Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.     

Negative affects deriving from the behavioral approach system

Does the behavioral approach system (BAS) relate to the experience of any negative affects, or are all negative affects tied to the behavioral inhibition system (BIS)? In Study 1, self-reported Fun Seeking predicted reports of greater frustration and sadness after frustrative nonreward. In Study 2, self-reported Reward Responsiveness predicted reports of greater anger in response to scenarios. In Study 3, self-reported Drive predicted reports of greater anger after the terrorist attacks of September 11, 2001. In no case did BIS sensitivity contribute uniquely to these affects, though BIS predicted nervousness in Study 2 and fear in Study 3. Discussion focuses on the role of frustration and anger in effortful pursuit of goals and depressed affect in disengagement from goals.     

A Beautiful Mind

It is often difficult to discern the line between creativity and madness. This presents a particular hazard for the analyst, whose failure to recognize real potential can result in undermining the individual's developmental strivings. This dilemma is explored through a case illustration of a woman whose creativity was undermined by a lack of recognition. To vivify the dilemma, the author invites the reader to look through her eyes into the lens offered by the film A Beautiful Mind, which portrays the struggles of Nobel Prize-winning mathematician John Nash to maintain his sanity while also testing the limits of his mind and imagination. These illustrations encourage us to consider the dilemma of the gifted individual when excessive tension arises between absorption in one's medium versus needs for recognition.     

The modulation of inhibition of return by objectinternal structure: Implications for theories of object-based attentional selection

Recently, Vecera, Behrmann, and McGoldrick (2000), using a divided-attention task, reported that targets are detected more accurately when they occur on the same structural part of an object, suggesting that attention can be directed toward object-internal features. We present converging evidence using the object-based inhibition of return (IOR) paradigm as an implicit measure of selection. The results show that IOR is attenuated when cues and targets appear on the same part of an object relative to when they are separated by a part boundary. These findings suggest that object-based mechanisms of selection can operate over shape representations that make explicit information about objectinternal structure.     

Online bargaining and interpersonal trust

The presented study explores the effect of interacting over the Internet on interpersonal trust when bargaining online. Relative to face-to-face negotiations, online negotiations were characterized by (a) lower levels of pre-negotiation trust and (b) lower levels of post-negotiation trust. The reduced levels of pre-negotiation trust in online negotiations (i.e., before any interaction took place) demonstrate that negotiators bring different expectations to the electronic bargaining table than to face-to-face negotiations. These negative perceptions of trust were found to mediate another aspect of the relationship, namely, desired future interaction. Those who negotiated online reported less desire for future interactions with the other party. Online negotiators also were less satisfied with their outcome and less confident in the quality of their performance, despite the absence of observable differences in economic outcome quality.     

On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal

We compared the effects of positive reinforcement alone, escape extinction alone, and positive reinforcement with escape extinction in the treatment of the food and fluid refusal of 4 children who had been diagnosed with a pediatric feeding disorder. Consumption did not increase when positive reinforcement was implemented alone. By contrast, consumption increased for all participants when escape extinction was implemented, independent of the presence or absence of positive reinforcement. However, the addition of positive reinforcement to escape extinction was associated with beneficial effects (e.g., greater decreases in negative vocalizations and inappropriate behavior) for some participants.     

Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs. exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt.     

The team halo effect: why teams are not blamed for their failures

In this study, the existence of the team halo effect, the phenomenon that teams tend not to be blamed for their failures, is documented. With 2 studies using both real teams and controlled scenarios, the authors found evidence that the nature of the causal attribution processes used to diagnose failure scenarios leads to individuals being more likely to be identified as the cause of team failure than the team as a collective. Team schema development, as indexed by team experience, influences this effect, with individuals who have more team experience being less likely to show the team halo effect     

Dispositional pessimism predicts illness-related disruption of social and recreational activities among breast cancer patients

The authors tested whether dispositional pessimism would predict withdrawal from social activities among women treated for breast cancer. In a cross-sectional sample 3-12 months postsurgery, disruption of social and recreational activities (measured by the Sickness Impact Profile) correlated with concurrently assessed pessimism. This association appeared mediated by emotional distress and fatigue. A longitudinal sample was studied shortly postsurgery and over the next year. Initial pessimism predicted disruption of social activities concurrently and prospectively (3, 6, and 12 months later) but predicted change in disruption from one time to the next only at final follow-up. These associations appeared partially mediated by distress. The authors conclude that pessimism places patients at risk for adverse outcomes in several respects rather than solely with regard to emotional distress.     

Rehabilitating equipoise

When may a physician legitimately offer enrollment in a randomized clinical trial (RCT) to her patient? Two answers to this question have had a profound impact on the research ethics literature. Equipoise, as originated by Charles Fried, which we term Fried's equipoise (FE), stipulates that a physician may offer trial enrollment to her patient only when the physician is genuinely uncertain as to the preferred treatment. Clinical equipoise (CE), originated by Benjamin Freedman, requires that there exist a state of honest, professional disagreement in the community of expert practitioners as to the preferred treatment. FE and CE are widely understood as competing concepts. We argue that FE and CE offer separable and, in themselves, incomplete justifications for the conduct of clinical trials. FE articulates conditions under which the fiduciary duties of physician to patient may be upheld in the conduct of research. CE sets out a standard for the social approval of research by institutional review boards. Viewed this way, FE and CE are not necessarily competing notions, but rather address complementary moral concerns.