An Investigation into the Acquired Capability for Suicide.

OBJECTIVE: The acquired capability for suicide (ACS) is one of the most important breakthroughs in suicide research. ACS refers to an individual's increased fearlessness about death over time from experiencing painful and provocative events (PPE) and is based on opponent-process theory-a habituation model. Few studies have investigated how ACS develops and found that ACS remained relatively stagnant. METHOD: This study sought to expand these findings by observing how ACS develops in two cross-sectional data sets involving high-risk nonclinical samples of physicians (n = 419) and veterinary students (n = 124). Participants completed online questionnaires assessing both general PPEs (e.g., witnessing abuse) and job-specific PPEs (e.g., exposure to euthanasia), as well as ACS. RESULTS: Our results partially replicated prior findings indicating that more PPEs do not significantly affect ACS. CONCLUSIONS: Limitations of this study include the use of cross-sectional data and self-report measures. These results, in combination with existing models of habituation, suggest ACS may not progress linearly.

Suicide in physicians and veterinarians: risk factors and theories.

Physicians and veterinarians are at increased risk for suicide compared to the general population. In particular, this risk appears to be especially pertinent to females in both of these professions. Although increased risk is well-documented, less is known about potential causes for suicidality in these groups. A host of risk factors have been examined in recent research, including job stressors, personality traits, access to lethal medications, and unique work experiences. In addition to these factors, the interpersonal psychological theory of suicidal behavior may provide promise in specifying why physicians and veterinarians are at increased risk for suicide. While there is recognition of mental health issues in these professions, significant treatment barriers remain.

Patients' Reported Usage of Weight Management Skills Following Bariatric Surgery.

Little is known about which specific weight management skills bariatric patients find most and least valuable. Participants completed a measure assessing their usage of weight management skills at a follow-up appointment one or more years after undergoing bariatric surgery. Decreased usage of skills was associated with unsuccessful weight outcome, defined as losing less than 50% of excess weight, as well as weight regain. Weighing regularly was the skill selected most often by successful participants as helpful, and was chosen by a significantly smaller percentage of unsuccessful participants and those who regained a clinically significant amount of weight. A majority of both successful and unsuccessful participants indicated that they had discontinued food journaling. Weighing regularly may be perceived as a more useful method of self-monitoring.

Provocative work experiences predict the acquired capability for suicide in physicians.

The interpersonal psychological theory of suicidal behavior (IPTS) offers a potential means to explain suicide in physicians. The IPTS posits three necessary and sufficient precursors to death by suicide: thwarted belongingness, perceived burdensomeness, and acquired capability. The present study sought to examine whether provocative work experiences unique to physicians (e.g., placing sutures, withdrawing life support) would predict levels of acquired capability, while controlling for gender and painful and provocative experiences outside the work environment. Data were obtained from 376 of 7723 recruited physicians. Study measures included the Acquired Capability for Suicide Scale, the Interpersonal Needs Questionnaire, the Painful and Provocative Events Scale, and the Life Events Scale-Medical Doctors Version. Painful and provocative events outside of work predicted acquired capability (ß=0.23, t=3.82, p<0.001, f(2)=0.09) as did provocative work experiences (ß=0.12, t=2.05, p<0.05, f(2)=0.07). This represents the first study assessing the potential impact of unique work experiences on suicidality in physicians. Limitations include over-representation of Caucasian participants, limited representation from various specialties of medicine, and lack of information regarding individual differences.

An Examination of the Interpersonal Psychological Theory of Suicidal Behavior in Physicians.

Physicians are commonly reported to die by suicide more frequently than individuals in the general population. Thus far, few reasons for this elevated suicide risk have been empirically investigated. Although the interpersonal psychological theory of suicidal behavior (IPTS) has been suggested as a fruitful means of explaining physician suicidality, it has yet to be examined quantitatively. Four hundred nineteen Pennsylvania physicians were assessed on a number of demographics, as well as all components of the IPTS. Findings indicated that physician scores on IPTS components are comparable to other groups displaying increased suicidality (e.g., military populations, prior attempters). Perceived burdensomeness was a significant predictor of suicidal ideation, while thwarted belongingness predicted prior suicide attempts. Acquired capability did not distinguish between prior attempters and nonattempters. Preliminary findings indicate the IPTS may be a useful framework for understanding and predicting physician suicidality.

Comparing chronic pain treatment seekers in primary care versus tertiary care settings.

BACKGROUND: Patients frequently seek treatment for chronic nonmalignant pain in primary care settings. Compared with physicians who have completed extensive specialization (eg, fellowships) in pain management, primary care physicians receive much less formal training in managing chronic pain. While chronic pain represents a complicated condition in its own right, the recent increase in opioid prescriptions further muddles treatment. It is unknown whether patients with chronic pain seeking treatment in primary care differ from those seeking treatment in tertiary care settings. This study sought to determine whether patients with chronic pain in primary care reported less pain, fewer psychological variables related to pain, and lower risk of medication misuse/abuse compared with those in tertiary care. METHODS: Data collected from patients with chronic pain in primary care settings and tertiary care settings were analyzed for significant differences using Wilcoxon rank sum tests, Fisher exact tests, and linear regression. A host of variables among populations, including demographics, self-reported pain severity, psychological variables related to pain, and risk for opioid misuse and abuse, were compared. RESULTS: Findings suggest that primary care patients with chronic pain were similar to those in tertiary care on a host of indices and reported more severe pain. There were no significant group differences for risk of medication misuse or abuse. CONCLUSION: It seems that primary care physicians care for a complicated group of patients with chronic pain that rivals the complexity of those seen in specialized tertiary care pain management facilities.