Lisa M. James

Suicidal ideation in college students varies across semesters: The mediating role of belongingness

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters--as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.

Revisiting the structure of mental disorders: Borderline personality disorder and the internalizing/externalizing spectra

OBJECTIVE Researchers have turned to dimensional models of psychopathology as a means of explaining robust patterns of comorbidity. A hierarchical model consisting of internalizing and externalizing dimensions has been a useful approach to understanding comorbidity among some mental disorders, although a limited number of disorders have been examined within this framework. The objective of the present study is to determine how borderline personality disorder fits into this framework. DESIGN AND METHODS Dimensional measures of nine psychiatric disorders were used in a confirmatory factors analysis to compare five models of comorbidity in 1,197 members (N=541 women) of a population-based sample. Symptom composites were derived from the Michigan Composite International Diagnostic Interview and the International Personality Disorders Examination Questionnaire. RESULTS Five models were fit to dimensional indicators of nine disorders. A model in which borderline personality disorder served as a multidimensional indicator of the externalizing factor and the anxious-misery subfactor of internalizing disorders provided the best fit to the data in the whole sample and in men. For women, this model also fit well but an alternative model in which borderline personality disorder served only as an indicator of the anxious-misery subfactor of internalizing disorders fit equally well. CONCLUSIONS The present study demonstrates the utility of the internalizing/externalizing framework for characterizing personality disorders as well as Axis I disorders. Future work should explore how other personality disorders fit into this framework.

Risk-taking behaviors and impulsivity among veterans with and without PTSD and mild TBI

Military personnel commonly experience post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), both of which are associated with premature mortality. The present study examined two factors that may play a role in premature mortality--impulsivity and risk-taking behaviors--in a sample of 234 veterans screening positive for PTSD, mTBI, PTSD + mTBI, and controls. Analyses of variance demonstrated that veterans with PTSD, regardless of mTBI status, reported engaging in more frequent risky behaviors and reported a greater tendency to engage in impulsive behaviors when in a negative affective state. They also reported more premilitary delinquent behaviors and more suicide-related behaviors than controls. The present study highlights associations between impulsivity, risk-taking behaviors, and PTSD, and suggests continuity across the lifespan in terms of a predisposition to engage in impulsive and/or risky behaviors. Thorough evaluation of impulsivity and potentially risky behaviors is important in clinical settings to guide interventions and reduce the mortality and public health impact of high-risk behaviors in veterans.

An exploratory examination of risk-taking behavior and PTSD symptom severity in a Veteran sample

The present study conducted an exploratory examination of the relationship between self-reported symptoms of post-traumatic stress disorder and an expanded definition of risk-taking behaviors among 395 veterans at a large Midwestern Veterans Affairs Medical Center. Post-traumatic stress disorder symptoms were associated with elevated rates of substance use, thrill seeking, aggression, risky sexual practices, and firearm possession. Results indicated that suicidal ideation and aggressive driving behavior were among the most frequently reported. The present findings hold significant public health implications and highlight the need to attend to risk-taking behaviors in treatment planning.

Disinhibitory trait profile and its relation to Cluster B personality disorder features and substance use problems

Certain personality and motivational traits may present vulnerability towards disinhibitory psychopathology (e.g. antisocial personality disorder, substance abuse). Cluster analysis was used to separately group 306 women and 274 men on impulsivity, Constraint, Negative Emotionality, behavioural activation system (BAS), and behavioural inhibition system (BIS) scores. As expected, a ‘disinhibited’ group with low Constraint, high impulsivity, weak BIS, and strong BAS emerged that showed elevated drug use problems, and histrionic and antisocial personality disorder features across gender. A ‘high affectivity’ group with high Negative Emotionality and strong BIS also showed elevated drug use problems and personality disorder features. Results suggested that two different trait profiles are associated with disinhibitory psychopathology and both may present vulnerability toward the development of such disorders. Copyright

Risk and Protective Factors Associated With Symptoms of Post-Traumatic Stress, Depression, and Alcohol Misuse in OEF/OIF Veterans

Military personnel returning from the conflicts in Iraq and Afghanistan commonly experience mental health problems and efforts are underway to determine risk and protective factors associated with postdeployment mental health concerns. This study examined the contribution of trait neuroticism, predeployment life events, combat experience, perceptions of threat, and postdeployment social support on mental health symptoms at 6 months, 12 months, and 24 months postdeployment. Two hundred seventy-one veterans completed self-report measures. Hierarchical regression analyses demonstrated that neuroticism predicted post-traumatic stress and depressive symptoms at all 3 time points; perceived threat predicted post-traumatic stress symptoms at time 1 and time 2 and depressive symptoms at time 2. Social support was a strong negative predictor of post-traumatic stress and depressive symptoms. Alcohol misuse was not significantly predicted by any of the variables. The present study highlights the role of perceived threat and trait neuroticism on postdeployment mental health symptoms and indicates social support is a robust protective factor. Efforts aimed at increasing sustained postdeployment social support may help defend against significant mental health problems among veterans.

Neural Network Modulation by Trauma as a Marker of Resilience Differences Between Veterans With Posttraumatic Stress Disorder and Resilient Controls

IMPORTANCE Posttraumatic stress disorder (PTSD) and resilience reflect 2 distinct outcomes after exposure to potentially traumatic events. The neural mechanisms underlying these different outcomes are not well understood. OBJECTIVE To examine the effect of trauma on synchronous neural interactions for veterans with PTSD and resilient controls using magnetoencephalography. DESIGN Participants underwent diagnostic interviews, a measure of exposure to potentially traumatic events, and magnetoencephalography. SETTING U.S. Department of Veterans Affairs medical center. PARTICIPANTS Eighty-six veterans with PTSD and 113 resilient control veterans recruited from a large Midwestern Medical Center. MAIN OUTCOME MEASURES Multiple regression analyses were performed to examine the effect of lifetime trauma on global and local synchronous neural interactions. In analyses examining the local synchronous neural interactions, the partial regression coefficient indicates the strength and direction of the effect of trauma on the synchronous interactions between the 2 neural signals recorded by a pair of sensors. The partial regression coefficient, or slope, is the primary outcome measure for these analyses. RESULTS Global synchronous neural interactions were significantly modulated downward with increasing lifetime trauma scores in resilient control veterans (P = .003) but not in veterans with PTSD (P = .91). This effect, which was primarily characterized by negative slopes (i.e., decorrelations) in small neural networks, was strongest in the right superior temporal gyrus. Significant negative slopes were more common, stronger, and observed between sensors at shorter distances than positive slopes in both hemispheres (P < .001 for all) for controls but not for veterans with PTSD. CONCLUSIONS. Neural modulation involving decorrelation of neural networks in the right superior temporal gyrus and, to a lesser extent, other areas distinguishes resilient veterans from those with PTSD and is postulated to have an important role in healthy response to trauma.

Support for Linehan's Biosocial Theory from a Nonclinical Sample

Linehans biosocial theory of borderline personality disorder (BPD) was tested in a sample of 1,044 female college students. Relationships between self-reported BPD symptoms, two personality traits (negative emotionality and constraint), and three key variables from the biosocial theory (emotional vulnerability, invalidation, and emotional dysregulation) were examined using structural equation modeling. Consistent with the biosocial theory, the best fitting model indicated that emotional vulnerability and emotional dysregulation were uniquely related to BPD symptoms after controlling for personality traits, and that dysregulation mediated the relationship between emotional vulnerability and BPD. However, invalidation was not significantly associated with BPD and could be dropped from that model. The full model with Linehans constructs and personality traits explained 58% of the variance in BPD and, as expected, explained considerably less variance in symptoms of other Cluster B PDs. The present results highlight the incremental value of the Linehans theory and its specificity to BPD.

Screening for Disinhibited Disorder Cases in a College Population : Performance of the SMAST, DAST, SCID-II-Q, and PDQ-4

Psychiatric disorders characterized by disinhibition--substance use disorders, antisocial personality disorder (PD), and borderline PD--represent a serious risk to the safety and health of college students. The ability of researchers and clinicians to identify students most at risk for disinhibited disorders associated with campus crime, violence, and self-harm depends on measures with strong evidence of diagnostic efficiency, yet data on the diagnostic efficiency of screening measures in college populations are lacking. The authors addressed this need by examining the diagnostic efficiency of commonly used screening measures for disinhibited disorders in a sample of 2,085 students, 79 of whom also completed diagnostic interviews. Results suggest that the diagnostic efficiency (e.g., sensitivity, specificity) of screening measures for substance use disorders and antisocial PD in college samples can be increased by making simple adjustments in screening cutoff criteria. Similar adjustments did not increase the diagnostic efficiency of the screening measure for borderline PD, and this suggested that certain screeners may best be aimed at ruling out disorders. This type of information offers users flexibility with which to tailor the screening threshold to serve different objectives.

Reduced Human Leukocyte Antigen (HLA) Protection in Gulf War Illness (GWI).

Background Gulf War Illness (GWI) is a disease of unknown etiology with symptoms suggesting the involvement of an immune process. Here we tested the hypothesis that Human Leukocyte Antigen (HLA) composition might differ between veterans with and without GWI. Methods We identified 144 unique alleles of Class I and II HLA genes in 82 veterans (66 with and 16 without GWI). We tested the hypothesis that a subset of HLA alleles may classify veterans in their respective group using a stepwise linear discriminant analysis. In addition, each participant rated symptom severity in 6 domains according to established GWI criteria, and an overall symptom severity was calculated. Findings We found 6 Class II alleles that classified participants 84.1% correctly (13/16 control and 56/66 GWI). The number of copies of the 6 alleles was significantly higher in the control group, suggesting a protective role. This was supported by a significant negative dependence of overall symptom severity on the number of allele copies, such that symptom severity was lower in participants with larger numbers of allele copies. Interpretation These results indicate a reduced HLA protection (i.e. genetic susceptibility) in veterans with GWI. Funding University of Minnesota and U.S. Department of Veterans Affairs.