Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.     

Celibacy and male psycho-sexual development

This prospective, observational pilot study was conducted on an academic inpatient rehabilitation unit. Ninety-three persons with spinal cord dysfunction or severe neurological illness participated. All completed admission surveys; 46 completed surveys six months after discharge. The aims were to describe admission and post-discharge spirituality and associations between spirituality and rehabilitation outcomes. At admission, participants reported spirituality similar to that of other samples of medical patients. After discharge, frequency of private spiritual practices increased and spiritual and existential well-being decreased. No significant associations were detected between spirituality and rehabilitation outcomes. Findings suggest the importance of spirituality to the participants and future research with a larger sample and modifications to the methodology.     

Comorbidity between SCARED anxiety factors and depressive symptomatology in 8- to 12-year-old children

The aim of this study was to examine the comorbidity between the SCARED anxiety factors and depressive symptoms in 8-12-year-old children. Participants were 792 girls and 715 boys, who completed: the 41-ítem version of the Screen for Child Anxiety Related Emotional Disorder (SCARED), the Children's Depression Inventory (CDI) and a Socio-demographic questionnaire. Of the sample, 47% showed anxiety symptoms and 11.5% showed depressive symptoms. Heterotypic comorbidity was 82% in children at risk of depression and 20% in children at risk of anxiety. Homotypic Comorbidity between anxiety factors was 87%. Homotypic comorbidity and heterotypic comorbidity were high; their early detection will prevent the continuity of an anxious disorder and the development of depression.     

Mortality-Related Differences and Changes in Episodic Memory Among the Oldest Old: Evidence From a Population-Based Sample of Nonagenarians

We examined cross-sectional differences and longitudinal changes in episodic memory performance related to impending death among a group of very old people, aged 90–101 years. Participants were assessed at 3 measurement points across a 6-year interval. Three groups were identified: those who survived the entire follow-up period (n =40), those who died before the first follow-up (n =44), and those who died after the first follow-up (n =14). Participants completed a battery of episodic memory tasks consisting of face recognition, word recognition, word recall, and object recall with selective reminding. Those who survived performed better than those who were going to die in object recall at baseline. A Cox regression analysis, controlling age, revealed that object recall performance was significantly related to subsequent mortality status. Longitudinal analyses demonstrated significant 3-year decline for both face recognition and object recall, but no evidence of differential decline as a function of mortality group. Thus, longitudinal changes in memory preceding death were not as pronounced as the corresponding cross-sectional differences in this very old sample. In general, the results suggest that mortality-related memory deficits are present in extreme old age, although these deficits are relatively small and task-specific.     

Factors of Early Suicide after Discharge: A National Linkage Study for Suicide Victims in Taiwan

Patients recently discharged from psychiatric inpatient care have a higher suicide rate. The study aimed to identify the characteristics associated with early suicide of those patients discharged from psychiatric wards in Taiwan. The results indicated that among 672 suicide victims who died within one year post‐discharge from psychiatric wards in Taiwan between 2000 and 2004, diagnosis of schizophrenia, shorter disease duration, and co‐morbidity with cancer were all significantly associated with suicide occurring within one month of discharge. Clinical diagnosis of psychiatric disorders, recent psychiatric diagnosis, and co‐morbidity with severe physical illnesses should receive special monitoring for potential suicide after discharge.     

Individual distress and dyadic adjustment over a three‐year follow‐up period in couple therapy: a bi‐directional relationship?

This study examined the relationship between depressive symptoms and dyadic adjustment, as well as between interpersonal problems and dyadic adjustment, during residential couple therapy and at a three‐year follow‐up (N=106). Mixed models were used in the analyses. Significant improvement (p<.001) occurred on all measures from admission to discharge (effect sizes .27?.83) and from admission to three‐year follow‐up (effect sizes .52?.79). During the observation period, improvement in depressive symptoms at the first time point predicted improvement in dyadic adjustment at the subsequent time point. Furthermore, the dyadic adjustment level at discharge predicted improvement in depressive symptoms in the follow‐up period. There were only modest associations between personality variables and dyadic adjustment. The clinical implication is that in couples suffering from co‐existing relational and symptomatic distress, couple therapy should include the aim of lowering depressive symptoms.     

The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents

Adolescents, particularly African American adolescents, are at high risk for sexually transmitted infections (STIs). The association between psychosocial factors and risky sexual behavior has been well established. However, only a small number of studies have examined the relationship between depressive symptomatology among African American female adolescents, specifically over time. The present study examined depressive symptoms as a predictor of risky sexual behavior, sexual communication, and STIs longitudinally among African American female adolescents between the ages 15 and 21. Binary generalized estimating equation models were conducted assessing the impact of depressive symptoms at baseline on risky sexual behavior and STIs over six- and 12-months follow-up. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high levels of depressive symptoms predicted no condom use during last sexual encounter and multiple sexual partners over six-months follow-up. Depressive symptoms also predicted having a main partner with concurrent partners, high fear of communication about condoms, and sex while high on alcohol or drugs over six- and 12-months follow-up. These findings could be used to inform HIV/STI prevention intervention programs and clinicians providing regular health care maintenance to African American female adolescents engaging in risky sexual behavior.     

Depression and suicide in schizophrenic patients

This study supports the idea that schizophrenic patients represent a distinctive subgroup of patients who can suffer from a major depressive illness and also can commit suicide. The study showed that 22.4% of the schizophrenic population in a medium-sized psychiatric facility showed severe depressive symptoms that met the criteria for the diagnosis of a major depressive episode according to the DSM-III classification. Seven patients committed suicide during the acute phase of the illness--five during hospitalization, and two within a year of discharge. Nine patients attempted suicide during the hospitalization period, and 10 attempted suicide within a year of discharge. Nearly one-third (215) of the patients were readmitted during that year because of a recurrence of acute schizophrenic symptoms; of these, 84 were having severe depressive symptoms. The study also provides indications of the causes of suicide in these patients.     

Spanish version of Super Skills for Life: short- and long-term impact of a transdiagnostic prevention protocol targeting childhood anxiety and depression

ABSTRACT

Background and Objectives: Super Skills for Life (SSL) is a transdiagnostic protocol based on cognitive–behavioral therapy designed for children with internalizing problems. The present study examined for the first time the impact of the Spanish-adapted version of SSL in reducing anxiety and depressive symptoms in Spanish-speaking children.

Design: A quasi-experimental design with one group, pre- and posttest, and 1-year follow-up was conducted. Analyses were performed on an intent-to-treat basis.

Methods: Participants were 119 children (42.9% female; 8–12 years) recruited from nine schools. Children completed assessments of anxiety, depression, emotional and behavioral difficulties, and the extent to which anxiety interfered with life before and after receiving the 8-session SSL, and 12-months post-intervention.

Results: Anxiety and depressive symptoms were significantly reduced at post-test and 12-month follow-up assessments. SSL also had positive impact on other symptoms assessed (e.g., interference of anxiety with children’s life, peer problems, conduct problems). Overall, the long-term benefits of SSL appeared to be greater than the short-term benefits.

Conclusions: The results of this study suggest that SSL may be useful in reducing symptoms of anxiety and depression, and a broad range of other issues, in Spanish children.     

The Associations Between Intensive Residential Couple Therapy and Change in a Three-Year Follow-Up Period

This Norwegian couple therapy effectiveness therapy study explored the course and prediction of relationships between depressive symptoms, interpersonal problems, and dyadic adjustment during residential treatment and over a 3-year post-treatment period (N = 117). All measures indicated significant improvement (p < .001) between admission and discharge (effect sizes .25 to .67), and improvement was maintained at 3-year follow-up. The proportion of recovered patients during treatment was stable at follow-up. Finding that initial levels of the Inventory of Interpersonal Problems (IIP) predicted dyadic adjustment change in the follow-up period, we discuss how such interpersonal problems may influence the course of couple therapy.     

Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.     

Behavioural group therapy for obsessive-compulsive disorder in Norway. An open community-based trial

The aim of the current study was to test the effectiveness of ERP-based 12 weeks group therapy for OCD patients in a community-based, general Norwegian outpatient clinic. The sample consisted of 54 patients diagnosed with OCD. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory (BDI) and the Spielberger State Anxiety Inventory (STAI-S) were administered before treatment, after treatment and at 3- and 12-month follow-ups. Analyses with mixed models for repeated measurements showed that group behavioural therapy offered to OCD patients significantly improved ratings of obsessive-compulsive symptoms, depression and anxiety. These improvements were maintained at 3- and 12-month follow-ups and an additional reduction in obsessive-compulsive symptoms was observed from post-treatment to 3-month follow-up. However, the delayed effect of therapy was no longer present at 12-month follow-up. The results also revealed that the patients had a lower chance for an increased outcome category (e.g. from unchanged to improved or recovered) with high scores on STAI-S at the given observation times (post-treatment, 3- and 12-months follow-ups). Depressive symptoms (BDI) at post-treatment and follow-ups had no significant influences on the three categories of outcome for OCD. In conclusion, the results indicate that behavioural group therapy can successfully be delivered to patients with considerable comorbidity in a real world setting conducted by therapists with limited training in the CBT.     

Longitudinal Results of Cognitive Behavioral Treatment for Youths with Inflammatory Bowel Disease and Depressive Symptoms

Youths with chronic physical illnesses face increased rates of psychological problems and the burden of coping with physical illness-related challenges. The following data describes treatment outcome maintenance results from a randomized clinical trial investigating the impact of a cognitive behavioral intervention Primary and Secondary Control Enhancement Therapy-Physical Illness (PASCET-PI) as compared to treatment as usual (TAU) on youths with inflammatory bowel disease (IBD). Forty-one participants aged 11-17 with IBD and concurrent depressive symptomatology were randomized to PASCET-PI (n?=?22) or TAU (n?=?19). Self-reported depressive features, global functioning, and DSM-IV depressive symptomatology were assessed immediately post-treatment (T2), followed by assessments at 6-months (T3) and 12-months (T4) post-treatment initiation. Repeated measure models revealed significantly improved global psychosocial functioning in youths randomized to PASCET-PI compared to youths randomized to TAU. Improvements in self-reported depressive features and DSM-IV depressive symptoms were found at the trend level for youths randomized to PASCET-PI relative to those receiving TAU. Effect size estimates for all outcome variables suggested large to medium treatment effects.     

Preliminary examination of sex differences in depressive symptoms among adolescent psychiatric inpatients: the role of anxious symptoms and generalized negative affect.

Assessed the emerging view that generalized negative affect and anxious symptoms are important in understanding sex differences in depressive symptoms. Sixty-three adolescent psychiatric inpatients (32 boys, 31 girls), ages 12 to 16 (M = 13.87, SD = 1.36), completed measures of positive and negative affect and anxious and depressive symptoms. Results demonstrated, as predicted, that depressive and anxious symptoms were more highly associated in adolescent girls than boys. Furthermore, girls with depressive symptoms were more likely to have comorbid anxious symptoms than boys with depressive symptoms. Sex differences were not found for adolescents with specific depressive symptoms and specific anxious symptoms (i.e., the absence of comorbidity). Our findings supported the possibility that sex differences in pure forms of depression are overestimated and that comorbid internalizing conditions may be more prevalent in adolescent girls than boys.     

A retrospective study on risk assessment and management of forensic psychiatric inpatients in Hong Kong

The Department of Forensic Psychiatry of Castle Peak Hospital is the only facility in Hong Kong that provides territory-wide forensic psychiatric services for patients with criminal involvement. This retrospective study aimed to explore whether the rehabilitation programs provided by the department could significantly reduce the risks of forensic psychiatric inpatients as measured by the Short-Term Assessment of Risk and Treatability (START). START ratings of inpatients who were hospitalized in the department for more than 3 months and were discharged to the community during the period from 11 April 2015 to 31 March 2019 were analyzed. A total of 79 patients were assessed, of whom 61 (77.2%) were males. Fifty-four (68.4%) patients suffered from schizophrenia. START scores upon admission (strength score = 5.67; vulnerability score = 17.43) and upon discharge (strength score = 6.87, vulnerability score = 11.18) indicated significant reduction of risks among inpatients (p < 0.05).     

Suicidal Ideation in Elderly Bereaved: The Role of Complicated Grief

This study examined whether symptoms of complicated grief at baseline predicted suicidal ideation during a depressive episode in elderly bereaved individuals. Over a 17-month period, serial ratings of suicidal ideation, hopelessness, and symptoms of depression, anxiety, and complicated grief were obtained from 130 elderly participants who had lost their spouses within the past 2 years. Groups of active and passive suicidal ideators, as well as nonideator controls, were compared via analysis of variance (ANOVA) with respect to levels of complicated grief, depression, and anxiety. Elderly bereaved with both active and passive suicidal ideation were found to have higher symptomatic levels of depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than nonideators at study entry. Fifty-seven percent of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores. Patients with any suicidal ideation had higher symptom levels of depression, anxiety, and complicated grief when they were ideators as compared with periods when they denied ideation. Fifteen out of the 39 ideators had recurrent depressive episodes versus 5 of the 91 nonideators. Patients with a history of suicide attempts were more likely to be ideators after loss than other bereaved. Thus, the condition of having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation. Detection of high levels of complicated grief could help clinicians identify patients who may be at heightened risk for suicide.     

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.     

Depressive Symptoms and Health Among Cardiovascular Disease Patients in Cardiac Rehabilitation Programs1

This study examined relations between depressive symptoms and health outcomes among 79 patients participating in cardiac rehabilitation. Results showed cross‐sectional negative associations between depressive symptoms and cardiac symptom appraisals at the beginning (Time 1) and end (Time 2) of rehabilitation. No longitudinal effects of depressive symptoms on cardiovascular functioning were found. Results also showed that improvements in depressive symptoms from Time 1 to Time 2 were related to improvements in cardiac symptom appraisals from Time 1 to Time 2. These results support the deleterious effects of depression on cardiovascular functioning. Findings such as these may help to understand the processes by which proximal health outcomes are affected by cardiac rehabilitation, thereby elucidating mechanisms linking depression to long‐term cardiovascular health.     

Task concentration training versus applied relaxation, in combination with cognitive therapy, for social phobia patients with fear of blushing, trembling, and sweating

Social phobia patients with fear of blushing, trembling, sweating and/or freezing as main complaint (N = 65) were randomly assigned to either task concentration training (TCT) or applied relaxation (AR) both followed by cognitive therapy (CT). Measurements took place before and after wait-list, after TCT or AR (within-test), after CT (post-test), at 3-months and at 1-year follow-up. Effects were assessed on fear of showing bodily symptoms (the central outcome variable), social phobia, other psychopathology, social skills, self-consciousness, self-focused attention, and dysfunctional beliefs. No changes occurred during wait-list. Both treatments were highly effective. TCT was superior to AR in reducing fear of bodily symptoms and dysfunctional beliefs at within-test. This difference disappeared after CT, at post-test and at 3-months follow-up. However, at 1-year follow-up the combination TCT-CT was superior to AR-CT in reducing fear of bodily symptoms, and effect sizes for TCT-CT reached 3. Furthermore, at all assessment moments TCT or the combination TCT-CT was superior to AR-CT in reducing self-consciousness and self-focused attention. The superior long-term effect of TCT on fear of showing bodily symptoms is explained by lasting changes in attentional focus.     

Psychological factors and depressive symptoms in ischemic heart disease.

The aim of this study was to determine whether learned helplessness, cognitive distortions, self-efficacy, and dispositional optimism assessed at Time 1 (T1; questionnaires mailed at 1 month postdischarge) would predict depressive symptoms at Time 2 (T2; questionnaires mailed at 1-year follow-up) in a sample of 86 patients hospitalized with ischemic heart disease. Multiple regression results indicated that optimism and cognitive distortions at T1 were significantly associated with T1 depressive symptoms after controlling for confounding variables. When the T1 psychological factors were analyzed with T2 depressive symptoms, only optimism continued to predict depressive symptoms after controlling for confounds and T1 depressive symptoms. The global expectancies that optimism assessed appeared to be more stable over time than the statelike beliefs of cognitive distortions and may have accounted for why optimism predicted T2 depressive symptoms.