Modern warfare in a civilian setting may expose combatants to severe moral challenges. Whereas most of these challenges are handled effectively, some potentially morally injurious events (PMIEs) may have deleterious psychological effects on the combatants, such as suicide ideation (SI). Self-disclosure, which includes sharing distressing thoughts and emotions, has been recognized as a protective factor against SI in the aftermath of stressful events.

The current study is the first to examine the moderating role of self-disclosure in the relationship between PMIEs exposure and SI among combat veterans.

A sample of 190 recently discharged Israeli combat veterans completed validated self-report questionnaires in a cross-sectional design study, tapping combat exposure, PMIEs, depressive symptoms, SI, and self-disclosure.

PMIE dimensions, and self-disclosure significantly contributed to current SI. Importantly, the moderating model indicated that self-disclosure moderated the link between PMIE-Self and current SI , as PMIE-Self and current SI were more strongly associated among veterans with low levels of self-disclosure than among high self-disclosing veterans.

Self-disclosure, as a factor promoting a sense of belongingness, interpersonal bonding, and support, might reduce SI risk following PMIE exposure. Various mechanisms accounting for these associations are suggested, and clinical implications of these interactions are discussed.

Y. Levi-Belz Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

Recent studies have indicated that grieving after suicide loss can be particularly complex and traumatic. However, studies have recognized the opportunity for personal growth among suicide-loss survivors.

This study signifies an effort to develop a comprehensive understanding of the underlying interpersonal facilitators of posttraumatic growth (PTG) among suicide-loss survivors in a longitudinal design.

Participants included 189 suicide-loss survivors (155 females), aged 21–73, who completed questionnaires of thwarted belongingness (TB), perceived burdensomeness (PB), and self-disclosure at T1. Moreover, participants were assessed on PTG levels at T1, 18 months (T2), and 42 months (T3).

The integrated mediation model indicated that both TB and PB contributed to the PTG trajectory. PB and self-disclosure contributed to PTG at T3 beyond the PTG trajectory across time. We also found self-disclosure to mediate the association of TB and PTG at T2 and T3.

These findings suggest that interpersonal factors play critical roles in contributing to PTG over time among suicide-loss survivors. Basic psychoeducational interventions designed to foster interpersonal behaviors may facilitate achieving PTG among survivors in the aftermath of suicide loss.

Y. Levi-Belz Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

Combatants who are exposed to events which transgress deeply held moral beliefs might face lasting psychopathological outcomes, referred to as Moral Injury (MI). However, knowledge about pre-deployment factors which might moderate the negative consequences of MI is sparse.

In this prospective study, we examined pre-enlistment characteristics and pre-deployment personality factors as possible moderators in the link between exposure to potentially morally injurious events (PMIEs) and psychiatric symptomatology among Israeli active-duty combatants.

A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements (T1: 12 months before enlistment, T2: 6 months following enlistment- pre deployment, and T3: 18 months following enlistment- post deployment). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures of personality factors: emotional regulation, impulsivity, and aggression (T2) and combat exposure, PMIEs, psychiatric symptomology and post traumatic symptoms (T3) between 2019-2021.

Pre-enlistment psychiatric difficulties and negative life events contributed to higher exposure to PMIEs post deployment. Higher levels of pre-deployment aggression and lower levels of emotional regulation and impulsivity moderated the association between betrayal, PMIEs and psychiatric symptomology post deployment, above and beyond pre-enlistment psychiatric difficulties and life events.

Our results highlight that pre-deployment emotional regulation, impulsivity and aggressiveness levels should be assessed, screened, and identified among combatants, as they all facilitate psychiatric symptomology (and PTSS) after combatants are exposed to PMIEs of betrayal. Such pre-assessment will enable identification of at-risk combatants and might provide them with tailor made preparation regarding moral and ethical situations that should be investigated in future researches.

Y. Levi-Belz: None Declared, G. Zerach Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no

Suicide-loss survivors (SLSs) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). However, limited data are available concerning the contribution of CG to SI among suicide survivors. Moreover, knowledge about possible psychological processes which may increase SI levels following CG is rare.

In this study, we aim to examine the role of two important emotion regulation variables––mentalization deficits and entrapment––as possible moderators of the association between CG and SI in the aftermath of suicide loss.

Participants were 152 suicide-loss survivors, aged 18-70, who completed questionnaires tapping CG, SI, mentalization deficits, and entrapment.

The findings revealed SI to have high and positive associations with CG, entrapment, and metallization deficits. Regression analysis showed mentalization deficits and entrapment contributing to SI beyond the contribution of CG. Notably, a significant interaction was found, indicating that CG and SI became more strongly associated at higher levels of mentalization deficits.

The study’s findings highlight the critical link between complicated grief and suicide ideation among SLSs and the role of metallization deficits as a possible facilitator of this link. Practical implications relating to suicide risk among SLSs are discussed, as well as focused clinical recommendations. The importance of mentalization-based interventions for decreasing SI levels in the aftermath of suicide loss is highlighted.

No significant relationships.

The COVID-19 pandemic can affect the mental health of health and social care workers (HSCWs) who are frontline workers in this continuous crisis. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and deleterious psychiatric consequences such as depression and anxiety symptoms.

To examine associations between exposure to PMIEs, MI symptoms, depression, and anxiety symptoms. We also aim to assess the moderating role of thwarted belongingness in these associations.

A sample of 243 Israeli HSCWs completed online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021.

About one-third (33.6%) of the sample met the criteria for major depressive disorder, 21.5% met the criteria for generalized anxiety disorder, and 19.1 % reported comorbidity of depression and anxiety. A moderated-mediation model shows that high thwarted belongingness intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and depression and anxiety symptoms. Importantly, the indirect effect of exposure to PMIEs on both depression and anxiety symptoms via MI symptoms existed only among those with high levels of thwarted belongingness.

The study’s findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the contribution of MI to possible mental health consequences. Clinicians should be aware of the importance of high thwarted belongingness in depression and anxiety sequelae of exposure to PMIEs among HSCWs.

No significant relationships.

Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as a significant stressful combat event that may lead to mental health problems, including suicide ideation (SI). Several studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SI. However, the contribution of social-emotional factors has yet to be examined.

In the current study, we examined the association between PMIE-Self and SI among combat veterans and explored the mediating role of trauma-related shame and the moderation role of collective hatred in this association.

A volunteer sample of 336 Israeli combat veterans was recruited, completing self-report questionnaires in a cross-sectional study.

indicated that PMIE-Self was positively associated with SI, and trauma-related shame mediated this association. Moreover, collective hatred moderated both their direct (PMIE -SI) and indirect (PMIE-Shame-SI) association. Notably, collective hatred had an inverse role for each of the associations. Thus, collective hatred was found to comprise both a risk and a protective factor for SI following PMIE-Self.

The current findings highlight the crucial contribution of trauma-related shame and collective hatred to the association between moral injury and suicidality. Moreover, the findings demonstrate that even years after their military service release, combat veterans exposed to PMIEs may still feel consumed by painful memories and maintain premonitions of a foreshortened future. Furthermore, the findings help to better understand the dynamics of collective hatred and the challenge of modifying it.

No significant relationships.

Pharmaceutical treatment and psychotherapy constitute the most common treatment methods for depression and anxiety. Physical training has been shown to have comparable effect to cognitive behavioral therapy in treatment of mild to moderate depression and anxiety. Physically active individuals also show lower risks to develop depression and relapse in depression.

The objectives are to evaluate how physical activity can affect depressive and anxiety symptoms, by examining biomarkers in the blood and from the gut and also by measuring cognitive functions. Hopefully, this can lead to new treatment strategies for patients with depression and anxiety.

102 patients are randomized to two groups and undergo 12 weeks intervention as add-on to standard outpatient psychiatric treatment. The first group will participate in physical training three times per week and the other group will receive relaxation therapy on a weekly basis. Daily activity intensity will be measured before and at the last week of intervention with an accelerometer. Blood and faeces sample collection, symptom grading by clinician together with self-rating scales and cognitive screening will be performed at baseline, week 12 and one year of follow-up. The cognitive screenings are performed digitally in cooperation with Mindmore.

The RCT is currently recruiting patients at the Department of Psychiatry of Örebro University Hospital.

The project aims to be holistic in its approach, combining the defining clinical psychiatric symptoms in patients who have both depression and anxiety with the finding and evaluation of new biomarkers from blood and gut to improve cognitive functions.

No significant relationships.

Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).

N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.

Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).

Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.

To compare treatment effects between AchEI (galantamine, GAL) and antipsychotics (risperidone, RIS) in patients with BPSD.

Open randomized trial in 100 patients (mean 78.7years, 67% females) using the NeuroPsychiatric Inventory score (NPI)>10 on patients (73% mild to moderate AD and 27% other dementias, treated with GAL (n=50) or RIS (n=50) for 12 weeks. Neuropsychiatric symptoms (NPI, CMAI, FAST), caregivers stress (PGWB), cognition (MMSE) and severity (CIBIC) were assessed at baseline and 12 weeks.

91 patients completed the trial. Safety and tolerability were good. 58% were APOEɛ4 carriers. At baseline MMSE was 20.1±4.6, and NPI 51.0±25.8. After 12 weeks NPI total scores had improved significantly (GAL: 16.6±16.1, RIS: 16.2±16.2).

In both groups there were statistically significant improvements after 12 weeks. In several of the NPI-domains galantamine and risperidone were equally effective. RIS showed a significant treatment advantage in the NPI-domains irritation (p=0.02), agitation (p=0.02) and a trend in aberrant motor behaviour (p=0.08). GAL showed a ppositive trend in apathy/indifference (p=0.09), night time behaviour (p=0.07) and appetite (p=0.06). GAL improved MMSE scores with 2.8 p (p< 0.001) and RIS with 1 p (p< 0.07).

This indicates that GAL could be beneficial in the treatment of neuropsychiatric and behavioural symptoms underlying AD unless aggressive symptoms are prominent.

Individuals grieving a suicide death (suicide survivors) may be at risk for psychiatric complications and suicidal behaviors. Support groups may provide valuable resource for survivors, who often do not seek out mental health treatment. Social support and self regulation which are at the nature of the support groups can facilitate growth from crisis.

The objective of the present study was to investigate the effectiveness of support groups for suicide survivors. The specific aims were to assess the relationship between group participation and stress related growth and to assess the role of self regulation and social support as mediating variables.

74 suicide survivors belonged to one of two groups: 32 survivors who participate in a support group, compared with 42 survivors who did not participate. All participants completed questionnaires covering of self regulation, social support and stress related growth.

Survivors who participated in a support group showed better recovery from stress than those who didn’t participate. The effect was stronger in survivors who lost their offspring. A hierarchical regression indicates that time past from the event as well as self regulation and social support explained more than 33% of the variance of stress related growth.

Support groups for suicide survivors are a helpful intervention tool and can serve as a powerful form of primary and secondary prevention. Social support as well as self disclosure to other survivors can facilitate growth from crisis and diminish feelings of guilt, shame and other psychiatric complications.

The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.

The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.

102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.

The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.

The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.

Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.

Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants’ working memory were measured using the reading span and backward location span tests.

Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.

Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.