Archives Of General Psychiatry Research Articles

Exploring participant’s experiences in a multifamily therapy group on schizophrenia : a qualitative approach

IntroductionPrevention of relapse in schizophrenia is a major public health issue. A recent network meta-analysis investigating interventions for relapse prevention in schizophrenia found that the efficacity of family psychoeducation and systemic integrated interventions were superior to treatment as usual at 12 months (Bighelli I, Leucht S et al. Lancet Psychiatry 2021). Other studies also found that multi-family therapies (MFT) were superior to treatment as usual and family psychoeducation in preventing relapses at 2 and 4 years (McFarlane WR, Lukens EP et al. Archives of General Psychiatry.1995). Considering this, we developped in our community center an MFT program based on systemic approach and psychoeducation.ObjectivesInvestigate the subjective experience of participants of an MFT group focusing on schizophrenia.MethodsA qualitative study was designed to explore personal experience of participants using the Interpretative Phenomenological Analysis (IPA) method in order to analyse participant’s feedback during semi-directive interviews. By using IPA, participants are experts of their experience. Eight participants took part in this study: 4 patients and 4 parents.ResultsWithin all participant’s feedback around 10 different themes emerged. We identified three major themes which we have described as: “Affiliation to the group”, “Framework of Discovery”, “Benefits of MFT”.According to “Affiliation to the group”, all participants report movements of adhesion or rejection towards the group. This theme has been subdivided into two sub-themes: “Temporality”, and “Identification/differentiation”. These sub-themes revealed inter-individuals’ differences.According to “Framework of discovery”, the MFT group has been identified as a secure place allowing self and other’s discovery place. This theme has been divided into two sub-themes: “discovering skills” and “improving oneself and relatives’ understanding”. Participants experience taking a step back and decentering oneself from usual personnal position. According to “Benefits of MFT”, participants report the feeling of belonging to a group, the impact on self-esteem, on mentalization skills, and on the reflexion on family members’ experience of the disease.Conclusions This study is, to our knowledge, the first qualitative study examining the subjective experience of members who participated in a psychoeducational and systemic MFT group focusing on schizophrenia. It provides insight into the families’ experience, both from the patient’s and from each family member’s perspective. Results highlight that participants seized the MFT group as a learning space at several levels: personal, intra-family and inter-family.These data could enlighten professionals working with families on the potential apprehensions of participants, their representations of the group and what process MFT could initiate.Disclosure of InterestNone Declared

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Obsessive-compulsive disorder after long-term cannabis use – case report

IntroductionObsessive-compulsive disorder (OCD) is characterised by intrusive thoughts and repetitive behaviours that considerably impact general functioning. Recent evidence links the endocannabinoid system to OCD neurobiology, and several case reports describe significant improvement after using dronabinol (synthetic tetrahydrocannabinol) in patients with severe OCD. Nevertheless, to what extent this new information can change our perspective on pharmacological treatment in OCD is unclear.Objectives We present the case of a patient with obsessive-compulsive symptoms triggered after increased long-term cannabis use. Our purpose is to emphasise the necessity of continuous research and a better understanding of the correlation between OCD and cannabis derivates before formulating treatment recommendations.MethodsWe used psychiatric assessments to evaluate the patient’s symptoms and evolution over time and exclude other possible causes that could have triggered the disorder.ResultsOur patient is a 37-year-old man who has been frequently brought to the hospital by the police in the last 11 years for psycho-motor agitation after cannabis use. This year, he came to the hospital by himself, complaining about intrusive thoughts that required motor and mental repetitions to reduce anxiety. His obsessions were mainly about the need for symmetry and exactness and his checking compulsions about his mother’s health. The symptoms required more than half a day and caused functional impairment. A detailed history did not outline any obsessive-compulsive symptoms before the previous year. The patient denies using new drugs, and we did not identify other medical conditions that could better explain the symptoms. However, he admits to increasing the doses and frequency of cannabis use during the last year. After two weeks of cannabis abstinence and Sertraline treatment, his symptomatology improved significantly, with a reduction of more than 50% in the time spent daily on mental and motor compulsions, reduced anxiety, and a noticeable increase in overall functionality. In addition, the Yale-Brown Obsessive Compulsive Scale result decreased from 35 on the first day to 17 on discharge.ConclusionsRecent studies support the use of cannabis derivates for treating OCD symptoms. However, this case report outlines that prolonged cannabis use could also trigger OCD. Therefore, further studies are necessary to identify not only the potential benefits but also the potential risks of using cannabinoids as a pharmacological intervention.ReferencesNicolini H et.al.CannabisUseInPeopleWithOC.FrontPsychiatry.2021May10; 12:664228.doi:10.3389/fpsyt.2021.664228.PMID:34040556;PMCID:PMC8141625KayserR.R. et.al.TheEndocannabinoidSystem:ANewTreatmentTargetforOCD? CannabisandCannabinoidResearch.Jun2019.7787.doi10.1089/can.2018.0049GoodmanWK et.al.1989.YBOCS:Archives of General Psychiatry,1006–1011.doi10.1001/archpsyc.1989.01810110048007Disclosure of InterestNone Declared

Clozapine: A Scientific Analysis of Global Publications during 1970-2021

Aim: This study evaluates the research output on Clozapine included in Scopus database during 1970-2021. Materials and Methods: The quantitative and qualitative analysis of publications on “Clozapine” covered in Scopus database during 1970-2021 was undertaken. The results obtained were further analysed using additional features in Scopus database. Results: 7399 publications on “Clozapine” were obtained from Scopus international database and these publications received 189068 citations, averaging 25.55 citations per paper (CPP). There was initial rise in the number of publications per year from 1988 to 1995, after that the number of publications has remained relatively stable. Authors from USA, U.K. and Germany contributed to the largest number of publications (2136, 709 and 457 publications respectively), and publications with authors from USA, Canada and Germany registered the highest CPP and relative citation index (RCI). The authors from King’s College London, U.K, The Zucker Hillside Hospital, USA and University of Toronto, Canada published the highest number of publications. The organization that registered the highest CPP and RCI was Sandoz International GmbH, Switzerland, Long Island Jewish Medical Centre, USA and Vanderbilt University, School of Medicine, USA. The authors who published the highest number of publications were H.Y. Meltzer (USA), J.A. Lieberman (USA) and A. Weizman (Israel). The authors who registered the highest CPP and RCI were R.W. Kerwin (U.K.) and J.P. Lindermayer. The journals that published the highest number of publications were Journal of Clinical Psychopharmacology (351 papers), Journal of Clinical Psychiatry (282 papers), and American Journal of Psychiatry (255 papers). The most impactful publications were published in Archives of General Psychiatry, Schizophrenia Bulletin, Journal of Pharmacology and Experimental Therapeutics, and American Journal of Psychiatry. Conclusion: This study suggests that the numbers of publications on clozapine have remained stable over the years and maximum research has emerged from the developed countries.

Global Research Trends, Top-100 Most Cited Studies, and Network Visualization of Eating and Feeding Disorders Research From 1900-2020: A Historical Bibliometric Analysis

Background: Eating disorders (EDs) are psychiatric disorders that leads to affect the health. In last few decades, EDs have been rising rapidly due to disturbed attitudes towards eating that play a critical role in the maintenance of EDs. This study was performed to assess key bibliometric indicators, visualize the research outcomes in the field, and find the current trends in EDs. Methods: A comprehensive search was conducted utilizing the Web of Science Core Collection (WoSCC) database. The obtained data was imported into Microsoft Excel 2019 and VOSviewer software for windows. The database search was performed for the period from the inception of WoSCC until 2020. The downloaded data was exported into VOSviewer software version 1.6.16 for Windows to construct co-authorship countries, keywords co-occurrence, and journal and organization sources network visualization. Results: The initial search yielded 16,693 publications, of which 11,322 articles were included in the overall analysis. Furthermore, the top-100 most cited papers were included based on number of citations in descending order. The average citation per year for overall publications (n=11,322) was 830.92 and that of top-100 most cited papers was 490.24. The study authored by Fairburn and Beglin in year 1994 received the highest citations (2,999). Among the top-100 highly cited articles, Fairburn CG was the most prolific author with 10 publications (6,254 citations). The frequently studied research area was psychiatry, and the leading source of publication was Archives of General Psychiatry with 20 published articles and 7,872 citations. The analysis of the overall articles indicted that International Journal of Eating Disorders got 2,500 publications and 88,921 citation score. The University of Minnesota was first in top-100 most cited articles for maximum number of publications (n=12) but from the overall analysis of all the articles, Harvard University was first with a total of 405 publications. The United States of America was the most prominent country with 58 number of documents. Conclusion: Majority of articles were produced by developed countries. Hence, there is a dire need for interdisciplinary research approaches to evaluate and intervene Eds. We believe that the highly cited articles in feed and EDs may help to some future novel ideas and regulate effective preventive strategies.

The adult outcome of children referred for autism: typology and prediction from childhood.

BackgroundAutism Spectrum Disorder is highly heterogeneous, no more so than in the complex world of adult life. Being able to summarize that complexity and have some notion of the confidence with which we could predict outcome from childhood would be helpful for clinical practice and planning.MethodsLatent class profile analysis is applied to data from 123 participants from the Early Diagnosis Study (Lord et al., Archives of General Psychiatry, 2006, 63, 694) to summarize in a typology the multifacetted early adult outcome of children referred for autism around age 2. The form of the classes and their predictability from childhood is described.ResultsDefined over 15 measures, the adult outcomes were reduced to four latent classes, accounting for much of the variation in cognitive and functional measures but little in the affective measures. The classes could be well and progressively more accurately predicted from childhood IQ and symptom severity measurement taken at age 2 years to age 9 years. Removing verbal and nonverbal IQ and autism symptom severity measurement from the profile of adult measures did not change the number of the latent classes; however, there was some change in the class composition and they were more difficult to predict.ConclusionsWhile an empirical summary of adult outcome is possible, careful consideration needs to be given to the aspects that should be given priority. An outcome typology that gives weight to cognitive outcomes is well predicted from corresponding measures taken in childhood, even after account for prediction bias from fitting a complex model to a small sample. However, subjective well‐being and affective aspects of adult outcome were weakly related to functional outcomes and poorly predicted from childhood.

Presidential Address: Emotion Dysregulation in Children and Adolescents

Presidential Address: Emotion Dysregulation in Children and Adolescents

Anxiety Sensitivity, Obsessive Beliefs, and the Prediction of CBT Treatment Outcome for OCD

Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) although a significant proportion of clients remain symptomatic following treatment. Knowledge regarding individual differences that influence treatment response could help guide future augmentations to CBT. The current study examined two potential predictors of treatment response to CBT for OCD: anxiety sensitivity and obsessive beliefs. Participants (n = 93) with a primary diagnosis of OCD completed measures of anxiety sensitivity (Anxiety Sensitivity Index (ASI); Reiss et al. in Behaviour Research and Therapy, 24(1), 1–8, 1986) and obsessive beliefs (Obsessive Belief Questionnaire (OBQ): OCCWG in Behaviour Research and Therapy, 35(7), 667–681, 1997, 39(8), 987–1006, 2001) before engaging in a course of group CBT for OCD. Obsessive-compulsive symptom severity was measured (Yale-Brown Obsessive-Compulsive Scale; Goodman et al. in Archives of General Psychiatry, 46(11), 1012–1016, 1989a, 1006–1011, 1989b) before and upon treatment completion. Results indicated a significant two-way interaction, whereby elevated ASI-Physical scores by elevated OBQ-Importance/Control significantly predicted higher post-treatment symptom severity. These results have implications for the cognitive modeling of OCD and its treatment with CBT.

Rethinking the 15-Minute Medication Management Visit: Does it Work?

Rethinking the 15-Minute Medication Management Visit: Does it Work?

Value of a One-Item OCD Severity Perception Screener

Obsessive compulsive disorder (OCD) is a debilitating mental illness comprised of unwanted obsessions followed by repetitive rituals (American Psychiatric Association, 2000). The gold standard for measuring OCD severity is the Yale-Brown Obsessive-Compulsive Scale (YBOCS; Goodman et al. Archives of General Psychiatry, 46(11), 1006–1011, 1989). This study sought to understand how well individuals with OCD reported their severity levels through the use of a one-item severity perception screener compared to the YBOCS and the impact that the accuracy of this rating can have on disability and motivation. Data were collected from assessments from a free and openly available OCD self-help internet website. Findings conclude that individuals with OCD have a good understanding and ability to accurately rate their OCD severity level and warrant additional research to determine if a one-item OCD severity perception screener can serve as a quick assessment tool to help understand one’s OCD severity level. Additionally, findings from this study conclude that inaccurately understanding one’s OCD severity level is associated with disability and motivation levels around wanting to keep one’s OCD versus challenge it. Future research should examine the validity of a one-item OCD severity perception screener and further examine the impact inaccurately rating one’s severity level has on disability, motivation, treatment, and treatment outcomes.

Influence of Antidepressants on Aphasia Recovery

Influence of Antidepressants on Aphasia Recovery

Polygenic Score × Intervention Moderation: an Application of Discrete-Time Survival Analysis to Model the Timing of First Marijuana Use Among Urban Youth.

The present study examines the interaction between a polygenic score and an elementary school-based universal preventive intervention trial and its effects on a discrete-time survival analysis of time to first smoking marijuana. Research has suggested that initiation of substances is both genetically and environmentally driven (Rhee et al., Archives of general psychiatry 60:1256-1264, 2003; Verweij et al., Addiction 105:417-430, 2010). A previous work has found a significant interaction between the polygenic score and the same elementary school-based intervention with tobacco smoking (Musci et al., in press). The polygenic score reflects the contribution of multiple genes and has been shown in prior research to be predictive of smoking cessation, tobacco use, and marijuana use (Uhl et al., Molecular Psychiatry 19:50-54, 2014). Using data from a longitudinal preventive intervention study (N = 678), we examined age of first marijuana use from sixth grade to age 18. Genetic data were collected during emerging adulthood and were genotyped using the Affymetrix 6.0 microarray (N = 545). The polygenic score was computed using these data. Discrete-time survival analysis was employed to test for intervention main and interaction effects with the polygenic score. We found main effect of the polygenic score approaching significance, with the participants with higher polygenic scores reporting their first smoking marijuana at an age significantly later than controls (p = .050). We also found a significant intervention × polygenic score interaction effect at p = .003, with participants at the higher end of the polygenic score benefiting the most from the intervention in terms of delayed age of first use. These results suggest that genetics may play an important role in the age of first use of marijuana and that differences in genetics may account for the differential effectiveness of classroom-based interventions in delaying substance use experimentation.

Update on WPA scientific publications.

The WPA continues to help support, mentor and encourage member societies and colleagues to use their considerable expertise to publish their work, in order to disseminate knowledge across the world. To that end, President D. Bhugra has appointed a highly qualified and representative group of experts to lead the publications program through the Operating Council. They are: M. Riba and D. Lecic‐Tosevski (co‐chairs); P. Chandra, C. Szabo and R. Heun (members); P. Tyrer and A. Cia (consultants); and J. Castaldelli‐Maia (observer). The Council brings together a diverse and balanced set of publication experiences that will help shape the future directions of the portfolio of WPA scientific publications. Future meetings of the Council will be held in conjunction with WPA International Congress in Istanbul, Turkey in July 2016 and at the World Congress in Berlin, Germany in September 2017. The WPA official journal, World Psychiatry, has now reached an impact factor of 14.225, ranking no. 3 among psychiatric journals (only Molecular Psychiatry and the Archives of General Psychiatry have a slightly higher impact factor, 14.496 and 14.480 respectively). In addition to a variety of scholarly papers, the journal regularly publishes news about the WPA initiatives1, 2, 3, 4, 5, 6 as well as information relevant to the WPA partnership with the World Health Organization7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. In addition, the WPA publication programme benefits from the important and significant work of WPA Scientific Sections, coordinated by Secretary A. Javed. An excellent example of publications emanating from the Sections is World Child and Adolescent Psychiatry, edited by N. Skokauskas, which is the official journal of the WPA Section on Child and Adolescent Psychiatry19. The journal features editorials, in‐depth perspectives, interviews, conference summaries, updates, and provides information on programs from around the world, as well as including a trainees’ forum. Prof. Skokauskas and the editorial board have noted their appreciation for contributors who have made the journal possible, and so successful. Other initiatives underway include a series of books on Psychiatry and Primary Care, with D. Bhugra and M. Riba as editors, that will be published by Springer. Plans are underway to work with editors and authors on such topics as physician wellness and interaction between psychiatry and primary care. H. Herrman, P. Chandra and others are also working on a book related to women's mental health. We very much look forward to these contributions. Finally, we are investigating ways to use the updated WPA website, developed by WPA Secretary General R.A. Kallivayalil and colleagues, for disseminating and publishing materials such as course work and other educational tools that at some point may be collated into books, either in print or online. Secretary E. Belfort has led efforts for such materials to be available through a growing number of conferences and meetings with WPA support and investment. Michelle Riba WPA Secretary for Publications

Children and Terrorism and commentaries

Children and Terrorism and commentaries

Additional Search Strategies May Not Be Necessary for a Rapid Systematic Review

A Review of:
 Westphal, A., Kriston, L., Hölzel, L.P., Härter, M., & von Wolff, A. (2014). Efficiency and contribution of strategies for finding randomized controlled trials: a case study from a systematic review on therapeutic interventions of chronic depression. Journal of Public Health Research, 3(2), 177. doi: 10.4081/jphr.2014.177
 
 Abstract
 
 Objective – To evaluate the efficiency and contribution of additional searching strategies for finding randomized controlled trials (RCTs) in a systematic review.
 
 Design – A methodological case study.
 
 Setting – Biomedical literature.
 
 Methods – A sensitive search (defined as “the ratio of the number of relevant reports identified to the total number of relevant reports in existence”) was conducted of electronic databases, Cochrane CENTRAL database, MEDLINE, EMBASE, PsycInfo, CINAHL, BIOSIS, and Web of Science databases (Science and Social Science Citation Indexes). The following additional searching strategies were conducted: hand-searching contents of relevant journals (Archives of General Psychiatry, Journal of Consulting and Clinical Psychology, and Journal of Affective Disorders), citation tracking (forwards tracking using Social Science and Science Citation Index and backwards tracking by looking through reference lists of included studies), screening reference lists of relevant systematic reviews, searching clinical trials registers (ClinicalTrials.gov and ICTRP registers), and contacting first authors of included studies to find any similar unpublished studies. 
 
 The number of articles identified by each of these methods was recorded and screened for inclusion in the systematic review. The authors calculated what they labelled as the ‘efficiency’ of each searching strategy (the number of included studies identified by the search method as a proportion of the full text articles screened) and the ‘contribution’ of the search strategies (the ratio of included studies identified by that method to the final number of included studies in the systematic review). The methodological quality of each included study was assessed using the Cochrane Risk of Bias Tool, which is a critical appraisal checklist used to judge the study’s value in the systematic review. The meta-analysis in the systematic review was conducted with and without the studies identified by the additional searching strategies to assess their impact on the review’s findings.
 
 Main Results – In total 50 studies were identified, 42 from electronic database searches and 8 from additional search strategies. As illustrated by the results in Table 1, the most useful additional search strategy was screening reference lists of relevant systematic reviews. Journal hand-searching and contacting authors also contributed to the review. 
 
 Of the eight studies identified by the additional search strategies none were judged to have a low risk of bias (four had high risk of bias and four were unclear). Of the 42 included 
 studies from electronic searches only 11 were judged to have a low risk of bias, whereas 9 studies had a high risk of bias and 22 were unclear. 
 
 Excluding the eight studies retrieved from additional search strategies in the systematic review meta-analysis did not influence the results on the effectiveness of the different interventions for chronic depression. These studies were found to be indexed correctly on the electronic databases, but were not identified in the initial search.
 
 Conclusion – Additional search strategies, especially screening reference lists of systematic reviews and hand-searching relevant journals, retrieved a substantial number of relevant studies for a systematic review of interventions for treating chronic depression. However, results of the review’s meta-analysis did not differ when these additional studies (rated as either high or unclear risk of bias) were not included and search methods were time consuming. It might be reasonable to rely on electronic searching strategies when resources for conducting a systematic review are limited or when doing a “rapid review.” The benefits and limitations of additional search strategies should be considered particularly when resources or time for conducting a systematic review are limited.
 
 If the electronic database search is sensitive and includes the Cochrane CENTRAL database additional search strategies may not be necessary, but these findings should be tested in other research areas.

UPDATE ON THERAPEUTICS: IMPROVING THE CLINICAL YIELD

The goal of the study was to examine mismatch negativity (MMN) in schizotypal personality disorder (SPD) individuals. Abnormal MMN has been a consistent finding in chronic schizophrenia and there also have been reports of reduced duration MMN in first episode schizophrenia patients [Umbricht, D., Krljes, S., Mismatch negativity in schizophrenia: a meta-analysis. Schizophrenia Research (2005); 76(1):1–23], with some studies finding no pitch MMN amplitude differences [Salisbury, D.F., Shenton, M.E., Griggs, C.B., Bonner-Jackson, A., McCarley, R.W., Mismatch negativity n chronic schizophrenia and first-episode schizophrenia. Archives of General Psychiatry (2002); 59(8):686–694.], while others reporting a modest reduction [Umbricht, D.S., Bates, J.A., Lieberman, J.A., Kane, J.M., Javitt, D.C., Electrophysiological indices of automatic and controlled auditory information processing in first-episode, recent-onset and chronic schizophrenia. Biological Psychiatry (2006); 59(8):762–772], in recent onset schizophrenia patients. To our knowledge no reports exist of MMN in SPD individuals.Twenty six normal (14 females) control and 23 SPD (12 females) individuals were tested using the pitch MMN paradigm. Normal control (NC) and SPD individuals were recruited from the general population and assessed using DSM-IV. SPD individuals were included if they met 5 or more criteria for SPD disorder. The subjects listened to 2000 frequent 1 kHz pure tones and 100 rare 1.2 kHz pure tones while reading a magazine article. MMN was measured from a difference waveform within the latency window of 175–276 ms.Reduced MMN amplitude was found in SPD relative to NC subjects (p < 0.045).These results point to potential differences between SPD and schizophrenia, where no reduction in MMN was found in most studies of first episode patients.

Celebrating the Work of William T. Carpenter Jr

Celebrating the Work of William T. Carpenter Jr

The new impact factor ofWorld Psychiatry

The new impact factor of World Psychiatry, based on citations in the year 2012 to papers published in the journal in the years 2010 and 2011, is 8.974. The impact factor of the journal was 3.896 in 2009, 4.375 in 2010, 5.562 in 2011, and 6.233 last year. The journal is now in the top 5 of psychiatric journals, preceded only by Molecular Psychiatry, the American Journal of Psychiatry, the Archives of General Psychiatry and Biological Psychiatry. The papers that received the highest number of citations during the period considered in the calculation of the new impact factor are the two pieces by De Hert et al on physical illness in patients with severe mental disorders (1,2); the special articles on resilience under conditions of extreme stress (3), prediction and prevention of schizophrenia (4) and long-term costs of traumatic stress (5); the research reports on self-experience in the early phases of schizophrenia (6), income-related inequalities in the prevalence of depression and suicidal behaviour following the economic crisis (7), and a randomized controlled trial of supported employment in England (8); the articles related to the development of the ICD-11 (9-12); the WPA guidance papers and recommendations (13-18); and the forums on psychiatrists as an endangered species (19), broadening the diagnosis of bipolar disorder (20), personality and psychopathology (21), and pathophysiology of schizophrenia (22-25). The journal editorial staff is grateful to the authors, the referees and the many colleagues worldwide who made this accomplishment possible.

The 100 Top-Cited Articles Published in Psychiatric Journals

An examination of top-cited articles is a tool that can be used to identify and monitor outstanding scientific research. The goal of this study was to identify and analyze the characteristics of the 100 top-cited articles published in international journals dedicated to psychiatry. The Science Citation Index Expanded provided by the Thomson Reuters Institute for Scientific Information Web of Knowledge was searched in December, 2011, and 128 journals were identified in the subject category "Psychiatry." Each journal was searched on the Web of Science under "Publication Name" and the results were sorted by category "Times Cited." The 100 top-cited articles were recorded, and the list was analyzed with regard to journals, number of citations, authors, year, institution, and country of origin. The original research articles of the 100 top-cited articles were classified into one of five categories: scale/measurement, descriptive/epidemiology, mechanism, management, and imaging. The 100 top-cited articles were cited between 26,578 and 781 times; they were published between 1957 and 2005, with the largest number (35) published in the 1990s. The articles appeared in 24 journals, with more than half published in the Archives of General Psychiatry (56), followed by the American Journal of Psychiatry (6), and Psychological Medicine (6). Articles that dealt with the development, application, or validity of measurements led the list of top-cited psychiatric publications (43) and had a significantly higher number of citations compared with the rest of the articles. The time and language of publication, field of study, country of origin, and journal in which the paper appeared are possible determinants of the likelihood of citation and impact.

Age of Child at Death Can Affect Parents’ Mortality

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessAge of Child at Death Can Affect Parents’ MortalityAaron LevinAaron LevinSearch for more papers by this authorPublished Online:1 Feb 2013https://doi.org/10.1176/appi.pn.2013.1b17AbstractLosing a child to sudden, unexpected death may seriously affect the health and other key aspects of life of the parents.The tragic deaths of 20 children in Newtown, Conn., in December brought to the forefront recent research on the health outcomes of bereavement by parents who have lost their children.Parents in Newtown will be at risk for at least several years and should be followed to see that they have access to care, said James Bolton, M.D., an assistant professor of psychiatry at the University of Manitoba, in an interview with Psychiatric News.“We have to recognize that they are vulnerable and that treatment needs to be readily available.”Bereavement responses vary widely, of course. Some people are more resilient than others. However, the death of a child—regardless of age—can have harmful physical effects on surviving parents, wrote Mikael Rostila, Ph.D., and colleagues in the October 2012 Journal of Epidemiology and Community Health. Rostila is an associate professor of sociology at the Centre for Health Equity Studies (CHESS) at Sweden’s Stockholm University and the Karolinska Institute.The researchers distinguished between death by “natural” causes, such as disease, and “unnatural” ones, such as by suicide, homicide, or accident.“Our data . . . indicate that unnatural causes of child death have a stronger impact than natural deaths on parental mortality, but mainly among mothers who lost young children (aged 10-17 years),” said the researchers. The mortality effect on fathers in the Swedish study was not significant.“In other age groups we found no difference in the effect of natural versus unnatural child deaths on the mortality of parents,” said Rostila in an interview. “In other words, unnatural child deaths are particularly detrimental for mothers when the child is young at the time of death.” Mothers of children aged 10-17, the youngest age group in this study, faced an increased risk of 31 percent in all-cause mortality, but that increase was driven largely by an increased risk of 48 percent among mothers whose children died unnatural deaths.Although his study did not cover younger children, Rostila speculated that the death of a child under age 10 might be at least as detrimental given the strong emotional bond and attachment between the child and the parent.“The death of a young child is also extremely unexpected, which could lead to strong feelings of grief and difficulty in coping with the death,” he said.Rostila and colleagues also found a 26 percent to 33 percent increased association with mortality among the siblings of the deceased child. But so little research has been done on this group that Rostila called them “the forgotten griever[s].”The psychological effects on parents can crop up in a relatively short time, Bolton pointed out.In a study published online December 10, 2012, in Archives of General Psychiatry, Bolton and colleagues compared parents bereaved by the death of their children by either suicide or motor-vehicle crash. He and his colleagues found associations in both groups with increased rates of depression, anxiety, and marital breakup, although not with drug or alcohol use disorders.“There was quite a dramatic effect on parents, but there wasn’t much of a difference in outcomes relating to the specific cause of the child’s death,” said Bolton. “So the parents of children killed in a mass shooting will be a very vulnerable group, and the increased risk will be visible soon, even with the first two years.”Bolton’s two-year study was too short to observe physical effects on bereaved parents of a child’s death, but the short-term mental health effects are likely to translate into physical effects eventually, he said.In one respect, the aftermath was different for parents following a suicide. The stigma faced by the parents of children who died by suicide was often manifested by the surrounding community, which shunned them or at least felt awkward in approaching the family, said Bolton. That should not be the case in Newtown, however, where the community has rallied around the parents of the children who were shooting victims at the elementary school, he said. ■An abstract of “Mortality in Parents Following the Death of a Child: A Nationwide Follow-up Study From Sweden” is posted at http://jech.bmj.com/content/66/10/927.long. An abstract of “Parents Bereaved by Offspring Suicide” is posted at http://archpsyc.jamanetwork.com/article.aspx?articleid=1483982. ISSUES NewArchived