Signalling need for care: a neglected functional role of medical treatment

Background and Objectives

While the primary goals of medical treatment are typically to shorten illness or relieve symptoms, we explore the idea that an important additional goal for some patients is to communicate their needs. Drawing on signalling theory, we argue that undergoing treatments can help patients legitimize their illness and thereby enable access to crucial support during convalescence.

Methods and Results

Four pre-registered within-subjects experiments (n = 874) show that participants are more inclined to provide care to people who undergo treatment, especially when that treatment is painful. Results show this incentivizes the use of antibiotic treatments for viral infections as well as drug treatments for mental illness. A cross-sectional study of 194 chronic pain patients shows that those who experience stigma and doubt over the legitimacy of their illness are more likely to accept aversive treatments. Furthermore, two experiments (n = 653) indicate that subtle manipulations of one's sense of social support may increase willingness to accept treatment.

Conclusions and Implications

These results indicate that people make decisions to provide care in part based on the presence or absence of treatment and furthermore that patients' treatment decision-making is informed by the social consequences of their choices. Signalling theory may help explain the surprising longevity of some ineffective and costly medical procedures.

The suffering ape hypothesis

The "fearful ape hypothesis" could be regarded as one aspect of a more general "suffering ape hypothesis": Humans are more likely to experience negative emotions (e.g., fear, sadness), aversive symptoms (e.g., pain, fever), and to engage in self-harming behavior (e.g., cutting, suicide attempts) because these might motivate affiliative, consolatory, and supportive behavior from their prosocial environment thereby enhancing evolutionary fitness.

Psychological Reasons of the Occurrence of Modern Adolescents` Self Injecting Behavior

The article is devoted to an urgent problem of modern society – the phenomenon of self-harming behavior among teenagers. Understanding the nature of the emergence of self-damaging behavior acts, the factors that are the catalyst for these actions, is beyond doubt, since awareness of this issue will help the psychologist to identify the target constructs for further practical work. The main aspects of the concept of self-harming behavior, the causes and factors of occurrence were analyzed. The psychological characteristics of adolescence and the crisis of growing up were explained as one of the main factors in the development of self-harming behavior. It was determined that the psychological characteristics of adolescence together with external factors complicate the process of forming adaptive strategies with the environment. Self-injurious behavior is the result of the adolescent's search for interaction with his own «I», and, as a result, difficulties arise in the formation of a subjective position and adequate ideas about himself. Among teenagers who commit acts of self-damaging behavior, the mechanisms for the occurrence of these actions have been determined, namely, there are observed violations of emotional regulation, as well as high level of internal conflict, which is accompanied by a heightened sense of guilt. Analisis of the questionnaire was based on the results of 3 groups of children were identified: the first – with the up-to-date experience of self-harming behavior, the second – with a penchant to self-harming behavior and the third – not inclined to self-harm. Thus, the distribution will help the psychologist to select the most effectively corrective program and provide psychological assistance with such requests. A comparative analysis was made between the choice of the method of self-harm and the tendency to such behavior. It was determined that somatic acts of self-harm are characteristic all groups of adolescents and are perceived by them as a bad habit. It was found that the leading reasons for committing acts of self-harm for all groups of adolescents is desire to calm dawn, to pull oneself together, to cope with emotions. It was detected that such indicators complicate the formation of adequate ideas of self perception and become a threat in the formation of the subjective position, and have a destructive effect on the planning of teenager`s own life activity.

Socioeconomic inequalities in impairment associated with depressive symptoms: Evidence from the National Survey on Drug Use and Health

OBJECTIVE

Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment.

METHODS

We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators.

RESULTS

The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54[1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91[1.35-2.70]).

CONCLUSION

Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.

Mental health is biological health: Why tackling "diseases of the mind" is an imperative for biological anthropology in the 21st century

The germ theory of disease and the attendant public health initiatives, including sanitation, vaccination, and antibiotic treatment, led to dramatic increases in global life expectancy. As the prevalence of infectious disease declines, mental disorders are emerging as major contributors to the global burden of disease. Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate-to-weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes. Consequently, despite dramatic increases in the treatment of some mental disorders, there has been no decrease in the prevalence of most mental disorders since accurate record keeping began. Many researchers and theorists are therefore endeavoring to rethink psychiatry from the ground-up. Anthropology, especially biological anthropology, can offer critical theoretical and empirical insights to combat mental illness globally. Biological anthropologists are unique in that we take a panhuman approach to human health and behavior and are trained to address each of Tinbergen's four levels of analysis as well as culture. The field is thus exceptionally well-situated to help resolve the mysteries of mental illness by integrating biological, evolutionary, and sociocultural perspectives.

Therapeutic encounters and the elicitation of community care

Singh's analysis of shamanism is regarded as a contribution to the evolutionary study of healing encounters and evolutionary medicine. Shamans must create convincing healing spectacles, while sick individuals must convincingly express symptoms and suffering to motivate community care. Both have a shared interest in convincing onlookers. This is not restricted to shamanic treatment, but is still true in modern medical care.

When Saying "Sorry" Isn't Enough: Is Some Suicidal Behavior a Costly Signal of Apology? : A Cross-Cultural Test

Lethal and nonlethal suicidal behaviors are major global public health problems. Much suicidal behavior (SB) occurs after the suicide victim committed a murder or other serious transgression. The present study tested a novel evolutionary model termed the Costly Apology Model (CAM) against the ethnographic record. The bargaining model (BRM) sees nonlethal suicidal behavior as an evolved costly signal of need in the wake of adversity. Relying on this same theoretical framework, the CAM posits that nonlethal suicidal behavior can sometimes serve as an honest signal of apology in the wake of committing a severe transgression, thereby repairing valuable social relationships. To test this hypothesis, the CAM was operationalized into a set of variables, and two independent coders coded 473 text records on suicidal behavior from 53 cultures from the probability sample of the Human Relations Area Files. The results indicated that in ethnographic accounts of suicidal behavior, transgressions, punishment, and shame were relatively common, supporting the CAM, but explicit motives to apologize and evidence of forgiveness were rare, contrary to the CAM. The theoretical variables of the CAM nevertheless formed a cluster distinct from the BRM, and a subset of cases of suicidal behavior were largely related to transgressions and other CAM variables rather than BRM or other variables. Support for the CAM varied widely across cultures, but there was evidence for it in every major geographical region. Exploratory analyses suggested that the CAM is potentially more likely to occur in response to severe conflicts concerning transgressions committed against nonkin. Furthermore, in text records that involved transgressions, male suicidal behavior was most frequently associated with murder, whereas female suicidal behavior was most frequently associated with sexual transgressions. In conclusion, the results provided mixed support for the hypothesis that some instances of suicidal behavior function to send a costly signal of apology to those harmed by a transgression.

Emotional face recognition in adolescent suicide attempters and adolescents engaging in non-suicidal self-injury

Little is known about the bio-behavioral mechanisms underlying and differentiating suicide attempts from non-suicidal self-injury (NSSI) in adolescents. Adolescents who attempt suicide or engage in NSSI often report significant interpersonal and social difficulties. Emotional face recognition ability is a fundamental skill required for successful social interactions, and deficits in this ability may provide insight into the unique brain-behavior interactions underlying suicide attempts versus NSSI in adolescents. Therefore, we examined emotional face recognition ability among three mutually exclusive groups: (1) inpatient adolescents who attempted suicide (SA, n = 30); (2) inpatient adolescents engaged in NSSI (NSSI, n = 30); and (3) typically developing controls (TDC, n = 30) without psychiatric illness. Participants included adolescents aged 13-17 years, matched on age, gender and full-scale IQ. Emotional face recognition was evaluated using the diagnostic assessment of nonverbal accuracy (DANVA-2). Compared to TDC youth, adolescents with NSSI made more errors on child fearful and adult sad face recognition while controlling for psychopathology and medication status (ps < 0.05). No differences were found on emotional face recognition between NSSI and SA groups. Secondary analyses showed that compared to inpatients without major depression, those with major depression made fewer errors on adult sad face recognition even when controlling for group status (p < 0.05). Further, compared to inpatients without generalized anxiety, those with generalized anxiety made fewer recognition errors on adult happy faces even when controlling for group status (p < 0.05). Adolescent inpatients engaged in NSSI showed greater deficits in emotional face recognition than TDC, but not inpatient adolescents who attempted suicide. Further results suggest the importance of psychopathology in emotional face recognition. Replication of these preliminary results and examination of the role of context-dependent emotional processing are needed moving forward.

Clinical Correlates of Non-Suicidal Self-Injury (NSSI) in an Outpatient Sample of Adolescents

Non-suicidal self-injury (NSSI) in adolescents is a major public health concern. The first goal of our study was to describe the characteristics and functions of NSSI and NSSI thoughts in an adolescent outpatient sample. The second goal was to examine which clinical factors discriminate between these two groups of patients. A group of 267 subjects was recruited from the Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 2011 to October 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI). A total of 21.7% of patients reported having engaged in NSSI at least once in their lifetime. The most strongly endorsed function for NSSI was automatic negative reinforcement. In comparison with patients in the NSSI Thoughts group and the control group, patients in the NSSI group scored higher in Internalization of Anger and in all the scales comprising the Children's Depression Inventory. Our findings on the prevalence and functions of NSSI are consistent with the literature. NSSI was mainly performed for emotion regulation purposes; specifically, NSSI seems to be used to cope with anger and depression. In addition, internalization of anger might play a significant role in the maintenance of this behavior.

Non-suicidal self-injury from the observer's perspective: a vignette study

The goal of this study was to understand how friends and family members view and respond to non-suicidal self-injury (NSSI). A sample of college undergraduates read fictional vignettes and indicated why they thought the person engaged in NSSI and how they would respond to the situation. Participants were able to differentiate NSSI from accidental injury and suicide attempts. However, beyond this, there was little differentiation among functions. In terms of responses, participants indicated that they would attempt to maintain the safety of the individual if they observed NSSI directly and would provide emotional support if told about it later. These results suggest that observers may lack understanding of the functions of NSSI, but respond with support.

The associations between non-suicidal self-injury and borderline personality disorder features among Chinese adolescents

This study examined the relative importance of four major BPD features, that is, affective instability, disturbed interpersonal relationship, unstable sense of self, and behavioral impulsivity, in explaining the presence, initiation, repetition, and discontinuation of non-suicidal self-injury (NSSI) among a 2-year follow-up sample of 4,782 (68.5% girls) Hong Kong Chinese secondary school students. Affective instability, disturbed interpersonal relationship and behavioral impulsivity were significantly associated with the presence of NSSI both concurrently and longitudinally. These three BPD features were also related to the future initiation of NSSI. On the other hand, only behavioral impulsivity made a significant contribution to the repetition of NSSI. Additionally, a lower level of affective instability was also associated with quitting NSSI. We discussed some possible mechanisms underlying the effects of different BPD features on different developmental stages of NSSI.

Why Can't We All Just Get Along? Evolutionary Perspectives on Violence, Homicide, and War

We review and discuss the evolutionary psychological literature on violence, homicide, and war in humans and nonhumans, and in doing so argue that an evolutionary perspective can substantially enhance our understanding of these behaviors. We provide a brief primer on evolutionary psychology, describing the basic tenets of the field. The theories of sexual selection and parental investment are explained and subsequently used to highlight the evolutionary logic underlying the use of violence by humans and other animals. Our examination of violent behavior begins with a focus on nonhuman animals, reviewing the different contexts in which violence occurs and discussing how an evolutionary perspective can explain why it occurs in these contexts. We then examine violence in humans and illustrate the similarities and differences between human and nonhuman violence. Finally, we summarize what an evolutionary perspective can offer in terms of understanding violence, homicide, and war, and discuss directions for future research.

Evolutionary theories of depression: a critical review

We critically review evolutionary theories of major depressive disorder (MDD). Because most instances of MDD appear to be caused by adversity, evolutionary theories of MDD generally propose that sadness and low mood evolved as beneficial responses to adversity, and that MDD is dysfunctional sadness and low mood. If so, MDD research should focus much more heavily on understanding the healthy functions of sadness and low mood to better understand how they dysfunction. A debate about the boundary between healthy sadness and MDD is then reviewed. In part, this debate turns on whether MDD's costliest symptoms could provide unknown benefits. Therefore, the review concludes by discussing 2 theories that explore possible benefits of prolonged anhedonia and suicidality.

Self-injury

People have engaged in self-injury-defined as direct and deliberate bodily harm in the absence of suicidal intent-for thousands of years; however, systematic research on this behavior has been lacking. Recent theoretical and empirical work on self-injury has significantly advanced the understanding of this perplexing behavior. Self-injury is most prevalent among adolescents and young adults, typically involves cutting or carving the skin, and has a consistent presentation cross-nationally. Behavioral, physiological, and self-report data suggest that the behavior serves both an intrapersonal function (i.e., decreases aversive affective/cognitive states or increases desired states) and an interpersonal function (i.e., increases social support or removes undesired social demands). There currently are no evidence-based psychological or pharmacological treatments for self-injury. This review presents an integrated theoretical model of the development and maintenance of self-injury that synthesizes prior empirical findings and proposes several testable hypotheses for future research.

Why do People Hurt Themselves? New Insights Into the Nature and Functions of Self-Injury

Nonsuicidal self-injury (NSSI) is a prevalent but perplexing behavior problem in which people deliberately harm themselves without lethal intent. Research reveals that NSSI typically has its onset during early adolescence; most often involves cutting or carving the skin; and appears equally prevalent across sexes, ethnicities, and socioeconomic statuses. Less is known about why people engage in NSSI. This article presents a theoretical model of the development and maintenance of NSSI. Rather than a symptom of mental disorder, NSSI is conceptualized as a harmful behavior that can serve several intrapersonal (e.g., affect regulation) and interpersonal (e.g., help-seeking) functions. Risk of NSSI is increased by general factors that contribute to problems with affect regulation or interpersonal communication (e.g., childhood abuse) and by specific factors that influence the decision to use NSSI rather than some other behavior to serve these functions (e.g., social modeling). This model synthesizes research from several different areas of the literature and points toward several lines of research needed to further advance the understanding of why people hurt themselves.