Suicide risk and psychopathology in immigrants: a multi-group confirmatory factor analysis

Suicide risk and suicide risk factors among immigrants in Italy: A bi-center matched sample study

Italy has the third-largest immigrant population of European Union countries, but only a few research papers have examined suicide risk in immigrant psychiatric patients in Italy. The main aim of this paper was to compare suicidal ideation and suicide attempts in a sample of 304 psychiatric patients. We included 152 immigrant patients matched with 152 Italian patients admitted to the same wards during the same time period by age, gender, and diagnosis. We also investigated sociodemographic and clinical characteristics of the two samples including psychiatric diagnosis, age of illness onset, duration of illness, previous hospitalizations, length of hospitalization, previous suicide attempts, and substance and alcohol abuse. There were no differences between immigrant and Italian patients in either suicidal ideation (previous or current) or suicide attempts (previous or current). Immigrant patients were more likely to have a shorter duration of illness than the Italian patients and Italian patients were more likely to report substance abuse than were immigrant patients. Despite similar suicide rates between immigrants and Italian psychiatric inpatients, appropriate assessment of suicide risk in these patients is essential in implementing therapeutic suicide prevention strategies.

The Impact of Affective Temperaments on Suicidal Ideation and Behaviors: Results from an Observational Multicentric Study on Patients with Mood Disorders

Suicide ideation and behaviors are major health issues in the field of mental health. Several psychological and psychosocial factors have been taken into account as possible predictors of suicidality. Only recently affective temperaments have been considered as possible factors linked to suicide. This study aims to investigate the relationship between affective temperaments and suicidality, including the lifetime onset of suicide ideation, lifetime presence of suicide attempts and the total number of lifetime suicide attempts. This is a naturalistic multicentric observational study, involving outpatient units of seven University sites in Italy. Patients were administered with the short version of TEMPS-M and the Columbia Suicide Severity Rating Scale. A total of 653 participants were recruited, with a diagnosis of bipolar (55.7%), unipolar (35.8%) and cyclothymic disorder (8.4%). Regression models showed that the presence of lifetime suicide behaviors was increased in patients presenting trait related impulsivity (p < 0.0001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.01), higher number of hospitalizations (p < 0.0001), cyclothymic and irritable affective temperaments (p < 0.05 and p < 0.05, respectively). Conversely, the presence of hyperthymic affective disposition reduced the likelihood of having suicidal behaviors (p < 0.01). Lifetime suicidal ideation was associated with trait-related impulsivity (p < 0.001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.001) and of hospitalizations (p < 0.001). Depressive temperaments increased the likelihood of presenting suicidal ideation (p < 0.05), along with irritable temperaments (p < 0.01), contrary to hyperthymic affective (p < 0.05). Results of the present study confirm that affective disposition has a significant impact on the onset of suicidal ideation and behaviors, and that affective dispositions should be assessed in clinical settings to identify people at risk of suicide. Moreover, a wider clinical evaluation, including different clinical psychopathological dimensions, should be taken into consideration to develop effective preventive interventions.

Proxy reliability of the 12-item world health organization disability assessment schedule II among adult patients with mental disorders

PURPOSE

Despite the wide usage of World Health Organization Disability Assessment Schedule II (WHODAS 2.0) in psychiatry research and clinical practice, there was limited knowledge on its proxy reliability among people with mental disorders. This paper aimed to compare the 12-item WHODAS 2.0 responses of adult patients with mental disorders to their family caregivers.

METHODS

In this study, 205 pairs of patients with mental disorders and primary family caregivers were consecutively recruited from one inpatient mental health department in a large hospital in China. All participants completed the 12-item version WHODAS 2.0 to assess patients' functioning in the 30 days prior to the hospitalization. Measurement invariance, including configural, metric and scalar invariance, was tested across patient and proxy groups, using multi-group confirmatory factor analysis. Agreement between patients and proxies was examined by paired Wilcoxon tests and intraclass correlation coefficients (ICC). Subgroup analyses for proxy reliability were conducted within strata of proxy kinship and patient psychiatric diagnosis.

RESULTS

The 12-item WHODAS 2.0 achieved configural, metric and partial scalar invariance across patient and proxy groups. Unsatisfactory consistency was found for most items (ICC < 0.75, P < 0.05), especially for items on Cognition, Getting along, Life activities, and Participation in society (ICC < 0.4, P < 0.05). Spouses agreed with patients more often than parents (ICC ≥ 0.4, P < 0.05). The paired Wilcoxon tests found that impairment of patients with psychotic disorders tended to be overestimated by proxies while proxies tended to underestimate impairment of patients with mood disorders.

CONCLUSION

Our study reveals inconsistency between self and proxy reports in the 12-item WHODAS 2.0 among adult patients with mental disorders. When proxy reports is needed, spouses are preferred than parents. We should be aware of proxies' impairment overestimation among patients with psychotic disorders and underestimation among patients with mood disorders.

How to increase the role of social workers in suicide preventive interventions

OBJECTIVE

Suicide is a serious public health issue that affects individuals, families and societies all over the world. International studies provide consistent evidence that the presence of psychiatrists in a region is associated with lesser suicide rates. However, many psychiatric patients including suicidal patients do not have access to psychiatrists. This indicates that mental health and non-mental health social workers need to be involved in suicide prevention efforts. This paper is the first comprehensive work that discusses how to increase the role of social workers in the area of suicide prevention.

METHODS

A review of the relevant literature.

RESULTS

Increasing the role of social workers in suicide prevention efforts may reduce suicide risk in groups and people at elevated risk for suicide, as well as the general population.

CONCLUSION

Recommendations are provided for how the social work profession can improve upon suicide prevention while incorporating universal, selective and indicated suicide preventive interventions. Social work research efforts should focus on how to increase the role of social workers in suicide prevention and the management of suicidal patients. Social work education programmes should modify their curricula and increase their attention on suicide prevention. Mental health social workers need to educate the patient and their family on suicide risk factors. Furthermore, mental health and non-mental health social workers need to educate the general public on suicide risk factors.

Pathways to and Results of Psychiatric Consultation for Patients Referred from the Emergency Department. Are there Differences between Migrant and Native Patients?

The aim of this study was to compare migrants and native Italians on the pathways to care and results of psychiatric consultation (PC) in the emergency department (ED). Patients who were referred from the ED for psychiatric consultation (EDPC) at the Maggiore della Carità Hospital between March 2008 and March 2015 were recruited consecutively. Socio-demographic, clinical and consultation variables were recorded along with information about suicidal behaviours; migrants ( n = 379; 42.74% males, 57.26% females; age: 45.38 ± 16.95 years) were compared with native Italians ( n = 2942; 43.51% males, 56.49% females; age: 42.08 ± 15.89 years). Migrants were younger, more likely to be unemployed and less likely to be already under the care of a psychiatrist. Symptoms related to use of alcohol or substances were more frequent in migrants, especially female migrants. Migrants were less likely than native Italians to be referred for PC because of the presence of psychiatric symptoms, however they were more likely to be referred because of self-harming behaviour. Nonetheless, migrant status was not identified as a risk factor for suicidal behaviour in the multivariate analysis. The outcome of EDPC showed differences between migrants and natives. In absolute terms migrants were less likely to be admitted to a psychiatric ward after the EDPC than native Italians, while they were more likely to be monitored in the ED before being discharged or referred to outpatient care. In a high percentage of psychiatric examinations of migrants, no psychiatric symptoms were identified. Further studies are warranted to disentangle the meaning of these findings.

Factors Influencing Suicide Behaviours in Immigrant and Ethno-Cultural Minority Groups: A Systematic Review

This paper reviews recent literature on factors influencing suicide behaviours, including thoughts, plans, and attempts, in immigrant and ethno-cultural minority groups, to inform a more comprehensive understanding of suicide behaviours in increasingly culturally diverse populations. Thirty-three studies published between 2002 and 2013 were identified through digital databases searches and included in this review. Analysis of study findings focused on impacts of ethno-cultural identity and acculturation, other cultural and immigration influences, and family and community supports on suicide behaviours. Policy, practice, and research recommendations are identified, to inform relevant suicide prevention efforts and enhance mental health supports for immigrant and ethno-cultural minority populations.

Predictors of suicidal ideation in Korean American older adults: analysis of the Memory and Aging Study of Koreans (MASK)

OBJECTIVE

Our aim is to investigate the prevalence and predictors of suicidal ideation among Korean American older adults and assess the self-rated mental health of Korean American older adults with suicidal ideation with or without depressive syndrome.

METHODS

The Memory and Aging Study of Koreans is a cross-sectional, epidemiologic study of a community-representative sample of Korean American older adults (N = 1116) residing in the Baltimore-Washington area. Participants were interviewed using the Korean version of the Patient Health Questionnaire (PHQ-9K). In addition, demographic information, self-rated mental health, and self-rated physical health status were obtained.

RESULTS

In this study, 14.7% of Korean American older adults reported suicidal ideation. Predictors of suicidal ideation included living alone, major or minor depressive syndrome (diagnosed by the PHQ-9K), shorter duration of residency in the USA, and poorer self-rated mental health status. Of those who reported suicidal ideation, 64% did not have minor or major depressive syndrome. However, their self-rated mental health was as poor as that of those with major or minor depressive syndrome but without suicidal ideation.

CONCLUSION

Suicidal ideation without depressive syndromes was common among Korean American older adults. For this group of elders with poor self-rated mental health, future studies should look to improving early detection of suicide risks and developing feasible suicide prevention interventions. Copyright © 2016 John Wiley & Sons, Ltd.

Migration, violence, and the role of psychiatry in Italy

Immigration to Italy has been increasing exponentially in the last decades due to the international political changes and conflicts in the Middle East. The relationship between immigration and crimes is a debated issue, and violent radicalization of second or third generations of migrants is under increased scrutiny. Consequently, many politicians and political parties use nationalist and xenophobic language. Inevitably, this will have an impact on reactions of the larger population, as well as that of migrants. Psychiatry can have a major role in dealing with immigrants' health needs, and also assessing risk and preventing violent behaviours due to mental disorders. It is possible to prevent some radicalization by employing strategies of education, leading to better integration of immigrants in the community (based on education, housing, work, etc.). However, often specialist services for migrants are lacking, and mental healthcare professionals may remain poorly trained. Italy is one of the major countries in Southern Europe with a large number of illegal and legal migrants; thereby, creating a major pressure on the resources. It is important to understand the links between globalization, migration, and violence in Italy, in order to prevent future radicalization. It is also useful for psychiatrists to act as advocates for migrants to help reduce xenophobia and discrimination supported by some national cultural and political movements. Ethno-psychiatric facilities should be promoted, as well as policies of support, integration, and prevention should be employed to promote legal migration through the European countries.

Obsessive-Compulsive Tendencies, Self/Other Perception, Personality, and Suicidal Ideation in a Non-clinical Sample

Research on the risk factors for SI in adults with OC tendencies is limited, and it is still unclear whether the association between OC tendencies and SI in non-clinical individuals exists. The goal of the present study was to test the associations between OC tendencies, self/other perception, personality traits, depressive symptoms and SI among a non-clinical adult population. We investigated an Italian sample of 337 adults, who were administered a set of self-report questionnaires to assess obsessive-compulsive tendencies, depression, self/other perception, personality traits, and hopelessness. Confirmatory factor analyses (CFA) were performed. In the final model we found that personality, obsessive-compulsive factor and suicidal ideation were significantly correlated with each other: personality correlated negatively with obsessive-compulsive factor and suicidal ideation, while obsessive-compulsive factor and suicidal ideation resulted as strongly positively associated. Our results highlight the importance of assessing OC tendencies, negative self/other perception and SI. Understanding their role and interplay will allow for the development and implementation of more advanced prevention and treatment policies.

Mental Health in Immigrants Versus Native Population: A Systematic Review of the Literature

The relationship between psychopathology and migration presents unresolved questions.

OBJECTIVES

To determine whether there is a higher incidence of mental illness among immigrants, to describe the nosologic differences between immigrant and native populations, and to identify the risk factors involved of immigration.

METHODS

A systematic review was conducted using the PubMed, Science Direct, ISI, Scopus, Psycinfo, Cochrane, and Cuiden databases. The search strategy was conducted using the MeSH thesaurus for the controlled terms "mental disorders," "mental health," "transients and migrants," "immigrants," and "epidemiology." The quality of the articles was analyzed by using the Equator Guidelines, following checklists according to the methodological design of the studies by two independent reviewers.

RESULTS

From a total of 817 studies found, 21 met the inclusion criteria. Out of the 21 studies selected, 13 showed a higher prevalence of mental illness.

CONCLUSIONS

Migration represents a major challenge, but it does not lead exclusively to mental distress. Immigrants experience more problems in depression, anxiety, and somatic disorders, pathologies related directly to the migration process and stress suffered. Resources should be oriented to primary and community care.

The Relationship between Neuroticism, Hopelessness, and Depression in Older Korean Immigrants

PURPOSE

This study aimed to investigate the relationship between neuroticism, hopelessness, and depression among older Korean immigrants. To extend this line of research, this study aimed to examine the effects of neuroticism and hopelessness in predicting depression among older Korean immigrants.

METHODS

Data for this study came from a survey of 220 first generation Korean immigrants aged 65 years or older in Los Angeles County in 2012. Data were collected by face-to-face interviews with trained social workers using a structured questionnaire translated into Korean. All interviews were conducted in Korean. The neuroticism sub-scale of the Eysenck Personality Questionnaire was used to assess neuroticism (EPQN). Hopelessness was measured by the Beck Hopelessness Scale (BHS). Depression was measured by the 20-item Center of Epidemiological Studies Depression (CES-D) scale.

RESULTS

The study found that age (β = .26, p< .01), gender (β = -.13, p< .01), income (β = -.13, p< .01), neuroticism (β = .51, p< .01), and hopelessness (β = .15, p< .01) were significant predictors of depression.

CONCLUSION

The study provides preventive strategies that would help in the development of depression-reduction services or programs for the population, especially for those living with neuroticism and hopelessness.

Confirmation of the factorial structure of the Japanese short version of the TEMPS-A in psychiatric patients and general adults

BACKGROUND

The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) is a 110-item questionnaire that assesses five affective temperaments. However, a valid shortened version is desired for large-scale investigations to enhance the compliance of respondents.

METHODS

A confirmatory factor analysis was conducted among 320 psychiatric patients and 61 general adults. The participants completed the Japanese 39-item short version of the TEMPS-A, and a portion of the participants completed the 110-item version. An exploratory factor analysis with the principal factor method and varimax rotation was conducted to identify a more suitable model of the short version of the TEMPS-A.

RESULTS

The confirmatory factor analysis revealed that the 39-item version exhibited a poor model fit. However, we found that the 18-item version exhibited a firm five-factor structure based on the exploratory factor analysis, and this model exhibited an acceptable model fit. It had good or acceptable internal consistency (Cronbach's αs: 0.672-0.819).

LIMITATIONS

The majority of the subjects in the present study were patients, and the temperament data may have been affected by psychiatric symptoms.

CONCLUSION

A firm five-factor structure was not found in the 39-item short version of the Japanese TEMPS-A. Therefore, an 18-item version was proposed. This new 18-item version of the TEMPS-A might be useful for clinical applications and large-scale investigations.