Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

OBJECTIVE: Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide. METHODS: We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated patients' severity of current and future suicide risk as low/moderate/high using the Brief Emergency Room Suicide Risk Assessment (BESRA). The association between each BESRA variable and level of suicide risk was analyzed. RESULTS: Many factors were commonly considered important in evaluating the severity of current and future suicide risk. However, the following factors were only associated with future suicide risk: female gender, having no religion, family psychiatric history, history of axis I disorders, having a will, harboring no regrets, and social isolation. CONCLUSION: Psychiatric residents use diverse factors when assessing suicide risk. Psychiatric residents might put more emphasis on non-modifiable demographic and clinical factors, concrete evidence showing suicide determination, and social isolation to assess the risk of future suicide.

Development and Standardization of Extended ChaeLee Korean Facial Expressions of Emotions

OBJECTIVE: In recent years there has been an enormous increase of neuroscience research using the facial expressions of emotion. This has led to a need for ethnically specific facial expressions data, due to differences of facial emotion processing among different ethnicities. METHODS: Fifty professional actors were asked to pose with each of the following facial expressions in turn: happiness, sadness, fear, anger, disgust, surprise, and neutral. A total of 283 facial pictures of 40 actors were selected to be included in the validation study. Facial expression emotion identification was performed in a validation study by 104 healthy raters who provided emotion labeling, valence ratings, and arousal ratings. RESULTS: A total of 259 images of 37 actors were selected for inclusion in the Extended ChaeLee Korean Facial Expressions of Emotions tool, based on the analysis of results. In these images, the actors' mean age was 38+/-11.1 years (range 26-60 years), with 16 (43.2%) males and 21 (56.8%) females. The consistency varied by emotion type, showing the highest for happiness (95.5%) and the lowest for fear (49.0%). The mean scores for the valence ratings ranged from 4.0 (happiness) to 1.9 (sadness, anger, and disgust). The mean scores for the arousal ratings ranged from 3.7 (anger and fear) to 2.5 (neutral). CONCLUSION: We obtained facial expressions from individuals of Korean ethnicity and performed a study to validate them. Our results provide a tool for the affective neurosciences which could be used for the investigation of mechanisms of emotion processing in healthy individuals as well as in patients with various psychiatric disorders.

The Impact of Personality Traits on Emotional Responses to Interpersonal Stress

OBJECTIVE: The aim of the present study was to examine the impact of personality traits on emotional responses to interpersonal stress. METHODS: Thirty-two healthy college students (18 men, 14 women; age 25.2+/-2.7 years) participated in the study. Mood and anxiety were assessed with the Beck Depression Inventory and the State Trait Anxiety Inventory. Personality traits were assessed with the Interpersonal Sensitivity Measure (IPSM). The subjective emotional responses of participants to different (i.e., negative, neutral, and positive) interpersonal feedback were measured. RESULTS: Subject responses were positive to positive interpersonal feedback and negative to negative interpersonal feedback. The IPSM fragile inner self subscore was negatively correlated with the subjective emotional ratings in response to interpersonal feedback. No correlation was found between validation measures (i.e., the degree of attention in the task and task difficulty) and subjective emotional responses. CONCLUSIONS: Taken together, emotional responses to interpersonal stress may be modulated by personality traits and may impact health and psychological outcomes. Therefore, proper screening and stress management programs that focus on personality traits may improve the mental health of college students.

Characteristics of Drug Overdose in Young Suicide Attempters

OBJECTIVE: Few studies have focused on the characteristic features of drug overdose in children and adolescents who have attempted suicide in Korea. The present study examined the characteristics of drug overdose in children and adolescents who visited the emergency room following drug ingestion for a suicide attempt. METHODS: The medical records of 28 patients who were treated in the emergency room following a drug overdose from January 2008 to March 2011 were analyzed. Demographic and clinical variables related to the suicide attempts were examined. RESULTS: The mean age of the patients was 16.6+/-1.7 years (range 11-19 years), and 20 of the patients (71.4%) were female. Most of the patients (n=23, 82.1%) overdosed on a single drug; acetaminophen-containing analgesics were the most common (n=12, 42.9%). Depression was the most common psychiatric disorder (n=22, 78.6%), and interpersonal conflict was the most common precipitating factor of the suicide attempts (n=11, 39.3%). This was the first suicide attempt for approximately 80% of the patients. About one fourth of the patients (n=7, 25%) had follow-up visits at the psychiatric outpatient clinic. CONCLUSION: Early screening and psychiatric intervention for depression may be an important factor in preventing childhood and adolescent suicide attempts. Developing coping strategies to manage interpersonal conflicts may also be helpful. Moreover, policies restricting the amount and kind of drugs purchased by teenagers may be necessary to prevent drug overdose in this age group.