Why did peri-pandemic suicide death rates decrease among non-Hispanic white people while increasing among most people of color?

INTRODUCTION: While suicides in the United States decreased during the COVID-19 pandemic, statistically significant decreases have been limited to White people throughout a large portion of 2020. METHODS: This paper outlines possible explanations for racial/ethnic differences in suicidality in the early pandemic phases. RESULTS: We propose both distal (i.e., tele-mental health usage, internet and technology access, employment protections, and economic security) and proximal (cultural beliefs, coping strategies, clustering, pulling together, and embracing life) factors that may have helped build and foster community and mental wellness. However, this paper argues these factors did not extend, or did not extend as much, to many communities of color. CONCLUSIONS: We argue that these disparities are due to the myriad effects of discrimination and systemic racism, encapsulated broadly by the minority stress theory, and provide suggestions for relief and research.

Psychoneurometric assessment of dispositional liabilities for suicidal behavior: phenotypic and etiological associations.

BACKGROUND: Can core genetic liabilities for suicidal behavior be indexed using psychological and neural indicators combined? The current work addressed this question by examining phenotypic and genetic associations of two biobehavioral traits, threat sensitivity (THT) and disinhibition (DIS) - operationalized as psychoneurometric variables (i.e., composites of psychological-scale and neurophysiological measures) - with suicidal behaviors in a sample of adult twins. METHODS: Participants were 444 identical and fraternal twins recruited from an urban community. THT was assessed using a psychological-scale measure of fear/fearlessness combined with physiological indicators of reactivity to aversive pictures, and DIS was assessed using scale measures of disinhibitory tendencies combined with indicators of brain response from lab performance tasks. Suicidality was assessed using items from structured interview and questionnaire protocols. RESULTS: THT and DIS each contributed uniquely to prediction of suicidality when assessed psychoneurometrically (i.e., as composites of scale and neurophysiological indicators). In addition, these traits predicted suicidality interactively, with participants high on both reporting the greatest degree of suicidal behaviors. Biometric (twin-modeling) analyses revealed that a high percentage of the predictive association for each psychoneurometric trait (83% for THT, 68% for DIS) was attributable to genetic variance in common with suicidality. CONCLUSIONS: Findings indicate that psychoneurometric assessments of biobehavioral traits index genetic liability for suicidal behavior, and as such, can serve as innovative targets for research on core biological processes contributing to severe psychopathology, including suicidal proclivities and actions.

Examination of the relationship between obesity and suicidal ideation.

OBJECTIVE: The relationship between obesity and suicidal ideation and behavior (suicidality) is not well understood, and conventional suicide risk factors do not adequately explain the associations observed. Thus, the current study aimed to further examine the relationship between body mass index (BMI; kg m(-2)) and suicidal ideation as well as potential mechanisms of this relationship. METHODS: Two hundred seventy-one adults (n=151 undergraduates; n=120 obesity treatment participants) completed self-report questionnaires assessing relevant variables, including suicidal ideation, perceived burdensomeness, thwarted belongingness and current height/weight used to calculate BMI. RESULTS: There was a significant, quadratic relationship between BMI and suicidal ideation (b=0.001, t=2.21, P=0.03, partial r=0.14) and between BMI and perceived burdensomeness (b=0.003, t=2.50, P=0.013, partial r=0.16), such that as BMI increased, these positive associations became more pronounced. Additionally, perceived burdensomeness partially mediated the relationship between BMI and suicidal ideation. CONCLUSIONS: Individuals with a higher BMI demonstrated increased suicidal ideation as well as greater feelings of perceived burdensomeness. These results provide novel information regarding potential mechanisms explaining the obesity-suicidal ideation association.

Prospectively predicting dietary restraint: the role of interpersonal self-efficacy, weight/shape self-efficacy, and interpersonal stress.

OBJECTIVE: This study investigated how the precursors of interpersonal self-efficacy and weight/shape self-efficacy would interact in the face of interpersonal stress to prospectively predict dietary restraint. Three models were explored, each with a different type of interpersonal stress: stress from same sex friendships, opposite sex friendships, or romantic relationships. METHOD: At Time 1 (T1), participants (N = 406) reported on their typical levels of interpersonal self-efficacy and weight/shape self-efficacy, and recent (past 28 days) dietary restraint. At Time 2 (T2), 11 weeks after T1, participants reported on their recent (past 28 days) levels of dietary restraint at that time. Between T1 and T2, participants completed inventories weekly on the previous week's interpersonal stressors. RESULTS: Consistent with prediction, low interpersonal self-efficacy and high weight/shape self-efficacy combined with high interpersonal stress (whether from same sex friendships, opposite sex friendships, or romantic relationships) to predict the highest levels of T2 dietary restraint after controlling for T1 levels. DISCUSSION: These results further link the interpersonal domain with dietary restraint and elucidate characteristics of women particularly apt to increase dietary restraint in response to interpersonal stress.

Examining a psychosocial interactive model of binge eating and vomiting in women with bulimia nervosa and subthreshold bulimia nervosa.

The current study tested a psychosocial interactive model of perfectionism, self-efficacy, and weight/shape concern within a sample of women with clinically significant bulimic symptoms, examining how different dimensions of perfectionism operated in the model. Individuals with bulimia nervosa (full diagnostic criteria or subthreshold) completed measures of bulimic symptoms, multidimensional perfectionism, self-efficacy, and weight/shape concern. Among those who were actively binge eating (n=180), weight/shape concern was associated with binge eating frequency in the context of high perfectionism (either maladaptive or adaptive) and low self-efficacy. Among those who were actively vomiting (n=169), weight/shape concern was associated with vomiting frequency only in the context of high adaptive perfectionism and low self-efficacy. These findings provide support for the value of this psychosocial interactive model among actively binge eating and purging samples and for the importance of considering different dimensions of perfectionism in research and treatment related to bulimia nervosa.

Predicting bulimic symptoms: an interactive model of self-efficacy, perfectionism, and perceived weight status.

An interactive model of perfectionism, perceived weight status, and self-efficacy was tested on 406 women to predict the bulimic symptoms of binge eating and inappropriate compensatory behaviors separately. This longitudinal study assessed hypothesized vulnerabilities of high perfectionism and low self-efficacy and the stressor of feeling overweight at Time 1 and then gathered weekly assessments of binge eating, vomiting, laxative use, fasting, and diet pill use for 11 weeks. As predicted, results showed that perfectionism, weight perception, and self-efficacy interacted to prospectively predict binge eating. In particular, women high in perfectionism who felt they were overweight and who had low self-efficacy reported the most number of weeks of binge eating. This interactive model did not predict inappropriate compensatory behaviors. Future directions and clinical implications are discussed.

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project.

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.

Cross-cultural examination of the tripartite model with children: data from the Barretstown studies.

The Positive and Negative Affect Scale for Children (PANAS-C) and the Physiological Hyperarousal Scale for Children (PH-C) were administered to a group of 240 children from European countries to determine their utility in examining the tripartite model of anxiety and depression in a cross-cultural sample. Most of the children (n = 196) had been diagnosed with a medical illness; the remainder were siblings of these youngsters (n = 44). Only slight variations were noted in items between this sample and samples from the United States. Despite these minor differences, 3 distinct scales measuring the positive affect, negative affect, and physiological hyperarousal constructs of the tripartite model were identified. These findings illustrate that the PH-PANAS-C provides a useful measure of the tripartite model in a cross-cultural sample of youth. The findings also demonstrate that the tripartite model is generalizable to a cross-cultural milieu.

Health beliefs and illness attitudes as predictors of breast cancer screening attendance.

BACKGROUND: This paper considers the breast cancer screening programme in the autonomous community of Navarre, Northern Spain. Women from different areas of Northern, Central and Southern Navarre are involved. METHODS: A sample of 512 women participants and 196 non-participants was taken from a total of 60,908 women between 45 and 65 years of age who received an invitation to attend the breast cancer screening programme. The participants were asked to fill in an individual structured questionnaire in their local Health Centre and the non-participants in their homes. This was done retrospectively. RESULTS: The response rate was 100% for participants and 83.9% for non-participants. This study investigates the attitude profiles of the women attending mammography mass screening, with non-attending women (matched in educational and occupational levels) as controls. Subjects were assessed on dimensions such as attitudes towards health and illness. The results support Rosenstock's 1974 model that perceived severity of breast cancer and perceived susceptibility to breast cancer are related to participation in screening. Furthermore, results demonstrated that hypochondriacal beliefs, disease phobia and feared effects of symptoms were related to decreased participation levels. CONCLUSION: This study has explored the implication of health belief attitudes and the attitudes toward illness variables with women's participation in a breast cancer screening programme. It assesses the relative contribution of these variables to levels of participation, and the results of the study indicate that belief sets and attitudes are important components of women's cancer prevention behaviours.

The interpersonal consequences of inflated self-esteem in an inpatient psychiatric youth sample.

This study tested R. F. Baumeister, L. Smart, and J. M. Boden's (1996) theory of inflated self-esteem with an inpatient psychiatric youth sample. Participants were assessed on their self-reported self-esteem, self-reported interpersonal problems, and peer rejection (measured by evaluations from 3 or 4 peers). Consistent with the hypotheses, those with low self-esteem reported the most interpersonal problems, followed consecutively by the moderate self-esteem group and then the high self-esteem group, who reported the fewest interpersonal problems. Also in line with the hypotheses, those with low and high self-esteem were rejected by their peers when compared with the moderate self-esteem group. Thus, the high self-esteem group was rejected by their peers but did not themselves report interpersonal problems. These findings provide further support for Baumeister et al.'s theory and generalize the theory to a clinical setting.

Excessive reassurance seeking: delineating a risk factor involved in the development of depressive symptoms.

Six studies investigated (a) the construct validity of reassurance seeking and (b) reassurance seeking as a specific vulnerability factor for depressive symptoms. Studies 1 and 2 demonstrated that reassurance seeking is a reasonably cohesive, replicable, and valid construct, discernible from related interpersonal variables. Study 3 demonstrated that reassurance seeking displayed diagnostic specificity to depression, whereas other interpersonal variables did not, in a sample of clinically diagnosed participants. Study 4 prospectively assessed a group of initially symptom-free participants, and showed that those who developed future depressive symptoms (as compared with those who remained symptom-free) obtained elevated reassurance-seeking scores at baseline, when all participants were symptom-free, but did not obtain elevated scores on other interpersonal variables. Studies 5 and 6 indicate that reassurance seeking predicts future depressive reactions to stress. Taken together, the six studies support the construct validity of reassurance seeking, as well as its potential role as a specific vulnerability factor for depression.

Psychopathy, antisocial personality, and suicide risk.

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.

On fatalism, pessimism, and depressive symptoms among Mexican-American and other adolescents attending an obstetrics-gynecology clinic.

There is growing evidence that Mexican-American adolescents may be at increased risk for depressive symptoms. We sought to replicate and explain this result in a study of adolescent girls attending an obstetric-gynecologic clinic. Three hundred and four girls of diverse ethnic backgrounds completed measures of depressive symptoms, negative attributional style, and locus of control. Consistent with predictions, we found that Mexican-American adolescent girls reported more depressive symptoms than adolescent girls from other ethnic backgrounds, and that Mexican-American adolescent girls displayed more negative cognitive styles than girls from other ethnic backgrounds. Depression differences appeared to be partly explained by differences in negative cognitive style. Implications of the results for a theory of increased Mexican-American adolescent depression, and for applied work, were discussed.

Defensiveness predicts peer rejection of depressed children.

The present study examined the ironic possibility that defensiveness, far from suppressing depression and staving off negative interpersonal consequences, is actually associated with interpersonal difficulties (e.g. peer rejection). Participants were 72 youth psychiatric inpatients (aged 7-17 years, mean+/-SD 13.18+/-2.59 years), who completed self-report measures of defensiveness and depression. Chart diagnoses were available, and peer rejection ratings were collected. Results indicated that depressed children with a defensive style obtained the highest peer rejection ratings, other children, including depressed but non-defensive children, were not as negatively rated by peers. Implications regarding self-presentation and depression, as well as regarding clinical work with depressed people, were discussed.

The course of post-crisis suicidal symptoms: how and for whom is suicide "cathartic"?

We investigated suicide "catharsis" as evidenced by decreased suicidality following a suicide attempt. Past research has examined this issue with mixed results (Bronisch, 1992; Davis, 1990; van Praag & Plutchik, 1985). In the present study, we examined Modified Scale for Suicide Ideation (MSSI) scores for 198 suicidal men during suicidal crisis, prior to entry into a treatment study, and again at 1-month and 12-month follow-ups. Patients were divided into ideators, single attempters, and multiple attempters. We found evidence for decreased suicidality, but interpreted it as the gradual action of interpersonal support, rather than as emotional catharsis. Also, multiple attempt status affected the long-term course of post-crisis suicidality.

Specificity of information processing styles to depressive symptoms in youth psychiatric inpatients.

Although information processing has been widely studied with depressed adults, little emphasis has been placed on the specificity of resultant findings to depression, as opposed to other psychological disorders. Analogously, even less effort has been directed toward examining the information processing styles of depressed children and adolescents. The present study investigated the specificity of information processing styles to depression and anxiety among 58 youth psychiatric inpatients. To assess information processing, we used a self-referent encoding task, in which participants were presented with positive and negative adjectives; participants were asked whether these adjectives described them or not, and were then tested on recall of the adjectives. After controlling for age and gender, lower rates of positive adjective endorsement and lower rates of positive adjective recall were found to be associated with depression, but not anxiety. Additionally, negative adjective endorsement was associated with anxiety symptoms. These results suggest specific cognitive features of depressive symptoms.

Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples.

Subtyping depression has been an interest of theorists and clinicians for at least four centuries. In this paper, we examined the validity of the symptom cluster component of the hopelessness theory of depression. We used structural equation modeling analyses on large samples of psychiatric outpatients (N=1604, 844, and 680) and Air Force cadets (N=1404) who completed the items of the Beck Depression Inventory (BDI). Findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome. Implications for the nosology of depression and for depression theory were discussed.

Health-oriented behaviors: their implication in attending for breast cancer screening.

OBJECTIVE: To assess the implication of health-oriented behavior and state of health variables estimated to influence women's participation in a breast cancer screening program. METHODS: A sample of 512 participants and 196 nonparticipants was taken from a total of 60,908 women between 45 and 65 years of age. RESULTS: There are significant differences in women's perception of their knowledge of breast cancer, estimated prognosis, and reasons for not performing self-examination. The nonparticipant group reports more health problems. CONCLUSION: The study assesses the relative contribution of these variables to participation levels, although further empirical testing of all these issues is recommended.

Negative attributional style, hopelessness depression and endogenous depression.

The hopelessness theory of depression [Abramson, L. Y., Metalsky, G. I. & Alloy, L. B. (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358-372.] postulates that a negative attributional style represents a risk factor for a particular constellation of depressive symptoms, termed 'hopelessness depression'. Four studies tested the relation of negative attributional style to hopelessness depression symptoms versus endogenous depression symptoms. Despite the considerable overlap of hopelessness and endogenous depression symptoms, negative attributional style was more related to the former than the latter, consistent with hopelessness theory.

Patterns of hemispheric perceptual asymmetries: left hemispatial biases predict changes in anxiety and positive affect in undergraduate women.

Consistent with the tripartite model of anxiety and depression, hemispheric asymmetries may be differentially associated with depressive and anxious symptoms. Indeed, research has demonstrated that asymmetries do exist when examining hemispatial biases in both anxious and depressed individuals; however, the magnitude and direction of these asymmetries has been variable. The Chimeric Faces Task was used here to measure these asymmetries, along with measures for current and future levels of anxiety and depression. Results indicated that (a) increased left hemispatial biases at Time 1 predict increased anxiety (i.e., physiological hyperarousal) at Time 2 among female undergraduate students and (b) decreased left hemispatial biases at Time 1 predict decreased positive affectivity at Time 2 among the same participants. The possibility that hemispatial biases represent a vulnerability to future anxiety and depression is discussed.