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Schafer KM, Mulligan E, Shapiro MO, Flynn H, Joiner T, Hajcak G. Antenatal anxiety symptoms outperform antenatal depression symptoms and suicidal ideation as a risk factor for postpartum suicidal ideation. ANXIETY, STRESS, AND COPING 2024:1-11. [PMID: 38523456 DOI: 10.1080/10615806.2024.2333377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Suicidal ideation (SI) during the postpartum phase is linked with suicide, a leading cause of death during this period. Antenatal depression and anxiety symptoms have both been linked with increased risk for postpartum SI. However, research aimed at examining the relative contributions of antenatal anxiety and depression symptoms towards postpartum SI remains nascent. In this study, we investigated the relative contribution of antenatal anxiety symptoms, depression symptoms, and SI towards postpartum SI. DESIGN These data are from a longitudinal study in which American mothers were assessed during pregnancy and again at six- to eight weeks postpartum. METHODS Data were analyzed using correlations and logistic regression models. RESULTS Antenatal anxiety symptoms and antenatal depression symptoms were significantly correlated with postpartum SI. Results from a logistic regression model indicated that antenatal anxiety symptoms (T1; OR = 1.185 [1.125, 1.245], p = .004), but not antenatal depression symptoms (T1; OR = 1.018 [0.943, 1.093], p = .812) or antenatal SI (T1; OR = 1.58 [0.11, 22.29], p = 0.73), were significantly associated with postpartum SI. CONCLUSIONS Antenatal anxiety symptoms, depression symptoms, and SI were positively associated with postpartum SI. When examined simultaneously, anxiety symptoms during the antenatal phase (but not depression symptoms or SI) predicted SI in the postpartum phase.
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Affiliation(s)
- Katherine Musacchio Schafer
- Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Nashville, TN, USA
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | | | - Mary O Shapiro
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Heather Flynn
- School of Medicine, Florida State University, Tallahassee, FL, USA
| | - Thomas Joiner
- Psychology, Florida State University, Tallahassee, FL, USA
| | - Greg Hajcak
- Psychology, Florida State University, Tallahassee, FL, USA
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Candon M, Benjamin Wolk C, Kattan Khazanov G, Oslin DW, Pieri MF, Press MJ, Anderson E, Jager-Hyman S. Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model. Suicide Life Threat Behav 2024; 54:15-23. [PMID: 37916734 PMCID: PMC10922361 DOI: 10.1111/sltb.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION The Collaborative Care Model (CoCM) is an evidence-based approach which embeds behavioral health providers (BHPs) into primary care. Whether patients with suicidal ideation (SI) are willing to engage in CoCM is unclear. METHODS Using Patient Health Questionnaire-9 (PHQ-9) administrative data from primary care practices within an urban academic health system, we identified patients with and without SI who were referred to a CoCM BHP. We compared engagement, defined as attendance at ≥1 CoCM visit, across groups. RESULTS Between 2018 and 2022, 7391 primary care patients were referred to a CoCM BHP. Eight hundred and ninety-two of these patients reported SI on the PHQ-9 (754 on "several days" during the previous 2 weeks and 138 on "more than half or most days"). Across groups, most patients engaged in CoCM. Patients reporting SI on several days engaged at a lower rate (61.4%) than those reporting SI on more than half or most days (65.9%). Both SI groups engaged at a lower rate than the 6499 patients who did not report SI (67.5%). CONCLUSION Most patients referred to a CoCM BHP engaged in ≥1 visit. Rates were lower for patients with SI, with the lowest rate among those reporting SI on several days.
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Affiliation(s)
- Molly Candon
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Gabriela Kattan Khazanov
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - David W. Oslin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Matteo F. Pieri
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew J. Press
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eleanor Anderson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Jobes DA, Mandel AA, Kleiman EM, Bryan CJ, Johnson SL, Joiner TE. Facets of Suicidal Ideation. Arch Suicide Res 2024:1-16. [PMID: 38174735 DOI: 10.1080/13811118.2023.2299259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.
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Schmidt K, Smith AR, Bodell LP. Influence of nonsuicidal self-injury functions on suicide risk in individuals with eating disorders. Suicide Life Threat Behav 2023; 53:1055-1062. [PMID: 37804065 DOI: 10.1111/sltb.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/27/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) display elevated rates of suicidality (i.e., suicidal ideation and behaviors) as well as nonsuicidal self-injury (NSSI) (e.g., self-harm behaviors without intent to die). NSSI-and particularly the functions of NSSI-predict suicidal ideation in general samples; however, to our knowledge, the relation between NSSI functions and suicidal ideation in ED populations has been unexplored. METHOD This study examined whether specific functions of NSSI are relevant to suicidal ideation in a treatment-seeking sample of women with EDs (n = 100). Participants completed self-report measures of suicidal ideation, NSSI, and related psychopathology upon intake to an ED treatment program. RESULTS Using the four-function model of NSSI, we found that intrapersonal and interpersonal-negative reinforcement, but not interpersonal-positive reinforcement functions, were related to suicidal ideation in women with EDs. Contrary to expectations, we did not find that endorsement of multiple NSSI functions was related to increased suicide risk. DISCUSSION Findings imply that some, but not all, functions of NSSI may be relevant to suicide risk in individuals with EDs. Implications for further research are discussed.
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Affiliation(s)
- Kendall Schmidt
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - April R Smith
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
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Izquierdo AM, Nelson JD, Daza A, Gasbarro A, Hardin R, Marino J, Fischer S. Predictors of current suicidal ideation in a multi-diagnostic sample of individuals with eating disorders. J Eat Disord 2023; 11:94. [PMID: 37291663 DOI: 10.1186/s40337-023-00789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Individuals with eating disorders (EDs) have high rates of suicidal ideation (SI) and attempts (SA). Fasting, body dissatisfaction, binge eating and purging have been associated with SI in non-clinical samples, individuals with anorexia nervosa or low-weight EDs, and a multi-diagnostic sample. However, few studies have examined how ED symptoms contribute to risk for SI in conjunction with other well-established risk factors, such as nonsuicidal self-injury (NSSI) and past SA. The aim of this study was to examine which ED symptoms contribute unique risk for current SI in a multi-diagnostic, clinical sample when statistically adjusting for gender, NSSI, past SA, and past SI. METHODS We conducted a chart review of 166 individuals who presented for ED treatment at an outpatient facility and signed informed consent. Initial intake interviews were coded for the presence versus absence of fasting, fear of weight gain, binge eating, purging, excessive exercise, restriction, body checking, self-weighing, and body dissatisfaction, as well as NSSI, past SA, past SI, and current SI. RESULTS A total of 26.5% of the sample endorsed current SI. In a logistic regression analysis, identifying as male (n = 17) or having a non-binary gender identity (n = 1), the presence of fasting, and past SI were all significantly associated with increased odds of current SI, whereas excessive exercise significantly decreased odds of current SI. Fasting was equally common across all diagnostic groups. CONCLUSIONS Future research should establish the temporal relationship between fasting and SI to better inform intervention.
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Affiliation(s)
- Alyssa M Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Daza
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | | | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Potomac Behavioral Solutions, Arlington, VA, USA
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