Barbara Stanley

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

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Publications (156)674.47 Total impact

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    ABSTRACT: Objective: Emergency departments (EDs) are often the primary contact point for suicidal individuals. The post-ED visit period is a high suicide risk time. To address the need for support during this time, a novel intervention was implemented in five Department of Veterans Affairs medical center EDs. The intervention combined the Safety Planning Intervention (SPI) with structured follow-up and monitoring (SFU) by telephone for suicidal individuals who did not require hospitalization. This study assessed the intervention's acceptability and perceived usefulness. Methods: A selected sample of 100 intervention participants completed a semistructured interview consisting of open-ended questions about the intervention's acceptability, usefulness, and helpfulness. Satisfaction with the SPI and SFU was separately evaluated. Results: Nearly all participants found the SAFE VET intervention to be acceptable, reporting that it was helpful in preventing further suicidal behavior and fostering treatment engagement. Conclusions: The SAFE VET intervention showed promise as an ED intervention for suicidal patients.
    No preview · Article · Feb 2016 · Psychiatric Services
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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.
    No preview · Article · Dec 2015 · Mindfulness
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    ABSTRACT: Objective: The degree of concordance between clinical and standardized assessments in the detection and classification of suicidal behavior and nonsuicidal self-injury behavior in psychiatric emergency department settings was examined. Method: Two hundred fifty-four patients at 3 psychiatric emergency departments between 2007 and 2011 were evaluated by research staff using standardized assessments of suicidal behavior and nonsuicidal self-injury behavior. Of 254 patients, 128 (50%) made a recent suicide attempt, 30 (12%) engaged in recent nonsuicidal self-injury behavior, 20 (8%) made a recent suicide attempt interrupted by self or others, and 76 (30%) had other psychiatric symptoms in the absence of recent suicidal or nonsuicidal self-injury behavior. The classifications derived from the standardized assessments using the Centers for Disease Control and Prevention (CDC) nomenclature were compared to clinical assessments independently extracted from emergency department medical records. Results: Agreement between clinical and standardized assessments was substantial for both suicide attempts (κ = 0.76, P < .001) and nonsuicidal self-injury behavior (κ = 0.72, P < .001). Importantly, 18% of patients determined to have made a suicide attempt in the past week by standardized assessment were not identified as such by clinical assessment. In addition, as measured by the Columbia Suicide Severity Rating Scale, the potential lethality of attempts for patients classified as making a recent suicide attempt by both clinician and standardized assessments was significantly greater (t120 = 2.1, P = .04) than that for patients who were classified as having made an attempt by the standardized but not clinical assessment. Conclusions: The use of standardized assessment measures may improve sensitivity and accuracy of identifying suicidal behavior and nonsuicidal self-injury behavior in psychiatric emergency departments.
    No preview · Article · Nov 2015 · The Journal of Clinical Psychiatry
  • Rasheda Browne · Eric Fertuck · Barbara Stanley

    No preview · Article · Nov 2015
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    ABSTRACT: Background: Many, but not all studies of suicide attempters' cortisol response to stress-either social stress or pharmacological challenge-report an exaggerated response. Recent studies of resting baseline cortisol in past suicide attempters, however, have found lower baseline levels. Methods: In this study, baseline salivary cortisols were obtained prior to a stress procedure from adults with lifetime diagnoses of a mood disorder (N=69), 31.9% of whom had made a prior suicide attempt. Data were collected during the piloting of this stress procedure, at various times of day and with/without an additional confederate in the room. Results: Adjusting for procedural, demographic and clinical variables that affect salivary cortisol levels-including time of day of sampling, order of procedure with respect to other assessments, past alcohol abuse, current medication use, and bipolar diagnosis-past suicide attempters had lower baseline cortisol levels compared to non-attempters. Limitations: This is a pilot study with modest sample sizes using statistical, rather than experimental control of numerous variables affecting salivary cortisol levels. Conclusions: Results confirm previous studies. Low baseline cortisol levels have been associated with childhood adversity and externalizing disorders, suggesting a potential role in reducing inhibitions for risky and dangerous behaviors. Further research is needed to more fully characterize these associations and their role in suicidal behavior risk.
    No preview · Article · Oct 2015 · Journal of Affective Disorders
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    ABSTRACT: Studies looking at the relationship of the hypothalamic-pituitary-adrenal axis (HPA) to suicidal behavior and its risk factors, such as depression, childhood abuse, and impulsive aggression, report inconsistent results. These studies also do not always differentiate between subjects who go on to attempt suicide, suicidal subjects who never attempted suicide, and non-suicidal subjects with psychiatric disorders. In this study, we examined cortisol responses to an experimental stressor, the Trier Social Stress Test (TSST), in 208 offspring of parents with mood disorder. Offspring suicide attempters showed lower total cortisol output [β=-0.47, 95% CI (-0.83, -0.11), p=0.01] compared to offspring with suicide-related behavior but never attempted, non-suicidal offspring, and a healthy control group. The result remained significant even after controlling for sex, age, race, ethnicity, site, socioeconomic status, and hour of the day when the TSST was conducted. Suicide attempters also showed lower baseline cortisol prior to the TSST [β=-0.45, 95% CI (-0.74, -0.17), p=0.002]. However, there were no significant differences between the groups on cortisol reactivity to stress [β=4.5, 95% CI (-12.9, 22), p=0.61]. Although subjects with suicide attempt and suicide-related behavior have similar clinical and psychosocial characteristics, this is the first study to differentiate them biologically on HPA axis indices. Blunted HPA axis activity may increase risk for suicide attempt among individuals with psychopathology by reducing their ability to respond adaptively to ongoing stressors. These results may help better identify subjects at high-risk for suicidal behavior for targeted prevention and intervention efforts.Neuropsychopharmacology accepted article preview online, 09 October 2015. doi:10.1038/npp.2015.309.
    No preview · Article · Oct 2015 · Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology
  • Ryan E Lawrence · Maria A Oquendo · Barbara Stanley
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    ABSTRACT: Although religion is reported to be protective against suicide, the empirical evidence is inconsistent Research is complicated by the fact that there are many dimensions to religion (affiliation, participation, doctrine) and suicide (ideation, attempt, completion). We systematically reviewed the literature on religion and suicide over the last ten years (89 articles) with a goal of identifying what specific dimensions of religion are associated with specific aspects of suicide. We found that religious affiliation does not necessarily protect against suicidal ideation, but does protect against suicide attempts. Whether religious affiliation protects against suicide attempts may depend on the culture-specific implications of affiliating with a particular religion, since minority religious groups can feel socially isolated. After adjusting for social support measures, religious service attendance is not especially protective against suicidal ideation, but does protect against suicide attempts, and possibly protects against suicide. Future qualitative studies might further clarify these associations.
    No preview · Article · Jul 2015 · Archives of suicide research: official journal of the International Academy for Suicide Research
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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).
    No preview · Article · Jun 2015 · American Journal of Public Health
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    Maria Ramberg · Barbara Stanley

    Preview · Article · May 2015
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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.
    No preview · Article · May 2015 · Contemporary clinical trials
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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.
    Full-text · Article · Jan 2015 · The western journal of emergency medicine
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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.
    No preview · Article · Dec 2014 · JAMA Psychiatry
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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.
    No preview · Article · Dec 2014 · Personality and Individual Differences
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    ABSTRACT: Objective: Suicide, a major cause of death worldwide, has distinct biological underpinnings. The authors review and synthesize the research literature on biomarkers of suicide, with the aim of using the findings of these studies to develop a coherent model for the biological diathesis for suicide. Method: The authors examined studies covering a large range of neurobiological systems implicated in suicide. They provide succinct descriptions of each system to provide a context for interpreting the meaning of findings in suicide. Results: Several lines of evidence implicate dysregulation in stress response systems, especially the hypothalamic-pituitary-adrenal axis, as a diathesis for suicide. Additional findings related to neuroinflammatory indices, glutamatergic function, and neuronal plasticity at the cellular and circuitry level may reflect downstream effects of such dysregulation. Whether serotonergic abnormalities observed in individuals who have died by suicide are independent of stress response abnormalities is an unresolved question. Conclusions: The most compelling biomarkers for suicide are linked to altered stress responses and their downstream effects, and to abnormalities in the serotonergic system. Studying these systems in parallel and in the same populations may elucidate the role of each and their interplay, possibly leading to identification of new treatment targets and biological predictors.
    No preview · Article · Dec 2014 · American Journal of Psychiatry
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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;; NCT00675129.
    Full-text · Article · Oct 2014 · Journal of the American Academy of Child & Adolescent Psychiatry
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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.
    Full-text · Article · Sep 2014 · Psychopathology
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    Anat Brunstein Klomek · Barbara Stanley · Andre Sourander
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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.
    Full-text · Article · Sep 2014 · European Journal of Marketing
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    Elin Anita Fadum · Barbara Stanley · Ping Qin · Lien My Diep · Lars Mehlum
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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.
    Full-text · Article · Sep 2014 · General Hospital Psychiatry
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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.
    No preview · Article · Sep 2014 · Contemporary Clinical Trials
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    Maria Ramberg · Barbara Stanley · Mette Ystgaard · Lars Mehlum
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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.
    Preview · Article · Jul 2014 · Archives of suicide research: official journal of the International Academy for Suicide Research

Publication Stats

5k Citations
674.47 Total Impact Points


  • 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
  • 2010
    • Icahn School of Medicine at Mount Sinai
      • Department of Psychiatry
      Borough of Manhattan, New York, United States
  • 1986-2010
    • CUNY Graduate Center
      New York, New York, United States
  • 1988-2009
    • City University of New York - John Jay College of Criminal Justice
      • Department of Psychology
      New York, New York, United States
    • Nathan Kline Institute
      Orangeburg, New York, United States
  • 2007
    • Weill Cornell Medical College
      New York, New York, United States
  • 2003-2007
    • 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