Barbara Stanley

New York State Psychiatric Institute, New York, New York, United States

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Publications (142)631.53 Total impact

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    ABSTRACT: We implemented an innovative, brief, easy-to-administer 2-part intervention to enhance coping and treatment engagement. The intervention consisted of safety planning and structured telephone follow-up postdischarge with 95 veterans who had 2 or more emergency department (ED) visits within 6 months for suicide-related concerns (i.e., suicide ideation or behavior). The intervention significantly increased behavioral health treatment attendance 3 months after intervention, compared with treatment attendance in the 3 months after a previous ED visit without intervention. The trend was for a decreasing hospitalization rate. (Am J Public Health. Published online ahead of print June 11, 2015: e1-e3. doi:10.2105/AJPH.2015.302656).
    American Journal of Public Health 06/2015; DOI:10.2105/AJPH.2015.302656 · 4.23 Impact Factor
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    ABSTRACT: There are no evidence-based, brief interventions to reduce suicide risk in Veterans. Death by suicide is a major public health problem. This article describes a protocol, Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment [SAFE VET], developed for testing the effectiveness of a brief intervention combining a Safety Planning Intervention with structured follow-up (SPI-SFU) to reduce near-term suicide risk and increase outpatient behavioral health treatment engagement among Veterans seeking treatment at Veteran Affairs Medical Center (VAMC) emergency departments (EDs) who are at risk for suicide. In addition to describing study procedures, outcome measures, primary and secondary hypotheses, and human subjects' protection issues, the rationale for the selection of SPI-SFU as the intervention is detailed, as are safety considerations for the unique study setting and sample. Copyright © 2015. Published by Elsevier Inc.
    Contemporary clinical trials 05/2015; 43. DOI:10.1016/j.cct.2015.05.003 · 1.99 Impact Factor
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    ABSTRACT: Suicidal behavior is an important public health problem. A few efficacious treatments to prevent suicidal behavior exist. The feasibility and broad applicability of these interventions to suicidal individuals are, however, limited. We thus developed a novel, nine-session protocol combining mindfulness-based cognitive therapy (MBCT) specifically tailored to address suicide-related concerns with the Safety Planning Intervention, a brief intervention focused on developing individual suicide crisis coping skills. Here, we report on the feasibility, acceptability, safety, and preliminary effectiveness of the intervention, mindfulness-based cognitive therapy to prevent suicidal behavior (MBCT-S). Eighteen high suicide risk psychiatric outpatients in treatment were enrolled and assessed for suicidal ideation, depression, and hopelessness using well-validated clinician-administered or self-report instruments. All participants received adjunct MBCT-S. Assessments were repeated at MBCT-S termination. To measure feasibility, acceptability, and safety, we calculated enrollment, drop out, and treatment completion rates. We also summarized satisfaction rating scale data, counted adverse events, and examined qualitative data. We found significant reductions in suicidal ideation and depressive symptoms, but not hopelessness, with MBCT-S treatment. The treatment was also feasible, acceptable, and safe for participants. Directions for future study of MBCT-S are discussed.
    Mindfulness 01/2015; DOI:10.1007/s12671-015-0405-8 · 3.69 Impact Factor
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    ABSTRACT: Our goal was to explore whether emergency department (ED) patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Participants (n=177) presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants' willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. No participants (0/177) refused to respond to the categorical question about sexual orientation, 168/177 (94.9%) agreed to provide information about prior sexual partners, and 100/109 (91.7%) provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0%) self-identified as heterosexual, 11 (6.2%) as bisexual, 10 (5.6%) as gay or lesbian, and 2 (1.1%) indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB) patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89) reported sexual attraction as other than 'only opposite sex,' and 10.3% (15/142) of sexually active 'heterosexual' participants reported previous same-gender sexual partners. Assessing patients' sexual orientation in the ED by a three-question approach appeared feasible in the ED and acceptable to ED patients. However, since many patients have sexual experiences not suggested by simple labels, self-report of sexual identity alone may not inform clinicians of health risks inherent in same or opposite gender sexual contact.
    The western journal of emergency medicine 01/2015; 16(1):80-4. DOI:10.5811/westjem.2014.12.22254
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    ABSTRACT: Suicide attempts are strong predictors of suicide, a leading cause of adolescent mortality. Suicide attempts are highly familial, although the mechanisms of familial transmission are not understood. Better delineation of these mechanisms could help frame potential targets for prevention. To examine the mechanisms and pathways by which suicidal behavior is transmitted from parent to child. In this prospective study conducted from July 15, 1997, through June 21, 2012, a total of 701 offspring aged 10 to 50 years (mean age, 17.7 years) of 334 clinically referred probands with mood disorders, 191 (57.2%) of whom had also made a suicide attempt, were followed up for a mean of 5.6 years. The primary outcome was a suicide attempt. Variables were examined at baseline, intermediate time points, and the time point proximal to the attempt. Participants were assessed by structured psychiatric assessments and self-report and by interview measures of domains hypothesized to be related to familial transmission (eg, mood disorder and impulsive aggression). Among the 701 offspring, 44 (6.3%) had made a suicide attempt before participating in the study, and 29 (4.1%) made an attempt during study follow-up. Multivariate logistic regression revealed that proband suicide attempt was a predictor of offspring suicide attempt (odds ratio [OR], 4.79; 95% CI, 1.75-13.07), even controlling for other salient offspring variables: baseline history of mood disorder (OR, 4.20; 95% CI, 1.37-12.86), baseline history of suicide attempt (OR, 5.69; 95% CI, 1.94-16.74), and mood disorder at the time point before the attempt (OR, 11.32; 95% CI, 2.29-56.00). Path analyses were consistent with these findings, revealing a direct effect of proband attempt on offspring suicide attempt, a strong effect of offspring mood disorder at each time point, and impulsive aggression as a precursor of mood disorder. Parental history of a suicide attempt conveys a nearly 5-fold increased odds of suicide attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder. Interventions that target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior.
    JAMA Psychiatry 12/2014; 72(2). DOI:10.1001/jamapsychiatry.2014.2141 · 12.01 Impact Factor
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    ABSTRACT: Borderline Personality Disorder (BPD) is theorized to develop from a combination of dispositional and environmental risk factors. Among these risk factors, both childhood emotional neglect and abuse (ENA) and rejection sensitivity (RS) have been independently associated with BPD symptomatology. However, to our knowledge, no studies have examined the interaction between these variables as they relate to BPD symptoms. In the current study, greater ENA and RS were independently associated with more BPD symptoms in a sample of undergraduate students (n = 133). In addition, there was an interaction such that RS was more strongly correlated with BPD symptoms at moderate and low levels of ENA. Our findings suggest dispositional and environmental factors combine to instantiate BPD symptoms and thus suggest RS and ENA merit investigation in clinical samples.
    Personality and Individual Differences 12/2014; 71:146–150. DOI:10.1016/j.paid.2014.07.038 · 1.86 Impact Factor
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    ABSTRACT: Objective: We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. Method: This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9,15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Results: Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. Conclusion: DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129.
    Journal of the American Academy of Child & Adolescent Psychiatry 10/2014; 53(10):1082-91. DOI:10.1016/j.jaac.2014.07.003 · 6.35 Impact Factor
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    ABSTRACT: Background: Borderline personality disorder (BPD) is a prevalent psychiatric disorder associated with significant distress, dysfunction, and treatment utilization. Though, theoretically, BPD is posited to arise from a combination of trait and environmental risk factors, few studies have tested trait-by-environment interactions in BPD. We investigated the roles of rejection sensitivity (RS) and childhood emotional neglect and abuse (ENA) as well as their interaction in BPD. Sampling and Methods: Eighty-five adults with a lifetime mood disorder who were recruited for outpatient studies in a psychiatric clinic were assessed for ENA using the Childhood Trauma Questionnaire and for RS with the Adult Rejection Sensitivity Questionnaire. BPD diagnoses were made by consensus using data collected on the Structured Clinical Interview for DSM-IV. Hierarchical logistic regression was used to test associations between RS, ENA, their interaction and BPD. Results: RS and ENA interacted to predict co-occurring BPD in our sample of mood-disordered patients, with the strength of the relationship between RS and BPD depending on the severity of ENA. In the context of little or no ENA, RS and BPD were more strongly related than when ENA was more severe. Conclusions: Our results extend previous findings suggesting RS and ENA are risk factors for BPD. They also provide preliminary support for contemporary theories of BPD positing trait-by-environment interactions in the development of BPD. Prospective studies are needed to confirm these findings. © 2014 S. Karger AG, Basel.
    Psychopathology 09/2014; 48(1). DOI:10.1159/000365196 · 1.56 Impact Factor
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    ABSTRACT: Background: Bullying among adolescents has increasingly been recognized as a highly prevalent problem that has long lasting consequences for both bullies and victims. Numerous school-wide interventions have been developed but there is a need for interventions that can be implemented by clinicians working with individual clients and patients who bully others. Methods: This manuscript describes a safety plan for youth who bully others which aims to prevent future bullying/ cyberbullying behavior. The ultimate goal of the Bullying Prevention Plan (BPP) is to stop bullying before it starts. Results: The (BPP) is a written plan of action created by the clinician and the youth involved in bullying that essentially charts the course of what the youth should do if he/she begins to experience bullying urges or even starts to bully others. The plan includes hierarchical steps including the identification of warning signs for bullying behavior, use of internal coping strategies, use of external coping strategies, involvement of an adult or professional provider etc. The plan should be periodically reviewed, discussed and possibly revised by the clinician and youth. It is recommended that the youth learn new skills and therefore the bullying prevention plan should be expanded. Conclusions: The bullying prevention plan offers a promising intervention that is directed toward youth who engage in bullying behaviors. Further research should study its efficacy in a systematic way.
    European Journal of Marketing 09/2014; 4(3). DOI:10.2174/221067660403140912162846 · 0.96 Impact Factor
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    ABSTRACT: Objectives To examine characteristics of hospital admissions and risk-factors associated with re-hospitalization for self-poisoning with medications in adolescents aged 10–19 years. Method This study used data from the Norwegian Patient Register (NPR) from 2008 to 2011. The main outcome was hospital readmission within the observation period. A complementary log-log regression model was used to assess the effect of characteristics at index hospital admission on readmission. Results Of 1,497 patients, 76.4% were females and 89.8% were aged 15–19 years. At their first hospital admission, about one-third received a secondary psychiatric diagnosis. Females (47.5%) were registered with an E-code for intentional self-harm more often than males (33.7%) and females were more often than males discharged to further treatment (27.8% vs. 21.5%). As many as 18.4% was re-hospitalized for self-poisoning by medications. Significant predictors for hospital readmission were female sex (HR = 2.4, 95% CI 1.7, 3.6), discharge to further treatment (HR = 2.3, 95% CI 1.8, 2.9) and psychiatric secondary diagnoses (HR = 1.5, 95% CI 1.2, 1.9). Conclusion This national study demonstrated significant sex differences in adolescents treated in hospital for self-poisoning with medications. Psychiatric secondary diagnoses had a strong predictive effect on readmission, which indicates the importance of psychiatric/psychosocial assessment of adolescents who are admitted to hospital for self-poisoning with medications.
    General Hospital Psychiatry 09/2014; DOI:10.1016/j.genhosppsych.2014.09.004 · 2.90 Impact Factor
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    ABSTRACT: Mental health related hospitalizations and suicide are both significant public health problems within the United States Department of Defense (DoD). To date, few evidence-based suicide prevention programs have been developed for delivery to military personnel and family members admitted for psychiatric inpatient care due to suicidal self-directed violence. This paper describes the rationale and detailed methodology for a study called Safety Planning for Military (SAFE MIL) which involves a randomized controlled trial (RCT) at the largest military treatment facility in the United States. The purpose of this study is to test the efficacy of a brief, readily accessible, and personalized treatment called the Safety Planning Intervention1. Primary outcomes, measured by blinded assessors at one and six months following psychiatric discharge, include suicide ideation, suicide-related coping, and attitudes toward help seeking. Additionally, given the study’s focus on a highly vulnerable patient population, a description of safety considerations for human subjects’ participation is provided. Based on this research team’s experience, the implementation of an infrastructure in support of RCT research within DoD settings and the processing of regulatory approvals for a clinical trial with high risk suicidal patients is expected to take up to 18–24 months. Recommendations for expediting the advancement of clinical trials research within the DoD are provided in order to maximize cost efficacy and minimize the research to practice gap.
    Contemporary Clinical Trials 09/2014; 39(1). DOI:10.1016/j.cct.2014.07.003 · 1.99 Impact Factor
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    ABSTRACT: Posttraumatic stress disorder and major depressive disorder are well-established risk factors for suicidal behaviour. This study compared depressed suicide attempters with and without comorbid posttraumatic stress disorder with respect to additional diagnoses, global functioning, depressive symptoms, substance abuse, history of traumatic exposure and suicidal behaviour. Adult patients consecutively admitted to a general hospital after a suicide attempt were interviewed and assessed for DSM-IV diagnosis and clinical correlates. Sixty-four patients (71%) were diagnosed with depression; of them, 21 patients (32%) had posttraumatic stress disorder. There were no group differences in social adjustment, depressive symptoms, or suicidal intent. However, the group with comorbid depression and posttraumatic stress disorder had more additional Axis I diagnoses, a higher degree of childhood trauma exposure, and more often reported previous suicide attempts, non-suicidal self-harm and vengeful suicidal motives. These findings underline the clinical importance of diagnosis and treatment of posttraumatic stress disorder in suicide attempters.
    Archives of suicide research: official journal of the International Academy for Suicide Research 07/2014; 19(1). DOI:10.1080/13811118.2014.915777
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    ABSTRACT: Objective We examined whether a shortened form of dialectical behavior therapy (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. Method This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Results Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. Conclusion DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129. Key Words: self-harm, attempted suicide, psychotherapy, randomized trial
    Journal of the American Academy of Child & Adolescent Psychiatry 07/2014; · 6.35 Impact Factor
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    ABSTRACT: We evaluated the feasibility of DBT training, adherence, and retention preparing for a randomized controlled trial of Dialectical Behavior Therapy (DBT) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder. Therapists were intensively trained and evaluated for adherence. Adherence scores, treatment retention, and present and previous self-harm were assessed. Twenty-seven patients were included (mean age 15.7 years), all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder. Therapists were adherent and 21 (78%) patients completed the whole treatment. Three subjects reported self-harm at the end of treatment, and urges to self-harm decreased. At follow up, 7 of 10 subjects reported no self-harm. DBT was found to be well accepted and feasible. Randomized controlled trials are required to test the effectiveness of DBT for adolescents.
    Archives of suicide research: official journal of the International Academy for Suicide Research 05/2014; 18(4). DOI:10.1080/13811118.2013.826156
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    ABSTRACT: Offspring of depressed parents are at increased risk for psychiatric disorders. Although bipolar disorder (BD) and major depressive disorder (MDD) are both found in the same families, it is not clear whether transmission to offspring of BD or MDD tends to occur from parents with the same mood disorder subtype. Our primary hypothesis was that the offspring of parents with BD would be at increased risk for BD and other comorbid disorders common to BD, such as anxiety and substance use, relative to the offspring of parents with MDD. The offspring of parents with BD versus those with MDD were also hypothesized to be at greater risk for externalizing disorders (i.e., conduct disorder, attention-deficit hyperactivity disorder, or antisocial personality disorder). Parents (n = 320) with mood disorders and their offspring (n = 679) were studied. Adult offspring were administered the Structured Clinical Interview for DSM-IV Axis I Disorders to establish the presence of psychopathology. Offspring aged 10-18 years were assessed using the School Aged Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version, and parents of children under the age of ten completed the Child Behavioral Checklist. Data were examined using Cox proportional hazard regression. There was no difference in hazard of mood disorders in the offspring of parents with BD as compared to the offspring of parents with MDD. However, a number of other parent and offspring characteristics increased the risk of mood, anxiety, externalizing, and substance use disorders in the offspring, including self-reported childhood abuse in the parent or offspring, offspring impulsive aggression, and the age at onset of parental mood disorder. Mood disorders are highly familial, a finding that appears independent of whether the parent's condition is unipolar or bipolar, suggesting considerable overlap in the heritability of MDD and BD. Although parental characteristics had a limited influence on the risk of offspring psychopathology, reported childhood adversity, be it in the parent or child, is a harbinger of negative outcomes. These risk factors extend previous findings, and are consistent with diathesis-stress conceptualizations.
    Bipolar Disorders 08/2013; 15(7). DOI:10.1111/bdi.12107 · 4.89 Impact Factor
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    ABSTRACT: This study examines whether there is a difference between urban versus suburban and rural adolescents in their use of health services following two types of self-harm distinguished as self-harm with or without suicide intent. A nationwide cross-sectional school survey of 11 406 Norwegian adolescents aged 13-19 years in 73 Norwegian junior and senior high schools. Adolescents who reported self-harm and provided valid responses to a follow-up question about having received subsequent help or treatment (n=959) were included in the study. Adolescents were divided into urban versus suburban and rural depending on: (1) the location of municipalities where they attended school and (2) the place of residence. Associations between urban versus suburban and rural areas and the use of health services following self-harm were assessed in those who self-harmed with and without suicide intent. Use of health services following self-harm. 1 in 4 adolescents reported using health services following self-harm. Adolescents reporting self-harm with suicide intent were more likely to use health services than those who self-harmed without suicide intent. Following self-harm without suicide intent, adolescents in urban areas were four times more likely to use health services than adolescents in suburban and rural areas. There was no statistically significant area difference in the use of health services following self-harm with suicide intent. This study found a geographical variation in the use of health services following self-harm without suicide intent, but not following self-harm with suicide intent. Differences in perception of self-harm and help-seeking behaviour between areas and different accessibility to services are suggested as possible explanations. There is a need to better understand how the interplay between individual characteristics and accessibility to services influences adolescents' use of health services following self-harm. We suggest that multilevel models are a valuable approach to achieve this goal.
    BMJ Open 07/2013; 3(7). DOI:10.1136/bmjopen-2013-002570 · 2.06 Impact Factor
  • Megan Chesin, Barbara Stanley
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    ABSTRACT: OBJECTIVES: Suicide is a leading cause of death in the USA. Although factors elevating long-term risk for suicide are known and include bipolar disorder, signs of imminent suicide risk are difficult to study and not well specified. Acute risk determinations must be made to determine the appropriate level of care to safeguard patients. To increase safety among at-risk patients in the short term and to decrease risk over time, psychosocial interventions to prevent suicide have been developed and tested in acute care and outpatient settings. METHODS: A narrative review of studies of imminent risk factors for suicide, suicide risk decision-making, and psychosocial suicide prevention interventions was conducted. RESULTS: Although some long-term risk factors of suicide have been established, accurate identification of individuals at imminent risk for suicide is difficult. Therefore, prevention efforts targeting individuals at high suicide behavior risk discharging from acute care settings tend to be generic and focus on psychoeducation and supportive follow-up contact. Data regarding the effectiveness of brief interventions (i.e., those not requiring more than one individualized treatment session) are mixed, showing better outcomes in the shorter term and when the incidence of suicidal behavior or ideation is the outcome. With respect to longer-term suicide prevention interventions (i.e., those with a minimum of ten sessions), Dialectical Behavior Therapy has the largest evidence base. CONCLUSIONS: To improve suicide prevention efforts, more rigorous study of imminent risk factors and psychosocial interventions is needed. Adaptations specific to individuals with bipolar disorder are possible and needed.
    Bipolar Disorders 06/2013; DOI:10.1111/bdi.12092 · 4.89 Impact Factor
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    ABSTRACT: Suicide is difficult to predict and prevent and remains a leading cause of death worldwide. Although soldiers historically have had a suicide rate well below that of the general population, the suicide rate among members of the U.S. Army has increased markedly over the past several years and now exceeds that of the general population. This paper reviews psychosocial factors known to be associated with the increased risk of suicidal behavior in general and describes how some of these factors may be especially important in understanding suicide among soldiers. Moving forward, the prevention of suicide requires additional research aimed at: (a) better describing when, where, and among whom suicidal behavior occurs, (b) using exploratory studies to discover new risk and protective factors, (c) developing new methods of predicting suicidal behavior that synthesize information about modifiable risk and protective factors from multiple domains, and (d) understanding the mechanisms and pathways through which suicidal behavior develops. Although the scope and severity of this problem is daunting, the increasing attention and dedication to this issue by the Armed Forces, scientists, and society provide hope for our ability to better predict and prevent these tragic outcomes in the future.
    Psychiatry Interpersonal & Biological Processes 06/2013; 76(2):97-125. DOI:10.1521/psyc.2013.76.2.97 · 3.18 Impact Factor
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    ABSTRACT: Childhood sexual abuse has been consistently associated with suicidal behavior. We studied suicide attempt features in depressed individuals sexually abused as children. On average, sexual abuse started before age 9. It frequently coexisted with physical abuse. Suicide attempters more often had personality disorders and had endured abuse for longer, but did not differ in terms of other clinical characteristics from non-attempters. Earlier onset of sexual abuse and its duration were associated with more suicide attempts. However, when personality disorders were included in the regression model, only these disorders predicted number of attempts. The severity of sexual abuse and the coexistence of physical abuse were correlated with age at first suicide attempt. However, only severity of sexual abuse was marginally associated with age at first suicide attempt in the regression model. Finally, the earlier the age of onset of sexual abuse, the higher the intent, even after controlling for age, sex and personality disorders. This suggests that the characteristics of childhood sexual abuse, especially age of onset, should be considered when studying the risk for suicidal behavior in abused populations.
    World psychiatry: official journal of the World Psychiatric Association (WPA) 06/2013; 12(2):149-54. DOI:10.1002/wps.20039 · 12.85 Impact Factor
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    ABSTRACT: Abstract To better understand alliance formation with BPD patients, we examined the relationship between pre-treatment patient characteristics and alliance at baseline and 2 months. Thirty-five volunteers who enrolled in a RCT comparing dialectical behavior therapy (DBT) and supportive psychotherapy, with or without antidepressant medication in the treatment of suicidal behavior, were included in this analysis. Participants were administered the SCID-I and II, Beck Depression Inventory, Working Alliance Inventory, Beck Hopelessness Scale, and the State Trait Anxiety Inventory. Results: depression, anxiety and hopelessness predicted poorer patient-rated alliance at 2 months. Depression and anxiety did not correlate with alliance at the start of treatment, but strongly correlated with 2-month alliance, suggesting patient-rated alliance at 2 months was influenced by the course of treatment. Therapist-rated alliance was not associated with either mood or BPD symptoms. Our findings suggest that focusing on BPD patients' mood early in treatment may improve alliance formation.
    Psychotherapy Research 05/2013; DOI:10.1080/10503307.2013.801001 · 1.75 Impact Factor

Publication Stats

4k Citations
631.53 Total Impact Points

Institutions

  • 1992–2015
    • New York State Psychiatric Institute
      • Anxiety Disorders Clinic
      New York, New York, United States
  • 1986–2015
    • Columbia University
      • • Department of Psychiatry
      • • College of Physicians and Surgeons
      New York, New York, United States
  • 2014
    • University of Oslo
      Kristiania (historical), Oslo, Norway
  • 1988–2010
    • City University of New York - John Jay College of Criminal Justice
      • Department of Psychology
      New York City, NY, United States
  • 2007
    • Weill Cornell Medical College
      New York, New York, United States
  • 1986–2006
    • CUNY Graduate Center
      New York City, New York, United States
  • 2002–2003
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 1984–1988
    • Wayne State University
      • School of Medicine
      Detroit, Michigan, United States
  • 1985
    • University of Iowa
      • Department of Anesthesia
      Iowa City, Iowa, United States