Carolyn M. Pepper

An examination of non-suicidal self-injury in men: Do men differ from women in basic NSSI characteristics?

Researchers have reported similar prevalence rates for non-suicidal self-injury (NSSI) among men and women, yet few studies have investigated gender differences in NSSI. This study describes and compares basic NSSI characteristics among a nonclinical sample by gender. Forty-eight individuals reporting a history of NSSI were interviewed (M = 18.52 years old, SD = 1.18 years). NSSI characteristics, including frequency, age of onset, method of NSSI, pain and control during NSSI, and degree of medical injury were compared between men (n = 19) and women (n = 29). Men and women differed significantly on age of onset, degree of medical injury, and NSSI methods. This study supports previous findings of gender differences in NSSI and suggests that further investigation of gender differences in NSSI is warranted.

Significance of prior episodes of depression in two patient populations

Perhaps the single best predictor of current depression is a prior episode of depression. This study examined the significance of prior depressive episodes in a weighted sample of 425 primary medical care (PC) patients. It also compared the 53 PC patients with major depression with 93 depressed psychiatric patients with respect to percentage of recurrences versus 1st episodes. PC patients with prior depression were over 8 times more likely to be currently depressed than those without such a history. Having at least 1 prior episode of depression was modestly more sensitive, but less specific, than an elevated Center for Epidemiologic Studies--Depression Scale score in predicting current depression. Most currently depressed patients in both PC (85%) and psychiatry (78%) had prior episodes of depression. These findings highlight the importance of assessing history of depression in research and clinical practice.

An analysis of suicidal ideation in a college sample.

Two studies were designed to develop and validate a model of current suicidal ideation. In Study 1, students that reported past suicide attempts (n = 48) were compared to controls (n = 49) on nine variables previously linked to suicidal behavior. In the resulting model, borderline personality characteristics and social support were found to correlate with current suicidal ideation, supporting a mediating model. In Study 2, the Borderline/Social Support (BTSS) model was validated in an independent sample. Implications for risk assessment, prevention and treatment of suicidal college students are discussed.

Indigenous perspectives on depression in rural regions of India and the United States.

Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a “Western baseline” (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.

Gender Differences in Grief Reactions following the Death of a Parent

This study examined gender differences in psychological functioning in a sample of college students who lost a parent to death. Male and female students (n = 65) who had a parent that had died were asked to complete a series of self report questionnaires to assess psychological distress, feelings of grief and bereavement, and coping strategies. Overall, no gender differences were found between bereaved students on measures of psychological distress. However an avoidant coping style was related to symptoms of depression in females, but not in males. Students who lost a mother were more likely to report symptoms of depression, hopelessness, and suicidal ideation as compared to students who lost a father. Future research implications and the clinical importance of these findings are discussed.

Case Identification of Mood Disorders in Asian American and Caucasian American College Students

Past studies have sometimes found that Asian American participants score higher on checklists that measure psychological distress compared to Caucasian American participants. However, studies using diagnostic interviews have not found corresponding elevated rates of mood disorders in Asian American parti- cipants. In the present study, Asian American (n =238) and Caucasian American students (n = 556) completed checklist measures of distress (the Beck Depression Inventory, BDI and the Mood and Behavior Questionnaire, MBQ) and a subsample of students (n =118) received a diagnostic interview. Asian American students had higher BDI scores, but the groups did not differ on either the MBQ, a measure closely tied to DSM criteria for major depression, or on rates of current mood disorders. Elevated BDI scores overestimate rates of mood disorders, particularly in Asian American students.

Functions, lifetime frequency, and variety of methods of non-suicidal self-injury among college students

Borderline Personality Disorder (BPD) and intrapersonal functions of non-suicidal self-injury (NSSI) have both been found to have strong relationships with NSSI. The present study examines their role in the lifetime frequency and variety of NSSI methods, taken as indicators of severity of NSSI. We hypothesized that intrapersonal functions would explain frequency and variety of NSSI beyond the effects of interpersonal functions. Further we hypothesized that intrapersonal functions would moderate the effect of BPD characteristics on frequency of NSSI. College students (n=52) who endorsed at least one lifetime act of NSSI completed self-report measures and semi-structured interviews about NSSI behaviors, frequency, variety and functions, and BPD symptoms. Results supported the hypotheses that intrapersonal functions play a role in the lifetime frequency and variety of NSSI behaviors in addition to that of interpersonal functions, but did not support the role of intrapersonal functions as a moderator. Findings are discussed in terms of relative importance of all factors involved in explaining severity of NSSI, measured as lifetime frequency and variety.

Family centered brief intensive treatment: a pilot study of an outpatient treatment for acute suicidal ideation

Family Centered Brief Intensive Treatment (FC BIT), a hospital diversion treatment program for individuals with acute suicidal ideation, was developed to treat suicidal clients and their families. Individuals who met criteria for hospitalization were treated as outpatients using FC BIT (n = 19) or an intensive outpatient treatment without the family component (IOP; n = 24). Clients receiving FC BIT identified family members or supportive others to participate in therapy. FC BIT clients had significantly greater improvement at the end of treatment compared to IOP clients on measures of depression, hopelessness, and suicidality. Further research is needed to test the efficacy of FC BIT.

Suicide in the Mountain West Region of the United States

Background: The Mountain West region of the United States consistently reports the highest rates of suicide in the country. This pattern could reflect a regional culture-of-suicide script in support of suicide that implicitly influences individuals behavior. Aims: The primary aim of this study was to investigate whether suicide rates are elevated in the Mountain West across a wide range of demographic groups, thereby supporting a regional cultural script. Method: Suicide rates in the Mountain West between 1999 and 2014 were compared to the rest of the country across a wide range of demographic categories and levels of population density using the Center for Disease Control Multiple Causes of Death dataset published on the WONDER online database. Results: Suicide rates are elevated in the Mountain West for men and women, all racial groups, all age groups, and at every level of population density compared to the rest of the country. Limitations: Missing and suppressed data, the use of coroner reports, and the arbitrary nature of state and regional boundaries are all discussed as possible limitations to this study. Conclusion: These findings support a broad culture-of-suicide script that is pervasive in this region across demographic groups and all levels of population density.

Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation

Impulsivity is thought to be a contributing factor in non-suicidal self-injury (NSSI), yet the research is limited and inconsistent. In particular, little is known about how impulsivity is associated with response latency between initial urge and later self-injury, emotion regulation processes, or severity of NSSI. In this study, we tested group differences between participants with and without a history of NSSI on a questionnaire measure of impulsivity. In addition, we tested hypothesized correlations between impulsivity and relevant variables within the NSSI sample using questionnaires and self-reported response latency between urge and injury. Participants included 159 undergraduate students, 84 with an NSSI history and 75 without an NSSI history. Results indicated greater impulsivity on facets of Urgency and (lack of) Perseverance for the NSSI group. Within the NSSI sample, facets of impulsivity were associated with difficulties in emotion regulation and NSSI severity, but not response latency. In addition, response latency, a possible behavioral marker of impulsivity, was not associated with emotion regulation processes or NSSI frequency. These results suggest that higher scores on self-report measures of impulsivity, but not behavioral response latency measures, are associated with emotion regulation processes in individuals who self-injure.