The Relationship between Personality Organization and Psychiatric Classification in Chronic Pain Patients

The assessment of PO is a crucial issue for diagnosis and treatment planning in CPPs, since it represents a measure of structural impairment that is to a considerable extent independent of axis I and II diagnoses. Moreover, the STIPO dimensional rating focuses on the most salient dysfunctions at a given time. Copyright (C) 2010 S. Karger AG, BaselBackground: The present study investigated the relationship between psychiatric classification and personality organization (PO) in a secondary/tertiary clinical sample of chronic pain patients (CPPs). Sampling and Methods: Forty-three patients were administered the Structured Clinical Interview for DSM-IV (SCID I+II) and the Structured Interview of Personality Organization (STIPO). The prevalence of axis I and axis II disorders was correlated with the STIPO level of PO. The STIPO dimensional ratings of patients without personality disorder (PD) were compared to those of patients diagnosed with one or more PDs. Results: Axis I comorbidity was high (93%), and 63% of the patients met the criteria for at least one axis II diagnosis. Twenty-five patients (58%) were diagnosed as borderline PO, with high-level impairments in the dimensions `coping/rigidity', `primitive defenses' and `identity'. Higher axis I and axis II comorbidity corresponded with greater severity of PO impairment. No difference was found between the dimensional ratings of patients without PD and those of patients with one or more PDs. Conclusions

Slovenska validacija Inventara sposobnosti za ljubav – preliminarno istraživanje

Our study aimed to test the psychometric properties of the Slovenian version of the Capacity to Love Inventory (CTL-I, Kapusta et al., 2018). The CTL-I is a 41-item self-report questionnaire that measures the construct of capacity to love. The measure itself has been operationalized based on findings from clinical practice and psychodynamic theory and relates to both clinically relevant symptoms as well as healthier manifestations of personality. The CTL-I measures six dimensions:interest in the life project of the other, basic trust, gratitude, common ego ideal, permanence of sexual passion and loss and mourning. Due to the concept of capacity to love being closely related to relationship quality, we used the Quality of Relationship Inventory (QRI) to examine external validity. Our final study sample consisted of 224 non-clinical adults. Overall, the Slovenian version of the CTL-I showed a satisfactory model fit, comparable to that of previous validation studies. The QRI subscales were found to correlate with most of the CTL-I factors, as well as the CTL-I subscales with each other. Because of the instrument being tested on a smaller convenience sample in this study, we believe our findings should be viewed as a preliminary attempt at validating the Slovenian translation of the CTL-I. While the results of the present study are promising, we believe additional research is needed to fully assess the psychometric properties of the Slovenian CTL-I.Cilj je ovoga istraživanja bio ispitati psihometrijske karakteristike slovenske verzije Inventara sposobnosti za ljubav (CTL-I; Kapusta i sur., 2018). CTL-I je upitnik za samoprocjenu od 41 čestice koji mjeri konstrukt sposobnosti za ljubav. Sama je mjera operacionalizirana na temelju istraživanja u kliničkoj praksi i psihodinamskoj teoriji, a odnosi se na klinički relevantne simptome, kao i na zdravije manifestacije ličnosti. CTL-I mjeri šest dimenzija: zanimanje za životni plan drugoga, osnovno povjerenje, zahvalnost, zajednički ego ideal, postojanost seksualne strasti te gubitak I žalost. Budući da je poznato da je koncept sposobnosti za ljubav usko povezan s kvalitetom veze, koristili smo Inventar kvalitete odnosa (QRI) za ispitivanje vanjske valjanosti. Konačni se uzorak ispitanika sastojao od 224 nekliničke odrasle osobe. Slovenska verzija CTL-I-ja pokazala je zadovoljavajuće pristajanje modela usporedivo s onim u prethodnim validacijskim studijama. Supskale QRI-ja koreliraju s većinom faktora CTL-I-ja, kao i supskale CTL-I-ja jedna s drugom. Budući da je instrument u ovome istraživanju testiran na manjemu prigodnom uzorku, vjerujemo da bi dobivene nalaze trebalo promatrati kao preliminarni pokušaj validacije slovenskoga prijevoda CTL-I-ja. Iako su rezultati ove studije obećavajući, potrebna su daljnja istraživanja da bi se u potpunosti procijenila psihometrijska svojstva slovenskoga prijevoda CTL-I-ja

Suicide and unintentional poisoning mortality trends in the United States, 1987-2006: two unrelated phenomena?

Background Two counter trends in injury mortality have been separately reported in the US in recent times - a declining suicide rate and a rapidly rising unintentional poisoning mortality rate. Poisoning suicides are especially difficult to detect, and injury of undetermined intent is the underlying cause-of-death category most likely to reflect this difficulty. We compare suicide and poisoning mortality trends over two decades in a preliminary assessment of their independence and implications for suicide misclassification. Methods Description of overall and gender- and age-specific trends using national mortality data from WISQARS, the Web-based Injury Statistics Query and Reporting System, maintained by the Centers for Disease Control and Prevention (CDC). Subjects were the 936,633 residents dying in the 50 states and the District of Columbia between 1987 and 2006 whose underlying cause of death was classified as suicide, unintentional poisoning, or injury mortality of undetermined intent. Results The official US suicide rate declined 18% between 1987 and 2000, from 12.71 to 10.43 deaths per 100,000 population. It then increased to 11.15 deaths per 100,000 by 2006, a 7% rise. By contrast to these much smaller rate changes for suicide, the unintentional poisoning mortality rate rose more than fourfold between 1987 and 2006, from 2.19 to 9.22 deaths per 100,000. Only the population aged 65 years and older showed a sustained decline in the suicide rate over the entire observation period. Consistently highest in gender-age comparisons, the elderly male rate declined by 35%. The elderly female rate declined by 43%. Unlike rate trends for the non-elderly, both declines appeared independent of corresponding mortality trends for unintentional poisoning and poisoning of undetermined intent. The elderly also deviated from younger counterparts by having a smaller proportion of their injury deaths of undetermined intent classified as poisoning. Poisoning manifested as a less common method of suicide for this group than other decedents, except for those aged 15-24 years. Although remaining low, the undetermined poisoning mortality rate increased over the observation period. Conclusions The official decline in the suicide rate between 1987 and 2000 may have been a partial artifact of misclassification of non-elderly suicides within unintentional poisoning mortality. We recommend in-depth national, regional, and local population-based research investigations of the poisoning-suicide nexus, and endorse calls for widening the scope of the definition of suicide and evaluation of its risk factors

Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history

Objective A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods. Methods This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011–2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. Results A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among drug intoxication cases than gunshot/hanging cases. The latter were more likely than intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43–49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11–44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11–2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10–1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for intoxication cases (OR, 45.43; 95% CI, 31.06–66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19–3.18) and depression (OR, 1.48; 95% CI, 1.17–1.87) were associated with suicide classification in intoxication but not gunshot/hanging cases. Conclusions Without psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and drug deaths

Suicide Seasonality: Complex Demodulation as a Novel Approach in Epidemiologic Analysis

Seasonality of suicides is well-known and nearly ubiquitous, but recent evidence showed inconsistent patterns of decreasing or increasing seasonality in different countries. Furthermore, strength of seasonality was hypothesized to be associated with suicide prevalence. This study aimed at pointing out methodological difficulties in examining changes in suicide seasonality. METHODODOLOGY/PRINCIPAL FINDINGS: The present study examines the hypothesis of decreasing seasonality with a superior method that allows continuous modeling of seasonality. Suicides in Austria (1970-2008, N = 67,741) were analyzed with complex demodulation, a local (point-in-time specific) version of harmonic analysis. This avoids the need to arbitrarily split the time series, as is common practice in the field of suicide seasonality research, and facilitates incorporating the association with suicide prevalence. Regression models were used to assess time trends and association of amplitude and absolute suicide numbers. Results showed that strength of seasonality was associated with absolute suicide numbers, and that strength of seasonality was stable during the study period when this association was taken into account.Continuous modeling of suicide seasonality with complex demodulation avoids spurious findings that can result when time series are segmented and analyzed piecewise or when the association with suicide prevalence is disregarded

Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?

<p>Abstract</p> <p>Background</p> <p>Suicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites.</p> <p>Methods</p> <p>This cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide.</p> <p>Results</p> <p>Blacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active."</p> <p>Conclusions</p> <p>Data disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.</p

A Social-Ecological Framework of Theory, Assessment, and Prevention of Suicide

The juxtaposition of increasing suicide rates with continued calls for suicide prevention efforts begs for new approaches. Grounded in the Centers for Disease Control and Prevention (CDC) framework for tackling health issues, this personal views work integrates relevant suicide risk/protective factor, assessment, and intervention/prevention literatures. Based on these components of suicide risk, we articulate a Social-Ecological Suicide Prevention Model (SESPM) which provides an integration of general and population-specific risk and protective factors. We also use this multi-level perspective to provide a structured approach to understanding current theories and intervention/prevention efforts concerning suicide. Following similar multi-level prevention efforts in interpersonal violence and Human Immunodeficiency Virus (HIV) domains, we offer recommendations for social-ecologically informed suicide prevention theory, training, research, assessment, and intervention programming. Although the SESPM calls for further empirical testing, it provides a suitable backdrop for tailoring of current prevention and intervention programs to population-specific needs. Moreover, the multi-level model shows promise to move suicide risk assessment forward (e.g., development of multi-level suicide risk algorithms or structured professional judgments instruments) to overcome current limitations in the field. Finally, we articulate a set of characteristics of social-ecologically based suicide prevention programs. These include the need to address risk and protective factors with the strongest degree of empirical support at each multi-level layer, incorporate a comprehensive program evaluation strategy, and use a variety of prevention techniques across levels of prevention

Geospatial examination of lithium in drinking water and suicide mortality

Abstract Background Lithium as a substance occurring naturally in food and drinking water may exert positive effects on mental health. In therapeutic doses, which are more than 100 times higher than natural daily intakes, lithium has been proven to be a mood-stabilizer and suicide preventive. This study examined whether natural lithium content in drinking water is regionally associated with lower suicide rates. Methods Previous statistical approaches were challenged by global and local spatial regression models taking spatial autocorrelation as well as non-stationarity into account. A Geographically Weighted Regression model was applied with significant independent variables as indicated by a spatial autoregressive model. Results The association between lithium levels in drinking water and suicide mortality can be confirmed by the global spatial regression model. In addition, the local spatial regression model showed that the association was mainly driven by the eastern parts of Austria. Conclusions According to old anecdotic reports the results of this study support the hypothesis of positive effects of natural lithium intake on mental health. Both, the new methodological approach and the results relevant for health may open new avenues in the collaboration between Geographic Information Science, medicine, and even criminology, such as exploring the spatial association between violent or impulsive crime and lithium content in drinking water.</p