Improper study design precludes valid effect estimates in important suicide prevention research.

The observational study design for estimating accuracy of diagnostic tests for suicide risk in clinical work is not ideal, due to the effects of directed suicide prevention to the high-risk group. This is an example of the confounding by indication and protopathic bias, which lead to misinterpretation of the accuracy terms sensitivity and specificity. The simple arithmetic mechanism presented here, forces the conclusion that the accuracy estimates sensitivity and specificity, applied in open prospective trials of surmised diagnostic tests for suicide risk, cannot be normally interpreted as accuracy estimators. Further, the related concept "prediction of suicide" is shown to be fundamentally illogical and should not be used in the present context. All these statements reveal a far-reaching problem within the suicide prevention research: Conclusions regarding the usefulness of diagnostic tests of suicide risk in the vast previous research since decades deserve reinterpretation. Diagnostic tests per se, can possess highly qualitative properties in estimating important suicidological aspects regarding a patient, but, when studied in an open design study, it cannot be demonstrated. This problem concerns rating scales and any biological and psychological tests in medicine, when confounding factors, for example, suicide prevention, influence the outcome because of the test result per se.

Effects of milk-based phospholipids on cognitive performance and subjective responses to psychosocial stress: A randomized, double-blind, placebo-controlled trial in high-perfectionist men.

OBJECTIVES: The aim of this study was to examine the stress-buffering potential of phospholipid (PL) intake on cognitive performance and neuroendocrine and psychological responses under conditions of psychosocial stress in a high-stress vulnerable (perfectionist) sample. METHODS: Fifty-four high-perfectionist men consumed a 6-wk daily intake of a bovine milk-derived PL (2.7 g/d) or placebo drink in a randomized, double-blind, placebo-controlled, parallel groups design. Working memory, executive control function, and acute physiological/subjective responses to an acute psychosocial stressor were examined before and after the 6-wk PL or placebo intake. RESULTS: PL intake improved post-stress reaction time performance on an attention-switching task (P = 0.01). No significant attenuation of the salivary cortisol stress response was shown. PL intake significantly increased mid-stress induction energetic arousal (P = 0.03). A non-significant reduction in anticipatory subjective stress was reported after PL intake (P = 0.06). Systolic and diastolic blood pressures (P<0.04 and P = 0.01, respectively) were significantly augmented in the PL condition. CONCLUSIONS: Dietary intake of bovine milk PLs conferred cognitive performance benefit under conditions of psychosocial stress but failed to moderate cortisol response. Moderation of subjective response to stress exposure may have underpinned this performance protection.

EUDOR-A multi-centre research program: A naturalistic, European Multi-centre Clinical study of EDOR Test in adult patients with primary depression.

BACKGROUND: Electrodermal reactivity has been successfully used as indicator of interest, curiosity as well as depressive states. The measured reactivity depends on the quantity of sweat secreted by those eccrine sweat glands that are located in the hypodermis of palmar and plantar regions. Electrodermal hyporeactive individuals are those who show an unusual rapid habituation to identical non-significant stimuli. Previous findings suggested that electrodermal hyporeactivity has a high sensitivity and a high specificity for suicide. The aims of the present study are to test the effectiveness and the usefulness of the EDOR (ElectroDermal Orienting Reactivity) Test as a support in the suicide risk assessment of depressed patients and to assess the predictive value of electrodermal hyporeactivity, measured through the EDOR Test, for suicide and suicide attempt in adult patients with a primary diagnosis of depression. METHODS AND DESIGN: 1573 patients with a primary diagnosis of depression, whether currently depressed or in remission, have been recruited at 15 centres in 9 different European countries. Depressive symptomatology was evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts were registered and the suicide intent of the worst attempt was rated according to the first eight items of the Beck Suicide Intent Scale. The suicide risk was also assessed according to rules and traditions at the centre. The EDOR Test was finally performed. During the EDOR Test, two fingers are put on gold electrodes and direct current of 0.5 V is passed through the epidermis of the fingers according to standards. A moderately strong tone is presented through headphones now and then during the test. The electrodermal responses to the stimuli represent an increase in the conductance due to the increased number of filled sweat ducts that act as conductors through the electrically highly resistant epidermis. Each patient is followed up for one year in order to assess the occurrence of intentional self-harm. DISCUSSION: Based on previous studies, expected results would be that patients realizing a suicide attempt with a strong intent or committing suicide should be electrodermally hyporeactive in most cases and non-hyporeactive patients should show only few indications of death intent or suicides. TRIAL REGISTRATION: The German Clinical Trials Register, DRKS00010082 . Registered May 31st, 2016. Retrospectively registered.

Dreading the boards: stress response to a competitive audition characterized by social-evaluative threat.

The capacity of psychosocial stressors to provoke the hypothalamic-pituitary-adrenal axis has been demonstrated to vary depending upon a number of psychological factors. Laboratory stressors characterized by social-evaluative threat are proposed to be the most efficacious in the elicitation of a cortisol stress response. Salivary cortisol, cardiovascular, and subjective responses of 16 healthy adults facing a naturalistic stressor characterized by social-evaluative threat (competitive performance auditions) were examined. Audition exposure was sufficient to provoke significant cortisol, arterial blood pressure (systolic and diastolic), and subjective stress responses. Cortisol response reactivity (area under the curve with respect to increase [AUCi]) also correlated with participants' subjective rating of social-evaluative threat. The competitive performance audition context is therefore considered a promising context in which to further explore cortisol responsivity to social-evaluative threat.

Hot flushes in healthy aging men differ from those in men with prostate cancer and in menopausal women.

Calcitonin gene-related peptide (CGRP) seems to be involved in hot flushes in women and in castrated men. Therefore, we studied whether the plasma concentrations of CGRP changed during flushes in a group of healthy aging men. Twelve men (49-71 years) with no history of current or former prostate cancer or hormonal treatment reporting ≥ 20 flushes/week were investigated. Blood samples were drawn during and between flushes for analysis of CGRP and also androgen concentrations, that is, testosterone and bioavailable testosterone were analysed. Skin temperature and skin conductance were monitored. Thirty-five flushes were reported by 10 men. The plasma concentrations of CGRP did not increase during flushes. No significant change in skin temperature or conductance was found. CGRP is probably not involved in the mechanisms of flushes in healthy aging men. Therefore, flushes in aging healthy men seem to be different from flushes in men and women deprived of sex steroids where CGRP increases during flushes.

Perceptions of the work environment among people with experience of long term sick leave.

PURPOSE: The aims were to describe and analyze how people with experience of long term sick leave perceive that factors in their work environment support or interfere with work performance, satisfaction, and well-being. METHOD: The 53 participants were interviewed with the Work Environment Impact Scale (WEIS). The WEIS ratings and belonging notes were analyzed by descriptive statistics and qualitative analysis respectively. Differences in WEIS ratings between; women and men; participants with somatic and mental diseases; and participants working and on full-time sick leave were tested. RESULTS: The most supportive factors concerned social interactions at work, and the value and meaning of work. The factors perceived as most interfering concerned work demands and rewards. The social relations at work were perceived as more supportive by the working group than by those on full-time sick leave. The participants with somatic diseases perceived physical work factors as more interfering than did participants with mental diseases, who in turn perceived the value and meaning of work as more interfering. CONCLUSION: Knowledge about the interaction between the worker and the work environment could reveal useful information about the complex phenomenon of reducing sick leave. The WEIS seems useful in providing information about how alterations and accommodations in the work environment could support individual workers.

Return to work: the predictive value of the Worker Role Interview (WRI) over two years.

Worker Role Interview (WRI) is an assessment tool designed to identify psychosocial and environmental factors which influence a person's ability to return to work. The purpose of this study was to investigate if the Worker Role Interview (WRI) can predict return to work over a period of two years. Fifty three long-term sick-listed people were interviewed and rated with the WRI. Differences in ratings and the ability of WRI to correctly predict whether these people would fall into the working or non-working groups at 6, 12 and 24 month follow-ups were tested by Mann-Whitney test and logistic regression respectively. Eight of 17 items in WRI were rated differently between the groups at one or more of the follow-ups. The regression models based on the WRI ratings had an overall correct prediction rate ranging from 81% to 96%. 'Expectation of job success' which concerns the person's belief in abilities in relation to return to work emerged as an important predictive factor for return to work in all statistical analyses. The WRI assessment contains items that could predict return to work. This implies that the WRI could be a useful tool in vocational rehabilitation for identifying individual rehabilitation needs.

Clinical perspective on the Swedish version of the Assessment of Communication and Interaction Skills: stability of assessments.

The purpose of the present study was to investigate whether ratings according to the Assessment of Communication and Interaction Skills, Swedish version (ACIS-S) are related to the settings in which the skills are assessed, and whether the client's comprehension of the setting is related to the ACIS-S rating scores. The ACIS-S is an observation rating scale applied immediately after each of two to six different social sessions that the client takes part in. The selection of settings relies on the client's judgement of them as being meaningful. In total, nine occupational therapists and 16 clients participated in the study. A total of 71 ratings were made in a mean of 4.4 settings per client. The results indicate that the client's rated comprehension of the settings is not significantly related, in general, to the ACIS-S rating scores given by the occupational therapist. However, the clients ACIS-S scores may vary a lot over settings. In the present study, 13- of the 20-items showed ratings of both the existence and the absence of problems in the same skill -- but in different settings -- in half or more of the client group. This may rise questions for the practitioners how to implement the ACIS-S in clinical practice, for example, how many and which kind of settings and how many times? Further research in the field is recommended.

"Reasons For Living"--translation, psychometric evaluation and relationships to suicidal behaviour in a Swedish random sample.

The protective role of positive beliefs and expectations against suicide has been studied using the Reasons For Living inventory (RFL). The RFL has shown to be useful in research and suggested for use in clinical practice. A Swedish translation of the RFL was examined for psychometric properties, reliability, latent structure and convergent validity in a Swedish general population. The RFL was distributed with the Suicide Behaviors Questionnaire (SBQ) to 1,366 randomly selected subjects aged 20-65 years in the county of östergötland. The results were based on 506 complete replies. The Cronbach alpha of the total RFL was 0.92, ranging from 0.72 to 0.93 in the six scales of RFL. The intercorrelations between the scales were weak and the scale to total RFL score moderate to high. The factor structure and item loadings of the inventory showed great similarities with the American one with exception for the scales Responsibility to Family and Child-related Concerns, which formed one common factor. The convergent validity was supported by significant relationships to the items of the SBQ. It is concluded that the Swedish translation of the RFL inventory in a Swedish general sample possesses great similarities to the American original RFL. Thus, it is suggested as an instrument for research and clinical usage in Sweden.

The worker role interview--preliminary data on the predictive validity of return to work of clients after an insurance medicine investigation.

The aim was to investigate the predictive validity of the Worker Role Interview (WRI) for return to work at a 2-year follow-up of clients who attended an insurance medicine investigation center. The WRI identifies psychosocial and environmental factors that influence a person's abilities to return to work. Forty-eight of 202 consecutively selected clients constituted the study group. The Mann-Whitney U test was used to test the statistically significant differences in WRI ratings between those who were working (n = 6) and those who were not (n = 42) 2 years after their investigations. Five of the 17 items in WRI had a tentative predictive validity of return to work. The content area "personal causation" in WRI, had the best predictive validity. The results emphasize the importance of considering the unique individual's beliefs and expectations of his/her effectiveness at work when assessing clients' work ability and planning for further rehabilitation.