Mental pain as a mediator in the association between avoidant attachment and suicidal ideation among older men.

OBJECTIVES: In the present study, our aim was to deepen the understanding of suicidality in older men by adopting a biopsychosocial approach. The study focused on older men as they face an elevated risk of suicide, surpassing not only other age groups but also exhibiting higher rates compared to women. We examined the contribution of mental pain as a mediator in the association between attachment avoidance and suicidal ideation among older men, taking into consideration the severity of their physical illnesses. METHODS: Participants were 200 men in Israel, aged ≥65 years, living in the community and without cognitive impairment. Data collection was based on self-report measures of suicidal ideation (Beck Scale for Suicidal Ideation, BSSI), attachment (Experience in Close Relationships, ECR-R), mental pain (Orbach and Mikulincer Mental Pain Scale, OMMP), and the severity of physical illnesses (Cumulative Illnesses Rating Scale, CIRS). RESULTS: Mental pain was found to mediate the association between attachment avoidance and suicidal ideation, but only among participants with higher levels of physical illnesses. CONCLUSIONS: Mental pain should be considered as a complication of an avoidant coping strategy, which increases the risk of suicide among older men, especially those suffering from significant physical illnesses. The theoretical and clinical implications of these findings are discussed.

The Moderating Effect of Religiousness on the Relation Between Sexual Guilt and Shame and Well-Being Among Jewish Religious Single Men.

Jewish religious singles may feel guilty and ashamed due to sexual behaviors that violate religious law, such as pre-matrimony sexual relations, viewing pornography, and masturbation. This study examined the relation between sexual guilt and shame (SGS) and psychological well-being, and whether this relation was moderated by level of religiousness. It was hypothesized that SGS would be negatively related to psychological well-being and that this relation would be stronger at higher levels of religiousness compared to lower levels of religiousness. Participants were single young-adult men (N = 165, Mage = 23.3) belonging to the national-orthodox Jewish community in Israel who completed online questionnaires. SGS was positively associated with anxiety and depression and negatively associated with life satisfaction. Additionally, the relations between SGS and measures of psychological well-being were moderated by the level of religiousness. However, contrary to the hypothesized moderation effect, SGS was positively related to negative psychological consequences and negatively related to life satisfaction at a low level of religiousness, whereas at a high level of religiousness no significant relationship between SGS and the psychological outcome measures was found. These findings may indicate that there may be adaptive elements in religion that can help an individual cope with SGS, and thus to negate its detrimental effects on psychological well-being.

Patients' response to moments of disappointment with their therapist: the roles of disappointment experience, emotional abilities, and perceived alliance negotiation.

OBJECTIVE: Disappointment has not received sufficient attention in psychotherapy research. I examined how patients experience and respond to disappointment events with their therapist, as a function of patients' emotional abilities and perceived alliance negotiation in their therapy. METHOD: A sample of 119 patients reported their emotional abilities (i.e., emotion dysregulation and alexithymia), perceived level of alliance negotiation, their experience during a specific disappointment event with their therapist and their responses to that event. Responses were conceptualized according to Rusbult's model as exit, voice, loyalty, and neglect, and by whether the therapy was ended following the event. RESULTS: Moments of disappointment were associated with premature termination. Patients' responses were related to the quality of their experience. Alexithymia and emotion dysregulation were positively correlated with passive and destructive responses to disappointment. Patients with high levels of emotion dysregulation or alexithymia perceived the therapeutic alliance as less negotiable and responded passively and destructively in moments of disappointment with their therapist. DISCUSSION: Patients' responses to disappointment moments depend on their emotional experience, emotional abilities, as well as on their perception of the therapist's willingness to discuss the different aspects of the therapeutic relationship. The theoretical and clinical implications of these results are discussed.

The role of meaning in life as a protective factor in suicidal ideation among elderly men with physical illnesses.

The highest suicide rates are among elderly men. The aim of the present study is to extend previous findings by focusing on meaning in life as a protective factor for suicidal ideation among elderly men. Self-report measures were administered to 170 elderly men aged 65 and over in community. Meaning in life and physical illness predicted suicidal ideation among elderly men. Physical illness moderated the association between meaning in life and suicidal ideation. In the young-old group (ages 65-74), meaning in life predicted suicidal ideation among those who reported higher rates of physical illness. This moderation effect was not found among the older group (aged 75 years and older). The findings of this study highlight the importance of age-differences in studying suicidal ideation among elderly men. Our findings emphasize the importance of cultivating and maintaining meaning in life when coping with chronic illnesses and point at meaning in life as a goal in therapeutic interventions designed to reduce suicidal ideation among elderly.

Loneliness and social integration as mediators between physical pain and suicidal ideation among elderly men.

OBJECTIVES: Suicide in the elderly is a complex and significant public health problem. The purpose of our study was to examine the role of loneliness and social integration as potential mediators in the relationship between physical pain and suicidal ideation in the elderly. DESIGN: Descriptive, bivariate correlations, and moderated mediation analyses were performed. SETTING: Personal meetings were held with participants in their homes. PARTICIPANTS: A total of 198 elderly men aged 65 and over. MEASUREMENTS: Self-report measures: Beck Scale for Suicidal Ideation, Physical pain subscale, Multidimensional Social Integration in Later Life Scale, and University of California, Los Angeles (UCLA) Loneliness Scale (Version 3). RESULTS: Our findings showed that the association between physical pain and suicidal ideation was mediated by loneliness and social integration. Further analyses revealed that this mediation model was significant among single, but not married, men. CONCLUSIONS: Physical pain and social factors are both important in understanding suicidality in late life. Elderly single men who experience physical pain may be lonelier and less socially integrated, and these factors may contribute to higher risk of suicidal ideation.

Perfectionism Moderates the Relationship between Thwarted Belongingness and Perceived Burdensomeness and Suicide Ideation in Adolescents.

According to the Interpersonal Theory of Suicide, suicide ideation is associated with thwarted belongingness and perceived burdensomeness. According to the Perfectionism Social Disconnection Model, excessive perfectionism is also considered to be a risk factor for depression and suicide. In the present study, the role of perfectionism as a moderator in the association between interpersonal distress (i.e., perceived burdensomeness, thwarted belongingness, low connectedness to parents and friends) and suicide ideation was examined in a nonclinical sample of adolescents. One-hundred and three adolescents were assessed through self-report instruments. Perceived burdensomeness and thwarted belongingness and disconnectedness to parents and friends were found to correlate with suicide ideation. As predicted, perfectionism was found to moderate the relation between these interpersonal distress variables and suicide ideation. Perfectionism augments the association between interpersonal distress and suicide ideation among adolescents. Interventions should consider that adolescents who face interpersonal challenges are particularly at risk if they tend to be highly perfectionist.

The Role of Intra-personal and Inter-personal Factors in Fear of Childbirth: A Preliminary Study.

Childbirth is a major life event, but for some women, the fear of childbirth goes beyond trepidation towards full-blown anxiety and panic, known as fear of childbirth (FOC) or tokophobia. In the present study the authors investigated and compared the intrapersonal and interpersonal factors that might be associated with FOC among women who previously gave birth (parous) and women who did not. A cross sectional survey was conducted among 529 women (parous women (n = 365) and women who had never given birth (n = 173). All participants completed self-report measures using an online survey system. The questionnaires assessed intrapersonal factors including attitudes toward pregnancy and birth, body image, self-esteem and life satisfaction as well as interpersonal factors namely relationship satisfaction. Multiple regression analyses revealed that among parous women age and attitudes toward pregnancy and birth, especially those that relate to body image and delivery were significantly associated with FOC. Among women who had never given birth, only attitudes toward pregnancy and birth, especially those that relate to body image, importance of pregnancy and delivery, and preference of caesarean section (CS), were significantly associated with FOC. In both groups, satisfaction with spousal relationship was not found to be associated with FOC. The results indicate that regarding FOC, intra-personal factors are more dominant than inter-personal factors. When assessing this medico-psychological fear, cognitive aspects should also be addressed.

Sheltered women's perceptions of their abusive marital relationship: Conflictual themes of dominance and submissiveness.

The Core Conflictual Relationship Themes (CCRT) approach was applied in order to examine the conflictual nature of sheltered women's perceptions of their marital relationship following domestic violence in Israel. Thirty-six sheltered women and 89 community-based women were compared. The CCRT method was useful in revealing that battered women, when thinking retrospectively about their relationships with their abusive partners, are concerned with conflictual themes of dominance and submissiveness. The sheltered women reported a desire to be more dominant and less submissive in their relationships with their abusive spouse, despite being less dominant than they wished in practice. These findings help clarify the emotional conflicts that battered women may be dealing with after leaving an abusive relationship and imply that interventions should promote their empowerment.

Effects of ethnicity on sub-clinical PTSD and depressive symptoms, following exposure to missile attacks in Israel--a pilot study.

OBJECTIVE: The aim of this pilot study was to compare the occurrence of post-traumatic stress disorder (PTSD) symptoms, major depression disorder (MDD)-related symptoms, and negative mood regulation capacities among Israeli Jewish and Arab children and their parents, all of whom had been exposed to recurrent missiles attacks during the Second Lebanon War. METHODS: Participants consisted of 28 Jewish and 14 Arab children (aged 4-18 years) and their parents. They were assessed by self-report instruments and a semi-structured interview (K-SADS-PL). RESULTS: Among children, PTSD and depressive symptoms were found to be interrelated. Parents' depression and mood regulation were found to be related to their children's PTSD and depressive responses. Both children's and parents' negative mood regulation capacities were inversely related to children's depressive and PTSD symptoms. Both Jewish and Arab children's scores on the Children Depression Inventory (CDI) and on the PTSD Scale Symptoms Interview (PSS-I) showed significant levels of emotional distress following the missile attacks. However, Arab children reported significantly higher levels of PTSD and depressive symptoms in comparison to Jewish children. CONCLUSION: Ethnicity seems to be an important factor in children's responses to war-related events.

Mental pain as a mediator of suicidal tendency: a path analysis.

BACKGROUND: This study used path-analysis to examine the assumption that the presence of mental pain in adults mediates the relationship between self-destruction, number of losses experienced in one's life, and suicidal tendency. METHODS: Fifty suicidal inpatients, 50 non-suicidal inpatients and 50 healthy volunteers were assessed for self-destruction, losses experienced, depression, suicidal tendency, and mental pain. RESULTS: Self-destruction was found to have both a direct effect on suicidal tendency as well as one mediated by the presence of mental pain. Number of losses effected suicidal tendency only indirectly, mediated by the presence of mental pain. Overall, self-destruction was a more significant determinant of suicidal tendency than were the number of losses experienced during one's life. A competing model, with depression replacing mental pain as the mediator, was also found to fit the data. DISCUSSION: These findings provide evidence that the presence of mental pain is a mediator in the relationships between both self-destruction and number of losses experienced, and between suicidal tendencies. More studies are needed in order to further differentiate between mental pain and depression as mediators in suicidal tendency.

The Hebrew version of the adolescent and adult time inventory-time attitudes scales (AATI-TA): a validation study.

In the present study, we examined the construct validity of scores on the Hebrew version of the Adolescent and Adult Time Inventory-Time Attitudes Scale (AATI-TA). The AATI-TA was translated into Hebrew by bilingual speakers, using the back-translation method. Participants included 452 young adults (Mage = 22.47, SDage = 1.98, 51.5% female). Several measures of psychological well-being were used to establish convergent validity, including scales assessing self-esteem, life satisfaction, and optimism, and depressive, anxiety, and somatic symptoms. Internal consistency estimates for AATI-TA scores were high and confirmatory factor analyses supported the six-factor structure. Correlational analyses indicated the expected relationships between time attitudes and measures of psychological well-being, providing convergent validity support for the AATI-TA scores. The findings of this study support the use of the Hebrew version of the AATI-TA in further studies about time attitudes.

Suicide-related calls to a national crisis chat hotline service during the COVID-19 pandemic and lockdown.

BACKGROUND: A COVID-19 pandemic-related rise in suicide rates has been predicted due to social isolation, fear, uncertainty, economic turndown and grief. Detecting an increase in suicide rates is difficult in the absence of real-time data. Alternative data sources for such trends in psychopathology and suicidal behavior must be sought. METHODS: Data from a national chat-based crisis hotline for the first half of 2019 (pre-COVID-19), were compared to data from the first half of 2020 (during COVID-19). Chat sessions were classified by content and demographics and the data compared between the two time periods. OUTCOME: Total chats (n = 6756) were 48% higher during COVID-19 (p < .05). Suicide-related chat (SRC) number was also higher, although the proportion relative to all chats was slightly lower during COVID-19, compared to pre-COVID-19 (p < .05). SRCs increased during the COVID-19 lockdown. The number of severe SRCs resulting in urgent police intervention, increased during the lockdown (April-May 2020) compared with the same period in 2019 (p = .04). Issues of anxiety were higher in 2020 (19.4%) vs. 2019 (16.5%) (p < .00001) while issues of depression were lower (22.4% vs 33%, respectively) (p < .00001). The overall use of chats among adults aged >50 yrs increased during COVID-19 and likewise, the rate of SRCs in this age-group increased 30-fold in this period when compared to pre-COVID-19 (p < .00001). SRCs included more women than men (p < .0001) in both pre-COVID-19 and during the COVID-19 period, when the proportion of women increased from 62% in 2019 to 73% during COVID-19 (p < .0001). INTERPRETATION: The rise in total chats, SRCs and SRCs resulting in police action, commenced during lockdown and was ameliorated by end of the lockdown, indicating that distress created by the lockdown was more impactful than mourning deaths of loved ones, fear and uncertainty, because all these factors persisted beyond the end of the lockdown. Older populations were probably more distressed due to greater risk and less adaptability to isolation, social media and staying home. More calls by women may reflect women's better help-seeking capacity. The increase in SRCs indicates the potential for more suicides and the need for bolstering mental health services and reach-out to older people during pandemic lock-downs.

Rejection Sensitivity, Self-Compassion, and Aggressive Behavior: The Role of Borderline Features as a Mediator.

This study used mediation analyses to examine the assumption that the presence of borderline personality features mediates the relationship between rejection sensitivity (RS), self-compassion, and aggressive behavior. Sixty adults consisting of 31 participants diagnosed with borderline personality disorder and 29 participants with no diagnosis of borderline personality disorder were assessed for RS, self-compassion, aggressive behavior, and borderline personality features. Mediation was found for the total aggression score, anger score, and hostility score regarding both self-compassion and RS. Mediation was also found regarding RS and verbal and physical aggression, and regarding self-compassion and verbal and physical aggression. These findings provide evidence that the presence of borderline personality features is an important factor in explaining the associations linking RS and self-compassion to aggressive behavior. High RS and low self-compassion are associated with greater borderline personality features, which in turn relate to increased aggressive behavior.

Continuous Performance Test Is Sensitive to a Single Methylphenidate Challenge in Preschool Children With ADHD.

Objective: There is a lack of evidence-based diagnostic paradigms and personalized interventions for preschoolers with ADHD. This study aimed to evaluate the performance of preschoolers diagnosed with ADHD on a continuous performance test (CPT) before and after a single methylphenidate (MPH) challenge. Method: The Test of Variables of Attention (TOVA)-a CPT-was administered to 61 preschoolers (5.64 ± 0.69 years; 74% boys) with ADHD before and after a single MPH challenge (0.3 or 0.5 mg/kg). Baseline TOVA performance was correlated with Conners' Rating Scales (CRS) and compared with post-MPH TOVA performance. Results: A high rate of omission errors and several significant correlations between TOVA values and CRS scores were found at baseline. A single MPH administration improved TOVA performance significantly and was well tolerated. Conclusion: TOVA assessment may assist in the evaluation of the effect of MPH in preschoolers with ADHD and may help in planning interventions for them.

An in-session exploration of ruptures in working alliance and their associations with clients' core conflictual relationship themes, alliance-related discourse, and clients' postsession evaluations.

This exploratory study examined (a) the relationship among the occurrence of ruptures in the working alliance, the emergence of client's core conflictual relationship themes (CCRT), and focus of discourse within therapeutic sessions and (b) the relationship between ruptures in the working alliance and client's postsession evaluations of session's smoothness and depth. The authors included 151 sessions from five therapies conducted in a student counseling center. Sessions were content analyzed by independent raters, and a self-report questionnaire was given to clients after each session. Ruptures were positively related to the emergence of clients' CCRT during the session, but only when the therapist was addressed as the "other." Sessions with ruptures were characterized by heightened discussion of working alliance components and were evaluated as less smooth than sessions without ruptures. Findings are discussed, and the importance of ruptures in working alliance for therapeutic change is emphasized.

Quality of depression among suicidal inpatient youth.

This study examined the relationship between suicidality and dependent and self-critical depression among adolescents. Ninety-six adolescents participated: 32 suicidal inpatients, 32 nonsuicidal inpatients and 32 healthy controls. The groups were matched for gender, age and education. Participants completed the Depressive Experience Questionnaire for Adolescents (DEQ-A), the Cognition Checklist (CCL), and the Multi-Attitude Suicidal Tendencies Scale (MAST). Results indicated that suicidal adolescents have significantly higher levels of self-critical and dependent depression, compared to nonsuicidal inpatients and healthy controls. The distinctive quality of depression among suicidal adolescents suggests assessment and treatment strategies for these individuals.

Plasma serotonin levels and suicidal behavior in adolescents.

To evaluate the relationship between plasma serotonin (p5-HT) levels and psychometric measures in suicidal adolescents vs. controls, 211 adolescents from three sites in Israel were divided into four groups: suicidal psychiatric inpatients (n=35); non-suicidal psychiatric inpatients (n=30); adolescents referred to the emergency room (ER) due to a suicide attempt (n=51); and a community-based control group from 4 high schools in the same catchment areas (n=95). All were interviewed and assessed for violence, aggression, depression, impulsivity, anger, anxiety, and p5-HT. p5-HT levels were significantly lower in the control group compared to all other groups. A significant negative correlation was found between p5-HT level and suicidal behavior severity among the suicidal inpatients. p5-HT did not discriminate between the psychiatric diagnostic categories and was significantly lower in ER violent compared to non-violent subjects. Gender, depression, and anger were associated with suicidal behavior in all four groups. Beck Depression Inventory (BDI) scores together with p5-HT levels discriminated between healthy controls and other groups. p5-HT level in combination with some of the psychometric scales may serve as a safe and inexpensive peripheral marker of psychopathology, and may help to differentiate between sub-populations of suicidal adolescents. The biological mechanism behind the serotonin dysregulation in suicidal adolescents requires further investigation.

Effect of the broadcast of a television documentary about a teenager's suicide in Israel on suicidal behavior and methods.

Portrayals of suicide in the media are controversial because they may impact on suicide rates and methods. The aim of this study was to analyze the effect of the broadcast of a television documentary wherein an adolescent girl is interviewed about her suicide plan and subsequently dies by suicide. National suicide rates during the 8 weeks prior to the program and the 4 weeks following it were compared to the same periods in the previous year. There was no significant difference in the rates of completed and attempted suicides before and after the program. There was a shift toward the method used in the film after the broadcast, but it was found to be nonspecific to that year. A significant decrease was noted in the mean age of suicide attempters in the last promotional week prior to the broadcast compared to the previous year (p = .032). These preliminary findings suggest that the repeated televised promotion of a documentary on suicide may raise the risk of suicide in vulnerable populations. Further investigations in bigger populations are needed.

Children's Depression Inventory (CDI) and the Children's Depression Rating Scale-Revised (CDRS-R): reliability of the Hebrew version.

The Children's Depression Inventory (CDI) and Children's Depression Rating Scale-Revised (CDRS-R) are two widely used instruments, which measure depression in children and adolescents. This pilot study assessed the reliability of the Hebrew versions of these two instruments. Both CDRS-R and CDI were translated from English into Hebrew and then back translated. Seventeen healthy Israeli bilingual children volunteers were interviewed with both scales with a one day intermission between the interviews. Non-parametric correlations were used to compare scores in the two versions for each item. Results showed high agreement between the two versions for almost all items of the CDI and moderate to high for the CDRS-R. When CDRS-R summary scores for each item were compared, the agreement was high for this instrument as well. It is concluded that both CDI and CDRS-R Hebrew versions are reliable and can be used for studies of depression in the Israeli pediatric population.

Attachment style, home-leaving age and behavioral problems among residential care children.

In a prospective study, the attachment style, home-leaving age, length of time in residential care, and behavioral problems among Israeli residential care children (N = 68), were studied. Data analyses showed that children removed from their homes at a later age suffered from higher levels of anxiety, depression and social problems compared to children taken from their homes at the age of 7 or less. It was also found that a prolonged stay (over 2 years) in residential care was related to higher levels of anxiety and depression. An interaction effect of a child's attachment style and home-leaving age was found in the child's level of aggressive behavior.