Abby Braden

Understanding Suicide Risk: Identification of High Risk Groups during High Risk Times

BACKGROUND The assessment of suicide risk is a complex task for mental health professionals. Certain demographic groups are associated with completed suicide including males, divorced adults, and Caucasians. However, demographic variables alone provide a crude assessment of suicide risk. Psychiatric diagnosis and recent life events might improve the identification of high-risk individuals. METHOD The current study evaluated 148 individuals who died by suicide compared with 257 adults who died suddenly from accidents or medical problems. Psychological autopsy was used to assess Axis I psychiatric diagnosis and recent stressful life events. RESULTS Suicide completers were significantly more likely than comparison subjects to have a depressive disorder, a substance abuse disorder, and to have experienced interpersonal conflict in the months leading up to their death. A discriminant function analysis revealed that the combination of demographic variables, recent stressful life events, and psychiatric diagnoses best discriminated between suicide completers and comparison subjects. CONCLUSIONS Proper assessment of suicide risk should include a comprehensive evaluation of demographic characteristics, recent life stressors, and psychiatric diagnosis.

From the Outside Looking In: Sense of Belonging, Depression, and Suicide Risk

Objective: Sense of belonging has demonstrated significant relationships with depression and suicidal thoughts, highlighting its potential utility in refining assessment of suicide risk. Method: Structured clinical interviews and self-report measures were used to assess depression, suicidal behaviors, hopelessness, life stress, social support, and sense of belonging in a sample of 116 depressed psychiatric patients. Results: Lower sense of belonging was significantly associated with greater severity of depression, hopelessness, suicidal ideation, and history of prior suicide attempt(s). However, sense of belonging did not predict suicidal ideation and history of prior suicide attempt(s) beyond the association between suicidal behaviors and established risk factors. Sense of belonging displayed a significant relationship with depression and hopelessness and is likely to play a critical role in both the development of and recovery from depression. Conclusions: Sense of belonging is directly related to depression and hopelessness, while indirectly related to suicidal ideation. Low sense of belonging provides an important target for assessment and intervention in the treatment of depression. Cognitive, behavioral, and interpersonal interventions may help improve an individual’s sense of belonging and decrease symptoms of depression and hopelessness.

You’ve Got to Believe: Core Beliefs that Underlie Effective Psychotherapy

A mixture of core beliefs may lay the foundation for effective psychotherapy. Sincere trust in these beliefs may help to promote therapeutic change. The therapist must have faith in the power of words to promote change. Clients usually change in a gradual manner, and the initial plan for therapy can be simplified by focusing on strategies for changing actions and attitudes. Also, therapy can help to improve various aspects of clients’ intimate relationships. However, before attempting to promote therapeutic change, it is important for the therapist to begin by understanding the client’s life situation, current distress, and natural tendencies. Clients benefit from emotional tolerance of stressors by recognizing that many negative life events turn out better than initially expected. A tendency to dwell on past events can perpetuate problems, while it can be more helpful to accept and grow from negative events. Therapists are encouraged to view a client’s emotions as natural reactions, not deviant dysfunctions that need to be blocked or suppressed through medications. In a similar manner, most labels, including many psychiatric diagnoses, pose a danger through societal discrimination and self-stigma. When therapists adopt these core beliefs, they can more effectively help clients move forward, making adaptive psychological changes.

Design of the FRESH study: A randomized controlled trial of a parent-only and parent–child family-based treatment for childhood obesity

Approximately 1 out of 3 children in the United States is overweight or obese. Family-based treatment (FBT) is considered the gold-standard treatment for childhood obesity, but FBT is both staff and cost intensive. Therefore, we developed the FRESH (Family, Responsibility, Education, Support, & Health) study to evaluate the effectiveness of intervening with parents, without child involvement, to facilitate and improve the childs weight status. Targeting parents directly in the treatment of childhood obesity could be a promising approach that is developmentally appropriate for grade-school age children, highly scalable, and may be more cost effective to administer. The current paper describes the FRESH study which was designed to compare the effectiveness of parent-based therapy for pediatric obesity (PBT) to a parent and child (FBT) program for childhood obesity. We assessed weight, diet, physical activity, and parenting, as well as cost-effectiveness, at baseline, post-treatment, and at 6- and 18-month follow-ups. Currently, all participants have been recruited and completed assessment visits, and the initial stages of data analysis are underway. Ultimately, by evaluating a PBT model, we hope to optimize available child obesity treatments and improve their translation into clinical settings.

Life Meaning Is Associated With Suicidal Ideation Among Depressed Veterans

Suicide is a major public health concern among U.S. veterans. Even when asked directly, veterans who die by suicide have been found to deny suicidal thoughts. Psychological assessment needs to go beyond the current risk factors and evaluate underlying factors that may increase suicide risk. In the present study, diagnostic interviews and self-report questionnaires were used to measure life meaning and suicidal ideation in a sample of 110 depressed veterans. Life meaning was significantly associated with suicidal ideation, even after accounting for depression and suicide history. Life meaning may be an important, previously ignored indicator of suicide risk.

Parent Changes in Diet, Physical Activity, and Behavior in Family-Based Treatment for Childhood Obesity

Currently, more than one third of US children are overweight or obese,1 and parental overweight is the strongest risk factor for child overweight.2 Family-based treatment (FBT), the gold standard treatment for pediatric obesity, is a treatment approach that relies heavily on parent involvement.3 In FBT, parents are often considered the agents of change, holding considerable responsibility for their child’s weight loss. Since parent weight change is the best predictor of child weight loss in FBT,4 identification of factors related to parent weight change in FBT is a valuable goal. A more thorough understanding of parent behavior change in FBT may be of clinical importance, as this information could ultimately improve both parent and child weight loss outcomes.

Parent binge eating and depressive symptoms as predictors of attrition in a family-based treatment for pediatric obesity

BACKGROUND Attrition is a significant problem in family-based treatment (FBT) for childhood obesity. Despite this, very few studies have examined factors associated with attrition. The current study examined parent symptoms of depression and binge eating as predictors of attrition in FBT. METHODS Participants included 77 parents of overweight children enrolled in FBT for childhood obesity. Data were collected at baseline and post-treatment. Binary logistic regression was used to assess associations between parent binge eating symptoms, depressive symptoms, and attrition. RESULTS Results showed that parent binge eating symptoms (p=0.02), but not depressive symptoms (p=0.07), were significantly associated with attrition, after controlling for parent BMI, treatment group assignment, and family income. CONCLUSIONS Higher reported parent binge eating symptoms were significantly related to attrition in FBT. Assessment of parent binge eating may be important in identifying families at risk for dropping out of FBT. Further, FBT may need to be adapted for families with parents who have a high level of psychopathology.

Eating when depressed, anxious, bored, or happy: Are emotional eating types associated with unique psychological and physical health correlates?

The majority of research on emotional eating has examined general emotional eating, to the exclusion of more distinct emotions such as boredom and positive emotions. The current study aimed to examine whether specific types of emotional eating (i.e., eating in response to depression (EE-D), anxiety/anger (EE-A), boredom (EE-B), and positive emotions (EE-P)) were related to a range of psychological (i.e., global psychological well-being, eating disorder symptoms, emotion regulation) and physical health variables. A sample of adults (n = 189) with overweight/obesity were recruited via Amazon Mechanical Turk. Participants self-reported height and weight and completed a battery of questionnaires. Correlational analyses showed that more frequent EE-D, EE-A, and EE-B were related to poorer psychological well-being, greater eating disorder symptoms, and more difficulties with emotion regulation. EE-P was not significantly related to outcome variables. In regression analyses, eating in response to depression (EE-D) was the type of emotional eating most closely related to psychological well-being, eating disorder symptoms, and emotion regulation difficulties. Exploratory analyses revealed associations between EE-D, EE-A, and EE-B and facets of emotion regulation and specific disordered eating symptoms. Findings suggest that unique patterns exist between specific types of emotional eating and psychological outcomes.

Parent Coaching Model for Adolescents With Emotional Eating

A significant proportion of both healthy and treatment-seeking youth report eating for emotional reasons. Emotional eating (EE) is associated with medical and psychological sequelae including overeating and eating disorder symptoms. Youth with EE are thought to have a predisposition toward a high level of emotional sensitivity, with a tendency to experience emotions intensely, and for a long duration. Interventions are needed to address emotion dysregulation associated with EE. Parent-focused interventions that emphasize training parents to respond to emotion dysregulation in their children have the potential to reduce the incidence of EE. This article describes an emotion-focused parent training intervention for youth who engage in EE.

Depression and reasons for living among AIDS patients: protecting quality of life when the end is in sight.

Background: Patients with AIDS are at risk for becoming depressed, pessimistic, and may begin to desire to die. The desire to live may remain strong in AIDS patients through the maintenance of physical health and a lack of pain. However, improvement in physical health is not always followed by resurgence in the will to live. Psychological variables may be important for protecting reasons for living in AIDS patients. Aims: The current study was designed to examine protective factors associated with the will to live among AIDS patients, including physical functioning, depression, and quality of life. Method: Sixty-eight AIDS patients participated in the current study during their outpatient visits to an infectious disease unit. Self-report questionnaires were administered to assess depression, quality of life, a variety of physical health variables, and reasons for living. Results: Analyses revealed that reasons for living reported by AIDS patients were best understood by overall quality of life. Depression was associated with pessimistic beliefs about the medical illness. Depression was not significantly related to physical functioning or role limitations. Conclusions: AIDS patients with poor physical functioning may maintain important reasons for living if a high sense of quality of life is achieved. The assessment and treatment of quality of life in AIDS patients should include strategies that foster a sense of achievement, strengthen interpersonal relationships, and increase positive self-expression.