Four studies on how past and current suicidality relate even when "everything but the kitchen sink" is covaried

T. E. Joiner's (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.     

Adaptation of panic-related psychopathology measures to Russian

The study reports results of adaptation of panic-related psychopathology measures to Russian, including the Anxiety Sensitivity Index (ASI), the Agoraphobic Cognitions Questionnaire (ACQ), and the Mobility Inventory for Agoraphobia (MIA). Psychometric properties (e.g., reliability, factor structure, endorsement) and external validity of the adaptations were evaluated in a representative sample of Moscow residents (N = 390) and Ukrainian undergraduates (N = 492). The adapted ASI was generally equivalent to the original English-language version. The ACQ showed structural equivalency but did not exhibit expected specificity to panic. Finally, the MIA displayed notable structural discrepancies but had external validity comparable to the original.     

Diathesis stress model for panic-related distress: a test in a Russian epidemiological sample

To investigate a cognitive diathesis-stress model, the present study evaluated the main and interactive effects of anxiety sensitivity (AS) and exposure to aversive conditions (past month) in predicting theoretically relevant panic vulnerability variables in an epidemiologically defined sample from Russia (N = 390). Consistent with expectation, findings suggested that the combination of high levels of exposure to aversive conditions and high AS physical concerns predicted panic attacks (past week) and agoraphobic avoidance above and beyond the variance accounted for by negative affect. These findings are discussed in relation to biopsychosocial theories of panic disorder, which emphasize the importance of both a cognitive diathesis and stress component in the pathogenesis of the disorder.     

The Ohio study in light of national data and clinical experience

The Siminoff, Burant, and Youngner study in Ohio is strikingly consistent with data from a national study. Both suggest that there might be significant public acceptance of future policies that violate the dead donor rule, or that further extend the boundary between life and death to include brain-damaged patients short of "brain death." Experience with donation suggests that many individuals would donate their loved ones' organs when they have concluded that the brain injury is not survivable, even if all the criteria for "brain death" are not met. It would be very helpful to have research on those who have gone through the real-life clinical situation. Based on the findings of this study and the increasing demand for organs, it may be appropriate for public policy to allow for ways to increase organ procurement from individuals who are not fully "brain dead" beyond the current method of procurement after cardiac death, but any change in this area should go slowly and with significant public input.     

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.     

Development of frontal electroencephalogram (EEG) and heart rate (ECG) responses to affective musical stimuli during the first 12 months of post-natal life

We examined the development of infants' regional electrocortical (EEG) and heart rate (ECG) responses to affective musical stimuli during the first 12 months of post-natal life. Separate groups of infants were seen at 3 (n=33), 6 (n=42), 9 (n=52), and 12 (n=40) months of age at which time regional EEG and ECG responses were continuously recorded during a baseline condition and during the presentation of three orchestral pieces that were known to vary in affective valence and intensity (happy, sad, fear). Overall, there were two important findings. First, we found that although the overall amount of EEG 4-8 Hz power increased between 3 and 12 months, the distribution of EEG power changed across age, with the younger infants (3- and 6-month-olds) showing no difference between frontal and parietal regions, but the older infants (9- and 12-month-olds) showing relatively more activation at frontal than at parietal sites. This development likely reflects the maturation of frontal lobe function. Second, we found that the presentation of affective music significantly increased brain activity at 3 months of age, had seemingly little effect at 6 and 9 months, and significantly attenuated brain activity at 12 months. Findings suggest that there is a clear developmental change in the effect of music on brain activity in the first year, with music having a "calming" influence on infants by the end of the first year of life.     

Flanker recall and the flanker validity effect may reflect different attentional processes.

High flanker recall in the correlated flanker task suggests a failure of selective attention. We used a dissociation approach to examine the role of attentional processing of the flankers' identities in the flanker validity effect (FVE). In three experiments, flanker recall decreased as flanker duration decreased, but the FVE was not affected by flanker duration. Masking also produced a dissociation, in that masking decreased flanker recall but the FVE was not affected. Examination of on-line flanker identification suggested that flanker recall was an adequate measure of attentional processing of the flankers' identities on most trials. The results suggest that attentional processing of the flankers' identities is not related to the magnitude of the FVE and is not necessary for it to obtain. Because there is a failure of selective attention, the dissociations suggest that flanker recall and the FVE may reflect different attentional processes.     

Adrenocortical reactivity and social competence in seven year-olds

We examined temporal changes in salivary cortisol in response to a peer self-presentation task in a group of seven year-olds, some of whom scored high, average, and low on the Harter, 1983 Perceived Social Competence Scale. Salivary cortisol was measured pre-task, and 20 and 35 min post-task. We found a significant relation between individual differences in perceived social competence and salivary cortisol reactivity in response to the task. Children who perceived themselves as socially competent exhibited a significantly greater decrease in salivary cortisol from 20 to 35 min following the task compared with children who self-reported a relatively lower degree of social competence. We speculate on the meaning of salivary cortisol changes in childrens socio-emotional development.