Paolo Iliceto

Temperament and Personality Dimensions in Suicidal and Nonsuicidal Psychiatric Inpatients

Background: Suicide is a serious public health problem. In the international literature there is evidence to support the notion that certain temperaments and personality traits are often associated with suicidal behavior. Sampling and Methods: In this study, 150 psychiatric inpatients were investigated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego autoquestionnaire, the Minnesota Multiphasic Personality Inventory, 2nd edition (MMPI-2) and the Beck Hopelessness Scale and evaluated for suicide risk by means of the critical items of the Mini International Neuropsychiatric Interview. Results: Statistical analysis, including logistic regression analysis and multiple regression analysis, showed that suicide risk contributed to the prediction of hopelessness. Among the temperaments, only the hyperthymic temperament, as a protective factor, and the dysthymic/cyclothymic/anxious temperament contributed significantly to the prediction of hopelessness. Irritable temperament and social introversion were predictive factors for suicidal risk. Hopelessness and depression were associated with higher suicidal behavior and ideation, but, unexpectedly, depression as measured by the MMPI did not contribute significantly to the multiple regressions. Conclusions: The present study indicated that, although suicidal psychiatric patients have MMPI-2 profiles in the pathological range, they exhibit several differences from nonsuicidal patients. Patients at risk of suicide have specific temperaments as well as personality and defense mechanism profiles. They are more socially introverted, depressed and psychasthenic, and use hysterical and schizoid mechanisms more often. Generalizability of the findings was limited by the small sample size and the mix of bipolar disorder I, bipolar disorder II, major depressive disorder and psychotic disorder patients.

Completed suicide in schizophrenia: Evidence from a case-control study.

Suicide is the single major cause of death among patients with schizophrenia. Despite great efforts in the prevention of such deaths, suicide rates have remained alarming, pointing to the need for a better understanding of the phenomenon. The present sample comprised 20 male patients with schizophrenia who committed suicide and who were investigated retrospectively for a large number of characteristics. Controls were 20 living patients with schizophrenia. The results suggest that suicide attempts, hopelessness and self-devaluation were the three variables most strongly associated with completed suicide. However, a number of variables were identified which may constitute risk factors, some of which have not been identified in the past: agitation and motor restlessness (OR = 3.66; 95%CI = 0.95/14.02), self-devaluation (OR = 28.49; 95%CI = 3.15/257.40), hopelessness (OR = 51.00; 95%CI = 7.56-343.72), insomnia (OR = 12.66; 95%CI = 0.95/14.02), mental disintegration (OR = 3.66; 95%CI = 0.95/14.02), and suicide attempt (OR = 3.66; 95%CI = 1.40/114.41). Poor adherence to medications was also predictive of completed suicide in our sample of schizophrenia patients, primarily because the suicide victims showed very low adherence.

Occupational stress and psychopathology in health professionals: An explorative study with the Multiple Indicators Multiple Causes (MIMIC) model approach

Occupational stress is a multivariate process involving sources of pressure, psycho-physiological distress, locus of control, work dissatisfaction, depression, anxiety, mental health disorders, hopelessness, and suicide ideation. Healthcare professionals are known for higher rates of occupational-related distress (burnout and compassion fatigue) and higher rates of suicide. The purpose of this study was to explain the relationships between occupational stress and some psychopathological dimensions in a sample of health professionals. We investigated 156 nurses and physicians, 62 males and 94 females, who were administered self-report questionnaires to assess occupational stress [occupational stress inventory (OSI)], temperament (temperament evaluation of Memphis, Pisa, Paris, and San Diego autoquestionnaire), and hopelessness (Beck hopelessness scale). The best Multiple Indicators Multiple Causes model with five OSI predictors yielded the following results: χ2(9) = 14.47 (p = 0.11); χ2/df = 1.60; comparative fit index = 0.99; root mean square error of approximation = 0.05. This model provided a good fit to the empirical data, showing a strong direct influence of casual variables such as work dissatisfaction, absence of type A behavior, and especially external locus of control, psychological and physiological distress on latent variable psychopathology. Occupational stress is in a complex relationship with temperament and hopelessness and also common among healthcare professionals.

Predictors of success in smoking cessation among Italian adults motivated to quit

We examined the role of sexual gender, age, working status, education, cigarettes per day, Fagerström test, age of onset, pharmacologic intervention (bupropion or varenicline), 10 sessions of cognitive-behavioral group counseling therapy (GCT) conducted over 6 weeks, and level of attendance of the counseling program as predictors of smoking cessation on 1282 Italian adult smokers. Results of a multi-variate forward stepwise conditional logistic analysis, at the first step, indicate that subjects who attended the program from 4 to 6 sessions and from 1 to 3 sessions, respectively, resulted about 3 times and 24 times more likely to smoke than those attending from 7 to 10 sessions; at the second step, subjects with high Fagerström score were 2 times more likely to smoke than subjects with low/middle Fagerström; at the third step, subjects treated only with GCT were 2 times more likely to smoke than subjects with combined pharmacologic interventions and GCT; at the fourth step, subjects with age of onset less than 17 years were 1.5 times more likely to smoke than subjects with a higher age of onset; eventually, at the fifth step women resulted 1.5 times more likely to smoke than men. In conclusion, we found that a steady attendance of the cognitive behavioral program, as well as the addition of pharmacologic interventions to counseling, remarkably increased the probability of the smoking cessation behavior to be determined. Nevertheless, FTQ was a valid measure in predicting the smoking cessation, and women revealed to be more likely to keep the smoking behavior, as well as subjects who declared an age of onset less than 17 years.

Hopelessness, Temperament, Anger and Interpersonal Relationships in Holocaust (Shoah) Survivors’ Grandchildren

The psychiatric literature is divided with regard to the long-term psychological effects associated with Holocaust (Shoah) experiences because the findings of clinical and empirical studies often contradict each other. Despite case reports of emotional sequelae related to intergenerational transmission of trauma, recent empirical research has suggested that offspring of survivors of the Shoah did not differ from other children and found no evidence that traumatic experiences of survivors of the Shoah affected their children’s and grandchildren’s adjustment. To shed light on some of the differences between the empirical and clinical observations, the present study set out to compare the grandchildren of survivors of the Shoah and persons of the same age whose families had not been through the Shoah experience. This study compared the two groups on some psychological dimensions relevant to traumatic sequelae: hopelessness, temperament, personality, attitudes, and interpersonal expectations. Subjects were 124 equally divided among the Shoah survivors’ grandchildren and comparison groups; we administered to all subjects TEMPS-A Rome, Beck Hopelessness Scale, State-Trait Anger Expression Inventory, and 9AP (9 Attachment Profile). We found no differences between two groups in Hopelessness, Dysthimic/Cyclotimic/Anxious, Hyperthimic temperament, and self-perception; instead the Shoah survivors’ grandchildren have a view of the other as rejecting, hostile, submissive, insecure, unreliable, and competitive in the interpersonal relationships. The Shoah survivors’ grandchildren are similar to controls in affective temperament, hopelessness and self-perception, but they are more irritable and angry than controls, and their perception about others is deeply negative. Attribution theory was used to elucidate these findings.

Hopelessness, Temperament, and Health Perception in Heroin Addicts

ABSTRACT The aim of this study was to investigate temperament, hopelessness (a measure of suicide risk), and health perception in heroin addicts. The study involved the administration of the TEMPS-A Rome, the Beck Hopelessness Scale (BHS), the MINI Neuropsychiatric Interview, and the Multidimensional Health Questionnaire. Participants were 100 heroin addicts who were matched by age and sex with 100 randomly selected non-users. Heroin addicts obtained higher scores on TEMPS-A Dys/Cyc/Anx temperament and on the irritable temperament. In the heroin addicts, anxiety, depression, preoccupation with health, health illness self-blame, health monitoring, and negative thinking about health were positively associated with hopelessness, dysthymic/anxious/cyclothymic temperament, and irritable temperament. Motivation to avoid unhealthiness, health assertiveness, health expectation optimism, and health satisfaction were negatively associated with hopelessness, dysthymic/anxious/cyclothymic temperament, and irritable temperament. More knowledge on health attitudes in heroin addicts may help in delivering a treatment plan for this selective population.

Depression and Suicidality in Obese Patients

A study of 70 obese patients indicated the presence of severe depression in 32% of the sample and some suicidal risk in 23%. Given this high prevalence, health professionals should always explore the presence of depression and suicidality in obese patients.

Relationship between temperament, depression, anxiety, and hopelessness in adolescents: A structural equation model

The purpose of this study was to test the validity of affective temperaments for predicting psychiatric morbidity and suicide risk, using a two-factor model to explain the relationships between temperament, anxiety, depression, and hopelessness. We investigated 210 high school students, 103 males and 107 females, 18-19 years old, who were administered self-report questionnaires to assess temperament (TEMPS-A), depression (BDI-II), anxiety (STAI) and hopelessness (BHS). The final structural model had a good fit with the data, with two factors significantly correlated, the first labeled unstable cyclothymic temperament including Dysthymic/Cyclothymic/Anxious temperament, Irritable temperament and Depression, and the second labeled Demoralization including Anxiety (State/Trait) and Hopelessness. Depression, anxiety and hopelessness are in a complex relationship partly mediated by temperament.

Personality and suicidal ideation in the elderly: factorial invariance and latent means structures across age

Objectives: Suicide among the elderly is a dramatic global health problem. Although fatal attempts are frequent in the elderly, research indicated that they rarely present long-term elaboration of suicidal ideation and communicate their intents. Consequently, risk factor detection and assessment are salient. Although evidence on the association between personality and suicidal ideation in young adults is accumulating, little is known about its relevance in the elderly. The purpose of the present study was to analyze the components of a measurement model that are invariant across young adults and older adults and then investigate the relations among dimensions of personality and suicide risk. We postulated a specific relation pattern a priori and tested the hypotheses statistically in order to examine the models for equivalency of the factorial measurement. Method: We investigated 316 young adults and 339 older adults, who were administered self-report questionnaires to assess depression, hopelessness, alternative five-factor model of personality, and self–other perception. Results: Multigroup confirmatory factor analyses were conducted, yielding a final model with excellent fit to the data. This model showed a similar pattern of associations between suicidal ideation and personality across both groups. Conclusions: Although the elderly are exposed to specific life stressors associated with suicidal ideation, our findings suggest that the elderly and young adults may be similar on personality and psychopathology variables predicting suicidal ideation than previously hypothesized. Implications are provided for enhanced assessment and intervention of the elderly high in neuroticism, depression, hopelessness, and with negative self–other perception.

Temperament, insecure attachment, impulsivity, and sexuality in women in jail

Background: Women constitute only a small proportion of inmates, but several studies have shown that they have higher rates of psychiatric disturbance than incarcerated men and community samples. Mental health treatment is necessary to prevent severe illness and suicide in these women. Methods: The convenience sample consisted of 40 female detainees and 40 controls who were administered self‐report questionnaires to assess temperament (TEMPS‐A), insecure attachment (ECR), impulsivity (BIS‐11), and sexual behavior (SESAMO). Results: The incarcerated women had higher levels of affective temperament (except for hyperthymia), avoidance, anxiety, impulsivity, and psychosexual issues than the female community sample. Conclusions: Many interrelated emotional and affective disturbances affect the physical and psychological well‐being of women in jail, and it is possible that these problems may lead to suicide. Health professionals need to develop gender‐specific therapeutic interventions for women in jail.