Predictors of Suicidality Among Patients with Psychotic Disorders in a Partial Hospital Treatment Program

Individuals with psychotic disorders are at increased risk for suicidality. Demographic and clinical characteristics were compared in individuals with psychotic disorders reporting either high or low suicidality. Among this sample of 259 partial hospital patients, 116 (44.8%) were classified as high risk on the suicidality section of the Mini Neuropsychiatric Interview, and 143 (55.2%) were considered low risk. Bivariate analyses revealed that patients classified as high risk demonstrated greater depression severity, more relationship difficulties, greater emotional lability, and more substance use problems. A logistic regression model indicated that substance use was the most powerful predictor of higher levels of suicidality. Monitoring and intervention for substance use should be targeted as a particularly important aspect of treatment for acutely ill patients diagnosed with psychotic disorders.     

Violent obsessions are associated with suicidality in an OCD analog sample of college students

The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.     

Assessing and Managing Risk With Suicidal Individuals

The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care recommendations for action, and allow for subsequent documentation of information gathered and actions taken. As such, it is a resource for providers treating high-risk populations across multiple contexts (e.g., primary care, outpatient psychotherapy, emergency department). This article describes both the UWRAP and UWRAMP. Taken together, these assessment and risk management tools include (a) assessment questions for gathering information to determine the level of risk, (b) action steps that can be taken to ensure safety, and (c) a companion therapist note where providers document their assessment and actions.     

Risk Factors for Suicidality Among Clients With Schizophrenia

Among clients with schizophrenia, suicidality is associated with extreme personal distress, an increased number of inpatient hospitalizations, increased health care expenditures, and early mortality. This study attempted to identify risk factors for current suicidality in clients diagnosed with schizophrenia (N = 223). Results indicated that severity of depressive symptoms most strongly correlated with degree of suicidality. Younger age and recent traumatic stress each significantly predicted suicidality independent of depressive symptoms. Stepwise regression procedures showed that the combination of depression, younger age, and traumatic stress might provide a general prediction model for suicidality among clients diagnosed with schizophrenia. Counseling implications of these findings are outlined.     

Suicidality in bipolar I disorder

People with bipolar disorder are at high suicide risk. The literature suggests that suicidality is predicted by higher symptom severity and less use of pharmacological agents, but few studies have examined the joint contributions of these variables. The present study examines the conjoint contribution of symptom severity and pharmacological treatment to suicidal ideation and behavior among participants with bipolar disorder. The model was able to account for 53% of the variance in suicidality scores. Depression, mixed state, and hopelessness were significantly associated with suicidality. All other variables were nonsignificant once symptom severity had been controlled. Implications for future research are described.     

Brief report: sudden gains in cognitive-behavioral group therapy and group psychotherapy for social anxiety disorder among college students

The present study examined sudden gains (SGs; large symptom improvements between adjacent treatment sessions) and its association with treatment outcome in a randomized-controlled trial comparing cognitive-behavioral group therapy (CBGT) versus group psychotherapy (GPT; designed to incorporate only non-specific factors) for social anxiety disorder (SAD). SAD symptoms were assessed after each treatment session in a sample of 45 college students. Independent assessors evaluated symptom severity at baseline, post-treatment and follow-up. A total of 10 (22.2%) participants experienced SGs during treatment. No differences were found in symptom improvement at post-treatment or follow-up between individuals with and without SGs. SGs appeared at similar rates across both treatments but were associated with greater improvements at post-treatment and follow-up in GPT compared to CBGT. Majority of SGs in CBGT occurred early in treatment before the provision of specific treatment techniques. These results suggest that non-specific treatment factors may be important in promoting SGs.     

Examination of relative reinforcement effects of stimuli identified through pretreatment and daily brief preference assessments.

Several brief preference assessments have recently been developed to identify reinforcers for individuals with developmental disabilities. One purported advantage of brief assessments is that they can be administered frequently, thus accommodating shifts in preference and presumably enhancing reinforcement effects. In this study, we initially conducted lengthy paired‐choice preference assessments and identified a hierarchy of preferred items for 5 individuals with developmental disabilities. Subsequently, brief multiple‐stimulus‐without‐replacement assessments using the same items were completed each day prior to work sessions. On days when results of the daily brief assessment differed from the one‐time lengthy assessment, the relative reinforcing effects of the top items from each assessment were compared in a concurrent‐schedule arrangement. The results revealed that when the two assessments differed, participants generally allocated more responses to the task associated with the daily top‐ranked item.     

Relative versus absolute reinforcement effects: implications for preference assessments

We compared results obtained in two previous studies on reinforcer identification (Fisher et al., 1992; Pace, Ivancic, Edwards, Iwata, & Page, 1985) by combining methodologies from both studies. Eight individuals with mental retardation participated. During Phase 1, two preference assessments were conducted, one in which stimuli were presented singly (SS method) and one in which stimuli were presented in pairs (PS method). Based on these results, two types of stimuli were identified for each participant: High-preference (HP) stimuli were those selected on 75% or more trials during both preference assessments; low-preference (LP) stimuli were those selected on 100% of the SS trials but on 25% or fewer of the PS trials. During Phase 2, the reinforcing effects of HP and LP stimuli were evaluated in reversal designs under two test conditions: concurrent and single schedules of continuous reinforcement. Two response options were available under the concurrent-schedule condition: One response produced access to the HP stimulus; the other produced access to the LP stimulus. Only one response option was available under the single-schedule condition, and that response produced access only to the LP stimulus. Results indicated that 7 of the 8 participants consistently showed preference for the HP stimulus under the concurrent schedule. However, when only the LP stimulus was available during the single-schedule condition, response rates for 6 of the 7 participants were as high as those observed for the HP stimulus during the concurrent-schedule condition (1 participant showed no reinforcement effect). These results indicate that, although the concurrent-schedule procedure is well suited to the assessment of relative reinforcement effects (preference for one reinforcer over another), absolute reinforcement effects associated with a given stimulus may be best examined under single-schedule conditions.     

Assessing object-to-picture and picture-to-object matching as prerequisite skills for pictorial preference assessments

Tangible and pictorial paired-stimulus (PPS) preference assessments were compared for 6 individuals with developmental disabilities. During tangible and PPS assessments, two edible items or photographs were presented on each trial, respectively, and approach responses were recorded. Both assessments yielded similar preference hierarchies for 3 participants who could match pictures and objects but different hierarchies for 3 participants who could not. Reinforcer assessments verified that items identified as high preference on PPS assessments functioned as reinforcers only for participants with matching skills.     

Differential Associations Between Perceived and Objective Measurement of Distress Tolerance in Relation to Antiretroviral Treatment Adherence and Response Among HIV-Positive Individuals

The present study sought to extend prior work, showing an association between self-reported distress tolerance and self-reported antiretroviral treatment (ART) adherence, by conducting a multimethod test of the association between distress tolerance and objective measures of ART adherence among a sample of 140 individuals (23.6% female) with human immunodeficiency virus (HIV). Findings indicated that, after accounting for negative affectivity and ART side-effect severity, distress tolerance was significantly associated with pill count adherence as well as viral load. Specifically, a differential association was observed whereby self-reported distress tolerance was associated with pill count adherence, whereas behavioral distress tolerance was associated with viral load. Importantly, no associations were observed between either measure of distress tolerance and CD4 count. Findings are discussed in terms of the importance of both behavioral and perceived distress tolerance assessment among patients with HIV as well as potential clinical implications related to the integration of distress tolerance-focused treatments into existing interventions for individuals with HIV.     

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.     

Some determinants of changes in preference over time

Results of longitudinal studies suggest that the stability of preferences varies across individuals, although it is unclear what variables account for these differences. We extended this work by conducting periodic assessments of preference for leisure activities over 3 to 6 months with 10 adults with developmental disabilities. Although previous research has collectively shown that preferences identified via repeated assessment are highly variable, our results showed that preferences were relatively stable for the majority (80%) of participants. In an attempt to identify some environmental determinants of shifts in preference, we provided extended daily access to high-preference items (preference-weakening manipulation) and paired access to low-preference items with social and edible putative reinforcers during brief sessions (preference-strengthening manipulation). Preference assessments continued over the course of these manipulations with 2 participants. Results showed that changes in preference across time could be produced systematically and suggest that naturally occurring changes in establishing operations or conditioning histories contribute to temporal shifts in preference. Implications for preference assessments, reinforcer usage, and planned attempts to change preferences are discussed.     

Predicting preference for items during periods of extended access based on early response allocation

Top‐ranked items were identified during 30‐min free‐operant preference assessments for 9 individuals. Data from each session were analyzed to identify the item (a) that was engaged with first in each session and (b) to which the most responding was allocated after 5 min, 10 min, 15 min, 20 min, and 25 min had elapsed in each session. The results indicated that the first‐engaged item and the 5‐min high‐allocation item predicted the top‐ranked item in 55% and 62% of the sessions, respectively. The results also showed that engagement with the top‐ranked item from the first session decreased across subsequent sessions for 6 of the 9 participants. The implications of the results for brief versus extended stimulus preference assessments are discussed.     

Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health and Substance Abuse Disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

The effects of providing access to stimuli following choice making during vocal preference assessments

Two variations of a vocal paired-stimulus preference assessment were evaluated to determine whether the verbal reports of preference, given by individuals with developmental disabilities when no access to the activity was given, matched their verbal reports when access to the activity was given contingent on their choice. The results indicated different outcomes between the two methods for 6 of the 7 participants. Subsequent reinforcer assessments, conducted for 2 participants, showed that activities identified in the preference assessments that provided access contingent on selection resulted in more responding than did activities identified in the preference assessment that did not include access to items following their selection.     

Personality in proportion: a bipolar proportional scale for personality assessments and its consequences for trait structure

Trait structures resulting from personality assessments on Likert scales are affected by the additive and multiplicative transformations implied in interval scaling and correlational analysis. The effect comes into view on selecting a plausible alternative scale. To this end, we propose a bipolar bounded scale ranging from -1 to +1 representing an underlying process in which the assessor would review and discount positive and negative behavioral instances of a trait. As an appropriate index of likeness between variables X and Y, we propose LXY = SigmaXY/N, the average of the raw scores cross products. Using this index, we carried out a raw scores principal component analysis on data consisting of 133 participants who had each been rated by 5 assessors including self on 914 items. Contrary to the Big-Five structure that was found in these data on standard analysis, the results showed a relatively large first principal component F1 and 2 very small ones, F2 and F3. The sizes LFF=SigmaF2/N, the averages of the squared component scores, were modest to small. It thus appears that the scale, bipolar proportional versus standard, has a profound impact on the size and structure of personality assessments. The dissimilarity remains on analyzing self-ratings rather than averaged (over the 5 assessors) ratings.     

Psychological distress and well-being in advanced cancer: The effects of optimism and coping

This study examined the relations among optimism, coping, functional status, and psychological adjustment in 75 adults diagnosed with cancer. Both the positive and the negative aspects of psychological adjustment were assessed. All participants had been diagnosed with advanced stages of cancer (i.e., Stages II, III, and IV). Participants completed three assessments across a 4-month time period. Both optimism and coping were associated with psychological adjustment, even after controlling for functional status and prior adjustment. Additionally, optimism and coping were differentially related to distress and well-being. Optimism was strongly and positively associated with well-being and inversely related to distress. Escape-Avoidance coping was positively associated with distress and Accepting Responsibility coping was negatively associated with well-being. Comparisons between the current and prior studies indicated that individuals who are diagnosed with more advanced stages of cancer or who have survived bone marrow transplantation exhibit higher levels of optimism than do healthy individuals and individuals with early-stage disease.     

Skin picking in patients with obesity: Associations with impulsiveness and self‐harm

Previous studies suggest elevated prevalence rates of skin picking and self‐harm in patients with obesity compared to individuals in the general population. Hence, further studies should investigate prevalence rates and correlates of skin picking in this population – especially its differentiation to self‐harm. Skin picking and obesity are both associated with specific facets of impulsiveness. This relation should be explored to shed light on potentially shared mechanisms in etiology. Therefore, the present study examined the occurrence of skin picking and its associations with impulsiveness and self‐harm in a sample of pre‐bariatric surgery patients with obesity class II/III. Within the routine preoperative psychiatric evaluation, a total of 139 bariatric surgery candidates (78% female, BMI range 35–69) completed a self‐report questionnaire assessing sociodemographic variables, anxiety, depression, self‐harm, impulsiveness, and skin picking severity (urges: frequency, intensity, controllability; behavior: frequency, intensity, controllability; resistance, emotional distress, impairment, and avoidance). Ten participants (7.2% of the sample) reported recurrent skin picking leading to skin damage, repeated attempts to decrease skin picking, and psychosocial impairment (emotional distress, impairment in functional areas, avoidance) due to skin picking. In line with previous findings, skin picking severity shows a medium correlation with attentional impulsiveness. The majority of self‐harm types were not associated with skin picking severity. The current study reveals a high occurrence of skin picking compared to the general population. The results indicate an association between skin picking severity and attentional impulsiveness. Further research is needed to investigate the differentiation of skin picking and self‐harm in more detail.     

The Comparison of Death Anxiety,Obsession, and Depression Between Muslim Population with Positive and Negative Religious Coping

Death anxiety, obsession, and depression constitute three dimensions of death distress which can be influenced by religious coping in religious individuals. The aim of this study was to compare death anxiety, depression, and obsession between Muslims with positive and negative religious coping. In a cross-sectional study, a sample of 339 participants were selected via stratified random sampling method. The participants were screened using the Brief Religious Coping Scale, in which 60 individuals were identified to have positive religious coping and 62 individuals were recognized as individuals with negative religious coping. They responded to Death Anxiety Scale, Death Obsession Scale, and Death Depression Scale. The data were analyzed using factor analysis and multiple analysis of variance. The results of principal component analysis showed that death anxiety, death obsession, and death depression were separate factors of death distress. The results also revealed that individuals with negative religious coping gained higher scores than those with positive religious coping in all the three variables of death anxiety, obsession, and depression. Consistent with the previous studies and Terror Management Theory, this finding lays emphasis on the role of positive religious coping in reducing death distress and the possible consequent psychopathology.

     

On the displacement of leisure items by food during multiple-stimulus preference assessments

Previous studies have demonstrated that when food and leisure stimuli are combined in multiple-stimulus preference assessments, individuals typically select food more often, although the leisure stimuli also have known reinforcing properties. The purpose of the current study was to replicate this effect and determine its durability by examining the effect after mealtimes. Four adults who had been diagnosed with severe mental retardation were given three initial multiple-stimulus (without replacement) preference assessments (i.e., food, leisure stimuli, and combined). All participants selected food items as the most preferred stimuli in the combined assessments. Combined assessments were then administered immediately before and after the evening meal for each participant for 1 week. The results showed similar data both before and after mealtimes.