A suicide attentional bias as implicit cognitive marker of suicide vulnerability in a high-risk sample.

INTRODUCTION Suicide risk assessment based on self-report questionnaires is considered as problematic because risk states are dynamic and at-risk individuals may conceal suicidal intentions for several reasons. Therefore, recent research efforts increasingly focus on implicit risk markers such as the suicide attentional bias (SAB) measured with the Suicide Stroop Task (SST). However, most SST studies failed to demonstrate a SAB in individuals with suicide risk and repeatedly demonstrated insufficient psychometrics of the SST. This study aimed to investigate a SAB using a modified SST (M-SST) and to test its psychometric properties. METHOD We compared n = 61 healthy controls and a high-risk inpatient sample of n = 40 suicide ideators and n = 40 suicide attempters regarding interference scores of positive, negative and suicide-related words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related words (mean RT Suicide -mean RT Neutral), resulting in a suicide-specific interference score. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. RESULTS A Group × Interference ANOVA showed a significant interaction effect (p <.001, ηp2 = .09), indicating that group effects significantly vary across interference type. Post hoc comparisons revealed that both ideators and attempters demonstrated greater interferences only for suicide-related words compared to healthy controls, indicating a SAB in patients, while a difference between ideators and attempters was lacking. The suicide interference score classified with an AUC = 0.73, 95% CI [0.65 - 0.82], p <.001, between controls and patients with STBs. The M-SST demonstrated good internal consistency and convergent validity. DISCUSSION The study adds evidence to the assumptions of the Cognitive Model of Suicide, viewing a SAB as a cognitive marker of suicide vulnerability independently of the engagement in suicidal behavior. The results' clinical implications are discussed in the context of recommended intervention strategies during an acute suicidal state. Future studies with the M-SST should include non-suicidal patient controls to investigate whether a SAB is uniquely related to suicidality

Implicit measures of suicide vulnerability: Investigating suicide-related information-processing biases and a deficit in behavioral impulse control in a high-risk sample and healthy controls.

OBJECTIVE Relevant implicit markers of suicidal thoughts and behaviors (STBs) have only been studied in isolation with mixed evidence. This is the first study that investigated a suicide attentional bias, a death-identity bias and a deficit in behavioral impulsivity in a high-risk sample and healthy controls. METHOD We administered the Death Implicit Association Test, the Modified Suicide Stroop Task, and a Go/No-Go Task to inpatient suicide ideators (n = 42), suicide attempters (n = 40), and community controls (n = 61). RESULTS Suicide ideators and attempters showed a suicide attentional bias and a death-identity bias compared to healthy controls. Ideators and attempters did not differ in these implicit information-processing biases. Notably, only attempters were more behaviorally impulsive compared to controls; however, ideators and attempters did not significantly differ in behavioral impulsivity. Moreover, implicit scores were positively intercorrelated in the total sample. CONCLUSION In line with the Cognitive Model of Suicide, ideators and attempters display suicide-related information processing biases, which can be considered as implicit cognitive markers of suicide vulnerability. Furthermore, attempters have elevated levels of behavioral impulsiveness. These results are highly relevant in the context of crisis intervention strategies and warrant further research

Determinants of Willingness to Pay for Health Insurance in Germany—Results of the Population-Based Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study)

Objective: To investigate which factors are associated with the willingness to pay (WTP) for health insurance. Methods: The analysis (n = 1,248 individuals) is based on data of a large population-based study—the Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study). With regard to WTP for health insurance, a contingent valuation method with a payment card was used. Several explanatory variables were included. For example, personality factors (in terms of agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience) were assessed using the NEO-16 Adjective Measure. Results: Average WTP for health insurance per month equaled about e240 which corresponds to ∼14% of household net equivalent income. Multiple regressions showed that an increased WTP was associated with lower age (β = −1.7, p < 0.001), higher (log) household net equivalent income (β = 153.6, p < 0.001), higher social support (β = 2.0, p < 0.05), and private health insurance (β = 131.1, p < 0.001). Furthermore, an increased WTP for health insurance was associated with higher openness to experience (β = 10.1, p < 0.05), whereas it was not associated with agreeableness, conscientiousness, extraversion, and neuroticism. Conclusion: The quite large amount of average WTP for health insurance may suggest that individuals accept current contributions to health insurances and would probably accept higher contributions. While previous studies mainly focused on individuals in late life, we identified a link between socioeconomic, health-related factors, and personality factors (in terms of openness to experience) and WTP in the general adult population

The course of pain intensity in patients undergoing herniated disc surgery: a 5-year longitudinal observational study

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support

Exposure and response prevention therapy augmented with naltrexone in kleptomania: a controlled case study using galvanic skin response for monitoring

BACKGROUND Kleptomania is a disease that shares features with obsessive compulsive spectrum disorders (OCD) and with substance abuse disorders (SAD). This is underlined by therapeutic approaches in kleptomania ranging from cognitive behavioural therapy and selective serotonin reuptake inhibitors that are effective in OCD, and opioid antagonists that are currently being used in SAD. However, almost no literature exists about exposure and response prevention (ERP) therapy in kleptomania. Furthermore, there is a clear lack of objective markers that would allow a therapeutic monitoring. AIM To show the effectiveness of ERP therapy in kleptomania in a single case report. METHOD An ERP therapy under real-world conditions and later augmentation with the opioid antagonist naltrexone is described. Continuous measurements of galvanic skin response (GSR) before, during and after therapy sessions are reported in association with changes of the Kleptomania Symptom Assessment Scale (KSAS) self-questionnaire. RESULTS While KSAS scores showed a clear treatment response to ERP sessions, the GSR was significantly lower during ERP treatment in comparison with baseline measures. However, during augmentation with naltrexone, GSR measures increased again and clinical severity did not further improve. CONCLUSIONS This case shows the possible usefulness of ERP-like approaches and therapy monitoring using electrophysiological markers of arousal for individualized treatment in kleptomania

EEG-arousal regulation as predictor of treatment response in patients suffering from obsessive compulsive disorder

OBJECTIVES Aim of this study was to analyze whether electroencephalogram (EEG)-based CNS-arousal markers differ for patients suffering from obsessive compulsive disorder (OCD) that either respond or do not respond to cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs) or their combination. Further the study aimed to identify specific response-predictors for the different therapy approaches. METHODS CNS-arousal from 51 unmedicated patients during fifteen-minute resting state was assessed using VIGALL (Vigilance Algorithm Leipzig). Clinical Global Impression (CGI) scores were used to assess response or non-response after three to six months following therapy (CBT, n=18; SSRI, n=11 or combination, n=22). Differences between Responders (R) and Non-Responders (NR) were identified using multivariate analysis of covariance (MANCOVA) models. RESULTS MANCOVA revealed that Responders spent significant less time at the highest CNS-arousal stage 0. Further, low amounts of the highest CNS-arousal stages were specifically predictive for a response to a combined treatment approach. CONCLUSIONS The fact that CNS-arousal markers allowed discrimination between Responders and Non-Responders and also between Responders of different treatment arms underlines a possible clinical value of EEG-based markers. SIGNIFICANCE These results encourage further research on EEG-arousal regulation for determining pathophysiological subgroups for treatment response

Psychometric properties of the modified Suicide Stroop Task (M-SST) in patients with suicide risk and healthy controls.

UNLABELLED The Cognitive Model of Suicide proposes a suicide attentional bias in individuals with suicidal thoughts and behavior (STBs). The Suicide Stroop Task (SST) was developed as a behavioral measure to assess this attentional bias. However, prior studies demonstrated poor psychometric properties of the SST. METHODS We developed a modified Suicide Stroop Task (M-SST) and tested its psychometric properties in a sample of healthy controls (n = 30) and inpatients with STBs (n = 24). Participants (50% female, aged 18 to 61 years) completed the M-SST with neutral, positive, negative, suicide-related positive and suicide-related negative words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related positive words (mean RTSuicide-Positive-mean RTNeutral) and suicide-related negative words (mean RTSuicide-Negative-mean RTNeutral), resulting in two suicide-specific interference scores. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. RESULTS When analyzed separately, patients with STBs showed greater interferences for suicide-related positive words (p = 0.039), and for suicide-related negative words (p = 0.016), however, we found no group differences in interference scores for positive and negative words, suggesting a suicide attentional bias in patients with STBs. Controlling for the repeated measure design, a repeated measure ANOVA failed to detect a significant group × interference interaction effect (p = 0.176), which limits the generalizability of the findings. However, the interference score of suicide-related negative words showed an adequate classification accuracy (AUC = 0.72, 95% CI [0.58-0.86], p = 0.006) for differentiating between healthy controls and patients with STBs. Moreover, the interference scores showed acceptable internal reliability for the total sample and only suicide-related interference scores were correlated with clinical characteristics, thus demonstrating convergent validity. CONCLUSION The results provide preliminary evidence for a suicide attentional bias in individuals with STBs compared to healthy controls. The M-SST represents a promising tool for assessing a suicide attentional bias by revealing adequate psychometric properties. Future studies with larger samples are needed to confirm these preliminary findings

Vocational Perspectives for People with Mental Illness Under Corona Conditions: An Exploratory Brief Survey

Dehn L, Böske N, Beblo T, Steinhart I, Stengler K, Driessen M. Arbeitsperspektiven für Menschen mit psychischen Erkrankungen unter Corona-Bedingungen: Eine explorative Kurzumfrage[Vocational Perspectives for People with Mental Illness Under Corona Conditions: An Exploratory Brief Survey]. Psychiatrische Praxis. 2021.OBJECTIVE: Exploratory study of corona-related impacts on vocational perspectives of people with mental illness.; METHODS: Short survey with quantitative and qualitative questions among employees from vocational rehabilitation.; RESULTS: More than 90 % of the n = 76 participants stated that the situation regarding vocational reintegration or job search had worsened due to corona. Moreover, 75 % considered that there would still be a negative impact on vocational rehabilitation in the longer term. In addition to the main problem of a lack of job offers, open responses on obstacles also referred to increased psychological stress among clients as well as problems in reaching cooperation partners or in dealing with online processes.; CONCLUSIONS: Under Corona conditions, the work-related perspectives and participation opportunities of people with mental illness have been additionally worsened. Thieme. All rights reserved.Ziel der Studie Explorative Untersuchung der coronabedingten Auswirkungen auf die beruflichen Perspektiven von Menschen mit psychischen Erkrankungen auf dem ersten Arbeitsmarkt. Methode Kurzumfrage mit quantitativen und qualitativen Fragen unter Mitarbeitenden aus der beruflichen Rehabilitation und Wiedereingliederung. Ergebnisse Von den n = 76 Teilnehmenden gaben über 90 % an, dass sich die Situation beim beruflichen Wiedereinstieg bzw. der Arbeitsplatzsuche coronabedingt (deutlich) verschlechtert habe. 75 % sahen auch auf längere Sicht hin negative Aussichten für die berufliche Rehabilitation. Offene Antworten zu Schwierigkeiten verwiesen neben dem Hauptproblem fehlender Stellenangebote u. a. auf erhöhte psychische Belastungen bei den Betroffenen sowie Probleme bei der Erreichbarkeit von Ansprechpersonen oder bei Online-Prozessen. Schlussfolgerung Durch die Corona-Situation ist es zu einer zusätzlichen Verschlechterung der beruflichen Perspektiven und Teilhabechancen von Menschen mit psychischen Erkrankungen gekommen

Gender-Specific Aspects of Suicide-Related Communication in a High Risk Sample of Psychiatric Inpatients

Background: In addition to help-seeking behavior in a professional context, suicide-related communication (SRC) with that discloses suicidal thoughts and plans to relatives and significant others play a major role in suicide prevention. While studies revealed gender differences in help-seeking behavior in case of suicidal thoughts and intent in a professional context, the empirical evidence on SRC and gender is limited. The present study aims to examine gender-specific aspects of prevalence, recipients, pathways, and content of SRC in a high-risk sample of psychiatric inpatients. Results may provide information for the development of gender-specific suicide prevention measures. Methods: This study considered data on SRC among individuals who had been admitted to a psychiatric ward due to suicide attempt or to an increased suicide risk and have previously attempted suicide. In this high-risk sample of 219 psychiatric inpatients (56.2% female: n = 123), SRC was assessed using the Suicide Attempt Self Injury Interview (SASII) and was analyzed with a mixed-method design. Results: There are no significant differences (Chi2 (4, n = 219) = 3.189, p = 0.074) in the frequencies of SCR between men and women. 34.4% (n = 33) of men and 46.3% (n = 57) of women reported SRC. Differences were found regarding the recipients. No differences in oral/written and explicit/implicit communication are evident. The most frequently addressed themes in SRC in men are exhaustion, resignation, and listlessness. For women, the suicide method is the most common topic, followed by the topics mentioned among men. Conclusions: A high proportion of participants reported having engaged in SRC. In contrast, the themes addressed are very ambiguous and not clearly suicide-related, especially among men. This can lead to difficulties in the interpretation of the statements by the recipients. Women seem to communicate more often with recipients who may provide assistance. These aspects ought to be considered for developing gender specific suicide prevention measures