Psychiatry-Interpersonal and Biological Processes最新文献

Objective: Among U.S. Army soldiers suicide attempts (SAs) are a significant public health concern, particularly early in service. We examined the association of attachment style with SA and suicide ideation (SI) among U.S. Army soldiers.

Methods: We analyzed survey data from new soldiers who participated in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). The sample consists of 38,507 soldiers entering Basic Combat Training (BCT) between April 2011 and November 2012. Attachment style (secure, preoccupied, fearful, and dismissing) was assessed using items from the Relationship Questionnaire. Lifetime (pre-enlistment) SA and SI were assessed with a modified Columbia Suicide Severity Rating Scale. Logistic regression analyses examined associations of attachment style with lifetime SA, SI, and attempts among ideators, after adjusting for socio-demographic characteristics.

Results: The secure attachment style was associated with lower odds of SA (OR = 0.76, 95% CI = 0.63-0.92), whereas preoccupied (OR = 4.63, 95% CI = 3.83-5.61), fearful (OR = 4.08, 95% CI = 3.38-4.94), or dismissing (OR = 1.56, 95% CI = 1.24-1.96) attachment styles were associated with higher odds of SA. Similar results were found for SI. Importantly, both preoccupied (OR = 1.67, 95% CI = 1.37-2.04) and fearful (OR = 1.70, 95% CI = 1.38-2.08) attachment were associated with attempts among ideators.

Conclusion: These findings highlight the clinical importance of attachment style in predicting suicidal behavior and as possible targets for intervention. A critical next step is for prospective research to examine whether attachment style predicts future suicidal behavior.

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

Objective: Metacognitive oriented treatments are novel therapies designed to address metacognition deficits in schizophrenia, defined as the set of mental activities that allows reflection on oneself and others, and the integration of this knowledge into sophisticated mental representations that guide adaptive responses to life's demands and to the challenges imposed by psychiatric illness. However, little is known about the first-person experiences of engaging in this treatment. Hence, the purpose of this qualitative study was to characterize first-person experiences of recovery outcomes among people with schizophrenia spectrum disorders who take part in metacognitively oriented psychotherapy.

Method: A sample of 13 adult veterans with schizophrenia or schizoaffective disorder in an outpatient setting who were receiving one form of individual metacognitively oriented therapy, Metacognitive Reflection and Insight Therapy, for a minimum of 12 months participated in an open-ended interview; 27 questions probed their experiences with therapy and the outcomes and changes they have observed within themselves as a result. Interviews were analyzed using an inductive consensus based approach.

Results: Findings indicate that participants observed changes in their lives in five recovery domains: improvements in real world functioning, increased formation of life pursuits, enhanced interpersonal connections, emergence of self compassion, and improved quality of life and wellness.

Conclusions: This study sheds further light on first person experiences of people with schizophrenia and adds to the growing body of evidence supporting the use of this form of metacognitively oriented psychotherapy to promote recovery in important life domains.

Objectives: iCOVER training is designed to prepare individuals in high-risk occupations to manage acute stress reactions in team members. Building on an initial pilot study, the present study evaluated iCOVER with soldiers just prior to their deployment to combat, documenting their feedback and changes in knowledge and attitudes.Methods: National guardsmen received a 1-hr training in iCOVER in the weeks prior to deploying to Iraq and Afghanistan. Surveys were administered before iCOVER training (i.e., "pre-training") and immediately afterward (i.e., "post-training"). In all, 129 of 146 (88.4%) soldiers consented to participate in the evaluation, and all consenting soldiers completed both surveys.Results: Participants rated iCOVER highly in terms of usefulness, relevance, and importance. Knowledge scores improved significantly from pre-training to post-training. In terms of attitudes, participants were more confident in their ability to handle an acute stress reaction, were more confident in their unit's ability to handle an acute stress reaction, were more likely to report their leaders emphasized the need to address acute stress, and were less likely to report stigma related to acute stress from pre-training to post-training.Conclusions: iCOVER training offers high-risk teams an opportunity to prepare for encountering acute stress in team members, strengthening the ability of teams to provide support to one another and respond effectively.

Objective: To: 1) identify sociodemographic and military differences between enlisted and commissioned U.S. military veterans; (2) examine sociodemographic, military, trauma, and mental health histories of enlisted and commissioned veterans; and (3) evaluate interactions between enlistment status and trauma exposures in relation to mental health.

Method: Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative sample of U.S. military veterans. Screening instruments were used to assess posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol and drug use disorders (AUD, DUD), and suicidal ideation (SI). Post-stratification weights were applied to analyses to permit generalizability to the U.S. veteran population.

Results: Enlisted veterans (7.5%-13.1%) were more likely than commissioned veterans (3.5%-11.1%) to screen positive for most mental health outcomes. Multivariable analyses revealed enlisted veterans were more likely than commissioned veterans to report past-year SI (odds ratio [OR] = 2.48). Enlistment status interacted with exposure to potentially traumatic events (PTEs), such that greater exposure to indirect PTEs was associated with a greater likelihood of screening positive for PTSD (OR = 1.12) and GAD (OR = 1.10) among commissioned relative to enlisted veterans. Commissioned veterans with higher exposures to adverse childhood experiences had increased odds (OR = 1.36) of endorsing SI relative to enlisted veterans.

Conclusions: The study found that while enlisted veterans had higher rates of SI relative to commissioned veterans, commissioned veterans with higher exposure to indirect PTEs may have an increased risk of screening positive for PTSD and GAD.

Objective: Population-based information on the extent of perceived need for mental health treatment and clinically significant psychological distress can help inform strategies for responding to the mental health impact of the COVID-19 pandemic.Methods: A representative sample of U.S. adults, age 20 and over (N = 1,957), completed surveys in May and June 2020. Potential target populations were distinguished based on perceived need for mental health treatment and psychological distress, assessed by the Kessler-6, among those without perceived need. Populations were characterized with respect to demographic characteristics and prior mental health treatment history using logistic regression models.Results: The prevalence of perceived need for mental health treatment was 21%. Perceived need was strongly associated with pre-pandemic treatment history; compared to those with no treatment history, perceived need was dramatically higher among those in treatment when the pandemic began (OR = 53.8 95% CI 28.2-102.8) and those with pre-pandemic treatment history (OR = 9.3, 95% CI 5.1-16.8). Among the 79% who did not perceive need, moderate or greater distress was reported by 19% and was associated with younger age and Hispanic ethnicity (OR = 2.1, 95% CI 1.2-3.6).Conclusions: In the U.S., where mental health treatment is relatively common, mental health treatment response during the pandemic, and perhaps other crises, should target people with a history of mental health treatment. Outreach to people less likely to seek care on their own despite clinically significant distress should target Hispanic populations.

Objective: Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disasters. This exploratory study of employees of workplaces affected by the September 11, 2001, attacks on the World Trade Center in New York City examined the specific relationships of personality variables (specifically, novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence) to incident postdisaster psychiatric disorders and resistance to the persistence/recurrence of preexisting psychiatric disorders after the disaster.

Methods: Approximately 3 years after the 9/11 attacks, 379 employees were recruited from 8 selected affected workplaces (3 in the World Trade Center towers, 5 at varied distances in the geographic area). Lifetime predisaster and postdisaster psychiatric disorders were assessed retrospectively with the Diagnostic Interview Schedule for DSM-IV, disaster experience details were collected with the Disaster Supplement, and personality was assessed with the Temperament and Character Inventory.

Results: Underdeveloped executive functioning (low self-directedness and/or low cooperativeness) was associated with incident postdisaster psychopathology, and components of resilience (low harm avoidance, high self-directedness, and high persistence) were associated with postdisaster resistance to persistence/recurrence of preexisting psychiatric illness.

Conclusions: Personality is related to both incident and persistent/recurrent portions of postdisaster psychopathology, not clearly distinguished in previous research. Personality variables related to executive functioning and resilience may aid in assessing risk and developing treatments to prevent disaster-related psychopathology.

Objective: Few investigations have comprehensively described methods for assessing and monitoring suicidal ideation in pragmatic clinical trials of mental health services interventions. This investigation's goal was to assess a collaborative care intervention's effectiveness in reducing suicidal ideation and describe suicide monitoring implementation in a nationwide protocol.

Method: The investigation was a secondary analysis of a stepped wedge cluster randomized trial at 25-Level I trauma centers. Injury survivors (N = 635) were randomized to control (n = 370) and intervention (n = 265) conditions and assessed at baseline hospitalization and follow-up at 3-, 6- and 12-months post-injury. The Patient Health Questionnaire (PHQ-9) item-9 was used to evaluate patients for suicidal ideation. Mixed model regression was used to assess intervention versus control group changes in PHQ-9 item-9 scores over time and associations between baseline characteristics and development of suicidal ideation longitudinally. As part of the study implementation process assessment, suicide outreach call logs were also reviewed.

Results: Over 50% of patients endorsed suicidal ideation at ≥1 assessment. Intervention patients relative to control patients demonstrated reductions in endorsements of suicidal ideation that did not achieve statistical significance (F[3,1461] = 0.74, P = .53). The study team completed outreach phone calls, texts or voice messages to 268 patients with PHQ-9 item-9 scores ≥1 (n = 161 control, n = 107 intervention).

Conclusions: Suicide assessment and monitoring can be feasibly implemented in large-scale pragmatic clinical trials. Intervention patients demonstrated less suicidal ideation over time; however, these comparisons did not achieve statistical significance. Intensive pragmatic trial monitoring may mask treatment effects by providing control patients a supportive intervention.

Trial registration: ClinicalTrials.gov NCT02655354.

Objective: Firesetting in children is thought to be an indicator of severe conduct problems in young people. However, no research has examined whether childhood firesetting is also associated with increased risk of externalizing and suicidal behaviors in adulthood.

Method: Data were obtained from a longitudinal study (n = 1265). Childhood firesetting/conduct problems (7-10 years) were derived from an assessment of antisocial behavior. Externalizing/suicidal behavior was derived from the Composite International Diagnostic Interview and the Self-Report Delinquency Inventory. Generalized estimating equation (GEE) models estimated associations between childhood firesetting and adult substance use disorders, criminal offending, and suicidal ideation, adjusting for childhood conduct problems and other confounding factors. Associations between childhood and adult firesetting (age 18-40 years) were examined using cross-tabulation (χ²).

Results: Five percent of children reported firesetting (7-10 years). Childhood firesetting appeared to increase the risk of adult firesetting; however, in most cases adult firesetting was not associated with childhood firesetting (χ² (1) = 4.15, p = .0417). Childhood firesetting was a risk marker for adult externalizing/suicidal behavior; however, the effect was relatively weak (IRR = 1.51; 95% CI: 1.11-2.05). Children with conduct problems who also engaged in firesetting were found to be at substantially higher risk of later externalizing/suicidal behavior (IRR = 2.84; 95% CI: 1.24-6.49).

Conclusion: This study found that childhood firesetting is a risk marker for adult externalizing/suicidal behavior, not an independent risk factor. It may be more useful for clinicians to focus on child conduct problems generally, rather than focussing on firesetting behavior.