Holly A. Parker

Mental illness and suicidality after Hurricane Katrina

OBJECTIVE To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey. METHODS The National Comorbidity Survey-Replication, conducted between February 2001 and February 2003, interviewed 826 adults in the Census Divisions later affected by Hurricane Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the same area before the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of personal growth that resulted from the trauma (for example, increased closeness to a loved one, increased religiosity). Outcome measures used were the K6 screening scale of serious mental illness and mild-moderate mental illness and questions about suicidal ideation, plans and attempts. FINDINGS Respondents to the post-Katrina survey had a significantly higher estimated prevalence of serious mental illness than respondents to the earlier survey (11.3% after Katrina versus 6.1% before; chi(2)1= 10.9; P < 0.001) and mild-moderate mental illness (19.9% after Katrina versus 9.7% before; chi(2)1 = 22.5; P < 0.001). Among respondents estimated to have mental illness, though, the prevalence of suicidal ideation and plans was significantly lower in the post-Katrina survey (suicidal ideation 0.7% after Katrina versus 8.4% before; chi(2)1 = 13.1; P < 0.001; plans for suicide 0.4% after Katrina versus 3.6% before; chi(2)1 = 6.0; P = 0.014). This lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma (faith in ones own ability to rebuild ones life, and realization of inner strength), without which between-survey differences in suicidality were insignificant. CONCLUSION Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.

Normal recognition of emotion in a prosopagnosic.

In the leading model of face perception, facial identity and facial expressions of emotion are recognized by separate mechanisms. In this report, we provide evidence supporting the independence of these processes by documenting an individual with severely impaired recognition of facial identity yet normal recognition of facial expressions of emotion. NM, a 40-year-old prosopagnosic, showed severely impaired performance on five of six tests of facial identity recognition. In contrast, she performed in the normal range on four different tests of emotion recognition. Because the tests of identity recognition and emotion recognition assessed her abilities in a variety of ways, these results provide solid support for models in which identity recognition and emotion recognition are performed by separate processes.

Measuring Expressed Emotion: An Evaluation of the Shortcuts

The construct of expressed emotion (EE) is a highly reliable and valid predictor of poor clinical outcomes in patients with major psychopathology. Patients are at early risk for relapse if they live with family members who are classified as high in EE. Conventionally, EE is assessed with the Camberwell Family Interview (CFI), a semistructured interview that is conducted with the patient’s key relatives. Unfortunately, training in the CFI is difficult to obtain. The CFI is also time-consuming to administer and labor intensive to rate. In this article, the authors discuss alternative ways of assessing EE. They also evaluate the predictive validity of these measures and make recommendations for researchers and clinicians interested in using these assessments.

Cortico-limbic response to personally challenging emotional stimuli after complete recovery from depression.

People vulnerable to depression are at increased risk of relapse if they live in highly critical family environments. To explore this link, we used neuroimaging methods to examine cortico-limbic responding to personal criticisms in healthy participants and participants with known vulnerability to major depression. Healthy controls and fully recovered participants with a past history of major depression were scanned while they heard praising, critical, and neutral comments from their own mothers. Prior to scanning, the formerly depressed and the control participants were indistinguishable with respect to self-reported positive, negative, or anxious mood. They also reported similar mood changes after being praised or criticized. However, formerly depressed participants responded to criticism with greater activation in the amygdala and less activation in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) than did controls. During praise and neutral commentary, amygdala activation was comparable in both groups, although lower levels of activation in the DLPFC and ACC still characterized formerly depressed participants. Vulnerability to depression may be associated with abnormalities in cortico-limbic activation that are independent of mood state and that remain even after full recovery. Criticism may be a risk factor for relapse because it activates the amygdala and perturbs the affective circuitry that underlies depression.

Inhibiting retrieval of trauma cues in adults reporting histories of childhood sexual abuse

Are people who report having forgotten their childhood sexual abuse (CSA) characterised by superior ability to inhibit retrieval of disturbing material? To test this hypothesis, we asked adults reporting either repressed, recovered, or continuous memories of CSA or no history of CSA to participate in a directed forgetting experiment (list method). They rated the emotionality of two consecutive lists of trauma‐related and positive words. After the first list, the experimenter instructed participants to forget these words, and to continue rating the remaining words. A surprise recall task revealed robust directed forgetting and valence effects: All groups recalled more words from the second list than from the first list, and recalled more trauma words than positive ones. Participants reporting either repressed or recovered memories of CSA did not exhibit superior forgetting of trauma versus positive words relative to the other two groups. Finally, a subsidiary analysis revealed that participants exhibiting a “repressor” coping style (low self‐reported anxiety plus high defensiveness) did not exhibit superior directed forgetting of trauma words.

Cortico-limbic response to personally challenging emotional stimuli after complete recovery from depression (DOI: 10.1016/j.pscychresns.2008.04.001)

People vulnerable to depression are at increased risk of relapse if they live in highly critical family environments. To explore this link, we used neuroimaging methods to examine cortico-limbic responding to personal criticisms in healthy participants and participants with known vulnerability to major depression. Healthy controls and fully recovered participants with a past history of major depression were scanned while they heard praising, critical, and neutral comments from their own mothers. Prior to scanning, the formerly depressed and the control participants were indistinguishable with respect to self-reported positive, negative, or anxious mood. They also reported similar mood changes after being praised or criticized. However, formerly depressed participants responded to criticism with greater activation in the amygdala and less activation in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) than did controls. During praise and neutral commentary, amygdala activation was comparable in both groups, although lower levels of activation in the DLPFC and ACC still characterized formerly depressed participants. Vulnerability to depression may be associated with abnormalities in cortico-limbic activation that are independent of mood state and that remain even after full recovery. Criticism may be a risk factor for relapse because it activates the amygdala and perturbs the affective circuitry that underlies depression.

Autobiographical memory specificity in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

Some psychotherapists believe that adult survivors of childhood sexual abuse (CSA) are characterised by memory deficits for their childhood. Using the Autobiographical Memory Test (AMT), we asked nonabused control participants and participants who reported either continuous, recovered, or repressed memories of CSA to retrieve a specific personal memory in response to either positive or negative cue words from either childhood or adolescence/adulthood. The results indicated that participants who believed they harboured repressed memories of abuse tended to exhibit the greatest difficulty retrieving specific memories from their childhood. Neither posttraumatic stress disorder (PTSD) nor major depression was related to diminished memory specificity.

Neural processing of emotional overinvolvement in borderline personality disorder.

OBJECTIVE Patients with borderline personality disorder (BPD) fare better clinically if their families are rated as being high in emotional overinvolvement, which is characterized by marked emotionality, anxious concern, and protective behavior. This is not true of patients with disorders such as schizophrenia or major depression. We used functional magnetic resonance imaging methods to explore the link between emotional overinvolvement (EOI) and better clinical outcome in BPD. Specifically, we tested the hypothesis that, unlike healthy controls or people with other psychiatric problems, people with BPD process EOI as an approach-related stimulus. METHOD Participants with BPD (n = 13) and dysthymia (n = 10) (DSM-IV criteria for both) and healthy controls (n = 11) were imaged using a high field strength (3T) scanner while they listened to a standardized auditory stimulus consisting of either 4 neutral or 4 EOI comments. Participants also rated their mood before and after exposure to the comments. RESULTS All participants reported increased negative mood after hearing EOI and rated the EOI comments as negative stimuli. However, after subtracting activation to neutral comments, participants with BPD showed higher activation in left prefrontal regions during EOI compared to the other groups. Increased left prefrontal activation during EOI was also correlated with clinical measures indicative of borderline pathology. Participants with dysthymia showed increased amygdala activation during EOI. This was not true for the healthy controls or participants with BPD. CONCLUSIONS For people with BPD, EOI may be activating neural circuitry implicated in the processing of approach-related stimuli. Increased left prefrontal activation to EOI may be a vulnerability marker for BPD. These findings may also help explain why BPD patients do better clinically in high EOI family environments.