The Fear of Losing-Nonsuicidal Self-Injury as a Protective Mechanism in Eating Disorders.

Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against "high damage" decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.

Major and minor life events, personality and psychopathology in children with tourette syndrome.

Environmental, psychological, and biological interactions underlie many psychopathologies. Tourette's Syndrome (TS) has an obvious biological substrate but environmental factors and personality play substantial roles in its expression. We aimed to study the interrelationships between stressful life events, personality traits, tics, and comorbid disorders in children with TS. To this end, 132 children with TS and 49 healthy controls were recruited for the study. Major life events in the 12-months prior to testing and minor life events in the month prior to testing were retrospectively assessed using the Life Experiences Survey (LES) and the Brief Adolescent Life Events Scale (BALES), respectively. Personality was assessed with the Junior Temperament and Character Inventory (JTCI). Tics, obsessive compulsive symptoms, attention deficit and hyperactivity symptoms, anxiety, depression and aggression were assessed by self-report questionnaires and semi-structured interviews. We found that major life events correlated with the severity of tics expression and complexity, and comorbid psychopathology. Minor life events correlated with more severe symptomatology. High levels of harm avoidance were related to more obsessions, anxiety, and depression whereas high levels of self-directedness were protective. To conclude, TS expression in childhood should be understood as the result of an interaction between biological, personality and environmental factors.

Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: A follow-up study of hospitalized patients.

BACKGROUND: This study examined the role of mental pain, communication difficulties, and suicide history in predicting the medical severity of follow-up suicide attempts. METHODS: The cohort included 153 consecutive psychiatric in-patients who participated in earlier studies 1-9 years previously. Fifty-three had a history of a medically serious suicide attempt (MSSA), 64 had a history of a medically non-serious suicide attempt (MNSSA), and 36 had no history of suicide. A MSSA was defined as a suicide attempt that warranted hospitalization for at least 24h and extensive medical treatment. Participants completed a battery of instruments measuring mental pain and communication difficulties. Findings were analyzed in relation to follow-up suicide attempts and their severity. RESULTS: Fifty-three patients (35.5%) had attempted suicide: 15 (9.9%) a MSSA (including 5 fatalities) and 38 (25%) a MNSSA. The medical severity of the index attempt and level of hopelessness at the index attempt were significantly correlated with medical severity of the follow-up attempt. In younger patients, high levels of depression and self-disclosure predicted the medical severity of the follow-up attempt. In patients with relatively low hopelessness, the medical severity of the attempt increased with the level of self-disclosure. LIMITATIONS: (i) Possibly incomplete patient information, as some of the patients who participated in the index studies could not be located. (ii) Relatively small group of patients with an index MSSA. CONCLUSIONS: Patients who have made a suicide attempt should be assessed for medical severity of the attempt, hopelessness, and communication difficulties, which are important factors in follow-up attempts.

A proposed model of the development of suicidal ideations.

BACKGROUND: Suicidal ideations may precede suicide attempts. They are of particular concern in psychiatric populations because psychopathology is a major risk factor for suicide. The factors affecting the development of suicide ideations may differ among psychiatric patients with and without a previous suicide attempt and individuals without a psychiatric diagnosis. OBJECTIVES: The aim of this study is to develop a model of suicide ideation in psychiatric patients and the general population. METHOD: The study included 196 participants: 92 psychiatric patients with a previous suicide attempt ("attempters"); 47 psychiatric patients who had never attempted suicide ("non-attempters"); and 57 healthy control subjects. Data were collected on socio-demographic parameters, clinical history, and details of the suicide attempts. Participants completed a battery of psychological instruments assessing aggression-impulsivity, mental pain (including depression and hopelessness) and communication difficulties, in addition to negative life events. Findings were correlated with suicidal ideation by group. RESULTS: The correlations of the different variables with suicidal ideation differed between suicide attempters and non-attempters; therefore, the model was analyzed separately for each group. The study yielded three major findings: negative life events had a significant effect on both anger-in and impulsivity in non-attempters but not in attempters; hopelessness moderately contributed to suicidal ideations in attempters but not in non-attempters; loneliness contributed significantly to depression in non-attempters but was less distressing in attempters. CONCLUSION: The mechanism underlying suicidal ideation appears to differ between psychiatric patients who have previously attempted suicide and those who have not, supporting a dual model of suicidal ideation. Although this is only a preliminary study, these findings are important for furthering our understanding of the process of transition of suicidal thoughts to completion of suicide. These results need further replication with a larger cohort of subjects.

Impact of environmental and personality factors upon adolescents before and after psychotherapeutic intervention.

It is important to understand the risk factors and resilience factors that contribute to psychological distress or to a sense of well-being in adolescents. This study focuses on life events and social support from an external-environmental aspect. The focus from an internal-personality aspect is on self-criticism and self-disclosure. In this study, 155 adolescents, ages 12-18 years, were divided into two groups. The experimental group included 70 adolescents requesting psychotherapy for emotional disorders. The control group included 85 adolescents without emotional disorders. Participants in the experimental group were followed up to the completion of six months of psychotherapy. Adolescents in the experimental group had undergone more negative life events and a significantly smaller number of positive life events compared to the control group [F(4, 143)=9.77, p<0.001, Eta(2)=.22]. The experimental group was characterized by a diminished degree of social support compared to the control group [F(2, 144)=7.27, p<0.01, Eta(2)=.09]. Regarding self-criticism and self-disclosure, no differences were found between the control and experimental groups [F(3, 148)=2.18, p>0.05, Eta(2)=.04]. The prospective analysis following six months of psychotherapy indicated a significant improvement in distress variables reported by the parents but not by the subjects themselves, pointing to the importance of family intervention as part of adolescent psychotherapy. A decrease in the level of self-criticism after psychotherapeutic intervention was found [F(1, 18)=4.41, p<0.05, Eta(2)=.20], altering self-criticism from a factor that needs to be neutralized to a factor that can be improved during psychotherapy.

Mental pain, communication difficulties, and medically serious suicide attempts: a case-control study.

Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed suicide. The aim of this study was to assess the role of mental pain and communication difficulties in MSSA. A total of 336 subjects were divided into 4 groups: 78 meeting criteria for MSSA compared with116 subjects who made a medically non-serious suicide attempt (MNSSA), 47 psychiatric controls with no history of suicidal behavior, and 95 healthy controls. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties explained some of the variance in suicide lethality, above and beyond the contribution of each component alone. This report underlines the importance of mental pain for suicide attempts in general while difficulties in communication abilities play a critical role in differentiating MSSA from MNSSA. The co-existence of unbearable mental pain with difficulties in communication significantly enhances the risk for more lethal forms of suicidal behavior.

Attachment patterns in medically serious suicide attempts: the mediating role of self-disclosure and loneliness.

Although the study of medically serious suicide behavior is an important strategy for understanding the nature of suicide, little is known about its underlying psychological mechanisms. This gap is addressed here by applying insights from attachment theory to severe suicidal behavior. The results show that both anxious and avoidant attachment patterns predict medical lethality. Path analysis indicated that interpersonal difficulties mediated the paths between insecure attachment patterns and lethality of suicide attempts. These results suggest that the psychological mechanisms of medically serious suicide behavior involve high levels of mental pain amplified by insecure attachment patterns and interpersonal difficulties. Implications for prevention and therapeutic intervention strategies are discussed.

Life events and Tourette syndrome.

INTRODUCTION: Tourette syndrome (TS) is a neuropsychiatric developmental disorder characterized by the presence of multiple motor tics and one or more vocal tics. Although TS is primarily biological in origin, stress-diatheses interactions most probably play a role in the course of the illness. The precise influence of the environment on this basically biological disorder is difficult to ascertain, particularly when TS is complicated by comorbidities. Among the many questions that remain unresolved are the differential impact of positive and negative events and specific subtypes of events, and the importance of major crucial events relative to minor daily ones to tic severity. OBJECTIVES: To examine the relationships between life events, tic severity and comorbid disorders in Tourette Syndrome (TS), including OCD, ADHD, anxiety, depression and rage attacks. Life events were classified by quantity, quality (positive or negative) and classification types of events (family, friends etc.). SUBJECTS: Sixty patients aged 7-17 years with Tourette syndrome or a chronic tic disorder were recruited from Psychological Medicine Clinic in Schneider Children's Medical Center of Israel. INSTRUMENTS: Yale Global Tic Severity Scale; Children's Yale Brown Obsessive Compulsive Scale; Life Experiences Survey; Brief Adolescent Life Events Scale; Screen for Child Anxiety Related Emotional Disorders; Child Depression Inventory/Beck Depression Inventory; ADHD Rating Scale IV; Overt Aggression Scale. RESULTS: Regarding tics and minor life events, there was a weak but significant correlation between severity of motor tics and the quantity of negative events. No significant correlation was found between tic severity and quantity of positive events. Analysis of the BALES categories yielded a significant direct correlation between severity of vocal tics and quantity of negative events involving friends. Regarding comorbidities and minor life events, highly significant correlations were found with depression and anxiety. Regarding tics and major life events, significant correlation was found between the quantity of major life events and the severity of motor tics, but not vocal tics. Regarding comorbidities and major life events, significant correlation was found between the severity of compulsions, ADHD, and aggression and the subjects' personal evaluation of the effect of negative major life events on their lives. CONCLUSIONS: Minor life events appear to be correlated with tic severity and comorbidities in children and adolescents with Tourette syndrome. The lack of an association between major life events and tic severity further emphasizes the salient impact of minor life events that occur in temporal proximity to the assessment of tic severity. Clinically, the results match our impression from patient narratives wherein they "blamed" the exacerbations in tics on social interactions. The high correlation between negative life events and depression, anxiety and compulsions symptoms, were reported also in previous studies. In conclusion, These findings may have clinical implications for planning supportive psychotherapy or cognitive behavioral therapy for this patient population.

Medically serious versus non-serious suicide attempts: relationships of lethality and intent to clinical and interpersonal characteristics.

BACKGROUND: The study of near-fatal suicide attempts may provide insight into the minds of suicidal subjects. The aim of the study was to investigate the relationship of intent and lethality in medically serious and medically non-serious suicide attempts and to examine relationship of specific psychological and clinical variables with the subjective and objective components of suicide intent. METHODS: The study group included 102 participants, 35 consecutive subjects hospitalized for a medically serious suicide attempt and 67 subjects who presented to the same tertiary medical center after a medically non-serious suicide attempt. All were interviewed with the SCID-I and completed the Suicide Intent Scale (SIS), the Lethality Rating Scale, and instruments measuring mental pain and communication difficulties. RESULTS: Patients who made medically serious suicide attempts had higher total SIS score and higher objective and subjective subscale scores. The objective component of the SIS was highly correlated with the lethality of the suicide attempt and communication difficulties; the subjective component was associated with mental pain variables. The interaction of mental pain and communication difficulties was predictive of the severity of the objective suicide intent. LIMITATIONS: Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability. CONCLUSIONS: Suicidal individuals with depression and hopelessness who cannot signal their pain to others are at high risk of committing a medically serious suicide attempts.

Relationship between ICD-10 psychosocial categories and psychiatric diagnosis in Israeli adolescents.

AIM: The study examined the relationship between psychosocial categories obtained by WHO-developed semistructured interviews (ICD-10 Axis V) and clinical Axis I psychiatric diagnoses in psychiatrically hospitalized adolescents. METHODS: The sample included 71 consecutive patients admitted to an adolescent unit and their mothers. Mothers completed a semi-structured interview derived from the criteria for each psychosocial category (Axis V), and the adolescents were diagnosed by experienced psychiatrists using the Schedule for Affective Disorders for School Age Children (K-SADS-P). RESULTS: Anorexia nervosa and conduct disorder were associated with a psychosocial category of 'abnormal qualities of upbringing,' and conduct disorder and schizophrenia were associated with a psychosocial category of 'events brought about by the child's own behavior.' CONCLUSIONS: The systematic assessment of psychosocial categories add specific information to the validity of the Axis I diagnosis.

Timing, quantity and quality of stressful life events in childhood and preceding the first episode of bipolar disorder.

BACKGROUND: A large body of evidence supports the importance of genetic risk factors in bipolar disorder (BPD), but less is known about the role of stressful life events (SLE). This study assessed the role of SLE in childhood, adulthood and one year prior to first episodes of both depression and mania in BPD. METHODS: Three groups of 50 matched subjects each were assessed: patients with BPD, with borderline personality disorder (BLPD) and healthy controls. Structured clinical interviews were used for diagnoses. The Coddington Life Events Schedule and the Israel Psychiatric Epidemiology Research Interview Life Event Scale measured life events and were confirmed with a semi-structured interview for subjective experience for each SLE. RESULTS: In BPD, the total number of SLE was lower during childhood and higher in the year preceding the first depression compared to controls and the proportion of loss-related events in childhood was higher. In the year preceding the first depressive episode, BPD subjects had more total, negative uncontrolled and independent but not positive SLE. In the year preceding the first episode of mania, the total number of uncontrolled, negative SLE were higher in BPD, whereas positive and separation-related SLE were not. After the first episode, BPD subjects had less SLE than controls. CONCLUSIONS: Negative and loss-related SLE are common in BPD subjects, occur in the year preceding the first episodes of depression and mania and are less common in childhood or after the onset of the disorder.

A comparison of life events in patients with unipolar disorder or bipolar disorder and controls.

OBJECTIVE: The present study aimed to explore the association between stressful life events (LEs) and the development of affective psychopathology. METHOD: Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls in regard to the rate of stressful LEs. Assessment measures included the Beck Depression Inventory, the Adult Life Events Questionnaire, and the Childhood Life Events List. RESULTS: The entire sample of affective patients had more LEs in general, more negative LEs, and more loss-related LEs in the year preceding their first depressive episode as compared with normal controls. Subjects with unipolar disorder had more positive LEs and more achievement LEs, whereas subjects with bipolar disorder had more uncontrollable LEs in the year preceding the first depressive episode. The relationship between LEs and manic episodes was prominent in the year preceding the first manic episode, with subjects with bipolar disorder reporting more LEs in general and more ambiguous events in that year. Almost no significant differences on LE frequency were observed in the year before the last depressive and manic episodes in the patient groups with unipolar and bipolar disorder. A significant relationship was found between childhood LEs and the development of affective disorders in adulthood, with patients with unipolar disorder exhibiting less positive and achievement LEs. CONCLUSIONS: In both the unipolar and the bipolar groups, the major impact of LEs on the onset of affective disorders was found in the year before the first depressive or manic episodes. This suggests that the accumulation of stressful LEs at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis.

Emotional reactivity and cognitive regulation in anxious children.

Recent models of anxiety disorders emphasize abnormalities in emotional reactivity and regulation. However, the empirical basis for this view is limited, particularly in children and adolescents. The present study examined whether anxious children suffer both negative emotional hyper-reactivity and deficits in cognitive emotion regulation. Participants were 49 children aged 10-17 with generalized anxiety disorder, social anxiety, or separation anxiety disorder as their primary diagnosis, as well as 42 age- and gender-matched non-anxious controls. After completing a diagnostic interview and self-report questionnaires, participants were presented with pictures of threatening scenes with the instructions either to simply view them or to use reappraisal, a cognitive emotion regulation strategy, to decrease their negative emotional response. Emotion ratings, content analysis of reappraisal responses, and reports of everyday use of reappraisal were used to assess negative emotional reactivity, reappraisal ability, efficacy and frequency. Relative to controls, children with anxiety disorders (1) experienced greater negative emotional responses to the images, (2) were less successful at applying reappraisals, but (3) showed intact ability to reduce their negative emotions following reappraisal. They also (4) reported less frequent use of reappraisal in everyday life. Implications for the assessment and treatment of childhood anxiety disorders are discussed.

A comparison of life events in suicidal and nonsuicidal adolescents and young adults with major depression and borderline personality disorder.

This retrospective study assessed the correlations between various types of stressful life events (SLE) and suicidal adolescents and young adults with major depressive disorder (MDD;22), borderline personality disorder (BPD;18), and nonsuicidal adolescents and young adults with MDD (20) and BPD (20). A community control group of 40 participants was also evaluated. The measurements used were Life Events Checklist, Childhood Sexual Abuse Questionnaire, Suicide Risk Scale, and Beck Depression Inventory. Suicidal participants experienced a greater number of total lifetime negative events compared with nonsuicidal participants, irrespective of diagnosis, including a greater amount of negative life events in the year before the suicide attempt compared with the year before referral in the nonsuicidal group. Participants with MDD reported more lifetime negative events than participants with BPD. Suicidal adolescents did not have more lifetime death-related SLE than nonsuicidal adolescents, but MDD adolescents experienced more lifetime death-related SLE than BPD adolescents. Suicidal BPD participants reported more lifetime sex abuse-related SLE compared with nonsuicidal BPD participants. The complexity of the relationships between SLE and the interplay of both suicidality and underlying psychopathology is discussed with the relevant treatment implications.

Post-adoption depression among adoptive mothers.

OBJECTIVE: To evaluate the rate of depressive symptomatology and possible underlying factors in adoptive mothers during the transition to motherhood. DESIGN: Cohort survey. SETTING: General Community. PARTICIPANTS: Thirty-nine adoptive mothers of reproductive age registered with international adoption agencies. INTERVENTIONS: All women completed the Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), and the Brief Symptom Inventory (BSI) before and 6 weeks after the adoption. MAIN OUTCOME MEASURES: Responses were compared between the study group and published findings for biological mothers in the general population, and within the study group, before and after adoption. RESULTS: Symptoms of depression were found in 15.4% of the study group. This rate was similar to that for postpartum depression in the general population, and lower than the rate recorded in the study group before adoption (25.6%). All women with symptoms of depression after the adoption had also shown evidence of depressive features before the adoption. Similar findings were noted for other psychopathologies as well. CONCLUSION: Adopting a child does not cause new-onset, reactive depression among adoptive mothers. It may even lead to a decrease in depressive features, perhaps in response to relief from other adjustment difficulties.

A comparison of life events in adolescents with major depression, borderline personality disorder and matched controls: a pilot study.

BACKGROUND: The study assessed the prevalence of life events (LE) in adolescents with major depressive disorder (MDD, n = 19), borderline personality disorder (BPD, n = 20) and matched controls (n = 20). METHODS: Assessment measures included: the Child Suicide Potential Scale, the Beck Depression Inventory, the Life Events Checklist, the Childhood Sexual Abuse Questionnaire and the Childhood Trauma Questionnaire. RESULTS: The percentage of negative lifetime LE was significantly higher in both MDD and BPD groups than in the control group, while the opposite was true for the percentage of positive LE. No difference was detected between the groups in the number of negative LE in the year preceding their admission. The MDD group reported more death-related LE than the control group, while the BPD group reported more sexual abuse LE than the control and MDD groups. CONCLUSIONS: The present study is a cross-sectional study, and therefore, we cannot draw definite conclusions regarding causality. Yet, the significance of negative LE as contributors to and of positive LE as protective factors against the development of nonsuicidal psychopathology is suggested. Further, the possible association between death of a first-degree relative and MDD and between sexual abuse occurring in early childhood and BPD is raised.

Stressful life events and major depressive disorders.

This study examined the relationship between stressful life events (SLE) and recurrent major depressive disorders. Three groups of 50 subjects were assessed: Patients with recurrent major depressive disorder with melancholic features; patients with borderline personality disorder; and healthy controls. Interviews for AXIS I and II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview Life Event Scale and the Coddington Life Events Schedule were used to measure life events and were confirmed with an interview. Beck Depression Inventory was also administered. The proportions of loss-related events in childhood and in the year preceding the first episode were higher in the depressed group than in the control groups during the same time period. Proportions of SLE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE differentiated the groups following the first depressive episode. The study's conclusion is that SLE play an important role in the onset of depressive disorders. There are specific kinds of SLE that occur in childhood and in the year preceding the first episode. SLE has a less significant role in the maintenance of this illness.

Mental pain and its communication in medically serious suicide attempts: an "impossible situation".

BACKGROUND: The study of near-fatal suicide attempters may provide insight into the minds of suicidal subjects. Our aim is to test the hypothesis that mental pain is a general risk factor for suicidal behavior and communication difficulties are a particular risk factor for medically serious suicidal behavior. METHODS: Thirty five subjects who made medically serious suicide attempts were compared with 67 medically not serious suicide attempters and 71 healthy controls. All were interviewed with the SCID-I and completed questionnaires covering mental pain, communication difficulties and seriousness of suicide attempt. RESULT: Variables from the mental pain domain (e.g. depression) predicted the presence of suicidal behavior, and variables from the communication difficulties domain (e.g., self-disclosure) predicted the lethality and seriousness of the suicide attempts. LIMITATIONS: Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability. CONCLUSIONS: Problems with sharing of feelings with others are an important risk factor for near-lethal suicide, over and above the contribution of psychiatric illness and mental pain, including depression and hopelessness.

Is onset of Tourette syndrome influenced by life events?

The aim of this study is to investigate the possible relationship between stressful life events, personality, and onset of Tourette syndrome in children. The study group included 93 subjects aged 7-18 years: 41 with Tourette syndrome (TS), 28 with obsessive-compulsive disorder (OCD), and 24 healthy controls. Diagnoses were based on the Child Schedule for Schizophrenia and Affective Disorders (K-SADS). All children were tested with the Screen for Child Anxiety Related Emotional Disorders, Children's Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory or Children's Depression Inventory, the Life Experience Survey, and the Junior Temperament and Character Inventory. The findings were compared among the groups. Subjects with Tourette syndrome and healthy controls had significantly less stressful life events than subjects with (OCD). There were no significant differences between the TS subjects and the healthy controls. This finding applied to total lifetime events, total lifetime negative events, and events in the year before and after illness onset. Subjects with TS and the healthy controls also showed a significantly lesser impact of life events than subjects with OCD. The Tourette syndrome group showed a significantly lesser impact of stressful life events than controls. Harm avoidance tended to be higher in the patients with Tourette syndrome and comorbid attention deficit hyperactivity disorder and obsessive-compulsive disorder than in patients with Tourette syndrome only. There seemed to be no association between life events, diagnosis, and personality. Although there is some research suggesting that tics can be influenced by the environment, the onset of Tourette syndrome does not seem to be related to stressful life events, nor to an interaction between stressful life events and personality.

Psychiatric morbidity in adolescents operated in childhood for congenital cyanotic heart disease.

AIM: The aim of the present study was to assess psychiatric morbidity of adolescents operated in childhood for congenital cyanotic heart disease (CCHD) and their parents. METHODS: Participants were 31 adolescents (19 boys, 12 girls) aged 10-21 (mean +/- SD, 14.7 +/- 0.3) years, who had undergone cardiac surgery 13.7 +/- 2.48 years before the study assessment period. Twenty-two mothers and nine fathers participated in the study. Assessment tools for adolescents included: the UCLA Post Traumatic Stress Disorder-Reaction Index, The Screen for Child Anxiety Related Emotional Disorders, and The Beck Depression Inventory; for the parents: The Posttraumatic Stress Diagnostic Scale, The Spielberger State Trait Anxiety Inventory, and The Beck Depression Inventory. RESULTS: Nine out of 31 adolescents (29.03%) were defined as 'full post-traumatic stress disorder (PTSD) likely' with a total post-traumatic stress symptom (PTSS) score significantly higher than that of the non-PTSS subgroup (P < 0.001). A non-significant trend was noted for more adolescents with 'anxiety disorder likely' (P = 0.096, NS) in the PTSS versus the non-PTSS subgroups. A non-significant trend was detected showing that on all symptom domains of PTSD, as well as on anxiety and depressive measures, parents of children with PTSS received higher scores than parents of children without PTSS (P = 0.095, 0.03, 0.04, respectively, NS). CONCLUSION: Children undergoing cardiac surgery for CCHD may be at a high risk for long-term PTSS.