Dov Har-Even

Correlation of Suicidal and Violent Behavior in Different Diagnostic Categories in Hospitalized Adolescent Patients

OBJECTIVE To determine the relative importance of aggression and depression in adolescent suicide within different diagnostic categories. METHOD One hundred sixty-three consecutive admissions to an adolescent psychiatric inpatient unit were assessed using a semistructure diagnostic instrument, the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Scores for depression, suicidal behaviors, and violent behaviors were calculated from this assessment. RESULTS Anorexia nervosa and conduct disorder patients had the highest suicidal behavior scores. In addition, patients with conduct disorder were significantly more violent than patients with major depressive disorder, and scores on the Violent Behavior Scale correlated with suicidal symptoms but not with depressive symptoms. CONCLUSION Aggression may be as important in some kinds of suicidal behaviors as is depression. Thus it seems that there are hypothetically at least two types of suicidal behaviors during adolescence: a wish to die (depression) and a wish not to be here for a time (impulse control). The first type of suicidal behavior characterizes that seen in disorders with prominent depression such as major depressive disorder and anorexia nervosa, and the second characterizes disorders of impulse control such as conduct disorder.

Attachment styles and aggression in physically abused and neglected children

Attachment theory provides a valuable conceptual model for understanding the role of the parent–child relationship and its consequences for the childs emerging self-concept and view of the social world. Attachment style is an individual-difference variable that is rooted in the childs early rearing experience and provides the context for later emotional, behavioral, and cognitive transactions with the environment. The aim of this study was to compare physically abused (n = 41), and neglected children (n = 38) with nonabused/nonneglected children (n = 35) aged 6–12 years, in terms of their attachment styles and their levels of aggression. We found that the physically abused children were significantly characterized by the avoidant attachment style and manifested significantly higher levels of aggression, and the neglected children were significantly characterized with the anxious/ambivalent attachment style. The strategies that the physically abused and neglected children adapted for interactions with their parents also marked their relationships outside the family. Thus, physically abused children are at risk of antisocial behavior and sustained suspicion toward the others, and neglected children are at risk of social withdrawal, and social rejection and feelings of incompetence.

Cognitive appraisals, coping strategies, and support resources as correlates of parenting and infant development.

By applying R. S. Lazaruss (1993) theoretical model, the authors explored the dynamics of stress and coping as central mechanisms underlying parenting adjustment and infant development. Longitudinal assessment of 140 primiparous mothers included measures of cognitive appraisals of parenting, coping strategies used, and supportive coping resources at pregnancy and 1 month, 6 months, and 12 months postpartum. Maternal outcome measures of adjustment included maternal well-being, parental efficacy, and observed behaviors of caregiving and affiliation. Infant developmental outcome was measured by the Bayley Scales of Infant Development (N. Bayley, 1993). All measures of the stress and coping model showed systematic developmental changes across the transition to parenthood as well as relative stability of individual differences. In addition, the stress and coping variables were found to have additive and interactive effects in predicting both maternal adjustment and infant development.

Association Between Multiple Suicide Attempts and Negative Affects in Adolescents

OBJECTIVE To compare the level of negative emotions-anxiety, depression, aggression, and impulsivity-in hospitalized adolescents with a history of either a single or multiple suicide attempts. METHOD Thirty-two adolescents hospitalized for a first suicide attempt, 19 hospitalized for a repeated attempt (fifth or more), 109 nonsuicidal psychiatric inpatients, and 85 community controls were assessed for level of depression, anxiety, aggression, and impulsivity with the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Multidimensional Anger Inventory, and the Suicide Potential Scale. RESULTS Both suicidal groups demonstrated higher levels of most of the negative emotions than both the normal controls and the nonsuicidal inpatients. When the first attempters were compared with the multiple attempters, similarly high levels were noted for most dimensions of anxiety and depression. A trend toward increased aggression was noted among the multiple suicide attempters on all parameters evaluated; some of these differences were significant. CONCLUSION In already highly anxious and depressed suicidal inpatients, a high level of aggression might significantly increase the risk of recidivism.

Perception of physical pain in accident and suicide attempt patients: Self-preservation vs self-destruction

The perception of physical pain and its relationship to psychological variables were examined in emergency-room (ER) patients who were admitted following suicide attempts or accident injuries, and in a control group of community subjects. Two pain measures, involving electric shocks, were administered to the subjects. Psychological variables included hardiness, body image, body satisfaction feelings about the body, stressful events, anxiety and depression. Suicidal subjects endured the highest number of shocks, scored lowest on the appraisal of pain, and scored lowest on psychological hardiness. Moreover, it was found that, among the suicidal subjects, the more negative the scores of psychological variables, the higher the endurance of pain. In accident victim subjects, the relationships were exactly opposite. These results were interpreted as reflecting two different core attitudes towards life under stressful circumstances: a life-destroying tendency in the suicidal subjects vs. a life-preserving tendency in the accident-victim subjects. These two core attitudes indicate different modes of defense: defensive detachment in the suicidal patients and avoidance of stress in the accident victims.

Serum cholesterol, suicidal tendencies, impulsivity, aggression, and depression in adolescent psychiatric inpatients

BACKGROUND This study was undertaken to examine the relationship between serum cholesterol levels and suicidal behaviors in adolescent psychiatric inpatients. Any association between serum cholesterol and measures of suicidal behavior, impulsivity, aggression, anxiety, and depression was also examined. METHODS Consecutive admissions (n = 152) to an adolescent psychiatric inpatient unit were assessed using measures of suicidal behavior, violence, impulsivity, and depression. Serum cholesterol was compared between those admitted for reasons of suicidal tendencies and those for other reasons. Correlation between serum cholesterol and measures of suicidal behavior, violence, impulsivity, and depression were examined. RESULTS Serum cholesterol levels were significantly higher in adolescent patients who were currently suicidal than in nonsuicidal adolescents. Within the suicidal group, but not in the total inpatient group, serum cholesterol correlated negatively with the degree of suicidal behavior. No correlation between serum cholesterol levels and depression, violence, and impulsivity were detected. No significant differences were found in serum cholesterol levels between diagnoses or between suicidal and nonsuicidal patients within each diagnostic group. CONCLUSIONS The association between cholesterol and suicidal tendencies remains complex and may depend on several variables within the population studied. Its usefulness as a biologic risk factor in clinical samples remains to be determined.

Tolerance for physical pain in suicidal subjects

This study investigated the tolerance for physical pain in suicidal subjects. Suicidal, psychiatric nonsuicidal, and normal young males and females were administered pain measures including electric shocks, appraisal of shocks, and a measure of thermal pain. Additional study variables included diagnosis, past suicide attempts, severity of suicidal intent, and length of hospitalization. Suicidal individuals showed higher tolerance for pain and appraised the pain as less intense than the other groups, regardless of diagnosis, length of hospitalization, and motivation to participate in the study. These findings were explained as a result of dissociative processes inherent in the development of suicidal tendencies and in terms of pain management strategies.

Maternal adjustment and infant outcome in medically defined high-risk pregnancy.

Biological and psychosocial risk factors in high-risk pregnancy and their relation to infant developmental outcomes were explored in a sample of 153 pregnant Israeli women who had pregestational diabetes mellitus, gestational diabetes mellitus, or were nondiabetic. Questionnaires on coping and resources as well as well-being and distress during the 2nd trimester were administered. Estimates of maternal fuels (HbAlc and fructosamine) were obtained throughout pregnancy. At 1 year, offspring were administered the Bayley Scales of Infant Development and mother-infant interactions were observed. Infants of mothers in the diabetic groups scored lower on the Bayley Scales and revealed fewer positive and more negative behaviors than did infants of mothers in the nondiabetic group. Infant outcomes in the maternal diabetic groups were associated with maternal metabolism. Maternal coping and resources differed in the 3 groups and differentially predicted infant development.

Suicidal Tendencies and Body Image and Experience in Anorexia nervosa and Suicidal Female Adolescent Inpatients

Background: The aim of this study was to assess the relationship between body image and suicidal tendencies in anorexia nervosa (AN). Methods: Three groups of hospitalized female adolescents – nonsuicidal AN, suicidal psychiatric and nonsuicidal psychiatric patients, as well as a community control group with no psychiatric disturbances were compared with regard to suicidal tendencies (in the form of attitudes to life and death), body image and experience, depression and anxiety. Results: The AN and suicidal patients showed less attraction to but more repulsion by life, and more attraction to and less repulsion by death compared with the other two groups. The AN and suicidal patients were also different from either one or both control groups in showing more negative attitudes and feelings towards their bodies, lower sensitivity to body clues, less body control, and elevated depression and anxiety. These between-group differences in suicidal tendencies were retained after controlling for age, body mass index, the different body image dimensions, anxiety and depression. Conclusions: Our findings suggest that female AN inpatients with no evidence of overt suicidal behavior demonstrate elevated suicidal tendencies that are similar to those of suicidal psychiatric inpatients. These self-destructive tendencies are highly associated with a pervasive sense of disturbance of body image and experience.

Cultural Patterns in the Choice of Leisure Time Activity Frameworks: A Study of Jewish and Arab Youth in Isreal

The choice of leisure time activities and satisfaction with these choices were compared among two separate cultural groups—164 Jews and 164 Arabs living in urban areas in Northern Israel. Subjects ...