Adverse Childhood Experiences and Hospital-Treated Self-Harm

Adverse childhood experiences (ACEs) have been implicated in a range of negative health outcomes in adulthood, including increased suicide mortality. In this study, we explored the relationship between ACEs and hospital-treated self-harm. Specifically, we investigated whether those who had a history of repeat self-harm reported more ACEs than those who had self-harmed for the first time. Patients (n = 189) admitted to two hospitals in Glasgow (UK) following first-time (n = 41) or repeated (n = 148) self-harm completed psychosocial measures. Univariate analyses revealed that those presenting with repeat self-harm reported higher depressive symptoms, anxiety symptoms, intent to die, and ACEs, and lower dependent attachment style. However, only ACEs, along with female gender and depressive symptoms, significantly differentiated between the repeat self-harm group and the first-time self-harm group in the multivariate model. Controlling for all other psychosocial variables, participants who reported 4+ ACEs were significantly more likely to be in the repeat self-harm group as compared to those who experienced 0–3 ACEs. This finding highlights the pernicious effect of exposure to multiple ACEs. Further research is urgently required to better understand the mechanisms that explain this relationship. Clinicians should be aware of the extent of the association between ACEs and repeat self-harm

Improvements in functioning and workplace productivity with esketamine nasal spray versus quetiapine extended release in patients with treatment resistant depression:Findings from a 32-week randomised, open-label, rater-blinded phase IIIb study

Patients with treatment resistant depression (TRD) experience a greater negative impact on their functioning and productivity at home and in the workplace versus treatment-responsive patients. Here, we report the effects of esketamine nasal spray (NS) versus quetiapine extended release (XR) on functioning, work productivity and activity impairment. ESCAPE‑TRD (NCT04338321) was a 32-week randomised, open‑label, rater‑blinded, active‑controlled phase IIIb study comparing the efficacy and safety of esketamine NS versus quetiapine XR, both alongside an ongoing selective serotonin reuptake inhibitor or serotonin norepinephrine reuptake inhibitor (SSRI/SNRI), in patients with TRD. Patient functioning was assessed via the Sheehan Disability Scale (SDS; functional remission ≤6). Absenteeism, presenteeism, work productivity loss and activity impairment over time were assessed using the Work Productivity and Activity Impairment: Depression (WPAI:D) questionnaire. Results were cumulated over the entire study duration. Esketamine NS-treated patients (N = 336) experienced 43.2 % more weeks with functional remission versus quetiapine XR-treated patients (N = 340) over the 32-week study period (difference: 2.0 weeks [95 % CI: 0.7, 3.3]; p = 0.0023 [ANCOVA models]). Up to Week 32, esketamine NS-treated patients experienced an 11.9 % reduction in productivity loss due to absenteeism (difference: −1.1 weeks [95 % CI: −2.9, 0.7]; p = 0.2285) and a 14.2 % reduction in overall work productivity loss (difference: –2.3 weeks, 95 % CI: [–3.9, –0.7] p = 0.0045) versus quetiapine XR-treated patients, based on mixed models for repeated measures. Patients receiving esketamine NS experienced greater improvements in functioning and productivity over 32 weeks versus quetiapine XR. These improvements demonstrate the clinical and functional benefit of treatment with esketamine NS for patients with TRD.</p

Exploring the role of self-compassion in self-harm and suicidal ideation

Background: To date suicide research has mostly focussed on the presence of risk factors for suicide, and as a result, we have a good understanding of how these factors interact and contribute to risk. However, despite major advances in understanding the psychology of suicide and self-harm there are many gaps in our knowledge. In particular, the evidence for factors that may protect against suicide risk is limited. Self‐compassion has been implicated in the aetiology and course of mental health with evidence suggesting an association between greater self‐compassion and lower emotional distress. Adopting a compassionate stance to the self may help individuals tolerate difficult emotions, and as self-compassion can be developed through meditation type exercises, it may present a potentially modifiable protective factor for psychological distress and perhaps protect against suicide risk. However, research into self-compassion, suicide and self-harm is a relatively new field and our understanding of how self-compassion relates to risk-factors and self-harm as a whole is limited. This thesis presents five studies designed to address the following research questions: 1. What is the nature of self-compassion?; 2. What is the relationship between self-compassion and suicidal ideation or self-harm?; 3. Is a brief self-compassion exercise acceptable to individuals with a history of self-harm? Methods: A range of self-report and experimental measures were utilised to address the above research questions. To investigate the first research question, the factor structure of the Self-Compassion Scale (SCS; Neff, 2003 a,b) was assessed in study 2. Exploratory and confirmatory factor analytical techniques were used (Time 1, n=526; Time 2, n= 332). Construct divergence of the SCS and a measure of self-criticism was assessed in studies 3 and 5. To address the second research question, a systematic review of the literature (study 1) was conducted to establish the extent of the extant knowledge on this relationship. In studies 3 and 5 self-compassion was investigated within the context of risk factors selected from the Integrated Motivational-Volitional model of suicidal behaviour (IMV; O’Connor & Kirtley, 2018; O’Connor, 2011). Study 3: a longitudinal (Time 1, n=514; Time 2, n= 269) online self-report survey was conducted to explore self-compassion’s role within the motivational phase of the IMV model. The SCS was included along with the core constructs (defeat and entrapment) of the motivational phase of the IMV model and suicidal ideation history. Studies 4 and 5 were laboratory studies which used experimental and qualitative components to develop and pilot a self-compassion exercise (SCM). Study 4 (n= 8) assessed the acceptability of the SCM to individuals with a history of self-harm (Question 3). Specifically study 4 contained a qualitative component to elicit feedback on the SCM and explore participant’s experiences of compassion. Study 5 (n= 61) was a randomised controlled comparison of the SCM versus relaxation exercise on autobiographical memory; an established risk factor for suicidality from the IMV model (Question 2). Results: Addressing the first research question, the factor analysis confirmed a bifactorial model of the SCS indicating that both total score or and subscale scores are valid. Additionally, the SCS demonstrated significant divergence from self-criticism indicating that these measures assess different constructs. In respect of research question 2, consistent with the systematic review, all the studies herein found that higher self-compassion was associated with no history of suicidal ideation or self-harm and lower levels of psychological distress. In studies 3 and 5, components of the SCS were found to mediate the different pathways between selected risk factors and suicidal ideation and self-harm. Individual mediation models indicated that defeat and entrapment were mediated by SCS total score and isolation; the entrapment-suicidal ideation relationship was mediated by isolation, self-kindness and self-judgement. In study 5 the relationship between overgeneral autobiographical memory and suicidal ideation was mediated by all the negative SCS subscales, mindfulness and the SCS total score. Also in study 5, non-significant opposing trends were evident for the SCM and relaxation exercises. Specifically, following the exercises, a main effect was observed in recall latency to negative cues; latency decreased following the SCM whereas latency increased following the relaxation exercise (both non-significant). Non-significant increases in specific memories were observed following the SCM while no change was observed following the relaxation exercise. This may suggest that SCM and relaxation exercises operate differentially within autobiographical memory. There was clear evidence that a brief self-compassion exercise acceptable in individuals with a history of self-harm with only some minor changes in administration highlighted. Following the SCM increases in self-compassion were reported by participants. Conclusions: The range of methods used in these studies allowed an in-depth evaluation of self-compassion’s role in suicidal ideation and self-harm. In line with previous research, the findings suggest that high levels of self-compassion are associated with lower suicidal ideation and self-harm. The results also indicate that components of self-compassion may play a role throughout the motivational phase of the IMV model. Findings from the laboratory studies indicated that individuals with a history of self-harm found the brief self-compassion exercise acceptable. Our findings demonstrate that a brief self-compassion meditation is acceptable and produces changes in levels of compassion. Signals in the data from study 5 suggest that brief self-compassion exercises may be useful to investigate the relationship between self-compassion and autobiographical memory. Overall, these findings suggest that self-compassion may be an important clinical target as, given the interconnected nature of its components, targeting self-compassion may have diffuse effects on various risk factors for suicidal ideation and self-harm. Further research should investigate feasibility and outcome signals of compassion-focussed interventions for suicidal behaviour. Ultimately further research is needed to better understand the role of self-compassion in suicidal ideation and self-harm

An investigation of the factor structure of the Self-Compassion Scale

The Self-Compassion Scale (SCS) is the most widely used measure of self-compassion. The scale is constructed of six factors measuring positive and negative components of compassion. Support for this factor structure has been subject to debate and alternative factor structures have been proposed. We tested the proposed factor structures against existing models of the SCS including one derived from an exploratory factor analysis of our data. Respondents (n = 526) completed the original version of the SCS online at two time points, at baseline (time 1) and 2.5 months later (n = 332, time 2). Exploratory factor analysis (EFA) was carried out on time 1 data and confirmatory factor analyses (CFA) were conducted on time 2 data and retested using time 1 data. The EFA yielded a five-factor model. CFA was used to compare the following models: Neff’s original six-factor correlated and higher-order models; a single-factor, two-factor, five-factor model (as suggested by the EFA) and a bi-factorial model. The bi-factorial model was the best fit to the data followed by the six-factor correlated model. Omega indices were calculated and yielded support for the bi-factorial model of SCS. In conclusion, this study supports the use of the six-factor scoring method of the SCS and the use of an overarching self-compassion score

The development of an instrument to identify factors which contribute to underachievement in mathematics in the Bahamas

The purpose of this research was to develop an instrument to identify factors which contribute to underachievement in mathematics among Bahamian high school students, and to determine the validity and reliability of the instrument. One hundred and thirty (130) college preparatory students, who were registered in college preparatory (developmental) mathematics courses ( Math 047 or Math 048) at The College of the Bahamas, participated in this study. Eight factors (Academic, Instructional, Psychological, School Policies, School Personnel Attitudes, Verbal/Non-Verbal Abilities, Mathematics Curriculum and Teaching Qualities) were identified in the research literature as possible contributors to underachievement in mathematics. A panel of judges made up of experienced high school teachers in the Bahamas, ranked the factors on a seven-point scale based on the perceived influence of each factor on underachievement in mathematics. A mean score of 4.0 on the seven-point scale assured the inclusion of a factor in the study. A list of 84 positively stated and negatively stated written items on the eight factors were reviewed by a panel of 7 experts in the area of mathematics and/or mathematics underachievement. The experts were selected on the basis of their pubUshed works or a minimum of 15 years teaching experience in mathematics. A total of 50 statements, each with a 50% or more agreement among the experts were included in the final scale which was administered to the study population. The scale was first administered to a pilot group of 39 students enrolled in college preparatory mathematics courses at The College of the Bahamas. The revised scale was administered to the study population of 130 students. Average inter-correlation of .70 between the factors and the Bahamas Mathematics Achievement Scale (DMAS) supports the interrelatedness and the validity of the DMAS. A test-retest reliability coefficient of .47 to .88 and alpha coefficient of .38 support the internal consistency of the scale. In conclusion, the Bahamas Mathematics Achievement Scale (DMAS) developed in this study was demonstrated to be a valid, reliable and stable instrument for assessing underachievement in mathematics among high school students in the Bahamas

Revising DSM-5 criteria for the bipolar disorders: Phase I of the AREDOC project.

Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders) an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. Method: The first stage of the process consisted of reviewing DSM-5 and recent ICD criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified.Results: Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge ‘impairment’ (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false positive diagnoses of the bipolar disorders.Conclusion: This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision, and to clarify whether they differ dimensionally or categorically.<br/

Predictors of Functional Impairment in Bipolar Disorder: Results from 13 Cohorts from Seven Countries by The Global Bipolar Cohort Collaborative

Objectives: Persistent functional impairment is common in bipolar disorder (BD) and is influenced by a number of demographic, clinical, and cognitive features. The goal of this project was to estimate and compare the influence of key factors on community function in multiple cohorts of well-characterized samples of individuals with BD. Methods: Thirteen cohorts from 7 countries included n = 5882 individuals with BD across multiple sites. The statistical approach consisted of a systematic uniform application of analyses across sites. Each site performed a logistic regression analysis with empirically derived “higher versus lower function” as the dependent variable and selected clinical and demographic variables as predictors. Results: We found high rates of functional impairment, ranging from 41 to 75%. Lower community functioning was associated with depressive symptoms in 10 of 12 of the cohorts that included this variable in the analysis. Lower levels of education, a greater number of prior mood episodes, the presence of a comorbid substance use disorder, and a greater total number of psychotropic medications were also associated with low functioning. Conclusions: The bipolar clinical research community is poised to work together to characterize the multi-dimensional contributors to impairment and address the barriers that impede patients' complete recovery. We must also identify the core features which enable many to thrive and live successfully with BD. A large-scale, worldwide, prospective longitudinal study focused squarely on BD and its heterogeneous presentations will serve as a platform for discovery and promote major advances toward optimizing outcomes for every individual with this illness.</p

Is there a risk of addiction to ketamine during the treatment of depression? A systematic review of available literature

Background: Ketamine has demonstrated both rapid and sustained efficacy in treating depression, especially in treatment-resistant cases. However, concerns regarding the addictive potential of ketamine during long-term depression treatment persist among clinicians. Aim: This review aimed to summarise the evidence on addiction phenomena associated with ketamine treatment of depression. Methods: A comprehensive search was conducted in MEDLINE, Embase, PsycInfo and Global Health databases, with additional relevant studies identified through reference lists. Sixteen studies were included, comprising six randomised controlled trials, three single-arm open-label studies, one retrospective study, three case series and three case reports, for a total of 2174 patients. Results: The studies employed various routes of administration, including intravenous, intramuscular, intranasal, oral and sublingual. Ketamine was administered in the racemic form, except for the studies that utilised intranasal esketamine. Among the included population, four patients were reported to exhibit clear signs of tolerance to the antidepressant effect of ketamine or dependence on the drug, while the majority did not. Cases of addiction phenomena reported in studies that did not meet the inclusion criteria are also discussed. Conclusions: Despite the heterogeneity in study designs and outcome assessment methods, the review underscores the relative safety of ketamine treatment for adult patients with depression, emphasising the importance of medically supervised administration, vigilant monitoring and judicious dosing. Future long-term studies employing quantitative scales to assess dependence phenomena could contribute to strengthening the evidence for the safe and effective use of ketamine in the treatment of depression.</p