Psychiatry-Interpersonal and Biological Processes最新文献

Objective: Attachment style and social support networks (SSN) are associated with suicide ideation (SI) and suicide attempt (SA). How these two factors interact is important to understanding the mechanisms of risk for suicidal behaviors and identifying interventions.

Method: Using the Army Study to Assess Risk and Resilience in Servicemembers New Soldier Study (N = 38,507 soldiers), we examined how three attachment styles (preoccupied, fearful, and secure) and SSN (smaller vs larger) were associated with lifetime SI, SA, and SA among soldiers with SI. The interaction of each attachment style by SSN was examined.

Results: All three attachment styles were associated with SI and SA in the total sample (for SA: preoccupied OR = 2.82, fearful OR = 2.84, and secure OR = 0.76). Preoccupied and fearful attachment were associated with SA among suicide ideators. Smaller SSN was associated with a higher risk for all three outcomes (range of ORs = 1.23-1.52). The association of SSN with SI and with SA among suicide ideators was significantly modified by the presence or absence of preoccupied attachment style. Among soldiers without preoccupied attachment, larger SSN was associated with lower risk of SI. Among suicide ideators with preoccupied attachment, a larger SSN was associated with lower risk of SA.

Conclusion: This study highlights the need for increased understanding of the role of attachment style and social networks in suicide risk, in particular preoccupied attachment among soldiers with SI. A critical next step is to explore these relationships prospectively to guide intervention development.

ObjectiveTo examine and compare the association between the presence of depression and anxiety symptoms and different sociodemographic and clinical factors including the adjustment to amputation and prosthesis satisfaction among Lebanese individuals with lower limb amputation (LLA). Method: This cross-sectional study was conducted between December 2022 and May 2023 among 72 participants with LLA. Participants completed a questionnaire that included sociodemographic and clinical variables, the revised Trinity Amputation and Prosthesis Experience Scale (TAPES-R), and the Hopkins Symptom Checklist (HSCL-25). Result: Using the HSCL depression and anxiety cut-off, 25% of participants were categorized as having depression symptoms, with unemployment being significantly associated (p-value < .05) with depression. Similarly, 25% were classified as having anxiety symptoms, with both lower education and unemployment (p-value < .05) significantly linked to anxiety. TAPES-R subscales scores exhibited significant differences between non-depressed and depressed, as well as non-anxious and anxious participants (p-value < .05). Correlation analysis demonstrated significant relationship between HSCL scales and TAPES-R subscales; lower scores in adjustment to amputation and prosthesis satisfaction were moderately associated with increased rates of depression (r ranging between -0.331 and -0.500, p-values < .005) and increased rates of anxiety symptoms (r ranging between -0.362 and -0.441, p-values < .002). In addition, higher scores in activity limitation were moderately correlated to increased rates of depression and anxiety (r = 0.438 for anxiety and 0.490 for depression; p < .001). Conclusion: Mental health symptoms are associated with educational level, employment status, and adjustment to amputation and prosthesis satisfaction in Lebanese individuals with LLA. These findings should be considered to achieve optimal prosthetic rehabilitation.

ObjectiveAdverse sexual experiences (ASE), including sexual violence, sexual risk behaviors, and regretted sex, are highly prevalent among sexual and gender minorities (SGM) compared to cisgender and heterosexual individuals. Research indicates ASEs are associated with increased mental health symptomatology and decreased subsequent protective behavior use. The Sexual and Negative Dating Inventory (SANDI) measures dating and sexual protective strategies and includes five factors: Location Sharing, Assertiveness, Self-Protection, Risk Reduction and Privacy. SANDI total scores are linked to lower ASEs in heteronormative samples. Method: SANDI was previously validated in a sample of n = 1,289 college students. Data were examined from n = 313 (24.28%) SGM individuals at baseline, and n = 95 at one-month follow-up. Individuals were 19.70 (2.98 SD) years old, and 25% were non-white. Model fit was adequate for SGM: χ²(484) = 1729.621, p < .001, CFI = .947, RMSEA = .063 (90% CI = .060, .066), SRMR = .048. Results: Non-cisgender men and non-heterosexual individuals endorse using more of the SANDI at the factor level. Using logistic regression, SANDI was not associated with history of sexual violence or sexual violence over the next month. SANDI is inversely associated with history of sexual risk and prospectively associated with less sexual risk over the next month. Negative binomial regression analyses showed SANDI was not associated with a history of regretted sex; however, SANDI was moderately associated with decreased regretted sex over the next month. Conclusion: Findings highlight the importance of dating and sexual protective behaviors across dimensions of gender and sexual orientation.

Objective: A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions.

Method: This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms.

Results: A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time.

Conclusions: Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.

ObjectiveEntrustable Professional Activities (EPA) are discretely measurable specific professional tasks that integrate multiple competencies to define and provide varying levels of faculty support per trainee needs. Methods: We developed an EPA-based psychiatry curriculum for medical interns. Fifty-four interns completed the OSCE stations, Multiple Choice Questions, and Attitude questionnaires to assess EPAs, knowledge and attitudes towards the relevance and utility of clinical psychiatry in general practice. Results: Two weeks of EPA-based psychiatry training resulted in improvement in median scores on attitude questions (p < 0.05), clinical skills measured using EPA levels. Conclusions: EPA-based curriculum can improve clinical skills, knowledge, and attitudes towards clinical psychiatry in interns.

Objective: This study provides nationally representative data on the prevalence, risk factors, and associated mental health and functional outcomes of mild traumatic brain injury (mTBI) in U.S. military veterans.

Methods: Data (N = 4,069) were analyzed from the National Health and Resilience in Veterans Study (NHRVS). Analyses estimated mTBI prevalence, exposure to different mTBI injuries, and past-week mTBI symptoms (i.e. persistent post-concussive symptoms [PCS]). Comparisons were made between veterans with and without mTBI+PCS on sociodemographic, military, trauma, and psychiatric characteristics. Associations between mTBI+PCS and measures of cognitive, mental, and psychosocial functioning were examined.

Results: Overall, 43.7% endorsed a possible mTBI event on the Veterans Affairs' Mild TBI Injury Screening and Evaluation tool, and 10.0% screened positive for mTBI. After combining a self-reported healthcare professional diagnosis of concussion/mTBI/TBI (5.8%) with a positive mTBI screen, the prevalence of mTBI+PCS was 3.0%. Veterans with specific trauma characteristics (e.g. adverse childhood events), military service (e.g. combat), and lifetime psychiatric conditions were more likely to have mTBI+PCS. mTBI+PCS was associated with increased odds of current posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, and drug use disorder. These veterans also scored significantly lower on cognitive, mental, and psychosocial functioning.

Conclusions: Overall, 3.0% of veterans had mTBI+PCS, suggesting that while mTBI may be prevalent in this population, the majority will likely recover without developing chronic symptoms. Those with mTBI+PCS are at significant risk for comorbid psychiatric diagnoses and poorer psychosocial functioning relative to those without mTBI+PCS, and early targeted identification may assist in prevention of disability and recovery.

Objective: We assessed the associations of substance (alcohol, tobacco, cannabis, and other illicit drugs) use of adolescents with that of their family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers, and the mediating role of school and mental difficulties (SMDs) which remained insufficiently addressed.

Methods: This cross-sectional population-based study included 1,559 middle-school adolescents in France (mean age = 13.5 ± 1.3, 778 boys, 781 girls). They completed a questionnaire including socioeconomic features (nationality, family structure and parents' education, occupation, and income), substance use, cumulative number of substance use of family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers (noted familySUcn and peerSUcn), SMDs (grade repetition, suffered physical/verbal violence, sexual abuse, lack of family/peer support, depressive symptoms, suicide attempt, and age at onset). Data were analyzed using logistic regression models and Kaplan-Meier estimates.

Results: Most adolescents had familySUcn 1-2, 3-5, and ≥ 6 (39.1%, 23.0%, and 4.5%, respectively) and peerSUcn 1-2 and ≥ 3 (36.1% and 13.0%, respectively). Strong dose-effect associations were found between all substance use and familySUcn and peerSUcn (odds ratio adjusted for sex, age, and socioeconomic features reaching 13.44 and 9.90, respectively, most with p < .001). SMDs explained more the associations of all substance use with familySUcn than with peerSUcn (contributions reaching 69% and 34%, respectively). The proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn or peerSUcn.

Conclusions: Early prevention reducing familySUcn, peerSUcn and SMDs among adolescents and their families may reduce efficiently initiation and regular use of substances during adolescents' life course.