From identity-based distress to thinking "I am better off being dead:" Minority stress, posttraumatic cognitions, and suicidal ideation

BACKGROUND

Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress - i.e., traumatic, insidious distress that results from acts of discrimination - may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI.

METHODS

Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337).

RESULTS

Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions.

LIMITATIONS

Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used.

CONCLUSIONS

Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality.

Associations between fearlessness about death and suicidal ideation in individuals with psychosis

BACKGROUND

Despite high rates of suicide among people with psychosis, relatively little is known about the mechanisms underlying the transition from suicidal ideation to behavior in this population. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that fearlessness about death (FAD) may play a role in this relationship. The present study tested whether constructs of the IPTS [thwarted belongingness (TB), perceived burdensomeness (PB), and FAD] were associated with the severity of suicidal ideation in a sample of adults with histories of psychosis.

METHOD

261 adults with histories of psychosis completed measures of IPTS constructs, current severity of suicidal ideation, and history of suicidal attempts. We examined differences between those with past suicide attempts and those without and conducted regression analyses to evaluate the associations among TB, PB, FAD and severity of current suicidal ideation.

RESULTS

Contrary to expectations, a history of suicidal behavior was not uniquely associated with FAD. Regression analyses revealed TB × PB and FAD × PB interactions emerged as significant correlates of the severity of suicidal ideation, with the relationship between PB and suicidal ideation more pronounced at higher levels of FAD and TB. Interestingly, positive symptoms of psychosis were positively associated with PB.

IMPLICATIONS

This study provides support for broadening the investigation of FAD as a contributor to suicidal ideation in individuals with psychotic symptoms. Future research investigating the role of other contributors that may influence capability for suicide (e.g., impulsivity) may add additional understanding of suicide in this population.

Development and validation of a self-report measure of perceived dehumanization from officers

PURPOSE

Emerging evidence indicates that incarcerated populations' perceptions of dehumanization by officers are prevalent, yet measures of it are few, and to our knowledge, no self-report measure of dehumanization from officers exists. To fill this gap, we have developed the Perceived Dehumanization from Officers Scale (PDOS), which is designed as a brief measure to assess perception of officer treatment as dehumanizing.

METHODS

In this article, we provide preliminary evidence from two studies examining the reliability and validity of the PDOS. In study 1, a jail sample (n = 411), we analyzed the exploratory factor structure, internal consistency, and discriminant validity (in relation to procedural justice [PJ]) of the PDOS. Additionally, using a cross-sectional ordinary least squares (OLS) regression analysis, we related independent variables with the PDOS, the dependent variable. In Study 2, a prison sample (n = 2993), we confirmed the findings from study 1.

RESULTS

The PDOS appears to be a psychometrically sound measure of perceived dehumanization from officers with strong association between perceptions of PJ and perceived dehumanization from officers.

CONCLUSIONS

The PDOS provides opportunity for future research, intervention through rehumanization efforts, and signals the important officer treatment. Importantly We close by discussing implications of these studies, limitations, and future research directions to further develop and test the PDOS.

Why did peri-pandemic suicide death rates decrease among non-Hispanic white people while increasing among most people of color?

INTRODUCTION

While suicides in the United States decreased during the COVID-19 pandemic, statistically significant decreases have been limited to White people throughout a large portion of 2020.

METHODS

This paper outlines possible explanations for racial/ethnic differences in suicidality in the early pandemic phases.

RESULTS

We propose both distal (i.e., tele-mental health usage, internet and technology access, employment protections, and economic security) and proximal (cultural beliefs, coping strategies, clustering, pulling together, and embracing life) factors that may have helped build and foster community and mental wellness. However, this paper argues these factors did not extend, or did not extend as much, to many communities of color.

CONCLUSIONS

We argue that these disparities are due to the myriad effects of discrimination and systemic racism, encapsulated broadly by the minority stress theory, and provide suggestions for relief and research.

"Terminal anorexia nervosa" may not be terminal: An empirical evaluation

Gaudiani et al. (2022) presented terminal anorexia nervosa (T-AN) as a potential new specifier to the anorexia nervosa (AN) diagnosis, with criteria including (a) AN diagnosis, (b) age > 30 years, (c) previously participated in high-quality care, and (d) the clear, consistent determination by a patient with decision-making capacity that additional treatment would be futile, knowing death will result. This study's purpose was to empirically examine a subgroup of participants with AN who met the first three criteria of T-AN-and a smaller subset who also met a proxy index of the fourth criterion involving death (TD-AN)-and compare them to an adult "not terminal" anorexia nervosa (NT-AN) group and to a "not terminal" subset 30 years of age or older (NTO-AN). Patients at U.S. eating disorder treatment facilities (N = 782; T-AN: n = 51, TD-AN: n = 16, NT-AN: n = 731, NTO-AN: n = 133), all of whom met criteria for a current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of AN, were compared regarding admission, discharge, and changes from admission to discharge on physiological indices (i.e., white blood cell counts, albumin levels, aspartate aminotransferase levels, and body mass index), as well as self-report measures (i.e., eating disorder, depression, anxiety, and obsessive-compulsive symptoms). In contrast to the tight syndromal symptom interconnections of, and inevitable spiral toward death expected for, a terminal diagnosis, results suggest substantial variability within the T-AN group and TD-AN subset, and an overall trend of improvement across physiological and self-report measures. This study thus provides some empirical evidence against the specification of the T-AN diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotion-related impulsivity across transdiagnostic dimensions of psychopathology

OBJECTIVE

Several dimensions have received attention for their potential role in explaining shared variance in transdiagnostic symptoms of psychopathology. We hypothesized emotion-related impulsivity, the trait-like tendency toward difficulty restraining responses to emotion, would relate to symptoms of psychopathology, with two separable dimensions of emotion-related impulsivity relating distinctly to internalizing and externalizing symptoms.

METHOD

Across two studies, we tested hypotheses using structural equation models of emotion-related impulsivity and multiple indicators of internalizing, externalizing, and thought symptoms.

RESULTS

In Study 1 (658 undergraduates), emotion-related impulsivity was highly correlated with the general psychopathology (p) factor. In study 2 (421 Mechanical Turk participants), models did not support a general p factor; however, we replicated the hypothesized associations of emotion-related impulsivity dimensions with internalizing and externalizing factors. Across both studies, forms of emotion-related impulsivity uniquely and differentially related to internalizing and externalizing symptoms.

CONCLUSIONS

Findings indicate emotion-related impulsivity may help explain transdiagnostic dimensions of psychopathology, such as the p factor.

Measurement invariance of the Depressive Symptom Inventory-Suicidality Scale across race, ethnicity, sexual orientation, and plurality of minoritized identities

Measurement invariance across diverse groups, though crucial for determining the generalizability of a measure, has not yet been tested in many assessments of suicidal thoughts. The present study assessed the measurement invariance and psychometric properties of one such assessment, the Depressive Symptom Inventory-Suicidality Subscale, across multiple identity dimensions in a large data set (n = 1,118) that combined three diverse samples. Findings supported measurement invariance of the scale by race, ethnicity, and sexual orientation when comparing those who were majority-aligning with their minoritized counterparts, as well as good internal consistency and expected convergent validity. The expected one-factor structure fit well for all three of the samples assessed. Overall, the results support measurement invariance and generalizability of the Depressive Symptom Inventory-Suicidality Subscale. Future studies should continue assessing measures of suicidal thoughts and behaviors through testing invariance across identities, especially as it pertains to specific identity subgroups and their intersections. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-burdensomeness, other-burdensomeness, and suicidal ideation

Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.

Self-hate, dissociation, and suicidal behavior in bulimia nervosa

BACKGROUND

Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs.

METHODS

In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior.

RESULTS

Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior.

LIMITATIONS

Future work should include longitudinal analyses to understand temporal relationships among study variables.

CONCLUSIONS

In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs.

Avoidant restrictive food intake disorder and suicidal ideation

Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.

Eating disorder behaviors as predictors of suicidal ideation among people with an eating disorder

OBJECTIVE

Suicidality is known to be elevated among people with an eating disorder. The aim of the current study was to examine whether any of three specific behavioral facets of eating disorders (i.e., purging, binge eating, restricting) would be the strongest predictors of suicidal ideation, controlling for one another, in longitudinal analyses from admission to discharge. We hypothesized that purging, above and beyond restricting or binge eating, would be the most important predictor of suicidal ideation.

METHOD

In the present study, patients with an eating disorder (N = 936), the majority of whom met criteria for a current DSM-5 diagnosis of Anorexia Nervosa (n = 560), completed the Eating Pathology Symptoms Inventory (EPSI) and the Beck Depression Inventory II-Item 9 suicidal ideation index, at admission and again at discharge. The settings were eating disorder treatment facilities offering inpatient, residential, partial hospitalization program (PHP), and intensive outpatient (IOP) levels of care. We pitted EPSI purging, EPSI restriction, and EPSI binge eating against one another in a regression framework predicting discharge suicidal ideation controlling for suicidal ideation at admission.

RESULTS

EPSI Purging significantly predicted both presence/absence of suicidal ideation (β = .22, t = 2.48, p = .01; OR = 1.25, 95% CI [1.05, 1.49]) and intensity of suicidal ideation (β = .04, t = 2.31, p = .02) at discharge, whereas neither EPSI Restricting nor EPSI Binge Eating did (p > .30).

DISCUSSION

Study results suggest that purging may have particular relevance in estimating suicide risk in patients with an eating disorder.

Emotion-related impulsivity and rumination: Unique and conjoint effects on suicidal ideation, suicide attempts, and nonsuicidal self-injury across two samples

INTRODUCTION

Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related impulsivity, though, are highly correlated, we consider their unique vs. conjoint influence on suicidal ideation and self-harm.

METHOD

Across two samples of adults (N's = 171 and 191), we examined how rumination and emotion-related impulsivity relate to suicidal ideation, suicide attempts, and NSSI. We assess the more general process of repetitive negative thinking and the more specific process of suicide-related rumination. Participants completed the Three-Factor Impulsivity Index and the self-report Columbia-Suicide Severity Rating Scale. Those in sample 1 completed the Perseverative Thinking Questionnaire and the Deliberate Self-Harm Inventory, and those in Sample 2 completed the Suicide Rumination Scale.

RESULTS

Emotion-related impulsivity and both forms of rumination showed robust bivariate correlations with suicidal ideation, suicide attempts, and NSSI. Neither rumination or impulsivity related to suicide attempts controlling for ideation or to NSSI. In multivariable analyses, emotion-related impulsivity but not general rumination was tied to suicidal ideation. In contrast, suicide-related rumination was more directly tied to suicidal ideation than was impulsivity.

CONCLUSIONS

Findings provide support for a more nuanced approach to the forms of impulsivity and rumination related to suicidal ideation.

Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes

OBJECTIVE

Psychotherapy access, utilization, retention, and effectiveness require continued improvement, especially for groups for whom availability and outcomes may be currently suboptimal, including ethnoracial minorities. Further, ethnoracial status' intersectionality with other identity variables (e.g., gender) may relate to structural barriers to care and effectiveness of care, an area in need of further research.

METHOD

The Florida State University Psychology Clinic, a low-cost population-facing treatment center, has routinely collected clinically relevant information on all consenting clients, including severity of clinical presentation at intake and over time, number of therapy sessions attended and of no-shows, premature termination, demographics, etc. A large sample of clients (N = 2,076; 57% women; 67.9% non-Hispanic White) on whom we collected and entered at least some data, though missing data were common, has accrued. We conducted chi-square tests to examine treatment utilization gaps, analysis of variance to measure differences in intake severity, and analysis of covariance to measure differences in treatment effectiveness.

RESULTS

Based on the percentages of ethnoracial minority groups with mental disorders in the broader local community, we are falling short in outreach to Black clients, and when we do engage them, we retain them suboptimally. Once well engaged, however, results across groups suggest few differences in outcomes by ethnoracial status, gender, or their intersection. Ethnoracial match was associated with more sessions attended in Black people.

CONCLUSIONS

Psychotherapy effectiveness has the potential to be optimized for everyone, and a promising direction in this regard is the case conceptualization of a cultural formulation interview and cultural humility mindset. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Robin's Wish and the Complex Causal Web of Death by Suicide

The documentary film Robin's Wish aims to reclaim the media scrutiny around Robin Williams' death, fixating on causation being solely attributed to a postmortem diagnosis of which Williams was unaware-Lewy Body Dementia. The film and other sources as well defined and animated the view that Williams' death by suicide was fully a result of this medical condition, dismissing any possible role for mental disorders. The need to distance from mental disorders can have a palpable undercurrent of stigmatization of them; the documentary missed the opportunity to make its point and simultaneously build allyship with others who have lost someone to suicide who were clearly battling a mental disorder. In this context, we emphasize the importance of looking at causation mediationally (e.g., a neurological condition triggering a major depressive episode culminating, in turn, in death by suicide). Only through encompassing all elements and complexities of the human spirit and condition can we appropriately pay tribute to those we have lost to suicide and simultaneously de-stigmatize mental disorders.

Effect of selenium intake and fetal age on mRNA levels of two selenoproteins in porcine fetal and maternal liver

The objective of this study was to determine if levels of mRNA encoding cytosolic glutathione peroxidase (cGPx) and thioredoxin reductase (TrxR-1) change during fetal development, and if maternal Se intake during gestation affects the mRNA levels of these proteins. Prepubertal gilts (n = 24) were randomly assigned to either Se-adequate (0.39 ppm of Se; n = 12) or Se-deficient (0.05 ppm of Se; n = 12) diets, 6 wk before breeding. Maternal liver was collected at d 10, 45, 70, and 114 of pregnancy, and fetal liver samples were collected at the same times except d 10. Complementary DNA sequences encoding cGPx and TrxR-1 were cloned and sequenced. Quantitative real-time PCR analysis indicated that levels of mRNA for cGPx in fetal liver decreased more than 3-fold between d 45 and 114 of gestation. Although the gilts were only marginally deficient in Se, and maternal Se intake did not affect cGPx mRNA levels in fetal liver, the low-Se diet tended (P = 0.1) to reduce fetal TrxR-1 mRNA levels. In the liver of the dams, the low Se intake did not affect mRNA levels for either cGPx or TrxR-1. Compared with the liver of the dams, mRNA levels for cGPx were about 3.5 times lower in fetal liver. Results of this study support the hypothesis that neonatal pigs are born with reduced cGPx corresponding to reduced cGPx mRNA levels during late gestation.

Multidisciplinary discharge assessment of the medically and socially high-risk infant

Discharge from a neonatal intensive care unit (NICU) requires assessment, coordination, and possible intervention by a multidisciplinary team. The infant's health condition and the family's social situation must be considered before discharge to design a discharge plan for the child's long-term well-being. This article presents the neonatal discharge assessment tool (N-DAT) as a method to identify risks at the time of discharge. The tool offers specific recommendations for use with infants who are medically or socially high risk. The implications for the NICU team and for coordination with community providers are discussed.

The EMS response to the Oklahoma City bombing

This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors. There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion. The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.

Outburst of Jupiter's synchrotron radiation after the impact of comet Shoemaker-Levy 9

Jupiter's nonthermal microwave emission, as measured by a global network of 11 radio telescopes, increased dramatically during the Shoemaker-Levy 9 impacts. The increase was wavelength-dependent, varying from approximately 10 percent at 70 to 90 centimeters to approximately 45 percent at 6 and 36 centimeters. The radio spectrum hardened (flattened toward shorter wavelengths) considerably during the week of impacts and continued to harden afterward. After the week of cometary impacts, the flux density began to subside at all wavelengths and was still declining 3 months later. Very Large Array and Australia Telescope images of the brightness distribution showed the enhancement to be localized in longitude and concentrated near the magnetic equator. The evidence therefore suggests that the increase in flux density was caused by a change in the resident particle population, for example, through an energization or spatial redistribution of the emitting particles.

EtOH self-administration in anticipation of noise stress in C57BL/6J mice

C57BL/6J mice were studied for self-administration of ethanol (EtOH) during a signal period that preceded delivery of an environmental stressor (noise) in the home cage. Animals were given 5 weeks of conditioning in which a 5-min period of 75-dB pulsed noise (SIGNAL) preceded a 20-min period of more intense, 90-dB pulsed noise (NOISE) five times daily. EtOH (10% w/v) was then provided in a choice procedure, and drink tube contacts were monitored by computer. Mice that had received the 5 weeks of SIGNAL and NOISE pairings showed an increase in EtOH-seeking behavior, as reflected in EtOH tube contacts during the SIGNAL period. The increase was significant as compared to contacts during baseline or QUIET periods and also as compared to contacts during the same period for control (Ctrl) mice that had received only the 75-dB SIGNAL during conditioning. A subsequent test for passive avoidance confirmed that the 75-dB SIGNAL was aversive for mice that had received noise conditioning but not for Ctrl mice. In sum, the results were in accord with a priori predictions that mice would not show increased EtOH tube contacts during occurrence of intense noise itself but would show increased contacts during the signal that preceded noise. These results were interpreted as preliminary evidence that C57BL/6J mice show self-administration of EtOH in anticipation of an environmental stressor.

A comparison of nonculture-dependent methods for detection of Chlamydia trachomatis infections in pregnant women

Two nonculture-dependent methods for the detection of Chlamydia trachomatis in endocervical samples from obstetric patients were compared with routine isolation in McCoy cell cultures. When compared with culture, the sensitivities and specificities of the methods were: direct fluorescent antibody staining (MicroTrak [Syva Co.]) 98.1 and 95.4%, and enzyme immunoassay (Chlamydiazyme [Abbott Laboratories]) 96.3 and 92.9%, respectively. In 89% of apparent false-positive direct fluorescent antibody cases and 64% of enzyme immunoassay cases, an additional positive nonculture result was considered to indicate infection missed by culture. Considering these data, revised sensitivities were 84.4% for culture, 95.2% for direct fluorescent antibody, and 95.3% for enzyme immunoassay. Revised specificities were 99.5% for direct fluorescent antibody and 97.3% for enzyme immunoassay. Both nonculture tests appear acceptable for screening high-risk obstetric patients, and may be more sensitive than routine cell culture.