A cultural script for suicide among White men in the Mountain West Region of the United States

The states of the Mountain West region of the United States consistently have the highest rates of suicide in the country, a pattern particularly pronounced in older White men. Although multiple constructs have been proposed to explain this long-standing pattern, including social isolation, cultural values, and psychopathology, relatively little research has been conducted to directly examine the predictive role of these risk factors and how they interact. We review the extant research for these constructs to establish (a) whether the risk factor occurs at a higher rate or is otherwise more influential in this region compared to the rest of the country and (b) whether the risk factor may account for specific effects in older White men in order to determine whether the evidence supports the role of each risk factor in understanding the high rates of suicide among older White men in this region. Using the results of this review, we then present a possible cultural script for suicide based on cultural scripts of gender and suicide theory (Canetto, 1997, 2017, 2021) that describes who dies by suicide, the methods they use, their emotions and motives, and the cultural understanding of the causes and acceptability of their suicidal behaviors within the Mountain West. This cultural script can serve as a guide for researchers investigating the complex mechanisms that account for elevated rates of suicide in this region. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bisexual-specific minority stress in nonsuicidal self-injury: The mediating role of perceived burdensomeness

Background

Bisexual-identifying individuals are at heightened risk for engaging in non-suicidal self-injury (NSSI), with the odds up to six times higher compared to heterosexual individuals and up to four times higher compared to lesbian/gay (L/G) individuals. While research has established that sexual minorities may be at increased risk because minority stressors exacerbate psychological processes associated with NSSI, little research has examined bisexual-specific pathways of risk. In this study, we replicated findings that suggest Interpersonal Theory of Suicide (IPTS) variables (i.e., perceived burdensomeness and thwarted belongingness) mediate the association between minority stress and NSSI and extended these findings by examining whether such mediation is moderated by sexual minority identity. Furthermore, we explored whether IPTS variables mediate the association between bisexual-specific minority stress and NSSI.

Method

A sample of 259 cisgender L/G (n = 93) and bisexual (n = 166) MTurk workers completed measures assessing minority stress, NSSI, and IPTS variables.

Results

Mediation analyses replicated findings that experiences of minority stress increase NSSI by increasing perceived burdensomeness [PB], though moderated mediation analyzes failed to provide evidence that sexual minority identity moderated this indirect effect. Rather, minority stress from both heterosexual and L/G individuals increased NSSI through increased PB for bisexual individuals.

Limitations

The use of cross-sectional data does not allow conclusions of causal relationships.

Conclusions

These results suggest that for bisexual individuals, minority stress from both heterosexual and L/G individuals increases NSSI by increasing PB. Future researchers and clinicians should consider the additive burden of minority stress in bisexual individuals.

Reliability and Validity of the Self-Rating Scale as a Measure of Self-Criticism

The Self-Rating Scale (SRS; Hooley et al., 2010), a widely used measure of self-criticism in self-injury research, did not utilize conventional test development methods and has limited psychometric data. We examined the internal consistency, test-retest reliability, and convergent and discriminant validity of the SRS. Participants were 295 psychology undergraduate students. The SRS demonstrated good internal consistency (α = .93), adequate test-retest reliability (r = .76), and satisfactory convergent validity with other measures of self-criticism. Convergent validity was also adequate for expected dimensions of perfectionism (socially prescribed, self-oriented, concerns about mistakes, and doubts about actions), depressive symptoms, and negative and positive affect. The SRS demonstrated adequate discriminant validity with expected constructs of perfectionism (other-oriented, personal standards, and organizational perfectionism). Although the SRS appears to be a psychometrically sound measure of self-criticism, high correlations with depression and perfectionism raise questions regarding the overlap of these constructs.

The effects of blood in self-injurious cutting: Positive and negative affect regulation

OBJECTIVE

Seeing one's own blood may be a factor in affect regulation in nonsuicidal self-injury (NSSI). This study examined changes in a negative (NA) and positive affect (PA) in response to a finger prick eliciting a small drop of participants' blood.

METHODS

Two groups (NSSI; N = 56 and Control; N = 70) of undergraduate students were randomly assigned to receive a finger prick and look at blood, receive a finger prick and not look at blood, or receive a sham finger prick. Following a mood induction, participants completed the PANAS three times: Time 1 (pre mood-induction, baseline), Time 2 (post-mood induction), and Time 3 (post-finger prick condition), and a Pain Severity Scale.

RESULTS

A significant three-way interaction revealed that the NSSI: Blood Group had an increased positive effect between Time 2 and Time 3.

CONCLUSION

Blood serves an important function in NSSI and requires additional research to fully understand the relationship.

Differential suicide risk factors in rural middle and high school students

Few studies have examined risk factors associated with suicidal ideation and attempts among younger adolescents compared to their high-school aged counterparts. To gain a better understanding of unique risk factors associated with suicidal ideation and attempts among middle-school aged students, the current study employed secondary data analyses on a statewide sample of middle school (6th and 8th grade; n = 7,453) and high school students (10th and 12th grade; n = 5,996) in the United States. Logistic regression analyses were used to determine the effects of fourteen empirically derived risk factors on odds of reporting suicidal ideation (SI) and suicide attempts (SA) in the past year. Results indicated unique factors associated with risk for SI and SA among middle and high school students. For middle-school aged students, female sex, lower perceptions of school safety, sensation seeking, psychological distress, bullying victimization, early initiation of drug use, and community disorganization predicted past year SI. Female sex, white race, perceptions of school safety, bullying victimization, aggregate drugs used, psychological distress, and community disorganization predicted SA. Conversely, sex, age, perceptions of school safety, and community disorganization were not associated with suicidal behavior in high school students. Developmental explanations and avenues for future research are discussed.

Masculine gender-related personality traits and acquired capability for suicide

In most countries, substantially more men than women die by suicide, implicating masculine gender-related personality (MGP) traits as a risk factor for suicide. The Interpersonal Theory of Suicide posits that acquired capability for suicide (ACS) is needed to end one's life. To investigate MGP traits and ACS, college students (N = 149) completed measures of stoicism, sensation seeking, physical aggression, and ACS. For both genders, most MGP traits were associated with increased ACS. Physical aggression mediated relations between both stoicism and sensation seeking and ACS, but gender did not moderate these associations, suggesting similar patterns for men and women.

A Daily Diary Investigation of the Defective Self Model Among College Students With Recent Self-Injury

The Defective Self Model of self-injury (Hooley, Ho, Slater, & Lockshin, 2010) asserts that individuals choose to self-injure to gratify the desire for self-punishment associated with a self-critical cognitive style. Specifically, self-injury is used to regulate negative self-directed thoughts and emotions and is made accessible via the belief that the individual deserves punishment. This study sought to test primary assumptions of the Defective Self Model using a 2-week daily diary protocol. It was hypothesized that trait self-criticism would predict daily self-injury urge intensity and behaviors directly, as well as indirectly, through daily thoughts about deserving punishment. We also posited that guilt would predict self-injury urge intensity and behaviors beyond sadness, hostility, and fear. Support for primary hypotheses was mixed. Self-criticism did not directly predict self-injury outcomes, but did indirectly predict urge intensity through daily thoughts about punishment. Daily guilt predicted self-injury urge intensity beyond daily sadness, hostility and fear and was the only type of negative affect associated with self-injury behavior. Results are primarily contextualized through a social cognitive lens in which self-injury urge is precipitated by the activation of a self-critical schema in daily life. Alternatively, self-criticism may serve as a gateway to initial self-injury but lack the sensitivity to predict individual self-injury episodes. Treatments designed to reduce self-critical thoughts and bolster self-compassion may decrease self-injury urge intensity, thereby affecting the frequency of self-injury episodes.

Interpersonal needs and psychological pain: The role of brooding and rejection sensitivity

The interpersonal theory of suicide proposes that thwarted belongingness (TB) and perceived burdensomeness (PB) predict psychological pain and desire for suicide. Brooding may be a mechanism in explaining how TB and PB predict pain. The conceptual similarity between rejection sensitivity (RS) and TB suggests that individuals with high RS may be likely to experience psychological pain in the context of TB. To test this model, 155 college students completed measures of psychological pain, TB, PB, brooding, and RS. As predicted, brooding mediated the relations between both TB and PB and psychological pain. RS interacted with TB in predicting psychological pain.

Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation

Impulsivity is thought to be a contributing factor in non-suicidal self-injury (NSSI), yet the research is limited and inconsistent. In particular, little is known about how impulsivity is associated with response latency between initial urge and later self-injury, emotion regulation processes, or severity of NSSI. In this study, we tested group differences between participants with and without a history of NSSI on a questionnaire measure of impulsivity. In addition, we tested hypothesized correlations between impulsivity and relevant variables within the NSSI sample using questionnaires and self-reported response latency between urge and injury. Participants included 159 undergraduate students, 84 with an NSSI history and 75 without an NSSI history. Results indicated greater impulsivity on facets of Urgency and (lack of) Perseverance for the NSSI group. Within the NSSI sample, facets of impulsivity were associated with difficulties in emotion regulation and NSSI severity, but not response latency. In addition, response latency, a possible behavioral marker of impulsivity, was not associated with emotion regulation processes or NSSI frequency. These results suggest that higher scores on self-report measures of impulsivity, but not behavioral response latency measures, are associated with emotion regulation processes in individuals who self-injure.

Suicide in the Mountain West Region of the United States

Abstract. Background: The Mountain West region of the United States consistently reports the highest rates of suicide in the country. This pattern could reflect a regional culture-of-suicide script in support of suicide that implicitly influences individual's behavior. Aims: The primary aim of this study was to investigate whether suicide rates are elevated in the Mountain West across a wide range of demographic groups, thereby supporting a regional cultural script. Method: Suicide rates in the Mountain West between 1999 and 2014 were compared to the rest of the country across a wide range of demographic categories and levels of population density using the Center for Disease Control Multiple Causes of Death dataset published on the WONDER online database. Results: Suicide rates are elevated in the Mountain West for men and women, all racial groups, all age groups, and at every level of population density compared to the rest of the country. Limitations: Missing and suppressed data, the use of coroner reports, and the arbitrary nature of state and regional boundaries are all discussed as possible limitations to this study. Conclusion: These findings support a broad culture-of-suicide script that is pervasive in this region across demographic groups and all levels of population density.

Self-Concept Clarity and Emotion Dysregulation in Nonsuicidal Self-Injury

Recent research has linked identity instability with engagement in nonsuicidal self-injury (NSSI; Claes, Luyckx, & Bijttebier, 2014; Claes et al., 2015). This study examined the relationship between self-concept clarity (SCC), an index of identity stability, and NSSI in a sample of 147 college students, using a cross-sectional survey design. The relationship between SCC and emotion dysregulation in NSSI severity was also examined. SCC was significantly negatively associated with NSSI engagement, as well as NSSI frequency and versatility, above negative affect or age. SCC fully accounted for the variance originally explained by emotion dysregulation in NSSI versatility. NSSI frequency was not significantly predicted by emotion regulation, but self-concept clarity reached marginal significance. These findings provide preliminary support for identity instability as a contributing factor to a relationship between emotion dysregulation and NSSI severity. Possible explanations and future research directions are discussed.

Gender Differences in Grief Reactions following the Death of a Parent

This study examined gender differences in psychological functioning in a sample of college students who lost a parent to death. Male and female students ( n = 65) who had a parent that had died were asked to complete a series of self report questionnaires to assess psychological distress, feelings of grief and bereavement, and coping strategies. Overall, no gender differences were found between bereaved students on measures of psychological distress. However an avoidant coping style was related to symptoms of depression in females, but not in males. Students who lost a mother were more likely to report symptoms of depression, hopelessness, and suicidal ideation as compared to students who lost a father. Future research implications and the clinical importance of these findings are discussed.

Family centered brief intensive treatment: a pilot study of an outpatient treatment for acute suicidal ideation

Family Centered Brief Intensive Treatment (FC BIT), a hospital diversion treatment program for individuals with acute suicidal ideation, was developed to treat suicidal clients and their families. Individuals who met criteria for hospitalization were treated as outpatients using FC BIT (n = 19) or an intensive outpatient treatment without the family component (IOP; n = 24). Clients receiving FC BIT identified family members or supportive others to participate in therapy. FC BIT clients had significantly greater improvement at the end of treatment compared to IOP clients on measures of depression, hopelessness, and suicidality. Further research is needed to test the efficacy of FC BIT.

Functions, lifetime frequency, and variety of methods of non-suicidal self-injury among college students

Borderline Personality Disorder (BPD) and intrapersonal functions of non-suicidal self-injury (NSSI) have both been found to have strong relationships with NSSI. The present study examines their role in the lifetime frequency and variety of NSSI methods, taken as indicators of severity of NSSI. We hypothesized that intrapersonal functions would explain frequency and variety of NSSI beyond the effects of interpersonal functions. Further we hypothesized that intrapersonal functions would moderate the effect of BPD characteristics on frequency of NSSI. College students (n=52) who endorsed at least one lifetime act of NSSI completed self-report measures and semi-structured interviews about NSSI behaviors, frequency, variety and functions, and BPD symptoms. Results supported the hypotheses that intrapersonal functions play a role in the lifetime frequency and variety of NSSI behaviors in addition to that of interpersonal functions, but did not support the role of intrapersonal functions as a moderator. Findings are discussed in terms of relative importance of all factors involved in explaining severity of NSSI, measured as lifetime frequency and variety.

Indigenous perspectives on depression in rural regions of India and the United States

Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.

Recruiting and retaining physicians in very rural areas

CONTEXT

Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians' decisions to locate in very sparsely populated areas.

PURPOSE

In this study, we investigated whether variables associated with rural background and training predicted physicians' decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state.

METHODS

Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans.

FINDINGS

Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state.

CONCLUSIONS

Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state.

How etiological explanations for depression impact perceptions of stigma, treatment effectiveness, and controllability of depression

BACKGROUND AND AIMS

There is controversy regarding how etiological explanations for depression, particularly biological explanations, influence perceptions of stigma, perceived controllability of depression, and perceived effectiveness of depression treatments. This study evaluated how biological and psychosocial explanations for depression relate to these variables.

METHOD

Undergraduate students who reported ever suffering from clinical depression (n = 36) and who reported no personal history of depression (n = 33) completed a diagnostic interview and questionnaires assessing etiology beliefs, stigma perceptions, perceived controllability of depression, and perceived effectiveness of different depression treatments.

RESULTS

Although "ever depressed" participants perceived more stigma than "never depressed" participants, endorsing either etiological model had little relation to perceived stigma. Endorsing psychosocial explanations was associated with perceiving self-initiated treatments as effective, and self-initiated treatments were viewed as more effective than either psychotherapy or medical interventions.

CONCLUSIONS

Stigmatizing attitudes about depression appear more meaningfully related to individuals' personal experiences with depression than to etiological explanations for depression; yet etiological models appear to have important implications for treatment preference and perceived controllability of mood.

An examination of non-suicidal self-injury in men: Do men differ from women in basic NSSI characteristics?

Researchers have reported similar prevalence rates for non-suicidal self-injury (NSSI) among men and women, yet few studies have investigated gender differences in NSSI. This study describes and compares basic NSSI characteristics among a nonclinical sample by gender. Forty-eight individuals reporting a history of NSSI were interviewed (M = 18.52 years old, SD = 1.18 years). NSSI characteristics, including frequency, age of onset, method of NSSI, pain and control during NSSI, and degree of medical injury were compared between men (n = 19) and women (n = 29). Men and women differed significantly on age of onset, degree of medical injury, and NSSI methods. This study supports previous findings of gender differences in NSSI and suggests that further investigation of gender differences in NSSI is warranted.

Self-mutilation and coping strategies in a college sample

The goal of this study was to examine the use of specific coping strategies among self-mutilating college students. The self-mutilating group (n = 44) reported utilizing avoidance strategies more often than did a control group (n = 44) matched for general psychological distress but with no history of self-mutilation. In addition, female, but not male, self-mutilators endorsed using problem-solving and social support seeking strategies less often than nonmutilators. These findings suggest that coping strategies in general and avoidance-based strategies in particular may be important targets for the treatment of self-mutilative behaviors.

An analysis of suicidal ideation in a college sample

Two studies were designed to develop and validate a model of current suicidal ideation. In Study 1, students that reported past suicide attempts (n = 48) were compared to controls (n = 49) on nine variables previously linked to suicidal behavior. In the resulting model, borderline personality characteristics and social support were found to correlate with current suicidal ideation, supporting a mediating model. In Study 2, the Borderline/Social Support (BTSS) model was validated in an independent sample. Implications for risk assessment, prevention and treatment of suicidal college students are discussed.

Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder

The goal of this study was to examine the relationship between self-mutilation and symptoms of depression and anxiety in a nonclinical population. Self-mutilators reported significantly more symptoms of depression and anxiety than did the control group. When the group of self-mutilators was divided into individuals who cut themselves and individuals who harm themselves in other ways, we found that the between-group differences were primarily due to individuals with a history of cutting. Yet when symptoms of borderline personality disorder (BPD) were statistically controlled, all significant between-group differences in depressive and anxious symptoms were reduced to nonsignificant. These findings highlight the importance of assessing symptoms of BPD in self-mutilators, regardless of diagnosis.

Treatment Practices and Barriers for Depression and Anxiety by Primary Care Advanced Practice Nurses in Wyoming

PURPOSE

The aim of this study was to investigate barriers to treatment and screening related to depression and anxiety and the diagnostic and treatment practices of primary care advanced practice nurses (APNs) in the state of Wyoming.

DATA SOURCES

Every primary care APN in Wyoming received a mailed questionnaire asking them about treatment barriers, screening and treatment practices, and attitudes toward depression and anxiety.

CONCLUSIONS

Wyoming APNs in primary care routinely identify, evaluate, and treat patients with both depression and anxiety. APNs generally felt positive about treating these patients, although they reported that their patients encounter a number of financial barriers in accessing treatment. Routine screening practices for depression and anxiety were relatively low among the APNs, and they used a wide variety of interventions for these patients.

IMPLICATIONS FOR PRACTICE

The findings identify a lack of standardized approaches to assessment, referral, and treatment, especially pharmacologic intervention, and may indicate the need for alterations in the educational preparation of primary providers in order to improve clinical outcomes of treatment for depression and anxiety.

The role of life events in depression in primary medical care versus psychiatric settings

BACKGROUND

The relationship between negative life events and depression is inconsistent. The purpose of the current study is to investigate the hypothesis that depression in the community may be related more to major life events than is depression in psychiatric settings.

METHODS

This hypothesis was tested using depressed primary medical care (PC; n=70) and psychiatric patients (n=62). Nondistressed (n=109) and distressed/nondepressed PC patients (n=43) served as comparison-control groups. Life events were rated using the contextual method of Brown and Harris (Brown, G.W., Harris, T.O., 1978. Social origins of depression. Tavistock, London).

RESULTS

Depressed PC patients, but not depressed psychiatric patients, were significantly more likely to have recent severe events than the comparison-control groups. Self-reported distress in the absence of depression was not associated with severe life events.

LIMITATIONS

History of depression was assessed using a simple count of number of previous episodes, and the assessment of depression history may require more sophisticated assessment. The measure of endogenous depression used in this study was created post-hoc and needs replication.

CONCLUSIONS

Diathesis-stress models need to accommodate a lack of universality for severe stress prior to the onset of depression. Clinical strategies may need to reflect patient treatment preferences associated with differences across settings with respect to the perceived role of stress in their depression.

Case identification of mood disorders in Asian American and Caucasian American college students

Past studies have sometimes found that Asian American participants score higher on checklists that measure psychological distress compared to Caucasian American participants. However, studies using diagnostic interviews have not found corresponding elevated rates of mood disorders in Asian American participants. In the present study, Asian American (n = 238) and Caucasian American students (n = 556) completed checklist measures of distress (the Beck Depression Inventory, BDI and the Mood and Behavior Questionnaire, MBQ) and a subsample of students (n = 118) received a diagnostic interview. Asian American students had higher BDI scores, but the groups did not differ on either the MBQ, a measure closely tied to DSM criteria for major depression, or on rates of current mood disorders. Elevated BDI scores overestimate rates of mood disorders, particularly in Asian American students.

Significance of prior episodes of depression in two patient populations

Perhaps the single best predictor of current depression is a prior episode of depression. This study examined the significance of prior depressive episodes in a weighted sample of 425 primary medical care (PC) patients. It also compared the 53 PC patients with major depression with 93 depressed psychiatric patients with respect to percentage of recurrences versus 1st episodes. PC patients with prior depression were over 8 times more likely to be currently depressed than those without such a history. Having at least 1 prior episode of depression was modestly more sensitive, but less specific, than an elevated Center for Epidemiologic Studies--Depression Scale score in predicting current depression. Most currently depressed patients in both PC (85%) and psychiatry (78%) had prior episodes of depression. These findings highlight the importance of assessing history of depression in research and clinical practice.

Significance of prior episodes of depression in two patient populations

Perhaps the single best predictor of current depression is a prior episode of depression. This study examined the significance of prior depressive episodes in a weighted sample of 425 primary medical care (PC) patients. It also compared the 53 PC patients with major depression with 93 depressed psychiatric patients with respect to percentage of recurrences versus 1st episodes. PC patients with prior depression were over 8 times more likely to be currently depressed than those without such a history. Having at least 1 prior episode of depression was modestly more sensitive, but less specific, than an elevated Center for Epidemiologic Studies--Depression Scale score in predicting current depression. Most currently depressed patients in both PC (85%) and psychiatry (78%) had prior episodes of depression. These findings highlight the importance of assessing history of depression in research and clinical practice.

The nature and prevalence of anxiety disorders in primary care

Primary goals of this study were to 1) establish the prevalence, nature, and correlates of anxiety disorders in primary care, and 2) examine the comorbidity of anxiety disorders with major depressive disorder. A weighted sample of 425 patients drawn from the waiting rooms of primary care physicians was used. Anxiety disorders were highly prevalent, relatively mild, and often comorbid with depression. Anxiety disorders aided physicians in their detection of depression. However, anxiety disorders were also misdiagnosed as depression. Although anxiety disorders are common in primary care, their relative mildness may generally not warrant increased attention by primary care physicians to detection and treatment. Instead, efforts should be focused on the more severe and impairing cases of anxiety disorder.

Understanding the comorbidity between early-onset dysthymia and cluster B personality disorders: a family study

OBJECTIVE

A number of studies have documented significant comorbidity between dysthymia and axis II personality disorders, particularly those grouped in cluster B. However, the nature of this comorbidity is poorly understood. The purpose of this investigation was to use the family study method to test five competing models of the comorbidity between early-onset dysthymia and cluster B personality disorders.

METHOD

Proband groups consisted of subjects with early-onset dysthymia and a co-occurring cluster B personality disorder (N = 28), subjects with early-onset dysthymia without a cluster B personality disorder (N = 69), and a comparison group of subjects who had never been psychiatrically ill (N = 45). The groups were compared on rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia in their first-degree relatives (N = 675).

RESULTS

The relatives of both subgroups of dysthymic probands exhibited higher rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia than the relatives of the never ill probands. In addition, the relatives of probands with comorbid dysthymia exhibited higher rates of cluster B personality disorders without dysthymia than the relatives of probands with noncomorbid dysthymia.

CONCLUSIONS

This pattern of results is consistent with the notion that dysthymia and cluster B personality disorders co-occur because of shared etiological factors. This was the only one of five models of the comorbidity between dysthymia and cluster B personality disorders that was supported by the family data.

Personality traits in the first degree relatives of outpatients with depressive disorders

This study examined several hypotheses regarding the relationship between personality and depression using a family study. Relatives of outpatients with depressive disorders and controls completed a battery of personality inventories assessing sociotropy, autonomy, dependency, self-criticism, neuroticism, extraversion, and hopelessness. Relatives with current mood disorders differed from healthy relatives on almost all measures. Relatives with past histories of affective disorder were more neurotic, self-critical and dependent than healthy relatives. Results suggest that scores on personality measures are mood state-dependent, and may change as a function of mood disorder.

DSM-III-R axis II comorbidity in dysthymia and major depression

OBJECTIVE

Dysthymia is generally believed to be associated with a high rate of DSM-III-R axis II comorbidity. However, it is unclear whether this rate is higher than that for other axis I disorders, how many dysthymic patients have personality disorders, and what the most common co-occurring axis II conditions are.

METHOD

Ninety-seven outpatients with early-on-set dysthymia and 45 with episodic major depression were administered structured diagnostic interviews for axis I and II disorders. In addition, knowledgeable informants were independently interviewed about axis II conditions in the patients.

RESULTS

A significantly greater proportion of dysthymic patients (60%) than patients with episodic major depression (18%) met criteria for a personality disorder. The most common axis II conditions among dysthymic patients were borderline, histrionic, and avoidant personality disorder. Informants' reports yielded similar results.

CONCLUSIONS

These data indicate that early-onset dysthymia is associated with significantly greater axis II comorbidity than episodic major depression. Further work is necessary to elucidate the processes underlying this association.

A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression

Chronic fatigue syndrome (CFS), a controversial clinical entity characterized by severe fatigue and constitutional symptoms, has been associated with a variety of psychiatric disorders. To further understand the psychiatric profile of CFS, the authors compared patients with CFS, multiple sclerosis (MS), and major depression by using diagnostic interviews and self-report measures of Axis I disorders and personality disorders. CFS patients differed from patients with major depression, with significantly less depression and fewer personality disorders. Compared with MS patients, CFS patients did not differ with regard to personality disorders. However, they did have significantly more frequent current depression than MS patients, particularly following onset of their illness.

A comparison of the effectiveness of intravenous morphine at attenuating the nociceptive responses of medullary dorsal horn and thalamic neurones

In anaesthetized rats microelectrode recordings were made of single neurone activity in the medullary dorsal horn and in the thalamus. Ratemeter records were made of responses evoked by peripheral noxious stimuli. When consistent control responses had been obtained, morphine sulphate was administered by intravenous injection, and the total dose necessary to abolish or maximally attenuate nociceptive responses was recorded. For thalamic responses a mean dose of 0.7 +/- 0.18 mg/kg (mean +/- SEM, n = 16) was obtained, whereas for attenuation of medullary dorsal horn responses a mean dose of 2.5 +/- 0.72 mg/kg (mean +/- SEM, n = 13) was required. The greater sensitivity of the thalamic responses suggests that the effect of morphine at this site is not merely a consequence of a spinal action of the opiate and that an important component of the antinociceptive action is supraspinal.

Electrophysiological properties of neurons contained in the locus coeruleus and mesencephalic nucleus of the trigeminal nerve in vitro

Intracellular recordings were made from neurones contained in the locus coeruleus and mesencephalic nucleus of the trigeminal nerve (MNV), in tissue slices cut from guinea-pig pons and maintained in vitro. Locus coeruleus neurones were of -52.7 +/- 2.7 mV resting membrane potential; had an input resistance of 58.0 +/- 7.6 M omega and a membrane time constant of 7.3 +/- 1.0 ms. These neurones fired action potentials in response to depolarizing current pulses. Depolarizing synaptic potentials (DSPs) were recorded in locus coeruleus neurones in response to focal stimulation of the surface of the slice. MNV neurones were of -51.9 +/- 3.6 mV resting membrane potential; had an input resistance of 15.0 +/- 1.8 M omega and a membrane time constant of 1.35 +/- 0.16 ms. These neurones were also excitable but differed from locus coeruleus neurones in that they showed accommodation to depolarizing current pulses and time-dependent anomalous rectification with hyperpolarizing current pulses. In MNV neurones focal stimulation did not give rise to DSPs. Intracellular injection of Lucifer yellow revealed that the cell bodies of locus coeruleus neurones were small and multipolar whereas MNV neurones had larger, monopolar cell bodies.

Opiates and opioid peptides hyperpolarize locus coeruleus neurons in vitro

Intracellular recordings were made from locus coeruleus neurons in a brain slice preparation. Opiates and opioid peptides produced a dose-dependent, stereospecific, naloxone-reversible hyperpolarization of the neuronal membrane. This was associated with an increase in membrane conductance.

Selective effects of morphine on the nociceptive responses of thalamic neurones in the rat

1. The effects of intravenous morphine on the firing of single sensory neurones in the thalamus of the anaesthetized rat are described. 2. Low doses (0.38 to 2.00 mg/kg) of morphine depressed the excitation of nucleus lateralis neurones produced by natural noxious stimuli but were without effect on spontaneous activity. The excitation of some of these neurones by iontophoretically applied acetylcholine or glutamate was also depressed by morphine. These effects were reversed by intravenous (0.25 to 1.17 mg/kg) but not iontophoretically applied (50 to 200 nA) naloxone. 3. Similar or higher doses of morphine (0.58 to 5.07 mg/kg) did not prevent the excitation of ventrobasal thalamic neurones by non-noxious stimuli. 4. The possibility of a direct action of intravenous morphine in the thalamus is discussed.

The depression of thalamic nociceptive neurones by D-ala2,D-leu5-enkephalin

The activity of single thalamic nociceptive neurones was recorded extracellularly. BW 180C, (D-ala2,D-leu5-enkephalin) applied locally, by iontophoresis (10--40 nA) or systemically by i.v. injection (1.5--6 mg/kg) markedly depressed the evoked excitation of these neurones following peripheral noxious stimulation. This effect could be antagonised by naloxone. Enhanced enzymic stability did not appear to prolong the duration of action of BW 180C iontrophoretically applied to these neurones.