Forgiveness, depression, and suicidal behavior among a diverse sample of college students

Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.     

From Marianism to terrorism: the many faces of violence against women in Latin America

Summary ¶Violence against women is widespread and highly tolerated in Latin America. In this paper, I will argue that this is because violence stems from deep cultural roots and because women are brought up in a patriarchal familial organization which promotes passivity and dependence. Traditional religious culture, which poses the Virgin Mary figure as role model, is ambivalent and distorted, repressing sex while overvaluing motherhood and self denial and demeaning women who do not conform to the established stereotypes. Patriarchal violence has serious emotional consequences for women. The stressful violent circumstances in womens lives lead to increased drug abuse that further exposes them to police and institutional violence. Political instability and civil wars in South America have caused many deaths, and have left many women with traumatic sequelae. Efforts at improving quality of life and diminishing violent conditions for women and girls in Latin America should include consideration of local cultural, political and economic peculiarities.Received December 18, 2002; accepted January 26, 2003 Published online April 17, 2003     

Health professionals’ perceptions of intimate partner violence against women in Serbia: Opportunities and barriers for response improvement

Objective

The aim of this study was to determine the perceptions and attitudes of health professionals toward violence against women in intimate relationships, and to discuss them as opportunities and barriers for improving health professionals’ response.

Methods

Six focus groups were conducted with 71 health professionals employed in the public primary health care centers in Belgrade (Serbia). The data were analyzed according to the direct approach of the qualitative content analysis.

Results

Findings suggest that the majority of health professionals perceive IPV as an unjustifiable act. They showed an understanding for women; see their role as providing support to women and collaborating with other institutions. They are willing to help, but do not know how. However, some health professionals appeared to be judgmental in terms of what preceded violence, and would insist on extracting a woman's disclosure that violence had occurred. As barriers, they emphasized the lack of training and specific education on IPV, a weak support network, and overall social insecurity.

Conclusion

There is a gap between health professionals’ willingness to help and resources needed, along with prejudice and interrogative attitudes. Barriers appeared at individual, organizational and societal levels.

Practice implications

Proper education and protocols are priorities in strengthening health professionals’ response to IPV.     

Indirect (chronic) self-destructiveness and modes of suicide attempts

Introduction

Suicides and suicide attempts may be considered as manifestations not only of direct self-destructiveness, but also of indirect (chronic) self-destructiveness. The aim of this work is to assess the relation between intensity of indirect self-destructiveness and suicide attempt modes.

Material and methods

The research was conducted among 147 persons after suicide attempts (114 women and 33 men) aged 14-33 years. The Polish version of the “Chronic Self-Destructiveness Scale” by Kelley (CS-DS) in Suchańska''s adaptation was used.

Results

Examined persons applied several modes of committing suicide: pharmacological drugs, exsanguination, hanging, jumping from a height, asphyxia, poisoning, and throwing oneself under a moving car. The most frequent are pharmacological drugs (42.31%) and exsanguination (25.60%); the rarest is throwing oneself under a car (1.28%). Relations between indirect self-destructiveness and the following suicide attempt modes were found: pharmacological drugs (0.366, p = 0.00001), poisoning (0.667, p = 0.01), and throwing oneself under a car (0.542, p = 0.04). There were found three clusters regarding the intensity of indirect self-destructiveness (low, medium and high). The largest differences concerned hanging, jumping from a height (medium CS-DS), poisoning and throwing oneself under a car (high CS-DS). There is a relation between indirect self-destructiveness and recurrence of suicide attempts (Kendall Tau = 0.217, p = 0.007); the intensity of indirect self-destructiveness differentiates the risk of consecutive suicide attempts (F = 2.871, p = 0.05).

Conclusions

The implications of the findings are mainly of preventive and therapeutic nature. In the preventative aspect, the subject of interest should be not only persons with a tendency to the active form of indirect self-destructiveness, but also persons exhibiting its passive form.     

Risk behaviors,suicidal ideation and suicide attempts in a nationally representative French sample

Background

Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women.

Methods

Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15–85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used.

Results

Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women.

Limitations

Cross-sectional survey.

Conclusion

The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior.     

Psychological and physical sequelae of intimate partner violence among women with limitations in their activities of daily living

Summary Objective: To compare the psychological and physical sequelae of physical/sexual intimate partner violence in women with and without activity limitations. Methods: We analyzed data from the Canadian 1999 General Social Survey. We included women reporting intimate partner violence in the previous 5 years (n = 897). Results: As a result of the violence, women with activity limitations were significantly more likely to feel ashamed/guilty (21.7 vs. 14.5%), depression/anxiety (31.5 vs. 19.8%), fearful (43.0 vs. 33.0%), lowered self-esteem (35.2 vs. 21.1%), increased caution/awareness (20.3 vs. 10.9%), and problems relating to men (16.4 vs. 5.4%). Significantly more women with activity limitations reported physical injury from violence (57.0 vs. 36.6%) and having to take time off from everyday activities (42.1 vs. 30.3%). Women with activity limitations had higher medication use for sleeping problems (OR = 3.17, 95% CI = 1.36, 5.73), anxiety (OR = 3.29, 95% CI = 1.75, 6.19) and depression (OR = 2.63, 95% CI = 1.41, 4.90). Conclusion: Results suggest an additive effect between intimate partner violence and activity limitations that adds disproportionately to the burden of health for women with activity limitations.     

Movement and sport therapy with women in Guatemalan context of violence and conflict

The programme of ‘psychosocial activity through movement, games and sport with women’ (APM) who suffer or suffered violence was developed and evaluated with two groups of Mayan women in rural area of Guatemala. We highlight the use of principals and methods of movement and sport therapy, a psychosocial approach, participatory group techniques, cultural sensitive methodologies and the model of Salutogenesis. Both qualitative (participatory observation, semi-structured interviews) and quantitative (questionnaire) research methods were used. Through ongoing evaluation we analysed key factors and intervention processes, based on verbal and non-verbal techniques. The outcome evaluation showed significant improvements on several psychosocial health aspects (Sense of Coherence, self-esteem).     

Childhood emotional abuse,self/other attachment,and hopelessness in African-American women

There is evidence that individuals emotionally abused as children endorse more hopelessness, a precursor of suicidal behavior in adulthood. However, there has been little focus on this association among African-Americans or on factors that may mediate the childhood emotional abuse (CEA) – adult hopelessness link. The present study examined whether CEA is linked to hopelessness in adulthood in African-American women suicide attempters and if adult self and other attachment models mediate this association. Participants included 116 African-American women recruited from a large, urban hospital. Results revealed that CEA had no direct effect on hopelessness in adulthood, but did have an indirect effect on hopelessness through attachment models. Bootstrapping analyses showed that higher levels of CEA were related to more negative self and other attachment models, which were then linked to higher levels of hopelessness. Implications for targeting attachment in suicide intervention programs are discussed.     

Intimate partner violence and health outcomes in mid-life women: a population-based cohort study

Summary Aim: To investigate the association between experience of intimate partner violence (IPV) and health outcomes measured prospectively. Method: Eleven-year prospective study of a population-based cohort of 438 Australian-born women aged 45–55 years at baseline (in 1991). Annual face-to-face interviews measured health status and quality of life; questionnaires on intimate partner physical, emotional and sexual violence and on experiences of childhood abuse completed in year 6 of follow-up. Results: In year 11 of follow-up 233 women (mean age 59.9 SD 2.5 years) were interviewed of whom 62 (27%) reported experiencing physical and/or emotional and/or sexual IPV prior to the 6^th year of follow-up. In bi-variate analysis a history of IPV was significantly associated with mental and sexual health variables and marital status at baseline and follow-up. Multivariate analysis found that at follow-up after allowing for baseline measures and other co-variates: Frequency of Sexual Activities was lower in women who had experienced IPV (p < 0.05); and negative mood was higher in women with the experience of IPV during the 12 months prior to completing the violence questionnaire (p < 0.05). Conclusion: IPV was a significant contributor to mental and sexual health status measured prospectively in this cohort of mid-aged Australian-born women.     

Differences in suicide risk correlates and history of suicide ideation and attempts as a function of disability type

Background

Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts).

Aims

This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type.

Methods

Individuals with mobility and vision disabilities (N = 102) completed semistructured interviews and online-based questionnaires. Analysis of variance/analysis of covaiance and Fisher's exact tests were conducted to examine whether mean levels of suicide-related correlates differed significantly between individuals with blindness/low vision (n = 63) versus mobility-related (n = 39) disabilities.

Results

No significant between-group differences were observed for most outcomes; however, individuals with vision disabilities reported higher mean levels of felt stigma and positive future disposition than those with mobility-related disabilities.

Limitations

The limited representation of disabilities among participants precludes generalization to individuals with other forms of disability and the cross-sectional design prevents inference about causality.

Conclusions

Interventions targeting cognitive processes that underlie suicide risk may be applicable to people with mobility and vision disabilities.     

Reexperiencing symptoms and the interpersonal-psychological theory of suicidal behavior among deployed service members evaluated for traumatic brain injury

Recent evidence suggests that military suicide rates now exceed those of the general public. Numerous recent efforts to address this growing concern have focused on the interpersonal psychological theory of suicidal behavior (IPTS). In the current study, we explored the relationships among reexperiencing symptoms of posttraumatic stress disorder and the three components of the IPTS in a sample of deployed military personnel examined for traumatic brain injury. Results indicated that reexperiencing symptoms were directly related to the acquired capability for suicide, but their relationships to perceived burdensomeness and thwarted belongingness were statistically explained by general mental health distress. Results indicate that mental rehearsal of painful and provocative experiences may have an impact on suicide risk.     

Recurrent suicide attempts in patients with depressive and anxiety disorders: The role of borderline personality traits

Background

The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts.

Methods

The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics).

Results

In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309).

Limitations

The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time.

Conclusions

Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patient's coping skills with regard to anger.     

No association of the tryptophan hydroxylase gene with bipolar affective disorder,unipolar affective disorder,or suicidal behaviour in major affective disorder

Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of 5-hydroxytryptamine (5-HT). An association study in bipolar affective disorder I or unipolar major affective disorder was performed by using a Bfa I restriction site polymorphism within intron 7 of the tryptophan hydroxylase gene. A total of 118 bipolar, 125 unipolar, and 437 control subjects were used in the study (1:3.7 bipolar:control, 1:3.5 unipolar:control). There were no significant differences in TPH allele or genotype frequencies between the affective disorder and control groups. In addition, bipolar and/or unipolar subjects with or without a history of suicide attempts were compared for the TPH polymorphism. No significant differences were found between suicidal and nonsuicidal groups in major affective disorder, in contrast to a previous study suggesting an association of this polymorphism with a history of suicide attempts among alcoholic violent offenders. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 81:245–247, 1998. © 1998 Wiley-Liss, Inc.     

Pain avoidance and functional connectivity between insula and amygdala identifies suicidal attempters in patients with major depressive disorder using machine learning

Pain avoidance can effectively classify suicide attempters from non-attempters among patients with major depressive disorder (MDD). However, the neural circuits underlying pain processing in suicide attempters have not been described comprehensively. In Study 1, we recruited MDD patients with a history of suicide attempts (MDD-SA), and those without (MDD-NSA) to examine the patterns of psychological pain using the latent profile analysis. Further, in Study 2, participants including the MDD-SA, MDD-NSA, and healthy controls underwent resting-state functional magnetic resonance imaging. We used machine learning that included features of gray matter volume (GMV), the functional connectivity (FC) brain patterns of the region of interest, and behavioral data to identify suicide attempters. The results identified three latent classes of psychological pain in MDD patients: the low pain class (18.9%), the painful feeling class (37.2%), and the pain avoidance class (43.9%). Furthermore, the proportion of suicide attempters with high pain avoidance was the highest. The accuracy of multimodality classifiers (63%–92%) was significantly higher than that of brain-only classifiers (56%–85%) and behavior-only classifiers (64%–73%). Pain avoidance ranked first in the optimal feature set of the suicide attempt classification model. The crucial brain imaging features were FC between the left amygdala and right insula, right orbitofrontal and left thalamus, left anterior cingulate cortex and left insula, right orbitofrontal, amygdala, and the GMV of right thalamus. Additionally, the optimal feature set, including pain avoidance and crucial brain patterns of psychological pain neural circuits, was provided for the identification of suicide attempters.     

SNAT1 and a family with high rates of suicidal behavior

Several lines of evidence suggest that suicide may have, in part, a genetic predisposition. In this study, we identified a family with high rates of suicidal behavior and assessed brain gene expression levels in the proband. A neuronally-expressed solute carrier for glutamine (Sodium-coupled neutral amino acid transporter 1 (SNAT1), also known as solute carrier family 38, member 1 (SLC38A1)) was identified as severely decreased across all brain regions. Follow-up analysis by semi-quantitative polymerase chain reaction (qPCR) and Western blot confirmed the reduction of SNAT1. We categorized the SNAT1 gene in human brain, cloned the gene promoter and assessed in silico the expression pattern of SNAT1 in >25 tissues from human. Complete DNA sequencing of the SNAT1 gene was performed in the family and 276 controls. The family was homozygous for rare alleles which suggests a possible association between low expression of SNAT1 and suicidal behavior.