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• Latinx ethnicity moderated associations between obesity and mental health. • In Latinx veterans, obesity associated strongly with externalizing disorders. • In White veterans, obesity associated strongly with internalizing disorders. • Obesity associated more strongly with PTSD in Latinx vs. White veterans. • Obesity linked to higher hostility and loneliness in Latinx veterans. Obesity disproportionately affects Latinx communities and is linked to an increased risk of mental health problems. Military veterans are more likely to develop mental health problems, but the role of Latinx ethnicity in moderating the association between obesity and these problems is unclear. To address this gap, this study examined psychiatric and psychosocial correlates of obesity in a nationally representative sample of Latinx and White U.S. military veterans. Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed 3524 Latinx and White veterans. Analyses revealed that Latinx ethnicity moderated associations between obesity and several measures. Specifically, among veterans with obesity, Latinx veterans had higher rates of major depression, generalized anxiety, post-traumatic stress disorders, drug use disorders, non-suicidal self-injury, and higher levels of childhood trauma, loneliness, and hostility relative to White veterans. These findings underscore the importance of culturally sensitive prevention and treatment efforts to help mitigate symptoms of internalizing disorders, drug use disorder, loneliness, and hostility, and to cultivate psychosocial resources such as resilience and coping self-efficacy among Latinx veterans with obesity. [ABSTRACT FROM AUTHOR]

• The Symptom Checklist-90-revised (SCL-90-R) is a valid tool to assess psychiatric disorders. • The three subscales Somatization, Hostility and Phobic Anxiety of the SCL-90-R are the top-3: they show the best reliability and validity properties. • These three subscales show better reliability in seven clinical and non-clinical samples in four European countries: Greece, Hungary, the Netherlands and France. While the reliability of SCL-90-R subscales is often questioned, five relatively recent European studies have examined the factor structure of SCL-90-R using a bifactor model and concluded that most of these subscales are reliable. However, examination of their results shows that three subscales, Somatization, Hostility, and Phobic Anxiety, consistently had significantly higher reliability than the other six across clinical and community samples recruited in three very different European countries, Greece, Hungary, and the Netherlands. The objective of this study was to examine whether this "top-3″ would be found in a sample from a fourth European country, France. To do this, we had 696 university students (387 women, 56 %) complete the SCL-90-R and we examined the reliability of the scales of this questionnaire by testing a bifactor model using Exploratory Structural Equation Modeling (ESEM). Our results confirmed that, in our sample, the three scales presented a higher reliability than the other six scales. It therefore seems that there exists, at least in the European cultural area, a stable structure of the SCL-90-R comprising a global distress factor and three reliable and robust specific factors: Somatization, Hostility, and Phobic Anxiety. [ABSTRACT FROM AUTHOR]

Highlights • We assessed cholesterol levels and aggression in suicide attempters. • Aggressive state and trait is associated with low cholesterol. • Low cholesterol is associated with aggression in suicide attempters. Abstract Low cholesterol levels have been correlated with both suicidal and aggressive behavior in psychiatric patients. Few studies have investigated associations between serum lipid profiles and both aggressive state and trait. Fifty-two psychiatric medication-free inpatients were included in this study after a suicide attempt. Composite scores of "State Aggression" and "Trait Aggression" were calculated using relevant items from the Comprehensive Psychopathological Rating Scale and the Karolinska Scales of Personality. State Aggression was significantly and negatively correlated with total cholesterol (TC) and low-density lipoprotein (LDL). Trait Aggression was also significantly and negatively correlated with LDL, but not TC. There were small but significant mediation effects of severity of anxiety symptoms on the relationship between State Aggression and TC as well as LDL. In exploratory analyses we found that low cholesterol was also associated with personality traits of hostility. Moreover, low cholesterol was more robustly associated with personality trait items related to interpersonal aggression, as opposed to items related to irritability or more indirect, non-overt aggression. Our findings suggest that low cholesterol is associated with both state and trait aggression in suicide attempters. Future mechanistic studies are warranted to better understand the relationship between low cholesterol and high aggression in suicide attempters. [ABSTRACT FROM AUTHOR]

Highlights • High levels of criticism, hostility, warmth and EOI were found in the ARMS group. • Levels of high-EE in ARMS were similar to that of FEP. • More criticism and hostility was linked with poorer functioning and worse symptoms. • Warmth and optimal family involvement improved functioning and reduced symptoms. • High criticism and EOI negatively impacted family member's health. Abstract The At-Risk Mental State (ARMS) for psychosis describes a state of high but not inevitable risk for developing a psychotic disorder. The distressing experiences for individuals with an ARMS may impact on themselves; their sense of wellbeing, psychosocial functioning and their family. Expressed emotion (EE) considers the environment and communication style of relatives towards the individual and is a key factor for determining outcomes in established psychosis. Following PRISMA guidelines, a systematic review of EE in relatives of ARMS was conducted. Fifteen studies were identified that investigated the presence of EE in the ARMS population. Approximately one third of ARMS relatives had high-EE. The results suggest that greater levels of criticism are associated with higher levels of symptoms and poorer functioning. In contradiction to psychosis literature, the construct emotional-over-involvement was found to be an adaptive response, where an optimal level of involvement combined with a warm-environment was associated with improved functioning and reduced symptoms. Limitations of the studies include small sample sizes and over-representation of Caucasian males and relatives as middle-aged mothers. Although approximately half of the studies included were longitudinal, only two measured EE over time, therefore, future research should include larger studies measuring EE at different time-points. [ABSTRACT FROM AUTHOR]

Highlights • We examined present and lifetime affective diagnoses and symptom severity among high or low expressed emotion (EE) parents of adolescents with bipolar disorder, as well as parents' family histories of affective illness. • Parents who were classified as high in EE reported more current symptoms of depression, anxiety, and anger/hostility than parents classified as low EE; the former also had more bipolar illness in their family pedigrees. • High and low EE parents did not differ in concurrent levels of interpersonal sensitivity, lifetime affective diagnoses, or family histories of anxiety disorders. • Parental distress and psychopathology may be critical targets for family interventions in adolescent bipolar disorder. Abstract Parental expressed emotion (EE) attitudes are important prognostic indicators in the course of bipolar disorder (BD) in adolescents and adults. This study examined the hypothesis that parents' own susceptibility to affective disturbances contributes to their likelihood of high-EE attitudes. We examined past-week levels of emotional distress, lifetime affective diagnoses, and family histories of affective disorder among high- and low-EE parents of 86 adolescents with bipolar I or II disorder who were recovering from an episode of depression or (hypo) mania. High EE parents endorsed higher concurrent levels of depression, anxiety, and anger/hostility than low EE parents, and reported a greater familial history of depression and BD. No differences between high and low EE parents were found in concurrent levels of interpersonal sensitivity, lifetime rates of affective disorders, or familial loading of anxiety disorder. Parents' distress at the time of the EE assessment was the strongest correlate of EE. The results suggest that susceptibility to affective psychopathology may be an important contributor to the development of EE attitudes among parents of adolescents with BD. [ABSTRACT FROM AUTHOR]

Highlights • PSMPU (Problematic Smart Mobile Phone Usage) was detected in 50.6% of the clinical adolescent sample. • Adolescents with problematic smartphone use were older than the others, with lower levels of maternal education and self-achievement. • Somatization, interpersonal sensitivity and hostility symptoms predict the risk of problematic smartphone use among adolescents. Abstract Problematic mobile phone use is an important problem which has increasing prevalence among adolescents. We should address risk factors to create intervention frameworks related to this problem. In this study, we aimed to determine the prevalence of problematic smartphone use among adolescents who were referred to clinics, its relationship to sociodemographic characteristics, psychiatric symptoms and emotion regulation problems. We included 150 adolescents aged 12–18 years who own smartphones. All participants filled out the Sociodemographic Information Form, Brief Symptom Inventory (BSI), Difficulties in Emotion Regulation Scale (DERS) and Problematic Mobile Phone Use Scale (PMPUS). Problematic smart phone use was detected in 50.6% of the sample. Adolescents with problematic use were found to be older than the others, with lower levels of maternal education and self-achievement. Regression analysis revealed that the factors predicting the risk of problematic smartphone use are somatization, interpersonal sensitivity and hostility symptoms. According to our results, we suggest psychiatrists consider the high prevalence of problematic smartphone use, address the relationship between hostility, somatic symptoms and interpersonal sensitivity (susceptibility) and the effects of this current problem on social-academic functioning while evaluating and treating adolescents. [ABSTRACT FROM AUTHOR]

Highlights • Violence towards caregivers in early psychosis was not uncommon in this sample. • Patient-initiated violence was associated with poor mental wellbeing in caregivers and negative appraisals of caregiving. • Patient-initiated violence was also related to high Expressed Emotion (criticism) and hostility in caregiver reports. • Risk of violence in caregiving relationships should be assessed as a priority to guide caregiver interventions. Abstract Patient-initiated violence may pose a significant risk to the strength and longevity of informal caregiving relationships in psychosis. We aimed to assess caregiver reports of patient-initiated violence in early psychosis and to examine the relationship between violent incidents and appraisals of caregiving, perceived mental wellbeing in caregivers and Expressed Emotion (EE) in the caregiving relationship. Eighty psychosis caregivers were recruited via Early Intervention (EI) psychosis services in London, United Kingdom. Caregivers were questioned about their experiences of patient-initiated violence during the semi-structured Camberwell Family Interview, and completed the Experience of Caregiving Inventory and the RAND SF-36 health survey in a cross-sectional experimental design. One third of the sample reported at least one incident of patient-initiated violence. Reports of violence were associated with poorer mental wellbeing scores amongst caregivers and more negative appraisals of caregiving. Patient-initiated violence also correlated with greater criticism and hostility expressed towards patients, and a rating of high EE in caregiver reports. The results underscore the need to ask explicitly and routinely about the physical safety of caregivers looking after someone with psychosis. Families should be directed towards appropriate interventions to help manage any risk of violence and the likely negative impact on the caregiving relationship. [ABSTRACT FROM AUTHOR]

Highlights • Effects of tonic sympathetic (SNS) activation on negative urgency were examined. • Higher SNS activity strengthened the association between neuroticism and urgency. • SNS also strengthened the link between neuroticism and hostile reactivity to stress. • Lower SNS strengthened link between neuroticism and shame reactivity to stress. • Hostile reactivity partially mediated the moderating effect of SNS on urgency. Abstract The tendency to engage in impulsive behavior in the context of negative affect, known as negative urgency, has emerged as a powerful transdiagnostic predictor of behavioral dysregulation. Although general vulnerability to negative affect (neuroticism) correlates with negative urgency, not all neurotic individuals engage in urgent behavior. Given prior experimental evidence that sympathetic nervous system (SNS) activation may promote emotion-related impulsivity, the present study examines tonic SNS activity as a moderator of the link between neuroticism and negative urgency. Participants (N = 194) completed measures of neuroticism and negative urgency, as well as a stress task. They also underwent assessment of tonic SNS activity (cardiac pre-ejection period). The link between neuroticism and negative urgency was strengthened for individuals with higher tonic SNS activity; however, this was not the case for behavioral performance on the task. A similar pattern was demonstrated for hostile reactivity to the stress task; increased hostile response partially explained the interaction between SNS activation and neuroticism on negative urgency. These findings suggest a potential facilitative role of the SNS in hostile reactivity and emotion-driven impulsivity among more neurotic individuals. [ABSTRACT FROM AUTHOR]

• We examined the impact of COVID-19-related behavioral restrictions in Japan. • Scant studies focused on university students' mental health during the pandemic. • COVID-19 negatively impacted upper-level university students' mental health. • Fourth-year students had greater mental health changes than did their counterparts. • This research informs public health interventions and programs. This study aimed to investigate the differences in mental health during COVID-19, specifically among second-, third-, and fourth-year Japanese university students (n = 2,157; n = 2,000; and n = 2,284; respectively). A one-way MANOVA was conducted to assess the association between year of enrollment (academic years 2020, 2021, and 2022) and each of the eight subscales of the counseling Center Assessment Psychological Symptoms-Japanese. For second-year students, depression and generalized anxiety mean scores were higher in 2021 than those in 2020 and 2022. Alcohol use mean scores got smaller each year. For third-year students, depression, generalized anxiety, social anxiety, hostility, and alcohol use were significantly higher in 2021 than those in 2020 and 2022. Among fourth-year students, means for all eight subscale categories were significantly higher in 2021 than those in 2020 and 2022. The findings found worsened mental health profiles during 2021, which recovered to approximate pre-pandemic levels in 2022. This study demonstrates that university students' mental health has been negatively impacted by the COVID-19 pandemic, an effect which is more salient among fourth-year students. Further, it offers insights into mental health trends among Japanese university students and a possible foundation for learning about changes among university students worldwide. [ABSTRACT FROM AUTHOR]

Maladaptive coping may play an important role in the manifestation of symptoms, functioning, and overt psychosis onset in individuals at ultra-high risk (UHR) for psychosis. To determine the factors associated with coping strategies, the relationships between cognitive appraisals and coping styles were investigated in UHR individuals. Sixty-five UHR individuals and 83 healthy controls were assessed for coping styles and cognitive appraisals of attribution bias as a primary appraisal and self-efficacy and perceived social support as a secondary appraisal. UHR participants relied more on a passive, tension-reduction coping style and less on an active, problem-focused coping style. These maladaptive coping styles in UHR individuals were significantly associated with their cognitive appraisals of stress. Aberrant attribution style of hostility perception and composite blaming bias were associated with problem-focused coping and tension-reduction, respectively. Perceived social support was related to problem-focused coping, seeking social support, and wishful thinking. General self-efficacy was associated with problem-focused coping. Our findings suggest that cognitive appraisals themselves may be the major determinants of coping styles in UHR individuals. The identified attribution styles, perceived social support, and self-efficacy may provide some clues regarding specialized interventions for the buildup of adaptive coping strategies in UHR individuals. [ABSTRACT FROM AUTHOR]

It is estimated that between 1.7 and 2.6 million people have had intermittent explosive disorder (IED) during their life in the United States alone. Co-occurring psychiatric disorders are very common in IED, being major depressive disorder arguably the most common. The objective of this study was to examine the clinical correlates of IED and depressive manifestations in 74 treatment-seeking subjects. After controlling for confounders, there were associations between major depressive disorder and severity of depressive symptoms, and (a) higher assault scores, (b) more severe hostile behavior and (c) worse social adjustment. Management of depressive symptoms may be an important for IED treatment. [ABSTRACT FROM AUTHOR]

This study employed secondary analyses of existing ecological momentary assessment (EMA) data to characterize hostile and irritable affect in the day-to-day experience of 52 smokers with, and 65 smokers without, posttraumatic stress disorder (PTSD). EMA monitoring occurred over a mean of 8.2 days, and participants responded to an average of 2.8 random prompts/day. Analyses included Wilcoxon rank sum tests of group differences, and path analyses of cross-lagged multilevel models. Participants with PTSD endorsed a significantly higher proportion of total EMA entries indicating hostile affect and irritable affect than did individuals without PTSD. Cross-lagged analyses indicated that over a period of hours, PTSD symptoms significantly predicted subsequent hostile and irritable affect, but hostile and irritable affect did not predict subsequent PTSD symptoms. Findings suggest that day-to-day exposure to PTSD-related trauma cues may contribute to chronically elevated levels of anger-related affect. Such heightened affective arousal may, in turn, underlie an increased risk for verbal or physical aggression, as well as other health and quality-of-life related impairments associated with PTSD. Clinical implications include conceptualizing anger treatment in the broader context of trauma history and symptoms, and specifically targeting physiological arousal and maladaptive hostile cognitions triggered by trauma reminders in patients with PTSD. [ABSTRACT FROM AUTHOR]

Internet addiction became a major mental health problem in college student. Our objective was to examine the relationship between psychological inflexibility and experiential avoidance (PIEA) and Internet addiction (IA) and the mediating effects of mental health problem indicators. 500 college students (238 men and 262 women) participated in this study. The level of PIEA was examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The levels of depression, anxiety, interpersonal sensitivity, and hostility were evaluated using the Symptom Checklist-90 item-Revised Scale. The relationship among PIEA, mental health problems, and IA was examined using structural equation modeling. The severity of PIEA was positively associated with the severity of IA as well as positively associated with the severity of mental health problems. In addition, the severity of mental health problem indicators was positively associated with the severity of IA. These results provide the severity of PIEA is directly related to the severity of IA and indirectly related to the severity of IA through increasing the severity of mental health problems. The PIEA should be one of the target objectives when administer cognitive-behavioral therapy to college students with IA and mental health problems. [ABSTRACT FROM AUTHOR]

Several studies demonstrated that maternal psychopathological risk is related to child’s maladjustment, but until recently research has relatively neglected fathers. Disruptive Behavior Disorder (DBD) and Eating disorders (ED) have a large prevalence during childhood but a few studies have focused on their association with paternal psychopathological risk. One-hundred and thirty-nine children and their fathers were recruited from pediatric hospitals and outpatient clinics and paired with a healthy control group (CG). Fathers were administered the SCL-90/R and the CBCL 6–18 to assess: 1) psychopathological risk of fathers of children with DBD, ED and CG; 2) significant differences between ED and DBD fathers’ psychopathological profiles; and 3) associations between specific fathers’ psychopathological symptoms and children’s emotional-behavioral problems. Fathers of children with ED showed a higher psychopathological risk than fathers of DBD offspring. Children with DBD showed higher externalizing symptoms. Paternal hostility was associated with internalizing problems in children with DBD. Paternal hostility showed a non-significant but clinically interesting association with internalizing problems in DBD children; interpersonal sensitivity was associated with internalizing problems in ED children. This study can constitute a contribution to a better understanding of the clinical characteristics of fathers of children with DBD and ED. [ABSTRACT FROM AUTHOR]

A number of studies have reported associations between pain and anger in samples with chronic pain, but research has mostly overlooked associations between pain and anger in those with problematic anger. The present study explored associations between pain severity and a variety of anger and hostility constructs in a sample seeking anger treatment ( n =131). Zero-order correlations and partial correlations were used to examine associations between pain, anger, and hostility, controlling for depressive symptoms. Hierarchical regression models examined potential interaction effects of gender on associations between pain and these outcomes. Pain severity was positively associated with trait anger, outward anger expression, hostile interpretation bias, hostile ideation, and inability to forgive others. These associations were independent of co-occurring depressive symptoms, with some exceptions. Gender moderated the association between pain and hostile ideation such that pain was positively associated with hostile ideation in women but not men. Pain severity was uniquely associated with multiple outcomes of relevance to individuals undergoing treatment for problematic anger. Clinical implications will be discussed. [ABSTRACT FROM AUTHOR]

Expressed emotion (EE) is a global index of familial emotional climate, whose primary components are emotional over-involvement (EOI) and critical comments (CC)/hostility. There is a strong theoretical rationale for hypothesising that carers’ guilt and shame may be differentially associated with their EOI and CC/hostility respectively. This systematic review investigates the magnitude of these theorised associations in carers of people with long-term mental health difficulties. Electronic searches (conducted in May 2016 across Medline, CINAHL, Embase, PsycINFO and ProQuest) were supplemented with iterative hand searches. Ten papers, reporting data from eight studies, were included. Risk of bias was assessed using a standardised checklist. Relevant data were extracted and synthesised narratively. EOI was positively associated with both guilt and shame, whereas CC/hostility was positively associated with shame. The strength of associations varied depending on whether or not guilt and shame were assessed within the context of the caring relationship. Based on these data, an argument can be made for the refinement, development and evaluation of systemic and individual interventions designed to target carers’ guilt and shame. However, more research is needed to clarify the strength of these associations and their direction of effect before firm conclusions can be drawn. [ABSTRACT FROM AUTHOR]

A computerized version of an assessment of Social-Emotional Information Processing (SEIP) using audio-video film stimuli instead of written narrative vignettes was developed for use in adult participants. This task allows for an assessment of encoding or relevant/irrelevant social-emotional information, attribution bias, and endorsement of appropriate, physically aggressive, and relationally aggressive responses to aversive social-emotional stimuli. The psychometric properties of this Video-SEIP (V-SEIP) assessment were examined in 75 healthy controls (HC) and in 75 individuals with DSM-5 Intermittent Explosive Disorder (IED) and were also compared with the original questionnaire (SEIP-Q) version of the task (HC=26; IED=26). Internal consistency, inter-rater reliability, and test-retest properties of the V-SEIP were good to excellent. In addition, IED participants displayed reduced encoding of relevant information from the film clips, elevated hostile attribution bias, elevated negative emotional response, and elevated endorsement of physically aggressive and relationally aggressive responses to the ambiguous social-emotional stimuli presented in the V-SEIP. These data indicate that the V-SEIP represents a valid and comprehensive alternative to the paper-and-pencil assessment of social-emotional information processing biases in adults. [ABSTRACT FROM AUTHOR]

Extant research has examined both genetic and environmental risk involved in the transmission of callous-unemotional traits in youth populations, yet no study has examined the intergenerational similarity of these traits between parents and their offspring. The current study examined whether the association between parent callous-unemotional traits and child callous-unemotional traits was mediated by parenting behavior and whether this association was moderated by household environment. Participants included 115 dyads of adolescents (48% female; Mean age=13.97) and their primary caregivers (87% female; Mean age=42.54). Measures of callous-unemotional traits, hostile parenting, and household chaos were collected from both adolescents and parents. A two group structural equation modeling revealed that hostile parenting serves as a mediating process in the association between parent and adolescent callous-unemotional traits, but only in the context of high household chaos. Our findings suggest that hostile parenting practices are a mediating process that may explain intergenerational similarity in callous-unemotional traits. Additionally, household chaos may exacerbate the effects of hostile parenting on callous-unemotional traits within adolescents, resulting in heightened vulnerability to intergenerational transmission of callous-unemotional traits. [ABSTRACT FROM AUTHOR]

Individuals with obsessive-compulsive disorder (OCD) may struggle with hostility and suspicious thinking, but this has not been the subject of much research. The purpose of this study is to examine the relationship between hostility, suspicious thinking, and OCD severity. Participants included 66 outpatients in treatment for OCD, 27 in treatment for other disorders, and 68 students (n=161). All completed the Inventory of Hostility and Suspicious Thinking (IHS), a measure of psychotic thinking/paranoia, the Obsessive Compulsive Inventory-Revised (OCI-R), the Beck Depression Inventory (BDI-II), and the Beck Anxiety Inventory (BAI). As expected, the IHS was significantly positively correlated with the BAI and BDI-II. Additionally, regression analyses revealed that individuals with OCD have higher levels of hostility than students. Hostility was also significantly positively associated with increased OCD severity. Hostility and suspicious thoughts are prominent in anxiety disorders in general, and thus necessitate continued research. [ABSTRACT FROM AUTHOR]

Hostility is associated with substantial mental and physical health consequences. Population-based data regarding the nature and longitudinal course of hostility in U. S. veterans are scarce. We analyzed data from 2157 U. S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U. S. veterans. We identified the prevalence of longitudinal courses of hostility (chronic, increasing, decreasing, or no hostility). We then evaluated relationships between sociodemographic, risk, and protective correlates measured at baseline and longitudinal courses of two aspects of hostility—aggressive urges and difficulties controlling anger. The majority of veterans (61.2%) reported experiencing difficulties controlling anger and a sizable minority of veterans (23.9%) reported experiencing aggressive urges over a two-year period. Protective psychosocial characteristics (e.g., optimism) and aspects of social connectedness (e.g., secure attachment style) were negatively associated with hostility. Psychological distress predicted all symptomatic hostility courses, while alcohol misuse predicted chronic aggressive urges and all symptomatic courses of difficulties controlling anger. These findings provide the first known population-based evaluation of the prevalence, course, and risk and protective correlates of hostility in U. S. veterans, and suggest targets for prevention and treatment efforts that can help mitigate risk for hostility in this population. [ABSTRACT FROM AUTHOR]

Current approaches in Dutch mental health care institutions towards inpatients' aggression have focused predominantly on environmental factors, such as training the staff in aggression management. However, personality traits might be an important factor in patients' aggression – as shown by incidents in the wards. This study explores the influence of dysfunctional impulsivity and alexithymia on psychiatric patients' aggressive behavior, through self-reports and through involvement in aggressive incidents. Personality traits influencing patients' aggression emphasize the importance of a more direct approach to their aggression. Clinical patients at Dutch mental health care institution Emergis ( n =84) filled out questionnaires about their aggressiveness (using Buss and Perry's Aggression Questionnaire Short Form), dysfunctional impulsivity and alexithymia. Multiple regression analyses indicated that dysfunctional impulsivity positively related to self-reported aggressive behavior. The relationship, however, could not be confirmed for inpatients' aggression as reported by the staff on the wards. Unexpectedly affective alexithymia negatively related to hostility. Gender differences in self-reported aggression were found. Female patients showed higher levels of hostility. Regression analyses indicated that the male gender positively related to physical aggression. Findings emphasize the importance of a new approach in Dutch mental health care, in which patients may engage in aggression-regulation training programs. [ABSTRACT FROM AUTHOR]

Increases in anger and hostility are commonly found after military deployment. However, it is unknown how anger and hostility develop over time, and which veterans are more at risk for developing these complaints. Data of 745 veterans one month before deployment to Afghanistan and one, six, twelve and 24 months after deployment were analyzed in a growth model. Growth mixture modeling revealed four classes based on their growth in hostility. Most of the participants belonged to a low-hostile group or a mild-hostile group that remained stable over time. Two smaller groups were identified that displayed increase in hostility ratings after deployment. The first showed an immediate increase after deployment. The second showed a delayed increase between twelve and 24 months after deployment. No groups were identified that displayed a decrease of hostility symptoms over time. Multinomial logistic regression was applied to predict group membership by age, education, early trauma, deployment stressors and personality factors. This study gains more insight into the course of hostility over time, and identifies risk factors for the progression of hostility. [ABSTRACT FROM AUTHOR]

• This cross-sectional study with relatively large sample size found that patients with untreated first-episode schizophrenia had low global functioning by the GAF. • Pearson correlation analysis revealed that the GAF was positively associated with the MCCB and its six domains, while negatively associated with the PANSS and its four dimensions. • The study found that the negative symptom factor, the positive symptom factor, the excitement hostility factor, and attention/vigilante were all independent risk factors for global functioning in untreated first-episode schizophrenia. Although many studies have been conducted on the relationship between cognitive functioning, psychopathological symptoms, and global functioning in patients with schizophrenia, these studies frequently suffer from a lack of control for confounding variables, high attrition rates, and a lack of cognitive domains completed at each assessment point. The purpose of this study is to select patients with untreated first-episode schizophrenia to investigate the relationship between psychopathological symptoms, cognitive functioning, and global functioning. A total of 117 untreated first-episode schizophrenia patients were evaluated using the global assessment functions (GAF), the Positive And Negative Syndrome Scale (PANSS), the MATRICS Consensus Cognitive Battery (MCCB), and some social and role functional parameters. The GAF, PANSS, and MCCB scores of 117 patients were significantly lower than normal. Multiple stepwise linear regression analysis revealed that the negative symptom factor, positive symptom factor, excitation-hostility factor, and attention/vigilance were all independent factors influencing global functioning. Our findings show that the negative symptom factor, the positive symptom factor, the excitement hostility factor, and attention/vigilante are all independent risk factors for GAF in first-episode schizophrenia. The negative symptom factor had the most noticeable effect among these influencing factors, followed by the positive symptom factor, the excitement hostility factor, and attention/vigilance in that order. [ABSTRACT FROM AUTHOR]

Man-made traumatic events such as combat and terrorism may cause individuals to develop various forms of psychopathology, including Post-Traumatic Stress Disorder (PTSD) and depression. Veterans who engage in combat experienced negative emotions such as anger, hostility and aggression. Forgiveness may buffer these feelings and prevent the development of psychiatric problems, in that it is a way of decreasing negative feelings and increasing positive feelings. The aim of the current study was to examine the mediating role of anger and negative affect on the relationship between forgiveness and both PTSD and depression co-morbid to PTSD among Turkish veterans who were exposed to combat experience because of terrorist attacks during their compulsory military service. Two hundred and forty-seven injured veterans participated in this study. Veterans were assessed using the Traumatic Stress Symptom Checklist (TSSC), Heartland Forgiveness Scale (HFS), State Trait Anger Expression Inventory (STAXI), and Positive and Negative Affect Schedule (PANAS). A path analysis supported the hypothesized model that both anger and negative affect fully mediated the relationship between forgiveness and both PTSD and depression co-morbid to PTSD. [ABSTRACT FROM AUTHOR]

Abstract: Social organizational stressors are well-known predictors of mental health disturbances (MHD). However, to what extent these stressors predict post-disaster MHD among employed victims hardly received scientific attention and is clearly understudied. For this purpose we examined to what extent these stressors independently predict MHD 1.5 years post-disaster over and above well-known risk factors such as disaster exposure, initial MHD and lack of general social support, life-events in the past 12 months and demographics (N=423). Exposure, social organizational stressors and support were significantly associated with almost all examined mental health disturbances on a bi-variate level. Multivariate logistic regression analyses showed that these stressors, i.e. problems with colleagues, independently predicted anxiety (Adj. OR=5.93), depression (Adj. OR=4.21), hostility (Adj. OR=2.85) and having two or more mental health disturbances (Adj. OR=3.39) in contrast to disaster exposure. Disaster exposure independently predicted symptoms of PTSD symptoms (Adj. OR=2.47) and agoraphobia (Adj. OR=2.15) in contrast to social organizational stressors. Importantly, levels of disaster exposure were not associated nor correlated with (levels of) social organizational stressors. Findings suggest that post-disaster mental health care programs aimed at employed affected residents, should target social organizational stressors besides disaster-related stressors and lack of general social support. [Copyright &y& Elsevier]

Abstract: Impulsivity is a multidimensional construct and has been previously associated with suicidal behaviour in borderline personality disorder (BPD). This study examined the associations between suicidal behaviour and impulsivity-related personality traits, as well as history of childhood sexual abuse, in 76 patients diagnosed with BPD using both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) Axis-II diagnoses and the self-personality questionnaire. Impulsivity-related traits were measured using the Barratt Impulsiveness Scale-11 (BIS-11), the Buss–Durkee Hostility Inventory (BDHI) and the Temperament and Character Inventory-Revised (TCI-R). We found that hostility and childhood sexual abuse, but not impulsivity or other temperament traits, significantly predicted the presence, number and severity of previous suicide attempts. Hostility traits and childhood sexual abuse showed an impact on suicide attempts in BPD. Our results support previous findings indicating that high levels of hostility and having suffered sexual abuse during childhood lead to an increased risk for suicidal behaviour in BPD. [Copyright &y& Elsevier]

Abstract: While hostility and sleep disturbance are the potential risk factors for health problems and disease, few studies have examined the relationship between the two factors. The present study was performed to investigate the relationship between hostility and sleep problems assessed both subjectively and objectively in a nonclinical sample. Sixty-one healthy subjects were enrolled in this study. Hostility was measured according to the Cook–Medley hostility scale. Subjective sleep quality was evaluated according to the global score of the Pittsburgh Sleep Quality Index. Objective sleep was evaluated using actigraphy. A multiple regression analysis revealed that a higher level of hostility was significantly associated with the global score of the Pittsburgh Sleep Quality Index and that a higher level of depression was not associated with the global score of the Pittsburgh Sleep Quality Index. Objective sleep measures were not found to be associated with hostility. Confirming the robust relationship between poor sleep and hostility would have several important treatment implications for preventing health problems. [Copyright &y& Elsevier]

Abstract: Symptoms of major depressive disorder (MDD) manifest variably across individuals. Accordingly, recent models of the disorder imply that MDD may be characterized according to independent symptom dimensions. In particular, several studies reveal that depression may be characterized along dimensions of negative affect, agitation and hostility, and lassitude and malaise. No research has examined the relationship between these dimensions and neuropsychological function. Towards this end, 133 in patients with unipolar MDD and 17 people without psychiatric illness were administered a brief battery of neuropsychological tests and the MMPI-2. Paralleling earlier research, principal component analysis of the MMPI-2 revealed symptom dimensions of negative affect, agitation, and lassitude and malaise. Multiple regression analyses showed that the negative affect and agitation dimensions accounted for significant variance on measures of executive function, speed of information processing, new learning, dexterity, and overall impairment. Lassitude and malaise failed to correspond with neuropsychological performance. Implications of these data for clinical practice and neural models of MDD are discussed. [Copyright &y& Elsevier]

Abstract: The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss–Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State–Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n =66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features. [Copyright &y& Elsevier]

Abstract: Inflated responsibility is increasingly regarded a pathogenetic mechanism in obsessive–compulsive disorder (OCD). In seeming contrast, there is mounting evidence that latent aggression is also elevated in OCD. Building upon psychodynamic theories that an altruistic façade including exaggerated concerns for others is partly a defense against latent aggression, evidence was recently obtained for high interpersonal ambivalence in OCD patients relative to psychiatric and healthy controls using a newly developed instrument entitled the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). A total of 46 OCD patients and 23 healthy participants took part in the present study. OCD patients displayed a higher social responsibility than controls. At the same time, patients also disclosed more latent aggression/calculating behavior and interpersonal distrust. While the pathogenic role of latent aggression is still not fully uncovered, it may deserve more consideration in treatment in view of frequent tensions in the families of OCD patients. Longitudinal studies with at-risk sample are needed to assess the relationship between problems with anger expression as well as (exaggerated) moral standards in OCD. [Copyright &y& Elsevier]

Abstract: The aim of this study was to investigate the relationship between self-mutilation (SM) and posttraumatic stress disorder (PTSD) in male alcohol-dependent inpatients, and to examine whether there is something unique about self-mutilaters with the PTSD/alcohol-dependence co-morbidity, compared with self-mutilaters without PTSD in this population. Participants were 156 consecutively admitted male alcohol-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Traumatic Experiences Checklist (TEC), the Clinician Administered PTSD Scale (CAPS), the Symptom Checklist-Revised (SCL-90-R) and the Michigan Alcoholism Screening Test (MAST). Among alcohol-dependent inpatients, 34.0% (n =53) were considered as group with SM. Rate of being unemployed, history of any trauma, history of suicide attempt and lifetime PTSD diagnosis were higher, whereas being married, current age, age at onset of regular alcohol use and duration of education were lower in the group with SM. Mean scores of SCL-90 subscales, TEC and MAST were higher in the SM group. Although SM might be related with PTSD among male alcohol-dependent inpatients, predictors of SM were age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and hostility. Age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and somatisation predicted SM in the subgroup of patients without PTSD, whereas hostility predicted SM alone in the subgroup of patients with PTSD. Results support the anti-suicide and the affect-regulation models of SM in the non-PTSD group, whereas they support the hostility model of SM in the subgroup with PTSD in alcohol-dependent inpatients. Thus, to reduce self-mutilative behaviour (SMB)among alcohol-dependent patients, clinicians must address different subjects in different subgroup patients; that is, focussing hostility in those with PTSD co-morbidity. [Copyright &y& Elsevier]

Abstract: Maternal psychopathology and the child''s autonomic nervous system functioning are risk factors for aggressive behaviour later in life. While research has shown that maternal psychopathology already affects young children, less is known about the association between autonomic functioning and aggressive behaviour in young children. In addition, maternal psychopathology and autonomic nervous system functioning may interact to determine the risk of aggressive behaviour. In a sample of 375 infants and their mothers, maternal psychiatric symptoms were assessed with the Brief Symptom Inventory and toddler aggressive behaviour with the Child Behaviour Checklist. Infant heart rate was recorded at 14months. Maternal psychiatric problems, including hostility and depression, were associated with toddler aggressive behaviour. Maternal psychiatric problems interacted with mean heart rate (P =0.01) and HF variability (P =0.03) in their effect on toddler aggressive behaviour. Mothers with high psychiatric problems, in particular, high hostility, were more likely to have toddlers with high aggressive behaviour. Moreover, in the presence of maternal risk factors, low autonomic arousal renders children particularly susceptible to aggressive behaviour. [Copyright &y& Elsevier]

Abstract: Many reports suggest that n−3 polyunsaturated fatty acids (PUFAs) influence the symptoms of psychiatric disorders. Moreover, it has also been reported that n−3 PUFAs control aggression and hostility. Acute symptoms of schizophrenia such as aggression can be a formidable clinical problem resulting in hospitalization. However, few investigations have determined the relationships between acute symptoms of drug-free schizophrenia and n−3 PUFAs. We recruited 75 inpatients with acute drug-free schizophrenia admitted to Chiba Psychiatric Medical Center, an emergency psychiatric hospital. Blood was sampled immediately after admission. The red blood cell (RBC) fatty acid composition and hostility score of Positive and Negative Syndrome Scale (PANSS) scores were measured. Multiple regression analysis showed that the concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the ratio of EPA/arachidonic acid (AA) in RBC showed significant negative correlations with the hostility score of PANSS scores after adjustment for age and sex. AA, on the other hand, showed significant positive correlations. The tissue n−3 PUFA and n−6 PUFA levels were negatively and positively associated with the hostility score of PANSS scores, respectively, suggesting possible effects of PUFA levels on hostile behavior in patients with schizophrenia. [Copyright &y& Elsevier]

Abstract: Psychotic symptoms are distributed along a continuum that extends from normality to diagnosable psychotic disorders and the presence of psychoticism among individuals in the general population may lead to morbidity and social impairment. This study examined a model in which psychoticism leads to several important psychological consequences. The analysis included 134 African Americans with no psychiatric history who were being seen in medical walk-in clinics for non-emergency medical problems. Psychoticism, perceived hassles, depression, hostility, and hopelessness were measured. The Linear Structural Relations Program (LISREL) was used to test the fit of the data to the proposed model, a trimmed hierarchical version, and two alternative models. The data supported a model in which psychoticism has substantial effects on several important characteristics: perceived daily hassles, depression, and hostility. Depression mediated the association between psychoticism and hopelessness. Goodness-of-fit indices for a final trimmed model that eliminated one path from the initial postulated model revealed good fit to the data, and the two alternative models were found not to fit the data. Like psychosis itself, psychoticism appears to cause meaningful dysfunction even among non-psychiatric individuals from the general population. Additional research is needed to further characterize the detrimental effects of psychoticism or self-reported psychotic symptoms in the general, non-psychiatric population. [Copyright &y& Elsevier]

Abstract: The main aim of the current study is to investigate the association of psychopathic traits and symptomatology with violence in male patients with schizophrenia. The Psychopathy Checklist-Revised (PCL-R) and the Brief Psychiatric Rating Scale (BPRS) were administered to 35 hospitalized male patients diagnosed with schizophrenia. Based on their history of violence, the sample was divided into violent (N =19) and nonviolent (N =16) groups. Data were analyzed using parametric, nonparametric and regression analyses. The mean psychopathy and hostility (component of the BPRS) scores were significantly higher for the violent group. Only three patients (16%), all from the violent group, met the diagnostic cutoff for psychopathy (a PCL-R score ≥30). Regression analyses suggest that both the hostility component of the BPRS and the behavioral component of the PCL-R (Factor 2) are significant predictors of violent behavior in male patients with schizophrenia. However, when the psychopathy scores are high, the probability for violence is already considerable and the level of hostility has only a slight effect. These findings suggest that improvement in illness condition may not reduce the likelihood for violence in male patients with a high psychopathic profile. [Copyright &y& Elsevier]

Abstract: The current study addresses the relationship of personality and atypical depression using the Five-Factor Model (FFM), a dimensional approach to personality. The aim of the study was to help clarify which personality traits are more characteristic of atypical depression than of other depressive subtypes. Outpatients (n =160) with non-psychotic major depression were characterized as having atypical (n =26), or non-atypical depression (n =134) based on DSM-IV criteria. To limit the effect of state depression, personality was assessed after subjects received a minimum of 14 weeks of antidepressant treatment. The Revised NEO Personality Inventory, which generates data based on the FFM, was the primary assessment measure. Post-treatment, relative to the non-atypical comparison group, the atypical group had significantly higher scores on the dimension of Neuroticism, the facets of Impulsivity and Anger–Hostility, and a significantly lower score on the facet of Deliberation. In sum, the FFM provides a new understanding of which unique personality characteristics may be associated with atypical depression. [Copyright &y& Elsevier]

The objective of this study was to test the hypothesis that platelet serotonin (5-hydroxytryptamine, 5-HT) content is correlated with measures of aggression in healthy human subjects. Platelet 5-HT content (ng/mg protein) was measured in personality-disordered (PD) and normal control (NC) subjects. Aggression was assessed with the Life History of Aggression (LHA), the Buss–Durkee Hostility Inventory (BDHI), and the Motor Aggression and Research Criteria for Intermittent Explosive Disorder (IED-IR); impulsivity was assessed with the Eysenck Personality Questionnaire II (EPQII) and the Barratt Impulsiveness Scale (BIS-11). LHA Aggression, but not impulsivity, scores showed significant inverse correlations with platelet 5-HT content in all subjects or in PD subjects alone. The findings in PD subjects remained significant after co-varying for race. PD subjects with IED-IR had lower platelet 5-HT content compared with PD subjects who did not have IED-IR, although this finding only approached significance after controlling for race. This study demonstrates an association between reduced platelet 5-HT content and aggression in PD subjects. Similar to other studies of platelet 5-HT markers, these data suggest that platelet 5-HT content may also reflect central 5-HT alterations and may be used as a biological marker in appropriate patient samples. [Copyright &y& Elsevier]

During pregnancy, the total serum cholesterol concentration rises up to 43%, followed by a rapid fall after delivery. Mild depressive symptoms (‘postpartum blues’) are a common complication of the puerperium and affect 30–85% of women in the early postpartum period. Based on these observations, it has been suggested that the sudden fall in cholesterol levels after delivery could serve as a ‘natural model’ to test the suggested association between cholesterol and mood. The present study was designed to expand the database concerning the association between cholesterol levels and mood in the postpartum period and to address some methodological problems raised by previous studies. Forty-seven healthy primiparous women were interviewed with a structured clinical interview on two occasions: during late pregnancy (median: day −20 before the expected delivery) and during the early postpartum period (median: day 32 after delivery). On both occasions, serum concentrations of total and HDL cholesterol were measured and mood symptoms were assessed with the state form of Spielberger''s State-Trait Anxiety Index (STAI), the state form of the State-Trait Anger Scale (STAS), and the Beck Depression Inventory (BDI). We found significant, albeit moderate, relationships between serum cholesterol levels and mood symptoms in the postpartum period that were not present during late pregnancy. Lower postpartum levels of total cholesterol were associated with symptoms of anxiety (r=−0.30, P=0.04), anger/hostility (r=−0.31, P=0.04), and depression (r=−0.35, P=0.02), and lower postpartum levels of HDL cholesterol were associated with symptoms of anxiety (r=−0.34, P=0.02). This study confirms that the physiological fall in blood lipids in the postpartum period can be a useful model to test the relationship between serum cholesterol levels and mood. [Copyright &y& Elsevier]

Since the one-child policy was implemented in China in 1979, many investigators have studied the psychological consequences to children without siblings. Although the results are not conclusive, there is evidence that children who have siblings, rather than only children, have increased anxiety and depression. Whether the differences between students with and without siblings would continue when they reached university age is an interesting question. We used the Zuckerman–Kuhlman Personality Questionnaire to assess personality traits and the Plutchik–van Praag Depression Inventory to measure depressed mood in 134 university students with and 126 university students without siblings. Most students without siblings (93.7%) were reared in urban areas, while 90.3% of students with siblings came from rural areas. Parental professions were higher in social status and annual family incomes were higher in students without siblings. Increased neuroticism–anxiety, aggression–hostility, and depressed mood were found in students with siblings. Gender and annual family income were not significantly related to personality in the two groups, and birth-order position was not related to personality in the students with siblings. In contrast, the depression score was positively correlated with neuroticism–anxiety and aggression–hostility, but negatively correlated with parental occupation and annual family income. The greater competition to receive high education, reduced benefits from society, and lower level of social respect might nurture these personality traits in students with siblings. These findings might, in some limited aspects, indicate that the one-child policy affects personality traits and depressed mood in students with siblings. [Copyright &y& Elsevier]

Female Veterans are the fastest growing demographic group in the Department of Veterans Affairs. Moreover, suicide rates in female Veterans are increasing, making suicide in female Veterans a topic of vital clinical and research significance. The current study examined the association between suicide, aggression, and mood symptoms by sex. Participants consisted of 264 Veterans (female=54, male=210) ages 18-55. Veterans completed well-validated measures of suicidal behaviors, aggression, anxiety, and depression. Male Veterans reported higher physical aggression, verbal aggression, anger, hostility, and total aggression compared to female Veterans. In male Veterans, lifetime suicidal behavior including ideation and attempts was correlated with total aggression and subscales of physical aggression, verbal aggression, anger, and hostility. However, in female Veterans lifetime suicidal behavior was significantly associated with hostility and anger. There were no between-group differences in measures of suicidal behaviors, anxious or depressive symptoms. These results suggest important differences in the association between aggression and suicidal behavior by sex. These data have significant clinical implications, as males with aggressive traits and females who endorse hostility and anger may be more likely to engage in suicidal behaviors. [ABSTRACT FROM AUTHOR]

• This longitudinal study was implemented at two timepoints, i.e., during the peak and the remission of the COVID-19 pandemic. • Fear significantly decreased over time, while depression level significantly increased during the second wave compared to the first wave of the survey. • Younger age, lower-income, increased level of perceived stress, and current quarantine experience were significant predictors of depression escalation. • The use of negative coping strategy plays a potential intermediating role in the stress-related increase in hostility, while social support acts as a buffer in hostility in the general population under high stress. The current COVID-19 pandemic is not only a threat to physical health, but also brings a burden to mental health in the general Chinese population. However, the temporal change of mental health status due to pandemic-related stress in relation to protective and risk factors to hostility is less known. This study was implemented at two timepoints, i.e., during the peak and the remission of the COVID-19 pandemic. 3233 Chinese individuals participated in the first wave, and among them 1390 participants were followed in a second wave. The result showed that fear significantly decreased over time, while depression level significantly increased during the second wave compared to the first wave of the survey. Younger age, lower-income, increased level of perceived stress, and current quarantine experience were significant predictors of depression escalation. Younger people and individuals who had a higher initial stress response tended to show more hostility. Furthermore, the use of negative coping strategy plays a potential intermediating role in the stress-related increase in hostility, while social support acts as a buffer in hostility in the general population under high stress. As the whole world is facing the same pandemic, this research provides several implications for public mental health intervention. [ABSTRACT FROM AUTHOR]

• Emotion adjustment is significantly negatively associated with Internet Gaming Disorder. • Emotion adjustment moderates the association between emotion concealment and Internet Gaming Disorder. • We believe the numerous problems arising from Internet Gaming Disorder could be partially resolved by employing emotion-focused therapy to intervene in the emotion-regulation deficit. Lack of control over Internet gaming habits may result in negative consequences. This study aimed to evaluate the emotional regulation of adults with Internet gaming disorder (IGD) and the association of emotion regulation, depression, and hostility. Advertisements were used to recruit 69 young adults with IGD, 69 sex- and age-matched controls, and 69 sex- and age-matched regular gamers. The diagnosis of IGD was according to diagnostic interviews based on DSM-5 IGD research criteria. Participants completed the Affective Style Questionnaire, the center of epidemiological studies depression scale and the short-form Chinese version of Buss-Durkee Hostility Inventory. In the IGD group, the emotion adjustment score was significantly lower, whereas the scores for depression, and hostility were significantly higher than in the other two groups. In addition, emotion adjustment is the most associated emotion regulation behavior of IGD, followed by emotion concealment. In IGD group, emotion adjustment had a negative correlation with depression and hostility. Our study demonstrate that emotion adjustment is significantly associated with IGD. The depression and hostility mediated the association. Knowing that emotion adjustment plays a critical role in IGD, future interventions should focus on this subscale of emotion regulation. [ABSTRACT FROM AUTHOR]

• 19% of chronically depressed individuals seeking therapy reported suicide attempts. • Attempts were more likely among those with more severe and more chronic depression. • Self-harm increased the risk of suicide attempts by a factor of nine. • Having experienced sexual abuse more than doubled the risk of suicide attempts. • Suicide attempters reported more dominant and hostile behavior in relationships. Chronically depressed individuals have a high suicide risk. However, it is an open question whether previously observed risk factors for suicide attempts also apply to chronic depression or whether there are specific risk factors related to chronic-recurrent illness. We drew from a large group of chronically depressed individuals seeking psychotherapy to investigate demographic and psychological factors related to previous suicide attempts. Participants took part in the SCID and filled out established questionnaires. Among 368 chronically depressed individuals (68.7% women; M age = 40.95 years), 75 participants (19.4%) reported previous suicide attempts. Men were more likely to have used violent methods. We tested the links of having attempted suicide with different variables using logistic regression analyses. Our findings corroborate previously observed risk factors (e.g. sexual abuse, personality disorders) and suggest other risk factors which could be especially relevant in chronic depression (e.g. depression severity, interpersonal problems, self-injurious behavior, and overall years of depression). Other risk factors from previous studies were not related to suicidal behavior within our sample (e.g. anxiety disorders, PTSD). Thus, mental health professionals should be aware that risk factors for suicidal behavior might vary between diagnosis groups and that chronic illness might be a risk factor in itself. [ABSTRACT FROM AUTHOR]