Demographic,Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide‐related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment for an injury, behavioral health specialty care visits, and opioid medication dispensation in the year prior to a suicide‐related visit compared to gender‐, age‐, and residence‐ (urban versus rural) matched controls. Odds of a suicide‐related visit were lower among those with private insurance and those with non‐primary care ambulatory clinic visits.     

Benchmarking the “Question,Persuade, Refer” Program Against Evaluations of Established Suicide Prevention Gatekeeper Trainings

Gatekeeper training is a common approach for aiding suicidal youth. This study utilizes comparative effectiveness “benchmarks” from established programs to evaluate the Question, Persuade, Refer (QPR) program. The QPR program was implemented with adults (N = 2,389) working in youth‐serving community agencies. Questionnaires assessed suicide prevention knowledge, attitudes, subjective norms, perceived behavioral control, and behaviors. Consistent with benchmarked studies, participants in QPR demonstrated knowledge and suicide prevention behavior gains compared with control groups. Future research should utilize benchmarking methods as a measure of effectiveness, and more thoroughly assess mechanisms that promote behavior change.     

"I couldn't have seen it coming": The impact of negative self-relevant outcomes on retrospections about foreseeability

We examined a phenomenon related to hindsight bias, specifically, retrospective judgements about the foreseeability of an outcome. We predicted that negative, self-relevant outcomes would be judged as less foreseeable by the recipient of the outcome than by others, unlike either positive outcomes or outcomes that are not self-relevant. In the context of a "stock market decision-making game", the hypothetical stock selected by one of two players showed an extreme increase or decrease. As predicted, the player who received an extreme negative outcome reported that this outcome was less foreseeable than did the opponent and an observer, for whom the outcome was less self-relevant. For no other kind of outcome was there a difference between the recipient of an outcome, the opponent, and the observer. The findings have several implications, including the possibility that hindsight bias should be considered as a special case of retrospective foreseeability.     

Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.

Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).

Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.

Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.     

Peer Culture and Body Image Concern Among Australian Adolescent Girls: A Hierarchical Linear Modelling Analysis

Peers may influence the body image concerns and disordered eating behaviours of adolescent girls through the creation of appearance cultures within friendship cliques. The present study investigates the role of friendship cliques and school gender composition in impacting upon adolescent girls’ body image concern and disordered eating behaviours, using hierarchical linear modelling (HLM), a statistical procedure employed in the analysis of nested data. A sample of 156 girls was drawn from four private schools located in the capital city of Western Australia (one single-sex school and three mixed-sex schools). Eighty students from the single-sex school and 76 female students from the mixed-sex schools, comprising 35 friendship cliques, completed questionnaires assessing body image, disordered eating, and a range of variables that have previously been associated with body image concern and disordered eating, including appearance-based social comparison, frequency of appearance-based conversation, appearance-based criticism, friends’ concern with thinness, media influence and media pressure. Hierarchical linear modelling analyses found that friendship cliques in all-girls schools exhibited similar levels of body image concern and dieting behaviours, with various peer and other media influence variables accounting for these similarities. Friendship cliques in mixed-sex schools were not found to be similar with regard to body image concern or disordered eating. These findings support the notion that friendship groups can be an important source of influence on the body image concerns of adolescent girls in single-sex schools, and show that both individual and friendship clique level measures of attitudes and behaviours make independent contributions to the prediction of these body image concerns.     

Immigration, suicidal ideation and deliberate self-injury in the Boston youth survey 2006

The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By contrast, U.S.-born youth who reported having been discriminated against because of their ancestry had an increased risk of deliberate self-injury (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9) and suicidal ideation (OR = 2.1, 95% CI = 1.2-3.8). The combination of being U.S.-born and experiencing ancestry-based discrimination identifies youth at increased risk for suicidal behavior.     

Adolescent Focused Psychotherapy for Adolescents with Anorexia Nervosa

The paper describes a manualized specific form on individually based developmentally oriented therapy for Anorexia Nervosa (AN) in adolescents. Adolescent focused psychotherapy for AN is derived from a self-psychology model and is designed to address key deficits in development associated with AN. Adolescents with AN are viewed as using food and weight to avoid negative affective states associated with adolescent developmental issues that they perceive as intolerable. To develop a more constructive coping style and improve self-efficacy, adolescent patients need to first learn to identify and define their emotions, and later, to tolerate emotions, particularly negative ones. In withdrawing from the environment and situations which provoke distress through self-starvation and preoccupations with food and weight, emotional and psychological development is arrested. Learning to identify and cope adaptively with emotions and developmental challenges presented by the environment form the key therapeutic targets of treatment. Specific therapeutic procedures, a case illustration and discussion of therapeutic rationale are also provided.