The prevalence of suicidal ideation and suicide attempt in patients with rheumatic diseases: a systematic review and meta-analysis

A number of studies have reported the suicidal ideation (SI) or suicide attempts (SA) of patients with rheumatic diseases. However, the estimated prevalence of those disorders varies substantially between studies. This systematic review aimed to describe the prevalence of SI and SA in rheumatic diseases. Literature search was done using Web of Science, Embase, the Cochrane database library, PubMed and CNKI database through June 2017. Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using STATA version 12.0. A random-effect meta-analysis was conducted on all eligible data. A total of 17 identified studies matched the inclusion criteria, involving 5174 participants with systemic lupus erythematosus (SLE), osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia (FM). Meta-analysis showed that rheumatic diseases patients have high prevalence of SI (26%, 95% CI: 19%-32%, I²=96.2%) and SA (12%, 95% CI: 3%-21%, I²=96.6%). We also found the prevalence of SI and SA in females may be higher than in males. All of these indicated that rheumatologists should screen for SI and SA in their patients. Early appropriate intervention is therefore essential to promote the patients’ good mental health.     

Age,Emotion Regulation,and Affect in Adulthood: The Mediating Role of Cognitive Reappraisal

Evidence indicates that older adults experience high levels of emotional well‐being. However, little is known empirically about the underlying mechanism of this state. The purpose of the present study was to investigate whether emotion regulation mediates the link between age and affect in adulthood. The sample consisted of 516 Japanese participants aged 30 (±1), 50 (±1), and 70 (±1) years, who were registered with an Internet survey company. Cognitive reappraisal and expressive suppression were measured as emotion regulation strategies. Positive and negative affect were assessed. Older participants reported lower negative affect than younger participants, while positive affect was not correlated with age. Cognitive reappraisal partially mediated the relationship between age and affect, whereas expressive suppression did not. The results suggested that age‐related increase in cognitive reappraisal could contribute to improvements in affect, but that another adaptive form of emotion regulation may mediate the relationship between age and affect. Our study thus indicates that developments in emotion regulation could explain the mechanism of stable everyday affect throughout adulthood, and that researchers should further explore another form of adaptive emotion regulation.     

The Pursuit of Happiness and Its Relationship to the Meta‐experience of Emotions and Culture

In this commentary, I provide a brief background of the meta‐experience of emotions, the philosophical and psychological literature on happiness, and further discuss the influence of culture on happiness. The meta‐experience of emotions implies that there are primary and secondary emotions (i.e., emotions about emotions), similar to the concept of meta‐cognitions. Primary and secondary emotions are closely associated with one's cultural background and happiness. Most scholars throughout history believe that happiness per se cannot be taught. However, it is possible to teach practices that lead to the path towards happiness. Promising strategies include loving‐kindness and compassion meditation. These strategies are based on Buddhist teachings, which are deeply rooted in a collectivistic culture. This illustrates the close association among emotions, approaches towards happiness, and cultural background.     

The ‘too muchness’ of excitement: Sexuality in light of excess,attachment and affect regulation

This paper brings together contemporary thinking about early attachment and affect regulation with our clinical and theoretical understanding of the problems of adult sexuality. In addition to recent theories of affect regulation and attachment, we incorporate Laplanche's idea of ‘excess’, which was an important transitional concept integrating real experience with fantasy in sexuality. We elaborate the idea of excess –‐ ‘too‐muchness’ –‐ to illuminate the early overwhelming of the psyche that affects the formation of sexuality. Linked to recent theoretical developments, this idea helps to grasp the relationship between sexual excitement and early affect regulation, showing how excitement becomes dangerous, thus impeding or distorting desire. The ‘too‐muchness’ of excitement recalls the experience of being a stimulated, overwhelmed, unsoothed child and influences later inability to tolerate sexual arousal and the excitement affect. A clinical case illustrates this connection between attachment trauma, anxiety about sexuality, as well as shameful experiences of gender identity as an area of trauma. We emphasize the importance of working through the terrors and desires of the mother–baby relationship as they emerge in the transference–countertransference in order to develop the ability to hold excitement and stimulation without experiencing the too‐much as the intolerable. This includes the working‐through of ruptures related to overstimulation as well as the delicate balance of attention to fantasy and intersubjective work in the transference.     

Knowledge and experience of time in primitive mental states2

The author proposes that time be considered an object of working through during the psychoanalysis of patients whose mental functioning reveals distinct primitive aspects. These so‐called ‘difficult patients’ are particularly intolerant of the temporal limits of analytic sessions and often attempt to undermine the analytic setting. He presents some hypotheses about time and the mind's depth levels. A series of clinical vignettes taken from the analysis of adolescent, borderline and psychotic patients shows several ways in which the analysand's perception of and relation to time surfaces and is worked through in the course of analysis. Analyzing the relationship with time and the conflict between denial and acceptance of temporality proved a significant catalyst in the development of cases that had tenaciously impeded progress. It thus became possible to bring about important changes in the ways such patients experienced affect in the analytic relationship and in object relations, not by acting directly upon these relationships but by working instead on the formal parameters that organize the mind–and primarily on its spatio‐temporal organization.