The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients

The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment group (n = 25) resolved their suicidality significantly more quickly than TAU patients (n = 30). CAMS was also significantly associated with decreased medical health care utilization in the 6 months after the start of suicide-related mental health treatment. These results provide promising preliminary support for the effectiveness of CAMS and a foundation for prospective research.     

An evaluation of the Psychache Scale on an offender population

This study examined the generalizability of a self-report measure of psychache to an offender population. The factor structure, construct validity, and criterion validity of the Psychache Scale was assessed on 136 male prison inmates. The results showed the Psychache Scale has a single underlying factor structure and to be strongly associated with measures of depression and hopelessness and moderately associated with psychiatric symptoms and the criterion variable of a history of prior suicide attempts. The variables of depression, hopelessness, and psychiatric symptoms all contributed unique variance to psychache. Discussion centers on psychache's theoretical application to the prediction of suicide.     

Perceptions concerning college student suicide: data from four universities

The issue of suicide, including prevention, intervention, and postvention, continues to be a problem on college campuses. For this study, data concerning a variety of issues related to college student suicide were collected from 1,865 students at four different universities. Incidence, risk factors, and potential solutions are described, as well as implications for mental health professionals in university settings.     

Suicide compared to other causes of mortality in physicians

Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results about cause-specific mortality such as suicide. In this study, we compared all-cause and cause-specific mortality in a sample of physicians to the age-gender matched general U.S. population from 1948 through 1998. We also compared the mortality experience across medical specialties. The risk of all-cause mortality was 56% lower than expected in men, and 26% lower in women, compared to the general population. Standardized mortality ratios (SMRs) were markedly lower for diseases strongly linked to smoking, e.g., cardiovascular diseases, respiratory diseases, and lung cancer. Suicide was the only cause of death where risk was greater than the general population. Overall, we found that physicians are at substantially lower risk of dying compared to the general population for all causes of death except suicide. The findings for suicide are strikingly different than other causes of death and should provide impetus for new research on the mental health of physicians.     

High-lethality status in patients with borderline personality disorder

Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.     

Evaluating the efficiency and community safety goals of the Broward County Mental Health Court

Mental health courts have developed as one response to persons with mental illness who are involved with the criminal justice system. This study investigated the efficiency and safety goals of one such court in Broward County, FL. Mental health court (MHC) clients spent significantly fewer days in jail for the index arrest associated with study enrollment than a comparison group. MHC clients had similar survival time to re-arrest up to one year after study enrollment. MHC clients did not significantly differ from the comparison group in self-reported aggressive acts over an 8 month follow-up period, while they did self-report significantly fewer acts of violence than the comparison group at the 8 month follow-up. These findings suggest that some of the benefits associated with the MHC reported in prior studies were not achieved at the expense of efficiency and safety.     

No aging bias favoring memory for positive material: evidence from a heterogeneity-homogeneity list paradigm using emotionally toned words

Some authors argue for a memory advantage of older adults for positively toned material. To investigate the contribution of selective processing to a positivity effect, the authors investigated young (n = 72, aged 18 to 31) and older (n = 72, aged 64 to 75) adults' memory for emotionally toned words using a multitrial paradigm that compares performance for heterogeneous (mixed valence) and homogeneous (single valence) lists. Regarding the age comparison, there was no evidence for an aging bias favoring positive material. Moreover, older adults' memory was less affected by emotion-based processing prioritization. Although there was no support for age-specific processing biases in memory for emotionally toned words, the findings are consistent with proposals that negative information receives processing priority in some contexts. Possible limits to the generalizability of the present findings (e.g., to nonverbal material) are discussed.     

Field reliability of comprehensive system scoring in an adolescent inpatient sample

The extent to which the Comprehensive System for the Rorschach is reliably scored has been a topic of some controversy. Although several studies have concluded it can be scored reliably in research settings, little is known about its reliability in field settings. This study evaluated the reliability of both response-level codes and protocol-level scores among 84 adolescent psychiatric inpatients in a clinical setting. Rorschachs were originally administered and scored for clinical purposes. Among response codes, 87% demonstrated acceptable reliability(> .60), and most coefficients exceeded .80. Results were similar for protocol-level scores, with only one score demonstrating less than adequate reliability. The findings are consistent with previous evidence, indicating reliable scoring is possible even in field settings.     

The<Emphasis Type="Italic">remember</Emphasis> response: Subject to bias,graded, and not a process-pure indicator of recollection

Recognition memory judgments have long been assumed to depend on the contributions of two underlying processes: recollection and familiarity. We measured recollection with receiver-operating characteristic (ROC) data and remember-know judgments. Under standard remember-know instructions, the two estimates of recollection diverged. When subjects were told they might need to justify theirremember responses to the experimenter, the two estimates were more likely to agree. The data support the conclusion thatremember responses are generally based on a continuous underlying process but that specific task instructions can produce data that appear consistent with a high-threshold recollective process. Models based on signal detection theory provide a better account of these data than does the dual-process model (Yonelinas, 1994) or process-pure interpretations.     

Attention capture is modulated in dual-task situations

Because some features affect the efficiency of visual search even when they are irrelevant to the task, they are thought tocapture attention in a stimulus-driven manner. If such attention shifts are stimulus driven, they should be unaffected by reduced resources. We added a concurrent auditory task to a traditional attention capture paradigm and found that capture by an irrelevant, abruptly appearing stimulus (i.e., an onset) was eliminated. In contrast, prioritization of an irrelevant color singleton—a stimulus that at most receives only mild prioritization in this paradigm—was increased under dual-task conditions. These results challenge the hypothesis that attention capture by irrelevant features is stimulus driven. Instead, prioritization depends on and is modulated by the availability of resources.