Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

Mortier, P., Conde, S., et al. (2024).

JAMA Network Open, 7(6), e2417131.

Link to article

Key Points

Question  What is the risk for premature death, suicide, and nonlethal intentional self-harm following discharge from psychiatric hospitalization?

Findings  In this cohort study including 49 108 patients, risk for postdischarge premature death (age <70 years) and suicide was significantly higher compared with the general population. Premature death was associated with cognitive disorders and alcohol-related disorders in both sexes; suicide was associated with postdischarge nonlethal intentional self-harm in both sexes, with depressive and adjustment disorders in males, and with bipolar disorder in females.

Meaning  The findings suggest individuals discharged from psychiatric inpatient care constitute a vulnerable population for premature death and suicidal behavior.

Here are some thoughts:

This study has shed light on a concerning reality: individuals discharged from psychiatric hospitalization face a significantly higher risk of premature death, suicide, and self-harm compared to the general population. This highlights the need for increased support and prevention strategies.

The study revealed specific mental health diagnoses, like cognitive and alcohol-related disorders, linked to a greater risk of premature death. Additionally, prior self-harm episodes and certain diagnoses, such as adjustment disorders and depression (males) or bipolar disorder (females), were identified as risk factors for suicide after discharge. The study also offers valuable insights into the prevalence of non-lethal self-harm, emphasizing the ongoing need for intervention.

These findings have significant implications. Early interventions for mental health conditions, particularly those linked to a higher risk of premature death, are crucial. Additionally, tailored support programs are essential for individuals with specific diagnoses and histories of self-harm. The study underscores the importance of robust aftercare plans that address suicide risk and self-harm tendencies as patients transition from inpatient care. Furthermore, the higher suicide rates among females discharged from care suggest potential disparities in access to treatment, highlighting the need for gender-sensitive approaches.

This research compels us to take action. We must advocate for increased resources for mental health services, raise awareness about suicide prevention and self-harm support systems, and work to reduce the stigma surrounding mental health conditions. By discussing these critical findings, we can contribute to a broader conversation about improving mental health outcomes and ensuring the well-being of individuals after discharge from psychiatric care.

A rural-urban political divide among whom? Race, ethnicity, and political behavior across place

Brown, T. E., et al. (2024).

Politics, Groups & Identities/Politics, Groups,

and Identities, 1–14.

https://doi.org/10.1080/21565503.2024.2328551

Abstract

Over the past 30 years, the United States has developed a rural-urban political divide, as rural voters have become increasingly reliable Republican voters while long-term patterns of Democratic voting in the largest cities have also consolidated in many smaller cities and suburbs as well. Yet, although 1 in 4 rural dwellers now identify as people of color, research on the rural-urban divide has either mostly centered on the behavior and attitudes of non-Hispanic whites, or assumed that nonwhites have exhibited similar behavior to whites. Does this political cleavage exist among people of color? We find that the growing rural-urban divide is driven primarily by white Americans, while rural people of color differ much less, if at all, from their urban counterparts in voting behavior and policy attitudes. In addition to highlighting the need for more research on the politics of rural people of color, our findings raise concerns about the political representation of rural Black Americans and Latinos.

Here are some thoughts:

The Rural-Urban Divide: Race Matters More Than You Think

For decades, the political landscape has been reshaped by a growing divide between rural and urban America. This research explores the complexities of this divide, particularly how race and ethnicity influence voting patterns and policy preferences.

The Widening Gap (But Not for Everyone)

Traditionally, rural and urban voters exhibited similar preferences. However, since the 2000s, a stark divide has emerged.  While rural voters have increasingly leaned Republican, Democratic support has solidified in cities. This trend, however, seems to hold true primarily for non-Hispanic whites.

People of Color: A Different Story

The research presented here sheds light on a crucial aspect often overlooked: the experiences of people of color in rural areas.  The data shows a surprising trend - Black and Latino voters, despite residing in rural areas, haven't mirrored the shift towards the Republican party seen in white voters. This challenges the notion that the rural-urban divide is solely driven by economic factors or cultural issues.

Beyond Economics: The Psychological Factors

The concept of "linked fate" might explain this phenomenon. Black and Latino voters may feel a stronger sense of solidarity with their racial/ethnic group, leading them to vote Democrat regardless of their location.  "Racialized social constraint" could also be at play, where social pressures within these communities influence voting behavior. Additionally, Republican rhetoric might be alienating these voters.

A Call for More Research

This study highlights the need for further investigation into the political experiences of rural people of color.  Future research should not only explore the voting behavior of Black and Latino populations but also delve into the experiences of other marginalized groups. Understanding the psychological aspects of race and ethnicity within the rural-urban divide is crucial for a more comprehensive picture of American politics.

In Conclusion

The rural-urban divide is a complex issue with racial undertones. While economic factors play a role, the experiences of people of color challenge simplistic explanations.  Further research that considers the psychological aspects of race and ethnicity is essential for bridging this divide and fostering a more inclusive democracy.

Moral foundations elicit shared and dissociable cortical activation modulated by political ideology.

Hopp, F.R., Amir, O., Fisher, J.T. et al.

Nat Hum Behav 7, 2182–2198 (2023).

https://doi.org/10.1038/s41562-023-01693-8

Abstract

Moral foundations theory (MFT) holds that moral judgements are driven by modular and ideologically variable moral foundations but where and how these foundations are represented in the brain and shaped by political beliefs remains an open question. Using a moral vignette judgement task (n = 64), we probed the neural (dis)unity of moral foundations. Univariate analyses revealed that moral judgement of moral foundations, versus conventional norms, reliably recruits core areas implicated in theory of mind. Yet, multivariate pattern analysis demonstrated that each moral foundation elicits dissociable neural representations distributed throughout the cortex. As predicted by MFT, individuals’ liberal or conservative orientation modulated neural responses to moral foundations. Our results confirm that each moral foundation recruits domain-general mechanisms of social cognition but also has a dissociable neural signature malleable by sociomoral experience. We discuss these findings in view of unified versus dissociable accounts of morality and their neurological support for MFT.

A pdf is here.

Here is a summary, of sorts:

This fMRI study investigated the neural basis of moral judgment using Moral Foundations Theory (MFT). The findings suggest that while moral foundations share some common brain regions with social norm judgments, they also have distinct neural signatures. This supports the theory that moral foundations are not isolated modules but rather rely on distributed brain systems.

Interestingly, the study also revealed that judging violations of group-oriented moral foundations (loyalty, authority, sanctity) activates brain regions associated with processing others, compared to individual-focused foundations (care, fairness). Additionally, liberals and conservatives showed distinct neural responses to moral foundations, suggesting that political ideology influences the emotional experience of moral violations. Overall, the study strengthens MFT's framework by demonstrating a neural basis for moral foundations and highlighting the role of political ideology in moral judgment.

“Abuser” or “Tough Love” Boss?: The moderating role of leader performance in shaping the labels employees use in response to abusive supervision

Lount, R. B., Choi, W., & Tepper, B. J. (2024).

Organizational Behavior and

Human Decision Processes, 183, 104339.

https://doi.org/10.1016/j.obhdp.2024.104339

Abstract

We invoke leader categorization theory and labeling theory to examine the circumstances under which individuals come to perceive their managerial leaders as “abusers” or “tough love” bosses. In a field study, we show that leader performance moderates the relationship between a leader’s abusive supervision and the degree to which their followers label them as an abuser or a tough love leader. Heightened leader performance lowers the willingness to label the leader as an “abuser” while increasing one’s labeling the leader as a “tough love” boss. This study also documents that leader performance moderates the indirect effect between abusive supervision and upward hostility (through abuser labeling) and the indirect effect between abusive supervision and positive career expectations (through tough love labeling). In a follow-up experiment, we again document that leader performance moderates the relationship between abusive supervision and the degree to which followers label their leaders as an abuser. Additionally, we provide support for a moderated indirect effect on a range of negative behavioral outcomes directed toward the leader through abuser labeling. We discuss the studies’ implications for theory, future research, and practice pertaining to abusive supervision.

Highlights

• Leader performance moderates labeling leaders who display abusive supervision.

• High leader performance weakens abuser labeling following abusive supervision.

• High leader performance strengthens tough love labeling following abusive supervision.

• Abuser labeling promotes upward hostility toward supervisor.

• Tough love labeling promotes increased career expectations.

The ethics of personalised digital duplicates: a minimally viable permissibility principle

Danaher, J., Nyholm, S.

AI Ethics (2024).

https://doi.org/10.1007/s43681-024-00513-7

Abstract

With recent technological advances, it is possible to create personalised digital duplicates. These are partial, at least semi-autonomous, recreations of real people in digital form. Should such duplicates be created? When can they be used? This article develops a general framework for thinking about the ethics of digital duplicates. It starts by clarifying the object of inquiry– digital duplicates themselves– defining them, giving examples, and justifying the focus on them rather than other kinds of artificial being. It then identifies a set of generic harms and benefits associated with digital duplicates and uses this as the basis for formulating a minimally viable permissible principle (MVPP) that stipulates widely agreeable conditions that should be met in order for the creation and use of digital duplicates to be ethically permissible. It concludes by assessing whether it is possible for those conditions to be met in practice, and whether it is possible for the use of digital duplicates to be more or less permissible.

Here are some thoughts:

Artificial intelligence advancements are making digital duplicates, recreations of real people in digital form, a more realistic possibility. This presentation explores the ethical considerations surrounding this new technology. The text defines "personalized digital duplicates" and clarifies how they differ from other AI creations.

A key concept introduced in the text is the "minimally viable permissible principle" (MVPP). This framework can be used to assess the ethics of creating and using digital duplicates in specific situations. The MVPP considers factors such as informed consent, potential benefits and harms, transparency, and whether the real person's presence is truly necessary.

The text acknowledges that the MVPP doesn't determine if creating a specific digital duplicate is a good idea, only if it's ethically permissible. Additionally, the authors recognize that permissibility can exist on a spectrum. There will be situations where creating a digital duplicate is clearly permissible, while others may be ethically questionable. The text concludes by calling for further research to weigh the potential benefits and harms of this technology.

Just brainstorming wildly here: The creation of a therapist's digital duplicate could provide wider access to psychotherapy services and enhance revenue, but ethical considerations around confidentiality, transparency, standards of care, psychologist responsibility, a lack of outcome data, safety, risk management, and the therapeutic relationship would need to be addressed.

Communal Narcissism and Sadism as Predictors of Everyday Vigilantism

Chen, F. X., Ok, E., & Aquino, K. (2023).

Personality Science, 4(1).

https://doi.org/10.5964/ps.10523

Abstract

Vigilantes monitor their social environment for signs of wrongdoing and administer unauthorized punishment on those who they perceive to be violating laws, social norms, or moral standards. We investigated whether the willingness to become a vigilante can be predicted by grandiose self-perceptions about one's communality (communal narcissism) and enjoyment of cruelty (sadism). As hypothesized, findings demonstrated both variables to be positively related to becoming a vigilante as measured by reports of past and anticipated vigilante behavior (Study 1) and by dispositional tendencies toward vigilantism (Studies 1 and 2). We also found communal narcissism and sadism predicted the perceived effectiveness of vigilante actions exhibited by others (Study 2) and the intention to engage in vigilantism after witnessing a norm violation (Study 3). Finally, Study 3 also demonstrated that the tendency for communal narcissists and sadists to become a vigilante might vary based on the expected consequences of the observed norm violation.

Relevance Statement

A prosocial orientation and cruelty seem antithetical. However, our results showed that these traits may converge in predicting individuals’ tendency to become a vigilante, marked by imposing unauthorized punishments on others.

Key Insights

• We study factors that predict willingness to become a vigilante.
• We found that communal narcissism predicted vigilante tendencies.
• Sadism was also a significant predictor of vigilantism.
• Effects hold even after controlling for demographic covariates.

Some thoughts as a clinical psychologist

This research on communal narcissism and sadism as factors in vigilantism is interesting from a clinical perspective. It sheds light on the motivations behind individuals who take justice into their own hands, often in ways that can be harmful.

The focus on communal narcissism, where people believe their group is superior and deserves special treatment, resonates with our understanding of in-group/out-group dynamics. These individuals might see themselves as righteous defenders of their community's morals, justifying their aggressive actions.

The link to sadism, the enjoyment of inflicting suffering, suggests a darker side to vigilantism. It's important to consider how a desire for control or even punishment might fuel some vigilante behavior, potentially escalating situations and overshadowing any sense of justice.

Crying wolf: Warning about societal risks can be reputationally risky

Caviola, L., Coleman, M. B., 

Winter, C., & Lewis, J. (2024, June 14).

https://doi.org/10.31234/osf.io/gtr53

Abstract

Society relies on expert warnings about large-scale risks like pandemics and natural disasters. Across ten studies (N = 5,342), we demonstrate people’s reluctance to warn about unlikely but large-scale risks because they are concerned about being blamed for being wrong. In particular, warners anticipate that if the risk doesn’t occur, they will be perceived as overly alarmist and responsible for wasting societal resources. This phenomenon appears in the context of natural, technological, and financial risks and in US and Chinese samples, local policymakers, AI researchers, and legal experts. The reluctance to warn is aggravated when the warner will be held epistemically responsible, such as when they are the only warner and when the risk is speculative, lacking objective evidence. A remedy is offering anonymous expert warning systems. Our studies emphasize the need for societal risk management policies to consider psychological biases and social incentives.

The research is here.

Here are some thoughts:

The research on the "crying wolf" phenomenon is crucial for clinical psychologists as it delves into the psychological and social dynamics of risk communication and trust. Clinical psychologists often work with individuals and communities to manage anxiety and stress related to perceived threats.

Understanding how repeated false alarms can lead to desensitization and reduced trust in warnings helps psychologists develop better strategies for communicating risks without causing undue alarm or complacency. This knowledge is particularly relevant in therapeutic settings where clients may struggle with anxiety disorders exacerbated by frequent, yet unfounded, warnings about societal risks.

Moreover, the study highlights the reputational risks faced by those who issue warnings, which can be a significant concern for mental health professionals who must balance the need to alert clients to potential dangers with the risk of being perceived as alarmist. This balance is critical in maintaining the therapeutic alliance and ensuring that clients continue to trust and follow professional advice. By understanding the dynamics of the "crying wolf" effect, clinical psychologists can better navigate these challenges, ensuring that their warnings are taken seriously without causing unnecessary panic or skepticism.

Finally, the research underscores the importance of effective communication strategies in mitigating the negative impacts of the "crying wolf" effect. Clinical psychologists can apply these insights to improve their own communication with clients, particularly in crisis situations. By adopting evidence-based approaches to risk communication, psychologists can help clients make informed decisions, reduce anxiety, and foster resilience. This is especially pertinent in the context of public health crises, natural disasters, and other scenarios where accurate and trusted communication can significantly impact mental health outcomes.

The Supreme Court upholds the conviction of woman who challenged expert testimony in a drug case

Lindsay Whitehurst

apnews.com

originally posted 20 June 24

The Supreme Court on Thursday upheld the conviction of a California woman who said she did not know about a stash of methamphetamine hidden inside her car.

In a ruling that crossed the court’s ideological lines, the 6-3 majority opinion dismissed arguments that an expert witness for the prosecution had gone too far in describing the woman’s mindset when he said that most larger scale drug couriers are aware of what they are transporting.

“An opinion about most couriers is not an opinion about all couriers,” said Justice Clarence Thomas, who wrote the decision. He was joined by fellow conservatives Chief Justice John Roberts, Justices Samuel Alito, Brett Kavanaugh and Amy Coney Barrett as well as liberal Justice Ketanji Brown Jackson.

In a sharp dissent, conservative Justice Neil Gorsuch wrote that the ruling gives the government a “powerful new tool in its pocket.”

“Prosecutors can now put an expert on the stand — someone who apparently has the convenient ability to read minds — and let him hold forth on what ‘most’ people like the defendant think when they commit a legally proscribed act. Then, the government need do no more than urge the jury to find that the defendant is like ‘most’ people and convict,” he wrote. Joining him were the court’s other liberal justices, Sonia Sotomayor and Elena Kagan.

The info is here.

Here are some thoughts:

The recent Supreme Court case involving a woman convicted of drug trafficking highlights a complex issue surrounding expert testimony, particularly for psychologists. In this case, the prosecution's expert offered an opinion on the general awareness of large-scale drug couriers, which the defense argued unfairly portrayed the defendant's mindset. While the Court allowed the testimony, it leaves some psychologists concerned.

The potential for expert testimony to blur the lines between general patterns and specific defendant behavior is a worry. Psychologists strive to present nuanced assessments based on individual cases. This ruling might incentivize broader generalizations, which could risk prejudicing juries against defendants. It's crucial to find a balance between allowing experts to provide helpful insights and ensuring they don't overstep into determining a defendant's guilt.

Moving forward, psychologists offering expert testimony may need to tread carefully.  They should ensure their testimony focuses on established psychological principles and avoids commenting on a specific defendant's knowledge or intent. This case underscores the importance of clear guidelines for expert witnesses to uphold the integrity of the justice system.

Turn a Kind Eye-Offering Positive Reframing

Menzin E. R. (2024).

JAMA internal medicine.

Advance online publication.

https://doi.org/10.1001/jamainternmed.2024.2379

Here is an excerpt:

I have seen many patients struggle with anxiety and obsessive-compulsive disorder. I firmly believe in my obligation to connect them with evidence-based therapy and offer pharmacologic treatment. The cognitive behavioral therapy technique of reframing, which is so useful for treating anxiety disorders, can serve as a useful lens for the disorder itself.1 I try to reframe by pointing out their ability to see patterns and the strengths intrinsic to this nonneurotypical brain. Perhaps with this mindset, they can look at their behaviors with grace.

Physicians are problem solvers by nature and training. When faced with symptoms, we tend to go directly for the cure. When there are no or only suboptimal solutions, we tend to offer sympathy instead of strategy. Rather than apologize, we can reframe build the scaffolding to allow patients to change their thought patterns. As with all strategies, this is not universally applicable. You cannot positively reframe a life-threatening diagnosis; to do so insults and minimizes the patient's distress. There are times to sit with patients as their house crumbles, and there are times to help them reframe the chaos.

Recently, I saw this done in another unlikely corner. I took my 89-year-old father to discuss a shoulder replacement with the orthopedist. "Hang on," the surgeon exclaimed enthusiastically, holding his capable hands in the air. "Before we talk about the surgical options, you tore your rotator cuff skiing Killington at 86? That's amazing!" With that phrase, he reframed my father's injury from the frailty of old age to a badge of athletic honor (though he never saw my dad ski). It does not change my father's difficult decision to live with the tear or a grueling repair. Yet as he uses his right hand to lift his left arm, perhaps he will think of the 50 years of skiing or the feeling of fresh snow beneath his skis. Instead of feeling angry, I now watch him maneuver that arm and recall the family ski trips, the children and grandchildren he taught to ski. Sometimes, we all need kind eyes.

The information is paywalled here.

Here are some thoughts: 

The article explores the concept of well-being as a complex interplay between internal mental states and external socio-cultural factors. It proposes a holistic view, emphasizing the importance of both internal and external influences on happiness.

The article likely discusses strategies for positive reframing, which involves shifting negative interpretations of situations or experiences towards a more positive perspective. This reframing could be applied to both internal thoughts and emotions, as well as external circumstances.

"Turning a kind eye" is a metaphor for adopting a positive and understanding perspective towards oneself and one's environment, ultimately contributing to greater well-being.