Perceived social support moderates the relations between mental health symptoms and current suicidal ideation

Despite efforts to identify risk factors associated with suicidal ideation (SI), less work has been conducted to highlight protective factors to promote prevention. Perceived social support has been shown to positively impact a wide range of psychological outcomes; however, prior efforts exploring whether perceived social support moderates the relationship between mental health (MH) symptoms and current SI among men and women have been hampered by limitations. To address knowledge gaps, data from the Comparative Health Assessment Interview Research Study was used to evaluate whether (a) perceived social support moderates the relationship between mental health symptoms (posttraumatic stress, anxiety, alcohol use, depressive) and current SI among veterans and nonveterans; (b) the strength of this moderating effect varies by gender and veteran status; and (c) the strength of this moderating effect varies by social support source (significant other, friend, family). Results suggest that perceived social support is more protective against SI for those with lower levels of mental health symptoms (≤ 25th percentile) than for those with higher symptom levels (≥ 75th percentile). Findings were largely consistent across study groups, support sources, and mental health symptoms examined; however, a significant moderating effect on the alcohol use-SI relationship was only observed for veteran men. Those with a lower mental health symptom severity may receive more benefit from strategies aimed at increasing perceived social support compared to those with higher symptom severity. Research is needed to match protective factors to individual phenotypes, with the goal of engaging those living with SI in more effective interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Real-World User Demographics of Three Web-Based Digital Mental Health Interventions Provided by the US Department of Veterans Affairs: Observational Study Using Web Analytics Data

BACKGROUND

Unguided digital mental health interventions (UDMHIs) have the potential to provide low-cost and effective mental health care at scale. Controlled trials have demonstrated the efficacy of UDMHIs to address mental health symptoms and conditions. However, few previous publications have described the demographics of real-world users of UDMHIs that are freely available to the public. The US Department of Veterans Affairs has created and hosts several UDMHIs on its Veteran Training Portal website. These web-based, free-to-use, and publicly available UDMHIs include Path to Better Sleep, Anger and Irritability Management Skills, and Moving Forward, which focus on insomnia, problematic anger, and depression symptoms, respectively.

OBJECTIVE

This study aimed to examine the user demographics of these 3 UDMHIs in the year 2021. In addition, it aimed to compare the age and gender distribution of the users of those 3 UDMHIs with one another and with the age and gender distribution of the total US veteran population.

METHODS

Google Analytics was used to collect user data for each of the 3 UDMHIs. The age and gender distribution of the users of each UDMHI was compared with that of the other UDMHIs as well as with that of the overall US veteran population using chi-square tests. Information on the total number of users, the country they were in, and the devices they used to access the UDMHIs was also collected and reported.

RESULTS

In 2021, the 3 UDMHIs together recorded 29,306 unique users. The estimated age range and gender were available for 24.12% (7068/29,306) of those users. Each UDMHI's age and gender distribution significantly differed from that of the other UDMHIs and from that of the overall US veteran population (P<.001 on all chi-square tests). Women and younger age groups were overrepresented among UDMHI users compared with the overall US veteran population. The majority of devices used to access the UDMHIs were desktop or laptop devices, although a substantial proportion of devices used were mobile devices (10,199/29,752, 34.28%). Most users (27,789/29,748, 93.41%) were located in the United States, with users from Canada, the United Kingdom, and Australia accounting for another 2.61% (775/29,748) of total users.

CONCLUSIONS

Our use of Google Analytics data provided useful information about the users of 3 free and publicly available UDMHIs provided by the US Department of Veterans Affairs. Although our findings should be considered in light of the limitations of autonomously collected web analytics data, they still offer useful information for health care policy makers, administrators, and UDMHI developers.

Rationale, design, and methods: A randomized placebo-controlled trial of an immunomodulatory probiotic intervention for Veterans with PTSD

Background

United States military Veterans from recent conflicts are experiencing symptoms related to posttraumatic stress disorder (PTSD). Many Veterans are resistant to conventional health and mental health interventions (e.g., medication, psychotherapy). Alternative treatment approaches are needed. An underlying feature of PTSD is exaggerated inflammation, both peripherally and in the central nervous system. This inflammation is thought to play an important role in the vulnerability to, aggravation of, and persistence of PTSD symptoms. Therefore, an innovative intervention strategy would be the use of immunoregulatory/anti-inflammatory probiotics to reduce inflammation. Here we describe the rationale, design, and methods of a randomized placebo-controlled trial (RCT) of Lactobacillus rhamnosus GG (LGG; ATCC 53103) for posttraumatic stress disorder (PTSD).

Methods

This is a Phase IIa trial of LGG for United States military Veterans with PTSD, using a longitudinal, double-blind, randomized placebo-controlled design. The primary outcome measure is plasma concentration of high-sensitivity C-reactive protein.

Conclusion

Despite the fact that symptoms associated with PTSD can be disabling, individuals living with this trauma-related disorder have limited options in terms of evidence-based interventions. Recent research efforts aimed at highlighting the biological mechanisms of PTSD suggest that increased inflammation and altered autonomic nervous system activity may be treatment targets, and that immunoregulatory probiotics, such as LGG, have the potential to decrease trauma-induced inflammatory responses, as well as associated symptoms. This manuscript describes the best powered human subjects Phase IIa trial, to date, of a probiotic intervention for those living with PTSD.

Firearm Injury Prevention and Extreme Risk Protection Orders

Extreme risk protection orders (ERPOs) represent a potential mechanism to facilitate firearm-related lethal means safety. ERPOs are a legal mechanism that enables law enforcement to temporarily remove firearms from, and prevent firearm purchase by, an individual who presents a significant danger to self or others, as determined by a court of law. While few jurisdictions currently allow mental health professionals to initiate ERPO petitions, it nonetheless seems important that clinicians be familiar with ERPOs, as clinicians may still serve an important role in disseminating information and facilitating judicious petitions. However, ERPO laws remain quite new, and the implications for mental health professionals when participating (directly or indirectly) in ERPOs remain unclear. This column introduces readers to ERPOs and offers resources to learn more about how ERPOs work across various jurisdictions.

Previously incarcerated individuals with psychotic symptoms are more likely to report a history of solitary confinement

We examined whether previously incarcerated individuals with self-reported psychotic symptoms were more likely to endorse a history of solitary confinement. A community-based sample of 176 previously incarcerated individuals residing in Baltimore or New York City were surveyed on prison experiences and mental health symptoms. Logistic regression found that previously incarcerated individuals who endorsed a schizophrenia diagnosis or past 12-month psychotic symptoms were significantly more likely to report a history of solitary confinement while incarcerated. This finding is consistent with other research suggesting that individuals with psychotic illness are disproportionately subjected to solitary confinement while incarcerated, which has important socio-legal implications.

The Relationship between Trauma Exposure and Psychiatric Hospitalization for Suicide Ideation or Suicide Attempt among Patients Admitted to a Military Treatment Setting

Suicide attempts and psychiatric hospitalization represent the final outcomes of a complex dynamical system of interacting factors that influence a particular individual’s likelihood of engaging in suicidal behavior, as well as their ability to seek help prior to acting upon suicidal impulses. This study examined the association between different types of lifetime trauma exposure and the likelihood of psychiatric hospitalization following a suicide attempt (SA) rather than suicidal ideation (SI) alone. Electronic medical records for 1100 U.S. military service members and their dependents admitted to a military psychiatric inpatient setting for SA or SI were reviewed for documented lifetime trauma exposure history. Findings indicated that exposure to at least one childhood trauma of any type, and childhood neglect in particular, increased the likelihood that an individual would be hospitalized for SA rather than SI. Exploratory gender-stratified analyses demonstrated that childhood neglect, childhood sexual abuse, and adulthood traumatic loss may be linked with the likelihood of being hospitalized for SA. These findings demonstrate the importance of developing more detailed and nuanced conception of factors known to be associated with suicide as their effects may depend on details of their timing and nature, as well as their interactions with other systems.

Cognitive impairment and depression symptoms are independently associated with suicidal ideation in US Veterans

Depression is associated with cognitive impairment and suicidality. The independent association between cognitive impairment and suicidality is less clear. We examined the relationship between suicidal ideation and cognitive impairment in a sample of 50 veterans with depressive disorder diagnoses. Using zero-inflated Poisson regression, the severity of suicidal ideation was negatively associated with attention (incidence rate ratio [IRR] = 0.78, p < .001), memory (IRR = 0.87, p < .001), and total cognition (IRR = 0.90, p = .007) index scores as measured by the Dementia Rating Scale 2 (DRS-2). These three indices continued to significantly predict suicidal ideation severity once depression symptoms were controlled for.

The prodrome and clinical risk for psychotic disorders

The psychosis prodrome offers great promise for identifying neural mechanisms involved in psychotic disorders and offers an opportunity to implement empirical interventions to delay, and ultimately ameliorate, illness onset. This article summarizes the literature on individuals in the putatively prodromal phase of psychosis/deemed at clinical high risk (CHR) for psychosis onset. Standardized measurement and manifestation of the CHR syndromes are discussed, followed by empirical findings that highlight the psychological deficits and biological abnormalities seen in CHR syndromes and psychotic disorders. Current controversies surrounding the diagnosis of CHR syndromes and issues related to the treatment of CHR individuals are also presented.

The development of psychotic disorders in adolescence: a potential role for hormones

This article is part of a Special Issue "Puberty and Adolescence". The notion that adolescence is characterized by dramatic changes in behavior, and often by emotional upheaval, is widespread and longstanding in popular western culture. In recent decades, this notion has gained increasing support from empirical research showing that the peri- and post-pubertal developmental stages are associated with a significant rise in the rate of psychiatric symptoms and syndromes. As a result, interest in adolescent development has burgeoned among researchers focused on the origins of schizophrenia and other psychotic disorders. Two factors have fueled this trend: 1) increasing evidence from longitudinal research that adolescence is the modal period for the emergence of "prodromal" manifestations, or precursors of psychotic symptoms, and 2) the rapidly accumulating scientific findings on brain structural and functional changes occurring during adolescence and young adulthood. Further, gonadal and adrenal hormones are beginning to play a more prominent role in conceptualizations of adolescent brain development, as well as in the origins of psychiatric symptoms during this period (Walker and Bollini, 2002; Walker et al., 2008). In this paper, we begin by providing an overview of the nature and course of psychotic disorders during adolescence/young adulthood. We then turn to the role of hormones in modulating normal brain development, and the potential role they might play in the abnormal brain changes that characterize youth at clinical high-risk (CHR) for psychosis. The activational and organizational effects of hormones are explored, with a focus on how hormone-induced changes might be linked with neuropathological processes in the emergence of psychosis.

Spectroscopic detection of methane by use of guided-wave diode-pumped difference-frequency generation

We report spectroscopic gas detection by the use of mid-infrared difference-frequency mixing of two diode lasers in a channel waveguide. The waveguide was fabricated by annealed proton exchange in periodically poled lithium niobate. We generated 3.43-3.73-microm tunable radiation in a single waveguide at room temperature by mixing diode lasers near 780 and 1010 nm. High-resolution spectra of methane were obtained in 2 s with electronically controlled frequency scans of 45 GHz. The use of highly efficient waveguide frequency converters pumped by fiber-coupled diode lasers will permit construction of compact, solid-state, room-temperature mid-infrared sources for use in trace-gas detection.

Pulse compression and spatial phase modulation in normally dispersive nonlinear Kerr media

Numerical simulations show that, because of the spatiotemporal coupling implied by the multidimensional nonlinear Schrödinger equation, self-focusing of ultrashort optical pulses can lead to pulse compression even in the normal-dispersion regime of a nonlinear Kerr medium. We show how this coupling can be further exploited to control the compression by use of spatial phase modulation. Both the compression factor and the position at which the minimum pulse width is realized change with the amplitude of the phase modulation.

Steering of optical beams in nonlinear Kerr media by spatial phase modulation

A simple scheme to steer optical beams is proposed. The basic idea is to impose a sinusoidal phase modulation on the optical beam and then propagate it in a nonlinear Kerr medium. Spatial phase modulation splits the input beam into multiple subbeams, while the nonlinear medium shapes a particular subbeam into a spatial soliton in such a way that most of the beam power appears in a narrow beam whose direction can be controlled by changing the modulation parameters. We present numerical results showing how spatial phase modulation can be used to alter the path of an optical beam propagating in a nonlinear Kerr medium.

An appraisal of some lesioning methods applied to the posterior hypothalamus in rats

The behavioral changes and histological damage to the brain of rats were examined following lesions of the midlateral posterior hypothalamic area (MLPHA) made by passing electrical current through a metal electrode or through a glass pipette containing hydrogen ion (HCl) or kainic acid. Control experiments included placement of pipettes containing saline and imposing the same current as used in kainic-acid-containing electrodes (sham). Subcutaneous injections of kainic acid assessed damage that may be attributed to general neuronal cytotoxicity or limbic seizures. The effect of diazepam on alleviating behavioral changes and structural damage in kainic-acid-injected rats was examined. The current used to inject kainic acid produced significant damage to both neurons and axons of passage at the injection site. Degeneration of nerve terminals following kainic acid injections in the MLPHA was widespread, not predictably reduced by diazepam premedication and differed in only minor details from degeneration induced by subcutaneous injections.

Sleep-waking patterns of intact and carotid sinus nerve-transected rats during hypoxic-CO2 breathing

Two groups, each consisting of six male rats, breathed 21% O2-4% CO2 or 10% O2-4% CO2, respectively, before and after carotid sinus nerve (CSN) transection. Polygraphic recording techniques served to monitor sleep and wakefulness. The effects of these gas mixtures on the sleep-waking pattern (SWP) were studied. The SWPs of the intact and CSN-transected rats breathing 21% O2-4% CO2 were no different from rats breathing air. While breathing 10% O2-4% CO2, the greatest alteration in the rat's SWP, compared with breathing 10% O2 devoid of CO2, was in the pattern of frequency of change of states, an effect unchanged by CSN transection. We conclude that CO2 added to air did not affect the rat's SWP. However, a hypoxic-CO2 gas mixture radically altered all parameters of the SWP, an effect which was centrally mediated.

The effects of hypoxia and CO2 on the sleep-waking pattern of the potoroo (Potorous tridactylus apicalis)

Four male potoroos (Potorous tridactylus apicalis) breathed 21% and 7% O2 with and without the addition of 5% CO2. The effects of these gas mixtures on the potoroo's sleeping-waking pattern (SWP) were studied. The SWP while breathing 21% O2/5% CO2 was unchanged when compared with that of breathing ambient air (21% O2). While breathing 7% O2, the SWP was severely disrupted: total sleep time (TST) and slow wave sleep (SWS) increased markedly. Brain temperature fell substantially. Paradoxical sleep (PS) was almost abolished and wakefulness (W) decreased. The addition of 5% CO2 to the O2 deficient gas mixture, i.e., 7% O2/5% CO2, restored the SWP to that obtained while breathing ambient air. It is concluded that CO2 neutralizes the disruptive effect which hypoxia has on the potoroo's SWP. It is hypothesized that this constitutes a homeostatic mechanism for stabilizing the SWP and is carried over from pouch life.

Sleep-wake patterns of intact and carotid sinus nerve sectioned rats during hypoxia

Six male rats breathed 21 an 10% O2 before and after carotid sinus nerve (CSN) section. Polygraphic recording techniques were used to monitor sleep and wakefulness. The effects that these gas mixtures had on the rats' sleep-wake pattern (SWP) were studied. The SWP of CSN sectioned rats breathing 21% O2 was unchanged compared with that of intact rats. While breathing 10% O2, the intact rats' SWP was altered dramatically. Paradoxical sleep (PS) was absent on the first day's exposure to hypoxia. After CSN section, the SWP approximated that of rats in normoxic conditions. The amount of PS increased considerably. It is concluded that the peripheral chemoreceptor reflex pathway contributes, in part, to disruption of the SWP under hypoxic conditions, but not under normoxic conditions. Mechanisms underlying changes in states of consciousness due to hypoxia are discussed.

Constriction of ear arteries from normotensive and renal hypertensive rabbits against different transmural pressures

Isolated segments of rabbit ear arteries were made to constrict against normotensive and hypertensive transmural pressures by perfusion with submaximal concentrations of norepinephrine (NE). Changes in load (force/unit length of artery) and stress (force/wall cross-sectional area) during constriction against a constant pressure have been evaluated. Weak concentrations of NE constricted the arteries equally well against transmural pressures of 80 and 120 mm Hg and, in doing so, utilized much of the contractile capacity of the muscle. A stretch-mediated, co-operative interaction between muscle cells has been put forward to explain these observations. Ear arteries from renal hypertensive rabbits differed from those of normotensive rabbits in having a higher NE threshold concentration and in constricting better against 140 mm Hg. They did so because of the mechanical advantage provided by a smaller internal radius and a thicker wall which reduced the load and stress placed on the muscle by the pressure. No muscle hyperplasia or hypertrophy was detected.

An electrophysiological analysis of sleep and respiration of rats breathing different gas mixtures: diaphragmatic muscle function

The effects of breathing 21% O2, 21% O2 + 5% CO2, 10% O2 + 4% CO2 and 10% O2 on the sleep-waking rhythm, respiratory rate, diaphragmatic EMG, inspiratory (Ti) and expiratory (Te) times were studied in rats. They carried chronically implanted electrodes to permit polygraphic recordings of the ECoG, EOG and dorsal neck and integrated diaphragmatic EMG activity. Average respiratory rates, independent of state of consciousness varied depending on the gas mixture breathed. Sleep-waking times, expressed as percentages, were determined as a function of the gas mixture breathed. Oxygen deficiency caused PS deprivation which was partially alleviated by the addition of 4% CO2. Diaphragmatic EMG activity decreased during PS when rats breathed gas mixtures rich in CO2 but increased when they breathed 10% O2. In general, at a given frequency of breathing, Ti was shorter during PS than during SWS except when rats breathed 10% O2. It is concluded that: (1) regardless of the state of consciousness hypoxia is a more potent stimulus of respiratory rate than hypercapnia, (2) diaphragmatic effort is reduced when rats breathe CO2 enriched gas mixtures but is increased by hypoxia due to changes in upper airway resistance, and (3) low O2 content of an inspired gas disrupts the inspiratory and expiratory off-switch mechanisms, this disruption being prevented by the addition of CO2.