A study of attitudes and experiences relating to alcohol use in a community of family farmers from Southern India.

Problematic drinking is found to be common among Indian farmers. This study aims to improve our understanding of the causes, consequences, and culture surrounding drinking in Indian farming communities. 36 semi-structured interviews with male and female farmers were thematically analyzed. Problematic drinking in male farmers was found to significantly impact farmer's relationships, work, finances, and health, and to be related to spousal abuse and neglect. Drinking to cope with mental and physical pain was common, and stigma around drinking appears to be a barrier to social support. Implications for future research and treatment efforts for Indian farmers are discussed.

Prospective prediction of PTSD diagnosis in a nationally representative sample using machine learning.

BACKGROUND: Recent research has identified a number of pre-traumatic, peri-traumatic and post-traumatic psychological and ecological factors that put an individual at increased risk for developing PTSD following a life-threatening event. While these factors have been found to be associated with PTSD in univariate analyses, the complex interactions of these risk factors and how they contribute to individual trajectories of the illness are not yet well understood. In this study, we examine the impact of prior trauma, psychopathology, sociodemographic characteristics, community and environmental information, on PTSD onset in a nationally representative sample of adults in the United States, using machine learning methods to establish the relative contributions of each variable. METHODS: Individual risk factors identified in Waves 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were combined with community-level data for the years concurrent to the NESARC Wave 1 (n = 43,093) and 2 (n = 34,653) surveys. Machine learning feature selection and classification analyses were used at the national level to create models using individual- and community-level variables that would best predict the new onset of PTSD at Wave 2. RESULTS: Our classification algorithms yielded 89.7 to 95.6% accuracy for predicting new onset of PTSD at Wave 2. A prior diagnosis of DSM-IV-TR Borderline Personality Disorder, Major Depressive Disorder or Anxiety Disorder conferred the greatest relative influence in new diagnosis of PTSD. Distal risk factors such as prior psychiatric diagnosis accounted for significantly greater relative risk than proximal factors (such as adverse event exposure). CONCLUSIONS: Our findings show that a machine learning classification approach can successfully integrate large numbers of known risk factors for PTSD into stronger models that account for high-dimensional interactions and collinearity between variables. We discuss the implications of these findings as pertaining to the targeted mobilization emergency mental health resources. These findings also inform the creation of a more comprehensive risk assessment profile to the likelihood of developing PTSD following an extremely adverse event.

Predictors of psychotherapy alliance in Borderline Personality Disorder.

UNLABELLED: To better understand alliance formation with BPD patients, we examined the relationship between pre-treatment patient characteristics and alliance at baseline and 2 months. Thirty-five volunteers who enrolled in a RCT comparing dialectical behavior therapy (DBT) and supportive psychotherapy, with or without antidepressant medication in the treatment of suicidal behavior, were included in this analysis. Participants were administered the SCID-I and II, Beck Depression Inventory, Working Alliance Inventory, Beck Hopelessness Scale, and the State Trait Anxiety Inventory. RESULTS: depression, anxiety and hopelessness predicted poorer patient-rated alliance at 2 months. Depression and anxiety did not correlate with alliance at the start of treatment, but strongly correlated with 2-month alliance, suggesting patient-rated alliance at 2 months was influenced by the course of treatment. Therapist-rated alliance was not associated with either mood or BPD symptoms. Our findings suggest that focusing on BPD patients' mood early in treatment may improve alliance formation.

Mental health needs of sex trafficking survivors in New York City: Reflections on exploitation, coping, and recovery.

Objective: It is increasingly acknowledged by academics, practitioners, and policymakers that sex trafficking can lead to various mental health sequelae, such as depression, anxiety, and trauma symptoms, and have lasting effects on the survivors' health and well-being. What has been lacking in this dialogue, however, are the firsthand stories of survivors. This qualitative, exploratory study was designed to capture the depth and complexity of survivors' lived experiences of mental health, pathways of recovery, and social reintegration posttrafficking. Method: Six female sex trafficking survivors were recruited for this study in partnership with two legal agencies in New York City. In-depth semistructured individual interviews were conducted with each survivor, and an interpretative phenomenological analysis method was used to analyze and interpret interview transcripts. Results: Participants shared about the chronic betrayal and violence in their trafficking experiences, struggles living with the effects of trafficking on their mental health, how they cope, and their recommendations for supporting other sex trafficking survivors. Practitioners are urged to build trust, address safety and shame, foster agency, avoid judgment, and develop unique knowledge and skills important for this population. Conclusion: These findings attempt to address a crucial gap in the field by amplifying survivor voices, providing valuable insights for practitioners working with this population, and paving the way for further research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Moral objections to suicide and suicidal ideation among mood disordered Whites, Blacks, and Hispanics.

UNLABELLED: Understanding the beliefs that protect individuals against suicide can help to enhance suicide prevention strategies. One measure of suicide non-acceptability is the moral objections to suicide (MOS) sub-scale of the reasons for living inventory (RFLI). This study examined the MOS and suicidal ideation of White, Black, and Hispanic individuals with mood disorders. We expected minority individuals to have stronger objections to suicide. METHOD: Eight hundred and four, White (588), Black (122) and Hispanic (94) participants with DSM-IV diagnoses of MDD or bipolar disorder were administered the scale for suicide ideation, the reasons for living inventory and several measures of clinical distress. RESULTS: Higher suicidal ideation was modestly correlated with lower MOS scores overall (r=0.15, p=0.001). Among Blacks however the relationship was inverted: despite having higher suicidal ideation than Whites or Hispanics, Blacks reported the least accepting attitudes toward suicide. CONCLUSION: These results suggest that attitudes regarding the acceptability of suicide may be independent of suicidal ideation.

Validity of cognitive complaints in substance-abusing patients and non-clinical controls: the Patient's Assessment of Own Functioning Inventory (PAOFI).

To determine the validity of substance-abusing (SA) patients' self-reports of cognitive impairments, we assessed the independent contributions of depression, actual neurocognitive performance and an index of cognitive decline, in predicting cognitive complaints in groups of SA patients and normal controls. The SA sample comprised 74 veterans enrolled in day treatment. The non-clinical sample consisted of 150 English-speaking adults. Assessment instruments were as follows: A modified version of the Patient's Assessment of Own Functioning Inventory (PAOFI) containing three subscale on: Memory, Language and Communication, and Higher Cognitive Functions; the Beck Depression Inventory; a battery of neuropsychological tests that measured domains of executive function, processing speed, verbal fluency and verbal and visual memory; and a measure of premorbid intellectual functioning. SA patients reported twice as many PAOFI complaints as non-clinical controls. SA patients' neuropsychological performance was lower than that of non-clinical controls. A higher percentage of SA patients had significant cognitive decline. The SA sample reported more depression. There was no association between PAOFI scores and neuropsychological performance for either group. PAOFI results were not associated with cognitive decline. BDI scores accounted for 12% of the variance in PAOFI total score for the SA sample and 44% for the non-clinical sample in multiple regression analysis. Cognitive complaints were related more to depression than cognitive performance for both SA and non-clinical samples. The results do not support self-report as a valid means of neuropsychological assessment in SA samples, although self-reports may provide other information about perceived cognitive difficulties that may be relevant to clinical evaluation.

Birth order: self-injurious and suicidal behaviour among adolescents.

A sample of 2553 children and adolescents in a psychiatry clinic in Germany were assessed using a structured interview inventory that included history of self-injurious behaviour, suicidal intent and socially disruptive and threatening behaviour, and diverse socio-demographic variables (the basis documentation or 'Ba-Do'). Birth order was associated with both suicidal and self-injurious behaviour, middle children being most likely to exhibit such behaviour. Females were more than twice as likely to have self-injured than males. Comparisons of birth order groups within gender found no significant differences in suicidal behaviour between birth positions for males, however among females, middle children were much more likely to have attempted suicide. Conversely, there was no difference in self-injurious behaviour among birth positions in females, but among males, middle children were significantly more likely to have self-injured than firstborns, only children or lastborns. The number of siblings in the family was significantly correlated with both suicidal history (r = 0.12, p < 0.001) and self-injurious behaviour (r = 0.10, p < 0.001). The risk of suicidal behaviour was highest for those with four or more siblings.

Suicidal subtypes, stress responsivity and impulsive aggression.

While prominent models of suicidal behavior emphasize the hypothalamic- pituitary-adrenal (HPA) axis dysregulation, studies examining its role have yielded contradictory results. One possible explanation is that suicide attempters are a heterogeneous group and HPA axis dysregulation plays a more important role only in a subset of suicidal individuals. HPA axis dysregulation also plays a role in impulsivity and aggression. We hypothesize subgroups of attempters, based on levels of impulsivity and aggression, will differ in HPA axis dysregulation. We examined baseline cortisol, total cortisol output, and cortisol reactivity in mood disordered suicide attempters (N = 35) and non-attempters (N = 37) during the Trier Social Stress Test. Suicide attempters were divided into four subgroups: low aggression/low impulsivity, high aggression/low impulsivity, low aggression/high impulsivity, and high aggression/high impulsivity. As hypothesized, attempters and non-attempters did not differ in any cortisol measures while stress response differed based on impulsivity/aggression levels in suicide attempters, and when compared to non-attempters. Specifically, attempters with high impulsive aggression had a more pronounced cortisol response compared with other groups. This is the first study to examine the relationship between cortisol response and suicidal behavior in impulsive aggressive subgroups of attempters. These findings may help to identify a stress responsive suicidal subtype of individuals.

Objections to suicide among depressed patients with alcohol use disorders.

BACKGROUND: Understanding how alcohol misuse interacts with beliefs that protect individuals against suicide can help to enhance suicide prevention strategies. One measure of suicide non-acceptability is the Moral Objections to Suicide (MOS) subscale of the Reasons for Living Inventory (RFLI). METHOD: 521 mood disordered patients with and without alcohol use disorders (AUD) were administered a battery of clinical measures including the Scale for Suicidal Ideation and the Reasons for Living Inventory. A multivariate analysis of covariance (MANCOVA) was conducted, examining the effects of alcohol use history on the five RFLI subscales and suicidal ideation, while controlling for differences in age, education, marital status and sex. RESULTS: RFL scores were no different between groups, except in one respect: patients with AUD had fewer moral objections to suicide. Higher suicidal ideation was associated with lower MOS scores. Prior suicidal behavior was associated with lower MOS, and higher current suicidal ideation. However, AUD history was not associated with suicidal ideation. CONCLUSION: Patients with AUDs had fewer objections to suicide, even though their level of current suicidal ideation was similar to those without AUD, suggesting that attitudes about the acceptability of suicide may be conceptually distinguished from suicidal ideation, and may be differentially associated with risk for suicidal behavior. These findings suggest that alcohol use and suicidal behavior predict current attitudes toward suicide, however causal mechanisms are not clearly understood.

Effect of acute alcohol use on the lethality of suicide attempts in patients with mood disorders.

Acute alcohol use is an important risk factor for attempted and completed suicide. We evaluated the effect of acute alcohol intake on the lethality of suicide attempts to test the hypothesis that acute alcohol intoxication is associated with more lethal suicide attempts. This retrospective study included 317 suicide attempters enrolled in mood disorders protocols. Demographic and clinical parameters were assessed. The use of alcohol at the time of the most lethal suicide attempt was determined. On the basis of their responses participants were classified into three groups: participants who reported "Enough alcohol intake to impair judgment, reality testing and diminish responsibility" or "Intentional intake of alcohol in order to facilitate implementation of attempt" were included in the group "Alcohol" (A); participants who reported "Some alcohol intake prior to but not related to attempt, reportedly not enough to impair judgment, reality testing" were included in the group "Some Alcohol" (SA); and participants who reported "No alcohol intake immediately prior to attempt" were included in the group "No Alcohol" (NA). Lethality of the most lethal suicide attempts was higher in the A group compared to the SA and NA groups. Prevalence of patients with alcohol use disorders was higher in the A group compared to the SA and NA groups. SA participants reported more reasons for living and lower suicide intent scores at the time of their most lethal suicide attempt compared to the A and NA groups. Acute alcohol use increases the lethality of suicide attempts in individuals with mood disorders.