Suicide prediction revisited.

Data from a 1983 prospective study of suicide in a cohort of 4800 psychiatric inpatients were reanalyzed using logistic regression, which is more appropriate for a binary outcome. The results were the same as in the previous study: too few of the subsequent suicides were identified and there were too many false positives to make this procedure useful. Several additional "artificial" logistic regression analyses were done: one series randomly removed increasing numbers of nonsuicide cases to increase the base rates; another series added an increasingly powerful hypothetical "test." Both of these maneuvers helped, but fell well short of perfection.

Stress, coping, family conflict, and adolescent alcohol use.

This study examined alcohol use among seventh graders in relation to life events, daily hassles, the supportive quality of the family environment, coping, and anxiety. Four hundred twenty-five students participated, 228 girls and 197 boys. Stepwise regression and discriminant function analyses indicated that the students reported more alcohol use if they also reported more life events, more daily hassles, and more conflict in the family. A stress-buffering effect of low family conflict on life events could not be substantiated for extent of alcohol use. The results are discussed in the context of the developmental transitions of adolescence.

Alcohol use by adolescents in disrupted families.

Alcohol use increases among adults in response to marital disruption and divorce, but data that are available regarding adolescent alcohol use are inconsistent in the light of whether or not families are intact. To explore this question we obtained measures of frequency and quantity of alcohol use from 2595 junior and senior high school students, together with information about family intactness and parental alcohol use. Adolescents in single and stepparent families reported more alcohol use than adolescents from intact families, for both frequency and quantity of use. This was the case for boys and for girls, as well as for junior high school and for senior high school students. Parents in nonintact families also were reported to be using more alcohol than parents in intact families. Adolescent alcohol use was significantly correlated with parental alcohol use. After adjusting adolescent alcohol use for parental alcohol use as a covariate, the finding of greater alcohol use by adolescents in non-intact families remained.

Selected behavioral features of patients with borderline personality traits.

Selected behavioral features felt historically and empirically to be significant in the borderline personality disorder were evaluated in 4,800 psychiatric inpatients. Variables measured included number of hospitalizations and type of discharge, suicidal behavior, physical violence, and outcome after discharge. A statistical analysis was performed to determine the relationship between depth and severity of borderline traits and the aforementioned behavioral features. Results indicated that irregular discharges, frequent suicide attempts, first suicide attempt prior to age 40, violence within and outside the hospital, and gradual deterioration in social and occupational functioning were found significantly more often in patients with high levels of borderline personality traits.

Self-derogation and adjustment in the community: a longitudinal study of psychiatric patients.

The authors assessed the symptoms and role performance of a group of psychiatric inpatients 1 year after their discharge to determine their level of adjustment in the community. Level of self-derogation at the time of discharge was consistently found to predict the level of adjustment. The occurrence of stressful life events was also predictive of symptoms but was not found to be significantly related to role performance. The chronicity of the disease was unrelated to adjustment. The change in self-derogation level and its ability to predict community adjustment is interpreted in terms of reestablishing the patient's belief in his or her own worth and efficacy.

Psychosocial correlates of alcohol use at two age levels during adolescence.

The correlations between self-reported alcohol use by adolescents and peer and parental alcohol use, tolerance of deviance, emotional maladjustment and self-derogation were studied in two independent samples--172 seventh-grade boys, 221 seventh-grade girls, 131 tenth-grade boys and 164 tenth-grade girls in Sample 1, and 166 seventh-grade boys, 149 seventh-grade girls, 120 tenth-grade boys and 129 tenth-grade girls in Sample 2. Regression analyses were performed to identify the relative contribution of each correlate in a prediction formula for alcohol use at the two grade levels and to determine whether the predictors differed at the two grade levels. The results were cross-validated in the two samples and showed that the predictors were similar at the two grade levels, despite the much greater alcohol use by tenth-graders. The major predictors for both grade levels and for both boys and girls were peer and parental alcohol use. Tolerance of deviance contributed to a much lesser degree and emotional maladjustment did not contribute to the prediction equations.

Affective and behavioral features of DSM-III borderline personality disorder. Are they valid?

This study was designed to determine if a set of seven clinical features, closely reflecting Diagnostic and Statistical Manual III criteria, were individually and collectively more common in borderlines compared to patients with schizophrenia, affective disorders, and anxiety disorders. A 7-item borderline subscale was generated from the expanded Brief Psychiatric Rating Scale and administered to 1,762 psychiatric inpatients. Results indicated that scores on the total borderline scale were significantly higher in borderline patients compared to the control groups. Borderline patients manifested significantly more hostility, uncooperativeness, manipulativeness, impulsiveness, emotional lability, and antisocial trends compared to controls.

Demography of psychiatric patients with borderline personality traits.

This study was designed to identify the intensity of borderline personality traits in a large sample of psychiatric inpatients (n = 4,800) and to determine the relationship between the borderline traits and a variety of demographic variables. Results indicated the intensity of borderline pathology increased in (1) students or the unemployed, (2) married and separated patients, (3) patients with a criminal record, (4) atheists, and (5) patients from a broken home. It lessened with increasing age of the patient. There was no relation between race or level of education and intensity of borderline traits. Findings are discussed in terms of previous empirical studies and the existent theoretical literature.

Effects of diagnosis and treatment history on relapse of psychiatric patients.

Of 400 patients followed up for 1 year after release from the hospital, 34% were readmitted during that year. For schizophrenic patients the readmission rate was 49%, and for nonschizophrenic patients it was 21%. Rate of rehospitalization was positively related to number of prior hospitalizations, cumulative months of prior hospitalization, and duration of illness, but the relationship varied between the schizophrenic and nonschizophrenic groups. In contrast to the findings of Linn and associates, in this study prior hospitalization of nonschizophrenic patients markedly increased the likelihood of rehospitalization.

A follow-up survey of drug abuse and alcoholism teaching in medical schools.

The authors sent a questionnaire regarding the teaching of drug abuse and alcoholism to a stratified random sample of 40 U.S. medical schools, and 35 provided usable replies. The findings are summarized and are contrasted with replies received five years earlier from the same schools. During these five years, there were notable improvements in the teaching of these topics, as reflected by increases in required teaching hours, percentage of total required hours, number of elective courses offered, and number of affiliated clinical programs. The effect of the presence of a career teacher in the addictions is also evaluated.

Prediction of suicide in psychiatric patients. Report of a prospective study.

A prospective research study attempted to identify persons who would subsequently commit or attempt suicide. The sample consisted of 4,800 patients who were consecutively admitted to the inpatient psychiatric service of a Veterans Administration hospital. They were examined and rated on a wide range of instruments and measures, including most of those previously reported as predictive of suicide. Many items were found to have positive and substantial correlations with subsequent suicides and/or suicide attempts. However, all attempts to identify specific subjects were unsuccessful, including use of individual items, factor scores, and a series of discriminant functions. Each trial missed many cases and identified far too many false positive cases to be workable. Identification of particular persons who will commit suicide is not currently feasible, because of the low sensitivity and specificity of available identification procedures and the low base rate of this behavior.

Order of appearance of alcoholic symptoms.

An extensive alcoholism history questionnaire was administered individually to 102 alcoholics. The results were analyzed by averaging the mean age of first occurrence of each symptom for the whole group, and separately by focusing on the order of appearance within each individual subject. The results of these two approaches are presented and compared.

Psychosocial antecedents of unwed motherhood among indigent adolescents.

PIP: This study was undertaken to test theoretically based hypotheses regarding psychosocial antecedents of unwed motherhood among indigent adolescents. These hypotheses were derived from the theory that deviant social responses result from previously acquired negative self-attitudes. Data was obtained by survey of a 50% sample of female 7th graders from an urban school system. The experimental group was made up of 82 subjects who received perinatal care at a clinic for indigent adolescents and who gave birth out of wedlock at least 1 year after the survey and before reaching age 18. One control group consisted of 164 students matched 2:1 with each unwed mother according to race, mother's education and school. A 2nd control group included 164 randomly selected students. Analysis of the data obtained permitted identification of specific self-rejecting attitudes developed among the prospective unwed mothers in the course of normative group experiences. These attitudes, together with the social positions of these subjects and the erosion of controls exerted by family and school authorities emerged as significant factors contributing to the adoption of deviant behavior patterns. These deviant patterns, including those associated with unwed motherhood, appear to be congruent with subculturally influenced values and with adaptive/defensive patterns. On the whole, results indicate that the general theory of deviant behavior that has been applied to other behaviors can be used to explain the precursors of unwed motherhood among indigent adolescents.^ieng

Prediction of chronicity in psychiatric patients.

In order to determine the best combination of variables for predicting which patients would be released from state mental hospitals and which would be retained, the 1,500 patients examined in the course of a cross-sectional survey of the residental population of Texas state mental hospitals in 1966 were followed up in 1971. Eighteen variables were selected for discriminant analysis, comparing the patients nerver released from the hospital with those known to be current extrainstitutional residents. The stepwise program selected four variables: (1) length of prior stay; (2) relatives' attitudes toward release; (3) social adequacy; and (4) conceptual disorganization. Applying this model to the study groups, 79% were correctly classified with regard to their in hospitals/not in hospital status, suggesting that early identification of chronicity in future studies is feasible.

Suicide following psychiatric hospitalization.

The hypothesis was tested that following psychiatric hospitalization, those subjects who subsequently completed suicide would be distinguished from those who did not by the interaction of two circumstances: a state of defenselessness at the time of hospitalization, and experience of adverse life events following release from hospital. Subjects were 40 male VA psychiatric inpatients: 20 who completed suicide following release, and 20 controls matched on age, race, and time at risk in the community. Defenselessness (the incapacity to defend against distressful negative self-feelings) was defined in terms of scores derived from the extended Brief Psychiatric Rating Scale administered shortly after the patient's hospitalization. Adverse life events were eight events characterized simultaneously as undesirable, unlikely to have been initiated by the subject, and having a score of 30 or above on the Social Readjustment Rating Scale. In confirmation of the hypothesis, it was found that completed suicide subjects were significantly and appreciably more likely both to have had high defenselessness scores at the time of hospitalization and to have experienced adverse life events during the posthospitalization period, whereas neither circumstance in the absence of the other was predictive. The findings support the position that suicide is a response to experiences with self-threatening implications, in the face of personal incapacity to defend against, adapt to, or cope with such experiences.

Self-attitudes and suicidal behavior.

Findings are reported concerning the hypothesized relationship between adoption of suicidal responses (ideation, threats, attempts) and antecedent negative self-attitudes. Data were provided by junior high school student (N = 3,148) responses to questionnaires administered three times at annual intervals. Antecedent negative self-attitudes were measured by a seven-item self-derogation scale at the first testing. Adoption of suicidal responses was indicated by earlier denial and subsequent affirmation of the response (self-reports). Findings indicate that suicidal behaviors are responses (whether or not subsequently continued) to experiences of negative self-attitudes in the more recent past. However, whether or not suicidal behaviors are related to self-derogating feelings in the more remote past can be seen as a function of a sex-social-class-mode of suicidal response interaction.

Two contrasting alcoholism treatment programs: a comparison of outcomes.

Participants in two 60-day alcoholism treatment programs with contrasting treatment philosophies and rationale were followed-up 1 year after discharge from the hospital. Widely different results were obtained with distinctly different alcoholic veteran populations. Response to treatment was highly favorable for less symptomatic alcoholics when direct emphasis was place upon the alcoholism per se and complete abstinence. Less favorable responses were achieved with overt neurotic alcoholics when treatment was designed to resolve underlying personality disturbances. Self-reports of marked depression, anxiety, and prior treatment for alcoholism were three pretreatment variables found significantly related to unsuccessful drinking outcome. The implication of these findings is that treatment outcome is largely dependent upon both the characteristics of the population treated and the treatment approach.