Development and validation of the self-injury stigma scale

Non-suicidal self-injury is a prevalent and concerning behavior. Negative beliefs and stereotypes about NSSI are associated with negative outcomes, and negative, self-referential beliefs (e.g., self-stigmatizing beliefs) related to engagement in NSSI may be particularly harmful. Despite this, there is no validated measure specifically designed to assess for NSSI self-stigma. As this significantly hinders the ability to understand and quantify the effect of NSSI self-stigma, this study sought to validate the newly developed Self-Injury Stigma Scale (SISS). It was hypothesized the SISS would follow a four-factor structure that parallels a widely cited theoretical model of stigma. It was also hypothesized measures of shame and help-seeking self-stigma would be moderately, negatively, correlated with the SISS subscales, supporting the measure's validity. Participants from Study 1 were college students (n = 264, 65.8% female) with at least one lifetime NSSI act. A series of factor analytic models revealed a one-factor structure for the Application of Stigma subscale (i.e., third step of the four-step model). As this was the only SISS subscale to achieve an appropriate model fit, this scale alone was retained as the final SISS. The factor structure was tested via confirmatory factor analysis on a second sample (i.e., community participants with at least one past month of NSSI act; n = 240, 41.3% female). An acceptable fit on most, but not all, indices was reached. Convergent and discriminant validity were supported. The SISS retrospectively predicted past 3 month NSSI frequency and method versatility, and lifetime NSSI versatility, but not lifetime NSSI frequency or disclosure. Thus, the clinical utility of the SISS was partially supported. Findings offering evidence in favor of the SISS's appropriateness and utility as a measure of self-stigma of NSSI. Future work using this measure has the potential to clarify the risk associated with NSSI self-stigma and inform behavioral interventions.

On the Selection of Item Scores or Composite Scores for Clinical Prediction

Recent shifts to prioritize prediction, rather than explanation, in psychological science have increased applications of predictive modeling methods. However, composite predictors, such as sum scores, are still commonly used in practice. The motivations behind composite test scores are largely intertwined with reducing the influence of measurement error in answering explanatory questions. But this may be detrimental for predictive aims. The present paper examines the impact of utilizing composite or item-level predictors in linear regression. A mathematical examination of the bias-variance decomposition of prediction error in the presence of measurement error is provided. It is shown that prediction bias, which may be exacerbated by composite scoring, drives prediction error for linear regression. This may be particularly salient when composite scores are comprised of heterogeneous items such as in clinical scales where items correspond to symptoms. With sufficiently large training samples, the increased prediction variance associated with item scores becomes negligible even when composite scores are sufficient. Practical implications of predictor scoring are examined in an empirical example predicting suicidal ideation from various depression scales. Results show that item scores can markedly improve prediction particularly for symptom-based scales. Cross-validation methods can be used to empirically justify predictor scoring decisions.

A Phase 1 Single-Ascending-Dose Trial in Healthy Volunteers to Evaluate the Safety, Tolerability, Pharmacokinetics, and Immunogenicity of Intravenous PNT001, a Novel Mid-domain Tau Antibody Targeting cis-pT231 Tau

BACKGROUND

PNT001 is a humanized full-length IgG4 S228P monoclonal antibody that binds the cis conformation of the phosphorylated Thr231-Pro232 motif in human full-length (2N4R) tau (cis-pT231 tau) with high selectivity and affinity. It binds selectively to cis-pT231 tau in human tauopathy brain sections, inhibits aggregation of tau, and has shown efficacy in preclinical models of tauopathy. Good Laboratory Practice six-month toxicology studies in cynomolgous monkeys have shown no test article-related findings.

OBJECTIVES

To evaluate the safety, tolerability, pharmacokinetics, and immunogenicity of single escalating intravenous doses of PNT001 in healthy volunteers.

DESIGN

Phase 1, randomized, double-blind, and placebo-controlled 16-week study.

SETTING

Subjects were recruited across three clinical research sites in the United States.

PARTICIPANTS

Fifty healthy volunteer subjects enrolled, with 49 receiving the double-blind study drug.

INTERVENTION

Six cohorts were administered single escalating doses of PNT001 (33, 100, 300, 900, 2,700, and 4,000 mg). The subjects were randomized 6:2 (PNT001:placebo).

MEASUREMENTS

Safety was evaluated by the occurrence of adverse events, electrocardiography, physical examinations, neurological examinations, vital signs, and suicidality. Pharmacokinetics and biomarkers were assessed via serum and cerebrospinal fluid sample analyses.

RESULTS

Dose continuation after review of sentinel group data and dose escalation after completion of full cohort data were determined by an external, independent safety board. There were no study pauses or safety concerns identified by the safety board. A total of 49 subjects received the study drugs, with 36 receiving PNT001 and 13 receiving placebo. There were three related non-serious adverse events, each Grade 1, which occurred at the lowest doses and resolved without sequelae. No maximum tolerated dose was identified, and no premature discontinuations, dose reductions, or interruptions due to treatment-related adverse events occurred. One unrelated serious adverse event occurred in a placebo subject with an undisclosed medical condition. No other safety findings were identified. Doses of 900-4,000 mg produced concentrations in the cerebrospinal fluid exceeding the binding affinity constant of PNT001 for cis-pT231 tau (45 ng/mL), indicating that concentrations sufficient for target engagement can be obtained in the cerebrospinal fluid within the tested dose range. The serum pharmacokinetic profile was as expected for a monoclonal antibody. The terminal half-lives ranged from 23.8-33.8 days, and the cerebrospinal fluid exposures were approximately 0.1% of the plasma concentration and dose-proportional. Of the 36 subjects receiving PNT001, one post-baseline positive anti-drug antibody result was observed at Day 112 in a subject who received PNT001 (300 mg).

CONCLUSIONS

Single doses of PNT001 were safe and well-tolerated at all dose levels studied, including those doses expected to produce therapeutic benefit. These results support multiple ascending dose trials in patients with neurodegenerative tauopathies for this novel mid-domain tau antibody.

Measurement invariance and response consistency of single-item assessments for suicidal thoughts and behaviors

The present study aimed to expand the literature on single-item assessments for suicidal thoughts and behaviors (STBs) by examining measurement invariance of commonly used single-item assessments of suicidal ideation (SI), planning (SP), and attempts (SA) with respect to race and ethnicity. Predictive invariance with respect to depression, and multi-item measures of passive and active SI were also explored. Measurement invariance was examined across (a) Black and White respondents and (b) Hispanic/Latinx and non-Hispanic/-Latinx respondents. Participants (N = 1,624; 51.66% male) were recruited from Mechanical Turk and Prime Panels. Participants were administered four distinct single-item measures each for SI, SP, and SA across three timeframes (past month, past year, lifetime). Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey) and common suicide risk assessments. Multiple group confirmatory factor analysis was used to examine measurement invariance; regression with group by measure interactions were used to evaluate predictive invariance. Measurement invariance was observed for both Black (N = 534) and White (N = 1,089) respondents as well as Hispanic/Latinx (N = 335) and non-Hispanic/-Latinx (N = 1,288) respondents across single-item outcomes. Thus, SI, SP, and SA rates can be defensibly compared between Black and White and Hispanic/Latinx and non-Hispanic/-Latinx respondents within studies; however, comparison of SI and SP rates across studies with differing assessment prompts should be met with caution. Multiple single-item STB measures demonstrated predictive bias across race and ethnicity suggesting potential differential screening capabilities. Elevated SI, SP, and SA rates for Hispanic/Latinx individuals were also observed. Findings reiterate the importance of minor language differences in single-item STB assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparing the role of perceived burdensomeness and thwarted belongingness in prospectively predicting active suicidal ideation

OBJECTIVE

The Interpersonal Theory of Suicide has been foundational in guiding current suicide literature. Despite recent research underscoring fluctuations of suicidal ideation within hours, there have been few studies examining the key constructs of perceived burdensomeness and thwarted belongingness within an intensive framework. Thus, the current study aimed to add cumulative knowledge regarding the within-person relationship between perceived burdensomeness, thwarted belongingness, and active suicidal ideation as assessed within an ecological momentary assessment design.

METHOD

A final sample of 35 individuals with a past-year history of suicidal thoughts or behaviors completed brief surveys four times per day for 30 days.

RESULTS

Findings highlighted that the addition of covariates may offer small improvements in modeling subsequent suicidal ideation, while controlling for SI at the prior time. Further, both thwarted belongingness and perceived burdensomeness were associated with next timepoint suicidal ideation, and their interaction added little incremental value.

CONCLUSION

Findings demonstrate the potential importance of thwarted belongingness in predicting suicidal ideation. Further, results highlight that the main effects of thwarted belongingness and perceived burdensomeness, rather than their interaction, may be more important to consider in relation to active suicidal ideation.

How we ask matters: The impact of question wording in single-item measurement of suicidal thoughts and behaviors

The present study aimed to extend prior literature on single-item assessment by examining response consistency (1) between several commonly used single-item assessments of suicidal ideation, planning, and attempts, and (2) across three timeframes (past month, past year, and lifetime) commonly employed in the literature. Participants (N = 613) were recruited from an online community, Amazon Mechanical Turk (mTurk). Participants were administered three sets of four distinct single-items assessing suicidal ideation, suicidal planning, and suicide attempt history, respecitvely. Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey; World Health Organization Mental Health Survey Initiative, Youth Risk Behavior Survey) and commonly used suicide risk assessments (i.e., Self-Injurious Thoughts and Behaviors Interview). Through examinations of intraclass correlations and confirmatory factor analyses, findings suggested mixed response agreement across most outcomes and timeframes. Response inconsistency among items assessing suicidal ideation and among items assessing suicidal planning were partly attributed to minor, yet important, language differences. Given findings that even minor language changes in suicidal ideation and planning items may inflate or restrict prevalence estimates in a meaningful way, it will be important for researchers and clinicians alike to pay close attention to the wording of single items in designing research studies, interpreting findings, and assessing patient risk.

A prospective examination of COVID-19-related social distancing practices on suicidal ideation

BACKGROUND

The COVID-19 pandemic has spurred the implementation of several public safety measures to contain virus spread, most notably socially distancing policies. Prior research has linked similar public safety measures (i.e., quarantine) with suicide risk, in addition to supporting the role of social connection in suicidal thoughts and behaviors; consequently, there is a need to better understand the relationship between widespread social distancing policies and suicide risk. The current study aimed to examine the prospective association between COVID-19-related social distancing practices and suicidal ideation.

METHODS

Participants (N = 472) completed measures of suicidal ideation and impacts of social distancing practices at baseline and two weeks later.

RESULTS

After controlling for general psychosocial distress (i.e., depression, social connectedness), cross-lagged regression models identified prospective, bidirectional relationships between perceived impacts of social distancing on one's mental health and both passive and active suicidal ideation. The impact of social distancing on work/social routine was not associated with suicidal ideation.

CONCLUSIONS

Overall, findings suggest the importance of an individual's perception regarding the effect of social distancing on their mental health, rather than the disruption to work or social routine, in suicide risk. Findings highlight potential targets for suicide risk prevention and intervention.

Preliminary investigation of the association between COVID-19 and suicidal thoughts and behaviors in the U.S

Evidence suggests that the negative consequences of COVID-19 may extend far beyond its considerable death toll, having a significant impact on psychological well-being. Despite work highlighting the link between previous epidemics and elevated suicide rates, there is limited research on the relationship between the COVID-19 pandemic and suicidal thoughts and behaviors. Utilizing an online survey, the current study aimed to better understand the presence, and extent, of the association between COVID-19-related experiences and past-month suicidal thoughts and behaviors among adults in the United States recruited via Amazon Mechanical Turk (n = 907). Results support an association between several COVID-19-related experiences (i.e., general distress, fear of physical harm, effects of social distancing policies) and past-month suicidal ideation and suicide attempts. Further, a significant proportion of those with recent suicidal ideation explicitly link their suicidal thoughts to COVID-19. Exploratory analyses highlight a potential additional link between COVID-19 and suicidal behavior, suggesting that a portion of individuals may be intentionally exposing themselves to the virus with intent to kill themselves. These findings underscore the need for suicide risk screening and access to mental health services during the current pandemic. Particular attention should be paid to employing public health campaigns to disseminate information on such services to reduce the enormity of distress and emotional impairment associated with COVID-19 in the United States.

On the thermal elevation of a 60-electrode epiretinal prosthesis for the blind

In this paper, the thermal elevation in the human body due to the operation of a dual-unit epiretinal prosthesis to restore partial vision to the blind affected by irreversible retinal degeneration is presented. An accurate computational model of a 60-electrode device dissipating 97 mW power, currently under clinical trials is developed and positioned in a 0.25 mm resolution, heterogeneous model of the human head to resemble actual conditions of operation of the prosthesis. A novel simple finite difference scheme combining the explicit and the alternating-direction implicit (ADI) method has been developed and validated with existing methods. Simulation speed improvement up to 11 times was obtained for the the head model considered in this work with very good accuracy. Using this method, solutions of the bioheat equation were obtained for different placements of the implant. Comparison with in-vivo experimental measurements showed good agreement.

Diverse signaling pathways activated by growth factor receptors induce broadly overlapping, rather than independent, sets of genes

We sought to explore the relationship between receptor tyrosine kinase (RTK) activated signaling pathways and the transcriptional induction of immediate early genes (IEGs). Using global expression monitoring, we identified 66 fibroblast IEGs induced by platelet-derived growth factor beta receptor (PDGFRbeta) signaling. Mutant receptors lacking binding sites for activation of the PLCgamma, PI3K, SHP2, and RasGAP pathways still retain partial ability to induce 64 of these IEGs. Removal of the Grb2-binding site further broadly reduces induction. These results suggest that the diverse pathways exert broadly overlapping effects on IEG induction. Interestingly, a mutant receptor that restores the RasGAP-binding site promotes induction of an independent group of genes, normally induced by interferons. Finally, we compare the PDGFRbeta and fibroblast growth factor receptor 1; each induces essentially identical IEGs in fibroblasts.

Effect of preadmission brochures on surgical patients' behavioral outcomes

This study tested the effects of preadmission teaching brochures on morning admission surgical patients' performance of specific postoperative exercises, teaching time, state anxiety, length of hospital stay, patient satisfaction, and return to functional status. The study participants were 38 women undergoing abdominal hysterectomies. Although the study results show no significant difference between those who received the preoperative teaching brochures and those who did not, the implications for further research are clearly defined. Preoperative nursing interventions that may help patients undergoing hysterectomies manage anxiety and return to function should be tested further.

Integration of neuropsychological and behavioral neurological assessment in psychiatry: a case example involving brain injury and polypharmacy

We present a case example that highlights the need for careful neurologic and neuropsychological reevaluations of psychiatric patients who sustain head injuries, and also illustrates the concept that psychopharmacological interventions may impair cognitive performance, especially in a brain-damaged person. As in a previous paper (Weinstein et al. 1991), we emphasize the importance of a multidisciplinary diagnostic and treatment approach that carefully considers psychodynamic, cultural, and neurobiological data. In our experience, a neuropsychological approach is particularly helpful in cases: (1) where brain dysfunction is suspected but focal neurological signs are not identified, and (2) where frank symptoms of medication toxicity are absent but cognitive impairment is greater than expected.

Milk antimicrobial drug residue assay results in cattle with experimental, endotoxin-induced mastitis

Antimicrobial drug residue testing was performed on milk samples obtained from 8 cows with experimental endotoxin-induced mastitis, using 4 commercially available assay kits. Although none of the cows in the study received antimicrobials, only 1 of the 4 assay procedures, assay C, had consistently negative results (specificity = 1.00). The proportion of positive assay results varied from 0 to 1.00 among combinations of sampling time, sample status (endotoxin-infused quarter vs composite noninfused sample). The proportion of positive results found when assay C was used (0) differed significantly from the proportion found when the 3 other assays were used. The proportion of positive results did not differ significantly between assay A (0.45) and assay B (0.48); however, both assays had a significantly lower proportion of positive assays than did assay D (0.86). Logistic regression models were developed predicting positive milk antimicrobial drug residue assay results as a function of assay kit, sample status, and time interval following experimental challenge exposure. Using assay A as a baseline risk, assay B and assay D were more likely to have positive assay results, and assay C had a decreased risk of positive assay results. Milk samples from endotoxin-infused quarters were at increased risk for positive assay results, compared with noninfused composite samples. Samples collected from endotoxin-infused quarters or control quarters were at increased risk for positive assay results following the intramammary infusion of endotoxin. Our findings suggest that specificity of milk antimicrobial drug residue assays varies greatly among assay kits and that intramammary inflammation may increase the proportion of false-positive assay results.