Effectiveness of psychosocial interventions for alcohol use disorder: a systematic review and meta-analysis update.

Background: Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO's Mental Health Gap Action Programme-2015 was necessary to ensure guidelines reflect effective strategies for alcohol use disorder (AUD).Objective: To estimate the effects of psychosocial interventions on drinking and related outcomes.Methods: We included randomized controlled trials published between January 2015 and June 2022 on adults with alcohol dependence (ICD 10/DSM-IV) and moderate to severe AUD (DSM-5), and those examined psychosocial interventions against treatment-as-usual (TAU) and active controls. Eight databases and registries were searched. Relative Risk (RR) and standardized mean difference (SMD) were used for dichotomous and continuous outcomes. We used Cochrane's risk of bias assessment (RoB2).Results: Of 873 screened records, 14 and 13 studies in the narrative synthesis and meta-analysis. Of the 2,575 participants, 71.5% were men. Thirteen studies used ICD 10/DSM IV diagnosis. Compared to TAU, any psychosocial intervention increased the relative risk of abstinence by 28% [N = 7, RR = 1.28, 95% CI: 1.07 to 1.53, p = .01, NNT = 9]. There were minimal heterogeneity and no evidence of publication bias. Psychosocial interventions were not effective in reducing the drinking frequency (n = 2, Hedge's g = -0.10, 95% CI: -0.46 to 0.26, p = .57) and drinks/drinking days (N = 5, g = -0.10, 95% CI: -0.37 to 0.16, p = .43). Treatment discontinuation did not differ between intervention and control groups [RR = 1.09, 95% CI: 0.66 to 1.80].Conclusion: Psychosocial interventions are effective in improving abstinence but not in reducing drinking frequency or amount. Policymakers must consider this evidence to generate AUD treatment guidelines.Registration: PROSPERO 2022 CRD42022342608.

User Experiences of CBT for Anxiety and Depression: A Qualitative Systematic Review and Meta-synthesis.

Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety and depression. It is important to determine the positive and negative aspects of CBT from the perspective of service users. However, there has been a lack of qualitative exploration into service user experiences of the therapy. This review aimed to address this gap by examining participants' experiences of CBT for anxiety and depression. Databases were searched and data were synthesised thematically. CBT was well-received by participants, though barriers to engagement were identified. CBT was often perceived as too difficult or demanding, as well as interventions being short and therefore superficial. Clinician qualities of being trustworthy, non-judgemental, and understanding appear to be significant contributors to client engagement and recovery. Findings support the delivery of in-depth clinician led CBT for anxiety and depression, as well as highlighting the need to review CBT delivery to better support service users.

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis.

Importance: Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective: To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources: CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection: Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis: At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures: The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results: Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance: These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

Supporting carers to improve patient safety and maintain their well-being in transitions from mental health hospitals to the community: A prioritisation nominal group technique.

INTRODUCTION: Carers of people with mental illness may face distinct challenges, including navigating fragmented health and social services during discharge from mental health hospitals. Currently, limited examples of interventions that support carers of people with mental illness in improving patient safety during transitions of care exist. We aimed to identify problems and solutions to inform future carer-led discharge interventions, which is imperative for ensuring patient safety and the well-being of carers. METHODS: The nominal group technique was used which combines both qualitative and quantitative data collection methods in four distinct phases: (1) problem identification, (2) solution generation, (3) decision making and (4) prioritisation. The aim was to combine expertise from different stakeholder groups (patients, carers and academics with expertise in primary/secondary care, social care or public health) to identify problems and generate solutions. RESULTS: Twenty-eight participants generated potential solutions that were grouped into four themes. The most acceptable solution for each was as follows: (1) 'Carer Involvement and Improving Carer Experience' a dedicated family liaison worker, (2) 'Patient Wellness and Education' adapting and implementing existing approaches to help implement the patient care plan, (3) 'Carer Wellness and Education' peer/social support interventions for carers and (4) 'Policy and System Improvements' understanding the co-ordination of care. CONCLUSION: The stakeholder group concurred that the transition from mental health hospitals to the community is a distressing period, where patients and carers are particularly vulnerable to safety and well-being risks. We identified numerous feasible/acceptable solutions to enable carers to improve patient safety and maintain their own mental wellbeing. PATIENT AND PUBLIC CONTRIBUTION: Patient and public contributors were represented in the workshop and the focus of the workshop was to identify the problems they faced and co-design potential solutions. Patient and public contributors were involved in the funding application and study design.

Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study.

INTRODUCTION: Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care. METHODS AND ANALYSIS: Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included. ETHICS AND DISSEMINATION: Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals.

Effectiveness of cognitive-behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis.

BACKGROUND: Cognitive-behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. AIMS: To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, medication, treatment-as-usual and no treatment in reducing depression at post-treatment and in the long term and (b) explore important factors that could moderate the effectiveness of these interventions. METHOD: MEDLINE, PsycInfo, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched to November 2021. Only randomised controlled trials were eligible for the subsequent network meta-analysis. RESULTS: We included 107 studies based on 15 248 participants. Core (s.m.d. = -1.14, 95% credible interval (CrI) -1.72 to -0.55 [m.d. = -8.44]), complex (s.m.d. = -1.24, 95% CrI -1.85 to -0.64 [m.d. = -9.18]) and ultra-complex CBT (s.m.d. = -1.45, 95% CrI -1.88 to -1.02 [m.d. = -10.73]) were all significant in reducing depression up to 6 months from treatment onset. The significant benefits of the ultra-complex (s.m.d. = -1.09, 95% CrI -1.61 to -0.56 [m.d. = -8.07]) and complex CBT (s.m.d. = -0.73, 95% CrI -1.36 to -0.11 [m.d. = -5.40]) extended beyond 6 months. Ultra-complex CBT was most effective in individuals presenting comorbid mental health problems and when delivered by non-mental health specialists. Ultra-complex and complex CBT were more effective for people younger than 59 years. CONCLUSIONS: For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people <59 years of age with comorbid conditions investments should focus on ultra-complex and complex CBT delivered without the help of mental health professionals.

Associations of anxiety and depression with suicide experiences in individuals with and without childhood trauma: The role of social support.

No studies have examined the differences and similarities between individuals with and without experiences of childhood sexual and/or physical abuse in relation to anxiety and depression severity, perceived social support, and suicide experiences. Furthermore, whether the strength of these associations differs between these two groups, and whether the buffering role of perceived social support is equally effective, remain unknown. This study, which was based on 842 British participants, aimed to address these gaps. There were three key findings: i) abused individuals reported significantly more severe depression, anxiety, and suicide experiences, and lower social support, ii) the associations between depression, anxiety, and suicide experiences did not differ between these groups, whereas the association between social support and suicide experiences was more pronounced in abused individuals, and iii) perceived social support acted as a moderator of the association between depression and suicide experiences in both groups. These findings are important because they suggest that for the individuals with childhood trauma perceptions of being less supported by their significant others may lead to suicide acts. Furthermore, perceptions of being socially supported appeared to weaken the association between depression and suicide experiences equally in individuals with and without childhood trauma.

Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations. METHOD: Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I2 statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations. RESULTS: Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong. DISCUSSION: The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.

Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis.

The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I2 statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.

Adverse Social Relationships in Childhood: Are there Links with Depression, Obsessive-Compulsive Disorder and Suicidality in Adulthood?

This study aimed to (i) explore the association between perceptions of negative social relationships in childhood with significant others, including peers, guardians and teachers, symptoms of depression and OCD, and suicide behaviors, and (ii) examine whether depression and OCD severity meditated the association between these perceptions and suicide experiences. In total, 783 individuals from the community were invited to complete self-report measures. There were strong associations between perceptions of adverse social relationships in childhood, severity of depression and OCD, and suicide behaviors. Furthermore, depression and OCD partially mediated the association between perceptions of adverse social relationships, especially with peers, and suicide behaviors. These results provide strong evidence for the importance of developing clinical interventions that directly target negative experiences of social relationships in childhood, and for raising public and scientific awareness that everyday adverse social interactions with significant others can impact negatively on mental health including suicide behaviors.

Alcohol-Related Neurocognitive Disorders: A Naturalistic Study of Nosology and Estimation of Prevalence in South Wales, United Kingdom.

OBJECTIVE: Existing studies relating to the prevalence of alcohol-related neurocognitive disorders (ARNDs; e.g., Korsakoff's Syndrome, alcohol-related dementia) are now outdated and few have been undertaken in the United Kingdom. The aim of this study was to estimate the prevalence of ARNDs in South Wales, U.K., and determine the specific diagnostic terms and criteria used in clinical practice. METHOD: A naturalistic, survey-based prevalence study was undertaken wherein data were collected retrospectively for all individuals with ARNDs attending services during all of 2015 and 2016. A diverse sample of health and social care services (N = 60) in South Wales took part in the study. RESULTS: A total of 490 individuals with ARNDs were identified by participating services, equating to an age-specific rate of 34 individuals per 100,000 inhabitants. Variability was observed across age ranges and genders, with most identified in the 45-64 year age range and a male:female ratio of 2.6:1. Twenty-three individuals younger than age 35 were identified, demonstrating an increase in younger cases compared with previous studies. Various diagnostic terms were used, with "alcohol-related brain damage" being most common. Only 6.3% of cases were diagnosed according to specific criteria and 44.3% were reported as having a "probable" ARND, meaning no official diagnosis had been designated but initial assessments indicated that they likely had an ARND. CONCLUSIONS: Findings provide a novel understanding of ARND prevalence in a previously understudied area, although the prevalence estimate is conservative and should be interpreted cautiously for reasons discussed. Findings also highlight an inconsistency between diagnoses presented in nosological systems (e.g., International Classification of Diseases-10th Revision) and those used in practice and therefore a need to evaluate novel diagnostic conceptualizations of alcohol-related neurocognitive impairment.

Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis.

Importance: Children and young people's reports of experiences of adverse childhood events have increased in recent years, and this trend has been associated with an elevated risk for suicide behaviors. However, a systematic review and meta-analysis is needed to confirm the significance of this association in young people. Objective: To quantify the association between core types of childhood maltreatment, including sexual, physical, and emotional abuse and/or neglect and suicide behaviors in children and young adults. Data Sources: Medline, PsychInfo, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health) databases were searched from January 1, 1980, until December 31, 2019. The reference lists of all the included studies were also checked. Study Selection: Quantitative studies that focused on the association between core types of childhood abuse and/or neglect and suicide ideation, plans, and attempts. Data Extraction and Synthesis: Data were extracted by 2 independent raters. Publication bias and risk of bias across studies were assessed. Meta-analyses using random-effect models were applied, and heterogeneity was quantified using the I2 statistic. Data were analyzed from January to May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Main Outcomes and Measures: The association between core types of childhood maltreatment and suicide behaviors. Results: Seventy-nine studies with 337 185 young individuals (mean [SD] age, 15.67 [2.11] years; 63.19% female) were included. The findings demonstrated that sexual abuse (odds ratio [OR], 3.41; 95% CI, 2.90-4.00), physical abuse (OR, 2.18; 95% CI, 1.75-2.71), emotional abuse (OR, 2.21; 95% CI, 1.37-3.57), emotional neglect (OR, 1.93; 95% CI, 1.36-2.74), physical neglect (OR, 1.79; 95% CI, 1.27-2.53), and combined abuse (OR, 3.38; 95% CI, 2.09-5.47) were significantly associated with higher rates of suicide attempts. Core types of childhood maltreatment were also associated with as much as 2.5-fold greater odds for suicide ideation, and sexual abuse with a 4.0-fold increase for suicide plans. Studies based on community samples (ß [SE] = -1.68 [0.79]; P = .04) or with lower methodological quality (ß [SE] = -2.86 [1.30]; P = .03) were associated more strongly with suicide attempts in those reporting experiences of sexual abuse, whereas young age was associated with both suicide attempts (ß [SE] = -0.59 [0.27]; P = .03) and ideation (ß [SE] = -0.41 [0.18]; P = .03). Conclusions and Relevance: These findings suggest that policy actions should focus on raising public awareness and offering proactive suicide prevention therapies for children and young adults who have experienced abuse and/or neglect.

A novel tool showing that perceptions of adverse social relationships in childhood were linked with mental health problems and suicidal experiences: Validation of the English version of the History of Social Punishment (HoSP) scale.

There is robust evidence for relationships between adverse events experienced in childhood and mental health problems experienced as an adult. However, the measurement of perceptions of different types of adverse relationships in childhood, especially those that are in social contexts, is lacking. Given the absence of an appropriate tool to measure perceptions of adverse social relationships in childhood within English-speaking populations, we endeavored to examine the construct validity of the English version of the History of Social Punishment (HoSP) scale. In total, 557 adults from the extant community participated by completing self-report scales that measured perceptions of adverse childhood relationships, symptoms of depression, obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), and suicidal experiences. Results demonstrated that the HoSP is a sound psychometric tool to evaluate perceptions of adverse social relationships within English-speaking populations. A strong association between perceptions of adverse social relationships in childhood, common mental health problems, and suicidal behaviors was established. These results provide robust evidence for the importance of screening for experiences of social adversities and for developing clinical interventions that directly target these experiences.

Obsessive-Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a disabling mental health problem that affects a significant proportion of the general population. Experiential avoidance appears to account for the development of anxiety and depressive symptoms. However, its relationship with OCD has yielded contradictory results. Furthermore, although OCD-specific thoughts and behaviors, including obsessing, checking, washing, and ordering, have been suggested to significantly predict suicidal ideation and behaviors, this line of research has received scant empirical attention. The overarching aim of this study was to explore the relationship between OCD, OCD-specific behaviors, experiential avoidance, and suicidal experiences. METHODS: Overall, 1,046 adults from the community who completed self-report scales participated. RESULTS: Strong links between overall OCD severity, obsessing, experiential avoidance, and suicidal experiences were established. Results from mediational analyses showed that overall OCD severity and individual obsessive-compulsive thoughts and behaviors were both directly and indirectly linked with suicidal experiences, via experiential avoidance. Obsessing was among the critical obsessive-compulsive symptoms leading to suicidal experiences. CONCLUSIONS: These findings are important because they identify experiential avoidance as a potential key explanatory construct in accounting for the development of OCD and suicidal experiences. However, future research using longitudinal and/or experimental designs is needed to infer causality.

Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review.

In the past decade, the links between core types of childhood maltreatment and suicidal acts have become an increasingly important area of investigation. However, no meta-analytic review has examined this relationship in prisoners. We undertook the first systematic meta-analytic review examining the link between childhood maltreatment and suicide attempts in prisoners to redress this important gap. We searched Medline, PsychINFO, Embase, Web of Science and CINAHL from inception until August 2019. Meta-analyses using random effect models were applied, and heterogeneity was quantified using the I2 statistic. Publication bias and risk of bias across studies were assessed. We identified 24 studies comprising 16 586 prisoners. The rates of different types of childhood maltreatment ranged between 29% and 68% [95% confidence interval (CI) 18-81%]. The rate of suicide attempts in prisoners was 23% (95% CI 18-27%). Main results demonstrated that sexual abuse [odds ratio (OR) 2.68, 95% CI 1.86-3.86], physical abuse (OR 2.16, 95% CI 1.60-2.91), emotional abuse (OR 2.70, 95% CI 1.92-3.79), emotional neglect (OR 2.29, 95% CI 1.69-3.10), physical neglect (OR 1.57, 95% CI 1.27-1.94) and combined abuse (OR 3.09, 95% CI 2.14-4.45) were strongly associated with suicide attempts in prisoners. There was an indication of publication bias. Duval and Tweedie's trim-and-fill method was applied, which increased the odds for suicide attempts. Given the high rates of prison suicide deaths and suicide attempts, our findings suggest an urgent need for targeted suicide prevention priorities for prisoners, with a particular focus on ameliorating the effects of childhood traumatic experiences on suicidal prisoners.

Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis.

This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using the I2 statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based on n = 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76-3.64], physical abuse (OR 2.52, 95% CI 2.09-3.04) and emotional abuse (OR 2.49, 95% CI 1.64-3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52-10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.

Examining the effects of punishment schedule density on the development and maintenance of avoidance and safety behaviours: Implications for exposure therapies.

BACKGROUND AND OBJECTIVES: Engaging in safety behaviors in the absence of actual threat is a key feature of many psychological disorders, including OCD and depression. Failure to discriminate between threatening and safe environments may make these behaviors resistant to change. The purpose of the current study is to investigate the conditions under which avoidance and safety behaviors are developed and maintained. METHODS: In experiment 1, sixty-seven participants who were initially screened for low obsessive-compulsive behavior were invited to play a computerized game to gain points and avoid their potential loss. In Phase 1, they were exposed to a lean punishment schedule (relatively frequent point losses) and a dense schedule (highly frequent point losses). In Phase 2, they were tested on engagement in safety behaviors, where no punishment had been programmed. In experiment 2, twenty-two new participants were exposed to the lean punishment schedule followed immediately by the no point loss condition (Phase 2), one and two weeks after their initial exposure to the punishment conditions to test for the maintenance of safety behavior over time. RESULTS: Findings demonstrated that participants developed avoidance immediately, but safety behavior was developed and maintained only for those who were exposed to the lean punishment schedule. LIMITATIONS: Prolonged exposure to dense punishment schedules may yield different results because the contrast between safe and aversive environments may be less discernible. CONCLUSIONS: These findings are important because they provide experimental evidence on the conditions that render safety behaviors difficult to amend, and offer important recommendations for clinical practice.

The effects of the non-contingent presentation of safety signals on the elimination of safety behaviors: An experimental comparison between individuals with low and high obsessive-compulsive profiles.

BACKGROUND AND OBJECTIVES: Safety behaviors, defined as engagement in avoidance within safe environments, are a key symptom of obsessive-compulsive and related disorders. They may interfere with daily functioning and as such their emission should be reduced. The purpose of the current study is to investigate the effects of the non-contingent presentation of safety signals (cues produced by safety behaviors) on reducing safety behaviors in participants self-reporting low and high OCD profiles. METHODS: In total, 32 participants were asked to play a game to gain points and avoid their loss. After having developed avoidance behavior, evidenced by maintaining all of their earned points, they were exposed to safe environments where no point loss was programmed. In Test 1, safety cues (blue bar) were produced contingent on performing safety behaviors. In Test 2, safety cues were presented continuously without any response requirement. RESULTS: Findings demonstrated that high OCD group displayed higher rates of safety behaviors than low OCD group. However, exposure to the non-contingent presentation of safety signals eliminated their emission in both groups. LIMITATIONS: Future studies need to evaluate the effects of different non-contingent schedules on the suppression of safety behaviors. CONCLUSIONS: These findings contribute to the literature by demonstrating that non-contingent introduction of safety signals eliminated safety behaviors completely, even in high OCD participants, who performed safety behavior at higher rates. Such a treatment protocol may ameliorate exposure therapy in which response prevention constitutes a key element and is generally associated with increased drop-out rates.

A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation.

Inconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13-15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.