Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs

Mediating effect of intolerance of uncertainty between fear of war and mental health in adults during the Israel-Palestine war of 2023

BACKGROUND

The Israel-Palestine war of 2023 has exposed many individuals to prolonged fear and uncertainty, contributing to significant psychological and behavioral consequences. Fear of war has been shown to exacerbate negative mental health outcomes such as anxiety, depression, aggression and suicidal ideation and reduce overall wellbeing. Intolerance of uncertainty is a trait characterized by difficulty coping with ambiguous situations. It was regarded as a potential mediator in the association between fear of war and these outcomes. Therefore, this study's aim is to investigate the mediating effect of intolerance of uncertainty between fear of war and mental health including anxiety, depression, aggression, suicidal ideation and wellbeing in adults during the Israel-Palestine war of 2023.

METHODS

This study employs a cross-sectional design; it included a total of 484 Lebanese participants. A snowball sampling method via Google forms was employed by the research team to collect data. They were assessed with self-reported measures using The War-related Media Exposure Scale (WarMES), the Buss Perry Aggression Questionnaire-Short Form (BPAQ-SF), Columbia-Suicide Severity Rating Scale (C-SSRS), Intolerance of Uncertainty Scale (IUS) and The World Health Organization 5-item Well-Being Index (WHO-5).

RESULTS

Higher fear of war was significantly associated with more inhibitory and prospective anxiety. More prospective anxiety and inhibitory anxiety were significantly associated with more aggression, higher suicidal ideation, higher depression, lower wellbeing and higher anxiety. Fear of war was directly associated with depression, anxiety and lower wellbeing. Whereas the results did not show a direct association with aggression and suicidal ideation. The mediation analysis revealed that inhibitory anxiety and prospective anxiety fully mediated the relation between fear of war and aggression and partially mediated the relation between fear of war and depression, anxiety and wellbeing. Whereas the association between fear of war and suicidal ideation was fully mediated by prospective anxiety but not by inhibitory anxiety.

CONCLUSION

Understanding the role of intolerance of uncertainty is crucial to developing interventions aimed to reduce mental health challenges in populations affected by conflict.

Why Are Autistic People More Likely to Experience Suicidal Thoughts? Applying the Integrated Motivational-Volitional Model with Autistic Adults

Background

Autistic people are at considerably greater risk of suicidality than non-autistic people, and the reasons behind this are not fully understood. Current suicide theories may be useful to help further our understanding of the mechanisms behind autistic suicidality. We aimed to test the key predictors of suicidal ideation-defeat and entrapment-as described in the integrated motivational-volitional (IMV) model of suicide behavior, in an autistic group. We also looked to extend the IMV model by including autism-related constructs of camouflaging and intolerance of uncertainty (IU).

Methods

We recruited 374 autistic adults from the community (female 42.5%; 18-63 years of age), who completed a cross-sectional online survey between August 2020 and January 2021. We collected data on lifetime suicidality, depression symptoms, defeat, entrapment, camouflaging, and IU.

Results

We found that entrapment significantly mediated the relationship between defeat and suicidal ideation. Camouflaging and IU were not found to moderate this pathway but were found to be significantly associated with suicidal ideation.

Conclusions

We found that entrapment mediates the relationship between defeat and suicidality in autistic adults. This is consistent with the predictions in the motivational phase of the IMV model of suicidal behavior, suggesting that this model is useful for understanding autistic suicidality. We did not find evidence that camouflaging and IU act as moderators within the mediated model. Nevertheless, there is some evidence that camouflaging and IU are worthwhile constructs to be aware of for future work researching autistic suicidality.

The psychological distress and suicide-related ideation in hospital workers during the COVID-19 pandemic: Second results from repeated cross-sectional surveys

The COVID-19 pandemic has been affecting the mental health of hospital workers. During the prolonged pandemic, hospital workers may experience much more severe psychological distress, leading to an increased risk of suicide. This study aimed to investigate changes in psychological effects on hospital workers over 12 months from the beginning of the pandemic and clarify factors associated with psychological distress and suicide-related ideation 1-year after the pandemic's beginning. These repeated, cross-sectional surveys collected demographic, mental health, and stress-related data from workers in 2 hospitals in Yokohama, Japan. The first survey, conducted in March-April 2020, contained the 12-item General Health Questionnaire (GHQ-12) assessing general distress and the Impact of Event Scale-Revised (IES-R) assessing event-related distress. In the second survey in March 2021, hospital workers at the same two hospitals were reassessed using the same questionnaire, and Item 9 of the Patient Health Questionnaire (PHQ-9) was added to assess their suicide-related ideation. The findings of the first and second surveys revealed that the average score of GHQ-12 (3.08 and 3.73, respectively), the IES-R total score (6.8 and 12.12, respectively), and the prevalence rates of severe general distress (35.0% and 44.0%, respectively) and severe event-related distress (7.0% and 17.1%, respectively) deteriorated. The second survey showed that 8.6% of the hospital workers were experiencing suicide-related ideation. Both the general and event-related distress were associated with suicide-related ideation. In these surveys, mental health outcomes among the hospital workers deteriorated over one year from the pandemic's beginning, and their severe psychological distress was the risk factor for the suicide-related ideation. Further studies are needed to compare the psychological effects on hospital workers during and after the prolonged pandemic and to explore appropriate measures to support hospital workers' mental health.

Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia

BACKGROUND AND AIM

The goal was to evaluate the moderators of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) to improve dyspareunia, reduce pain catastrophizing, and improve overall sexual function in women with provoked vestibulodynia (PVD). Both treatments effectively reduced self-reported pain, sexual dysfunction, and pain catastrophizing in women with PVD.

METHODS

A total of 130 women with PVD were assigned to CBT or MBCT.

OUTCOMES

Potential moderators included (i) PVD subtype (primary or secondary), (ii) baseline pain intensity, (iii) trait mindfulness, (iv) treatment credibility, (v) relationship duration, and (vi) age. Outcomes were pain intensity, sexual function, and pain catastrophizing at 4 time points: before and after treatment and 6- and 12-month follow-up. Moderation was tested using multilevel models, nesting 4 time points within participants. The interaction of the moderator, time effect, and treatment group was evaluated for significance, and a simple slope analysis of significant interactions was performed.

RESULTS

Pain reduction across 4 time points was the greatest in women who were younger, in relationships of shorter duration, and with greater baseline pain. Treatment credibility moderated pain intensity outcomes (B = 0.305, P < .01) where those with higher treatment credibility ratings (for that particular treatment) improved more in MBCT than CBT. PVD subtype moderated pain catastrophizing (B = 3.150, P < .05). Those with primary PVD improved more in the CBT condition, whereas women with secondary PVD improved more in the MBCT condition. Relationship length moderated sexual function (B = 0.195, P < .01). Women in shorter relationships improved more with MBCT, whereas women in longer relationships improved more on sexual function with CBT. No other tested variables moderated outcomes differentially across both treatment conditions.

CLINICAL IMPLICATIONS

Women who present with high credibility about mindfulness, in shorter relationships, and with secondary PVD might respond better to MBCT whereas those with primary PVD and longer relationships might respond better to CBT.

STRENGTHS & LIMITATIONS

Clinical sample. Half the women who were not sexually active were omitted from analyses of sexual function.

CONCLUSION

Overall, treatment credibility, relationship length, and PVD subtype were found to moderate improvements differently in MBCT and CBT. These findings may assist clinicians in individualizing psychological treatment for women with PVD.

CLINICAL TRIAL REGISTRATION

This clinical trial was registered with clinicaltrials.gov, NCT01704456. Brotto LA, Zdaniuk B, Rietchel L, et al. Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia. J Sex Med 2020;17:2247-2259.