center, Box 3400, Durham, NC, 27710, USA.
| | - Faten Al Zaben
- Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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A cognitive behavioural therapy (CBT) approach for working with strong feelings of guilt after traumatic events. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
This article outlines a cognitive behavioural therapy (CBT) approach to treating feelings of guilt and aims to be a practical ‘how to’ guide for therapists. The therapeutic techniques were developed in the context of working with clients with a diagnosis of post-traumatic stress disorder (PTSD); however, the ideas can also be used when working with clients who do not meet a diagnosis of PTSD but have experienced trauma or adversity and feel guilty. The techniques in this article are therefore widely applicable: to veterans, refugees, survivors of abuse, the bereaved, and healthcare professionals affected by COVID-19, amongst others. We consider how to assess and formulate feelings of guilt and suggest multiple cognitive and imagery strategies which can be used to reduce feelings of guilt. When working with clients with a diagnosis of PTSD, it is important to establish whether the guilt was first experienced during the traumatic event (peri-traumatically) or after the traumatic event (post-traumatically). If the guilt is peri-traumatic, following cognitive work, this new information may then need to be integrated into the traumatic memory during reliving.
Key learning aims
(1)
To understand why feelings of guilt may arise following experiences of trauma or adversity.
(2)
To be able to assess and formulate feelings of guilt.
(3)
To be able to choose an appropriate cognitive technique, based on the reason for the feeling of guilt/responsibility, and work through this with a client.
(4)
To be able to use imagery techniques to support cognitive interventions with feelings of guilt.
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Raudales AM, Weiss NH, Dixon-Gordon KL, Contractor AA, Schatten HT. The role of emotion dysregulation in the association between posttraumatic stress disorder symptoms and suicidal thoughts and behaviors among veterans. J Clin Psychol 2021; 77:2096-2108. [PMID: 33175404 PMCID: PMC8110601 DOI: 10.1002/jclp.23084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although research has established a link between posttraumatic stress disorder (PTSD) symptoms and suicidal thoughts and behaviors (STBs), little is known about factors that may accentuate this relation. This study evaluated the influences of negative and positive emotion dysregulation on the association between PTSD symptoms and STBs among veterans. METHODS Four-hundred and sixty-five trauma-exposed military veterans in the community (M age = 38.00, 71.4% male, 69.5% White) completed online questionnaires. RESULTS Negative emotion dysregulation did not moderate the relation between PTSD symptoms and STBs. Results showed significant interactive effects of PTSD symptoms and positive emotion dysregulation on STBs, such that PTSD symptoms were more strongly related to STBs at high (vs. low) levels of positive emotion dysregulation. This effect was sustained across domains of positive emotion dysregulation. CONCLUSIONS Findings suggest a potential need to consider positive emotion dysregulation in the assessment and treatment of STBs among veterans with PTSD symptoms.
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Affiliation(s)
- Alexa M. Raudales
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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33
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Okulate GT, Akinsanmi MA, Oguntuase RA, Majebi MA. Moral Injury Among Nigerian Soldiers Following Combat: Case Reports and a Review of the Literature. Mil Med 2021; 186:e1048-e1052. [PMID: 33242066 DOI: 10.1093/milmed/usaa373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
Moral injury is a phenomenon in which unpleasant psychological consequences such as guilt and shame follow exposure to activities that transgress one's deeply held moral beliefs and expectations. Combat engagement places service members at a heightened risk on account of exposure to potentially morally injurious experiences (PMIEs). It remains a more recent construct in comparison with posttraumatic stress disorder (PTSD) despite several studies. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) effectively subsumed moral injury as a part of PTSD, recognizing moral injury as symptoms rather than events that are followed by specific symptoms. Nothing has been reported on moral injury, its prevalence, and associated factors among Nigerian soldiers despite exposure to PMIE in combat and abundance of literature worldwide. Unlike PTSD, moral injury is often under-recognized by clinicians and military and nonmilitary health personnel, and particularly, in our setting where nonmilitary mental health personnel sometimes have to treat postcombat military patients. Failure of recognition of moral injury (and not addressing it) can adversely affect overall mental health and may increase the risk of suicide. We report three cases of personnel of the Nigerian Army referred to our clinic after combat in northeastern Nigeria and following exposure to PMIE, the circumstances of exposure to morally injurious situations and subsequent reactions. Our study brought up several findings including the effect of exposure to multiple potentially injurious events, apparent frequent co-occurrence of moral injury with PTSD, and the complicating unpleasant mental health outcomes. Being a report of cases, this implies that generalizations might not be warranted but serve as possible questions for future research.
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Affiliation(s)
- Gbenga Taiwo Okulate
- Department of Psychiatry, 68 Nigerian Army Reference Hospital Myhoung Barracks Yaba, Lagos, PMB 2004, Nigeria
| | - Mojisola Abosede Akinsanmi
- Department of Psychiatry, 68 Nigerian Army Reference Hospital Myhoung Barracks Yaba, Lagos, PMB 2004, Nigeria
| | - Rufus Akinwande Oguntuase
- Department of Psychiatry, 68 Nigerian Army Reference Hospital Myhoung Barracks Yaba, Lagos, PMB 2004, Nigeria
| | - Michael Adeiza Majebi
- Department of Psychiatry, 68 Nigerian Army Reference Hospital Myhoung Barracks Yaba, Lagos, PMB 2004, Nigeria
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Bryan CJ, Bryan AO. Delayed reward discounting and increased risk for suicide attempts among U.S. adults with probable PTSD. J Anxiety Disord 2021; 81:102414. [PMID: 33962144 DOI: 10.1016/j.janxdis.2021.102414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/16/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND PTSD is an established risk factor for suicide attempts and suicide death, but the mechanisms underlying this association remain unknown. The present study examined associations among delayed reward discounting-the balance between smaller immediate available rewards versus larger delayed rewards-self-reported PTSD symptoms, and recent suicide attempts among individuals reporting suicide ideation within the past year. METHODS A cross-sectional survey of U.S. adults completed the Primary Care PTSD Screen for DSM-5, the 21-item Monetary Choice Questionnaire, and the Self-Injurious Thoughts and Behaviors Interview-Revised. Analyses of variance and multinomial regression models were used to test associations among variables. RESULTS Among participants reporting suicide ideation within the past year, discount rates were significantly higher among those reporting more PTSD symptoms and a past-year suicide attempt, suggesting these participants expressed a preference for immediately available rewards. CONCLUSIONS Choice behavior among individuals reporting many PTSD symptoms and a recent suicide attempt is influenced to a greater degree by immediately available rewards. Sensitivity to immediate rewards at the expense of larger delayed rewards may reflect a vulnerability for suicidal behavior among individuals screening positive for PTSD.
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Affiliation(s)
- Craig J Bryan
- The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, 1670 Upham Dr., Columbus, OH, 43210, United States.
| | - AnnaBelle O Bryan
- The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, 1670 Upham Dr., Columbus, OH, 43210, United States
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Rizvi SL, Fitzpatrick S. Changes in suicide and non-suicidal self-injury ideation and the moderating role of specific emotions over the course of dialectical behavior therapy. Suicide Life Threat Behav 2021; 51:429-445. [PMID: 32969037 DOI: 10.1111/sltb.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/12/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dialectical behavior therapy (DBT) targets suicidal behavior and non-suicidal self-injury (NSSI) as well as urges/ideation to engage in these behaviors. However, it remains unclear which specific suicidal ideation (SI) and NSSI ideation domains (i.e., frequency, worst intensity, average intensity, perceived likelihood of future ideation, and duration of ideation), if any, are impacted, and whether specific emotions moderate these effects. METHOD 73 individuals with borderline personality disorder (BPD), enrolled in six months of DBT, completed interviews of suicide and NSSI ideation and self-report measures of specific emotions at baseline, mid-treatment, and post-treatment. RESULTS Generalized estimation equations revealed that all domains of suicidal ideation decreased over the course of DBT, but for NSSI domains, only ideation intensity decreased. Higher levels of shame/guilt predicted less, and higher fear predicted more, reduction in SI and NSSI ideation frequency. Higher shame/guilt also predicted more reduction in worst SI intensity. Higher sadness predicted greater reductions in SI intensity and duration, but less reductions in the perceived likelihood of future NSSI ideation. CONCLUSIONS These findings suggest that DBT effectively reduces several facets of SI, but more work is required to target NSSI ideation. Results also suggest that targeting shame/guilt may be important to reducing SI and NSSI ideation.
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Affiliation(s)
- Shireen L Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Skye Fitzpatrick
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.,Department of Psychology, York University, Toronto, ON, Canada
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Nichter B, Norman SB, Maguen S, Pietrzak RH. Moral injury and suicidal behavior among US combat veterans: Results from the 2019-2020 National Health and Resilience in Veterans Study. Depress Anxiety 2021; 38:606-614. [PMID: 33666315 DOI: 10.1002/da.23145] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Recent research suggests that exposure to potentially morally injurious experiences (PMIEs) may be associated with increased risk for suicidal behavior among US combat veterans, but population-based data on these associations are scarce. This study examined the association between PMIEs with current suicidal ideation (SI), lifetime suicide plans (SP), and suicide attempts (SA) in a contemporary, nationally representative sample of combat veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US combat veterans (n = 1321). PMIEs were assessed using the Moral Injury Events Scale (MIES). Multivariable logistic regression analyses were conducted to examine associations between MIES total scores and specific types of PMIEs with suicidal behavior. RESULTS Thirty-six point three percent of veterans reported at least one PMIE. Perceived transgressions by self, others, and betrayal were associated with SI, SP, and SA (odds ratios [ORs] = 1.21-1.27, all p s < .05), after adjusting for sociodemographic, trauma, and psychiatric characteristics. MIES total scores were significantly, albeit weakly, associated with SP (OR = 1.03, p < .01), but not SI/SA. Depression, posttraumatic stress disorder (PTSD), and age emerged as the strongest correlates of SI/SP/SA (14.9%-38.1% of explained variance), while PMIEs accounted for a comparatively modest amount of variance (3.3%-8.9%). CONCLUSIONS Reports of potentially morally injurious experiences are prevalent among US combat veterans, and associated with increased risk for suicidal behavior, above and beyond severity of combat exposure, PTSD, and depression. Implications for clinical practice and future research are discussed, including the need for methodological advancements in the measurement of moral injury.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,National Center for PTSD, Vermont, Vermont, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California-San Francisco, San Francisco, California, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Braun TD, Uebelacker LA, Ward M, Holzhauer CG, McCallister K, Abrantes A. "We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma. Complement Ther Med 2021; 59:102729. [PMID: 33965560 DOI: 10.1016/j.ctim.2021.102729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST. DESIGN Collective case series (N = 7). SETTING New England Vet Center. INTERVENTIONS Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy. MAIN OUTCOME MEASURES Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2). RESULTS Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2. CONCLUSIONS TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.
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Affiliation(s)
- Tosca D Braun
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States(1); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States.
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
| | - Mariana Ward
- Memorial Sloan Kettering, Sloan Kettering Institute, 1275 York Ave., New York, NY, 10065, United States.
| | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave., North Worcester, MA, 01655, United States.
| | - Kelly McCallister
- West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States.
| | - Ana Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
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Johnson CM, Holmes SC, Suvak MK, Song J, Shields N, Lane JEM, Sijercic I, Cohen ZD, Stirman SW, Monson CM. The Effect of PTSD Symptom Change on Suicidal Ideation in a Combined Military and Civilian Sample Engaged in Cognitive Processing Therapy. Behav Ther 2021; 52:774-784. [PMID: 33990249 DOI: 10.1016/j.beth.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
In light of the well-established relationship between posttraumatic stress disorder (PTSD) and suicidal ideation (SI), there has been a push for treatments that simultaneously improve symptoms of PTSD and decrease SI. Using data from a randomized controlled hybrid implementation-effectiveness trial, the current study investigated the effectiveness of Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2016) on PTSD and SI. The patient sample (N = 188) was diverse in military and veteran status, gender, and comorbidity, and 73% of the sample endorsed SI at one or more points during CPT. Participants demonstrated significant improvement in SI over the course of CPT. Multilevel growth curve modeling revealed a significant association between PTSD symptom change and change in SI. Results from cross-lagged multilevel regressions indicated that PTSD symptoms predicted SI in the next session, yet SI in a given session did not predict PTSD symptoms in the next session. Potentially relevant clinical factors (i.e., military status, gender, depression diagnosis, baseline SI, study consultation condition) were not associated with the relationship between PTSD symptoms and SI. These results add to the burgeoning literature suggesting that evidence-based treatments for PTSD, like CPT, reduce suicidality in a range of individuals with PTSD, and that this reduction is predicted by improvements in PTSD symptoms.
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Affiliation(s)
- Clara M Johnson
- Dissemination and Training Division, National Center for PTSD
| | - Samantha C Holmes
- College of Staten Island, City University of New York; Yale School of Medicine
| | | | - Jiyoung Song
- Dissemination and Training Division, National Center for PTSD
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Kealy D, Treeby MS, Rice SM. Shame, guilt, and suicidal thoughts: The interaction matters. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:414-423. [PMID: 33836103 DOI: 10.1111/bjc.12291] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/01/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study examined associations between generalized shame and guilt, and suicidal ideation. METHODS Individuals attending outpatient mental health services (N = 100) completed study measures at a single time point. Correlation and regression analyses examined associations between recent suicidal ideation and generalized shame and guilt, both concurrently and interacting, controlling for depressive symptoms and history of previous suicide attempt. RESULTS When examined concurrently, guilt - but not shame - remained significantly associated with suicidal ideation, after accounting for effects of depressive symptoms and past suicide attempt. A significant shame × guilt interaction revealed the association between guilt and suicidal ideation intensified with higher shame. CONCLUSIONS Findings emphasize consideration of generalized shame and guilt - and their interaction - when working with patients exhibiting suicidal thoughts. PRACTITIONER POINTS Shame and guilt are self-conscious emotions that, when generalized and excessive, may confer risk for suicidal ideation Generalized guilt may be uniquely linked with suicidal ideation, yet this association may also amplified by shame Both shame and guilt - and their interaction - are important to consider when working with patients exhibiting suicidal thoughts.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matt S Treeby
- School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Simon M Rice
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
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Kanen JW, Arntz FE, Yellowlees R, Cardinal RN, Price A, Christmas DM, Apergis-Schoute AM, Sahakian BJ, Robbins TW. Serotonin depletion amplifies distinct human social emotions as a function of individual differences in personality. Transl Psychiatry 2021; 11:81. [PMID: 33518708 PMCID: PMC7847998 DOI: 10.1038/s41398-020-00880-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
Serotonin is involved in a wide range of mental capacities essential for navigating the social world, including emotion and impulse control. Much recent work on serotonin and social functioning has focused on decision-making. Here we investigated the influence of serotonin on human emotional reactions to social conflict. We used a novel computerised task that required mentally simulating social situations involving unjust harm and found that depleting the serotonin precursor tryptophan-in a double-blind randomised placebo-controlled design-enhanced emotional responses to the scenarios in a large sample of healthy volunteers (n = 73), and interacted with individual differences in trait personality to produce distinctive human emotions. Whereas guilt was preferentially elevated in highly empathic participants, annoyance was potentiated in those high in trait psychopathy, with medium to large effect sizes. Our findings show how individual differences in personality, when combined with fluctuations of serotonin, may produce diverse emotional phenotypes. This has implications for understanding vulnerability to psychopathology, determining who may be more sensitive to serotonin-modulating treatments, and casts new light on the functions of serotonin in emotional processing.
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Affiliation(s)
- Jonathan W Kanen
- Department of Psychology, University of Cambridge, Cambridge, UK.
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
| | - Fréderique E Arntz
- Department of Psychology, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychology, Leiden University, Leiden, The Netherlands
| | - Robyn Yellowlees
- Department of Psychology, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rudolf N Cardinal
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Annabel Price
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - David M Christmas
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Annemieke M Apergis-Schoute
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Neuroscience, Psychology, and Behaviour, University of Leicester, Leicester, UK
| | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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41
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Holliday R, Forster JE, Schneider AL, Miller C, Monteith LL. Interpersonal Violence Throughout the Lifespan: Associations With Suicidal Ideation and Suicide Attempt Among a National Sample of Female Veterans. Med Care 2021; 59:S77-S83. [PMID: 33438887 DOI: 10.1097/mlr.0000000000001447] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Female veterans experience interpersonal violence (ie, physical and sexual violence) more often than male veterans and nonveteran females. There is limited knowledge of types of interpersonal violence across the lifespan in relation to suicidal ideation and suicide attempt. Prior research has also focused on those accessing the Veterans Health Administration (VHA) care. OBJECTIVE This study examined if physical and sexual violence at differing time points (ie, premilitary, during military service) were associated with suicidal ideation and a suicide attempt at subsequent time points. We anticipated that violence would be associated with an increased risk of suicidal ideation and attempt; however, given limited prior research, we were uncertain which types of violence and time points would be associated with risk. RESEARCH DESIGN Data from a cross-sectional national survey. SUBJECTS A total of 407 female veterans using, formerly using, or who never used VHA care. MEASURES Suicidal ideation, suicide attempt, physical violence, and sexual violence were assessed. RESULTS Premilitary sexual, but not physical, violence was associated with military suicidal ideation. Both premilitary and military sexual and physical violence were associated with postmilitary suicidal ideation. Premilitary and military sexual, but not physical, violence were associated with a postmilitary suicide attempt. These results were maintained after accounting for VHA use. A significant model for military suicide attempt was not generated. CONCLUSIONS Assessment of premilitary and military sexual violence among female veterans is warranted within the context of suicide risk assessment and prevention. Preventing sexual violence among female veterans may be important for preventing suicidal ideation and attempt.
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Affiliation(s)
- Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
| | - Christin Miller
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
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Autotraumatic Stress Disorders: Posttraumatic Stress Disorder Variants When the Victim Bears Responsibility for the Trauma. J Nerv Ment Dis 2020; 208:947-952. [PMID: 32925695 DOI: 10.1097/nmd.0000000000001235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autotraumatic stress disorders (ATSD), variants of posttraumatic stress disorder PTSD, may develop in individuals after traumatic stressors for which they carry some responsibility, for example, serious self-injury and injury or death to others after murderous rages or careless vehicular driving. In ATSD, the individual is both the causative actor and casualty. As a result, in ATSD, distinctive negative psychological sequelae are grafted onto the usual distressing symptoms of PTSD, differentiating them from both PTSD and complex-PTSD. Whether the actions were intentional or unintentional and regardless of complications by comorbid psychiatric disorders, individuals with ATSD additionally experience some or all of the following symptoms stemming from actions for which they were responsible, wholly or in part: severe and unrelenting reality-based guilt, shame, remorse, regret, bitterness, self-betrayal, inability to trust oneself, and moral injury. Empirical studies investigating trauma-associated guilt and moral injury provide evidence to support these formulations. Clinical vignettes illustrate a range of circumstances leading to ATSD, in each instance adding significantly to the individual's distress, impeding recovery, and often requiring specific psychotherapeutic attention over and above that required for PTSD or complex-PTSD. These psychotherapeutic strategies have included intense, prolonged, noninterruptive, open-minded listening; avoiding premature whitewashing of responsibility and guilt; facilitating grief over lost innocence; helping create personal narratives that permit self-acceptance despite permanently altered damaged self-image; and, for some individuals, guiding repentance and restorative actions. Systematic case series and additional studies are necessary to ascertain how intentionality, self-harm versus harming others, and various comorbidities shape ATSD presentations, and to better delineate effective treatment strategies.
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43
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Eaton E, Capone C, Shea MT, Cameron A. Evaluation of Self-Compassion Focused Group Treatment for Co-Occurring PTSD and Substance Use in Veterans with Posttraumatic Guilt: A Case Study. Int J Group Psychother 2020; 70:481-508. [PMID: 38449164 DOI: 10.1080/00207284.2020.1805617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) following combat exposure affects a significant proportion of military veterans. Guilt and shame are common to PTSD-SUD, suggesting a possible role as a mechanism underlying both disorders. Cultivating self-compassion (SC) among veterans is a logical approach to treating guilt and shame. The purpose of this article is threefold: (a) present scientific theories of SC in the veteran population with emphasis on PTSD, substance use, and guilt and shame; (b) present a case study that highlights how self-compassion-focused treatment (SCFT) can be utilized in a group format with veterans with PTSD-SUD and posttraumatic guilt; and (c) discuss implications of our findings for refining SCFT within a group intervention setting among this population and for future research.
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Mantri S, Lawson JM, Wang Z, Koenig HG. Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP. JOURNAL OF RELIGION AND HEALTH 2020; 59:2323-2340. [PMID: 32681398 PMCID: PMC7366883 DOI: 10.1007/s10943-020-01065-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This study aims to develop and assess the psychometric properties of a measure of moral injury (MI) symptoms for identifying clinically significant MI in health professionals (HPs), one that might be useful in the current COVID-19 pandemic and beyond. A total of 181 HPs (71% physicians) were recruited from Duke University Health Systems in Durham, North Carolina. Internal reliability of the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP) was examined, along with factor analytic, discriminant, and convergent validity. A cutoff score was identified from a receiver operator curve (ROC) that best identified individuals with significant impairment in social or occupational functioning. The 10-item MISS-HP measures 10 theoretically grounded dimensions of MI assessing betrayal, guilt, shame, moral concerns, religious struggle, loss of religious/spiritual faith, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation (score range 10-100). Internal reliability of the MISS-HP was 0.75. PCA identified three factors, which was confirmed by CFA, explaining 56.8% of the variance. Discriminant validity was demonstrated by modest correlations (r's = 0.25-0.37) with low religiosity, depression, and anxiety symptoms, whereas convergent validity was evident by strong correlations with clinician burnout (r = 0.57) and with another multi-item measure of MI symptoms (r = 0.65). ROC characteristics indicated that a score of 36 or higher was 84% sensitive and 93% specific for identifying MI symptoms causing moderate to extreme problems with family, social, and occupational functioning. The MISS-HP is a reliable and valid measure of moral injury symptoms in health professionals that can be used in clinical practice to screen for MI and monitor response to treatment, as well as when conducting research that evaluates interventions to treat MI in HPs.
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Affiliation(s)
- Sneha Mantri
- Duke University Movement Disorders Center, and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University Medical Center, Durham, NC USA
| | - Jennifer Mah Lawson
- Faculty Associate, Trent Center for Bioethics, Humanities, and History of Medicine, and Associate of the Duke Initiative for Science and Society, Duke University Medical Center, Durham, NC USA
| | - ZhiZhong Wang
- Department of Epidemiology, School of Public Health, Zunyi Medical University, Zunyi, Guizhou People’s Republic of China
| | - Harold G. Koenig
- Department of Psychiatry & Behavioral Sciences, and Department of Medicine, Duke University Medical Center, Box 3400, Durham, NC USA
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
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45
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Lee JS. Borderline Personality Disorder in the Courtroom. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 28:206-217. [PMID: 34712092 PMCID: PMC8547869 DOI: 10.1080/13218719.2020.1767718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The insanity defense has been criticized with consequences for individuals with real mental illness. In the United States, several states have redefined the insanity defense by excluding antisocial personality disorder from consideration for the not guilty by reason of insanity plea. Four states have eliminated the insanity defense completely. The purpose of this article is to analyze the diagnosis of borderline personality disorder, its relevance in the courtroom setting, and how this speaks to the approach of the insanity defense in general. The history of the insanity defense, impulsive nature of borderline personality disorder, and the reasons that make personality disorders controversial are reviewed. The impulsive nature, and the association to childhood trauma, dissociation, and frontolimbic abnormalities support the continued protection of borderline personality disorder under the insanity defense. Knowledge of these facts will assist the forensic psychiatrist in effectively educating the courtroom about borderline personality disorder.
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Affiliation(s)
- Jin S. Lee
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
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46
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Kern Popejoy E, Perryman K, Broadwater A. Processing Military Combat Trauma Through Sandtray Therapy: A Phenomenological Study. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2020. [DOI: 10.1080/15401383.2020.1761499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Alvarez DV. Using shame resilience to decrease depressive symptoms in an adult intensive outpatient population. Perspect Psychiatr Care 2020; 56:363-370. [PMID: 31612527 DOI: 10.1111/ppc.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/29/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The author explores the results of a 12-session therapy to address shame resilience as a mediator of empathy in the treatment of depression. DESIGN AND METHODS Two instruments (the Beck Depression Inventory-II and the Test of Self-Conscious Awareness 3S) were used as pre-, mid-, and posttest measures given to a group (n = 20) in an intensive outpatient program receiving an intervention to increase shame resilience. FINDINGS A statistical decline in depressive symptoms at both mid- and posttest was noted. PRACTICE IMPLICATIONS Adding shame resilience therapy to traditional psychotherapy may be useful to improve patient adherence and alliance but further evidence is needed.
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Affiliation(s)
- David V Alvarez
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois
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48
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Grove JL, Smith TW, Carlson SE, Bryan CJ, Crowell SE, Czajkowski L, Williams PG, Parkhurst K. Prospective association between suicide cognitions and emotional responses to a laboratory stressor: The mediating role of nightly subjective sleep quality. J Affect Disord 2020; 265:77-84. [PMID: 31957695 DOI: 10.1016/j.jad.2020.01.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sleep is a reliable correlate of suicidal thoughts and behaviors (STBs), yet few studies have directly examined negative affect in the context of this association. The present study combined daily experience methods with a laboratory paradigm to investigate suicide cognitions as a predictor of emotional responses to environmental stressors, and tested the role of nightly sleep parameters. METHOD 72 participants (Mage = 24.25; 41 with a recent history of suicide ideation and 31 without a history of STBs) completed a four-day study. Suicide cognitions were measured on the first day, and actigraphy-based sleep duration and fragmentation, and morning ratings of prior night subjective sleep quality (SSQ) were subsequently measured over three consecutive nights. Participants returned on the fourth day to complete the Trier Social Stress Task, where self-report changes in negative affect immediately post-task (i.e., reactivity) and five minutes post-task (i.e., recovery) were observed. RESULTS Regression analyses indicated that suicide cognitions predicted negative affect reactivity and recovery. Simple mediation analyses revealed that SSQ partially mediated the relation between suicide cognitions and negative affect recovery (especially shame), but not reactivity. No significant associations were observed for the actigraphy-based sleep parameters. LIMITATIONS Just three nights of actigraphy-based data collection. A single item was used to measure SSQ. CONCLUSIONS Suicide cognitions predict negative affective responses to situational stressors and SSQ may have a key role in this effect, especially the duration of negative emotional reactions. Hence, sleep and emotional reactivity may be potential targets for suicide prevention efforts.
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Affiliation(s)
- Jeremy L Grove
- Rutgers, State University of New Jersey 53 Avenue E, Piscataway, NJ 08854.USA.
| | | | | | - Craig J Bryan
- University of Utah USA; National Center for Veterans Studies USA
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Cameron AY, Shea MT, Randall AB. Acute Shame Predicts Urges for Suicide but not for Substance Use in a Veteran Population. Suicide Life Threat Behav 2020; 50:292-299. [PMID: 31524303 DOI: 10.1111/sltb.12588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is an urgent need to identify ways to reduce rates of suicide among Veterans with a substance use disorder. Since co-occurring disorders can make diagnosis and treatment complex, it is useful for the mental health field to examine common factors that may underlie both problems. One common factor that underlies both substance use and suicidal behavior is shame. This brief report presents data collected in an experimental study examining shame as an acute risk factor for suicide and substance use in Veterans. METHOD Thirty-eight Veterans admitted to an inpatient Veterans Affairs Medical Center unit with suicidal ideation completed measures on depression, hopelessness, addiction, and suicidality. Participants were randomized to either a shame mood induction group or a control group, and completed pre- and postexperiment measures on urges for suicide, urges for substance use, and level of shame. RESULTS Results indicate that an acute increase in shame resulted in an increase in an urge for suicide, but was not associated with changes in urges for substance use. CONCLUSIONS Acute feelings of shame may be a risk factor for increases in suicidal ideation. Limitations and suggestions for future directions are discussed.
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Affiliation(s)
- Amy Y Cameron
- Department of Veterans Affairs, VA Medical Center, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - M Tracie Shea
- Department of Veterans Affairs, VA Medical Center, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Sheehy K, Noureen A, Khaliq A, Dhingra K, Husain N, Pontin EE, Cawley R, Taylor PJ. An examination of the relationship between shame, guilt and self-harm: A systematic review and meta-analysis. Clin Psychol Rev 2019; 73:101779. [PMID: 31707184 PMCID: PMC6891258 DOI: 10.1016/j.cpr.2019.101779] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/12/2019] [Accepted: 09/14/2019] [Indexed: 01/29/2023]
Abstract
Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of Science and ProQuest) was undertaken to identify studies measuring shame, guilt and self-harm (including suicidal and non-suicidal behaviour). Meta-analysis was undertaken where papers focused on the same subtype of shame or guilt and shared a common outcome. Thirty studies were identified for inclusion. Most forms of shame were associated with non-suicidal self-injury (NSSI), but research was sparse concerning suicidal behaviour. Fewer studies examined guilt and findings were more varied. Methodological issues included a paucity of longitudinal designs and lack of justification for sample sizes. Results of this review support the link between shame and self-harm, particularly NSSI. The direction of this relationship is yet to be established. Clinically, consideration should be given to the role of shame amongst individuals who present with NSSI. This review was pre-registered on PROSPERO (CRD42017056165).
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Affiliation(s)
- Kate Sheehy
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Amna Noureen
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Ayesha Khaliq
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Katie Dhingra
- School of Social Sciences, Leeds Beckett University, LS1 3HE England, United Kingdom
| | - Nusrat Husain
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Eleanor E Pontin
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Rosanne Cawley
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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