An Examination of Risk and Protective Factors for Suicidal Behavior in a Low-Income, Underserved Primary Care Sample

Suicidal behavior, including ideation and attempts, is a significant public health problem. Due to the complexity of suicidal behavior, it is necessary to consider an array of factors that could serve as risk and protective factors. Previous research has shown that deficits in social problemsolving ability are associated with increased risk for suicidal ideation and attempts; conversely, problem solving strengths are associated with reduced risk. This dissertation project, consisting of 3 individual manuscripts, was designed to explore the relationship between social problemsolving ability and suicidal behavior in low-income primary care patients. Furthermore, additional constructs including health related quality of life, interpersonal needs, neuroticism, and hopelessness were also explored as they related to social problem solving and suicidal behavior. In a sample of 220 primary care patients ages 19-79 (M = 44.08; SD = 12.11), we examined the following: 1) health related quality of life as a mediator of the relationship between social problem solving and suicidal behavior, 2) interpersonal needs as a mediator of the relationship between social problem solving and suicidal behavior, and 3) the potential mediating role of hopelessness on the relation between neuroticism and suicidal behavior and the moderating role of social problem-solving ability on these associations. Participants completed self-report questionnaires including the Social Problem Solving Inventory-Revised-Short Form, Suicidal Behaviors Questionnaire-Revised, Short-Form 36, Interpersonal Needs Questionnaire, NEO-Five Factor Inventory, and the Beck Hopelessness Scale. Scores were analyzed using bootstrapped mediation and moderated mediation techniques. In Manuscript 1 mediating effects were found for mental health related quality of life. In Manuscript 2 thwarted belongingness and perceived burdensomeness mediated the relationship between social problem solving and suicidal behavior. Finally, in Manuscript 3 there was a significant indirect effect of neuroticism on suicidal behavior through hopelessness, and this indirect effect was moderated by social problem-solving ability. Our findings indicate that social problem-solving ability serves as both a risk and protective factor for suicidal behavior and impacts other variables that influence suicide risk among primary care patients. Interventions that bolster social problem-solving ability may reduce suicide risk in primary care

Family Criticism and Depressive Symptoms in Older Adult Primary Care Patients: Optimism and Pessimism as Moderators

Objective: Depression is a significant global public health burden, and older adults may be particularly vulnerable to its effects. Among other risk factors, interpersonal conflicts, such as perceived criticism from family members, can increase risk for depressive symptoms in this population. We examined family criticism as a predictor of depressive symptoms and the potential moderating effect of optimism and pessimism. Methods: One hundred five older adult, primary care patients completed self-report measures of family criticism, optimism and pessimism, and symptoms of depression. We hypothesized that optimism and pessimism would moderate the relationship between family criticism and depressive symptoms. Results: In support of our hypothesis, those with greater optimism and less pessimism reported fewer depressive symptoms associated with family criticism. Conclusion: Therapeutic enhancement of optimism and amelioration of pessimism may buffer against depression in patients experiencing familial criticism

Newborn Outcomes Among Veterans Utilizing VHA Maternity Benefits, 2016-2020

INTRODUCTION: Public Law 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act amended the Veterans Health Administration\u27s (VHA) medical benefits package to include 7 days of medical care for newborns delivered by Veterans. We examined the newborn outcomes among a cohort of women Veterans receiving VHA maternity benefits and care coordination. MATERIALS AND METHODS: We conducted a secondary analysis of phone interview data from Veterans enrolled in the COMFORT (Center for Maternal and Infant Outcomes Research in Translation) study 2016-2020. Multivariable regression estimated associations with newborn outcomes (preterm birth; low birthweight). RESULTS: During the study period, 829 infants were born to 811 Veterans. Mothers reported excellent health for 94% of infants. The prevalence of preterm birth was slightly higher in our cohort (11% vs. 10%), as were low birthweight (9%) deliveries, compared to the general population (8.28%). Additionally, 42% of infants in our cohort required follow-up care for non-routine health conditions; 11% were uninsured at 2 months of age. Adverse newborn outcomes were more common for mothers who were older in age, self-identified as non-white in race and/or of Hispanic ethnicity, had a diagnosis of posttraumatic stress disorder, or had gestational comorbidities. CONCLUSIONS: The current VHA maternity coverage appears to be an effective policy for ensuring the well-being and health care coverage for the majority of Veterans and their newborns in the first days of life, thereby reducing the risk of inadequate prenatal and neonatal care. Future research should examine costs associated with extending coverage to 14 days or longer, comparing those to the projected excess costs of neonatal health problems. VHA policy should continue to support expanding care and resources through the Maternity Care Coordinator model

New Measure to Screen Deaf Women for Perinatal Depression

Approximately 1 million women in the U.S. have profound hearing loss and use American Sign Language (ASL) as their primary language. Many providers are unfamiliar with the unique linguistic and cultural needs of the Deaf community, therefore Deaf women experience major obstacles to receiving effective physical and mental healthcare. For example, failure to provide ASL interpreters or translations from written English is a common communication barrier that prevents Deaf women from receiving health-related treatment and information. In 2017, Drs. Melissa Anderson, Kelly Wolf Craig, and Nancy Byatt were awarded a 1-year pilot project grant for their Creating the Capacity to Screen Deaf Women for Perinatal Depression project. The primary goal of this project was to translate the Edinburgh Postnatal Depression Scale (EPDS) from written English to American Sign Language (ASL). Using the new ASL EPDS, the team aimed to recruit 50 Deaf perinatal women from across the United States to conduct depression screening interviews. This brief describes the study, its results and future plans

International Psychogeriatrics: page 1 of 8 C International Psychogeriatric Association

ABSTRACT Background: We assessed the association between medical illness burden and anxiety symptoms, hypothesizing that greater illness burden would be associated with symptoms of anxiety, and that optimism would buffer, while pessimism would exacerbate, this relationship

Antigen Load and Viral Sequence Diversification Determine the Functional Profile of HIV-1–Specific CD8+ T Cells

Marcus Altfeld and colleagues suggest that the exhaustion of virus-specific CD8+ T cells during chronic HIV infection likely results from the persistence of antigen

Mycobacterial Acid Tolerance Enables Phagolysosomal Survival and Establishment of Tuberculous Infection In Vivo.

The blockade of phagolysosomal fusion is considered a critical mycobacterial strategy to survive in macrophages. However, viable mycobacteria have been observed in phagolysosomes during infection of cultured macrophages, and mycobacteria have the virulence determinant MarP, which confers acid resistance in vitro. Here we show in mice and zebrafish that innate macrophages overcome mycobacterial lysosomal avoidance strategies to rapidly deliver a substantial proportion of infecting bacteria to phagolysosomes. Exploiting the optical transparency of the zebrafish, we tracked the fates of individual mycobacteria delivered to phagosomes versus phagolysosomes and discovered that bacteria survive and grow in phagolysosomes, though growth is slower. MarP is required specifically for phagolysosomal survival, making it an important determinant for the establishment of mycobacterial infection in their hosts. Our work suggests that if pathogenic mycobacteria fail to prevent lysosomal trafficking, they tolerate the resulting acidic environment of the phagolysosome to establish infection.National Institutes of Health (Grant IDs: R37AI054503, R01 AI076327, 5T32HD007233, 5F30HL110455), Wellcome Trust, National Institute of Health Research Cambridge Biomedical Research CentreThis is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.chom.2016.07.00