Child sleep problems, maternal sleep and self-efficacy: Sleep's complicated role in maternal depression.

Depression, poor sleep duration and low self-efficacy are common in mothers of children with sleep problems. However, research rarely extends beyond the postpartum period. This study investigated the multifaceted relationship between child sleep and maternal depression in early motherhood. A confidential survey assessed child sleep problems, maternal sleep duration, parental self-efficacy and depressive symptoms in 477 Australian mothers of children aged 3 months to 5 years. We found no relationship between child age and maternal depression, supporting our decision to look beyond postpartum depression. Robust bootstrapped mediation modelling tested the hypothesis that both maternal sleep duration and parental self-efficacy would mediate child sleep problems as predictors of maternal depression. After controlling for child age, results showed a significant parallel mediation effect, demonstrating that maternal sleep duration and parental self-efficacy both mediate the relationship between child sleep problems on maternal depression. While the total effect of child sleep problems on maternal depression was statistically significant, after partialling out the effects of other variables, child sleep problems no longer predicted maternal depression. Akaike information criterion analyses supported the full model, with both mediators explaining meaningful variance in maternal depression. This study expands our knowledge beyond the postpartum period, and divulges the disparate effects of sleep deprivation and parental self-efficacy on the relationship between child sleep and depression in early motherhood. Maternal sleep duration and self-efficacy are modifiable risk factors of maternal depression, indicating possible efficacious treatments. Parental self-efficacy stands out as a direction for clinical practice and further psychobiological study.

Development and Psychometric Evaluation of the IPV Internalized Stigma Scale.

Self-stigma is the internalization of widespread and negative attitudes around a devalued attribute. Being a victim of intimate partner violence (IPV) is a stigmatized identity, with IPV self-stigma is a potential barrier to help seeking. The lack of an IPV self-stigma scale limits current measurement of this latent trait; this study sought to fill this gap. We developed the IPV Internalized Self-stigma Scale (IPVIS) by revising existing self-stigma and devaluation/discrimination measures and adding new items to fill perceived gaps. Using an online survey, a diverse sample (N = 455, M = 39.51, SD = 12.03) with various relationship types (e.g., heterosexual, same-sex), IPV circumstances (e.g., male or female perpetrators/victims) and different gender and sexual identities was recruited. Participants first completed the item pool (44-items), followed by measures of IPV, anxiety, depression, social health, and self-efficacy with data analyzed using a multi-model approach (e.g., factor analysis, item response theory [IRT]). Factor analyses revealed one dominant factor; IRT analyses further refined the unidimensional item set. The final 11 items had high internal consistency, ω = .90, 95% CI [0.89, 0.91], and were highly informative with moderate to high discrimination levels. The IPVIS demonstrated measurement invariance by demographics, showing no differential item functioning by age groups, sex, residence (urban/suburban/rural), ethnicity (European/Caucasian vs. others), or relationship status (partnered/unpartnered). Initial validity examination revealed significant correlations between the IPVIS and related measures (e.g., depression, anxiety, social health). The IPVIS is suitable for research and has widespread clinical applicability. To the best of our knowledge, the IPVIS is the first scale developed that assesses IPV self-stigma inclusive of a diverse range of clients/participants, relationship types, and IPV circumstances.

Measuring the suicidal mind: The 'open source' Suicidality Scale, for adolescents and adults.

Clinicians are expected to provide accurate and useful mental health assessments, sometimes in emergency settings. The most urgent challenge may be in calculating suicide risk. Unfortunately, existing instruments often fail to meet requirements. To address this situation, we used a sustainable scale development approach to create a publicly available Suicidality Scale (SS). Following a critical review of current measures, community input, and panel discussions, an international item pool survey included 5,115 English-speaking participants aged 13-82 years. Revisions were tested with two follow-up cross-sectional surveys (Ns = 814 and 626). Pool items and SS versions were critically examined through item response theory, hierarchical cluster, factor and bifactor analyses, resulting in a unidimensional eight-item scale. Psychometric properties were high (loadings > .77; discrimination > 2.2; test-retest r = .87; internal consistency, ω = .96). Invariance checks were satisfied for age, gender, ethnicity, rural/urban residence, first language, self-reported psychiatric diagnosis and suicide attempt history. The SS showed stronger psychometric properties, and significant differences in bivariate associations with depressive symptoms, compared with included suicide measures. The 'open source' Suicidality Scale represents a significant step forward in accurate assessment for people aged 13+, and diverse populations. This study provides an example of sustainable scale development utilizing community input, emphasis on strong psychometric evidence from diverse samples, and a free-to-use license allowing instrument revisions. These methods can be used to develop a wide variety of psychosocial instruments that can benefit clinicians, researchers, and the public.

Negative self-appraisal: Personal reasons for dying as indicators of suicidality.

Reasons for dying (RFD) are one of the most authentic factors illustrating the lived experience of suicidal individuals. However, the field has been criticized for inadequate evaluation of risk factors and suicidal symptoms, such as RFD, to develop more robust theoretical models and risk assessments. In this study, we aimed to critically examine RFD themes as predictors of suicidal symptoms to improve our understanding of the suicidal mind, test suicide theory validity and improve risk assessment. This cross-sectional mixed-method study included anonymous survey data (N = 713) with a subsample (n = 474; 77% female; age M = 31.48, SD = 13.53) who provided RFD. Participants were asked to write down five RFD (ranked 1st to 5th most important) and completed the Suicidal Affect-Behavior-Cognition Scale (SABCS). Thematic analysis revealed eight valid RFD themes-Negative Self-appraisal, Hopelessness, Desire to Escape, Escape Pain, Relationships, Loneliness, Financial Hardship, and Physical Health. Themes were quantified by rank and total endorsements of the theme. Hierarchical regression modelling, statistically controlling for demographics, showed all RFD themes, except Physical Health, were positive predictors of suicidality, accounting for 26% of variance in suicidal symptoms. Negative Self-appraisal was the strongest predictor. RFD differences were also found by gender, age and education. From these findings, we determined current suicide theories do not fully account for suicidal persons' RFD. There is a pressing need for more critical review of current theories, as current theories only partially represent this key attribute of the suicidal mind, and none of the reviewed theories accurately reflected suicidal participants' RFD. Clinical implications include integrating financial therapies into suicide prevention treatments and incorporating RFD into assessments and treatments. To aid research and risk assessment efforts, we propose a new RFD Index, with eight five-point response items.

Peripherally Physiological Responses to External Emotions and Their Transitions in Bipolar I Disorder With and Without Hypersexuality.

Hypersexuality is associated with psychiatric disorders such as mania; however, it remains unclear whether bipolar I disorder with (BW) or without (BO) hypersexuality demonstrates different responses to external emotional stimuli and their transitions that were composed of pictures and sounds of same domain. In 21 BW patients, 20 BO patients, and 41 healthy volunteers, we administered polygraph tests (electrocardiogram, electromyogram, electrooculogram, and galvanic skin response) to measure transitions from a primer emotion (i.e., external disgust, erotica, fear, happiness, neutral, and sadness) to a noncongruent emotion (out of the remaining five) and to the primer emotion again (repeat-primer). We also evaluated participants' concurrent states of mania, hypomania, and depression. With neutral as the noncongruent emotion, the heart rate difference in BW was greater than in controls when responses to the primer erotica were subtracted from responses to the repeat-primer erotica, or when to the primer sadness were subtracted from the repeat-primer sadness. The difference of the masseter electromyographic activity in BW was lower than in BO and controls when responses to the noncongruent happiness were subtracted from responses to the repeat-primer neutral, and was lower than in BO when to the noncongruent neutral were subtracted from the repeat-primer erotica. The eyeball movement difference was greater in BW than in BO and controls when responses to the noncongruent sadness were subtracted from responses to the repeat-primer neutral. The heart rate difference when responses to the primer happiness were subtracted from responses to the noncongruent neutral was negatively correlated with mania in BO. BW and BO patients behaved differently to external emotions and their transitions, particularly regarding erotica and sadness, which might characterize unique pathophysiological processes of the two bipolar I disorder subtypes.

Emergency first aid readiness in Antarctica: Australian Antarctic expeditioners' first aid credentials and self-efficacy.

INTRODUCTION: To help prevent future morbidity and mortality, this study examined Australian Antarctic expeditioners' first aid credentials and self-efficacy in providing emergency first aid in extreme environments. METHODS: A mixed method survey assessed Australian personnel working on Antarctic stations. Volunteer participants (n = 83) provided data on first aid training, self-confidence of first aid readiness, and first aid preparations. The Extreme Conditions First Aid Confidence Scale (EC-FACS) was developed and validated for this study. Multivariate analyses tested associations between first aid background, demographics and EC-FACS. Open-ended comments were subjected to thematic analysis. RESULTS: Over one-third of participants did not hold current first aid certificates at expedition commencement. Factor analysis demonstrated the EC-FACS was unidimensional, and internal consistency was high (α = 0.94), and showed first aid self-efficacy was moderately high, but participants' confidence decreased as first aid scenarios became more complex. Experience providing emergency first aid and level of first aid qualification were the strongest predictors of overall first aid self-efficacy. Thematic analysis revealed expeditioners support higher first aid qualifications and want Antarctic-specific wilderness first aid training. CONCLUSIONS: These findings revealed that many Antarctic expeditioners may not be adequately prepared for first aid emergencies and have low confidence in handling complex medical situations. Based on these findings, we recommend higher first aid qualifications and training tailored to the Antarctic context. These modest steps can help prevent unnecessary and costly morbidity and mortality for extreme-condition expeditioners.

Phylogeny of the gall midges (Diptera, Cecidomyiidae, Cecidomyiinae): Systematics, evolution of feeding modes and diversification rates.

Gall midges (Cecidomyiidae) constitute one of the largest and most diverse families of Diptera, with close to 6600 described species and thousands of undescribed species worldwide. The family is divided into six subfamilies, the five basal ones comprising only fungivorous taxa, whereas the largest, youngest and most diverse subfamily Cecidomyiinae includes fungivorous as well as herbivorous and predatory species. The currently accepted classification of the Cecidomyiinae is morphology-based, and the few phylogenetic inferences that have previously been suggested for it were based on fragmentary or limited datasets. In a first comprehensive phylogenetic analysis of the Cecidomyiinae we sampled 142 species representing 88 genera of 13 tribes from all feeding guilds and zoogeographic regions in order to test the validity of the systematic division of the subfamily and gain insight into patterns of diversification and the evolution of feeding modes. We used sequences from five mitochondrial and nuclear genes to reconstruct maximum likelihood and Bayesian, time-calibrated phylogenies and conducted ancestral state reconstruction of feeding modes. Our results corroborate to a great extent the morphology-based classification of the Cecidomyiinae, with strong support for all supertribes and tribes, all were apparently established in the Upper Cretaceous concordant with the major radiation of angiosperms. We infer that transitions from fungus-feeding to plant-feeding occurred only once or twice in the evolution of the subfamily and that predation evolved only once, contrary to previous hypotheses. All herbivorous clades in the subfamily are very species rich and have diversified at a significantly greater rate than expected, but we found no support for the assertion that herbivorous clades associated with symbiotic fungi in their galls diversify faster than clades that do not have such associations. Currently available data also do not support the hypothesis that symbiotic clades have broader host ranges than non-symbiotic clades.

Clinical assessment of suicide risk and suicide attempters' self-reported suicide intent: A cross sectional study.

This study explored medical doctors' clinical assessment of suicide risk and suicide attempters' self-reported suicide intent. Three years of archival assessment records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Records related to 460 suicide attempters (70.4% females; 28.6% males) were analysed using logistic regressions. Their ages ranged from 12 to 85 (M = 29.08, SD = 12.86). The strongest predictor of suicide intent was habitual poor coping, followed by serious financial problems, and expressed regret. The strongest predictor of suicide risk was hiding the attempt followed by prior planning. The findings were discussed in regards to implications in clinical assessments and suicide prevention efforts.

Clinician perceptions of My Health Record in mental health care: medication management and sharing mental health information.

My Health Record (MHR) is a national personally controlled electronic health record, which is projected to be used by all Australian health professionals by 2022. It has also been proposed for use in mental health care, but there is limited information on how clinicians will successfully implement it. This study interviewed seven general practitioners and four psychologists in Tasmania, Australia. Participants were asked about information continuity and barriers and benefits to using My Health Record in mental health care. Thematic analysis identified two pertinent themes: Medication Management and Mental Health Information. Participants reported MHR could improve the quality and frequency of medication information shared between clinicians, but wanted additional medication-related alert features. Mental health information issues were broad in scope and included concerns over sensitive data that might be accessed through MHR and completeness of information. Participants also reported barriers to MHR use, including time burdens and privacy and confidentiality concerns. My Health Record used in mental health care may improve the timely sharing of medication-related information, but clinicians' concerns regarding the sharing of patients' highly sensitive mental health information need to be addressed.

Prediction of Lethality in Suicide Attempts: Gender Matters.

This study explores gender differences in lethality of suicide attempts. Three years of medical records related to suicide attempters (N = 666) were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0 % Malay. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). More males than females made attempts with high perceived lethality (χ2 = 12.10, p < .0001) and high medical lethality (χ2 = 10.59, p < .0001). Available variables were subjected to regression analyses. The regression models predicted more than 60% of high medical lethality suicide attempts and more than 80% of high perceived lethality attempts. Suicide intent and opportunity for rescue were significant predictors for both measures of lethality. Gender differences were examined. Findings were discussed in regard to implications in suicide assessments and interventions.

What predicts medical lethality of suicide attempts in Asian youths?

This study explores youth suicide attempts in Singapore using multiple databases of comprehensive archival records. Three years of medical records related to suicide attempters (N=666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to retrospective analysis. Compared to other age groups, a peak in suicide attempts (n=207) was observed in youths aged between 15 and 24 years old (76.3% females; 23.7% males, mean age=19.30, SD=2.89). The model using recognized risk and protective factors was significant in predicting medical lethality, and correctly classified 62.8% of high lethality cases. Only resolution of precipitant made a unique statistical significant contribution. Analysis was separately conducted for males and females. Implications of the findings are discussed.

Suicidality, psychopathology, and the internet: Online time vs. online behaviors.

This study investigated whether several psychopathology variables, including suicidality, could predict the time people spend using the internet (hours online). Next, we examined a specific at-risk population (suicidal individuals) by their online behaviors, comparing suicidal individuals who went online for suicide-related purposes with suicidal individuals who did not go online for suicide-related purposes. An anonymous online sample of 713 (aged 18-71) reported hours online, psychiatric histories, and completed several standardized scales. After accounting for age and education, hierarchical regression modeling showed that the assessed psychopathology variables, including suicidality, did not explain significant variance in hours online. Hours online were better predicted by younger age, greater willingness to develop online relationships, higher perceived social support, higher curiosity, and lower extraversion. Suicidal participants, who did or did not go online for suicide-related purposes, did not differ on hours online. Multiple regression modeling showed that those who went online for suicide-related purposes were likely to be younger, more suicidal, and more willing to seek help from online mental health professionals. These findings revealed that hours online are not a valid indicator of psychopathology. However, studying online behaviors of specific at-risk groups could be informative and useful, including for suicide prevention efforts.

Does ethnicity matter in risk and protective factors for suicide attempts and suicide lethality?

This study explored ethnic differences in risk and protective factors for suicide attempts, for the major ethnic groups in Singapore, and ethnic differences in prediction of lethality. Three years of medical records related to suicide attempters (N = 666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0% Malay. Indians were over-represented in this sample, as compared with the ethnic distribution in the general population. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). Ethnic differences were found in risk and protective factors, and perceived lethality of suicide attempts. All available variables were subjected to regression analyses for Chinese, Indian and Malay attempters to arrive at parsimonious models for prediction of perceived lethality. The findings were discussed in regards to implications in assessment of suicide risk and primary prevention for the multiethnic society in Singapore.

Analysis of print news media framing of ketamine treatment in the United States and Canada from 2000 to 2015.

OBJECTIVES: There are multifaceted views on the use of ketamine, a potentially addictive substance, to treat mental health problems. The past 15 years have seen growing media coverage of ketamine for medical and other purposes. This study examined the print news media coverage of medical and other uses of ketamine in North America to determine orientations and trends over time. METHODS: Print newspaper coverage of ketamine from 2000 to 2015 was reviewed, resulting in 43 print news articles from 28 North American newspapers. A 55-item structured coding instrument was applied to assess news reports of ketamine. Items captured negative and positive aspects, therapeutic use of ketamine, and adverse side effects. Chi-squares tested for changes in trends over time. RESULTS: In the 15-year reviewed period, the three most frequent themes related to ketamine were: abuse (68.2%), legal status (34.1%), and clinical use in anesthesia (31.8%). There was significant change in trends during two periods (2000-2007 and 2008-2015). In 2008-2015, print news media articles were significantly more likely to encourage clinical use of ketamine to treat depression (p = 0.002), to treat treatment resistant depression (p = 0.043), and to claim that ketamine is more effective than conventional antidepressants (p = 0.043). CONCLUSIONS: Our review found consistent positive changes in the portrayals of ketamine by the print news media as a therapeutic antidepressant that mirror the recent scientific publications. These changes in news media reporting might influence the popularity of ketamine use to treat clinical depression. Guidance is required for journalists on objective reporting of medical research findings, including limitations of current research evidence and potential risks of ketamine.

Exposure to suicidal behaviors: A common suicide risk factor or a personal negative life event?

BACKGROUND: Numerous suicide risk factors have been proposed but not adequately validated for epidemiology, treatment and prevention efforts. AIMS: Exposures to suicidal behaviors (ESB), from family and friend suicide attempts and completions, were tested for validity as a suicidal risk factor and also for measurement and construct adequacy. METHODS: An anonymous online survey yielded 713 participants (aged 18-71), who reported ESB, completed the Suicidal Affect-Behavior-Cognition Scale (SABCS), and comprised a broad spectrum on those variables. RESULTS: Tests of dimensionality and internal consistency showed the four ESB variables (attempts/completions through family/friends) were independent and did not form a common factor or an identifiable ESB latent trait. ESB variables were, however, associated with demographic and psychiatric histories. A battery of tests revealed no meaningful associations between ESB and total suicidality or suicide risk factors (social support, depression, anxiety, stress, satisfaction with life and emotional stability). In addition, in contrast to previous reports, young adults ( n = 200; aged 18-20) showed no increased suicidality due to ESB. CONCLUSION: Results showed no validity for ESB as a common risk factor for suicidality or other psychopathology, or as a latent trait. ESB showed evidence as a personal negative life event with individual effects and interpretations.

Is suicide assessment harmful to participants? Findings from a randomized controlled trial.

There is considerable debate on whether suicide assessment carries an iatrogenic risk for participants/patients. A double-blind randomized controlled trial (registration: R000022314) tested the emotional impact of suicide assessment on participants (n = 259) randomly assigned to experimental (n = 122) or control conditions (n = 137). The experimental condition included the Suicidal Affect-Behavior-Cognition Scale and intensive death-related questions, the control condition a quality of life scale. Both included measures of depression, social support and loneliness. Affective states were assessed immediately before and after testing, and research biases minimized. Post-test debriefing interviews collected qualitative reactions. Experimental participants ranged from nonsuicidal to highly suicidal. Between-groups ANCOVAs and repeated measures ANOVAs showed no differences by study condition, and no pre-post-test affect changes for either condition or suicidal participants (P > 0.10), supporting the null hypothesis of no iatrogenic effects. However, depressive participants in both conditions showed significant decreases in positive affect (P < 0.05). Smallest real difference (SRD) scores approximated clinically meaningful differences and showed 20% of participants had a significant positive survey reaction, 24% a negative reaction, with the rest neutral. Linear regressions revealed depressive symptoms and perceived family support, but not suicidality or other factors, predicted negative affect changes, which was supported by qualitative findings. Social desirability bias was also found in qualitative survey responses. No evidence of iatrogenic effects of suicide assessment were found. Recommendations are made to counter possible negative assessment effects on depressive participants/patients, and nurses and other caregivers are encouraged to talk to patients about suicidal symptoms.

Online Friendship, Romance, and Sex: Properties and Associations of the Online Relationship Initiation Scale.

Online relationships are increasingly central to many people's lives. As a result, there is a growing need to scientifically examine their psychosocial implications. This study developed and tested the Online Relationship Initiation Scale (ORIS) through classical and item response theory analyses to address this need. An anonymous online survey included 713 adults, aged 18-71 years. The ORIS was tested on psychometric properties and examined for associations with gender and several standardized psychosocial measures. Results demonstrated unidimensionality of nine items, strong factor loadings, and high internal consistency (α = 0.90, ωt = 0.94). All items captured significant information on the latent trait and none showed differential item functioning by sex, age group, or ethnicity. General linear modeling confirmed hypotheses that men were more likely than women to initiate online relationships. Online relationship initiation was not strongly associated with perceived social support, but was positively related to financial distress, and willingness to engage in infidelity or unprotected sex. The ORIS was negatively associated with age and satisfaction with life and showed modest interactions with ethnicity and hours online. This study provided empirical evidence for an interpersonal relationship initiation construct. The ORIS was shown to be a psychometrically sound instrument for evaluating online interpersonal behaviors and their associations with psychosocial and demographic factors. Such psychometrically sound instruments can be useful in exploring online interpersonal behaviors and their significance.

Estimating Suicide Rates in Developing Nations: A Low-Cost Newspaper Capture-Recapture Approach in Cambodia.

This study tested a low-cost method for estimating suicide rates in developing nations that lack adequate statistics. Data comprised reported suicides from Cambodia's 2 largest newspapers. Capture-recapture modeling estimated a suicide rate of 3.8/100 000 (95% CI = 2.5-6.7) for 2012. That compares to World Health Organization estimates of 1.3 to 9.4/100 000 and a Cambodian government estimate of 3.5/100 000. Suicide rates of males were twice that of females, and rates of those <40 years were twice that of those ≥40 years. Capture-recapture modeling with newspaper reports proved a reasonable method for estimating suicide rates for countries with inadequate official data. These methods are low-cost and can be applied to regions with at least 2 newspapers with overlapping reports. Means to further improve this approach are discussed. These methods are applicable to both recent and historical data, which can benefit epidemiological work, and may also be applicable to homicides and other statistics.

Offline Versus Online Suicide-Related Help Seeking: Changing Domains, Changing Paradigms.

OBJECTIVE: Suicidal individuals are among the most reluctant help-seekers, which limits opportunities for treating and preventing unnecessary suffering and self-inflicted deaths. This study aimed to assist outreach, prevention, and treatment efforts by elucidating relationships between suicidality and both online and offline help seeking. METHOD: An anonymous online survey provided data on 713 participants, aged 18-71 years. Measures included an expanded General Help-Seeking Questionnaire and the Suicidal Affect-Behavior-Cognition Scale. RESULTS: General linear modeling results showed that, as predicted, face-to-face help-seeking willingness decreased as risk level increased. However, for emerging adults help-seeking likelihood increased with informal online sources as risk increased, while other online help-seeking attitudes differed little by risk level. Linear regression modeling determined that, for suicidal individuals, willingness to seek help from online mental health professionals and online professional support sites was strongly related (ps < .001). Help seeking from social networking sites and anonymous online forums was also interrelated, but more complex, demonstrating the importance of age and social support factors (ps < .001). CONCLUSION: These findings show that the Internet has altered the suicide-related help-seeking paradigm. Online help seeking for suicidality was not more popular than face-to-face help seeking, even for emerging adults. However, treatment and prevention professionals have good reasons to increase their online efforts, because that is where some of the highest risk individuals are going for help with their most severe personal problems.