What predicts suicide attempts in women with eating disorders?

BACKGROUND: Suicide is a common cause of death in anorexia nervosa and suicide attempts occur often in both anorexia nervosa and bulimia nervosa. No studies have examined predictors of suicide attempts in a longitudinal study of eating disorders with frequent follow-up intervals. The objective of this study was to determine predictors of serious suicide attempts in women with eating disorders. METHOD: In a prospective longitudinal study, women diagnosed with either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) were interviewed and assessed for suicide attempts and suicidal intent every 6-12 months over 8.6 years. RESULTS: Fifteen percent of subjects reported at least one prospective suicide attempt over the course of the study. Significantly more anorexic (22.1%) than bulimic subjects (10.9%) made a suicide attempt. Multivariate analyses indicated that the unique predictors of suicide attempts for anorexia nervosa included the severity of both depressive symptoms and drug use over the course of the study. For bulimia nervosa, a history of drug use disorder at intake and the use of laxatives during the study significantly predicted suicide attempts. CONCLUSIONS: Women with anorexia nervosa or bulimia nervosa are at considerable risk to attempt suicide. Clinicians should be aware of this risk, particularly in anorexic patients with substantial co-morbidity.

Auditory supplements to speechreading: combining amplitude envelope cues from different spectral regions of speech.

Many listeners with severe-to-profound hearing losses perceive only a narrow range of low-frequency sounds and must rely on speechreading to supplement the impoverished auditory signal in speech recognition. Previous research with normal-hearing subjects [Grant et al., J. Exp. Psychol. 43A, 621-645 (1991)] demonstrated that speechreading was significantly improved when supplemented by amplitude-envelope cues that were extracted from various spectral regions of speech and presented as amplitude modulations of carriers with frequencies at or below the speech band from which the envelope was derived. This experiment assessed the benefit to speechreading provided by pairs of such envelope cues presented simultaneously. In general, greater improvements in speechreading scores were observed for pairs than for single envelopes when the carrier signals were chosen appropriately. However, when pairs of envelope signals were transposed to low frequencies, the benefit to speechreading was no better than the most effective single-band envelope signal tested, or for a low-pass-filtered speech signal with the same overall bandwidth. Suggestions for improving the efficacy of frequency-lowered envelope cues for hearing-impaired listeners are discussed.

Single band amplitude envelope cues as an aid to speechreading.

Amplitude envelopes derived from speech have been shown to facilitate speech-reading to varying degrees, depending on how the envelope signals were extracted and presented and on the amount of training given to the subjects. In this study, three parameters related to envelope extraction and presentation were examined using both easy and difficult sentence materials: (1) the bandwidth and centre frequency of the filtered speech signal used to obtain the envelope; (2) the bandwidth of the envelope signal determined by the lowpass filter cutoff frequency used to "smooth" the envelope fluctuations; and (3) the carrier signal used to convey the envelope cues. Results for normal hearing subjects following a brief visual and auditory-visual familiarization/training period showed that (1) the envelope derived from wideband speech does not provide the greatest benefit to speechreading when compared to envelopes derived from selected octave bands of speech; (2) as the bandwidth centred around the carrier frequency increased from 12.5 to 1600 Hz, auditory-visual (AV) performance obtained with difficult sentence materials improved, especially for envelopes derived from high-frequency speech energy; (3) envelope bandwidths below 25 Hz resulted in AV scores that were sometimes equal to or worse than speechreading alone; (4) for each filtering condition tested, there was at least one bandwidth and carrier condition that produced AV scores that were significantly greater than speechreading alone; (5) low-frequency carriers were better than high-frequency or wideband carriers for envelopes derived from an octave band of speech centred at 500 Hz; and (6) low-frequency carriers were worse than high-frequency or wideband carriers for envelopes derived from an octave band centred at 3150 Hz. These results suggest that amplitude envelope cues can provide a substantial benefit to speechreading for both easy and difficult sentence materials, but that frequency transposition of these signals to regions remote from their "natural" spectral locations may result in reduced performance.