Acute Life Stressors Research Articles

Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020

Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

18-Year-Old Man With Chest Pain

A previously healthy 18-year-old man presented with chest pain that awoke him. The pain was described as constant, grade 2/10, left-sided chest pressure without radiation or correlation with exertion. This was preceded by 1 day of nausea, vomiting, and fever to 102℉. He did not have dyspnea, diaphoresis, palpitations, edema, orthopnea, risk factors for venous thromboembolism, recent travel, acute life stressors, trauma, or known connective tissue disorders. He did not have any chronic medical conditions and was not taking any medications as an outpatient.

Surveillance for Violent Deaths - National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018.

Surveillance for Violent Deaths - National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018.

The “high cost of low living”: Substance use recovery among older formerly homeless adults

Background The population of older homeless substance-using adults is growing considerably, and we sought to understand how such individuals gain control of problematic substance use amidst other life problems. Methods: Data were collected in an NIMH-funded study in which four in-depth interviews were conducted over 18 months with formerly homeless adults living in permanent supportive housing. The study subsample was comprised of 15 predominantly African American individuals over age 45 who were in recovery for at least six months. Cross-case analyses used a template approach followed by inductive sub-theme analyses. Results: Three themes drawn from the literature yielded seven sub-themes as follows. Theme #1: Acute life stressors: (a) “substance use as primary”; (b) “acute life events and substance use”; (c) “incarceration as turning point.” Theme #2: Attributions of recovery: (a) “quitting as personal decision”; (b) “I just got to stay on top of it”; Theme #3: Social relationships: (a) “I have associates, not friends”; (b) “taking a cautious approach.” Conclusion: Participants viewed substance use as the primary problem in their lives despite other adversity. Recovery was viewed as a personal decision, but maintaining recovery involved positive social relationships. Policies and practices related to recovery should address the complexities of lives-as-lived.

Insomnia symptoms during the COVID-19 pandemic: an examination of biopsychosocial moderators

Objective/backgroundHealthy sleep is vital for physical and psychological health, and poor sleep can result in a myriad of negative physical and psychological outcomes. Insomnia symptoms often manifest as a result of acute life stressors or changes, and COVID-19 experiences may be one such stressor. Other known predisposing factors to insomnia may moderate the impact of COVID-19 experiences on sleep. The present study aimed to determine current levels of insomnia severity in a US sample, to investigate the relation of COVID-19 experiences to insomnia symptoms, and to determine which individuals are most susceptible to this association. MethodsData were drawn from a larger online survey investigating sleep and health outcomes across the lifespan. COVID-19 experiences were assessed with the exposure and impact subscales of the CAIR Pandemic Impact Questionnaire (C-PIQ). The Insomnia Severity Index (ISI) measured insomnia symptoms. Biological, psychological, and social moderators were measured using other brief self-report measures. ResultsInsomnia symptoms prevalence was as follows: moderate-to-severe symptoms (25.5%), subthreshold symptoms (37.7%), and no symptoms (36.7%). Individuals’ COVID-19 experiences significantly predicted insomnia symptom severity [F(1,997) = 472.92, p < 0.001, R2 = 0.32]. This association was moderated by race, anxiety symptoms, depressive symptoms, physical somatization, and social loneliness, but not age, gender, or education. ConclusionsAlthough negative experiences with COVID-19 are associated with worse insomnia symptoms, this relationship is not the same for everyone.

Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017.

Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017.

No Crystal Stair: Predictors of Pessimism Among Black Men

Social scientists have paid scant attention to factors relating to pessimism among Black American men. Drawing from Fankl’s existentialist framework, this study explored the association between life stress, everyday racism, existential well-being (EWB), religiosity and self-reported pessimism among a community sample of Black men ( n = 147). Regression analysis revealed that life stress was positively associated with pessimism, while EWB was negatively associated with pessimism. Relative weights analysis indicated that EWB had the greatest explanatory power in the model. Findings suggest that future studies of pessimism among Black American men should account for men’s sense of purpose and life stress, while also considering the potentially moderating effects of chronic and acute life stress on men’s future orientation.

Surveillance for Violent Deaths - National Violent Death Reporting System, 32 States, 2016.

Surveillance for Violent Deaths - National Violent Death Reporting System, 32 States, 2016.

Postmortem blood alcohol content among late-middle aged and older suicide decedents: Associations with suicide precipitating/risk factors, means, and other drug toxicology

BackgroundThis study examined blood alcohol content (BAC) among suicide decedents aged 50+ and its associations with suicide precipitating/risk factors, means, and other drug toxicology. MethodsThe National Violent Death Reporting System, 2005–2015, provided data (N = 56,118 for all suicide decedents and N = 29,115 with alcohol test results). We used logistic regression models, with BAC > 0.0 (BAC positive) and BAC > = 0.08 (intoxication) as the dependent variables. ResultsAlmost a third of decedents who were tested for alcohol were BAC positive, and almost two-thirds of those who were positive had a BAC > = 0.08. Alcohol problems prior to suicide (AOR = 6.71, 95% CI = 6.24–7.21), relationship problems (AOR = 1.53, 95% CI = 1.44–1.63), and death/suicide of family/friends (AOR = 1.22, 95% CI = 1.11–1.35) were associated with greater odds of a positive BAC, but suicide means were not significantly associated with a positive BAC. Alcohol problems (AOR = 2.98, 95% CI = 2.68–3.31), relationship problems (AOR = 1.18, 95% CI = 1.06–1.30), firearm use (AOR = 1.85, 95% CI = 1.59–2.16), and hanging/suffocation (AOR = 1.38, 95% CI = 1.16–1.64) were associated with greater odds of a BAC > = 0.08. A toxicology positive for antidepressants, marijuana, cocaine, or amphetamines was associated with greater odds of a positive BAC; however, a toxicology positive for antidepressants, opiates, or amphetamines was associated with lower odds of a BAC > = 0.08. BAC > = 0.08 rates increased over the study period. ConclusionsAlcohol intoxication may have contributed to using more violent suicide means. The significant association between relationship problems and intoxication before suicide calls for restricting access to alcohol and suicide means for individuals with these problems. Suicide prevention may require crisis counseling/support for acute life stressors and ongoing emotional support.

Australian Mass Shootings: An Analysis of Incidents and Offenders.

Mass shooting events are relatively underresearched, and most study comes from the United States. Despite significant international interest, little is known about other countries' experiences of these events. The current study examines Australian mass shooting incidents and offenders, with emphasis on mental illness, life strains, and offenders' life histories. Australia had 14 mass shootings between 1964 and 2014. Most offenders experienced acute life stressors and/or chronic strains leading up to the event; however, diagnosed mental illness was less commonly documented. These observations provide new information about mass shooting incidents and offenders, and can help to inform international policy development.

Emotion regulation in first episode adolescent non-suicidal self-injury: What difference does a year make?

We examined the roles of cognitive reappraisal, expressive suppression, and rumination in first episode non-suicidal self-injury (NSSI) among adolescents, and the impact of age-related differences in emotion regulation use. Adverse life events and psychological distress played a significant role in NSSI onset. Being male and less use of cognitive reappraisal contributed to NSSI risk but only in regard to 12-month incidence; this effect was not observed when predicting 24-month incidence. Neither expressive suppression nor rumination was related to NSSI onset in our sample. Age-related differences in emotion regulation were found, but did not modify the above relationships. Findings hint at the possible impact of developmental changes in adolescents' cognitive-emotional processing and their subsequent risk of NSSI. Results support further investigation into prevention and early intervention initiatives aimed at assisting adolescents cope with acute life stressors to prevent/delay first episode NSSI.

Current thinking on the premarketing evaluation of abuse-deterrent opioid formulations

Aims: Numerous prediction studies have identified variables (e.g., substance use and psychiatric severity) associated with attrition from outpatient substance abuse treatment (SAT). Very few studies have examined factors associated with dropout from the client’s perspective. Those that have indicate that dissatisfaction with aspects of treatment as well as individual status factors are reported reasons for dropout. The present study rates clients’ selfreported reasons for early attrition from outpatient SAT. Methods: Clients (N=106) recently admitted to two outpatient SAT programs, who irregularly attended treatment during the first 2–3weeks,were contacted for a brief telephonemotivational intervention. During this call they were queried about reasons for lack of attendance, which were then abstracted and coded. Results: Clients reported various and multiple reasons for poor early engagement in treatment that roughly paralleled those reported for dropping out of treatment by clients in previous studies. These reasons can be categorized as: Client Factors—particularly medical and psychological problems, and acute life stressors; Treatment Factors including issueswith clients and staff, as well as the schedule and nature of the treatment itself; and Environmental or Logistical Factors such as transportation, finances, and competing employment demands. Conclusions: Client attributions for outpatient treatment attrition are not fully parallel with variables identified in prediction studies obtained via patient assessments. Further, clients identify many issues that appear to be actionable in some way, and that if prepared for or dealt with by the clinics at both the programmatic and individual client levels, could improve retention. Financial support: NIAAA 1-P01-AA016821-01A1 and NIDA 2P60-DA005186-21.

Depressive symptoms in people with chronic physical conditions: prevalence and risk factors in a Hong Kong community sample

BackgroundDepression is predicted to become one of the two most burdensome diseases worldwide by 2020 and is common in people with chronic physical conditions. However, depression is relatively uncommon in Asia. Family support is an important Asian cultural value that we hypothesized could protect people with chronic physical conditions from developing depression. We investigated depressive symptom prevalence and risk factors in a Chinese sample with chronic medical conditions, focusing on the possible protective role of family relationships.MethodsData were obtained from the Hong Kong Jockey Club FAMILY Project cohort study in 2009–2011, which included 6,195 participants (age ≥15) with self-reported chronic conditions. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived family support and neighborhood cohesion were assessed. Factors associated with a non-somatic (PHQ-6) depression score were also examined.ResultsThe prevalence of depressive symptoms (PHQ-9 scores ≥5) was 17% in those with one or more chronic conditions, and was more prevalent in women than in men (19.7% vs. 13.9%; p < 0.001). In multilevel analyses, life stress, number of chronic conditions and satisfaction with family support explained 43% of the variance in PHQ-9 scores (standardized regression coefficients of 0.46, 0.15, and −0.12 respectively, all p <0.001). Body mass index, problem alcohol drinking, physical activity, and unmarried status were significantly associated with PHQ-9 scores, although these associations were weak. Variables associated with depression explained 35% of the variance in non-somatic (PHQ-6) depression scores. Satisfaction with family support played a stronger protective role against depressive symptoms (both PHQ-9 and PHQ-6 scores) among women than men (p < 0.05).ConclusionsAcute life stress and the number of chronic conditions, together with socio-demographic factors, explain most variance in depressive symptoms among chronically ill Chinese individuals. Somatic items in the PHQ-9 increased the depression scores but they did not alter the pattern of predictors. Family support appears to be an important protective factor in Chinese cultures for individuals with chronic conditions.

Spontaneous Normal Sinus Rhythm Conversion Using Integrative Medicine in Atrial Fibrillation

The relationship between acute life stress and the development of atrial fibrillation (AF) has been noted in the literature. However, the use of integrative medicine (IM) in restoring cardiac rhythm has not been adequately studied. This case report describes how an IM approach was used in a patient with atrial fibrillation and acute pain. Spontaneous cardioversion to normal sinus rhythm occurred during the IM session, in addition to marked decreases in self-reported pain, anxiety, and nausea at the conclusion of IM treatment. These results provide initial support that for some cases of AF, IM therapies can help to reduce costs via avoidance of additional hospitalization, electrocardioversion, and general anesthesia.

Suicide in Asia: Opportunities and Challenges

Asian countries account for approximately 60% of the world's suicides, but there is a great mismatch in the region between the scale of the problem and the resources available to tackle it. Despite certain commonalities, the continent itself is culturally, economically, and socially diverse. This paper reviews current epidemiologic patterns of suicide, including suicide trends, sociodemographic factors, urban/rural living, suicide methods, sociocultural religious influences, and risk and protective factors in Asia, as well as their implications. The observed epidemiologic distributions of suicides reflect complex interplays among the traditional value/culture system, rapid economic transitions under market globalization, availability/desirability of suicide methods, and sociocultural permission/prohibitions regarding suicides. In general, compared with Western countries, Asian countries still have a higher average suicide rate, lower male-to-female suicide gender ratio, and higher elderly-to-general-population suicide ratios. The role of mental illness in suicide is not as important as that in Western countries. In contrast, aggravated by access to lethal means in Asia (e.g., pesticide poisoning and jumping), acute life stress (e.g., family conflicts, job and financial security issues) plays a more important role than it does in Western countries. Some promising suicide prevention programs in Asia are illustrated. Considering the specific socioeconomic and cultural aspects of the region, community-based suicide intervention programs integrating multiple layers of intervention targets may be the most feasible and cost-effective strategy in Asia, with its populous areas and limited resources.

The Integrated Motivational-Volitional Model of Suicidal Behavior

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

Appraisals of Stressful Life Events as a Genetically-Linked Mechanism in the Stress–Depression Relationship

Variation in the promoter region of the serotonin transporter gene (5-HTTLPR) has been linked to various cognitive-affective indices of stress sensitivity hypothesized to underlie vulnerability to depression. The current study examined the association of 5-HTTLPR with appraisals of naturally occurring acute life stressors in a community sample of 384 youth at elevated risk for depression due to oversampling for maternal depression. Interview measures administered at youth age 20 were used to assess subjective and objective (assigned by an independent rating team) appraisals of the negative impact of recent acute stressful life events. The presence of at least one S allele was associated with elevated subjective appraisals of the negative impact of acute stressors (P = 0.03). Consistent with an endophenotype perspective, support was found for a 5-HTTLPR-stress appraisals-depression mediation model both concurrently and longitudinally. Results indicate that enhanced stress sensitivity may act as an intermediate phenotype through which 5-HTTLPR affects risk for depression.

Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis–stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children ( n = 515) over a 6 month period (Time 1–Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism–critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

Intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first‐episode psychosis in Finland

Being at high risk of developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis. Reducing levels of stress could support overall functioning and mental condition in those at risk. The Jorvi Early Psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital, Jorvi Hospital, Finland, is an early intervention team for adolescents at risk of developing first-episode psychosis. The project is based on the idea of multiprofessional, community, home, family and network-oriented, stress-reducing, overall functioning-supporting, low-threshold care. The JERI team meets multiprofessionally with adolescents in their natural surroundings, for example, at school or at home, together with their parents, network and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. Subjects were assessed with the PROD-prodromal screen to identify those at risk of developing first-episode psychosis. Statistically significant difference between baseline and follow-up measures was found in at risk subjects (n = 28) in scales of overall functioning (P = 0.000), depression (P = 0.001), anxiety (P = 0.001), quality of life (QOL) and pre-psychotic symptoms. JERI-type intervention may improve level of overall functioning and support mental condition in adolescents at risk of developing first-episode psychosis, even though further study with larger numbers of subjects, with a control group and with a longer follow-up time, is needed.