Religiosity is a protective factor against self-injurious thoughts and behaviors in Jewish adolescents: findings from a nationally representative survey.

PURPOSE: Few studies have investigated the association between religiosity and self-injurious thoughts and behaviors specifically in adolescents, yielding inconsistent results. To date, no study has examined this relationship in a Jewish adolescent cohort. METHODS: Self-injurious thoughts and behaviors, as well as depression, were assessed in a nationally representative sample of Jewish adolescents (n=620) and their mothers, using the Development and Well-Being Assessment Inventory (DAWBA) structured interview. Degree of religiosity was obtained by a self-report measure. RESULTS: Using multivariate analysis, level of religiosity was inversely associated with self-injurious thoughts and behaviors (Wald χ(2)=3.95, P=0.047), decreasing the likelihood of occurrence by 55% (OR=0.45, 95% CI 0.2-0.99), after adjusting for depression and socio-demographic factors. This model (adjusted R(2)=0.164; likelihood ratio χ(2)=7.59; df=1; P<0.047) was able to correctly classify 95.6% of the patients as belonging either to the high or low risk groups. CONCLUSION: This is the first study demonstrating religiosity to have a direct independent protective effect against self-injurious thoughts and behaviors in Jewish adolescents. This finding has clinical implications regarding risk assessment and suicide prevention. Further research can potentially elucidate the complex relationship between religiosity, self-injury and suicide in this population.

Cancer risk among parents and siblings of patients with schizophrenia.

BACKGROUND: A reduced risk of cancer has been noted among people with schizophrenia. Given that genetic causes have been proposed as an explanation of this finding, one would expect that the risk of cancer among first-degree relatives would be equally reduced. AIMS: To investigate the risk of cancer among the biological parents and full siblings of people receiving in-patient care for schizophrenia. METHOD: Linkage analysis was conducted between national population, psychiatric and cancer databases. Standardised incidence ratios for all cancer sites were calculated by comparing the incident rates among first-degree relatives with national incidence rates. RESULTS: A reduced cancer risk was found across all groups examined. Among parents, whose numbers were adequately large, the findings reached statistical significance. For index cases and siblings--a markedly younger population--only a trend was elicited. CONCLUSIONS: The genetic hypothesis--namely, the presence of a gene with the dual effect of reducing the cancer risk and disrupting neurodevelopment--is a plausible explanation for these findings.

Psychiatric services and training for children and adolescents in Europe: results of a country survey.

Mental health budgets, services and programs are seldom commensurate with mental health needs in the countries, particularly of population groups whose voice in advocacy is weak. In this inquiry we explored the adequacy of mental health care resources available for the young in Europe. To achieve this objective this survey investigated a few variables (e. g., number of services, degree of coverage, trained personnel) that were used as gross indicators of the discrimination suffered by this health sector. We sent a short postal questionnaire to the mental health focal points of the 51 countries included in the World Health Organization European Region. Thirty six countries (70.5 %) responded. The results showed that the degree of coverage and quality of services for the young were generally worse in comparison with those for adults, including for serious disorders. A lack of both specialized and in-training personnel was identified. The exposure of general practitioners and pediatricians to psychiatry for the young was limited. Generally, the lower the income level of the country the worse the situation. Our mapping confirmed findings of previous inquiries. European child psychiatry leaders had raised a set of recommendations to improve the current situation; their implementation can now benefit from novel strategies adopted by the World Health Organization to advance mental health worldwide.

Quality of life and coping with schizophrenia symptoms.

The question addressed in this paper is whether different coping styles mediate the relationship between psychopathology and related distress and the quality of life (QOL) among patients with schizophrenia. In a cross-sectional design, 161 schizophrenia inpatients were comprehensively evaluated with standardized measures of QOL, psychopathology, psychological distress and coping styles. Correlations and regression analyses were performed to examine the relationship among parameters and to estimate the mediating effect of coping styles on QOL in the framework of a distress/protection model. Life quality correlated positively with task- and avoidance-oriented coping styles and slightly negatively with emotion-oriented coping. Emotion-oriented coping mediated the relationship between the severity of activation, anxiety/depression symptoms, and QOL, while avoidance-oriented (distraction) coping was mediated between QOL and paranoid symptoms. Coping styles accounted for 25% of the variance in subjective QOL scores compared with 15% for psychological distress, and only 3% for clinical variables. The ability to cope with symptoms and associated distress substantially contributes to QOL appraisal in schizophrenia. Thus, different coping strategies may reduce the negative influence of specific symptoms and related distress on the subjective QOL of schizophrenia patients.

Clinical evaluation of prior suicide attempts and suicide risk in psychiatric inpatients.

BACKGROUND: In practice psychiatrists rely on their own experience and intuition to evaluate the suicide potential of individual patients, but the algorithms for the decision-making process remain unclear. OBJECTIVES: (1) to establish models for the decision making process for evaluating suicide risk; (2) to simulate the impact of information concerning the number of previous suicide attempts on the clinician's ability to detect patients who performed medically serious suicide attempts (MSSAs). METHODS: Four decision models (linear, dichotomized, hyperbolic, and undifferentiated) depicting the influence of the number of previous suicide attempts on the clinician's recognition of MSSAs in 250 psychiatric inpatients were elicited and tested by a series of discriminant analyses. RESULTS: The dichotomized model ("all or none") was found to be the most efficient in detecting medically serious suicide attempts. CONCLUSION: The "all or none" paradigm seems to be the most appropriate way to evaluate the weight of previous suicide attempts in the decision-making process identifying medically serious suicide attempt patients.

Subjective quality of life in severely mentally ill patients: a comparison of two instruments.

Although many quality of life (QOL) scales have been developed, comparison of specific QOL instruments is lacking. We compared the psychometric properties of two QOL measures in parallel samples of mentally disturbed and non-patient subjects. We simultaneously administered the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and self-report items of the Lancashire Quality of Life Profile (LQOLP) to 199 patients with severe mental disorders and 175 non-patients. The patients were evaluated with psychiatric rating scales. We identified five concordant domains, and five instrument-specific domains for the LQOLP and four for the Q-LES-Q. The Q-LES-Q provides better psychometric properties than the LQOLP in both samples. Both instruments show a good capacity to evaluate QOL and discriminate between the patients and non-patient controls. Within the patient sample, both QOL measures showed similarly negative correlations with severity of depression, but not mania, positive, negative, and general symptomatology. Both instruments proved to be mental health related, but neither was mental-disorder specific. Despite the acceptable psychometric properties and correlation of general QOL indices, similar QOL domains proved to be instrument specific and not sufficiently compatible. These discrepancies should be considered when comparing evaluations from similar domains in these QOL scales.

Validation of the Computerized Suicide Risk Scale--a backpropagation neural network instrument (CSRS-BP).

BACKGROUND: Medically serious suicide attempts have been recognized as the most important predictor of suicide. The Computerized Suicide Risk Scale based on backpropagation neural networks (CSRS-BP) has been recently found efficient in the detection of records of patients who performed medically serious suicide attempts (MSSA). OBJECTIVES. To validate the CSRS-BP by: 1) using the CSRS-BP with patients instead of records; 2) comparing the ability of expert psychiatrists to detect MSSA, using the CSRS checklist; and 3) comparing the results of the Risk Estimator for Suicide (RES) and the self-rating Suicide Risk Scale (SRS) with the CSRS-BP. METHODS: Two hundred fifty psychiatric inpatients (35 MSSA and 215 non-MSSA) were diagnosed by clinicians using the SCID DSM-IV. Three expert psychiatrists completed the CSRS checklist, and the RES for each patient, and the patients completed the self-report SRS assessment scale. The CSRS-BP was run for each patient. Five other expert psychiatrists assessed the CSRS checklists and estimated the probability of MSSA for each patient. Comparisons of sensitivity and specificity rates between CSRS-BP, assessment scales and experts were done. RESULTS: Initially, the CSRS-BP, RES, SRS, and experts performed poorly. Although sensitivity and specificity rates significantly improved (two to four times) after the inclusion of information regarding the number of previous suicide attempts in the input data set, results still remained insignificant. CONCLUSIONS: The CSRS-BP, which was very successful in the detection of MSSA patient records, failed to detect MSSA patients in face-to-face interviews. Information regarding previous suicide attempts is an important MSSA predictor, but remains insufficient for the detection of MSSA in individual patients. The detection rate of the SRS and RES scales was also poor and could therefore not identify MSSA patients or be used to validate the CSRS-BP.

Phospholipid patterns of erythrocytes in schizophrenia: relationships to symptomatology.

The phospholipid composition of red blood cells (RBC) from 32 haloperidol-treated schizophrenic patients, classified according to the positive and negative syndrome scale (PANSS) as showing either predominantly positive or predominantly negative symptoms, was determined and compared with that of normal controls. While the levels of phosphatidylcholine and phosphatidylserine were similar in all three groups, sphingomyelin (SM) and phosphatidylethanolamine (PE) were, respectively, increased and decreased in RBCs of schizophrenic patients. In both patient groups, the SM/PE ratios correlated directly with the PANSS negative symptom scale scores and inversely with the positive symptom scale scores. However, the inverse changes in the contents of SM and PE were much more expressed in the negative group. It is suggested that a main source of that difference is a higher activity of the polyunsaturated acid-selective phospholipase A(2) in the negative syndrome patients than in the positive syndrome and control groups.

Gender differences in psychosocial risk factors for psychological distress among immigrants.

The reasons for a greater prevalence of psychological distress among women than men remain unknown. We sought to test two hypotheses that gender operates either as (1) a moderator or (2) a mediator between psychosocial risk factors and experienced distress. A cross-sectional community survey of 1,062 adult Russian-born Jewish immigrants to Israel was conducted. The Demographic Psychosocial Inventory (DPSI) and the Talbieh Brief Distress Inventory (TBDI) were used to measure the parameters of interest. Univariate and multivariate analyses were used to test the moderation versus mediational hypotheses of gender in the stress-distress relationship. The aggregate levels of psychological distress and depression, anxiety, and obsessive symptoms were significantly higher for women than for men. Five sources of distress were more likely to be reported by women: family problems, inappropriate climatic conditions, anxiety about the future, poor health status, and uncertainty in the present life situation. Men scored higher on three stress-protective factors: the number of reasons for immigration, commitment to the host country, and job adequacy. Results of multiple regression and multivariate analysis of variance (MANOVA) supported the mediation hypothesis that gender differences in psychological distress stem from women's greater exposure to specific psychosocial stressors. Our findings demonstrate the validity of gender as an important mediating mechanism underlying the differential perception of risk factors for the development of psychological distress.

Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients.

BACKGROUND: Although treatment of severe mental disorders should strive to optimize quality of life (QOL) for the individual patient, little is known about variations in QOL domains and related psychopathologic and psychosocial factors in patients suffering from schizophrenia, schizoaffective disorder, and/or mood disorders. We hypothesized that QOL in severe mental disorder patients would have a more substantial relationship with psychosocial factors than with illness-associated factors. METHOD: A case-control, cross-sectional design was used to examine QOL of 210 inpatients who met DSM-IV criteria for a severe mental disorder and who were consecutively admitted to closed, open, and rehabilitation wards. Following psychiatric examination, 210 inpatients were assessed using standardized self-report measures of QOL, insight, medication side effects, psychological distress, self-esteem, self-efficacy, coping, expressed emotion, and social support. QOL ratings for patients and a matched control group (175 nonpatients) were compared. Regression and factor analyses were used to compare multidimensional variables between patients with schizophrenia and schizoaffective and mood disorders. RESULTS: In all QOL domains, patients were less satisfied than nonpatient controls. Patients with schizophrenia reported less satisfaction with social relationships and medication when compared with patients with schizoaffective and/or mood disorders. Regression analysis established differential clusters of predictors for each group of patients and for various domains of QOL. On the basis of the results of factor analysis, we propose a distress protection model to enhance life satisfaction for severe mental disorder patients. CONCLUSION: Psychosocial factors rather than psychopathologic symptoms affect subjective QOL of hospitalized patients with severe mental disorders. The findings enable better understanding of the combining effects of psychopathology and psychosocial factors on subjective life satisfaction and highlight targets for more effective intervention and rehabilitation.

Changes in psychological symptoms during the adjustment of recent immigrants.

In the present study, we sought to compare the number, severity, and frequency of psychological symptoms and the intensity of perceived stressors among immigrants with previously identified positive, negative, or normal patterns of distress. We evaluated 199 recent immigrants from the former Soviet Union to Israel using the Talbieh Brief Distress Inventory (TBDI) and the Perceived Immigration-Related Stressors Scale (PIRSS) with a 1-year follow-up period. As predicted, the number, severity, and frequency of psychological symptoms and the intensity of perceived stress factors vary among immigrants showing different distress patterns. A negative pattern was associated with an increase in the total number, severity, and frequency of distress-related symptoms and persisting cultural-related stress over time. A positive pattern was associated with a reduction in the overall number and severity of symptoms, as well as a decline in the frequency of distress-free symptoms and the intensity of all but informational-related stressors. A normal pattern was characterized by the reduction of distress symptoms within a normal range along with material- and health-related stresses. Our findings confirm the validity of the suggested classification for different patterns of distress and its usefulness in establishing the prognosis for the adjustment of immigrants.

Somatization in an immigrant population in Israel: a community survey of prevalence, risk factors, and help-seeking behavior.

OBJECTIVE: Knowledge about the frequency, severity, and risk factors of somatization (somatic manifestations of psychological distress) among immigrants is limited. The authors examined somatic distress in an immigrant population in Israel, explored its relationship with psychological distress symptoms and health-care-seeking behavior, and determined its correlation with the length of residence in Israel. METHOD: Two reliable and validated self-report questionnaires, the Brief Symptom Inventory and the Demographic Psychosocial Inventory, were administered in a cross-sectional community survey of 966 Jewish immigrants from the former Soviet Union who had arrived in Israel within the previous 30 months. RESULTS: The 6-month prevalence rate for somatization was 21.9% and for psychological distress, 55.3%. The current rate of co-occurrence of somatization and psychological distress was 20.4%. The most common physical complaints were heart or chest pain, feelings of weakness in different parts of the body, and nausea. Somatization was positively correlated with the intensity of psychological distress and with help-seeking behavior during the 6 months preceding the survey. Women reported significantly more somatic and other distress symptoms than men. Older and divorced or widowed individuals were more likely to meet the criteria for somatization. Within the first 30 months after resettlement, longer length of residence was associated with higher levels of somatization symptoms. CONCLUSIONS: Somatization is a prevalent problem among individuals in cross-cultural transition and is associated with psychological distress; demographic characteristics such as gender, age, marital status, and duration of immigration; self-reported health problems; and immigrants' help-seeking behavior.

Suicidal ideation and suicide attempts among immigrant adolescents from the former Soviet Union to Israel.

OBJECTIVE: A community survey was conducted to examine suicidal ideation and suicide attempts, behavior problems, psychological distress, social support, and adjustment difficulties in a sample of adolescents. METHOD: Four hundred six Russian-born Jewish immigrants to Israel, aged 11 to 18 years, were selected to match the age and sex distribution of the total immigrant adolescent population. Two indigenous samples of Jewish adolescents in Russia (n = 203) and in Israel (n = 104) were matched with immigrants for comparison. Parameters of interest were measured with self-administered questionnaires. RESULTS: The 6-month prevalence rate of suicidal ideation in the immigrant sample (10.9%) was significantly higher than that for Russian controls (3.5%) but not for Israeli natives (8.7%). There were few gender differences in suicidal ideation and suicide attempts. Older adolescents reported suicidal ideation 2 times more frequently than their younger counterparts. Suicide ideators scored significantly higher than nonideators on all scales of psychological distress and behavior problems. They rated higher sources of immigration difficulties concerning language, physical health, personality characteristics, and family problems but had less socioeconomic and intercultural problems of migration and lower social support from the family but not from other sources. CONCLUSIONS: Results clearly support the migration-convergence hypothesis of suicide risk among adolescents.

Psychological distress through immigration: the two-phase temporal pattern?

A large community sample, cross-sectional and in part longitudinal design, and comparison groups was used to determine the timing of psychological distress among immigrants. A total of 2,378 adult immigrants from the former Soviet Union to Israel completed the self-administered questionnaire Talbieh Brief Distress Inventory. The aggregate levels of distress and six psychological symptoms--obsessiveness, hostility, interpersonal sensitivity, depression, anxiety, and paranoid ideation--were compared at 20 intervals covering 1 to 60 months after resettlement. The level of psychological distress was significantly higher in the immigrants than that of Israeli natives but not in the potential immigrant controls. A two-phase temporal pattern of development of psychological distress was revealed consisting of escalation and reduction phases. The escalation phase was characterized by an increase in distress levels until the 27th month after arrival (a peak) and the reduction phase led to a decline returning to normal levels. The 1-month prevalence rate was 15.6% for the total sample, and for highly distressed subjects it reached 24% at the 27th month after arrival, and it declined to 4% at the 44th month. The time pattern of distress shared males and females, married and divorced/widowed (but not singles), as well as subjects of all age groups (except for immigrants in their forties). The two-phase pattern of distress obtained according to cross-sectional data was indirectly confirmed through a longitudinal way. Claims of early euphoric or distress-free period followed by mental health crisis frequently referred to in the literature on migration was not supported by this study.

Suicide ideation among recent immigrants to Israel from the former Soviet Union: an epidemiological survey of prevalence and risk factors.

This paper reports results of a national community survey of self-reported suicide ideation and attempts and their relation to psychological distress, depression, social support, and adjustment difficulties in a sample of recent immigrants from the former Soviet Union (FSU) to Israel. Using a door-to-door sampling procedure, a sample of 788 Russian-born Jewish immigrants, ages 18-74 years, was selected to match the age and sex structure of the total immigrant population. An indigenous sample of Jews in Russia (n = 411) was matched with the immigrants for comparison. Parameters of interest were measured with the Demographic Inventory, Talbieh Brief Distress Inventory, Beck Depression Inventory, and Multidimensional Scale of Perceived Social Support. The 1-month prevalence rate of suicide ideation in the immigrant sample (15.1%) was found to be significantly higher than that in Russian controls (6.6%). A total of 5.5% of immigrants but only 0.5% of controls had made a suicide attempt at some time in their lives. Risk factors for suicide ideation included younger age, living without a spouse, low level of social support, being a physician or teacher, a history of immigration from the Baltic countries or Moscow, or duration of stay in Israel from 2 to 3 years. The strongest risk factors were higher level of psychological distress and symptoms such as depression, hostility, and paranoid ideation. These findings can be used as a point of departure for the development of community-based suicide prevention programs for recent immigrants.

A clinical-psychological approach to suicidal behavior in depression from Moscow.

This contribution strives to familiarize Western readers with the theoretical concept of suicidal behavior which was developed at the Department of Suicidology of Moscow Psychiatric Research Institute and has been in use there for the last two decades. In describing this approach the paper concentrates on what differentiates it from traditional Western management without making value judgments about either approach. Such an account of the concept and its development will hopefully afford the reader an opportunity to arrive at his or her own conclusions regarding its clinical value.

Psychological distress among Ethiopian and Russian Jewish immigrants to Israel: a cross-cultural study.

A community survey was conducted examining the differences in levels of psychological distress and its symptomatology, comparing 110 Ethiopian-Jewish and 400 Russian-Jewish immigrants to Israel. Psychological distress was measured by the Talbieh Brief Distress Inventory. Russian immigrants were found to be more distressed than their Ethiopian counterparts and this between-group difference can be attributed to the greater relative number of females, older immigrants and those with longer duration of stay in Israel in the Russian sample. The highest levels of distress were observed for paranoid ideation in the Ethiopian sample and anxiety and hostility in the Russian sample. These symptoms were independent of gender and time since immigration. Russians with longer duration of stay demonstrated higher scores signifying adjustment difficulties than their Ethiopian counterparts. These results suggest that the differences in levels and symptom expression of psychological distress are determined, to a considerable extent, by demographic factors (sex, age) and the differing cultural backgrounds of the two immigrant groups.

Psychological symptoms among an immigrant population: a prevalence study.

A community survey evaluating the prevalence of psychological symptoms among 1,953 Russian immigrants living in Israel was conducted. Symptoms of psychological distress were measured using a self-administered questionnaire, the Talbieh Brief Distress Inventory (TBDI). Criterial thresholds for six symptoms--obsessiveness, hostility, interpersonal sensitivity, depression, anxiety, and paranoid ideation--were established. Respondents with four or more psychological symptoms met the criterion for psychological distress syndrome (PDS) with a likelihood greater than 73%. A total of 13% of the respondents reported no psychological symptoms, and 21% reported all six symptoms of distress in the last month. One-month prevalence figures for distress-free and distress-related symptoms are presented. The prevalence rate for distress-free symptoms is 9% to 20%, and for distress-related symptoms, 38% to 43%. Sex differences were found regarding most symptoms, with higher prevalence rates in women than in men. No age differences were found for distress-related symptoms, whereas distress-free symptoms generally tended to change with age. The findings of this survey emphasize the importance of using our suggested quantitative approach when assessing psychological symptoms in further epidemiological investigations of stress-related psychopathology.

Does supported housing protect recent immigrants from psychological distress?

Psychological distress measured by the Talbieh Brief Distress inventory was compared between two groups of immigrants: consumers of supported housing (N = 302) and non-consumers living in community settings (N = 419), matched by sex, age and education level. Overall, distress level was found to be significantly lower in consumers of supported housing than in non-consumers. Consumers also exhibited significant lower hostility, obsessive-compulsive and paranoid ideation symptoms, but they were similar to nonconsumers on level of depression, anxiety and sensitivity. The results suggest that supported housing protects recent immigrants from environmental stresses to a greater extent than community residence.