Objective: The etiology of suicidal thoughts and behaviors (STBs) is complex, multifactorial, and difficult to predict, which limits suicide prevention efforts. The biopsychosocial model of suicide suggests that risk for suicidal ideation, attempts, and death by suicide emerges through the interplay of biological, psychological, and social factors. Yet, these factors are often studied in isolation and assessed inconsistently in practice, making it difficult for researchers and clinicians to appreciate their combined impact in suicide risk assessment and prevention.Method: Charlotte Wells' film Aftersun was examined through the lens of the biopsychosocial model of suicide. Cinematic depictions of important risk factors for STBs, including adverse childhood experiences, shame, social disconnection, financial difficulties, and alcohol use, were integrated with empirical evidence to illustrate how these factors may interact to influence suicide risk.Results: This analysis identifies several empirically supported risk factors for STBs depicted in Aftersun and illustrates how their co-occurrence may increase vulnerability to death by suicide. The film provides a useful example of how suicide risk may be shaped not by any single factor, but by the accumulation and interaction of multiple biological, psychological, and social vulnerabilities.Conclusion: Aftersun provides trainees, clinicians, and researchers with an accessible illustration of the multifactorial nature of suicide and the importance of considering interacting biopsychosocial risk factors during assessment and prevention efforts.
ObjectiveThis study sought to identify independent factors influencing short-term treatment responses in schizophrenia, covering both positive and negative symptoms, and developed a validated nomogram prediction model. Method: The study examined clinical data from 446 schizophrenia patients diagnosed between 2019 and 2023, focusing on health status, admission vital signs, and initial lab results. Participants were split into training and validation groups (6:4 ratio) and classified as improvers or non-improvers based on a ≥ 30% symptom score reduction. LASSO and multivariable logistic regression analyzed the data, with a nomogram illustrating the prediction model. The Bootstrap method generated the ROC curve, and the AUC was calculated. Calibration and clinical decision curves evaluated the model's discrimination, calibration, and clinical utility. Results: The study involved 446 schizophrenia patients, divided into 267 for training and 179 for validation. Of these, 122 improved in psychiatric symptoms, while 324 did not. Key factors linked to improvement- gender, age, smoking, LDL, homocysteine, and folic acid, were identified using LASSO and logistic regression. These factors formed a predictive model, visualized with nomograms. The model's performance, tested with 1000 Bootstrap iterations, had a C-index of 0.7817. ROC analysis showed an AUC of 0.814 for the training group and 0.7863 for the validation group. Conclusion: Gender, age, smoking habits, LDL, homocysteine, and folic acid independently influence the improvement of psychiatric symptoms in schizophrenia. Predictive models using these factors are effective and clinically valuable, with the resulting nomogram serving as a practical tool for evaluating potential symptom improvement in patients.
OBJECTIVE:Medical cannabis use is often motivated by somatic or affective concerns, and both are common among older adults. Protective behavioral strategies (PBS) are known to mitigate adverse outcomes associated with substance use. Goals of this study were to examine how somatic and affective use motives relate to use of PBS, cannabis use, and symptoms of cannabis use disorder. METHOD:The sample included 471 participants age 55+, recruited through social media, who self-reported legal medical cannabis use. Measures included cannabis use motives, subjective cannabis use patterns, the Protective Behavioral Strategies for Marijuana Scale (PBSM), Cannabis Use Disorder Symptoms questionnaire, Cannabis Use Disorder Identification Test-Revised (CUDIT-R). RESULTS:Both a measurement and a hypothesized model fit the data well (RMSEA = .036, CFI = .981, c2 = 112.57). Somatic use justifications were associated with greater PBS use, less cannabis use, and lower CUDIT scores. Affective use justifications were associated with less PBS use, more cannabis use, and higher CUDIT scores. Indirect pathways linking both somatic and affective use justifications with CUDIT score through PBS were statistically significant. CONCLUSIONS:Findings indicate that somatic justifications for cannabis use among older adults are associated with use of protective behaviors that reduce the risk for CUD symptoms, while affective motives suggest higher risk for CUD symptoms. These findings support the common practice of referring older adults with mental health concerns for conventional treatment, including evidence-based psychotherapy. Training in PBS use may mitigate escalation of CUD symptoms in this vulnerable population, and future research should examine that hypothesis.
OBJECTIVE:Although the relationship between childhood maltreatment (CM) and obsessive-compulsive disorder (OCD) is well known, no studies to date have examined the potential mediating roles of thought-action fusion (TAF) and schizotypal traits in the relationship between CM and OCD. In this study, we investigated whether TAF and/or schizotypal traits mediate the association between CM subtypes and OCD. METHOD:This study was conducted in 83 patients (18-65 years) with OCD. Participants completed Yale Brown Obsessive-Compulsive Scale (YBOCS) Childhood Trauma Questionnaire-Short Form (CTQ-SF), Thought-Action Fusion Scale (TAFS), and Schizotypal Personality Questionnaire-Brief (SPQ-B). Descriptive, correlational, and mediation analyses were used to determine the extent of the relationship between CM and OCD. RESULTS:The YBOCS scores showed significant correlations with SPQ-B total and SPQ-B interpersonal traits. Positive correlations were found between the YBOCS scores and emotional abuse, physical abuse, and emotional neglect. Emotional abuse was associated with cognitive, perceptual, and disorganized traits and TAF subscales. Emotional neglect was significantly associated with SPQ-B total, interpersonal, and cognitive-perceptual traits, as well as TAF likelihood-self. The mediation analysis indicated that the SPQ-B total significantly mediated the relationship between emotional abuse and emotional neglect and the YBOCS total. CONCLUSIONS:Contrary to expectations, neither moral nor the likelihood dimensions of TAF were significantly associated with OCD severity. As hypothesized, the indirect effects of emotional abuse and emotional neglect on OCD through total schizotypy were significant. Clinicians treating individuals who develop new or worsening OCD following maltreatment exposure should consider the role of schizotypal traits for treatment.
OBJECTIVE:This study examined the associations between childhood emotional maltreatment (CEM) and healthy diet among university students, and tested the roles of depression and physical exercise using a conditional process framework. METHOD:A cross-sectional survey was conducted among 3,007 Chinese undergraduates (42.1% male; mean age = 19.03 ± 1.18 years). CEM, depressive symptoms (PHQ-2), physical exercise, and healthy diet were assessed via self-report. Demographic variables were controlled. PROCESS macro Model 14 in SPSS 29.0 was used with 5,000 bootstrap samples to test moderated mediation models. RESULTS:Across three independently estimated models (overall CEM, childhood emotional abuse, and childhood emotional neglect), CEM and its subdimensions were positively associated with depressive symptoms (β = 0.300-0.373, p < .001) and negatively associated with healthy diet (β = -0.192 to -0.222, p < .001). Depression was negatively associated with healthy diet (β = -0.148 to -0.162, p < .001) and statistically mediated the association between CEM and healthy diet. Physical exercise was positively associated with healthy diet (β = 0.174-0.175, p < .001) and showed a small but significant moderating association in the depression-healthy diet relationship in the overall CEM and emotional abuse models, but not in the emotional neglect model. CONCLUSIONS:CEM was associated with poorer healthy diet partly through elevated depressive symptoms. Physical exercise demonstrated a limited buffering association. These findings underscore the relevance of integrating psychological support with physical activity and nutrition interventions to promote healthier eating among university students.
ObjectiveThe aim of this study was to evaluate the relationships between attempted suicide and depression, non-suicidal self-injury, temperament, defence styles, and impulsivity Method: The study included 60 individuals aged 18-60 years who had attempted suicide (30 diagnosed with depressive disorder and 30 without mental disorder), recruited from referrals, walk-in clinics, and inpatients, all of whom had normal mental capacity, were not using drugs that could affect cognitive functions, and had no physical or neurological disease, as well as 30 healthy controls. The Temperament Evaluation Inventory, the Defense Style Questionnaire, and the Beck Depression Inventory were administered to all participants. The Tower of London test and the Go/NoGo test were applied as neuropsychological tests. Results: The suicide attempters were found to have higher levels of dysthymic temperament (p=0.003), irritable temperament (p=0.025), anxious temperament (p=0.008), and non suicidal self-injury (p=0.000) than the healthy controls. Those with a history of attempted suicide used immature defences more than the healthy controls (p=0.003). In the group of all attempted suicides, the scores for attention deficits and impulsivity were found to be higher than those of the healthy controls. The Go/NoGo test was determined to be able to differentiate those with attempted suicide from the controls (p=0.041). Conclusions: The study findings showed that temperament characteristics, non-suicidal self-injury, executive function deficits, and impulsivity could be risk factors for suicide attempts. Depressed suicide attempters exhibited greater deficits in planning and problem-solving.This study provides evidence regarding the usability of neurocognitive tests in evaluating future suicide risk. Key Words: Attempted suicide, temperament, defence styles, executive functions, non-suicidal self-injury.
ObjectiveChildhood maltreatment is a well-established risk factor for the development of mental disorders. Interpretation bias has been proposed as a potential mechanism mediating the relationship between childhood maltreatment and subsequent psychopathology. This study investigated differences in interpretation bias and psychopathology symptoms based on experiences of childhood abuse and neglect. It also examined whether interpretation bias mediates the relationship between childhood maltreatment and symptoms of psychopathology using network analysis.Methods:A cross-sectional sample of 123 university students aged 19 to 25 participated. Childhood maltreatment was assessed using the Childhood Maltreatment Experiences Scale, and psychopathological symptoms were measured with the Symptom Checklist-90-Revised. Interpretation bias was assessed using a facial emotion judgment task involving morphed anger-happiness and anger-sadness expressions presented at varying intensity levels.Results:Participants with a history of abuse were more likely to interpret ambiguous anger-happiness expressions as anger, especially at the most ambiguous levels, and reported higher symptoms across all domains of psychopathology compared to those without maltreatment experiences. Participants with a history of neglect showed elevated depression and paranoid ideation but did not show significant interpretation bias. Network analysis revealed that abuse was directly connected to interpretation bias, somatization, and phobic anxiety. Interpretation bias and somatization served as bridge nodes, with anxiety emerging as the most central symptom.Conclusions:Interpretation bias may serve as a transdiagnostic factor linking childhood abuse to various forms of psychopathology, highlighting its importance for early identification and intervention in individuals with childhood abuse histories.
ObjectiveIdentification-the experience of perceiving oneself as like another-is a central process in human relatedness, empathy, and emotion regulation. Although well-established in psychoanalytic and developmental theory, its function under stress and trauma has received limited systematic attention. This paper integrates interpersonal, cognitive, and neurobiological perspectives to conceptualize identification as a core mental operation and to propose thinking by similarity as its underlying cognitive process.MethodThrough focused conceptual synthesis, the manuscript draws on psychoanalytic, developmental, social-cognitive, and neurobiological research to examine the origins, mechanisms, and manifestations of identification across the life span and following high-stress and traumatic events.ResultsIdentification emerges early in development through attachment and imitation, shaping empathy and social understanding. Neurobiological evidence, including mirror neurons and limbic system activation, demonstrates shared brain activations that ground identification biologically. Under threat or trauma, cognition may shift to thinking by similarity, facilitating appraisal of safety and danger but also increasing vulnerability to distress and cognitive rigidity. Following traumatic events, this process may yield adaptive empathy and solidarity or maladaptive over-identification with victims and aggressors and posttraumatic stress disorder.ConclusionsIdentification is a fundamental psychological and neurobiological process. The concept of identification as thinking by similarity offers a unifying linking of psychodynamic, developmental, and neurobiological models. This framework advances understanding of empathy, resilience, and vulnerability under stress, with implications for trauma-informed clinical practice and research.
ObjectiveLittle is known about the day-to-day variation in suicide ideation (SI) associated with posttraumatic stress disorder (PTSD). This study examined daily variations in SI frequency and intensity in individuals with and without PTSD. Methods: Using an ecological momentary assessment methodology, participants (N = 156; 78 with probable PTSD, 78 without PTSD) completed self-report assessments of SI four times daily for 15 days. SI was measured by Patient Health Questionnaire (PHQ-9) item 9. The SI assessment adherence rate was 80.0%. For each person, overall and daily measures of frequency of endorsing SI (FSI), mean SI intensity (MSI intensity; range 0-10), and highest SI intensity (HSI intensity; range 0-10) were obtained. Linear mixed models were used to examine associations between the 7 days of the week and weekday/weekend variations in FSI, MSI intensity, and HSI intensity and PTSD. Results: Individuals with PTSD (vs. those without) reported a higher overall FSI (23.2% vs. 2.0%, t = 5.44, p < .001), MSI intensity (1.01 vs. 0.04, t = 4.17, p < .001), and HSI intensity (3.26 vs. 0.87, t = 4.97, p < .001). Among those with PTSD and SI, 10.9% had overall MSI intensity scores between 5 and 10 (range 0-10) and 32.6% had overall HSI intensity scores of 8-10. Among the latter group, the overall HSI intensity was episodic for 60.0% and persistent for 40.0% of individuals. No day of the week or weekday versus weekend differences were found. Conclusions: Understanding the characteristics of SI frequency and intensity will aid in understanding the transition from SI to suicide attempts and may inform interventions and clinical care.
ObjectiveWe assessed the impact of the COVID-19 pandemic on the implementation of a peer-integrated enhancement of integrated clinical care intervention to address the mental health needs of 450 patients undergoing treatment for a physical injury.MethodsQualitative data were collected by 7 clinician investigators of a randomized controlled trial acting as participant observers in a trauma care setting of a major U.S. metropolitan hospital and analyzed in collaboration with an external mixed methods specialist.ResultsThe pandemic created or exacerbated several implementation barriers, including increased risk of infection, homelessness, hospitalizations and comorbid conditions such as fentanyl overdoses that increased demand on emergency department and Trauma Center services, imposition of safety measures to reduce risk of infection in clinical settings, transition from face-to-face to virtual interactions with study patients, shortages of specialty mental health providers, suspension of recruitment of patients into the study, scheduling calls with patients, and an increased workload for the study clinical interventionists. Peer specialists perceived the transition to virtual interactions with patients reduced their effectiveness; however, this was not reflected in assessments of patient satisfaction with services received and may have inadvertently increased adoption by Trauma Center staff. Reduction in reach of the intervention to target population was temporary.ConclusionsThe COVID-19 pandemic exacerbated existing barriers and created new barriers to successfully implementing evidence-based practices in trauma care settings, resulting in an attenuation of their effectiveness. However, the shift from face-to-face to virtual services delivery may have actually led to improved implementation outcomes.Trial RegistrationClinicalTrials.gov identifier: NCT03569878. Registered June 15, 2018.
OBJECTIVE:Digital social technologies, such as social media and online multiplayer video games (MVGs), have ushered in an era of peer relationships that evolve online, in addition to in person. This report reviews existing research about the dual role of social media and MVGs in shaping youth social connectedness, recognizing both their potential benefits and their associated risks on youth mental health. By providing evidence-based insights, it aims to inform strategies that optimize these technologies' advantages while safeguarding youth mental health and well-being. METHOD:This report reviews peer-reviewed literature, clinical recommendations, reports, and surveys that assess youth usage of social media and MVGs and their associated psychological and physical health outcomes. RESULTS:Social media provides many opportunities for peer connection, including self-expression and social support, fostering positive social development and well-being. MVGs combine entertainment with collaboration, further strengthening social bonds. However, the use of these technologies has also been linked to negative outcomes, including social isolation, depression, anxiety, and sleep disorders. Publically-available, evidence-based resources can provide caregivers and professionals with guidance and clinical recommendations regarding youth social media and MVG use. CONCLUSIONS:Digital social technologies have become increasingly user-specific and immersive as the internet evolves and social media algorithms become more powerful. Additional research is required to understand how current youth usage of these technologies impacts physical and psychological outcomes. Future research should also investigate the differences in usage, outcomes, and the efficacy of treatments across youth sex and age.
