U.S. involuntary mental health commitment statutes: requirements for persons perceived to be a potential harm to self

The civil commitment statutes of all 50 states and the District of Columbia were reviewed to determine: (1) What is required for a person who is believed to be at serious and imminent risk of self-harm to be eligible for involuntary hospitalization; and (2) Whether an attempt to involuntarily hospitalize was required or was merely an option when the requirements found in number 1 were met. The analysis revealed that nearly 85% of the jurisdictions require dangerousness to self to be the result of a mental illness, and only two jurisdictions mandate attempts at involuntary commitment if a person is deemed to be an imminent harm to self. These results have implications for practice with individuals who are suicidal.     

Is Exposure to Suicide Beyond Kin Associated with Risk for Suicidal Behavior? A Systematic Review of the Evidence

Suicide bereavement and postvention literature often espouses risk for subsequent suicidal behavior among those previously exposed to a suicide death. Most often risk is discussed in relation to kin; however, many more individuals are exposed to suicide, and the impact of this exposure is important to understand in relation to targeting postvention. This review examined the research literature (1990–2014) to determine the evidence base for risk among those exposed to suicide. The findings demonstrate that risk of suicidal behaviors among those exposed to the suicide is significantly higher than those unexposed. These results are discussed within the context of current research in the field of postvention, and suggestions for future research are suggested.     

The Emergence of Suicidal Ideation During the Post‐Hospital Treatment of Depressed Patients

There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study‐related outpatient treatments. Fifty‐five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post‐discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post‐discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.     

Psychiatric hospitalization after deliberate self-poisoning

The decision for psychiatric hospitalization after deliberate self-poisoning (DSP) is not well understood. This study, a longitudinal cohort study of 3,148 consecutive DSP patients found 920 (29.2%) subjects were referred for psychiatric hospitalization, 576 (18.3%) on involuntary basis. A logistic regression analysis showed increased risk for: age 25 or older, homelessness, unemployment, previous self-harm, psychiatric inpatient treatment within 12 months, earlier psychiatric inpatient treatment, suicidal ideation or plan, mood or psychotic disorders, and lower clinician experience; and lower risk for being married/defacto, and after hours presentation. Recommendation for psychiatric hospitalization was based on complex decision making. These findings have implications for clinical practice guidelines, service costs, and service organization.     

Six‐Month Trajectory of Suicidal Ideation in Adolescents with Borderline Personality Disorder

Few studies have longitudinally examined suicidal ideation in those with adolescent‐onset borderline personality disorder (BPD). The current study aimed to examine the trajectory of suicidal ideation in adolescents with BPD longitudinally over 6 months, with follow‐ups at 2, 4, and 6 months posthospitalization for elevated suicide risk. Results indicated that the BPD group exhibited a greater decrease in suicidal ideation in the months following hospitalization than those without a BPD diagnosis. The findings of this study indicated that suicidal ideation in adolescents with BPD is not stable, and although ideation may decrease quickly after hospitalization, regular assessment of ideation is recommended.     

The Moderating Effects of Gratitude on the Association Between Perceived Parenting Styles and Suicidal Ideation

Suicidal ideation is defined as the thoughts about engaging in suicidal-related behaviors. Very few studies have been conducted on children’s suicidal ideation as there is a biased perception that suicidal behavior under the age of 12 is scarce. However, suicide is the leading cause of death among young children. Child suicidal ideation is predictive of suicidal ideation and suicide attempts in adulthood. Association between certain parenting styles and suicidal ideation have been found in empirical studies. However, little is known about the role of parenting and suicidal ideation in Chinese young children. We examined whether gratitude can reduce the risk of suicide by moderating the association between parenting styles and child suicidal ideation. We recruited 447 Chinese children (53.3% female; mean age?=?10.06, SD?=?1.76) to participate in a survey. Perceived parenting style (warmth/accepting, dominating, and autonomy granting), gratitude, and suicidal ideation were assessed using self-reported measures. We found that all three perceived parental styles were significantly associated with child suicidal ideation. Further, gratitude was found to have a significant moderating effect on suicidal ideation, across the analysis of the three perceived parenting styles. This suggests that gratitude may be adopted in preventive and clinical interventions so that children at risk can benefit from reducing the negative effects of ineffective parenting styles and suicidal ideation.     

Pluralism in Multicultural Liberal Democracy and the Justification of Female Circumcision

This article discusses the problems that a liberal, multicultural democracy has in dealing with cultural practices, such as female circumcision, which themselves suppress the liberal values of autonomy and pluralism. In this context I have chosen the justification of female circumcision as my issue for three reasons. First, with increasing immigration, in Western multicultural and pluralistic societies this practice has recently been given a good deal of public attention; second, I believe that it is time to put this cruel and discriminatory tradition finally in the past; and third, the paradox that the victims of this practice are also often its strongest proponents well demonstrates the problems that liberal democracies have in dealing with the question of autonomy and tolerance in real-life situations. My main argument is that, without giving up tolerance, we can show that there can be no moral justification for such a tradition as female circumcision, even within a multicultural and pluralist society.
I shall first show why neither female circumcision nor any other tradition that oppresses and harms individuals and is maintained by coercion can be satisfactorily defended by liberal arguments. Then I shall discuss why 'communitarian'counter-arguments which appeal to the significance of communal values and traditions or to cultural rights also fail to give any plausible support to the maintenance of this tradition. Finally, I shall consider in more detail how the value of autonomy should be normatively understood in a modern pluralist society [1].     

The Centralized-Use Compromise on Recreational Drug Policy

The current debate on recreational drug policy is roughly a contest between prohibition advocates and legalization advocates. This paper offers a third alternative that is a compromise between those two. The centralized-use compromise can secure the autonomy interests that are important to defenders of legalization, and it can prevent harms to others that are the focus of prohibition arguments. The centralized-use compromise also offers a possible way to reduce the black market while also reducing the rate of addiction and the associated debasing harms to self.     

ASSESSING THE CANDIDATE AS A WHOLE: A HISTORICAL AND CRITICAL ANALYSIS OF INDIVIDUAL PSYCHOLOGICAL ASSESSMENT FOR PERSONNEL DECISION MAKING

Although individual assessment is a thriving area of professional practice in industry, it receives little, if any, attention from textbooks on industrial psychology or personnel management. This article is an attempt to establish individual assessment's place in the history of personnel selection, and to examine why the practice has survived despite receiving little attention in research and graduate training. It is argued that the clinical, holistic approach that has characterized individual-assessment practice has survived primarily because the "elementalistic" testing approach, focusing on traits and abilities, has often been dismissed as inadequate for addressing the complexities of the executive profile. Moreover, public displeasure with standard paper-and-pencil testing in the 1960s and 1970s made the holistic approach to assessment an attractive, alternative. The article contrasts individual assessment practice with the current state of knowledge on psychological assessment and personnel decision making. Like psychotherapy in the 1950s, individual psychological assessment appears to have achieved the status of functional autonomy within psychology.     

厌恶情绪与自杀行为的关系

自杀导致人类死亡的人数与日俱增,然而自杀的心理机制却并不清楚。最近研究发现,厌恶情绪是导致自杀的主要情绪因素,个体因为自身厌恶而走向自杀。厌恶情绪是一种对自己和他人排泄物等反感的基本情绪,促进个体远离毒性和疾病,从而产生“免疫行为”。许多心理问题来自于对周围人或事物的厌恶,有自杀行为的个体对自身极其厌恶,说明他们的厌恶情绪出现了问题。如同躯体免疫攻击自身一样,自身厌恶是自杀意念的关键因素,早年创伤是其根源,生活压力和精神疾病也参与厌恶诱发自杀意念。厌恶诱发自杀意念的神经基础与HPA轴和五羟色胺系统有关。未来研究可利用神经影像和电生理等神经科学技术,检验自杀行为的神经机制,探讨厌恶情绪影响自杀行为的心理和神经机制。     

A study of enforced treatment in relation to Stone's “thank you” theory

The authors investigated the attitudes of 104 state hospital patients concerning their own hospitalization and treatment. Sixty patients were reinterviewed at discharge; nearly two-thirds of these were involuntary patients who initially doubted the value of their hospitalization. At discharge, 15 of these involuntary patients had modified their views, perceiving hospitalization as helpful. These patients, in contrast to those who maintained that hospitalization had not been helpful, were younger, diagnosed schizophrenic or affective disorder, and were judged as improved at discharge. The authors discuss the results in relation to Stone's “thank you” theory, and conclude that only when high quality treatment is available for an Axis I disorder should involuntary hospitalizaton be considered as a possible treatment option.     

Automaticity and preattentive processing.

The characteristics of automatized performance resemble those of preattentive processing in some respects. In the context of visual search tasks, these include spatially parallel processing, involuntary calling of attention, learning without awareness, and time-sharing with other tasks. However, this article reports some evidence suggesting that extended practice produces its effects through different mechanisms from those that underlie preattentive processing. The dramatic changes in search rate seem to depend not on the formation of new preattentive detectors for the task-relevant stimuli, nor on learned abstracted procedures for responding quickly and efficiently, but rather on changes that are very specific both to the particular stimuli and to the particular task used in practice. We suggest that the improved performance may depend on the accumulation of separate memory traces for each individual experience of a display (see Logan, 1988), and we show that the traces differ for conjunction search in which stimuli must be individuated and for feature search where a global response to the display is sufficient.     

The Impact of Exposure to Peer Suicidal Self‐Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross‐study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.     

A virtue ethical approach to decisional capacity and mental health

It is a common assumption that lack of autonomy is incompatible with decisional capacity and mental health. However, there are two general conceptions of autonomy, one value-neutral and the other value-laden, which imply different notions of mental health. I argue that the value-neutral notion of autonomy is independently inadequate and that it also provides an inadequate foundation for judging whether someone is decisionally incapable or mentally disordered. I propose an alternative, value-laden account which posits ten capabilities required for basic human functioning. I then defend this account against objections and highlight its practical utility in designing optimal treatment.     

Feminism and Women's Autonomy: the Challenge of Female Genital Cutting

Feminist studies of female genital cutting (FGC) provide ample evidence that many women exercise effective agency with respect to this practice, both as accommodators and as resisters. The influence of culture on autonomy is ambiguous: women who resist cultural mandates for FGC do not necessarily enjoy greater autonomy than do those women who accommodate the practice, yet it is clear that some social contexts are more conducive to autonomy than others. In this paper, I explore the implications for autonomy theory of these understandings of the relation between culture, FGC, and women's agency. I review the range of worldwide FGC practices – including "corrective" surgery for "ambiguous genitalia" in Western cultures as well as the various initiation rites observed in some African and Asian cultures – and the diverse cultural rationales for different forms of FGC. I argue that neither latitudinarian, value-neutral accounts of autonomy nor restrictive, value-saturated accounts adequately explain women's agentic position with respect to FGC. I then analyze a number of educational programs that have enhanced women's autonomy, especially by strengthening their introspection, empathy, and imagination. Such programs, which engage women's autonomy skills without exposing them to autonomy-disabling cultural alienation, promote autonomy-within-culture. This understanding of autonomy as socially situated, however, entails neither endorsement of FGC nor resignation to its persistence.     

Involuntary commitments to public mental institutions: issues involving the overrepresentation of blacks and assessment of relevant functioning

This article contributes to the debate in the mental health and legal systems concerning involuntary commitments to mental hospitals. The focus is on issues involving the overrepresentation of Black people among adults committed to U.S. public mental institutions and issues involving the assessment of relevant behavioral functioning in particular. Empirical findings, legal principles and procedures, and methodological limitations are reviewed to identify problems in current practice and relevant evidence bearing on those problems. Special emphasis is placed on the possible explanations for the overrepresentation of Blacks and on dependable assessments of relevant functioning that are needed to justify the state's coercive power to involuntarily confine people, regardless of race. The article concludes with a summary and recommendations for research and practice.     

Presumed consent for organ preservation in uncontrolled donation after cardiac death in the United States: a public policy with serious consequences

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death.     

Contingent attentional capture or delayed allocation of attention?

Under certain circumstances, external stimuli will elicit an involuntary shift of spatial attention, referred to as attentional capture. According to the contingent involuntary orienting account (Folk, Remington, & Johnston, 1992), capture is conditioned by top-down factors that set attention to respond involuntarily to stimulus properties relevant to one's behavioral goals. Evidence for this comes from spatial cuing studies showing that a spatial cuing effect is observed only when cues have goal-relevant properties. Here, we examine alternative, decision-level explanations of the spatial cuing effect that attribute evidence of capture to postpresentation delays in the voluntary allocation of attention, rather than to on-line involuntary shifts in direct response to the cue. In three spatial cuing experiments, delayed-allocation accounts were tested by examining whether items at the cued location were preferentially processed. The experiments provide evidence that costs and benefits in spatial cuing experiments do reflect the on-line capture of attention. The implications of these results for models of attentional control are discussed.     

The link between involuntary non-regular employment and poor mental health: A cross-sectional study of Japanese workers

Involuntary non-regular employment is a severe inequity problem worldwide, and it may significantly affect the mental health of employees. The present study aimed to examine the relationship between employment type and mental health. Additionally, the characteristics of involuntary non-regularly employed workers were explored. An online-based cross-sectional study was conducted in Japan, and 1566 participants were included in the data analysis. The eligible participants were divided into four categories: regularly employed (n = 1092), voluntary (n = 134), average (n = 233) and involuntary (n = 107) non-regularly employed individuals, respectively. Involuntary non-regular employment was associated with greater lack of vigour, anger-irritability, fatigue, anxiety, and depression. It was higher among women, those who were single or had no childcare, and those who had lower personal income or shorter working hours, or who tended not to practice relaxation activities. Lower personal income was associated with a risk of anxiety and depressive symptoms. Those individuals experiencing involuntary non-regular employment had a higher risk of poor mental health; subgroup analysis showed that this was particularly true among men. Both encouragement of employment stability via policy reform and workplace mental health support for involuntary non-regularly employed individuals are urgent health concerns.     

The buffering role of social support on the associations among discrimination,mental health,and suicidality in a transgender sample

Introduction: Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity–related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals and whether social support moderates these relationships. Methods: Participants (N = 78) completed measures of these constructs as part of a national online survey. Results: A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to participants who had moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. Conclusions: Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.