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Brucato G, Hesson H, Dishy G, Lee K, Pia T, Syed F, Villalobos A, Rogers RT, Corbeil T, Stone MH, Lieberman JA, Appelbaum PS, Girgis RR. An Analysis of Motivating Factors in 1,725 Worldwide Cases of Mass Murder Between 1900-2019. J Forens Psychiatry Psychol 2023; 34:261-274. [PMID: 37600153 PMCID: PMC10435045 DOI: 10.1080/14789949.2023.2208570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/25/2023] [Indexed: 08/22/2023]
Abstract
Mass murder, particularly mass shootings, constitutes a major, growing public health concern. Specific motivations for these acts are not well understood, often overattributed to severe mental illness. Identifying diverse factors motivating mass murders may facilitate prevention. We examined 1,725 global mass murders from 1900-2019, publicly described in English in print or online. We empirically categorized each into one of ten categories reflecting reported primary motivating factors, which were analyzed across mass murderers generally, as well as between U.S- and non-U.S.-based mass-shooters. Psychosis or disorganization related to mental illness were infrequently motivational factors (166; 9.6%), and were significantly more associated with mass murder committed using methods other than firearms. The vast majority (998, 57.86%) of incidents were impulsive and emotionally-driven, following adverse life circumstances. Most mass murderers prompted by emotional upset were found to be driven by despair or extreme sadness over life events (161, 16.13% within the category); romantic rejection or loss, or severe jealousy (204, 20.44% within the category); some specific non-romantic grudge (212, 21.24% within the category); or explosive, overwhelming rage following a dispute (266, 26.65% within the category). Results suggest that policies seeking to prevent mass murder should focus on criminal history, as well as subacute emotional disturbances not associated with severe mental illness in individuals with poor coping skills who have recently experienced negative life events.
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Affiliation(s)
- Gary Brucato
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Hannah Hesson
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Gabriella Dishy
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Kathryn Lee
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Tyler Pia
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Faizan Syed
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Alexandra Villalobos
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - R. Tyler Rogers
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Thomas Corbeil
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Michael H. Stone
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Jeffrey A. Lieberman
- Columbia University Irving Medical Center, Department of Psychiatry, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Paul S. Appelbaum
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
| | - Ragy R. Girgis
- Columbia University Irving Medical Center, Department of Psychiatry, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, N.Y., 10032
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Becker TD, Blasco D, Burrone MS, Dishy G, Velasco P, Reginatto G, Mascayano F, Wu MS, Hu C, Bharadwaj S, Khattar S, Calderon L, Filgueira C, Alvarado R, Susser ES, Yang LH. Stigma toward psychosis in urban Chile: Engaging "what matters most" to resist stigma through recovery-oriented services. Psychiatr Rehabil J 2023; 46:65-73. [PMID: 36548067 DOI: 10.1037/prj0000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. METHODS In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. RESULTS Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, NewYork-Presbyterian Hospital, Weill Cornell Medicine
| | - Drew Blasco
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | | | - Gabriella Dishy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons
| | - Paola Velasco
- Instituto de Ciencias de la Salud, Universidad de O'Higgins
| | | | - Franco Mascayano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons
| | | | - Cindy Hu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University
| | - Simran Bharadwaj
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University
| | - Shivangi Khattar
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Liz Calderon
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University
| | - Cynthia Filgueira
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins
| | - Ezra S Susser
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University
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Hesson HM, Shea EA, Appelbaum PS, Dishy G, Cohen-Romano C, Kennedy L, Bornico M, Lee K, Pia T, Syed F, Villalobos A, Lieberman JA, Wall MM, Brucato G, Girgis RR. Victimology of Mass Shootings and Mass Murders Not Involving Firearms. Violence Vict 2023; 38:15-24. [PMID: 36717195 DOI: 10.1891/vv-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Most research to date has focused on perpetrators of mass murder incidents. Hence, there is little information on victims. We examined 973 mass murders that occurred in the United States between 1900 and 2019 resulting in 5,273 total fatalities and 4,498 nonfatal injuries for a total of 9,771 victims (on average 10 victims per incident). Approximately 64% of victims of mass murder were White individuals, 13% were Black individuals, 6% were Asian individuals, and 14% were Latinx individuals. Given the higher number of nonfatal injuries per non-firearm mass murder event (11.0 vs. 2.8, p < .001), the total number of victims was only 50% higher for mass shootings (5,855 victims) vs. non-firearm mass murder events (3,916 victims). Among the 421 incidents of mass murder in the United States since 2000, Black, Asian, and Native American individuals were overrepresented among victims of mass shootings compared with their representation in the general U.S. population, and White individuals were underrepresented (all p ≤ .002). Findings of racial/ethnic differences were similar among victims of mass murder committed with means other than firearms for Black, Asian, and White individuals. These findings highlight different areas of victimology within the context of these incidents.
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Affiliation(s)
- Hannah M Hesson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Eileen A Shea
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Gabriella Dishy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Carol Cohen-Romano
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Leda Kennedy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Melissa Bornico
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Kathryn Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Tyler Pia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Faizan Syed
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Alexandra Villalobos
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Gary Brucato
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA
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Agrest M, Nemirovsky M, Dishy G, Abadi D, Leiderman E. 'Love comes first, and it is ahead of any different political partisanism': How political polarizations compare to other forms of discrimination in Buenos Aires (Argentina). Int J Soc Psychiatry 2022; 68:808-817. [PMID: 33794687 DOI: 10.1177/00207640211006736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Affective polarization and stigma toward individuals with schizophrenia and toward immigrants in Argentina are not new despite its importance and dissemination. However, no research has been conducted taking into consideration political partisanship and attitudes toward these groups. AIMS Political polarization and attitudes toward socialization across party lines are studied in conjunction with attitudes toward immigrants and toward individuals with schizophrenia. METHOD Individuals from Buenos Aires (n = 712) were surveyed for their political partisanship and their attitudes toward Peruvian and Bolivian immigrants, people with schizophrenia and partisans from the opposing political party. A modified version of the Bogardus scale was used. RESULTS Social distance was from highest to lowest toward people with schizophrenia, political opponents, and immigrants. Individuals with schizophrenia were strongly discriminated against by most participants: 86% would definitely or probably not want them to take care of their children, 83% would not want them to be their healthcare provider, and 81% would not want to marry them. Immigrants were comparatively not discriminated against: 10% would not want them to take care of their children, 8% would not want to receive health care from them, and 28% would not want to marry them. Cristina Fernández de Kirchner partisans showed the lowest level of discrimination toward these two groups, compared to Mauricio Macri partisans and to independent voters. However, the former group had greater discriminatory attitudes toward Mauricio Macri partisans than the latter. CONCLUSIONS As compared to other discriminatory attitudes, discrimination toward persons with schizophrenia is widespread and pervasive. Lower levels of discrimination toward people with schizophrenia and toward immigrants would not predict attitudes toward the opposing political partisans.
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Affiliation(s)
- Martín Agrest
- Proyecto Suma, Community Mental Health Service, Buenos Aires, Argentina
| | - Martín Nemirovsky
- Proyecto Suma, Community Mental Health Service, Buenos Aires, Argentina
| | | | - Daniel Abadi
- Proyecto Suma, Community Mental Health Service, Buenos Aires, Argentina
| | - Eduardo Leiderman
- Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
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Le PD, Agrest M, Mascayano F, Dev S, Kankan T, Dishy G, Tapia-Muñoz T, Tapia E, Toso-Salman J, Pratt C, Alves-Nishioka S, Schilling S, Jorquera MJ, Castro-Valdez J, Geffner N, Price LN, Conover S, Valencia E, Yang LH, Alvarado R, Susser ES. Understanding Users' Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile. Community Ment Health J 2022; 58:111-120. [PMID: 33646493 PMCID: PMC8408283 DOI: 10.1007/s10597-021-00800-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/08/2021] [Indexed: 01/03/2023]
Abstract
This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.
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Affiliation(s)
- PhuongThao D Le
- School of Global Public Health, New York University, New York, USA.
| | | | - Franco Mascayano
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Saloni Dev
- Teachers College, Columbia University, New York, NY, USA
| | - Tanvi Kankan
- Teachers College, Columbia University, New York, NY, USA
| | | | - Thamara Tapia-Muñoz
- Department of Behavioural Science and Health, University College London, London, UK
| | - Eric Tapia
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Charissa Pratt
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Sara Schilling
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - María José Jorquera
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | | | - LeShawndra N Price
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Sarah Conover
- Center for the Advancement of Critical Time Intervention, Silberman School of Social Work, Hunter College, City University of New York, New York, NY, USA
| | - Eliecer Valencia
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Teachers College, Columbia University, New York, NY, USA
| | - Rubén Alvarado
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ezra S Susser
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Kennedy L, Brucato G, Lundgren B, Califano A, Dishy G, Hesson H, Masucci MD, Pia T, Goldberg PH, Xu Q, Wall MM, Girgis RR. Thematic content of obsessive and compulsive symptoms and conversion to psychosis in a clinical high-risk cohort. Early Interv Psychiatry 2021; 15:1423-1428. [PMID: 33047875 DOI: 10.1111/eip.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/11/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
AIM We sought to explore the complex phenomenological overlap between obsessive and compulsive symptoms (OCS), and attenuated positive symptoms among 156 young people at clinical high-risk (CHR) for psychosis. METHODS In order to explore the hypothesis that OCS of an implausible nature might optimally predict future transition to syndromal psychosis, ideas associated with obsessive and compulsive experiences elicited by clinical measures were thematically categorized as "plausible" or "implausible." RESULTS While OCS were found to be common in our CHR sample, we did not find that implausible OCS themes were predictive of conversion. CONCLUSION Given the absence of qualitative differences between OCS and early psychotic symptoms, we propose that clinicians encountering adolescent or young adult patients with new-onset OCD or OCS in the past year should monitor such symptoms for a minimum of 2 years to assess for the possible emergence of psychosis.
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Affiliation(s)
- Leda Kennedy
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Gary Brucato
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Brooke Lundgren
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Allegra Califano
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriella Dishy
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Hannah Hesson
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Michael D Masucci
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Tyler Pia
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Pablo H Goldberg
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Qing Xu
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Melanie M Wall
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
| | - Ragy R Girgis
- New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York, USA
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Brucato G, Appelbaum PS, Hesson H, Shea EA, Dishy G, Lee K, Pia T, Syed F, Villalobos A, Wall MM, Lieberman JA, Girgis RR. Psychotic symptoms in mass shootings v. mass murders not involving firearms: findings from the Columbia mass murder database. Psychol Med 2021; 52:1-9. [PMID: 33595428 DOI: 10.1017/s0033291721000076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mass shootings account for a small fraction of annual worldwide murders, yet disproportionately affect society and influence policy. Evidence suggesting a link between mass shootings and severe mental illness (i.e. involving psychosis) is often misrepresented, generating stigma. Thus, the actual prevalence constitutes a key public health concern. METHODS We examined global personal-cause mass murders from 1900 to 2019, amassed by review of 14 785 murders publicly described in English in print or online, and collected information regarding perpetrator, demographics, legal history, drug use and alcohol misuse, and history of symptoms of psychiatric or neurologic illness using standardized methods. We distinguished whether firearms were or were not used, and, if so, the type (non-automatic v. semi- or fully-automatic). RESULTS We identified 1315 mass murders, 65% of which involved firearms. Lifetime psychotic symptoms were noted among 11% of perpetrators, consistent with previous reports, including 18% of mass murderers who did not use firearms and 8% of those who did (χ2 = 28.0, p < 0.01). US-based mass shooters were more likely to have legal histories, use recreational drugs or misuse alcohol, or have histories of non-psychotic psychiatric or neurologic symptoms. US-based mass shooters with symptoms of any psychiatric or neurologic illness more frequently used semi-or fully-automatic firearms. CONCLUSIONS These results suggest that policies aimed at preventing mass shootings by focusing on serious mental illness, characterized by psychotic symptoms, may have limited impact. Policies such as those targeting firearm access, recreational drug use and alcohol misuse, legal history, and non-psychotic psychopathology might yield more substantial results.
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Affiliation(s)
- Gary Brucato
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Hannah Hesson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Eileen A Shea
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Gabriella Dishy
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Kathryn Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Tyler Pia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Faizan Syed
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Alexandra Villalobos
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 31, New York, NY10032
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Thiel F, Berman Z, Dishy G, Chan S, Seth H, Tokala M, Pitman RK, Dekel S. Traumatic memories of childbirth relate to maternal postpartum posttraumatic stress disorder. J Anxiety Disord 2021; 77:102342. [PMID: 33276245 PMCID: PMC7856222 DOI: 10.1016/j.janxdis.2020.102342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
The trauma memory is a crucial feature of PTSD etiology and maintenance. Nonetheless, the nature of memories associated with childbirth-related posttraumatic stress disorder (CB-PTSD) requires explication. The present study, as part of a larger project on psychological outcomes of childbirth, utilized a multi-method approach to characterize childbirth memories in relation to CB-PTSD symptoms. We here assessed 413 women who completed self-report measures pertaining to CB-PTSD, postpartum depression, and childbirth memories. Additionally, a subset of 209 women provided written childbirth narratives, analyzed using Linguistic Inquiry and Word Count software. Women endorsing CB-PTSD symptoms on the PTSD-Checklist (PCL)-5 reported more incoherent childbirth memories with more emotional and sensory details, and more frequent involuntary recall and reliving of the memory. They also indicated the childbirth experience was more central to their identity. Written narratives in those with probable CB-PTSD were characterized by less (positive) affective processes, and more cognitive processes. We infer that childbirth memories in women who endorse symptoms of CB-PTSD in the early postpartum period resemble those described in the general PTSD literature. This suggests that childbirth may be experienced as traumatic and evoke a traumatic memory, implicated in symptom endorsement. Opportunities for therapeutic interventions modifying traumatic memories of childbirth in women at risk for CB-PTSD need to be investigated. Future research examining characteristics of traumatic childbirth memories is needed to advance our understanding of this overlooked postpartum condition.
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Affiliation(s)
- Freya Thiel
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Zohar Berman
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Gabriella Dishy
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Sabrina Chan
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Himani Seth
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Meghan Tokala
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
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Jutla A, Califano A, Dishy G, Hesson H, Kennedy L, Lundgren B, Pia T, Veenstra-VanderWeele J, Brucato G, Girgis RR. Neurodevelopmental predictors of conversion to schizophrenia and other psychotic disorders in adolescence and young adulthood in clinical high risk individuals. Schizophr Res 2020; 224:170-172. [PMID: 33144031 DOI: 10.1016/j.schres.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/28/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Amandeep Jutla
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA.
| | - Allegra Califano
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Gabriella Dishy
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Hannah Hesson
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Leda Kennedy
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Brooke Lundgren
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Tyler Pia
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | | | - Gary Brucato
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Ragy R Girgis
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
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10
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Thiel F, Ein-Dor T, Dishy G, King A, Dekel S. Examining Symptom Clusters of Childbirth-Related Posttraumatic Stress Disorder. Prim Care Companion CNS Disord 2018; 20. [PMID: 30277674 DOI: 10.4088/pcc.18m02322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022] Open
Abstract
Objective Recent studies document posttraumatic stress disorder (PTSD) symptoms in women following at-term deliveries with health baby outcomes. However, the notion that childbirth can trigger PTSD remains controversial, and the symptom clusters are mostly unknown. The objective of this study was to examine the clustering of childbirth-induced postpartum PTSD (PP-PTSD) symptoms in comparison to DSM-5 clusters. Methods We examined the symptom presentation of childbirth-related postpartum PTSD (PP-PTSD) in a sample of 685 women. The majority of these women delivered at term. Peritraumatic stress reactions to childbirth and PP-PTSD symptoms were assessed approximately 3 months after delivery. A hierarchical cluster analysis was used to detect grouping of the PP-PTSD symptoms. Results Childbirth-related peritraumatic stress was strongly and positively associated with PP-PTSD symptom severity. Cluster modeling revealed 4 distinguished symptom groups: reliving (some reexperiencing symptoms), namely nightmares and flashbacks; avoidance coupled with unwanted memories (other reexperiencing symptoms); negative cognitions and mood; and hyperarousal reactivity. Conclusions Our findings show that the representation of symptoms of PTSD that develops following a stressogenic childbirth experience appears, for the most part, to resemble DSM-5 symptom clusters. More research integrating descriptive symptom assessment with biological measures is warranted to better characterize the symptom presentation of this neglected posttraumatic stress syndrome.
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Affiliation(s)
- Freya Thiel
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,University of Groningen, Grote Kruisstraat 2/1, Groningen, Netherlands
| | | | - Gabriella Dishy
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Amanda King
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129. .,Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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11
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Dekel S, Stuebe C, Dishy G. Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors. Front Psychol 2017; 8:560. [PMID: 28443054 PMCID: PMC5387093 DOI: 10.3389/fpsyg.2017.00560] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Posttraumatic stress related with the childbirth experience of full-term delivery with health outcomes has been recently documented in a growing body of studies. The magnitude of this condition and the factors that might put a woman at risk for developing childbirth-related postpartum posttraumatic stress disorder (PP-PTSD) symptoms are not fully understood. Methods: In this systematic review of 36 articles representing quantitative studies of primarily community samples, we set to examine PP-PTSD prevalence rates and associated predictors with a focus on the role of prior PTSD and time since childbirth. Results: A significant minority of women endorsed PP-PTSD following successful birth. Acute PP-PTSD rates were between 4.6 and 6.3%, and endorsement of clinically significant PP-PTSD symptoms was identified in up to 16.8% of women in community samples of high quality studies. Negative subjective experience of childbirth emerged as the most important predictor. Endorsement of PTSD before childbirth contributed to PP-PTSD; nevertheless, women without PTSD also exhibited PP-PTSD, with acute rates at 4.6%, signifying a new PTSD onset in the postpartum period. Conclusion: Although the majority of women cope well, childbirth for some can be perceived as a highly stressful experience and even result in the development of PP-PTSD symptoms. More research is needed to understand postpartum adaption and childbirth-related posttraumatic stress outcomes.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical SchoolBoston, MA, USA.,Department of Psychiatry, Massachusetts General HospitalCharlestown, MA, USA
| | - Caren Stuebe
- Department of Psychiatry, Massachusetts General HospitalCharlestown, MA, USA
| | - Gabriella Dishy
- Department of Psychiatry, Massachusetts General HospitalCharlestown, MA, USA
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12
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Dekel S, Mamon D, Solomon Z, Lanman O, Dishy G. Can guilt lead to psychological growth following trauma exposure? Psychiatry Res 2016; 236:196-198. [PMID: 26795127 DOI: 10.1016/j.psychres.2016.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/10/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
With the growing interest in posttraumatic growth (PTG) and its predictors, this study examined the relationship between trauma-related guilt and PTG in a sample of veterans over time. Self-reported guilt, PTG, and posttraumatic stress disorder (PTSD) symptoms were measured in combat veterans and prisoners of war (POWs). Positive correlations were found between guilt, PTSD, and PTG levels. Hierarchical regression revealed that initial guilt levels predicted subsequent PTG controlling for initial PTSD in combat veterans but not in POWs. The findings suggest that posttraumatic growth can be facilitated by trauma-related guilt, underscoring the complex relationship between positive and negative trauma outcomes.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | | | - Zahava Solomon
- School of Social Work, Tel Aviv University, Tel Aviv, Israel; I-Core Research Center for Mass Trauma, Tel Aviv, Israel
| | - Olivia Lanman
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA; Boston University, Boston, MA, USA
| | - Gabriella Dishy
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA; Northeastern University, Boston, MA, USA
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