Journal of Clinical Psychiatry最新文献

Objective: Shorter sleep duration has been linked to increased suicidal ideation (SI). However, limited research has examined the relationship between nightly sleep duration and short-term fluctuations in suicide risk, as well as the potential clinical utility of leveraging indices of recent (ie, past 3 days) patterns of sleep duration as a marker of acute suicide risk. This study examined associations between nightly and cumulative sleep duration and suicidal desire and intent utilizing ecological momentary assessment (EMA) in a high risk sample of community-based adults.

Methods: A sample of 237 community based adults with severe SI provided daily indices of self-reported sleep duration and ratings of suicidal desire and intent 6 times per day for 14 consecutive days of EMA monitoring. Data collection took place between February and May 2019.

Results: Between-person nightly sleep duration and cumulative sleep duration were negatively associated with suicidal desire (Bs = -3.48 and -4.78) and intent (Bs = -1.96 and -2.46). At the within person level, nightly sleep duration was negatively related to suicidal desire (Bs = -0.51 and -0.47) and intent. Within person cumulative sleep duration, on the other hand, was unrelated to both suicidal desire and intent (Bs = -0.26 and -0.09).

Conclusion: Our findings highlight the clinical utility of examining individual differences in sleep duration as a marker for suicide-related outcomes, as well as deviations from one's typical nightly sleep as a potential acute predictor of suicide-related outcomes, in addition to information about recent duration over one or more nights of sleep. Limitations and future directions are discussed.

Objective: We explored depressive symptom trajectories and their associations with underweight and obesity in Korean women.

Methods: This prospective cohort study involved 7,691 women enrolled in the Korean Longitudinal Survey of Women and Families, with a follow-up period spanning from 2014 to 2020. Depressive symptoms were evaluated through the 10-item version of the Center of Epidemiologic Studies Depression Scale. Growth mixture modeling was employed to identify trajectories of depressive symptoms. Multinomial logistic regressions were conducted to investigate the correlation between depression trajectories and the evolving risks of underweight and obesity over the study period.

Results: Five distinct trajectory classes were observed ("persistent low symptoms": N = 5,236, 68.1%; "decreasing symptoms": N = 930, 12.1%; "transient high symptoms": N = 421, 5.5%; "increasing symptoms" N = 825, 10.7%; and "persistent high symptoms": N = 279, 3.6%). Those with a low socioeconomic status, comorbidity, and who were divorced or widowed were more likely to follow the persistent high symptom trajectory. Among the 5 trajectories, the risks of underweight and obesity steadily increased in women following the trajectory with persistent high symptoms. For these women, the odds ratio (OR) of underweight increased from 2.27 (95% CI, 1.32-3.92) in 2014 to 3.39 (1.91-6.05) in 2020. They were not associated with obesity in 2014 (OR [95% CI]: 1.38 [0.61-3.11]) but exhibited an elevated risk of obesity in 2020 (3.76 [1.97-7.17]).

Conclusion: We observed considerable heterogeneity in the trajectories of depressive symptoms among women, and individuals with persistent high depressive symptoms face an escalating risk of both underweight and obesity.

Importance: Extensively researched, exposure-focused therapies have dominated the treatment of posttraumatic stress disorder (PTSD). No treatment benefits all patients. Interpersonal psychotherapy (IPT), a nonexposure, affect-focused treatment, has emerged over 2 decades as an alternative evidence-based PTSD intervention.

Objective: This narrative review critically assesses IPT outcomes for PTSD. Time limited IPT focuses on affect toleration and the interpersonal consequences of trauma rather than on reconstructing the trauma narrative and exposure to traumatic cues.

Evidence Review: The author searched the outcome literature on IPT for adults with syndromal PTSD and drew upon personal involvement in studies since 2001. Subsyndromal PTSD studies and 1 adolescent trial were excluded.

Findings: Thirteen published studies of IPT targeted PTSD in individual and group formats for 592 civilians (n = 8, 6 randomized controlled trials [RCTs]) and 187 military veterans (n = 5, 1 RCT). Some trials had methodological limitations. IPT surpassed outcomes of waiting lists and other weak controls and was noninferior to evidence-based PTSD treatments including Prolonged Exposure (n = 2) and sertraline (n = 1). Depression and other outcomes improved. The RCTs demonstrate IPT efficacy for PTSD and allow preliminary exploration of outcome mediators and moderators and differential therapeutics.

Conclusion: While the number of studies remains limited, research by multiple investigators in differing populations supports the efficacy of IPT as a non trauma-focused PTSD treatment and justifies its inclusion in PTSD treatment guidelines. More research is necessary to determine how IPT compares to exposure-focused treatments in patient preference, attrition, and response for PTSD comorbid with major depression or due to sexual trauma.

Objective: The Mind after Midnight hypothesis proposes that nocturnal wakefulness increases the risk for dysregulated behaviors. Prior studies highlight a greater risk for suicide at night after adjusting for population wakefulness. How this risk varies hour to hour, differs across subgroups, or applies to other behaviors is unknown.

Methods: Data on 78,647 suicides and 50,526 homicides from the National Violent Death Reporting System were combined with population wakefulness data for 2003-2017 from the American Time Use Survey. Hourly incident risk ratios (IRRs) were estimated after adjusting for population wakefulness. Two-way analysis of variances identified significant time-by-subgroup interactions that were quantified in post hoc analyses.

Results: Suicide counts peaked at 12:00 PM, while homicide counts peaked at 10:00- 11:00 PM. Adjusting for demographics and population wakefulness revealed a 5-fold greater risk for suicide at 3:00 AM (aIRR: 5.20 [4.74-5.70]) and an 8-fold greater risk for homicide at 2:00 AM (aIRR: 8.04 [6.35-10.2]). Hourly risk for suicide varied by age, ethnicity, blood alcohol level, and current partner conflict. Hourly risk for homicide varied by sex and blood alcohol level.

Conclusions: Risk for suicide and homicide is greater at night than expected based on the number of people awake at that time. Nighttime risk was greater among young adults and those intoxicated with alcohol, but not among those with a history of suicidal ideation or attempts. Further research should evaluate mechanisms of risk and confirm these findings at an individual level.