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.

ObjectiveCollege students consume more alcohol and engage in binge drinking more frequently than their non-college attending peers, and prevalence of alcohol-related consequences (e.g., drinking and driving; taking avoidable risks) has not decreased proportionally with decreases in consumption. Social anxiety and alcohol expectancies, or beliefs about the effects of alcohol, have been found to be significantly related to alcohol use and account for significant variance in alcohol use and related consequences. Few studies, however, have examined how other social variables such as need to belong and social connectedness may fit into existing models of increased and risky alcohol use. Methods: Students at a large state university (n = 1,278) completed an online survey measuring alcohol expectancies, need to belong, social anxiety, and social connectedness. Mean age of participants was 19.65 years, and 59.5% self-identified as female, 39.8% male, and 0.7% identified as transgender. Structural equation modeling supported hypothesized relationships between need to belong, social anxiety, social connectedness, alcohol expectancies, and alcohol use, a mean centered variable that included binge drinking, drinking frequency, and amount of consumption. Results: Positive alcohol expectancies related to tension reduction, sociability, and sexuality, were positively related to drinking, such that increased alcohol expectancies were associated with increased drinking. Alcohol expectancies mediated the relationship between need to belong and increased alcohol use, as well as social connectedness and increased alcohol use. Similarly, social anxiety also mediated these relationships. No direct relationships were found between need to belong or social connectedness and alcohol use, suggesting previous research exploring these relationships may have excluded control variables (e.g., biological sex, race/ethnicity) that better explain the impact of need to belong and social connectedness on alcohol use. Conclusion: Prevention and intervention efforts might be more effective in reducing alcohol use if social factors are more broadly targeted.

ObjectiveTo investigate the influence of visual contextual information on emotion recognition of ambiguous facial expressions in depression and schizophrenia spectrum disorders. Method: Ambiguous facial expressions and emotional contexts representing anger, disgust, fear, joy, sadness and surprise were validated in a pre-test with healthy independent raters. Afterwards, 20 healthy participants (8 women, 12 men; mean age 24.35 ± 2.85 years), 20 participants with schizophrenia spectrum disorders (9 women, 11 men; mean age 40.25 ± 11.68 years) and 19 participants with depression (11 women, 8 men; mean age 43.74 ± 12.65 years) rated the emotional content of nine different faces in seven different emotion-suggesting contexts. The proportions of context-congruent answers and differences between emotion ratings in each context were analysed using non-parametric Kruskal-Wallis and explorative, paired Wilcoxon tests. Correlational analyses explored the influence of clinical symptoms assessed by clinician-administered scales. Results: The overall proportion of context-congruent answers did not differ between participants with depression and schizophrenia spectrum disorders compared to healthy participants. Participants with schizophrenia spectrum disorders were more susceptible to anger-suggesting contexts and participants with depression were more susceptible to fear-suggesting contexts. Differences in emotion recognition were associated with the severity of depressive, but not psychotic, symptoms. Conclusion: Despite increased susceptibility to anger-suggesting cues in schizophrenia and to fear-suggesting cues in depression, visual contextual influence remains largely consistent with healthy participants. Preserved emotional responsiveness suggests an efficacy of emotion training but emphasizes the need for additional research focusing on other factors contributing to social interaction deficits.

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.

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.

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.

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.