Suicide-related behavior after psychiatric hospital discharge: Implications for risk assessment and management

Suicide-related behavior (SRB), including suicide attempts and instrumental SRB, occurs far more often than completed suicide and exacts a toll on patients, their loved ones, and society. Nevertheless, few prospective studies of SRB have been conducted. In this study, 954 patients were interviewed in a psychiatric hospital and then followed for one year after discharge. During this one-year period, nearly one-quarter of patients (23%) engaged in SRB, with the rate of suicide attempts (18%) three times greater than the rate of instrumental SRB (5%). Risk factors for SRB were demographic (White ethnicity, female gender), clinical (past SRB, depression, impaired functioning), and contextual (unemployment, large social networks). In contrast with other studies, there was no "peak" in the risk of SRB shortly after hospital discharge. Instead, patients' rate of SRB was relatively constant over the one-year follow-up. Implications for risk assessment and management in acute inpatient settings are discussed.     

Screening as an approach for adolescent suicide prevention

Among the provisions of the recently signed Garrett Lee Smith Memorial Act, Congress called for the use of screening to detect adolescents who are at risk for suicide. After a review of the literature, 17 studies involving screening instruments and programs were identified. We addressed the question: What do we know about the demonstrated effectiveness and safety of screening as a tool or program to prevent suicide among adolescents? While youth suicide screening programs offer the promise of improving identification for those who need treatment the most, further research is essential to understand how, when, where, and for whom screening programs can be used effectively and efficiently.     

What causes residual dual-task interference after practice?

Practice can dramatically reduce dual-task interference, but typically does not eliminate interference entirely. Residual interference after practice is especially large with certain non-preferred modality pairings (e.g., auditory–manual and visual–vocal). Does this residual interference imply the existence of a persistent central-processing bottleneck? To address this question, we transferred participants with previous dual-task practice to a psychological refractory period design. Although we observed residual dual-task costs in all four experiments, there was no evidence for a bottleneck, even with non-preferred modality pairings. We conclude that practice can eliminate the bottleneck limitation, but performance is still subject to other sources of interference, such as competition between central codes of the two tasks.     

Programming strategies for rapid aiming movements under simple and choice reaction time conditions

Increases in reaction time (RT) as a function of response complexity have been shown to differ between simple and choice RT tasks. Of interest in the present study was whether the influence of response complexity on RT depends on the extent to which movements are programmed in advance of movement initiation versus during execution (i.e., online). The task consisted of manual aiming movements to one or two targets (one- vs. two-element responses) under simple and choice RT conditions. The probe RT technique was employed to assess attention demands during RT and movement execution. Simple RT was greater for the two- than for the single-target responses but choice RT was not influenced by the number of elements. In both RT tasks, reaction times to the probe increased as a function of number of elements when the probe occurred during movement execution. The presence of the probe also caused an increase in aiming errors in the simple but not choice RT task. These findings indicated that online programming was occurring in both RT tasks. In the simple RT task, increased executive control mediated the integration between response elements through the utilization of visual feedback to facilitate the implementation of the second element.     

Evaluation of a healthy-weight treatment program for bulimia nervosa: a preliminary randomized trial

Objective: Conduct a randomized treatment trial to test whether healthy dieting maintains bulimic symptoms or effectively reduces this eating disturbance.

Methods: Female participants (n=85) with full- and sub-threshold bulimia nervosa were randomly assigned to a 6-session healthy dieting intervention or waitlist condition and assessed through 3-month follow-up.

Results: Relative to control participants, intervention participants showed modest weight loss during treatment and demonstrated significant improvements in bulimic symptoms that persisted through follow-up.

Discussion: These preliminary results suggest that this intervention shows potential for the treatment of bulimia nervosa and may be worthy of future refinement and evaluation. Results also provide experimental evidence that dieting behaviors do not maintain bulimia nervosa, suggesting the need to reconsider maintenance models for this eating disorder.     

Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.     

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample. The Fake Bad scale (FBS) was the only validity measure that produced acceptable TPR and FPR or a significant correlation with malingering status.     

Combined antecedent variables as motivating operations within functional analyses

Functional analysis test conditions typically manipulate a single antecedent variable and an associated consequence to better isolate response-reinforcer relations. In some instances no problem behavior is observed, perhaps representing a false-negative finding. The present study evaluated one approach to assess potentially false-negative findings within functional analyses. Participants were exposed to single-antecedent functional analysis test conditions and combined-antecedent test conditions within a multielement design. Both participants engaged in problem behavior primarily during the combined-antecedent test conditions, and treatments matched to the results were effective in reducing problem behavior. Findings are discussed in terms of clinical implications of combining antecedent variables to further examine potentially false-negative functional analysis results.     

Interpersonal perception and pathological personality features: consistency across peer groups

This study investigated the consistency of interpersonal perceptions regarding people who exhibit features of personality disorders. The participants (N=82) were college students who were assessed for features of personality disorders, using both self-report and peer nominations at Time 1. Two years later, participants attended four meetings in groups of 7 to 12 people for a total of 2 hours. Group discussions were designed to encourage interaction and give participants an opportunity to behave in ways that might be expected from people with personality problems. After Meetings 1 and 4, group members ranked their impressions of each other with regard to several personality traits and behavioral attributes. We observed important consistencies between the peer nominations collected at Time 1 and personality rankings made by a different peer group at Time 2. There was considerable convergence between personality disorder features and negative evaluations by others, with participants high in detachment eliciting the most negative reactions from peers in the lab.