1
|
Berardelli I, Sarubbi S, Trocchia MA, Longhini L, Moschillo A, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, Pompili M. The Mediating Role of Insomnia Severity in the Relationship Between Anxiety Symptoms and Suicidal Ideation: A Real-World Study in a Psychiatric Inpatient Setting. J Nerv Ment Dis 2024; 212:479-484. [PMID: 39120957 DOI: 10.1097/nmd.0000000000001793] [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: 08/11/2024]
Abstract
ABSTRACT Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.
Collapse
Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maria Anna Trocchia
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Ludovica Longhini
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Antonella Moschillo
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
2
|
Fan H, Liu Z, Wu X, Yu G, Gu X, Kuang N, Zhang K, Liu Y, Jia T, Sahakian BJ, Robbins TW, Schumann G, Cheng W, Feng J, Becker B, Zhang J. Decoding anxiety-impulsivity subtypes in preadolescent internalising disorders: findings from the Adolescent Brain Cognitive Development study. Br J Psychiatry 2023; 223:542-554. [PMID: 37730654 DOI: 10.1192/bjp.2023.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Internalising disorders are highly prevalent emotional dysregulations during preadolescence but clinical decision-making is hampered by high heterogeneity. During this period impulsivity represents a major risk factor for psychopathological trajectories and may act on this heterogeneity given the controversial anxiety-impulsivity relationships. However, how impulsivity contributes to the heterogeneous symptomatology, neurobiology, neurocognition and clinical trajectories in preadolescent internalising disorders remains unclear. AIMS The aim was to determine impulsivity-dependent subtypes in preadolescent internalising disorders that demonstrate distinct anxiety-impulsivity relationships, neurobiological, genetic, cognitive and clinical trajectory signatures. METHOD We applied a data-driven strategy to determine impulsivity-related subtypes in 2430 preadolescents with internalising disorders from the Adolescent Brain Cognitive Development study. Cross-sectional and longitudinal analyses were employed to examine subtype-specific signatures of the anxiety-impulsivity relationship, brain morphology, cognition and clinical trajectory from age 10 to 12 years. RESULTS We identified two distinct subtypes of patients who internalise with comparably high anxiety yet distinguishable levels of impulsivity, i.e. enhanced (subtype 1) or decreased (subtype 2) compared with control participants. The two subtypes exhibited opposing anxiety-impulsivity relationships: higher anxiety at baseline was associated with higher lack of perseverance in subtype 1 but lower sensation seeking in subtype 2 at baseline/follow-up. Subtype 1 demonstrated thicker prefrontal and temporal cortices, and genes enriched in immune-related diseases and glutamatergic and GABAergic neurons. Subtype 1 exhibited cognitive deficits and a detrimental trajectory characterised by increasing emotional/behavioural dysregulations and suicide risks during follow-up. CONCLUSIONS Our results indicate impulsivity-dependent subtypes in preadolescent internalising disorders and unify past controversies about the anxiety-impulsivity interaction. Clinically, individuals with a high-impulsivity subtype exhibit a detrimental trajectory, thus early interventions are warranted.
Collapse
Affiliation(s)
- Huaxin Fan
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Zhaowen Liu
- School of Computer Science, Northwestern Polytechnical University, China
| | - Xinran Wu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Gechang Yu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Xinrui Gu
- Sino-European School of Technology, Shanghai University, China
| | - Nanyu Kuang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Kai Zhang
- School of Computer Science and Technology, East China Normal University, Shanghai, China
| | - Yu Liu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Tianye Jia
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK and Department of Psychiatry, University of Cambridge School of Clinical Medicine, UK
| | - Trevor W Robbins
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China; Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK and Department of Psychology, University of Cambridge, UK
| | - Gunter Schumann
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and PONS-Center, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Germany
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Fudan ISTBI-ZJNU Algorithm Centre for Brain-inspired Intelligence, Zhejiang Normal University, China and Shanghai Medical College and Zhongshan Hospital Immunotherapy Technology Transfer Center, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Benjamin Becker
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Jie Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, China and Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| |
Collapse
|
3
|
Zuckerman E, Fernandes SN, Sullivan SR, Ortin-Peralta A, Jeglic E, Miranda R, Baroni A. Sleep quality and in-person versus online social interaction during the early COVID-19 pandemic lockdown: Impact on affect and interpersonal needs among young adults. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:100134. [PMID: 37736570 PMCID: PMC10512736 DOI: 10.1016/j.psycom.2023.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
We examined relationships among sleep quality and forms of social interaction (in-person vs. online) as predictors of change in affect and interpersonal needs (perceived burdensomeness, thwarted belongingness) - correlates of suicidal thoughts and behaviors - during the early COVID-19 pandemic lockdown. New York City undergraduates (N = 58) from four public colleges completed a baseline survey and daily diaries up to 30 days in April-June 2020. Adjusting for relevant covariates, better sleep quality and in-person communication predicted greater positive affect and lower negative affect over time, but online social interaction only predicted greater positive affect and did not predict negative affect. Better sleep quality predicted lower perceived burdensomeness but not thwarted belongingness. Both in-person and online social interaction - but not total hours on social media - predicted lower thwarted belonging and perceived burdensomeness. Greater hours spent on social media each day lessened the relationship between in-person interaction and positive affect and lessened the buffering effect of in-person interaction on perceived burdensomeness. Improving sleep quality and increasing in-person interaction may ameliorate psychological variables that increase risk for suicidal thoughts and behaviors. However, when in-person interaction is limited, such as during the COVID-19 pandemic, online social interaction might be encouraged - depending on the nature of the interactions - to increase positive affect and buffer against suicide-related factors.
Collapse
Affiliation(s)
- Emily Zuckerman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
- Department of Psychology, Hunter College, City University of New York, USA
| | | | - Sarah R. Sullivan
- Department of Psychology, The Graduate Center, City University of New York, USA
| | - Ana Ortin-Peralta
- Department of Psychology, Hunter College, City University of New York, USA
- School-Clinical Child Psychology Program, Ferkauf Graduate School of Psychology, Yeshiva University, USA
| | - Elizabeth Jeglic
- Department of Psychology, The Graduate Center, City University of New York, USA
- John Jay College of Criminal Justice, City University of New York, USA
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York, USA
- Department of Psychology, The Graduate Center, City University of New York, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, USA
| |
Collapse
|
4
|
Guo W, Gu Y, Zhou J, Wang X, Sun Q. Characteristics and associated factors of violence in male patients with schizophrenia in China. Front Psychiatry 2023; 14:1106950. [PMID: 36970285 PMCID: PMC10036402 DOI: 10.3389/fpsyt.2023.1106950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveTo investigate the characteristics and associated factors of violence in male patients with schizophrenia in China.MethodsA total of 507 male patients with schizophrenia were recruited, including 386 non-violent and 121 violent patients. The socio-demographic information and medical history of the patients were collected. Psychopathological characteristics, personality traits psychopathology, and factors related to risk management were assessed using the Brief Psychiatric Rating Scale (BPRS), the History of Violence, Clinical, Risk Assessment Scale (HCR-20), and the Psychopathy Checklist-Revised (PCL-R), as appropriate. Differences in these factors were compared between the violent and non-violent patients, and logistic regression analysis was performed to explore the risk factors for violence in male patients with schizophrenia.ResultsThe results showed that the violent group had a lower level of education, longer duration of illness, as well as a higher rate of hospitalization, history of suicidal attempts, and history of alcohol compared with the non-violent group. The violent group scored higher in items of symptoms in BPRS, personality traits and psychopathy in PCL-R, and risk management in HCR-20. The regression analysis showed that previous suicidal behavior (OR = 2.07,95% CI [1.06-4.05], P = 0.033), antisocial tendency in PCL-R (OR = 1.21, 95% CI [1.01-1.45], P = 0.038), H2: young age at violent incident (OR = 6.39, 95% CI [4.16-9.84], P < 0.001), C4: impulsivity (OR = 1.76, 95% CI [1.20-2.59], P = 0.004), and H3: relationship instability (OR = 1.60, 95% CI [1.08-2.37], P = 0.019) in HCR-20 were risk factors of violence among male patients with schizophrenia.ConclusionThe present study found significant differences in socio-demographic information, history of treatment, and psychopathy characteristics between male patients with schizophrenia who had engaged in violent behaviors and their non-violent counterparts in China. Our findings suggested the necessity of individualized treatment for male patients with schizophrenia who had engaged in violent behaviors as well as the use of both HCR-20 and PCL-R for their assessment.
Collapse
Affiliation(s)
- Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Yu Gu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Qiaoling Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
- *Correspondence: Qiaoling Sun,
| |
Collapse
|
5
|
Ki M, Shim HY, Lim J, Hwang M, Kang J, Na KS. Preventive health behaviors among people with suicide ideation using nationwide cross-sectional data in South Korea. Sci Rep 2022; 12:11615. [PMID: 35803980 PMCID: PMC9270366 DOI: 10.1038/s41598-022-14349-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/06/2022] [Indexed: 12/28/2022] Open
Abstract
This study aimed to investigate the association between suicide ideation and health-related behaviors and preventive health service use behaviors. We used data from the 2017 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative survey. The final sample included 4486 participants aged 40 years or older. Preventive health behaviors were assessed for smoking, high-risk drinking, physical activities, regular meal intake, influenza vaccination, general health examination, and cancer screening. Logistic regression was used to examine the association between suicide ideation and preventive health behaviors with a series of adjustments for covariates. In general, suicide ideation was associated with unfavorable outcomes of preventive health behaviors, except for flu vaccination. For example, the adjusted prevalence of suicide ideation and non-suicide ideation groups were 54.3% vs. 43.7% for flu vaccination, 23.1% vs. 41.6% for physical activity, and 24.8% vs. 18.6% for high-risk alcohol drinking. After adjustment for covariates, the associations of suicide ideation with behaviors remained significant for physical activity (OR 0.52, 95% CI 0.34-0.81) and high-risk alcohol drinking (OR 2.22, 95% CI 1.34-3.69). Suicide ideation leads to the disruption of self-management of health behaviours, especially for physical activity and high-risk alcohol drinking, independently of depressive feelings.
Collapse
Affiliation(s)
- Myung Ki
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- BK21FOUR R&E Center for learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Hye-Young Shim
- Department of Preventive Medicine, Eulji University School of Medicine, 77, Gyeryong-ro 771beon-gil, Jung-gu, Daejeon, 34824, Republic of Korea
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University School of Medicine, 77, Gyeryong-ro 771beon-gil, Jung-gu, Daejeon, 34824, Republic of Korea.
| | - Minji Hwang
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea
- BK21FOUR R&E Center for learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Jiwon Kang
- Department of Preventive Medicine, Eulji University School of Medicine, 77, Gyeryong-ro 771beon-gil, Jung-gu, Daejeon, 34824, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| |
Collapse
|
6
|
Yoon SH, Shim SH, Kim JS. Electrophysiological Changes Between Patients With Suicidal Ideation and Suicide Attempts: An Event-Related Potential Study. Front Psychiatry 2022; 13:900724. [PMID: 35669267 PMCID: PMC9163438 DOI: 10.3389/fpsyt.2022.900724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Inhibitory control is regarded as an important ability related to the transition from suicidal ideation to suicide attempts. In event-related potential, patients with dysfunction of inhibitory control demonstrate a reduction in the no-go amplitude. This study aimed to determine the association between the no-go event-related potential component and suicidal behaviors among suicide attempters and ideators who never attempted suicide. METHODS Overall, 150 patients who visited the emergency room by suicide attempts or patients who visited the psychiatric department with suicidal ideation were recruited and instructed to perform a go/no-go task during electroencephalography recording. The Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale, Difficulties in Emotional Regulation Scale, and Acquired Capability for Suicide Scale were used. Individuals were divided into two groups: those with suicide attempt group) and with suicidal ideation (SI group) without SA. The psychological characteristics and event-related potentials of the two groups were compared. Correlation analyses were conducted to test the association between the clinical characteristics and event-related potentials. RESULTS The SA group had significantly decreased no-go P3 amplitudes at all electrodes compared to the SI group. In the correlation analysis between the clinical measurements and event-related potentials in all the participants, no-go P3 amplitudes in whole electrode sites were negatively correlated with the scores of the acquired capability for the suicide scale. CONCLUSIONS This study revealed that suicide attempters have dysfunction in controlling inhibition compared to suicide ideators reflected in the no-go P3. Our findings suggested that no-go P3 can be a biomarker associated suicide attempts in suicide ideators.
Collapse
Affiliation(s)
- Sung Hoon Yoon
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Ji Sun Kim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| |
Collapse
|
7
|
Martin RL, Smith NS, McGrew SJ, Capron DW. Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs. Arch Suicide Res 2021; 25:353-372. [PMID: 31749417 DOI: 10.1080/13811118.2019.1689877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Suicide is a public health concern and has been the tenth leading cause of death in the United States since 2008. The Interpersonal-Psychological Theory of Suicidal Behavior is an empirically supported model of suicide. The theory posits that thwarted belongingness and perceived burdensomeness examine the individual's perceived connectedness to others around them and together create suicidal desire. Anxiety is another widespread public health concern, associated with suicidal ideation and suicide attempts above and beyond the effects of socio-demographic factors and other mental disorders. A key factor in anxiety disorders is intolerance of uncertainty, or the individual's tendency to perceive ambiguous situations and events as being aversive to emotional and behavioral well-being. Additionally, different facets of aggression have been associated with both intolerance of uncertainty and suicidal desire. The current study sought to examine how facets of aggression moderated the associations between intolerance of uncertainty (both prospective and inhibitory) and thwarted belongingness/perceived burdensomeness. Participants were 440 adults recruited online. The hypotheses of aggression facets moderating the association between intolerance of uncertainty and perceived burdensomeness were largely supported with statistical significance for six out of eight models. Similarly, the hypotheses of aggression facets moderating thwarted belongingness were largely supported with significant moderations for seven out of eight models. The results were upheld when using Benjamini-Hochberg test of significance to account for Type I error. Overall, results indicate that aggressive facets can amplify the associations between intolerance of uncertainty and thwarted belongingness/perceived burdensomeness; however, results differed based on the intolerance of uncertainty dimensions.
Collapse
|
8
|
Werbart Törnblom A, Sorjonen K, Runeson B, Rydelius PA. Life Events and Coping Strategies Among Young People Who Died by Suicide or Sudden Violent Death. Front Psychiatry 2021; 12:670246. [PMID: 34512410 PMCID: PMC8429488 DOI: 10.3389/fpsyt.2021.670246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/02/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Most empirically anchored psychological models of suicide focus either on the perceived situational stress or on vulnerability factors and coping deficits. The interaction between life stressors and vulnerability factors is less explored. Methods: This case-control study examines interactions between life events and coping strategies in three groups of young people: cases of suicide, cases of other sudden violent death (SVD), and control cases. Results: Four coping strategies, two more adaptive and two more maladaptive, were identified. Distinctive of the suicide and the SVD group was significantly less Planful Problem-Solving, and more Escape-Avoidance and Confrontive Coping than among the controls. Furthermore, Confrontive Coping had significantly higher level in the SVD group than in the suicide group. Between-group differences were partly accounted for differences in negative life events, early and late in life. Both target groups experienced significantly more adverse childhood experiences and recent stressful life events than the controls-the suicide group being more exposed to recent stressful life events even in comparison with the SVD group. This might indicate that adverse childhood experiences are a risk factor for both causes of death, whereas proximal stressful life events are a risk factor for death by suicide to a higher degree than for SVD. Conclusions: Improved understanding of the interplay between life events, both in the far past and present, and coping styles, may facilitate the identification of young people at risk of suicide and violent death.
Collapse
Affiliation(s)
- Annelie Werbart Törnblom
- Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
| | - Kimmo Sorjonen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
| | - Per-Anders Rydelius
- Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
9
|
Persistent cannabis use as an independent risk factor for violent behaviors in patients with schizophrenia. NPJ SCHIZOPHRENIA 2020; 6:14. [PMID: 32393793 PMCID: PMC7214412 DOI: 10.1038/s41537-020-0104-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/09/2020] [Indexed: 11/09/2022]
Abstract
Although recent studies have shown a moderately strong association between cannabis use and violence among people with severe mental disorders, the direction of this association has not been investigated prospectively in a population with schizophrenia. Therefore, this study aims to determine, using cross-lag models, whether a temporal relationship between cumulative cannabis use and violence exists in a population with schizophrenia. The authors reported findings covering an 18-month period from a randomized, double-blind clinical trial of antipsychotic medications for schizophrenia treatment. Among the 1460 patients enrolled in the trial, 965 were followed longitudinally. Although persistent cannabis use predicted subsequent violence, violence did not predict cannabis use. The relationship was therefore unidirectional and persisted when controlling for stimulants and alcohol use. Finally, a significant body of evidence suggests a link between persistent cannabis use and violence among people with mental illnesses. Studies to further investigate the mechanisms underlying this association should be conducted.
Collapse
|
10
|
Lopez-Castroman J, Jaussent I, Gorwood P, Courtet P. Activation syndrome induced by the antidepressant tianeptine and suicidal ideation: Evidence from a large depressed outpatient sample. Prog Neuropsychopharmacol Biol Psychiatry 2020; 97:109762. [PMID: 31526830 DOI: 10.1016/j.pnpbp.2019.109762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the characteristics of the activation syndrome (AS) that predict the emergence or worsening of suicidal ideation (SI) in the first month of antidepressant treatment with tianeptine, as well as the temporal relationship between both conditions. METHOD A naturalistic sample of 2422 depressed outpatients starting a new antidepressant treatment with tianeptine was assessed at 2, 4 and 6 weeks of follow-up using validated questionnaires. Four main dimensions of AS were examined: impulsivity, sleep problems, anxiety and agitation. RESULTS The emergence of an AS was more likely in long-lasting depressive episodes, but less likely if the patient responded to the antidepressant or benzodiazepines were added as an add-on treatment. Treatment-emergent SI was strongly associated to the presence of an AS, particularly in case of sleep problems (OR = 8.42) or impulsivity upsurges (OR = 3.89), even after adjustment for all relevant confounding factors. CONCLUSIONS Our findings suggest a dose-effect mechanism modulating the relationship between treatment-related SI and AS. AS symptoms may need to be monitored closely in the weeks that follow the introduction of an antidepressant treatment.
Collapse
Affiliation(s)
- Jorge Lopez-Castroman
- Inserm u1061, Université de Montpellier, 39 Avenue Charles Flahault, 34090 Montpellier, France; Department of Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nîmes, France; CIBERSAM, Spain.
| | - Isabelle Jaussent
- Inserm u1061, Université de Montpellier, 39 Avenue Charles Flahault, 34090 Montpellier, France
| | - Philip Gorwood
- Sainte-Anne Hospital (CMME), INSERM U894, 1 Rue Cabanis, 75014 Paris, France
| | - Philippe Courtet
- Inserm u1061, Université de Montpellier, 39 Avenue Charles Flahault, 34090 Montpellier, France; Department of Emergency Psychiatry and Acute Care, Montpellier University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France
| |
Collapse
|
11
|
Zhu R, Tian S, Wang H, Jiang H, Wang X, Shao J, Wang Q, Yan R, Tao S, Liu H, Yao Z, Lu Q. Discriminating Suicide Attempters and Predicting Suicide Risk Using Altered Frontolimbic Resting-State Functional Connectivity in Patients With Bipolar II Disorder. Front Psychiatry 2020; 11:597770. [PMID: 33324262 PMCID: PMC7725800 DOI: 10.3389/fpsyt.2020.597770] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/04/2020] [Indexed: 01/04/2023] Open
Abstract
Bipolar II disorder (BD-II) major depression episode is highly associated with suicidality, and objective neural biomarkers could be key elements to assist in early prevention and intervention. This study aimed to integrate altered brain functionality in the frontolimbic system and machine learning techniques to classify suicidal BD-II patients and predict suicidality risk at the individual level. A cohort of 169 participants were enrolled, including 43 BD-II depression patients with at least one suicide attempt during a current depressive episode (SA), 62 BD-II depression patients without a history of attempted suicide (NSA), and 64 demographically matched healthy controls (HCs). We compared resting-state functional connectivity (rsFC) in the frontolimbic system among the three groups and explored the correlation between abnormal rsFCs and the level of suicide risk (assessed using the Nurses' Global Assessment of Suicide Risk, NGASR) in SA patients. Then, we applied support vector machines (SVMs) to classify SA vs. NSA in BD-II patients and predicted the risk of suicidality. SA patients showed significantly decreased frontolimbic rsFCs compared to NSA patients. The left amygdala-right middle frontal gyrus (orbital part) rsFC was negatively correlated with NGASR in the SA group, but not the severity of depressive or anxiety symptoms. Using frontolimbic rsFCs as features, the SVMs obtained an overall 84% classification accuracy in distinguishing SA and NSA. A significant correlation was observed between the SVMs-predicted NGASR and clinical assessed NGASR (r = 0.51, p = 0.001). Our results demonstrated that decreased rsFCs in the frontolimbic system might be critical objective features of suicidality in BD-II patients, and could be useful for objective prediction of suicidality risk in individuals.
Collapse
Affiliation(s)
- Rongxin Zhu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shui Tian
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing, China
| | - Huan Wang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing, China
| | - Haiteng Jiang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyi Wang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing, China
| | - Junneng Shao
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing, China
| | - Qiang Wang
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shiwan Tao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haiyan Liu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing, China
| |
Collapse
|
12
|
Thompson JM, Heber A, VanTil L, Simkus K, Carrese L, Sareen J, Pedlar D. Life course well-being framework for suicide prevention in Canadian Armed Forces Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2018-0020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone’s responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.
Collapse
Affiliation(s)
- James M. Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Alexandra Heber
- Veterans Affairs Canada, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Linda VanTil
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | | | - Lina Carrese
- Veterans Affairs Canada, Montreal, Quebec, Canada
| | | | | |
Collapse
|
13
|
Levi-Belz Y, Gavish-Marom T, Barzilay S, Apter A, Carli V, Hoven C, Sarchiapone M, Wasserman D. Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study. Suicide Life Threat Behav 2019; 49:759-773. [PMID: 29851140 DOI: 10.1111/sltb.12475] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/06/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents' psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others. METHOD A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior. RESULTS Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs. CONCLUSIONS Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed.
Collapse
Affiliation(s)
- Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.,The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Timor Gavish-Marom
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Shira Barzilay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Apter
- The Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - Cristina Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mario Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Dnuta Wasserman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
14
|
Siciliano M, Trojano L, Trojsi F, Monsurrò MR, Tedeschi G, Santangelo G. Assessing anxiety and its correlates in amyotrophic lateral sclerosis: The state-trait anxiety inventory. Muscle Nerve 2019; 60:47-55. [PMID: 30897219 DOI: 10.1002/mus.26475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We evaluated: (1) psychometric properties of State-Trait Anxiety Inventory Form Y (STAI Form Y); (2) clinical correlates of state and trait anxiety; (3) associations of anxiety with quality of life (QoL) dimensions. METHODS We assessed 159 patients with amyotrophic lateral sclerosis (ALS) on STAI Form Y and on tests and questionnaires for depression, apathy, QoL, and cognitive abilities. RESULTS Clinically diagnosed anxiety (by Mini International Neuropsychiatric Inventory) occurred in 30 (19%) patients. STAI Form Y fitted a 2-factor structure and showed good psychometric properties. State and trait anxiety were weakly associated with female sex, bulbar functional decay, and cognitive decline in language and memory; trait anxiety was associated with lower educational attainment and poorer scores on visuospatial tasks. State and trait anxiety were associated with poorer physical and psychosocial QoL dimensions. CONCLUSIONS Anxiety is tightly associated with QoL in ALS, and can be reliably assessed by STAI Form Y. Muscle Nerve, 2019.
Collapse
Affiliation(s)
- Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Rosaria Monsurrò
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences - MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| |
Collapse
|
15
|
de Cates AN, Catone G, Bebbington P, Broome MR. Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data. Int J Soc Psychiatry 2019; 65:114-122. [PMID: 30776948 DOI: 10.1177/0020764019827986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Impulsivity may be an important risk factor in terms of future self-harm. However, the extent of this, whether it may relate to self-harm that is new in onset and/or repetition of self-harm, and the detail of any interaction with mood instability (MI) and childhood sexual abuse (CSA) requires detailed examination. AIMS We used the 2000 Adult Psychiatry Morbidity Survey and an 18-month follow-up data to test hypotheses relating to the role of impulsivity, CSA and MI in the inception and persistence of self-harm. METHODS We assessed associations of impulsivity with (1) suicidal self-harm (SSH) and (2) non-SSH (NSSH) at baseline and follow-up, controlling for confounders including MI. Finally, we tested whether impulsivity mediated the relationship between CSA and self-harm. RESULTS A total of 8,580 respondents were assessed at baseline and 2,406 at follow-up as planned. Impulsivity significantly predicted emergence of new NSSH at 18-month follow-up even after adjustment for MI and other confounders. Impulsivity did not significantly predict repetition of NSSH, or repetition or new inception of SSH, even before inclusion of MI in the model. However, the absolute numbers involved were small. Cross-sectionally, impulsivity was a stronger mediator of the link between CSA and SSH (13.1%) than that between CSA and NSSH (4.8%). CONCLUSION Impulsivity may increase the risk of future development of NSSH independently of MI, which is clinically important for risk assessment. The involvement of impulsivity in the repetition of self-harm generally appears less certain. However, impulsivity may have a role in SSH in the context of previous CSA.
Collapse
Affiliation(s)
- Angharad N de Cates
- 1 Unit of Mental Health and Wellbeing, Warwick Medical School, The University of Warwick, Coventry, UK.,2 Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Gennaro Catone
- 3 Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy.,4 Faculty of Educational Sciences, Suor Orsola Benincasa University of Naples, Naples, Italy
| | - Paul Bebbington
- 5 Division of Psychiatry, University College London, London, UK
| | - Matthew R Broome
- 6 Department of Psychiatry, University of Oxford, Oxford, UK.,7 Institute for Mental Health and School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
16
|
Jung S, Lee D, Park S, Hong HJ. Subtypes of suicidal ideation in Korean adolescents: A multilevel latent profile analysis. Aust N Z J Psychiatry 2019; 53:158-167. [PMID: 29544350 DOI: 10.1177/0004867418763530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors. METHOD Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted. RESULTS Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables. CONCLUSION The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies.
Collapse
Affiliation(s)
- Song Jung
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dayoung Lee
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea.,2 Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Seongjun Park
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hyun Ju Hong
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea.,2 Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| |
Collapse
|
17
|
Oh Y, Yoon HJ, Kim JH, Joung YS. Trait Anxiety as a Mediator of the Association between Attention Deficit Hyperactivity Disorder Symptom Severity and Functional Impairment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:407-414. [PMID: 30466213 PMCID: PMC6245288 DOI: 10.9758/cpn.2018.16.4.407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/22/2017] [Accepted: 08/26/2017] [Indexed: 11/18/2022]
Abstract
Objective Anxiety has been shown to influence functional impairment in patients with attention deficit hyperactivity disorder (ADHD). This study aimed to compare functional impairment in subjects with and without adult ADHD and to investigate the associations among trait anxiety, functional impairment, and ADHD symptom severity. Moreover, the effects of ADHD symptom subtypes on trait anxiety and functional impairment were also examined. Methods The sample included 209 adults between the ages of 20 and 31 years. Fifty-one adults received a diagnosis of ADHD, and an additional age, sex-matched group of 51 adults comprised the adult control. Participants were assessed with Conners’ Adult ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Spielberg Trait Anxiety Inventory (STAI-T), and the Sheehan Disability Scale (SDS). The relationships among ADHD severity, anxiety, and functional impairment were investigated using Pearson’s correlation analysis. Subtypes of ADHD symptoms that predicted anxiety and functional impairment were investigated using regression analyses. Results Adult ADHD patients significantly differed from normal control subjects according to BDI, STAI-T, and SDS assessment. Significant positive correlations were noted between ADHD severity, anxiety, and functional impairment. Multiple linear regression analysis confirmed anxiety as a mediator between functional impairment and ADHD CAARS symptom subscales. Conclusion Patients with adult ADHD showed higher levels of anxiety, depression, and functional impairment. Additionally, ADHD symptoms and anxiety impacted subject functional impairment. Our results suggest that anxiety may be a strong mediator between ADHD severity and functional impairment.
Collapse
Affiliation(s)
- Yunhye Oh
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Psychiatry, National Center for Mental Health, Seoul, Korea
| | - Hee Joon Yoon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hae Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study. Eur J Clin Pharmacol 2018; 75:393-400. [DOI: 10.1007/s00228-018-2586-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
|
19
|
Lenz B, Röther M, Bouna-Pyrrou P, Mühle C, Tektas OY, Kornhuber J. The androgen model of suicide completion. Prog Neurobiol 2018; 172:84-103. [PMID: 29886148 DOI: 10.1016/j.pneurobio.2018.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 09/02/2017] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
Suicide is a devastating public health issue that imposes severe psychological, social, and economic burdens not only for the individuals but also for their relatives, friends, clinicians, and the general public. Among the different suicidal behaviors, suicide completion is the worst and the most relevant outcome. The knowledge of biological etiopathological mechanisms involved in suicide completion is limited. Hitherto, no objective markers, either alone or in combination, can reliably predict who will complete a suicide. However, such parameters are strongly needed to establish and optimize prediction and prevention. We introduce here a novel ideation-to-completion framework in suicide research and discuss the problems of studies aiming at identifying and validating clinically useful markers. The male gender is a specific risk factor for suicide, which suggests that androgen effects are implicated in the transition from suicidal ideation to suicide completion. We present multiple lines of direct and indirect evidence showing that both an increased prenatal androgen load (with subsequent permanent neuroadaptations) and increased adult androgen activity are involved in suicide completion. We also review data arguing that modifiable maternal behavioral traits during pregnancy contribute to the offspring's prenatal androgen load and increase the risk for suicide completion later in life. We conclude that in utero androgen exposure and adult androgen levels facilitate suicide completion in an synergistic manner. The androgen model of suicide completion provides the basis for the development of novel predictive and preventive strategies in the future.
Collapse
Affiliation(s)
- Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
| | - Mareike Röther
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Polyxeni Bouna-Pyrrou
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Ozan Y Tektas
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| |
Collapse
|
20
|
Beşirli A. The relationship between impulsivity and panic disorder-agoraphobia: The role of affective temperament. Psychiatry Res 2018; 264:169-174. [PMID: 29649673 DOI: 10.1016/j.psychres.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/27/2017] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
There are opinions regarding that impulsivity may play a role in the pathogenesis of neuropsychiatric disorders. The aim of this study was to investigate the relationship between impulsivity and panic disorder (PD) in the patient group, to compare impulsivity and affective temperamental traits between patients and healthy controls and to investigate whether there is a relationship between impulsivity and affective temperamental traits. Participants comprised 70 patients with PD and 58 healthy volunteers. The Panic Agoraphobia Scale (PAS), the Barratt Impulsiveness Scale (BIS-11) and the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A) were applied. Patients have significantly higher scores in affective temperament (except hyperthymic) and attentional impulsiveness subscales than the healthy controls. Positive and negative correlations were found between some PAS and BIS-11 scores as well as correlations between especially cyclothymic, hyperthymic, irritable and anxious subscale scores of the TEMPS-A and the BIS-11 scores in the patient group. The results of this study indicate a relationship between impulsivity and PD. The correlations found between affective temperament dimensions and impulsivity suggest how affective temperamental traits may influence different impulsivity dimensions.
Collapse
Affiliation(s)
- Aslı Beşirli
- Department of Psychiatry, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Halaskargazi Street, 34371 Şişli, İstanbul, Turkey.
| |
Collapse
|
21
|
Harford TC, Chen CM, Kerridge BT, Grant BF. Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III). Psychiatry Res 2018; 262:384-392. [PMID: 28939392 PMCID: PMC5849477 DOI: 10.1016/j.psychres.2017.09.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/26/2022]
Abstract
A combined history of violence toward self and others has been reported in clinical and incarcerated populations. Psychiatric disorders have been implicated as risk factors. This study examines the lifetime prevalence of this combined violence in the general population and its associations with DSM-5 psychiatric disorders in comparison with other- and self-directed violence. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were analyzed, including 36,309 U.S. adults ages 18 and older. Violent behavior was defined by suicide attempts; recurrent suicidal behavior; gestures, threats, or self-mutilating behavior (self-directed); and multiple items of violence toward others (other-directed) in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression examined these violence categories in association with sociodemographics and lifetime DSM-5 psychiatric disorders. Results show that approximately 18.1% of adults reported violent behavior, including self-directed only (4.4%), other-directed only (10.9%), and combined self- and other-directed violence (2.8%). DSM-5 psychiatric disorders significantly associated with the violence typology include alcohol, tobacco, cannabis, and other drug use disorders; mood disorders; posttraumatic stress disorder; and schizotypal, antisocial, and borderline personality disorders. Findings extend the clinical literature regarding the co-occurrence of self- and other-directed violent behaviors to the general population.
Collapse
Affiliation(s)
- Thomas C. Harford
- CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA,
22203, United States
| | - Chiung M. Chen
- CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA,
22203, United States,Corresponding author: CSR, Incorporated, 4250 N. Fairfax Dr.,
Suite 500, Arlington, VA 22203. Tel.: + 1 703 741 7125; fax: + 1 703 312
5230
| | - Bradley T. Kerridge
- Department of Psychiatry, Columbia University, New York State
Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032,United
States
| | - Bridget F. Grant
- Epidemiology and Biometry Branch, Division of Epidemiology and
Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National
Institutes of Health, Room 3077, 5635 Fishers Lane, M.S. 9304, Bethesda, MD,
20892-9304, United States
| |
Collapse
|
22
|
Harford TC, Yi HY, Chen CM, Grant BF. Substance use disorders and self- and other-directed violence among adults: Results from the National Survey on Drug Use And Health. J Affect Disord 2018; 225:365-373. [PMID: 28846958 PMCID: PMC5626648 DOI: 10.1016/j.jad.2017.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/30/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous studies have identified a violence typology of self- and other-directed violence. This study examines the extent to which substance use disorders (SUDs) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), independent of serious psychological distress, major depressive episodes, assault arrest, and criminal justice involvement, are associated with these violence categories. METHOD Data were obtained from the National Survey on Drug Use and Health (NSDUH) pooled across survey years 2008-2015, with a combined sample of 314,881 adult respondents. According to self-report data on suicide attempt (self-directed) and attacking someone with the intent for serious injury (other-directed), violence was categorized in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression was used to estimate the adjusted odds ratios associated with the risk factors for different forms of violence. RESULTS Nicotine dependence and the number of DSM-IV SUDs criteria (except the criterion of legal problems) for alcohol, marijuana, and pain reliever use disorders are significantly associated with the self-/other-directed violence categories. LIMITATIONS Cross-sectional data do not allow assessment of directionality of important factors. CONCLUSIONS The identification of the combined self- and other-directed violence among adults in the general population extends studies in the adolescent population, and significant correlation between self- and other-directed violence provides additional support for clinical studies that established this association. Findings expand the associated risk factors identified in previous studies for the adult population. Prevention and treatment programs need to address both forms of violence and suicidality.
Collapse
Affiliation(s)
| | | | - Chiung M. Chen
- Corresponding author: CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA 22203, , Telephone: (703) 741-7125, Fax: (703) 312-5230
| | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, MD 20892, United States
| |
Collapse
|
23
|
Baik SY, Jeong M, Kim HS, Lee SH. ERP investigation of attentional disengagement from suicide-relevant information in patients with major depressive disorder. J Affect Disord 2018; 225:357-364. [PMID: 28846957 DOI: 10.1016/j.jad.2017.08.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/28/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous studies suggest the presence of attentional bias towards suicide-relevant information in suicidal individuals. However, the findings are limited by their reliance on behavioral measures. This study investigates the role of difficulty in disengaging attention from suicide-relevant stimuli using the P300 component of event-related potentials (ERPs). METHODS Forty-four adults with Major Depressive Disorder (MDD) were administered the spatial cueing task using suicide-relevant and negatively-valenced words as cue stimuli. Disengagement difficulty was measured using reaction time and P300 during invalid trials. RESULTS P300 amplitudes at Pz were higher in suicide-relevant compared to negatively-valenced word condition on invalid trials for participants with low rates of suicidal behavior. However, no such difference was found among participants with high rates of suicidal behavior. P300 amplitudes for suicide-relevant word condition were negatively correlated with "lifetime suicide ideation and attempt" at Pz. No significant results were found for the reaction time data, indicating that the ERP may be more sensitive in capturing the attentional disengagement effect. LIMITATIONS The groups were divided according to Suicidal Behaviors Questionnaire-Revised (SBQ-R) total score. Neutral stimulus was not included as cue stimuli. Most participants were under medication during the experiment. CONCLUSIONS Our results indicate that patients with MDD and low rates of suicidal behavior show difficulty in disengaging attention from suicide-relevant stimuli. We suggest that suicide-specific disengagement difficulties may be related to recentness of suicide attempt and that acquired capability for suicide may contribute to reduced disengagement difficulties.
Collapse
Affiliation(s)
- Seung Yeon Baik
- Department of Psychology, Sogang University, Seoul, Republic of Korea; Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
| | - Minkyung Jeong
- Department of Psychology, Sogang University, Seoul, Republic of Korea
| | - Hyang Sook Kim
- Department of Psychology, Sogang University, Seoul, Republic of Korea.
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychiatry, Inje University Ilsan Paik Hospital, Ilsan, Republic of Korea.
| |
Collapse
|
24
|
Electrophysiological indicators of inhibitory control deficits in depression. Biol Psychol 2017; 130:1-10. [DOI: 10.1016/j.biopsycho.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 01/02/2023]
|
25
|
Pezzia C, Sanders C, Welch S, Bowling A, Lee WM. Psychosocial and behavioral factors in acetaminophen-related acute liver failure and liver injury. J Psychosom Res 2017; 101:51-57. [PMID: 28867424 PMCID: PMC5595657 DOI: 10.1016/j.jpsychores.2017.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Acetaminophen overdoses result in nearly 500 deaths annually and a much larger number of hospitalizations. Suicidal overdoses are exceeded in number in the United States by unintentional overdoses. We evaluated clinical, demographic and psychosocial factors among unintentional and intentional overdose patients whose acetaminophen (APAP) toxicity had resulted in acute liver failure. We hypothesized that APAP overdose patients would be more likely to suffer from behavioral health issues and display higher impulsivity scores than the general population. METHODS Within 4days of admission and initial recovery of alertness, we administered a detailed questionnaire that included questions on APAP intake (e.g., dose taken, intent, other substances ingested), the Mini International Neuropsychiatric Interview modules on depression, alcohol use, substance use, and pain disorders and The Barratt Impulsiveness Scale-11. RESULTS The group included 44 intentional (single time point ingestions with the intent to self-harm) and 51 unintentional (multiple time point ingestions to manage pain or other condition) APAP patients enrolled in the Acute Liver Failure Study Group registry between 2007 and 2013. Both groups were characterized by similar frequencies of chronic pain, depressive symptoms at time of ingestion and alcohol and substance use disorders, all at higher rates than the general population. Overall, APAP patients scored higher than the general population for Non-planning aspects of impulsivity, with no apparent differences between other impulsivity scores or between intentional and unintentional APAP patients. CONCLUSIONS Depression, mismanagement of problematic chronic pain, frequent substance abuse, and increased impulsivity appear to provide the substrate for many APAP overdoses.
Collapse
Affiliation(s)
- Carla Pezzia
- Department of Human Sciences, University of Dallas, 1845 E Northgate, Irving, TX 75062, United States.
| | - Corron Sanders
- Population Health Data Strategies Children's Health System of Texas, 1935 Medical District Dr, Dallas, TX 75235, United States.
| | - Suzanne Welch
- University of Michigan Congenital Heart Center, 1540 E Hospital Dr, Ann Arbor, MI 48109, United States.
| | - Angela Bowling
- Population Health Data Strategies Children's Health System of Texas, 1935 Medical District Dr, Dallas, TX 75235, United States.
| | - William M Lee
- Department of Internal Medicine University of Texas Southwestern Medical Center at Dallas, 5959 Harry Hines Blvd, Dallas, TX 75235, United States.
| |
Collapse
|
26
|
Võhma Ü, Raag M, Tõru I, Aluoja A, Maron E. Association between personality traits and Escitalopram treatment efficacy in panic disorder. Nord J Psychiatry 2017; 71:433-440. [PMID: 28472591 DOI: 10.1080/08039488.2017.1316772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is strong evidence to suggest that personality factors may interact with the development and clinical expression of panic disorder (PD). A greater understanding of these relationships may have important implications for clinical practice and implications for searching reliable predictors of treatment outcome. AIMS The study aimed to examine the effect of escitalopram treatment on personality traits in PD patients, and to identify whether the treatment outcome could be predicted by any personality trait. METHOD A study sample consisting of 110 outpatients with PD treated with 10-20 mg/day of escitalopram for 12 weeks. The personality traits were evaluated before and after 12 weeks of medication by using the Swedish universities Scales of Personality (SSP). RESULTS Although almost all personality traits on the SSP measurement were improved after 12 weeks of medication in comparison with the baseline scores, none of these changes reached a statistically significant level. Only higher impulsivity at baseline SSP predicted non-remission to 12-weeks treatment with escitalopram; however, this association did not withstand the Bonferroni correction in multiple comparisons. LIMITATIONS All patients were treated in a naturalistic way using an open-label drug, so placebo responses cannot be excluded. The sample size can still be considered not large enough to reveal statistically significant findings. CONCLUSIONS Maladaptive personality disposition in patients with PD seems to have a trait character and shows little trend toward normalization after 12-weeks treatment with the antidepressant, while the association between impulsivity and treatment response needs further investigation.
Collapse
Affiliation(s)
- Ülle Võhma
- a North Estonia Medical Centre Foundation, Psychiatry Clinic , Tallinn , Estonia
| | - Mait Raag
- b Department of Public Health , University of Tartu , Tartu , Estonia
| | - Innar Tõru
- c Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Anu Aluoja
- c Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Eduard Maron
- a North Estonia Medical Centre Foundation, Psychiatry Clinic , Tallinn , Estonia.,c Department of Psychiatry , University of Tartu , Tartu , Estonia.,d Centre for Neuropsychopharmacology, Imperial College London , London , UK
| |
Collapse
|
27
|
Harford TC, Chen CM, Grant BF. Other- and Self-Directed Forms of Violence and Their Relationship With Number of Substance Use Disorder Criteria Among Youth Ages 12-17: Results From the National Survey on Drug Use and Health. J Stud Alcohol Drugs 2016; 77:277-86. [PMID: 26997186 DOI: 10.15288/jsad.2016.77.277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the associations between the number of substance use disorder (SUD) criteria as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and other- and self-directed forms of violence among youth ages 12-17 in the general population. METHOD Data were obtained from the National Survey on Drug Use and Health pooled across survey years 2008-2013, with a combined sample of 108,560 respondents ages 12-17. Violence categories defined by suicide attempt (self-directed) and attacking someone with the intent for serious injury (other-directed) were categorized as follows: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression estimated odds ratios of the increased number of criteria for alcohol, marijuana, and other illicit drug use, and nicotine dependence for each violence category, by controlling for sociodemographics and criminal justice involvement. RESULTS The multivariable model indicates that increased number of SUD criteria confers significantly higher odds for each violence category versus no violence. For combined violence versus self-directed violence, male gender, non-Hispanic Black and mixed race (with non-Hispanic White as referent), nicotine dependence, increased number of alcohol use disorder criteria, and other drug use disorder criteria have significantly higher odds, whereas Native Hawaiian/Pacific Islander and age have significantly lower odds. For combined violence versus other-directed violence, non-Hispanic mixed race and the increased number of other drug use disorder criteria have significantly higher odds, whereas male gender, non-Hispanic Black and Native Hawaiian/Pacific Islander, and Hispanic have significantly lower odds. CONCLUSIONS The identification of the combined self-/other-directed violence in the general population provides additional support for clinical studies that established associations between self- and other-directed violent behaviors. Prevention and treatment programs need to address both instances of violence and suicidality.
Collapse
Affiliation(s)
| | | | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
28
|
Bhui K, Silva MJ, Topciu RA, Jones E. Pathways to sympathies for violent protest and terrorism. Br J Psychiatry 2016; 209:483-490. [PMID: 27609812 DOI: 10.1192/bjp.bp.116.185173] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities. AIMS To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT). METHOD A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis. RESULTS Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59-4.23, P<0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT (death of a close friend: OR = 0.24, 95% CI 0.07-0.74; donating money to a charity: OR = 0.52, 95% CI 0.3-0.9). CONCLUSIONS Independent of SVPT associations with depressive symptoms, some expressions of social connectedness (measured as life events and political engagement) are associated with a lower risk of SVPT.
Collapse
Affiliation(s)
- Kamaldeep Bhui
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Joao Silva
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Raluca A Topciu
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Edgar Jones
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
29
|
Yaseen ZS, Galynker II, Briggs J, Freed RD, Gabbay V. Functional domains as correlates of suicidality among psychiatric inpatients. J Affect Disord 2016; 203:77-83. [PMID: 27280966 PMCID: PMC4975988 DOI: 10.1016/j.jad.2016.05.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Suicide remains poorly understood and unpredictable. Addressing this challenge, this study examined the independent contributions of several research domain criteria (RDoC) constructs in relation to suicidality in patients hospitalized for acute suicide risk. Specifically, we examined anhedonia, anxiety/entrapment, and attachment disturbances, reflecting disturbances in reward processes, negative valence systems, and social processes, respectively. METHODS Anhedonia, anxiety, entrapment, and fearful attachment, were assessed quantitatively in 135 adults hospitalized for suicidality. Current suicidality and suicidal history were assessed with the Columbia Suicide Severity Rating Scale. Bivariate analyses (with significance threshold of p<.01 to account for multiple comparisons) and multivariate models examined relationships between symptom dimensions and severity of suicidal ideation (SI). We also assessed differences between patients with a history of suicide attempt and those who exhibited only suicidal ideations. RESULTS Using bivariate analyses all symptoms except for fearful attachment correlated robustly with SI (r =.37-0.50, p<.001). However, when using multivariate analyses, only anhedonia (β=.28, p=.01) and entrapment (β=.19, p=.03) were independently associated with SI across the entire sample. No functional domain measures differed between patients with history of suicide attempt versus ideation only. LIMITATIONS The reliance on self-report data and a cross-sectional design. CONCLUSIONS Disturbances in reward and threat processing may represent independent factors in the development of suicidal ideation in this high suicide risk cohort. Future studies should assess their role as risk factors.
Collapse
Affiliation(s)
- Zimri S Yaseen
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, New York, NY 10029, USA; Mount Sinai Beth Israel, Department of Psychiatry, First Avenue at 16th Street, New York, NY 10003, USA.
| | - Igor I Galynker
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, New York, NY 10029, USA; Mount Sinai Beth Israel, Department of Psychiatry, First Avenue at 16th Street, New York, NY 10003, USA
| | - Jessica Briggs
- Mount Sinai Beth Israel, Department of Psychiatry, First Avenue at 16th Street, New York, NY 10003, USA
| | - Rachel D Freed
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Vilma Gabbay
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, New York, NY 10029, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
| |
Collapse
|
30
|
The Red Blood Cell Acetylcholinesterase Levels of Depressive Patients with Suicidal Behavior in an Agricultural Area. Indian J Clin Biochem 2016; 31:473-9. [PMID: 27605747 DOI: 10.1007/s12291-016-0558-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
Long-term exposure to organophosphate pesticides (OPs) without acute poisoning can lead to various OPs. Environmental exposure to organophosphate pesticides may be associated with depression and suicide attempts in a population living in a rural agricultural area. Patients (n = 149) suffering from major depressive disorder (with and without attempted suicide) and a control group of healthy individuals (n = 64) who had been living in the same rural district for at least 1 year were selected. Red blood cell acetylcholine esterase (RBC-AChE) activity was examined as the basis of evaluating the degree of chronic environmental exposure to OPs residues. There were negative association between RBC-AChE activity levels and suicide attempts, the number of past suicide attempts and hopelessness levels in the depressive patients. The results of the study may support the idea that environmental exposure to OPs may be associated with mental health in individuals living in agricultural districts who are not farmers or working in occupations with access to OPs.
Collapse
|
31
|
O'Donnell O, House A, Waterman M. The co-occurrence of aggression and self-harm: systematic literature review. J Affect Disord 2015; 175:325-50. [PMID: 25665494 DOI: 10.1016/j.jad.2014.12.051] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiological research supports an association between aggression and self-harm through data on the frequency with which individuals exhibit both behaviours. Unbiased evidence, however, is needed to draw conclusions about the nature and extent of co-occurrence. METHOD Systematic review of published studies was undertaken to evaluate whether or not the frequency with which aggression and self-harm co-occur is beyond that which would be expected by chance. Outcome measures included: (a) between-group differences on a standardised aggression/self-harm measure - the groups defined by scores on a measure of the other behaviour; (b) correlations between the two behaviours; (c) co-occurrence rates in populations defined by the presence of either behaviour; (d) co-occurrence rates in populations not defined by either behaviour. Odds ratios were calculated for studies presenting complete frequency data. RESULTS 123 studies, some yielding more than one type of result, met the inclusion criteria. Most case-control studies found elevated levels of aggression in self-harming populations (or self-harm in aggressive populations) compared to controls. The majority of correlational, co-occurrence rate, and odds ratio data found aggression and self-harm to be associated. LIMITATIONS Results were subject to descriptive synthesis only and thus, unable to report an overall effect size. CONCLUSIONS Evidence suggests that aggression and self-harm frequently co-occur. Such evidence necessitates more theoretical discussion and associated research on the source and nature of co-occurrence. Nonetheless, individuals who present with one behaviour may be considered an 'at-risk' group in terms of exhibiting the other. Such evidence holds implications for practice (e.g. risk assessment).
Collapse
Affiliation(s)
| | | | - Mitch Waterman
- Institute of Psychological Sciences, Faculty of Medicine and Health, University of Leeds, UK
| |
Collapse
|
32
|
King R, Lloyd C, Meehan T, O’Neill K, Wilesmith C. Development and evaluation of the Clinician Suicide Risk Assessment Checklist. ACTA ACUST UNITED AC 2014. [DOI: 10.5172/jamh.5.1.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert King
- Department of Psychiatry, The University of Queensland, Brisbane, Australia
- The Park Centre for Mental Health, Brisbane, Australia
| | - Chris Lloyd
- Division of Occupational Therapy, The University of Queensland, Brisbane, Australia
| | - Tom Meehan
- The Park Centre for Mental Health, Brisbane, Australia
| | - Khaleda O’Neill
- Division of Occupational Therapy, The University of Queensland, Brisbane, Australia
| | - Cindy Wilesmith
- Division of Occupational Therapy, The University of Queensland, Brisbane, Australia
| |
Collapse
|
33
|
Dell'osso L, Mandelli L, Carlini M, Bouanani S, Rotondo A, Conversano C, Serretti A, Marazziti D. Temperamental and genetic predictors of suicide attempt and self-mutilation. Neuropsychobiology 2014; 68:250-7. [PMID: 24280759 DOI: 10.1159/000356228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 10/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Literature findings mainly support the notion that suicide attempts (SA) and self-mutilating behavior (SMB) are distinct behaviors, although they may share common psychopathological features. In the present paper we aimed to identify behavioral phenotypes in patients with SA, SMB, or both (SAM) and to analyze the association with candidate genes. METHODS One hundred forty-two inpatients with a history of SA (n = 86), SMB (n = 22), and SAM (n = 39) were included in this study. Subjects were evaluated using the Tridimensional Personality Questionnaire (TPQ) and the Buss-Durkee Hostility Inventory (BDHI). Polymorphisms within serotonin transporter (SLC6A4, HTTLPR), catechol-O-methyl transferase (COMT, Val158Met), and tryptophan hydroxylase (TPH, 218C>A) were also analyzed. RESULTS Principal component factor analysis including the BDHI and TPQ produced 3 factors that could classify the 3 groups of patients with good sensitivity. However, only the 'pure suicidal' factor had a sufficient positive predictive value. This factor was characterized by high levels of persistence (PS) and, to a lower extent, reward dependence. The distribution of genotypes was not different across patient groups for all polymorphisms, but the SS genotype of HTTLPR was significantly associated with the 'self-mutilation' factor, characterized by high levels of hostile traits, novelty seeking, and harm avoidance. CONCLUSION The results of the present study suggest that different and overlapping temperamental traits in suicidal and self-mutilating patients are present, although only high levels of PS could predict SA repetition. Finally, HTTLPR may mediate the risk for SMB through modulation of some temperamental traits.
Collapse
Affiliation(s)
- Liliana Dell'osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Woo YS, Jun TY, Jeon YH, Song HR, Kim TS, Kim JB, Lee MS, Kim JM, Jo SJ. Relationship of temperament and character in remitted depressed patients with suicidal ideation and suicide attempts--results from the CRESCEND study. PLoS One 2014; 9:e105860. [PMID: 25279671 PMCID: PMC4184783 DOI: 10.1371/journal.pone.0105860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/29/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the Temperament and Character Inventory (TCI) scores of a sample of Korean patients with remitted depression who had attempted suicide and reported suicidal ideation and to compare their scores with those of remitted depressed patients without suicidal ideation. Adult depression patients who had completed 12 weeks of follow-up (N = 138) were divided into three groups: patients with a history of suicide attempts (N = 23); patients with current suicidal ideation (N = 59); and patients without current suicidal ideation (N = 56). After controlling for covariates, no significant differences were found among the three groups on any measure of temperament or character except self-directedness and self-transcendence. The self-transcendence scores of the lifetime suicide-attempt group were significantly higher compared with those of the suicidal-ideation group; post hoc analysis revealed that self-directedness was significantly lower in the suicide-attempt group compared with the non-suicidal group. The results from the present study suggest that remitted depression patients with a history of suicide attempts do not differ from non-attempters in temperament, but do differ in certain character traits.
Collapse
Affiliation(s)
- Young Sup Woo
- Department of Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Tae-Youn Jun
- Department of Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Yang-Hwan Jeon
- Department of Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Hoo Rim Song
- Department of Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Tae-Suk Kim
- Department of Psychiatry, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Jin Jo
- Department of Preventive Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| |
Collapse
|
35
|
Harford TC, Yi HY, Grant BF. Associations between childhood abuse and interpersonal aggression and suicide attempt among U.S. adults in a national study. CHILD ABUSE & NEGLECT 2014; 38:1389-98. [PMID: 24656711 PMCID: PMC4117716 DOI: 10.1016/j.chiabu.2014.02.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 05/16/2023]
Abstract
The aim of this study is to examine associations among childhood physical, emotional, or sexual abuse and violence toward self (suicide attempts [SA]) and others (interpersonal aggression [IA]). Data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2 (n=34,653). Multinomial logistic regression examined associations between type of childhood abuse and violence categories, adjusting for demographic variables, other childhood adversity, and DSM-IV psychiatric disorders. The prevalence of reported childhood abuse was 4.60% for physical abuse, 7.83% for emotional abuse, and 10.20% for sexual abuse. Approximately 18% of adults reported some form of violent behavior, distributed as follows: IA, 13.37%; SA, 2.64%; and SA with IA, 1.85%. After adjusting for demographic variables, other childhood adversity, and psychiatric disorders, each type of childhood abuse was significantly related to increased risk for each violence category as compared with the no violence category. Furthermore, the odds ratio of childhood physical abuse was significantly higher for SA with IA when compared with IA, and the odds ratio of childhood sexual abuse was significantly higher for SA and SA with IA when compared with IA. Childhood physical, emotional, and sexual abuse is directly related to the risk for violent behaviors to self and others. Both internalizing and externalizing psychiatric disorders impact the association between childhood abuse and violence. The inclusion of suicidal behaviors and interpersonal aggression and internalizing/externalizing psychiatric disorders within an integrated conceptual framework will facilitate more effective interventions for long-lasting effects of child abuse.
Collapse
Affiliation(s)
- Thomas C. Harford
- CSR, Incorporated, 2107 Wilson Boulevard, Suite 1000, Arlington, VA 22201, USA
| | - Hsiao-ye Yi
- CSR, Incorporated, 2107 Wilson Boulevard, Suite 1000, Arlington, VA 22201, USA
| | - Bridget F. Grant
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD 20892, USA
| |
Collapse
|
36
|
Saddichha S, Schuetz C. Impulsivity in remitted depression: a meta-analytical review. Asian J Psychiatr 2014; 9:13-6. [PMID: 24813029 DOI: 10.1016/j.ajp.2014.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/26/2022]
Abstract
AIM Depressive disorder and suicide have been associated with impulsivity in several studies. This paper aimed to review measures of trait impulsivity in remitted depressive disorder. METHODS We used keywords "impulsivity and depression"; "impulsivity and depressive disorder" to narrow down our search on Medline, EMBASE and Psychinfo to include those studies that had reported impulsivity scores using validated and reliable assessment measures in remitted depressive disorder. We searched all English language studies from 1990 to December 2012 with 9 reports meeting the inclusion criteria for depression, which were then reviewed by the two reviewers independently. We generated weighted mean differences (WMDs) for depression from the pooled data using RevManager 5.1 from Cochrane analysis. RESULTS The Barratt Impulsivity Scale (BIS) 11 was the instrument commonly used in depression. 9 studies met inclusion criteria in depression, which yielded a WMD of 10.12 on BIS 11 total scores. CONCLUSION There is a strong association of impulsivity and depression, which persists even in remission.
Collapse
Affiliation(s)
- Sahoo Saddichha
- Senior Registrar, NWMH, Melbourne Health, Victoria, Australia.
| | - Christian Schuetz
- Department of Psychiatry & Psychiatrist, Burnaby Centre for Addiction & Mental Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
37
|
Hollingdale J, Woodhouse E, Asherson P, Gudjonsson GH, Young S. A Pilot Study Examining ADHD and Behavioural Disturbance in Female Mentally Disordered Offenders. AIMS Public Health 2014; 1:100-108. [PMID: 29546079 PMCID: PMC5689798 DOI: 10.3934/publichealth.2014.2.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/05/2014] [Indexed: 11/18/2022] Open
Abstract
Compared with general population rates, prevalence rates of ADHD have been consistently reported to be higher in both male and female offender populations, the latter estimated to range between 10-29%. Research in forensic institutional settings has reported that aggressive behaviour is a particularly prominent source of impairment among men with ADHD. However there is a paucity of research investigating the type of behavioural incidents that may arise in female offenders with ADHD. This pilot study therefore aimed to further our understanding of ADHD within a cohort of female mentally disordered offenders by ascertaining estimated rates of ADHD and associated functional disturbance presenting in this population. Fifty female offenders completed the Barkley ADHD rating scales. Data on aggressive and self-harming behaviours were obtained from patients' clinical records. Almost one-third of patients (28%) screened positive for ADHD, most commonly hyperactive/impulsive and combined subtypes. They were significantly younger than their peers and there were no significant differences in behavioural disturbance records between groups. When controlling for age, hyperactive/impulsive symptoms and combined symptoms were significantly and positively correlated with measures of behavioural disturbance. ADHD symptoms correlated more strongly with self-harm than outward aggression, which is a novel finding. This pilot study has contributed to the knowledge base about the rate and functional problems of female offenders with ADHD. Future research should replicate the study using a larger sample and explore the effect of treatment (pharmacological and psychological) on the reduction of ADHD symptoms, behavioural disturbance, length of stay and quality of life.
Collapse
Affiliation(s)
- Jack Hollingdale
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Emma Woodhouse
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Philip Asherson
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Gisli H. Gudjonsson
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
- Broadmoor Hospital, Crowthorne, West London Mental Health Trust, UK
| | - Susan Young
- Broadmoor Hospital, Crowthorne, West London Mental Health Trust, UK
- Centre for Mental Health, Imperial College London, London, UK
| |
Collapse
|
38
|
Pape H. Sexual assault while too intoxicated to resist: a general population study of Norwegian teenage girls. BMC Public Health 2014; 14:406. [PMID: 24774966 PMCID: PMC4023494 DOI: 10.1186/1471-2458-14-406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/24/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Underage drinking is widespread, but studies on alcohol-related sexual victimization among teenage girls are almost non-existent. Research on individual correlates and risk factors of sexual victimization more generally is also meager. This study focuses on sexual assault while incapacitated due to drunkenness among 15-18 year-old girls and examines how age, drinking behavior, impulsivity and involvement in norm-violating activities are associated with such victimization experiences. METHODS Data stemmed from a school survey (response rate: 85%) in 16 Norwegian municipalities. Almost all analyses were restricted to girls who had been intoxicated in the past year (n = 2701). In addition to bivariate associations, adjusted odds ratios and relative risks of incapacitated sexual assault (ISA) were estimated. Further, population-attributable fractions were calculated to explore how the prevalence of ISA victimization was likely to be affected if effective preventive measures were targeted solely at high-risk groups. RESULTS The majority of the girls (71%) had been intoxicated in the past year, of which 7% had experienced ISA victimization in the same period. The proportion of victims decreased by age within the group that had been intoxicated, reflecting that the youngest girls were more likely to get severely drunk. Impulsivity and involvement in norm-violating behaviors were identified as potential risk factors, but the population-attributable fractions indicated that the groups with the highest risk of ISA victimization accounted for only a minority of all the cases of such victimization. CONCLUSION Sexual assault against teenage girls who are too drunk to resist seems to be prevalent in Norway - notably among the youngest girls who engage in heavy episodic drinking. This study also suggests that one should reconsider the notion that no individual attributes are related to females' sexual assault victimization. It also indicates that a high risk approach to prevention, targeting groups with a high level of impulsivity or behavioral problems, may have limited effect on the prevalence of ISA victimization. Thus, from a public health perspective, it may be advisable to give priority to universal preventive measures to curb young girls' risk of being sexually assaulted in a state of alcohol-induced incapacitation.
Collapse
Affiliation(s)
- Hilde Pape
- Norwegian Institute for Alcohol and Drug Research (SIRUS), PB 565 Sentrum, 0105 Oslo, Norway.
| |
Collapse
|
39
|
Witt K, Hawton K, Fazel S. The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophr Res 2014; 154:61-7. [PMID: 24581550 PMCID: PMC3988953 DOI: 10.1016/j.schres.2014.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/20/2014] [Accepted: 02/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness. AIMS The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia. METHOD Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk. RESULTS Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior. CONCLUSIONS Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.
Collapse
Affiliation(s)
- Katrina Witt
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK
| | - Seena Fazel
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
| |
Collapse
|
40
|
Gvion Y, Horresh N, Levi-Belz Y, Fischel T, Treves I, Weiser M, David HS, Stein-Reizer O, Apter A. Aggression-impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters. Compr Psychiatry 2014; 55:40-50. [PMID: 24209607 DOI: 10.1016/j.comppsych.2013.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 08/29/2013] [Accepted: 09/18/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Unbearable mental pain, depression, and hopelessness have been associated with suicidal behavior in general, while difficulties with social communication and loneliness have been associated with highly lethal suicide attempts in particular. The literature also links aggression and impulsivity with suicidal behavior but raises questions about their influence on the lethality and outcome of the suicide attempt. OBJECTIVES To evaluate the relative effects of aggression and impulsivity on the lethality of suicide attempts we hypothesized that impulsivity and aggression differentiate between suicide attempters and non-attempters and between medically serious and medically non-serious suicide attempters. METHOD The study group included 196 participants divided into four groups: 43 medically serious suicide attempters; 49 medically non-serious suicide attempters, 47 psychiatric patients who had never attempted suicide; and 57 healthy control subjects. Data on sociodemographic parameters, clinical history, and details of the suicide attempts were collected. Participants completed a battery of instruments for assessment of aggression-impulsivity, mental pain, and communication difficulties. RESULTS The medically serious and medically non-serious suicide attempters scored significantly higher than both control groups on mental pain, depression, and hopelessness (p<.001 for all) and on anger-in, anger-out, violence, and impulsivity (p<.05 for all), with no significant difference between the two suicide attempter groups. Medically serious suicide attempters had significantly lower self-disclosure (p<.05) and more schizoid tendencies (p<.001) than the other three groups and significantly more feelings of loneliness than the medically non-serious suicide attempters and nonsuicidal psychiatric patients (p<.05). Analysis of aggression-impulsivity, mental pain, and communication variables with suicide lethality yielded significant correlations for self-disclosure, schizoid tendency, and loneliness. The interaction between mental pain and schizoid traits explained some of the variance in suicide lethality, over and above the contribution of each component alone. CONCLUSIONS Aggression-impulsivity and mental pain are risk factors for suicide attempts. However, only difficulties in communication differentiate medically serious from medically non-serious suicide attempters. The combination of unbearable mental pain and difficulties in communication has a magnifying effect on the risk of lethal suicidal behavior.
Collapse
Affiliation(s)
- Yari Gvion
- Department of Clinical Psychology, Bar Ilan University, Ramat Gan, Israel; Department of Clinical Psychology, Tel Aviv-Jaffa Academic Center, Tel Aviv, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Gobbi G, Comai S, Debonnel G. Effects of quetiapine and olanzapine in patients with psychosis and violent behavior: a pilot randomized, open-label, comparative study. Neuropsychiatr Dis Treat 2014; 10:757-65. [PMID: 24855361 PMCID: PMC4019623 DOI: 10.2147/ndt.s59968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Patients suffering from psychosis are more likely than the general population to commit aggressive acts, but the therapeutics of aggressive behavior are still a matter of debate. METHODS This pilot randomized, open-label study compared the efficacy of quetiapine versus olanzapine in reducing impulsive and aggressive behaviors (primary endpoints) and psychotic symptoms (secondary endpoints) from baseline to days 1, 7, 14, 28, 42, 56, and 70, in 15 violent schizophrenic patients hospitalized in a maximum-security psychiatric hospital. RESULTS Quetiapine (525±45 mg) and olanzapine (18.5±4.8 mg) were both efficacious in reducing Impulsivity Rating Scale from baseline to day 70. In addition, both treatments reduced the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression Scale scores at day 70 compared to baseline, and no differences were observed between treatments. Moreover, quetiapine, but not olanzapine, yielded an improvement of depressive symptoms in the items "depression" in Brief Psychiatric Rating Scale and "blunted affect" in Positive and Negative Syndrome Scale. Modified Overt Aggression Scale scores were also decreased from baseline to the endpoint, but due to the limited number of patients, it was not possible to detect a significant difference. CONCLUSION In this pilot study, quetiapine and olanzapine equally decreased impulsive and psychotic symptoms after 8 weeks of treatment. Double-blind, large studies are needed to confirm the validity of these two treatments in highly aggressive and violent schizophrenic patients.
Collapse
Affiliation(s)
- Gabriella Gobbi
- Neurobiological Psychiatric Unit, Department of Psychiatry, McGill University and McGill University Health Center, Montréal, QC, Canada ; Institut Philippe Pinel, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Stefano Comai
- Neurobiological Psychiatric Unit, Department of Psychiatry, McGill University and McGill University Health Center, Montréal, QC, Canada
| | - Guy Debonnel
- Neurobiological Psychiatric Unit, Department of Psychiatry, McGill University and McGill University Health Center, Montréal, QC, Canada ; Institut Philippe Pinel, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
42
|
Abstract
Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social, and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena.
Collapse
Affiliation(s)
- Shira Barzilay
- a Feinberg Child Study Center, Schneider Children's Medical Center of Israel , Petach Tikva , Israel
| | | |
Collapse
|
43
|
Jacobson C, Batejan K, Kleinman M, Gould M. Reasons for attempting suicide among a community sample of adolescents. Suicide Life Threat Behav 2013; 43:646-62. [PMID: 23889468 DOI: 10.1111/sltb.12047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 05/01/2013] [Indexed: 11/28/2022]
Abstract
The motives of suicide attempts among a community sample of 99 U.S. high school students were explored. Participants completed an in-depth computer-assisted self interview about their most recent attempts as well as additional psychosocial measures. Results indicated that nearly 75% of the adolescents engaged in suicide attempts for reasons other than killing themselves and that depressive symptoms and premeditation prior to the attempt were significantly associated with increased risk for engaging in the attempts with death as a clear motive. Linking motive for an attempt (death, interpersonal communication, emotion regulation) and treatment approach may improve prevention of subsequent attempts and completed suicides.
Collapse
|
44
|
Kumar PNS, Rajmohan V, Sushil K. An exploratory analysis of personality factors contributed to suicide attempts. Indian J Psychol Med 2013; 35:378-84. [PMID: 24379499 PMCID: PMC3868090 DOI: 10.4103/0253-7176.122231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND People who attempt suicide have certain individual predispositions, part of which is contributed by personality traits. AIMS The present study was conducted to identify the psycho-sociodemographic and personality related factors contributing to suicide attempts. MATERIALS AND METHODS 104 suicide attempters admitted in various departments and referred to the department of psychiatry of IQRAA Hospital formed the study sample. They were evaluated with a self designed socio-demographic proforma, Eysenck's Personality Questionnaire Revised, Albert Einstein College of Medicine-Impulsivity Coping Scale, and Past Feelings and Acts of Violence Scale. STATISTICS ANALYSIS The data was initially analyzed by percentage of frequencies. Association between socio-demographic and selected psychological factors was analyzed using t-test and Chi-square test. Intercorrelation among psychological factors was calculated by Pearson's correlation coefficient "r". RESULTS AND CONCLUSION Factors such as young age, being married, nuclear family, feeling lonely and burden to family, inability to solve the problems of day to day life, and presence of psychiatric diagnosis and personality traits such as neuroticism, impulsivity, and violence were contributed to suicide attempt. A significant positive relationship between these factors was also identified. Findings of the present study call the attention of mental health professionals to identify these high risk factors in susceptible individuals and to modify these factors to prevent them from attempting suicide.
Collapse
Affiliation(s)
- P. N. Suresh Kumar
- Department of Psychiatry, Kunhitharuvai Memorial Charitable Trust Medical College, Calicut, Kerala, India
| | - V. Rajmohan
- Department of Psychiatry, Kunhitharuvai Memorial Charitable Trust Medical College, Calicut, Kerala, India
| | - K. Sushil
- Department of Psychiatry, Kunhitharuvai Memorial Charitable Trust Medical College, Calicut, Kerala, India
| |
Collapse
|
45
|
Harford TC, Yi HY, Grant BF. Other- and self-directed forms of violence and their relationships to DSM-IV substance use and other psychiatric disorders in a national survey of adults. Compr Psychiatry 2013; 54:731-9. [PMID: 23587529 PMCID: PMC3779474 DOI: 10.1016/j.comppsych.2013.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 01/22/2013] [Accepted: 02/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine associations between DSM-IV psychiatric disorders and other- and self-directed violence in the general population. METHODS Data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 & 2 (n=34,653). Four violence categories were derived from a latent class analysis (LCA) of 5 other-directed and 4 self-directed violent behavior indicators. Multinomial logistic regression examined class associations for gender, race-ethnicity, age and DSM-IV substance use, mood, anxiety, and personality disorders. RESULTS Approximately 16% of adults reported some form of violent behavior distributed as follows: other-directed only, 4.6%; self-directed only, 9.3%; combined self- and other-directed, 2.0%; and no violence, 84.1%. The majority of the DSM-IV disorders included in this study were significantly and independently related to each form of violence. Generally, other-directed violence was more strongly associated with any substance use disorders (81%) and any personality disorders (42%), while self-directed violence was more strongly associated with mood (41%) and anxiety disorders (57%). Compared with these two forms of violence, the smaller group with combined self- and other-directed violence was more strongly associated with any substance use disorders (88%), mood disorders (63%), and personality disorders (76%). CONCLUSION Findings from this study are consistent with recent conceptualizations of disorders as reflecting externalizing disorders and internalizing disorders. The identification of the small category with combined forms of violence further extends numerous clinical studies which established associations between self- and other-directed violent behaviors. The extent to which the combined violence category represents a meaningful and reliable category of violence requires further detailed studies.
Collapse
Affiliation(s)
- Thomas C. Harford
- Alcohol Epidemiologic Data System, CSR, Incorporated, Arlington, Virginia
| | - Hsiao-ye Yi
- Alcohol Epidemiologic Data System, CSR, Incorporated, Arlington, Virginia
| | - Bridget F. Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
46
|
Delay discounting task in pigs reveals response strategies related to dopamine metabolite. Physiol Behav 2013; 120:182-92. [DOI: 10.1016/j.physbeh.2013.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/09/2013] [Accepted: 08/07/2013] [Indexed: 11/18/2022]
|
47
|
Schaefer KE, Esposito-Smythers C, Riskind JH. The role of impulsivity in the relationship between anxiety and suicidal ideation. J Affect Disord 2012; 143:95-101. [PMID: 22925350 DOI: 10.1016/j.jad.2012.05.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/01/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of the present study was to examine the degree to which trait and cognitive (looming cognitive style) measures of anxiety are associated with suicidal ideation (SI), as well as whether trait and cognitive (time misperception) measures of impulsivity moderate the association between these variables. METHODS The sample included 100 undergraduate students (72% female) who completed the Spielberger State-Trait Anxiety Inventory, Looming Maladaptive Style Questionnaire, Barratt Impulsiveness Scale, Time Paradigm Version 1.0 Task, Beck Scale for Suicidal Ideation, and the Brief Symptom Inventory. RESULTS Trait anxiety and looming cognitive style were found to be positively associated with SI. Further, both trait impulsivity and time misperception moderated the association between these variables and SI, but in a different manner. Consistent with study hypotheses, among those high in trait anxiety, greater overestimation of time was associated with a higher likelihood of SI. Contrary to study hypotheses, among those low in trait anxiety, high trait impulsivity was associated with a greater likelihood of SI. The same pattern of results was found when looming cognitive style served as the independent variable. LIMITATIONS The use of a cross-sectional design limits the ability to determine the temporal relationship of the study variables. Further, the sample included predominantly Caucasian undergraduates and thus study results may not generalize to other populations. CONCLUSIONS Clinically, results suggest that high trait anxiety, looming cognitive style, time misperception, and trait impulsivity may be important risk factors for SI among college students and thus should be assessed when students present for treatment. Treatments that focus on problem solving, cognitive restructuring, and affect regulation strategies may help decrease anxiety and impulsivity, which in turn may help reduce the likelihood of suicidal thoughts.
Collapse
Affiliation(s)
- Karen E Schaefer
- George Mason University, Department of Psychology, 4400 University Dr., Mail Stop 3F5, Fairfax, VA 22030, USA.
| | | | | |
Collapse
|
48
|
Lewitzka U, Doucette S, Seemüller F, Grof P, Duffy AC. Biological indicators of suicide risk in youth with mood disorders: what do we know so far? Curr Psychiatry Rep 2012; 14:705-12. [PMID: 22996299 DOI: 10.1007/s11920-012-0329-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Suicidal behaviour in youth is a major public health concern worldwide, and youth in the early stages of a primary mood disorder are an identifiable high-risk population. Neurobiological research in youth at risk for suicidality has sought to investigate the most promising parameters from research in adults. The present paper provides an overview of the current findings of neurobiological research in children and adolescents with mood disorders and suicidality including genetic/epigenetic findings, neuro-hormonal and immunological investigations. Longitudinal research in high-risk youth is a powerful way to investigate the influences and their pathways in determining suicidal risk in the context of a developing mood disorder. In the meantime, there are clear clinical indicators of risk to help identify youth who would benefit from close surveillance and early intervention.
Collapse
Affiliation(s)
- Ute Lewitzka
- Department of Psychiatry, IWK Health Centre, Dalhousie University, 5850 University Ave, Halifax, B3K 6R8, Canada.
| | | | | | | | | |
Collapse
|
49
|
Harford TC, Yi HY, Freeman RC. A Typology of Violence against Self and Others and Its Associations with Drinking and Other Drug Use among High School Students in a U.S. General Population Survey. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2012; 21:349-366. [PMID: 26478688 PMCID: PMC4607080 DOI: 10.1080/1067828x.2012.710028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined associations between binge drinking and other substance use and perpetration of violence against self and others. Data were pooled from the 2003, 2005, and was constructed to reflect four categories of behaviors: other-directed violence only, self-directed violence only, combined other- and self-directed violence, and no violence. Results from multinomial logistic regressions show that the frequency of binge drinking and other substance use were significant risk factors for each of the violence categories relative to no-violence. However, the strengths of these associations varied across the violence categories.
Collapse
Affiliation(s)
| | | | - Robert C Freeman
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| |
Collapse
|
50
|
Del Carlo A, Benvenuti M, Fornaro M, Toni C, Rizzato S, Swann AC, Dell'Osso L, Perugi G. Different measures of impulsivity in patients with anxiety disorders: a case control study. Psychiatry Res 2012; 197:231-6. [PMID: 22357357 DOI: 10.1016/j.psychres.2011.09.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/14/2011] [Accepted: 09/21/2011] [Indexed: 10/28/2022]
Abstract
The relationship between anxiety and impulsivity is controversial and not well explored. The present investigation aims to compare impulsivity, measured by different rating tools, in patients with anxiety disorders vs. healthy controls. Forty-seven subjects with different anxiety disorders and 45 matched controls underwent diagnostic and symptomatological evaluations by the Mini Neuropsychiatric Interview (M.I.N.I) Plus 5.0, Bech-Raphaelsen Depression and Mania Scale (BRDMS), State-Trait Anxiety Inventory (STAI), Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); temperamental evaluations by the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Modified (TEMPS-M), the Separation Anxiety Sensitivity Index (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI); and psychometric and a neurocognitive evaluations of impulsivity using the Barratt Impulsiveness Scale (BIS-11) and the Immediate and Delayed Memory Task (IMT-DMT). Subjects with anxiety disorders were more impulsive than the controls in all the explored measures, with higher scores in symptomatological and, temperamental scales. Patients with anxiety disorders but without a lifetime history of comorbid major mood episodes had greater trait and state impulsivity than controls. Further investigations are needed to assess the extent to which impulsivity might or might not be directly related to the anxiety disorder.
Collapse
|