Bergljot Gjelsvik

BICLUSTERING MODELS FOR TWO-MODE ORDINAL DATA

The work in this paper introduces finite mixture models that can be used to simultaneously cluster the rows and columns of two-mode ordinal categorical response data, such as those resulting from Likert scale responses. We use the popular proportional odds parameterisation and propose models which provide insights into major patterns in the data. Model-fitting is performed using the EM algorithm, and a fuzzy allocation of rows and columns to corresponding clusters is obtained. The clustering ability of the models is evaluated in a simulation study and demonstrated using two real data sets.

Looking Back on Self-Poisoning: The Relationship between Depressed Mood and Reporting of Suicidal Intent in People Who Deliberately Self-Poison.

&NA; Lifetime worst‐point suicidality is associated with risk of subsequent death by suicide. Yet little is known about how people who deliberately self‐poison (DSP) change their appraisal of suicidal intent of a single DSP episode over time. We assessed whether suicidal intent for a single index episode of DSP changed over time and factors associated with such change. We studied 202 patients admitted for DSP (66.3% female, all Caucasian), 18–85 years old (M = 37.8, SD = 14.8), using a longitudinal design (0, 3, and 12 months). The primary outcome measure was change in suicidal intent for a single index DSP episode, analyzed using multilevel modeling. Wish to die and whether the episode was considered a suicide attempt increased significantly with depressed mood. Wish to die associated with the index episode also increased over time independently of depressed mood. No association with time or depressed mood was found for perceived likelihood of dying. Depressed mood was strongly associated with appraisal of suicidal intent associated with a DSP episode. In suicide risk assessment, reports of the nature and severity of past DSP should be interpreted in light of current mood.

Embodied cognition and emotional disorders: Embodiment and abstraction in understanding depression

Research into embodied cognition (EC) in cognitive neuroscience and psychology has risen exponentially over the last 25 years, covering a vast area of research; from understanding how ability to judge speech sounds depends on an intact motor cortex, to why people perceive hills as steeper when carrying a heavy backpack. Although there are many theories addressing these phenomena, increasing evidence across EC studies suggests simulation (i.e., re-enactment of the motor-sensory aspects of meaning) as an important basis of knowledge. The authors 1) review evidence for the EC paradigm’s claim to simulation effects in cognition, suggesting that simulation exists within a “distributed plus hub” model, 2) discuss the implications of simulation for the understanding of cognitive dysfunctions in emotional disorders, particularly depression, 3) suggest that emotional disorders arises as a result of failed simulation processes, hypothesizing that semantic processing reactivates motor-sensory simulations previously associated with low mood (enactment/re-enactment networks), and that truncation of such simulation by means of over-use of language-based, abstract processing, motivated by a wish to reduce the affective disturbance associated with episodic, embodied representations, maintains psychopathology, 4) review evidence for effects of truncated simulation on emotional pathology, and 5) discuss the relevance of EC to treatments of emotional pathology.

Deliberate self-poisoning with prescribed drugs is not related to medical severity of acts.

To the Editor: Patients engaging in deliberate self-poisoning (DSP) often repeat the acts and are at increased risk of dying by suicide. It is therefore crucial to delineate the association between prescription of medication and the nature of DSP episodes at an individual level including consideration of the potential lethality of the acts. We previously reported findings showing that DSP patients have a much greater prescribed medication load (ie, the total amount of prescribed medication collected by an individual over a specified period of time) than the general population.1 We also found that most patients ingested medication prescribed for themselves in the DSP episodes, whereas the remaining patients predominantly ingested medication prescribed for other people.1 However, the relationship between availability of prescription medication and clinical aspects of DSP episodes such as medical severity is not well understood. DSP consists of a heterogeneous group of acts in terms of suicidal intent and medical severity. The objective of the current investigation was to find out whether DSP patients who ingested medication prescribed to them in the episode engaged in medically more severe self-poisonings than those who ingested either medication that was prescribed to others or over-the-counter drugs.

Implicit Identification with Illness in Patients with Irritable Bowel Syndrome (IBS)

Identification with pain has been linked to symptom severity in chronic pain conditions. However, the role of identification with illness in patients with Irritable Bowel Syndrome (IBS) is unknown. We investigated whether participants with IBS show identification with illness and if the degree of illness identification is related to IBS symptom severity and additional physical and psychological variables. In this cross-sectional study, 42 participants with IBS and 41 healthy participants completed an Implicit Association Test (IAT) to measure their level of identification with illness and health. Data on illness duration, explicit illness associations, IBS severity, depression, anxiety, stress and additional symptoms were obtained. IBS participants scored significantly lower on identification with health than healthy participants. The level of health identification was negatively correlated with ‘Nonspecific Somatic Symptoms’. Reduced health identification may be a maintaining factor of IBS that could be targeted with psychological treatments to reduce symptoms. Further, it may be possible to use the IAT to monitor the course of recovery.

Thought–Action Fusion in Individuals with a History of Recurrent Depression and Suicidal Depression: Findings from a Community Sample

Although suicidal ideation is one of the most consistent symptoms across recurrent episodes of depression, the mechanisms underpinning its maintenance are poorly understood. In order to develop effective treatments for suicidally depressed patients, understanding what maintains suicidal distress is critical. We hypothesised that Thought–Action Fusion (TAF), i.e., to assume that having a thought has real world consequences, originally described in Obsessive–Compulsive Disorder, might be a bias in recurrently suicidally depressed people. To assess this, we revised the original TAF scale, and assessed TAF in three samples: healthy controls, recurrently depressed individuals with no history of suicidality (D-NS) and individuals with a history of recurrent suicidal depression (D-S). Exploratory and confirmatory factor analyses indicated a three-factor solution of TAF: (1) TAF for uncontrollable events, (2) self-suicidal TAF for suicidal acts related to oneself, and (3) TAF for positive controllable events. Compared to healthy controls, the D-NS group reported significantly higher total TAF, TAF uncontrollable, and TAF self-suicidal subscales, whilst positive controllable TAF was lower compared to healthy controls. Both D-S and D-NS samples reported higher TAF for suicidal thought compared to healthy controls, i.e., believing that having suicidal thoughts means they will act on them, however in the context of low mood this became more pronounced for the D-S group. These findings suggest that targeting TAF both in suicidal and non-suicidal depression has merit.

Is There a Relationship between Suicidal Intent and Lethality in Deliberate Self-Poisoning?

&NA; The relationship between suicidal intent and lethality of deliberate self‐poisoning (DSP) episodes and their associations with suicide have yielded contradictory findings. The aims of this study were to investigate the association between patients’ suicidal intent and independently rated lethality of DSP episodes, and whether the association changes over time. Eighty‐nine DSP patients were investigated longitudinally. Self‐reported suicidal intent, including perceived likelihood of dying, wish to die, and whether or not the DSP was considered a suicide attempt, was measured at the time of the index episode (t1), 3 months (t2), and 12 months (t3) later. Lethality was assessed independently by three clinical toxicologists. Lethality was significantly associated with patients’ reported wish to die (p = .01) and perceived likelihood of dying (p = .04) at t1, but not at t2 and t3. No association was found between whether the episode was considered a suicide attempt or not and lethality at t1, t2, or t3. Lethality and suicidal intent should be considered as largely separate dimensions of self‐harm. Clinicians should bear this in mind during clinical assessment, especially regarding historical information.

Ian Curtis: Punk rock, epilepsy, and suicide

Ian Curtis was the front man of the post-punk band Joy Division. He suffered from epilepsy and actively incorporated his experiences of the disease in his lyrics. Curtis had frequent epileptic seizures, both on and off stage. After dying from suicide in 1980, he became a legend in the post-punk milieu. The impact which the epilepsy, the epilepsy treatment, and comorbid depression had on his artistic life and premature death is not well known.