Yossi Levi-Belz

Attachment patterns in medically serious suicide attempts: the mediating role of self-disclosure and loneliness

Although the study of medically serious suicide behavior is an important strategy for understanding the nature of suicide, little is known about its underlying psychological mechanisms. This gap is addressed here by applying insights from attachment theory to severe suicidal behavior. The results show that both anxious and avoidant attachment patterns predict medical lethality. Path analysis indicated that interpersonal difficulties mediated the paths between insecure attachment patterns and lethality of suicide attempts. These results suggest that the psychological mechanisms of medically serious suicide behavior involve high levels of mental pain amplified by insecure attachment patterns and interpersonal difficulties. Implications for prevention and therapeutic intervention strategies are discussed.

The "Facebook-self": characteristics and psychological predictors of false self-presentation on Facebook.

In this study we present and empirically examine a new phenomenon related to social networking sites, such as Facebook, the “false Facebook-self.” Arguably false self-presentation on Facebook is a growing phenomenon, and in extreme cases; i.e., when ones Facebook image substantially deviates from their true image, it may serve as a gateway behavior to more problematic behaviors which may lead to psychological problems and even pathologies. In this study we show that certain users are more vulnerable to such false self-presentation than others. The study involved 258 Facebook users. Applying ANOVA and SEM analyses we show that users with low self-esteem and low trait authenticity are more likely than others to present a Facebook-self which deviates from their true selves. These social-interaction-related traits are influenced by one’s upbringing and the anxious and avoidant attachment styles he or she has developed. Several cases (7.5%) with large gaps between the true and false Facebook-self were detected, which implies that future research should consider the adverse consequences and treatments of high levels of false Facebook-self.

Aggression-impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters

BACKGROUND Unbearable mental pain, depression, and hopelessness have been associated with suicidal behavior in general, while difficulties with social communication and loneliness have been associated with highly lethal suicide attempts in particular. The literature also links aggression and impulsivity with suicidal behavior but raises questions about their influence on the lethality and outcome of the suicide attempt. OBJECTIVES To evaluate the relative effects of aggression and impulsivity on the lethality of suicide attempts we hypothesized that impulsivity and aggression differentiate between suicide attempters and non-attempters and between medically serious and medically non-serious suicide attempters. METHOD The study group included 196 participants divided into four groups: 43 medically serious suicide attempters; 49 medically non-serious suicide attempters, 47 psychiatric patients who had never attempted suicide; and 57 healthy control subjects. Data on sociodemographic parameters, clinical history, and details of the suicide attempts were collected. Participants completed a battery of instruments for assessment of aggression-impulsivity, mental pain, and communication difficulties. RESULTS The medically serious and medically non-serious suicide attempters scored significantly higher than both control groups on mental pain, depression, and hopelessness (p<.001 for all) and on anger-in, anger-out, violence, and impulsivity (p<.05 for all), with no significant difference between the two suicide attempter groups. Medically serious suicide attempters had significantly lower self-disclosure (p<.05) and more schizoid tendencies (p<.001) than the other three groups and significantly more feelings of loneliness than the medically non-serious suicide attempters and nonsuicidal psychiatric patients (p<.05). Analysis of aggression-impulsivity, mental pain, and communication variables with suicide lethality yielded significant correlations for self-disclosure, schizoid tendency, and loneliness. The interaction between mental pain and schizoid traits explained some of the variance in suicide lethality, over and above the contribution of each component alone. CONCLUSIONS Aggression-impulsivity and mental pain are risk factors for suicide attempts. However, only difficulties in communication differentiate medically serious from medically non-serious suicide attempters. The combination of unbearable mental pain and difficulties in communication has a magnifying effect on the risk of lethal suicidal behavior.

Mental Pain, Communication Difficulties, and Medically Serious Suicide Attempts: A Case-Control Study

Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed suicide. The aim of this study was to assess the role of mental pain and communication difficulties in MSSA. A total of 336 subjects were divided into 4 groups: 78 meeting criteria for MSSA compared with116 subjects who made a medically non-serious suicide attempt (MNSSA), 47 psychiatric controls with no history of suicidal behavior, and 95 healthy controls. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties explained some of the variance in suicide lethality, above and beyond the contribution of each component alone. This report underlines the importance of mental pain for suicide attempts in general while difficulties in communication abilities play a critical role in differentiating MSSA from MNSSA. The co-existence of unbearable mental pain with difficulties in communication significantly enhances the risk for more lethal forms of suicidal behavior.

On the role of impulsivity and decision-making in suicidal behavior.

Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. Impulsivity is a long-known risk factor for suicide attempts. However, research based on clearer conceptual refinement in this area is imperative. One emerging field of study is that of decision-making. Impulsivity involves a failure of higher-order control, including decision-making. Using standardized operational definitions that take into consideration relevant aspects of impulsivity, including state- and trait-components and a deeper understanding of the process of decision-making in the suicidal mind, we may come a step closer to understanding suicidality and winning the fight in this scourge of human suffering.

Stress-Related Growth among Suicide Survivors: The Role of Interpersonal and Cognitive Factors

Although stress-related growth had been documented in bereaved individuals, it is still not clear to what extent it can be experienced by suicide survivors or which psychological processes facilitate it. The current study examined the role of interpersonal factors—self disclosure and social supports as well as cognitive coping strategies in stress-related growth among suicide survivors. The sample consisted of 135 suicide survivors (104 women and 31 men) aged 18–70. All participants completed the stress-related growth questionnaire as well as instruments measuring interpersonal activities, cognitive strategies, and demographic characteristics concerning the bereavement. The findings showed significant positive correlations between time elapsed since death, self-disclosure, social support, adaptive cognitive strategies, and stress-related growth. Furthermore, hierarchical regression analysis revealed that together these variables accounted for over 38% of the variance in stress-related growth. Interpersonal activities such as talking and interacting with others, as well as a cognitive focus on planning for the future emerged as important factors in personal transformation after suicide loss.

Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: A follow-up study of hospitalized patients

BACKGROUND This study examined the role of mental pain, communication difficulties, and suicide history in predicting the medical severity of follow-up suicide attempts. METHODS The cohort included 153 consecutive psychiatric in-patients who participated in earlier studies 1-9 years previously. Fifty-three had a history of a medically serious suicide attempt (MSSA), 64 had a history of a medically non-serious suicide attempt (MNSSA), and 36 had no history of suicide. A MSSA was defined as a suicide attempt that warranted hospitalization for at least 24h and extensive medical treatment. Participants completed a battery of instruments measuring mental pain and communication difficulties. Findings were analyzed in relation to follow-up suicide attempts and their severity. RESULTS Fifty-three patients (35.5%) had attempted suicide: 15 (9.9%) a MSSA (including 5 fatalities) and 38 (25%) a MNSSA. The medical severity of the index attempt and level of hopelessness at the index attempt were significantly correlated with medical severity of the follow-up attempt. In younger patients, high levels of depression and self-disclosure predicted the medical severity of the follow-up attempt. In patients with relatively low hopelessness, the medical severity of the attempt increased with the level of self-disclosure. LIMITATIONS (i) Possibly incomplete patient information, as some of the patients who participated in the index studies could not be located. (ii) Relatively small group of patients with an index MSSA. CONCLUSIONS Patients who have made a suicide attempt should be assessed for medical severity of the attempt, hopelessness, and communication difficulties, which are important factors in follow-up attempts.

Dissociation and acquired capability as facilitators of suicide ideation among soldiers.

BACKGROUND The phenomenon of suicide and suicidal behaviors during military service is universal, with a recent dramatic rise in some armies. AIMS The aim of this study was to shed light on the role of dissociation and habituation as facilitators of suicidal behavior, beyond other well-established risk factors of stress, such as depression and hopelessness. METHOD The study group included 167 soldiers, aged 18-21 years divided into three research groups: soldiers who made suicide attempts, soldiers who were psychologically treated, and a control group of soldiers having no history of mental health treatment. All subjects completed a suicide ideation scale and instruments measuring stress, mental pain, bodily dissociation, and habituation. RESULTS Suicide attempters had higher levels of subjective stress as well as depression and hopelessness compared with the psychologically treated and control groups. Using regression analysis, suicide facilitators of dissociation and habituation explained a significant proportion of the suicidal ideation variance, above and beyond the contribution of stress, depression, and hopelessness. A combined effect of stress and facilitating factors amplifies the level of suicidal ideation among soldiers. CONCLUSION Identifying psychological facilitators of suicide-like dissociation and habituation may contribute to understanding suicidal behavior in soldiers and assist in developing effective suicide-prevention initiatives in the military setting.

To share or not to share? The contribution of self-disclosure to stress-related growth among suicide survivors

ABSTRACT This study examined to what extent suicide survivors can experience growth in the aftermath of suicide loss, as well as the role of self-disclosure and coping strategies in stress-related growth (SRG) among suicide survivors, compared to bereavement following sudden and expected death types. One hundred forty-five bereaved individuals (aged 18–73) completed questionnaires measuring SRG, self-disclosure, and coping strategies. Significant interaction between self-disclosure and types of death was found, in which suicide survivors with low levels of self-disclosure manifested the lowest level of SRG compared to other subgroups. This finding suggests that sharing intimate information can be beneficial in struggling with a situation of suicide in the family.

Suicide Ideation and Deliberate Self-Harm among Ex-Prisoners of War

The current study aims to assess the relations among war captivity, PTSD, suicidal ideation (SI), and deliberate self-harm (DSH) among former prisoners of war (ex-POWs). Israeli ex-POWs (N = 176) and a matched control group of combat veterans (controls; N = 118) were assessed using self-report measures. Ex-POWs with PTSD reported higher levels of both SI and DSH compared to ex-POWs and comparable veterans without PTSD. Furthermore, captivity-related variables as well as PTSD symptom clusters were positively related to both SI and DSH. However, only loss of emotional control in captivity and posttraumatic intrusion and emotional numbing symptoms, predicted SI. Ex-POWs with PTSD endorse high levels of SI and DSH. Among ex-POWs, both SI and DSH share similar captivity-related and posttraumatic symptoms correlates but only posttraumatic intrusion and emotional numbing symptoms predict SI.