A two-year review of suicide ideation assessments among medical,nursing, and pharmacy students

Suicide is the 10th leading cause of death in the U.S. and has increased in prevalence during the past 15 years. Patients who attempt suicide are more likely to have contact with their primary care provider than a mental health provider in the month before attempting suicide, highlighting the need for competency in suicide ideation (SI) assessment. The Communications Skills for Health Professionals is an interprofessional course involving first-year medical, nursing, and pharmacy students. Specific instruction regarding assessment of SI was delivered through an online module and later practiced by students with standardized patients (SP). A final Objective Structured Clinical Examination featured an SP with depression, but without SI, though an assessment of SI was indicated. Three hundred fifty six interviews were reviewed and 55.1% (196/356) of students assessed for SI. Across professions, 65.5% (93/142) of medical students, 52.5% (32/61) of nursing students, and 46.4% (71/153) of pharmacy students performed an assessment. Medical students’ SI assessment was highest across the groups (p = 0.001), while pharmacy students’ SI assessment was lowest (p = 0.004). Results suggest that additional educational strategies should be developed and implemented to increase SI assessment performance in all professions, but especially in pharmacy students.     

Psychosocial and socio-demographic factors associated with outcomes for patients undergoing rehabilitation for chronic whiplash associated disorders: A pilot study

Purpose. Identify psychosocial and socio-demographic factors (measured prior to treatment) that were associated with post-treatment self-perceived pain and disability and two secondary outcomes: psychological distress, and return to work in patients undergoing multidisciplinary rehabilitation for chronic whiplash associated disorders (WAD).

Method. Interviews were conducted with 28 patients with chronic WAD at entry to and completion of an intensive rehabilitation program, and a telephone interview was carried out three months later. Participants completed pain and disability, and psychological distress questionnaires, at baseline and at both follow-ups. They also completed psychosocial questionnaires and provided socio-demographic information. The effect of each of the independent variables on the outcomes was first evaluated by simple regressions, and then subsequently by multiple regression analysis.

Results. Higher baseline pain and disability predicted higher pain and disability at both follow-ups (p < 0.001), and higher psychological distress at program completion (p = 0.003). Younger age (p = 0.028) and higher baseline psychological distress (p = 0.002) were associated with higher psychological distress three months post-rehabilitation. Greater social support at work was prognostic of return to work at program completion (p = 0.04).

Conclusions. Baseline pain and disability was the only factor that affected pain and disability post-rehabilitation. Psychosocial factors played a role in the prognosis of psychological distress and return to work.     

Needs and Strengths Associated With Acute Suicidal Ideation and Behavior in a Sample of Adolescents in Mental Health Treatment: Youth and Family Correlates

This study examined a comprehensive set of adolescent and family needs and strengths associated with acute suicidal ideation and/or behavior among youth using mental health services in Indiana (U.S.). Youth (n = 3292) were assessed with the Child and Adolescent Needs and Strengths questionnaire. Findings revealed that mental health issues (depression, psychosis) were the most important cofactors of acute suicidal ideation and/or behavior, followed by high-risk behaviors and psychosocial adjustment (nonsuicidal self-injury, harmful behavior, aggression, sleep disruption), and strengths (optimism). Family and caregiver needs were not significant predictors after controlling for other variables. Prevention and outpatient treatment among adolescents should encompass a wide array of individual needs and strengths.     

Suicidal thinking in multiple sclerosis

Purpose.?Studies demonstrate that suicidal ideation ((SI)) is greater in persons with multiple sclerosis ((MS)) than in the general population. SI may offer some MS patients a mechanism for feeling in control of their lives, in the face of a daunting, unpredictable disease. In this study, we determined what specific mental constructs or perceptual themes occur for MS patients experiencing SI, while also examining the construct of ‘control’ as a central theme.

Methods.?Individual interviews ((N == 16)) were audiotaped, transcribed and qualitatively analysed by two independent raters to test for key themes in MS patients reporting SI.

Results. In relation to SI, eight key themes were identified by both raters as having been expressed in interviews: perceived loss of control, increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control and failure to achieve desired or expected role functioning. We created a model to explain the emergence of these themes as they contribute to SI among patients with MS. All participants indicated that perceived loss of control elicited thoughts of suicide.

Conclusion.?Perceived loss of control appears to be a major disease related burden associated with SI in MS patients.     

RELATIONSHIPS OF FAMILY FUNCTIONING,SELF-ESTEEM,AND RESOURCEFUL COPING OF THAI ADOLESCENTS WITH ASTHMA

Within the context of Rosenbaum's theory of learned resourcefulness, this correlational study examined the relationships among family functioning, self-esteem, and resourceful coping in Thai adolescents with asthma. A convenience sample of 132 Thai adolescents (aged 12–17 years) with asthma was recruited from the outpatient asthma clinics of four hospitals in Bangkok. Self-administered questionnaires included an assessment of demographic information and asthma status, the revised Family APGAR, the Rosenberg Self-Esteem Scale, and the Children's Self-Control Scale. Hierarchical multiple regression analysis was used to examine the relationships among variables. Effective family functioning had a significant positive effect on self-esteem (β = .27, p < .01) and resourceful coping (β = .30, p < .01), controlling for gender and age. However, self-esteem was not significantly correlated with resourceful coping (β = .15, p = .08). The findings suggest that nursing interventions should take into account the role of family functioning in promoting self-esteem and resourceful coping in Thai adolescents with asthma. Recommendations for future research include replication of the study with a larger sample of adolescents with asthma and with adolescents with other chronic illnesses.     

Optimism Reduces Suicidal Ideation and Weakens the Effect of Hopelessness Among Military Personnel

Suicide risk is an issue of increasing concern among military personnel. To date, most studies have focused on identifying risk factors for suicide in military personnel, but have by and large overlooked possible protective factors that reduce suicide risk, such as optimism. In a clinical sample of 97 treatment-seeking active duty Air Force personnel, the protective effects of optimism on suicidal ideation was investigated by considering the direct effect of optimism on suicidal ideation as well as the possible moderating effects of optimism on several suicide risk factors: depression, posttraumatic stress, and hopelessness. When adjusting for demographic and clinical covariates, results of multiple regression indicated that optimism was significantly associated with less severe depression, hopelessness, and suicidal ideation, but not posttraumatic stress symptoms. The interaction of optimism with hopelessness was also significant, and indicated that severe hopelessness contributed to more severe suicidal ideation only among participants with low levels of optimism. Results suggest that optimism is associated with less severe suicidal ideation, and buffer the effects of hopelessness among military patients.     

General psychological acceptance and chronic pain: There is more to accept than the pain itself

An increasing body of research demonstrates that acceptance of pain is significantly associated with the quality of daily functioning in people with chronic pain. The aim of the present study was to examine acceptance more broadly in relation to a wider range of undesirable experiences these people may encounter, such as other physical symptoms, experiences of emotional distress, or distressing thoughts. One hundred forty‐four, consecutive, adult patients attending interdisciplinary treatment for chronic pain participated in this study. They completed the Acceptance and Action Questionnaire‐II (AAQ‐II [Bond F, Hayes SC, Baer RA, Carpenter KM, Orcutt HK, Waltz T, Zettle RD. Preliminary psychometric properties of the Acceptance Action Questionnaire‐II: a revised measure of psychological flexibility and acceptance, submitted for publication]), measuring their general psychological acceptance. They also completed measures of emotional, physical, and psychosocial functioning, pain acceptance, and mindfulness. The AAQ‐II achieved satisfactory internal consistency, α = .89, and factor analysis revealed a unitary factor structure. Primary results showed that general psychological acceptance significantly correlated with depression, r = −.69, pain‐related anxiety, r = −.59, physical disability, r = −.42, and psychosocial disability, r = −.65, all p < .001. Hierarchical regression analyses showed that general psychological acceptance added a significant increment of explained variance to the prediction of patient functioning, independent of patient background characteristics, pain, acceptance of pain, and mindfulness. These results suggest that, when people with chronic pain are willing to have undesirable psychological experiences without attempting to control them, they may function better and suffer less. General acceptance may have a unique role to play in the disability and suffering of chronic pain beyond similar processes such as acceptance of pain or mindfulness.     

Age‐Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center Study

Background: Common psychological adjustment difficulties have been identified for groups of implantable cardioverter defibrillator patients, such as those who are young (<50 years old), have been shocked, and are female. Specific aspects and concerns, such as fears of death or shock and body image concerns, that increase the chance of distress, have not been examined in different aged female implantable cardioverter defibrillator (ICD) recipients. The aim of the study was to investigate these areas of adjustment across three age groups of women from multiple centers. Methods: Eighty‐eight female ICD patients were recruited at three medical centers: Shands Hospital at the University of Florida, Brigham and Women's Hospital in Boston, and Royal North Shore Hospital in Sydney, Australia. Women completed individual psychological assessment batteries, measuring the constructs of shock anxiety, death anxiety, and body image concerns. Medical record review was conducted for all patients regarding cardiac illnesses and ICD‐specific data. Results: Multivariate and univariate analyses of variance revealed that younger women reported significantly higher rates of shock and death anxiety (Pillai's F = 3.053, P = 0.018, η²_p= 0.067) and significantly greater body image concerns (Pillai's F = 4.198, P = 0.018, η²_p= 0.090) than middle‐ and older‐aged women. Conclusions: Women under the age of 50 appear to be at greater risk for the development of psychosocial distress associated with shock anxiety, death anxiety, and body image. Clinical‐based strategies and interventions targeting these types of adjustment difficulties in younger women may allow for improved psychosocial and quality of life outcomes.     

Anxiety and coping in patients with chronic work-related muscular pain and patients with fibromyalgia

The aims of this study were: (1) to compare two groups of patients with chronic pain conditions (work-related muscular pain, mainly low back pain, and fibromyalgia) in general coping and pain-specific coping; (2) to examine the relationship between general and pain-specific coping and, (3) to examine the influence of state-trait anxiety on general and pain-specific coping. The sample included 80 individuals (range = 19–70 years; mean = 47; SD = 9.9), who were patients at two pain management clinics for examination of their physical and psychosocial health conditions and consideration on disability pension. The patients were asked to respond to the Strategies to Handle Stress Questionnaire, the Coping Strategies Questionnaire and the State-Trait Anxiety Inventory. Patients with fibromyalgia scored significantly higher on T-anxiety and adopted ‘problem-solving’ (p<0.01) and ‘catharsis’ (p<0.05) less often and ‘religion’ more often (p<0.01) than patients with work-related muscular pain in coping with stressful situations in general. No differences were revealed in pain-related coping between the groups. T-anxiety was positively correlated to pain-related “catastrophizing” (p<0.001) and negatively to abilities to control and reduce pain (p<0.05 and p<0.01, respectively). The correlation between general and pain-specific coping was weak to moderate. In conclusion, patients with fibromyalgia scored significantly higher on trait-anxiety and seem to interpret stressful situations as more threatening than patients with work-related muscular pain. Anxiety seems to be of central importance for coping with chronic pain. Anxiety-prone patients with fibromyalgia might benefit from psychological support in the process of coping with pain.     

Filling the glass: Effects of a positive psychology intervention on executive task performance in chronic pain patients

Background

Chronic pain is associated with emotional problems as well as difficulties in cognitive functioning. Prior experimental studies have shown that optimism, the tendency to expect that good things happen in the future, and positive emotions can counteract pain‐induced task performance deficits in healthy participants. More specifically, induced optimism was found to buffer against the negative effects of experimental pain on executive functioning. This clinical experiment examined whether this beneficial effect can be extended to a chronic pain population.

Methods

Patients (N = 122) were randomized to a positive psychology Internet‐based intervention (PPI; n = 74) or a waiting list control condition (WLC; n = 48). The PPI consisted of positive psychology exercises that particularly target optimism, positive emotions and self‐compassion.

Results

Results demonstrated that patients in the PPI condition scored higher on happiness, optimism, positive future expectancies, positive affect, self‐compassion and ability to live a desired life despite pain, and scored lower on pain catastrophizing, depression and anxiety compared to patients in the WLC condition. However, executive task performance did not improve following completion of the PPI, compared to the WLC condition.

Conclusions

Despite the lack of evidence that positive emotions and optimism can improve executive task performance in chronic pain patients, this study did convincingly demonstrate that it is possible to increase positive emotions and optimism in chronic pain patients with an online positive psychology intervention. It is imperative to further explore amendable psychological factors that may reduce the negative impact of pain on executive functioning.

Significance

We demonstrated that an Internet‐based positive psychology intervention strengthens optimism and positive emotions in chronic pain patients. These emotional improvements are not associated with improved executive task performance. As pain itself often cannot be relieved, it is imperative to have techniques to reduce the burden of living with chronic pain.     

Contact between patients with suicidal ideation and nurses in mental health wards: Development and psychometric evaluation of a questionnaire

Suicide prevention and treatment opportunities often depend on interpersonal contact between patients and professionals. Presently, there is a lack of valid and reliable instruments to obtain the perspective of patients with suicidal ideation regarding their contact with professionals in mental health wards. This was a three‐stage study to develop and psychometrically evaluate a questionnaire: the Contact with Nurses from the perspective of Patients with Suicidal ideation (CoNuPaS). First, the construct was defined by a systematic review, qualitative study, and face validity among experts. Second, the content was validated through a Delphi procedure with professional experts (n = 14) and cognitive interviews with hospitalized patients (n = 12). Third, using a sample of adult patients with suicidal ideation in the past year (n = 405), the psychometric properties were assessed by an exploratory factor analysis, a test‐retest procedure, and the internal consistency. The CoNuPaS comprises 23 items and two subsections, to examine patients’ perceptions of contact experiences with nurses (CoNuPaS‐experience) and what they find important in that contact (CoNuPaS‐importance). The subsections comprise four components: encountering a space to express suicidal thoughts and explore needs, being recognized as a unique and self‐determining individual, encountering nurses’ availability/information‐sharing/transparency on expectations, and trusting nurses in communication about suicidality. Content validity scores were excellent (0.78–1.00); test‐retest intraclass correlation coefficient and internal consistency were >0.90. Thus, the CoNuPaS demonstrated good psychometric properties. The availability of a valid questionnaire to examine patient‐nurse contact in mental health wards is central to improving understanding of nurses’ contributions to suicide prevention and suicidal ideation treatment.     

Use of age shock index in determining severity of illness in patients presenting to the emergency department with gastrointestinal bleeding

ObjectivesThis study aimed to make a comparison between classical shock index (SI), modified shock index (MSI), and age shock index (age SI) for predicting critical patients presenting to the emergency department (ED) with gastrointestinal bleeding (GIS).MethodsThe study, which was planned retrospectively, consisted of patients diagnosed with GIS bleeding at the ED admission. Triage time vital signs were used to calculate SI, MSI, and age SI. These results were compared with intensive care admission, endoscopic/colonoscopic (E/C) intervention, blood transfusion, and mortality criteria, which we define as adverse outcomes.ResultsThe study included 151 patients. Seventy-nine (52.32%) of the patients had at least one adverse outcome. Of the 151 patients, 19 (12.58%) had ICU admission, 27 (17.88%) underwent endoscopic/colonoscopic (E/C) intervention, 68 (45.03%) received a blood transfusion, and 6 (3.97%) died. There was a significant difference between patients who had no adverse outcome and those who had at least one adverse outcome in terms of SI, age SI, and MSI. We performed ROC curve analyses to evaluate the diagnostic performances of all indices for predicting adverse outcomes. AUC (area under the curve) values for age SI was the highest (age SI AUC = 0.711, p < 0.001; SI AUC = 0.616; MSI AUC = 0.617). The performance of the age SI was significantly higher than the SI (p = 0.013) and the MSI (p = 0.024) for predicting adverse outcomes. The cut-off value for the age shock index was 45.12.ConclusionsIn patients with GIS bleeding, age SI, which can be easily calculated in triage, is more significant than SI and MSI for predicting the critical patient.     

Disease knowledge and treatment adherence among patients with thalassemia major and their mothers in Taiwan

Aims. The current study had three aims: (i) to examine disease knowledge in both thalassemia major patients and their mothers; (ii) to understand the relationships between disease knowledge and treatment adherence in thalassemia major patients; and (iii) to explore the importance of selected factors in predicting patients’ knowledge about thalassemia major. Background. Patients with thalassemia major must be treated with life‐long blood transfusions. Evidence suggests that patients with more knowledge/information about their illnesses adhere more readily to treatment schedules. However, there has been little evaluation of knowledge and treatment adherence in thalassemia major patients. Design and methods. A cross‐sectional correlational survey design and purposive sampling were used. Thirty‐two thalassemia major patients (mean age 17·5 years) and 32 mothers (mean age 40·5 years) were recruited. Results. On a scale ranging from 0–20, the average of the patients’ disease knowledge about thalassemia major was 15·19 and the average of their mothers’ disease knowledge was 16·44. The scores for the patients’ disease knowledge about thalassemia major were positively correlated with follow‐up visit adherence (r = 0·690, p < 0·001) and with desferrioxamine infusion adherence (r = 0·791, p < 0·001). 95.6% of variance in patients’ knowledge was explained by a model that included mothers’ knowledge (β = 0·901, p < 0·001), follow‐up visit adherence (β = 0·084, p = 0·140) and annual household income (β = 0·042, p < 0·387). Conclusions. The positive association between knowledge and treatment adherence and factors of patients’ knowledge indicate the need for systematic education for patients and caregivers to improve adherence to treatment. Relevance to clinical practice. Improvement of the quality of patient care, reinforcement of medical education and enhanced efforts by clinical staff to provide practical knowledge to patients with thalassemia major should significantly improve patient adherence to treatment.     

Outcome of psychological treatment of patients with substance use disorders in routine care

Background: More knowledge is needed about outcome of treatments in routine care for patients with substance use disorders (SUDs). These patients often suffer from psychological distress in addition to SUDs. Objectives: To evaluate the effects of community-based psychological treatment on SUD patients’ psychosocial problems, as well as on their substance use. Design: All patients who were referred or self-referred for psychological treatment to a social worker or a psychotherapist at three outpatient treatment centers for SUD patients were asked to participate in the study. Methods: Ratings at treatment start and end were obtained on Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM, n = 100), Alcohol Use Disorders Identification Test - Consumption (AUDIT-C, n = 49), and Drug Use Disorders Identification Test - Consumption (DUDIT-C, n = 27). Results: CORE-OM mean scores were significantly improved. In total 14% of the patients were recovered, 10% improved, and 5% deteriorated. Both AUDIT-C and DUDIT-C mean scores were significantly improved for patients with alcohol use and patients using illicit drugs, respectively. Conclusions: Routine psychological treatment had positive effects on psychological distress as well as on reduction of substance use. A substantial number of patients remained however unchanged, particularly regarding psychological distress. More studies with larger patient groups are needed to develop treatment for SUD patients in routine care.     

DCE‐MRI in experimental chronic pancreatitis

To assess pancreatic perfusion in experimental chronic pancreatitis (CP) by dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI). DCE MRI on a 1.5 T MR scanner was performed on 21 piglets with the ligation of pancreatic duct. They were divided into four groups based on pathology, including seven normal pigs and seven, three and four piglets with grade I, II and III CP, respectively. The signal intensity measured in the pancreatic body on DCE MRI was plotted against time to create a signal intensity–time (SI–T) curve for each piglet. The steepest slope (SS), time‐to‐peak (TTP) and peak enhancement ratio (PER) of the SI–T curve were noted. In the four groups, on the SI–T curve derived from DCE MRI, the SS was, respectively, 10.88 ± 1.20, 10.59 ± 1.02, 6.67 ± 1.31 and 5.48 ± 1.97%/s (F = 20.509, p = 0.000) from normal piglets to piglets with grade III CP. The TTP was 13.82 ± 3.09, 12.31 ± 5.52, 20.55 ± 3.79 and 37.26 ± 14.56 s (F = 10.681, p = 0.000) and the PER was 62.95 ± 20.20, 60.44 ± 20.00, 46.33 ± 22.70 and 67.65 ± 32.66% (F = 0.529, p = 0.668), respectively. The SS (r = –0.719, p = 0.000) and TTP (r = 0.538, p = 0.012) of the SI–T curve was correlated to the severity of CP, respectively. DCE MRI has a potential to diagnose moderate to advanced CP. The SS and TTP of the SI–T curve were correlated to the severity of CP. Copyright © 2009 John Wiley & Sons, Ltd.     

Physical Disability and the Interpersonal Theory of Suicide

Interpersonal Theory of Suicide constructs were examined in individuals with physical disabilities, a population identified as having heightened suicidal ideation. Students (N = 184) answered online-based self-report questionnaires. Students with physical disabilities (n = 49) were expected to endorse higher levels of constructs relative to other students (n = 133). Analyses of covariance indicated that those with disabilities reported higher perceived burdensomeness, but not thwarted belongingness, fearlessness about death, or suicidal ideation. Suicide prevention efforts, particularly in university settings, may benefit from focusing on reducing perceived burdensomeness in this population, as these individuals may be at heightened risk.     

首发抑郁症伴自杀意念患者大脑功能连接时间动力学改变

目的 观察伴自杀意念(SI)首发抑郁症患者大脑功能连接(FC)的时间动力学改变。方法 前瞻性纳入57例首发抑郁症伴SI患者(SI组)、42例首发抑郁症不伴SI患者(NSI组)及48名健康志愿者(HC组),行脑功能MRI和抑郁症相关量表评估;根据FC密度(FCD)标准差量化整个大脑、大脑半球间及半球内动态FCD(dFCD)的时间变异性,分析FC时间动力学改变。结果 SI组汉密尔顿抑郁量表24项(HAMD-24)总分大于NSI组(P<0.05)。SI组左侧颞中回的全脑dFCD方差值高于NSI组和HC组(P均<0.05),SI组右侧颞中回半球内dFCD方差值高于HC组(P<0.05),而SI组和NSI组右侧额中回/额下回半球间dFCD方差值均低于HC组(P均<0.05)。结论 首发抑郁症伴SI患者额、颞叶FC存在动态改变。