Assessing the Links of Sexting,Cybervictimization, Depression,and Suicidal Ideation Among University Students

The main objective of this study was to analyze the direct and indirect relationships among sexting, cybervictimization, depression, and suicidal ideation. The sample consisted of 303 university students from Mexico (mean age?=?19.73, SD?=?1.73) who completed a questionnaire about the variables of interest. The relationships among the variables were analyzed using structural equation modeling. The results show that sexting was associated with being the victim of cyberbullying, which, in turn, was related to depressive symptoms. In addition, sexting, cybervictimization, and depressive symptoms were significantly associated with suicidal ideation. These results contribute to a better understanding of the relationship between online risk behaviors, such as sexting, and their possible negative consequences, such as cybervictimization, depression, and suicidal ideation.     

Effectiveness of Cognitive Behavioral Therapy for Veterans with Depression and Suicidal Ideation

The current study examined suicidal ideation (SI) and depression outcomes among Veterans receiving Cognitive Behavioral Therapy for depression (CBT–D) throughout the Department of Veterans Affairs health care system. Patient outcomes included Beck Depression Inventory–II total score and SI item. Of 902 patients, 427 (47%) had no SI, 405 (45%) had SI but no suicidal intent, 26 (3%) indicated suicidal desire, 8 (1%) indicated suicide intent if they had the chance, and 36 (4%) did not answer this question at session one. The odds of SI decreased by 64% from 1.03 at session one to 0.37 at final assessment (OR = 0.36; 95% CI: 0.31, 0.43). Findings reveal that CBT–D was associated with significant decreases in SI and depression among Veterans.     

No Relationship Between Serum Cholesterol and Suicidal Ideation and Depression in African-American Diabetics

ABSTRACT

Low serum cholesterol has been associated with suicidal behavior. Depression has been postulated to be a mediating factor between low serum cholesterol and suicidal behavior. Therefore, this possibility was examined in a large group of 459 diabetic patients that had blood drawn for serum cholesterol levels on the same day that they completed the Beck Depression Inventory. The results failed to show any significant relationship between serum cholesterol levels and either total Beck Depression Inventory (BDI) scores or BDI scores on the item measuring current suicidal ideation. The limitations of the study are discussed.     

Beyond the Usual Suspects: Positive Attitudes Towards Positive Symptoms Is Associated With Medication Noncompliance in Psychosis

Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.     

Comparative Effectiveness of Antipsychotics for Risk of Attempted or Completed Suicide Among Persons With Schizophrenia

ObjectiveThe objective of our study was to investigate the comparative effectiveness of antipsychotics for the risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. MethodsTwo nationwide register-based cohort studies were conducted, including all individuals with schizophrenia in Finland (n = 61 889) and Sweden (n=29 823). The main exposure was 10 most commonly used antipsychotic monotherapies; also, adjunctive pharmacotherapies were investigated. The main outcome measure was attempted or completed suicide, which was analyzed with within-individual models by comparing use and nonuse periods in the same individual to minimize selection bias. Sensitivity analyses included attempted suicide (hospitalization only) as an outcome. ResultsCompared with no use of antipsychotics, clozapine use was the only antipsychotic consistently associated with a decreased risk of suicidal outcomes. Hazard ratios (HRs) and 95% CIs for attempted or completed suicide were 0.64 (0.49–0.84) in the Finnish cohort and 0.66 (0.43–0.99) in the Swedish cohort. No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide. Benzodiazepines and Z-drugs were associated with an increased risk of attempted or completed suicide (HRs: 1.29–1.30 for benzodiazepines and 1.33–1.62 for Z-drugs). ConclusionClozapine was the only antipsychotic associated with decreased risk of attempted or completed suicide among patients with schizophrenia, and it should be considered as first-line treatment for high-risk patients.     

Prospective Study on Suicidal Ideation Among Japanese Undergraduate Students: Correlation with Stressful Life Events,Depression, and Depressogenic Cognitive Patterns

The present study examines the effects of stressful life events, depression, and depressogenic cognitive patterns on suicidal ideation in 500 Japanese undergraduate students. The above factors were assessed at baseline (T1) and two weeks later (T3). At T1, structural equation modeling confirmed that (1) cognitive patterns and depression, but not stressful life events, influence suicidal ideation, and (2) cognitive patterns also influence suicidal ideation through depression. These findings were confirmed in a longitudinal analysis. The results suggest that the effects of stressful life events on suicidal ideation are indirect and are mediated by depressogenic cognitive styles and depressed mood.     

The Clinical Antipsychotic Trials Of Intervention Effectiveness (CATIE) Schizophrenia Trial: clinical comparison of subgroups with and without the metabolic syndrome

The metabolic syndrome (MS) is highly prevalent among patients with schizophrenia (current estimates 35-40%), yet no data exist on the correlation of this diagnosis with illness severity, neurocognitive or quality of life measures in this population. METHODS: Using baseline data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial, assignment of MS status was performed using an updated definition derived from the National Cholesterol Education Program (NCEP) criteria. Those with and without MS were compared on the basis of primary and secondary variables of interest from baseline data encompassing psychiatric, neurocognitive and quality of life measures. RESULTS: Of 1460 subjects enrolled at baseline, MS status could be reliably assigned for 1231 subjects, with a prevalence of 35.8% using the NCEP derived criteria. After adjustment for age, gender, race, ethnicity and site variance, those with MS rated themselves significantly lower on physical health by SF-12 (p < .001), and scored higher on somatic preoccupation (PANSS item G1) (p = .03). There were no significant differences between the two cohorts on measures of symptom severity, depression, quality of life, neurocognition, or self-rated mental health. Neither years of antipsychotic exposure nor alcohol usage were significant predictors of MS status when adjusted for age, gender, race, and ethnicity. CONCLUSIONS: The metabolic syndrome is highly prevalent in this large cohort of schizophrenia patients and is strongly associated with a poor self-rating of physical health and increased somatic preoccupation. These results underscore the need for mental health practitioners to take an active role in the health monitoring of patients with schizophrenia to minimize the impact of medical comorbidity on long-term mortality and on daily functioning. Outcomes data from CATIE will provide important information on the metabolic and clinical impact of antipsychotic treatment for those subjects with MS and other medical comorbidities.     

The Association between Anhedonia,Suicidal Ideation,and Suicide Attempts in a Large Student Sample

Depression is a significant risk factor for suicide. Evidence suggests that anhedonia may be a symptom of depression that is uniquely associated with suicidality. However, exactly how anhedonia is related to suicide is unclear. To provide more specific evidence regarding this association, we investigated relationships between anhedonia, suicidal ideation, and suicide attempts. A large combined undergraduate sample completed the novel Specific Loss of Interest and Pleasure Scale (SLIPS), the Center of Epidemiological Studies Depression Scale (CES-D), and the Suicidal Behaviors Questionnaire—Revised (SBQ-R). Anhedonia was associated with suicidal ideation, even when accounting for depressive symptoms. Additionally, anhedonia was not associated with suicide attempts when symptoms of depression were held constant. The current study provides novel evidence regarding the relationship between anhedonia and risk of attempting suicide. Future research can examine the role anhedonia plays in the unfolding of suicidal behavior over time.     

Obsessive-Compulsive Symptoms and Other Symptoms of the At-risk Mental State for Psychosis: A Network Perspective

BackgroundThe high prevalence of obsessive-compulsive symptoms (OCS) among subjects at Ultra-High Risk (UHR) for psychosis is well documented. However, the network structure spanning the relations between OCS and symptoms of the at risk mental state for psychosis as assessed with the Comprehensive Assessment of At Risk Mental States (CAARMS) has not yet been investigated. This article aimed to use a network approach to investigate the associations between OCS and CAARMS symptoms in a large sample of individuals with different levels of risk for psychosis. MethodThree hundred and forty-one UHR and 66 healthy participants were included, who participated in the EU-GEI study. Data analysis consisted of constructing a network of CAARMS symptoms, investigating central items in the network, and identifying the shortest pathways between OCS and positive symptoms. ResultsStrong associations between OCS and anxiety, social isolation and blunted affect were identified. Depression was the most central symptom in terms of the number of connections, and anxiety was a key item in bridging OCS to other symptoms. Shortest paths between OCS and positive symptoms revealed that unusual thought content and perceptual abnormalities were connected mainly via anxiety, while disorganized speech was connected via blunted affect and cognitive change. ConclusionsFindings provide valuable insight into the central role of depression and the potential connective component of anxiety between OCS and other symptoms of the network. Interventions specifically aimed to reduce affective symptoms might be crucial for the development and prospective course of symptom co-occurrence.     

The Psychopathology and Neuroanatomical Markers of Depression in Early Psychosis

Depression frequently occurs in first-episode psychosis (FEP) and predicts longer-term negative outcomes. It is possible that this depression is seen primarily in a distinct subgroup, which if identified could allow targeted treatments. We hypothesize that patients with recent-onset psychosis (ROP) and comorbid depression would be identifiable by symptoms and neuroanatomical features similar to those seen in recent-onset depression (ROD). Data were extracted from the multisite PRONIA study: 154 ROP patients (FEP within 3 months of treatment onset), of whom 83 were depressed (ROP+D) and 71 who were not depressed (ROP−D), 146 ROD patients, and 265 healthy controls (HC). Analyses included a (1) principal component analysis that established the similar symptom structure of depression in ROD and ROP+D, (2) supervised machine learning (ML) classification with repeated nested cross-validation based on depressive symptoms separating ROD vs ROP+D, which achieved a balanced accuracy (BAC) of 51%, and (3) neuroanatomical ML-based classification, using regions of interest generated from ROD subjects, which identified BAC of 50% (no better than chance) for separation of ROP+D vs ROP−D. We conclude that depression at a symptom level is broadly similar with or without psychosis status in recent-onset disorders; however, this is not driven by a separable depressed subgroup in FEP. Depression may be intrinsic to early stages of psychotic disorder, and thus treating depression could produce widespread benefit.     

Development and Evaluation of a Guideline for Nursing Care of Suicidal Patients With Schizophrenia

PURPOSE. The purpose of this study was to develop and test an evidence-based guideline that would support nursing care for suicidal patients with schizophrenia. DESIGN AND METHODS. Systematic review of the literature and consultation of experts preceded completion of the guideline. Twenty-one nurses from two mental health institutions tested the guideline for feasibility in nursing practice. FINDINGS. The guideline was found to support discussing suicidality with patients and assessing suicide risk. Participants endorsed implementation of the guideline in mental health care. PRACTICE IMPLICATIONS. Nurses who care for patients with schizophrenia are advised to use this guideline as a foundation for their care.     

Cost-effectiveness measures, methods, and policy implications from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) for schizophrenia

Sales of atypical antipsychotics have expanded rapidly as their use for treatment of schizophrenia and other illnesses has increased. The CATIE trial was designed to evaluate the cost-effectiveness of these medications. Cost-effectiveness analysis in CATIE examined the benefits and costs of treatments and attempted to determine whether one treatment would result in better outcomes and lower costs than another one. While the data from CATIE on cost-effectiveness have not been analyzed yet, it is still possible to consider the potential implications of the analysis, including how the roles of researchers and stakeholders should be considered in deciding optimal clinical practices and public policies.