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Disentangling depression and anxiety in relation to neuroticism, extraversion, suicide, and self-harm among adult psychiatric inpatients with serious mental illness
- Author:
- SUBICA Andrew M.
- Journal article citation:
- British Journal of Clinical Psychology, 55(4), 2016, p.349–370.
- Publisher:
- Wiley
Objectives: Little is known about depression–anxiety comorbidity and its association with personality traits and suicide/self-harm in adult psychiatric inpatients with serious mental illness (SMI), impacting clinical assessment and treatment. This study sought to determine the symptom structure of depression–anxiety comorbidity and its relation to neuroticism, extraversion, and suicide/self-harm behaviour in this high-risk population. Design: Nine hundred and sixty-two adults receiving inpatient care at a private psychiatric hospital completed questionnaires at admission. Methods: Confirmatory factor analyses compared a bifactor solution specifying a general distress factor and two specific depression and anxiety factors against unidimensional and correlated factors solutions. The bifactor solutions' factors were subsequently correlated with neuroticism and extraversion subscales and pre-hospitalisation suicide/self-harm behaviours. Results: The bifactor model rendered superior fit to sample data and a robust general factor – accounting for 77.61% of common item variance – providing the first evidence for a tripartite structure of depression and anxiety among adult inpatients. The bifactor solution-outputted independent general distress, depression, and anxiety factors positively correlated with neuroticism, the personality dimension corresponding to trait negative affectivity. The general distress and depression factors associated with recent self-harm, but factors showed no associations with prior suicidal behaviour. Conclusions: In adult psychiatric inpatients, general distress substantially underlies comorbid depression and anxiety symptom variation and may contribute to recent incidence of self-harm. Transdiagnostic assessments and interventions targeting general distress may temper depression, anxiety, and self-harm in adult inpatients. Practitioner points - Clinical implications: a) Depression–anxiety comorbidity symptomology in adult psychiatric inpatients is primarily composed of general distress; b) General distress and specific depression are associated with recent self-harm but not suicidal behaviour; c) Assessing and treating general distress rather than depression or anxiety specifically may best mitigate comorbid depression and anxiety, and reduce self-harm behaviour in this clinical population. Cautions and limitations: a) The large sample lacked ethnocultural diversity, and data were cross-sectional; b) The use of brief self-report measures to assess depression and anxiety may have reduced measurement range. (Edited publisher abstract)
Witnessing violence and self-harming behaviors in women and men with severe mental illness
- Authors:
- O'HARE Thomas, SHEN Ce, SHERRER Margaret V.
- Journal article citation:
- Social Work in Mental Health, 14(4), 2016, pp.313-326.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
People with severe mental illness (SMI) report high rates of having witnessed violence resulting in injury or death, but little is known about the relationship between having witnessed violence and self-harming behaviours. With 420 women and men diagnosed with SMI, the authors tested the hypothesis that one or more lifetime episodes of having seen someone “seriously harmed or killed in combat, home, or crime situation” would correlate with self-harming behaviours while controlling for other correlates of self-harm. Results showed that depression and having witnessed another person being harmed or killed were significantly associated with self-harm. Limitations included the cross-sectional design. (Edited publisher abstract)
Suicide and mental disorders: do we know enough?
- Authors:
- BERTOLOTE Jose, et al
- Journal article citation:
- British Journal of Psychiatry, 183(11), November 2003, pp.382-383.
- Publisher:
- Cambridge University Press
The association of suicide and mental disorders has been widely discussed and documented, leaving the key role of the management of mental disorders in the prevention of suicide uncontested. However, do we know enough about this issue? Gaps in knowledge need to be filled, particularly with regard to different cultural settings, because little information is available on a global basis. From a methodological point of view there are still more issues to consider. The publications available go back over 40 years. Different diagnostic manuals were used (DSM-III, DSM-III-R, ICD-8 to ICD-10), which makes comparisons of those studies somewhat problematic.
Psychosocial treatment for severe personality disorder: 36-month follow-up
- Authors:
- CHIESA Marco, FONAGY Peter
- Journal article citation:
- British Journal of Psychiatry, 183(10), October 2003, pp.356-362.
- Publisher:
- Cambridge University Press
It has been found that a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care. The aim of this article is to evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period. Two samples allocated to the in-patient treatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake. Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patients in the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group. Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model.
Emotional dysregulation: the key to a treatment approach for violent mentally ill individuals
- Authors:
- NEWHILL Christina E., MULVEY Edward P.
- Journal article citation:
- Clinical Social Work Journal, 30(2), Summer 2002, pp.157-171.
- Publisher:
- Springer
- Place of publication:
- New York
Prior research has suggested that psychopathy, substance abuse, and the presence of a personality disorder increase an individual's risk for violence toward others. Substantial clinical literature has established emotional dysregulation as a risk marker for violence toward self. It is hypothesized that emotional dysregulation may be an important component in a constellation of risk markers for violence toward others and may interact with psychopathy and substance abuse in individuals with personality disorders to enhance risk for violence. If these hypothesized relationships exist, it suggests that the development of an intervention approach which directly targets these factors may hold promise. A potential intervention approach based on dialectical behavioral therapy, with case illustrations, is provided.
The law on managing patients who deliberately harm themselves and refuse treatment
- Author:
- HEWSON Barbara
- Journal article citation:
- British Medical Journal, 2.10.99, 1999, pp.905-907.
- Publisher:
- British Medical Association
A British Medical Journal article on managing patients who harm themselves and refuse treatment prompted many requests for legal advice. This paper clarifies the legal issues.
Using a psychoanalytic model to approach acts of self-harm
- Author:
- EVANS Marcus
- Journal article citation:
- Nursing Times, 19.10.94, 1994, pp.38-40.
- Publisher:
- Nursing Times
Recent changes in health service policy mean that nurses working in out-patients settings are probably seeing more people with severe mental health needs. Draws on findings from the field of psychoanalysis to offer nurses some guidance on working in this field of practice.
Establishing a clinical database for hospital attendances because of self-harm
- Authors:
- HORROCKS Judith, HOUSE Allan, OWENS David
- Journal article citation:
- Psychiatric Bulletin, 28(4), April 2004, pp.137-139.
- Publisher:
- Royal College of Psychiatrists
Self-harm is a major risk factor for suicide with around a quarter of suicides preceded by non-fatal self-harm in the previous year. Strategies for suicide prevention should include accurate monitoring of health service contacts due to self-harm. Unfortunately, the published literature points to few practical steps for ensuring this accuracy. We offer an account of running a database, to assist others who might be setting out on this monitoring process.
Adults with a psychotic disorder living in private households, 2000
- Author:
- GREAT BRITAIN. Office for National Statistics
- Publisher:
- Stationery Office
- Publication year:
- 2002
- Pagination:
- 68p.,tables.
- Place of publication:
- Norwich
The data covered in this report come from two sources: a survey which was carried out in 2000 and is a repeat of an earlier survey of adults living in private households, and a supplementary sample of people with psychosis identified through GP records held on the General Practice Rsearch Database. Overall, 91% of this sample of people with a psychotic illness were receiving some form of treatment, either medication or some form of counselling or therapy. Over half of this sample of people with psychotic disorder (56%) reported difficulties with one or more activities of daily living (ADL). Most of these (49% of the whole sample) said that they needed help to overcome at least one of these difficulties. In this sample of people with a psychotic disorder, a very high proportion of people, 70%, were economically inactive. Just over a quarter (27%) were in paid employment, half of them full time and half part time. A large proportion of this sample of people with a psychotic illness were, or had been, smokers. Among this sample, 27% of respondents had an AUDIT score of 8 or more, that is, they were found to have a hazardous level of drinking in the year before interview. Over two-thirds (70%) of this sample of people with a psychotic illness had thought about suicide at some time in their lives and 45% had attempted suicide. In addition, 21% had harmed themselves without intending to commit suicide.
Suicide in special populations and circumstances: a review
- Authors:
- RANGE Lillian M., et al
- Journal article citation:
- Aggression and Violent Behavior, 2(1), Spring 1997, pp.53-63.
- Publisher:
- Elsevier
Describes the characteristics of people at risk of suicidality and discusses implications for prevention strategies.