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Jeon ME, Robison M, Robertson L, Udupa NS, Potter MR, Joiner TE. From identity-based distress to thinking "I am better off being dead:" Minority stress, posttraumatic cognitions, and suicidal ideation. J Affect Disord 2024; 354:143-151. [PMID: 38490586 DOI: 10.1016/j.jad.2024.03.064] [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: 07/10/2023] [Revised: 02/18/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress - i.e., traumatic, insidious distress that results from acts of discrimination - may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI. METHODS Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337). RESULTS Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions. LIMITATIONS Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used. CONCLUSIONS Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality.
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Affiliation(s)
- Min Eun Jeon
- Department of Psychology, Florida State University, United States of America.
| | - Morgan Robison
- Department of Psychology, Florida State University, United States of America
| | - Lee Robertson
- Department of Psychology, Florida State University, United States of America
| | - Nikhila S Udupa
- Department of Psychology, Florida State University, United States of America
| | - Miracle R Potter
- Department of Psychology, Florida State University, United States of America
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States of America
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Chen S, Park EC, Harris LM, Sigel AN, Broshek CE, Joiner TE, Ribeiro JD. Beyond words: Semantic satiation and the mental accessibility of the concept of suicide. Behav Res Ther 2024; 179:104573. [PMID: 38781625 DOI: 10.1016/j.brat.2024.104573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/22/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
Disrupting the accessibility of the mental representation of suicide may be a possible pathway to a strategy for suicide prevention. Our study aims to theoretically evaluate this perspective by examining the impact of temporarily disrupting the concept of suicide on perceptions of suicide. Using a within-subject design, we tested the effects of semantic satiation targeting the word "suicide" on the perceptual judgment of suicide-relevant pictures in 104 young adults. On each trial, participants repeated aloud one of the three words (i.e., "accident," "murder," or "suicide") either three times (priming) or 30 times (satiation) and indicated whether a subsequent picture matched with the word. Results indicated that satiation of the word "suicide" slowed the accurate categorization of pictures related to all three words, and satiation of "murder" and "accident" delayed participants' judgment of suicide-relevant pictures. Our findings support that semantic satiation can render the suicide concept temporarily less accessible, thereby providing preliminary support for the strategy of concept disruption in suicide prevention.
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Affiliation(s)
- Shenghao Chen
- Department of Psychology, Florida State University, USA.
| | - Esther C Park
- Department of Psychology, Florida State University, USA
| | | | - Anika N Sigel
- Department of Psychology, Florida State University, USA
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3
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De Luca GP, Parghi N, El Hayek R, Bloch-Elkouby S, Peterkin D, Wolfe A, Rogers ML, Galynker I. Machine learning approach for the development of a crucial tool in suicide prevention: The Suicide Crisis Inventory-2 (SCI-2) Short Form. PLoS One 2024; 19:e0299048. [PMID: 38728274 PMCID: PMC11086905 DOI: 10.1371/journal.pone.0299048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/04/2024] [Indexed: 05/12/2024] Open
Abstract
The Suicide Crisis Syndrome (SCS) describes a suicidal mental state marked by entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal that has predictive capacity for near-term suicidal behavior. The Suicide Crisis Inventory-2 (SCI-2), a reliable clinical tool that assesses SCS, lacks a short form for use in clinical settings which we sought to address with statistical analysis. To address this need, a community sample of 10,357 participants responded to an anonymous survey after which predictive performance for suicidal ideation (SI) and SI with preparatory behavior (SI-P) was measured using logistic regression, random forest, and gradient boosting algorithms. Four-fold cross-validation was used to split the dataset in 1,000 iterations. We compared rankings to the SCI-Short Form to inform the short form of the SCI-2. Logistic regression performed best in every analysis. The SI results were used to build the SCI-2-Short Form (SCI-2-SF) utilizing the two top ranking items from each SCS criterion. SHAP analysis of the SCI-2 resulted in meaningful rankings of its items. The SCI-2-SF, derived from these rankings, will be tested for predictive validity and utility in future studies.
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Affiliation(s)
- Gabriele P. De Luca
- Department of Psychiatry, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Neelang Parghi
- Department of Biology, New York University, New York City, New York, United States of America
| | - Rawad El Hayek
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Devon Peterkin
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Amber Wolfe
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Megan L. Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, United States of America
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
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4
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Patel TA, Raines AM, Morabito DM, Schmidt NB. Obsessive-compulsive symptoms, perceived burdensomeness, and thwarted belongingness: Associations and implications among US veterans. J Clin Psychol 2024; 80:323-338. [PMID: 37837647 DOI: 10.1002/jclp.23609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders worldwide, but has gone relatively unnoticed within the US veteran population. Simultaneously, suicide rates continue to remain high within this population despite the high volume of veterans who receive psychiatric care. With recent research demonstrating OCD's unique relationship with suicidality, it is imperative to explore this association and factors that may explain this association within veterans. METHODS The present study investigated OCD symptoms and their relationship with two known risk factors of suicide, perceived burdensomeness (PB) and thwarted belongingness (TB), in two samples of veterans. RESULTS In the first study (N = 100), OCD symptoms were found to be uniquely related to both PB and TB even after covarying for demographics, trauma exposure, and probable depression. In the second study (N = 99), these relationships were replicated longitudinally. OCD symptoms at baseline were found to be indirectly related to suicidal ideation severity at a 1-month follow-up via PB and TB at post-treatment. CONCLUSION This study highlights the importance of assessing and addressing OCD symptoms within veterans due to the unique relationship these symptoms have with suicidal constructs. A deeper understanding of the impact of OCD within the veteran population will inform future prevention and intervention efforts.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, Los Angeles, USA
- Louisiana State University School of Medicine, New Orleans, Los Angeles, USA
| | - Danielle M Morabito
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Dodge MC, Hicks AD, McCord DM. Rapid screening for suicide risk: An algorithmic approach. Suicide Life Threat Behav 2024; 54:83-94. [PMID: 37983744 DOI: 10.1111/sltb.13020] [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: 06/27/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION In the United States, primary medical care settings are the first accessed resource for both medical and behavioral health care. Thus, there is a clear need for accurate and efficient behavioral health screening in this setting, including routine surveillance screening for suicide risk. The Multidimensional Behavioral Health Screen (MBHS), a broadband but very brief screening tool developed specifically for primary care, has been updated to include an algorithm that classifies suicide risk based on the interpersonal-psychological theory of suicide, and associated interview and decision framework. This study aims to evaluate the predictive accuracy of the new MBHS 2.0 suicide risk algorithm, with actual risk determined by clinical suicide risk interview. METHOD Data were collected as part of a larger study that, overall, included 551 college student participants. Of these, 309 completed the MBHS 2.0 and the clinical suicide risk interview, the two measures reported here. The final participant count was 299 following the removal of incomplete or invalid cases. Predicted suicide risk as determined by the MBHS 2.0 (Low, Mild, At least Moderate) was compared to actual risk as determined by clinical interview (Low, Moderate, Severe, Extreme). RESULTS Utilizing chi-square analyses, data show a significant association between the predicted suicide risk category based on the MBHS 2.0 algorithm and the actual risk category based on the semi-structured clinical interview. Furthermore, classification analyses suggest that primary care providers will be able to confidently assess the suicide risk level for the majority of their patients when using the MBHS. CONCLUSION Findings suggest that the MBHS 2.0 can be an accurate and efficient tool for use by primary care providers in classifying suicide risk. Future research will be useful to evaluate the utility of the suicide risk algorithm among primary care populations.
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Affiliation(s)
- Matthew C Dodge
- Department of Psychology, Western Carolina University, Cullowhee, North Carolina, USA
| | - Adam D Hicks
- Department of Psychology, Western Carolina University, Cullowhee, North Carolina, USA
| | - David M McCord
- Department of Psychology, Western Carolina University, Cullowhee, North Carolina, USA
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Picou P, Moscardini EH, Perkins K, Tucker RP, Hill RM. Negative Urgency, (Lack of) Premeditation, and Sensation Seeking: Indirect Relationships with Suicidal Ideation through Thwarted Interpersonal Needs. Arch Suicide Res 2024; 28:358-371. [PMID: 36786540 DOI: 10.1080/13811118.2023.2176271] [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] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Differences in how impulsivity is conceptualized, along with a myopic focus on impulsivity's relationship with historical suicidal behaviors, have resulted in limited implications made from prior research regarding impulsivity and suicidal thoughts and behaviors. The current study investigated the indirect effect facets of impulsivity may have on suicidal ideation, specifically, through thwarted interpersonal needs. METHODS Participants were N = 424 undergraduate students who completed a cross-sectional survey. Participants completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS), the Adult Suicide Ideation Questionnaire (ASIQ), and the Interpersonal Needs Questionnaire (INQ). Parallel mediation models were run to examine the relation between facets of impulsivity, perceived burdensomeness, thwarted belongingness, and suicidal ideation. RESULTS Thwarted belonginess and perceived burdensomeness significantly accounted for the variance in the relation between negative urgency and suicidal ideation. Neither thwarted belongingness nor perceived burdensomeness significantly explained variance in the relation between (lack of) premeditation and suicidal ideation. Conversely, perceived burdensomeness and thwarted belonginess significantly explained the inverse relation between sensation seeking and suicidal ideation (i.e., greater sensation seeking was related to lower perceived burdensomeness and thwarted belongingness and in turn lower suicidal ideation). CONCLUSION Negative urgency, in particular, is related to suicidal ideation through thwarted interpersonal needs. Future research should continue to differentiate between various types of impulsivity and its relationship with both suicidal ideation and behaviors utilizing both cross-sectional and ambulatory assessments of these constructs.HIGHLIGHTSNegative urgency is related to suicidal ideation.Negative urgency is related to thwarted interpersonal needs.Thwarted interpersonal needs partially explain the relation between negative urgency and suicidal ideation.
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7
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Beaton MA, Gratch I, Cha CB. Specificity, frequency, and intent: Multiple characteristics of adolescents' suicide plan correlate with their history of suicidal behavior. Suicide Life Threat Behav 2023; 53:1025-1037. [PMID: 37720928 DOI: 10.1111/sltb.13002] [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: 04/08/2023] [Revised: 08/12/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Suicide plans (SP) can be a common precipitant to suicidal behavior (SB) during adolescence, and SPs can vary in how specific they are, how frequently they are thought about, and how strongly they are intended to be enacted. To date, we have limited understanding of how discrete SP characteristics (i.e., specificity, frequency, and intent to act) present among adolescents, and whether they relate to SB. In the current study, we investigated SP characteristics and their association with SB history among adolescents who had previously considered suicide. METHODS Participants were 142 community-based adolescents (14-19 years; M = 17.6, SD = 1.4) who reported a history of suicidal ideation. Adolescents provided responses pertaining to their SP history, SP characteristics, and SB history, via the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R). RESULTS Greater specificity, frequency, and intent were each associated with modestly increased odds of reporting an SB history. The associations between plan specificity and SB history, as well as between frequency of thinking about one's SP and SB history, were mediated by adolescents' intent to act on their SP. CONCLUSIONS It may not only be whether, but how, adolescents plan for suicide that relates to their tendency to engage in SB.
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Affiliation(s)
- Maura A Beaton
- Department of Counseling & Clinical Psychology, Teachers College - Columbia University, New York, New York, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Ilana Gratch
- Department of Counseling & Clinical Psychology, Teachers College - Columbia University, New York, New York, USA
| | - Christine B Cha
- Department of Counseling & Clinical Psychology, Teachers College - Columbia University, New York, New York, USA
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8
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Gallyer AJ, Burani K, Mulligan EM, Santopetro N, Dougherty SP, Jeon ME, Nelson BD, Joiner TE, Hajcak G. Examining Blunted Initial Response to Reward and Recent Suicidal Ideation in Children and Adolescents Using Event-Related Potentials: Failure to Conceptually Replicate Across Two Independent Samples. Clin Psychol Sci 2023; 11:1011-1025. [PMID: 38098687 PMCID: PMC10720695 DOI: 10.1177/21677026221120426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
A recent study by Tsypes and colleagues (2019) found that children with recent suicidal ideation had blunted neural reward processing, as measured by the reward positivity (RewP), compared to matched controls, and that this difference was driven by reduced neural responses to monetary loss, rather than to reward. Here, we aimed to conceptually replicate and extend these findings in two samples (n = 264, 27 with suicidal ideation; and n = 314, 49 with suicidal ideation at baseline) of children and adolescents (11 to 15 years and 8 to 15 years, respectively). Results from both samples showed no evidence that children and adolescents with suicidal ideation have abnormal reward or loss processing, nor that reward processing predicts suicidal ideation two years later. The results highlight the need for greater statistical power, as well as continued research examining the neural underpinnings of suicidal thoughts and behaviors.
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Affiliation(s)
| | | | | | | | | | - Min Eun Jeon
- Department of Psychology, Florida State University
| | | | | | - Greg Hajcak
- Department of Psychology, Florida State University
- Department of Biomedical Sciences, Florida State University
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9
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Bruno S, Anconetani G, Rogier G, Del Casale A, Pompili M, Velotti P. Impulsivity traits and suicide related outcomes: A systematic review and meta-analysis using the UPPS model. J Affect Disord 2023; 339:571-583. [PMID: 37459976 DOI: 10.1016/j.jad.2023.07.086] [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: 03/08/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The affective, cognitive, and behavioral aspects of impulsivity involved in suicide-related outcomes can be investigated through the UPPS model, which conceptualizes these facets in multidimensional terms related to negative and positive urgency, lack of premeditation and perseverance, and sensation seeking. This systematic review and meta-analysis provided a comprehensive understanding of the role of all facets of impulsivity in the development of suicidal ideation and behaviors. METHODS We conducted a systematic search on six databases (PsycINFO, PsycARTICLES, PubMed, MEDLINE, Scopus, and Web of Science) until May 5,2023. Overall, 49 studies met the criteria for systematic review, of which 37 were included in a meta-analysis of data from 17.898 individuals. Additional moderation analyses included age, gender, sample status, country of study conduct, assessment instruments, type of suicide-related outcome, study quality, and research design. RESULTS We found significant relationships between aspects of impulsivity and suicide-related outcomes. Specially, affective facets related to impulsivity showed a stronger association with suicidal ideations and attempts than cognitive and behavioral dimensions, recommending the main involvement of emotional aspects-positive and negative-in suicide-related dimensions. LIMITATIONS The limited number of studies may have negatively impacted the power of moderation analyses. In addition, for most dimensions of impulsivity, the limited number of longitudinal studies did not allow to test the moderating role of research design. CONCLUSIONS This study supports the role of impulsivity in suicidal ideation and behavior, identifying the affective component of impulsivity as the most involved, providing a significant contribution from a clinical and diagnostic point of view.
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Affiliation(s)
- Serena Bruno
- Department of Dynamic and Clinical Psychology, Health Studies, University of Rome Sapienza, Italy
| | - Gerardo Anconetani
- Department of Dynamic and Clinical Psychology, Health Studies, University of Rome Sapienza, Italy
| | - Guyonne Rogier
- Department of Educational Sciences, University of Genoa, Italy
| | | | | | - Patrizia Velotti
- Department of Dynamic and Clinical Psychology, Health Studies, University of Rome Sapienza, Italy.
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10
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Teismann T, Brailovskaia J, Robison M, Joiner TE. Self-burdensomeness, other-burdensomeness, and suicidal ideation. Behav Res Ther 2023; 169:104388. [PMID: 37643552 DOI: 10.1016/j.brat.2023.104388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - Morgan Robison
- Department of Psychology, Florida State University, USA.
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Stanley IH, Marx BP, Fina BA, Young-McCaughan S, Tyler HC, Sloan DM, Blankenship AE, Dondanville KA, Walker JL, Boffa JW, Bryan CJ, Brown LA, Straud CL, Mintz J, Abdallah CG, Back SE, Blount TH, DeBeer BB, Flanagan J, Foa EB, Fox PT, Fredman SJ, Krystal J, McDevitt-Murphy ME, McGeary DD, Pruiksma KE, Resick PA, Roache JD, Shiroma P, Taylor DJ, Wachen JS, Kaplan AM, López-Roca AL, Nicholson KL, Schobitz RP, Schrader CC, Sharrieff AFM, Yarvis JS, Litz BT, Keane TM, Peterson AL. Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans. Assessment 2023; 30:2332-2346. [PMID: 36644835 DOI: 10.1177/10731911221143979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.
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Affiliation(s)
- Ian H Stanley
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- University of Colorado, School of Medicine, Aurora, USA
| | - Brian P Marx
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, USA
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Hannah C Tyler
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Denise M Sloan
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | | | | | - James L Walker
- University of Texas Health Science Center at San Antonio, USA
| | - Joseph W Boffa
- Southeast Louisiana Veterans Health Care System, New Orleans, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Chadi G Abdallah
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sudie E Back
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Bryann B DeBeer
- University of Colorado, School of Medicine, Aurora, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Julianne Flanagan
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, USA
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John Krystal
- VA Connecticut Healthcare System, West Haven, USA
- Yale University, New Haven, CT, USA
| | | | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John D Roache
- University of Texas Health Science Center at San Antonio, USA
| | - Paulo Shiroma
- Minneapolis VA Medical Center, MN, USA
- University of Minnesota, Minneapolis, USA
| | | | | | | | | | - Karin L Nicholson
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | | | - Allah-Fard M Sharrieff
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- U.S. Department of Homeland Security, Miami, FL, USA
| | - Jeffrey S Yarvis
- Tulane University School of Medicine, New Orleans, LA, USA
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Brett T Litz
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- Boston University, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
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Crosby Ms Msw ES, Witte PhD TK. A pilot study of sleep scholar: A single-session, internet-based insomnia intervention for college students with a history of suicide ideation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1984-1998. [PMID: 34283711 DOI: 10.1080/07448481.2021.1953028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 05/18/2021] [Accepted: 07/02/2021] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Establish the feasibility and acceptability of Sleep Scholar, a single-session, self-guided, internet-based insomnia intervention. PARTICIPANTS College students with a lifetime history of suicide ideation and at least subclinical insomnia symptoms. METHODS Participants (N = 38) completed pretreatment sleep diaries, Sleep Scholar, and post-treatment feasibility, acceptability, and clinical measures. RESULTS Approximately 33 students could be recruited per semester, the overall attrition rate was 47%, Sleep Scholar was completed in approximately 30 minutes, and the majority of treatment information was retained. Participants reported positive acceptability and satisfaction, and approximately half of participants adhered to their prescribed time in bed recommendations. Most clinical measures had adequate variability and internal consistency, and post-hoc analyses revealed clinically significant reductions in several mental health symptoms. CONCLUSIONS Sleep Scholar is feasible in college settings, acceptable for college students, and produced reductions in mental health symptoms during an uncontrolled trial. Implications for a randomized-controlled trial are discussed.
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Affiliation(s)
| | - Tracy K Witte PhD
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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13
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Fekih-Romdhane F, Azzi V, Hallit R, Malaeb D, Dabbous M, Sakr F, Obeid S, Hallit S. Validation of the Arabic version of the brief irritability test (Ar-BITe) in non-clinical adolescents. BMC Psychiatry 2023; 23:701. [PMID: 37752461 PMCID: PMC10521430 DOI: 10.1186/s12888-023-05211-y] [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: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe). METHODS Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey. RESULTS Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores. CONCLUSION The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Mehrabi A, Naghavi A, Afsharzada ME, Friedrich S, Forkmann T, Glaesmer H, Teismann T. Validation of the Farsi version of the Suicide Ideation and Behavior Scale. Front Psychiatry 2023; 14:1201193. [PMID: 37736059 PMCID: PMC10509848 DOI: 10.3389/fpsyt.2023.1201193] [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: 04/06/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Objective Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS). Methods Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted. Results The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity. Discussion The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.
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Affiliation(s)
- Ali Mehrabi
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Azam Naghavi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | | | - Sören Friedrich
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Duisburg, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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15
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Patel TA, Wilver NL, Cougle JR. Appearance-related safety behaviors predict symptoms of body dysmorphic disorder following internet-based treatment. Body Image 2023; 46:84-90. [PMID: 37245382 DOI: 10.1016/j.bodyim.2023.05.004] [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: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
Recent experimental evidence has found that appearance related safety behaviors (i.e., practices meant to avoid a perceived feared outcome) likely play a crucial role in maintaining symptoms of body dysmorphic disorder (BDD). The present study sought to determine if these behaviors predicted BDD symptom severity following treatment. Participants (N = 50) with BDD were randomized to either eight sessions of interpretation bias modification or progressive muscle relaxation. Both treatments led to reductions in BDD symptom severity and appearance-related safety behaviors, though moderate levels of safety behaviors persisted at both posttreatment and follow-up. Importantly, post-treatment appearance related safety behaviors significantly predicted BDD symptom severity at three-month follow-up. Taken together, the present findings suggest appearance related safety behaviors maintain BDD symptoms following effective computerized treatments and provide further evidence for their importance in the treatment of BDD.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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16
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Cox RC, Brown SL, Chalmers BN, Scott LN. Examining sleep disturbance components as near-term predictors of suicide ideation in daily life. Psychiatry Res 2023; 326:115323. [PMID: 37392522 PMCID: PMC10527974 DOI: 10.1016/j.psychres.2023.115323] [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: 03/10/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
Suicide ideation emerges and fluctuates over short timeframes (minutes, hours, days); however, near-term predictors of such fluctuations have not been well-elucidated. Sleep disturbance is a distal suicide risk factor, but less work has examined whether daily sleep disturbance predicts near-term changes in suicide ideation. We examined subjective sleep disturbance components as predictors of passive and active suicide ideation at the within-person (i.e., day-to-day changes within individuals relative to their own mean) and between-persons (individual differences relative to the sample mean) levels. A transdiagnostic sample of 102 at-risk young adults ages 18-35 completed a 21-day ecological momentary assessment protocol, during which they reported on sleep and passive and active suicide ideation. At the within-persons level, nightmares, sleep quality, and wake after sleep onset predicted passive suicide ideation, and sleep quality and wake after sleep onset predicted active suicide ideation. At the between-persons level, nightmares, sleep onset latency, and sleep quality were associated with passive suicide ideation, and sleep onset latency was associated with active suicide ideation. In contrast, suicide ideation did not predict subsequent sleep at the within-person level. Specific sleep disturbance components are near-term predictors of intraindividual increases in suicide ideation and may hold promise for suicide prevention and intervention.
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Affiliation(s)
- Rebecca C Cox
- Department of Integrative Physiology, University of Colorado Boulder, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Sarah L Brown
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Brittany N Chalmers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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17
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Ammerman BA, Jacobucci R. The impact of social connection on near-term suicidal ideation. Psychiatry Res 2023; 326:115338. [PMID: 37453309 DOI: 10.1016/j.psychres.2023.115338] [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: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
While predominant suicide theories emphasize the role of social connectedness in suicidal thinking, there is a need to better understand (a) how specific aspects of social connection relate to suicidal ideation and (b) the timeframe over which these relationships persist. The current study examined ecological momentary assessment data over a 30-day period from 35 participants with past-year suicidal thoughts or behaviors (mean age = 25.88; 62.9% women; 68.6% White) to address these questions. Results demonstrated that absence of social contact was associated with next timepoint suicidal ideation, even after considering the suicidal ideation autoregressive effect (i.e., concurrent), with effects strongest in the short-term. Findings provide preliminary evidence of the need to assess for the presence of social contact, and for assessments to occur in close proximity (i.e., a few hours), to capture the true dynamics of risk for suicidal ideation. Although needing replication, results suggest importance of just-in-time interventions targeting suicidal ideation.
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Affiliation(s)
- Brooke A Ammerman
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46656, United States.
| | - Ross Jacobucci
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46656, United States
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18
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Ladis I, Seitov A, Barnes LE, Teachman BA. Perceived Burdensomeness and Thwarted Belongingness in Text Messages of Suicide Attempt Survivors. Arch Suicide Res 2023:1-12. [PMID: 37350046 PMCID: PMC10739607 DOI: 10.1080/13811118.2023.2226692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Perceived burdensomeness and thwarted belongingness are considered interpersonal risk factors for suicide. Examining these themes in personal text messages may help identify proximal suicide risk. METHOD Twenty-six suicide attempt survivors provided personal text messages and reported dates for past periods characterized by positive mood, depressed mood, suicidal ideation (with no attempt), or the two-week period leading up to suicide attempt(s). Texts were then classified into the applicable period based on matching dates. Texts (N = 194,083; including n = 86,705 outgoing texts) were coded for perceived burdensomeness and thwarted belongingness by masked trained raters. Multilevel models were fit to examine whether the target themes (combined into one overall interpersonal risk variable due to low base rate) were more prevalent in texts sent during higher risk episodes (e.g., suicide attempt vs. depressed mood episodes). RESULTS 0.57% of outgoing texts contained either target theme. As hypothesized, logistic models showed participants were more likely to send texts containing the target themes during suicide attempt episodes relative to suicidal ideation (with no attempt) episodes, depressed mood episodes, and positive mood episodes, and during suicidal ideation (with no attempt) episodes relative to positive mood episodes. All contrasts were robust to post-hoc correction except for suicide attempt episodes vs. ideation (with no attempt) episodes. No other significant pairwise differences for episode type emerged. CONCLUSIONS Despite the small sample size and low base rate of target themes in the texts, perceived burdensomeness and thwarted belongingness were associated with intra-individual suicide risk severity in personal text messages.
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Affiliation(s)
- Ilana Ladis
- Department of Psychology, University of Virginia
| | - Arsen Seitov
- Department of Psychology, University of Virginia
| | - Laura E. Barnes
- Department of Engineering Systems and Environment, University of Virginia
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19
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Kobrinsky V, Siedlecki KL. Mediators of the Relationship Between Adverse Childhood Experiences (ACEs) and Symptoms of Anxiety, Depression, and Suicidality among Adults. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:233-246. [PMID: 37234827 PMCID: PMC10205933 DOI: 10.1007/s40653-022-00510-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 05/28/2023]
Abstract
Adverse childhood experiences (ACEs) are consistently found to be negatively associated with physical, psychological, and psychosocial well-being throughout the lifespan. While previous research has established risk factors and noxious outcomes arising post-ACEs, less attention has been given to factors such as resilience, perceived social support, and subjective well-being that may help explain the relationship between ACEs and psychopathology. Hence, the objectives of this study are to examine: (1) the relationships among ACEs and symptoms of anxiety, depression, and suicidality in adulthood, and (2) whether resilience, social support, and subjective well-being mediate the relationship between ACEs and psychopathological symptoms. Cross-sectional data on ACEs, psychological factors, potential mediating variables, and sociodemographic factors were collected from a community sample of adults aged 18-81 (N = 296) via an on-line survey. Endorsing ACEs was significantly and positively correlated with symptoms of anxiety, depression, and suicidality. Results of parallel mediation analyses showed that social support, negative affect, and life satisfaction statistically mediated the relationships between ACEs and psychopathological outcomes in adulthood. These results highlight the importance of identifying potential mediators of the ACEs-psychopathological symptoms relationship to aid in the development of screening and intervention practices that could bolster developmental outcomes following traumatic childhood experiences.
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Affiliation(s)
- Veronika Kobrinsky
- Department of Psychology, Fordham University, 113 W. 60th Street, New York, NY 10023 USA
| | - Karen L. Siedlecki
- Department of Psychology, Fordham University, 113 W. 60th Street, New York, NY 10023 USA
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20
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Tong Y, Yin Y, Conner KR, Zhao L, Wang Y, Wang X, Conwell Y. Predictive value of suicidal risk assessment using data from China's largest suicide prevention hotline. J Affect Disord 2023; 329:141-148. [PMID: 36842651 DOI: 10.1016/j.jad.2023.02.095] [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: 07/16/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Suicide hotlines are widely used, with potential for identification of callers at especially high risk. METHODS This prospective study was conducted at the largest psychological support hotline in China. From 2015 to 2017, all distressed callers were consecutively included and assessed, using a standardized scale consisting of 12 elements, yielding scores of high risk (8-16), moderate risk (4-7), and low risk (0-3) for suicidal act. All high-risk and half of moderate- and low-risk callers were scheduled for a 12-month follow-up. Main outcomes were suicidal acts (nonlethal attempt, death) over follow-up. RESULTS Of 21,346 fully assessed callers, 5822, 11,791, and 3733 were classified as high-, moderate-, or low-risk for suicidal acts, with 8869 callers (4076 high-, 3258 moderate-, and 1535 low-risk) followed up over 12 months. Over follow-up, 802 (9.0 %) callers attempted suicide or died by suicide. The high-risk callers (15.1 %) had 3-fold higher risk for subsequent suicidal acts than moderate- (5.1 %) and 12-fold higher risk than low-risk callers (1.3 %). The weighted sensitivity, specificity, and positive predictive value of high risk scores were 56.4 %, 74.9 %, and 14.4 %. LIMITATIONS Assessed callers with different risk levels were followed disproportionally. CONCLUSIONS Suicidal risk assessment during a hotline call is both feasible and predictive of risk, guiding resource allocation to higher risk callers.
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Affiliation(s)
- Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, Beijing, China.
| | - Yi Yin
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Liting Zhao
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yuehua Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Xuelian Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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21
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Rogers ML, McMullen L, Liang Y, Perez N, Richards JA, Akülker G, Barzilay S, Bilici R, Blum Y, Chistopolskaya K, Dudeck M, Husain MI, Kuśmirek O, Luiz JM, Menon V, Pilecka B, Sadovnichaya V, Titze L, Valvassori SS, You S, Galynker I. Cross-national presence and sociodemographic correlates of the suicide crisis syndrome. J Affect Disord 2023; 329:1-8. [PMID: 36828142 DOI: 10.1016/j.jad.2023.02.076] [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: 10/29/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The Suicide Crisis Syndrome (SCS) has been proposed as an acute, pre-suicidal mental state that precedes imminent suicidal behavior; however, its cross-national applicability and sociodemographic correlates have not yet been determined. The present study assessed the presence and severity of the SCS in ten countries and examined several potential sociodemographic correlates (i.e., age, gender, marital status, race/ethnicity) of the SCS. METHODS 5528 community-based adults across 10 participating countries provided information on their SCS symptoms and sociodemographic characteristics in an anonymous online survey obtained via convenience sampling during the first year of the COVID-19 pandemic. RESULTS The SCS occurred cross-nationally, with rates ranging from 3.6% (Israel) to 16.2% (Poland). Those in the United States, South Korea, Poland, and Turkey had the highest severity of symptoms. Participants who were older, identified as cisgender men, and married tended to have lower rates of the SCS than their respective counterparts. There were minimal differences in the SCS by race/ethnicity. LIMITATIONS These data were both cross-sectional and collected via convenience sampling, limiting generalizability of findings and information about the SCS's predictive utility. CONCLUSIONS These findings support the cross-national presence of the SCS during the COVID-19 pandemic. Sociodemographic correlates aligned with those of suicidal behavior more generally, providing additional evidence for the concurrent/predictive validity of the SCS.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Lauren McMullen
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Yinan Liang
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Nazareth Perez
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Jenelle A Richards
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | | | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Yarden Blum
- Department of Psychology, College of Management, Rishon LeZion, Israel
| | | | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Oskar Kuśmirek
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Jhoanne M Luiz
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Larissa Titze
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Samira S Valvassori
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
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Schmidt NB, Capron D, Raines AM, Albanese B, Short N, Mathes BM, Morabito DM, Saulnier K, Allan N. Evaluating the long-term (Three Year) durability of brief interventions targeting risk factors for psychopathology. J Anxiety Disord 2023; 96:102710. [PMID: 37058765 DOI: 10.1016/j.janxdis.2023.102710] [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: 08/08/2022] [Revised: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023]
Abstract
Despite their brevity, prior work indicates that computer-based interventions can substantially impact risk factors for psychopathology including anxiety sensitivity (AS), thwarted belongingness (TB), and perceived burdensomeness (PB). However, very few studies have assessed the long-term (> 1 year) effects of these interventions. The primary aim of the current study was to evaluate post-hoc, the long-term (3 year) durability of brief interventions targeting risk factors for anxiety and mood psychopathology using data from a pre-registered randomized clinical trial. Moreover, we were interested in evaluating whether mitigation in these risk factors mediated long-term symptom change. A sample determined to be at-risk for anxiety and mood pathology based on elevations on several risk factors (N = 303) was randomly assigned to one of four experimental conditions focused on: (1) reducing TB and PB; (2) reducing AS, (3) reducing TB,PB, and AS; or (4) a repeated contact control condition. Participants were assessed at post-intervention, one, three, six, 12, and 36 month follow-ups. Participants in the active treatment conditions showed sustained reductions in AS and PB through long-term follow-up. Mediation analyses suggested that reductions in AS mediated long-term reductions in anxiety and depression symptoms. These findings suggest that brief and scalable risk reduction protocols have long-term durability and efficacy both in terms of reducing risk factors for psychopathology.
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Affiliation(s)
- Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W Call Street, Tallahassee, FL 32304, USA.
| | - Daniel Capron
- School of Psychology, University of Southern Mississippi, 118 College Dr., Hattiesburg, MS 39406, USA
| | - Amanda M Raines
- School of Medicine, Louisiana State University, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Brian Albanese
- Department of Psychological & Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX 77843, USA
| | - Nicole Short
- Department of Psychology, University of Nevada Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV 89154, USA
| | - Brittany M Mathes
- Department of Psychology, Florida State University, 1107 W Call Street, Tallahassee, FL 32304, USA
| | - Danielle M Morabito
- Department of Psychology, Florida State University, 1107 W Call Street, Tallahassee, FL 32304, USA
| | - Kevin Saulnier
- Department of Psychology, Ohio University, Porter 200, Athens, OH 45701, USA
| | - Nicholas Allan
- Department of Psychology, Ohio University, Porter 200, Athens, OH 45701, USA
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Park EC, Harris LM, Sigel AN, Huang X, Chen S, Ribeiro JD. Is physical pain causally related to suicidal behavior: An experimental test. Behav Res Ther 2023; 165:104321. [PMID: 37116304 DOI: 10.1016/j.brat.2023.104321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/25/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
Existing evidence suggests a link between physical pain and suicide, but the nature of this relationship remains unknown. To address this critical gap in knowledge, the present study leveraged a validated virtual reality (VR) suicide paradigm to experimentally examine the causal effects of physical pain on subsequent virtual suicidal behaviors. Based on previous findings, we hypothesized that physical pain would causally drive virtual suicidal behavior only if suicide was conceptualized as having desirable anticipated consequences (e.g., a means of escaping from current pain; an opportunity to avoid future pain). We tested this by randomizing 326 participants across four different conditions: a physical pain condition, an anticipated escape condition, an anticipated avoidance condition, and a control condition. As predicted, physical pain alone did not result in statistically significant increases in VR suicide rates; however, the anticipation that virtual suicidal behavior would result in the avoidance of future physical pain had a large causal effect on VR suicide rates (B = 1.61, p < .001, IRR = 5.01). We failed to find evidence that anticipating that VR suicide would provide an escape from currently experienced physical pain increases the likelihood of VR suicide. Our findings add to a growing body of evidence suggesting that the anticipated consequences of suicide (e.g., avoidance of future physical pain) may serve as primary causes of suicidal behavior.
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Affiliation(s)
- Esther C Park
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL, 32304, United States.
| | - Lauren M Harris
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL, 32304, United States
| | - Anika N Sigel
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL, 32304, United States
| | - Xieyining Huang
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL, 32304, United States
| | - Shenghao Chen
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL, 32304, United States
| | - Jessica D Ribeiro
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL, 32304, United States
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24
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Velkoff EA, Smith AR. Temporal dynamics of interoceptive attention and positive and negative affect in adults engaging in disordered eating and nonsuicidal self-injury. J Clin Psychol 2023. [PMID: 36905648 DOI: 10.1002/jclp.23508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/28/2022] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Interoception (the sense of the body's state) is associated with eating disorders and nonsuicidal self-injury, potentially through relationships with affect. We examined the relationship between interoceptive attention and both positive and negative affect. METHODS Participants (N = 128) who reported recent self-harm (i.e., disordered eating and/or non-suicidal self-injury) completed ecological momentary assessment for 16 days. Participants completed multiple daily assessments of affect and interoceptive attention. We then tested the temporal dynamic relationship between interoceptive attention and affect. RESULTS There was a relationship between positive affect and interoceptive attention such that people with higher average positive affect, and times when people were above their typical positive affect, were associated with higher interoceptive attention. There was a negative relationship between negative affect and interoceptive attention, such that people with higher average negative affect, and times when people were above their own typical negative affect, were associated with lower interoceptive attention. CONCLUSIONS Better mood may associate with greater willingness to attend to body sensations. Our findings support active inference models of interoception and highlight the importance of refining our understanding of the dynamic nature of interoception and its relationship with affect.
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Affiliation(s)
- Elizabeth A Velkoff
- Department of Psychology, Miami University, Oxford, Ohio, USA.,Department of Psychiatry, The University of California, San Diego, California, USA
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio, USA.,Department of Psychology, Auburn University, Auburn, Alabama, USA
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25
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Fartacek C, Kunrath S, Aichhorn W, Plöderl M. Therapeutic alliance and change in suicide ideation among psychiatric inpatients at risk for suicide. J Affect Disord 2023; 323:793-798. [PMID: 36529412 DOI: 10.1016/j.jad.2022.12.028] [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: 12/17/2021] [Revised: 09/14/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Therapeutic alliance is thought to be essential in the treatment of suicidality. Surprisingly, studies about the association between therapeutic alliance and change in suicide ideation over the course of treatment are sparse and reported inconsistent results. Furthermore, theoretically important moderators were rarely explored empirically. METHODS We investigated the association between therapeutic alliance and change in suicide ideation (difference between intake and discharge), unadjusted and adjusted for potential confounding variables (diagnoses, sociodemographics etc.) in a sample of 351 inpatients treated in a psychiatric department specialized in crisis intervention and suicide prevention. We also explored if the association was moderated by suicide ideation at intake, history of suicide attempts, and borderline personality disorder (BPD). We ran sensitivity analyses for different diagnostic subgroups, history of suicide attempts, and a quantitative measure of BPD symptoms. RESULTS We found a moderate association between therapeutic alliance and change in suicide ideation (r = 0.30, p < 0.01). This association remained robust after accounting for potentially confounding variables. Suicide ideation at intake, history of suicide attempts, and BPD were not statistically significant moderators. Sensitivity analyses led to similar results. LIMITATIONS Therapeutic alliance was assessed only at the end of treatment and causality cannot be inferred from our study method. CONCLUSIONS Therapeutic alliance was a robust correlate of improvement in suicide ideation among psychiatric inpatients at risk for suicide, independent from diagnostic groups and other patient characteristics. Our results support the crucial role of therapeutic alliance in the treatment of patients at risk for suicide.
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Affiliation(s)
- Clemens Fartacek
- Department for Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria; Department of Clinical Psychology, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria; Institute of Synergetics and Psychotherapy Research, University Clinic of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria.
| | - Sabine Kunrath
- California Institute for Telecommunications and Information Technology (Calit2), Irvine, CA, USA
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research, University Clinic of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Martin Plöderl
- Department for Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria; Department of Clinical Psychology, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
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26
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Park JY, Rogers ML, Bloch-Elkouby S, Richards JA, Lee S, Galynker I, You S. Factor Structure and Validation of the Revised Suicide Crisis Inventory in a Korean Population. Psychiatry Investig 2023; 20:162-173. [PMID: 36891601 PMCID: PMC9996151 DOI: 10.30773/pi.2022.0208] [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: 07/19/2022] [Accepted: 12/07/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Because of the exceptionally high suicide rates in South Korea, new assessment methods are needed to improve suicide prevention. The current study aims to validate the revised Suicide Crisis Inventory-2 (SCI-2), a self-report measure that assesses a cognitiveaffective pre-suicidal state in a Korean sample. METHODS With data from 1,061 community adults in South Korea, confirmatory factor analyses were first conducted to test the proposed one-factor and five-factor structures of the SCI-2. Also, an exploratory factor analysis (EFA) was performed to examine possible alternative factor structure of the inventory. RESULTS The one-factor model of the SCI-2 resulted in good model fit and similarly, the five-factor model also exhibited strong fit. Comparing the two models, the five-factor was evaluated as the superior model fit. An alternative 4-factor model derived from EFA exhibited a comparable model fit. The Korean version of the SCI-2 had high internal consistency and strong concurrent validity in relation to symptoms of suicidal ideation, depression, and anxiety. CONCLUSION The SCI-2 is an appropriate and a valid tool for measuring one's proximity to imminent suicide risk. However, the exact factor structure of the SCI-2 may be culture-sensitive and warrants further study.
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Affiliation(s)
- Ji Yoon Park
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA.,Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | | | - Sungwoo Lee
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
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Khazem LR, Pearlstien JG, Anestis MD, Gratz KL, Tull MT, Bryan CJ. Differences in suicide risk correlates and history of suicide ideation and attempts as a function of disability type. J Clin Psychol 2023; 79:466-476. [PMID: 35909343 PMCID: PMC10087921 DOI: 10.1002/jclp.23419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/31/2022] [Accepted: 07/10/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts). AIMS This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type. METHODS Individuals with mobility and vision disabilities (N = 102) completed semistructured interviews and online-based questionnaires. Analysis of variance/analysis of covaiance and Fisher's exact tests were conducted to examine whether mean levels of suicide-related correlates differed significantly between individuals with blindness/low vision (n = 63) versus mobility-related (n = 39) disabilities. RESULTS No significant between-group differences were observed for most outcomes; however, individuals with vision disabilities reported higher mean levels of felt stigma and positive future disposition than those with mobility-related disabilities. LIMITATIONS The limited representation of disabilities among participants precludes generalization to individuals with other forms of disability and the cross-sectional design prevents inference about causality. CONCLUSIONS Interventions targeting cognitive processes that underlie suicide risk may be applicable to people with mobility and vision disabilities.
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Affiliation(s)
- Lauren R Khazem
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer G Pearlstien
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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28
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Tull MT, DeMoss ZT, Anestis MD, Lavender JM, McDermott MJ, Gratz KL. Examining associations between suicidal desire, implicit fearlessness about death, and lifetime frequency of suicide attempts. Suicide Life Threat Behav 2022; 52:1110-1120. [PMID: 35899809 PMCID: PMC10087538 DOI: 10.1111/sltb.12905] [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: 03/22/2022] [Revised: 06/01/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of learned or pre-existing associations between fearlessness and death, implicit measures of FAD hold promise. This study used a novel implicit association test (IAT), the IAT-FAD, to examine associations between suicidal desire, implicit FAD, and lifetime suicide attempt frequency. METHODS Patients in residential substance use treatment (N = 75), a population with increased suicide risk and exposure to painful and provocative events, completed the IAT-FAD and assessments of suicidal desire and past suicide attempts. RESULTS Implicit FAD moderated the association between suicidal desire and lifetime frequency of suicide attempts associated with an intent to die and requiring medical attention (although not ambivalent suicide attempts). Suicidal desire related to medically attended suicide attempts only at high implicit FAD levels, and to suicide attempts with a clear intent to die only at high or mean implicit FAD levels. CONCLUSION Results provide initial support for the relevance of implicit measures of FAD for understanding suicide risk.
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Affiliation(s)
- Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Zachary T DeMoss
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA.,School of Public Health, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, Maryland, USA.,The Metis Foundation, San Antonio, Texas, USA
| | - Michael J McDermott
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Reduced working memory performance in PTSD and suicide among veterans presenting for treatment. J Psychiatr Res 2022; 156:299-307. [PMID: 36283133 DOI: 10.1016/j.jpsychires.2022.10.043] [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: 03/26/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022]
Abstract
Suicide is among the leading causes of death in the United States, underscoring the continued need to understand the mechanisms underlying suicide risk. A growing body of research has examined the role of working memory deficits in suicidal thoughts and behaviors (STBs), yet little research has evaluated putative pathways via which working memory impairments may heighten suicide risk. Elevated posttraumatic stress symptoms (PTSS) represent one plausible mechanism through which poor working memory performance may increase STBs. The present study utilized data from 140 treatment-seeking veterans who presented for an intake evaluation in the PTSD Clinical Team of a large VA Medical Center. Veterans completed self-report measures, a semi-structured PTSD evaluation, and a digit span working memory test. In addition to concurrent suicidal ideation assessed during the intake, additional information regarding past suicide attempts, presence of a safety plan, documentation of past suicidal behaviors, and engagement with suicide crisis lines were collected via electronic medical records. Consistent with hypotheses, a significant indirect path emerged such that poor working memory performance predicted greater suicidal ideation, greater likelihood of a past suicide attempt, and greater latent suicide risk via increased PTSS. However, no direct effect of working memory on STBs or indirect paths of PTSS on STBs via working memory emerged. These findings suggest that the relation between working memory and STBs may be explained by PTSS severity.
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30
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Gioia AN, Forrest LN, Smith AR. Diminished body trust uniquely predicts suicidal ideation and nonsuicidal self-injury among people with recent self-injurious thoughts and behaviors. Suicide Life Threat Behav 2022; 52:1205-1216. [PMID: 36029117 DOI: 10.1111/sltb.12915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/13/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Self-injurious thoughts and behaviors (SITBs) are difficult to predict, and novel risk factors must be identified. While diminished interoception is associated with SITBs cross-sectionally, the current study assesses whether multiple measures of interoception predict future SITBs. METHODS Adults (N = 43) with recent SITBs completed assessments of interoception during a baseline visit. Participants then completed biweekly assessments for 6 months in which they reported the presence and severity/frequency of suicidal ideation and nonsuicidal self-injury (NSSI). RESULTS Multilevel models were performed, where baseline interoceptive measures predicted presence and severity/frequency of suicidal ideation and NSSI at follow-up. The Multidimensional Assessment of Interoceptive Awareness (MAIA) Trusting subscale was the only significant predictor of the presence/severity of suicidal ideation. The MAIA Trusting, Emotional Awareness, and Body Listening subscales significantly predicted the presence of NSSI. The MAIA Emotional Awareness subscale and the Body Perception Questionnaire significantly predicted NSSI frequency. DISCUSSION Diminished body trust predicted both suicidal ideation and NSSI, indicating a potential shared risk pathway. However, two interoception measures (Body Listening subscale and Body Perception Questionnaire) were associated with NSSI only, indicating potentially unique risk pathways. Given the differential associations between interoception measures and SITBs, results highlight the importance of clearly defining how interoception is measured.
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Affiliation(s)
- Ayla N Gioia
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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31
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Linthicum KP, Ribeiro JD. Suicide plan prevalence, recurrence, and longitudinal association with nonfatal suicide attempt. Suicide Life Threat Behav 2022; 52:1062-1073. [PMID: 35851502 DOI: 10.1111/sltb.12901] [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: 10/19/2021] [Revised: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Each year, millions of people develop suicide plans. These plans are assumed to indicate imminent suicide risk, yet this has rarely been tested. The present study seeks to address two questions: (1) how prevalent are specific thoughts of suicide plans among individuals with a history of suicidal thoughts and behaviors and (2) do suicide plans confer risk of future suicide attempts in the short term? METHODS Secondary data analysis was performed on a longitudinal dataset (N = 1021). Prevalence and frequencies of suicide planning features (i.e., method, time, place) at baseline and 3, 14, and 28 days post-baseline were calculated. Logistic regressions were conducted to assess whether suicide plans confer risk of suicide attempts across a 28-day follow-up period. RESULTS Suicide planning more commonly involved thoughts of method than place and/or time. High variability in suicide planning was evident and thoughts of suicide plans frequently recurred. Contrary to assumptions, suicide plans displayed weak associations with nonfatal suicide attempt across the 28-day follow-up period. CONCLUSIONS Suicide plans appear heterogeneous in nature. They do not appear to play a strong role in predicting nonfatal suicide attempts. Re-evaluation of the central role that suicide plans occupy within clinical risk assessments may be warranted.
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Affiliation(s)
- Kathryn P Linthicum
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Oh Y, Lee S, Rogers ML, You S. Assessment of acute and non-acute suicide crisis symptoms: Validation of the Korean version of the acute suicidal affective disturbance inventory. Front Psychol 2022; 13:1034130. [DOI: 10.3389/fpsyg.2022.1034130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide risk assessment is predominantly based on assessing current/recent suicidal ideation and past suicidal behavior. However, suicidal ideation and lifetime suicide attempt are poor predictors of imminent suicide risk or crisis. The acute suicidal affective disturbance inventory-lifetime (ASADI-L) was developed to assess symptoms of acute suicidal affective disturbance, which includes a drastic increase in suicidal intent, perceptions of social and/or self-alienation, hopelessness, and overarousal. However, the ASADI-L has not yet been validated in a Korean population. Also, the ASADI-L has only been validated for people who experience a drastic increase in suicidal intention over the course of hours or days (i.e., the acute suicidal intention group) and not validated for those who experience suicidal intention for a longer period (i.e., the non-acute suicidal intention group). Thus, the aims of this study were to (1) validate the ASADI-L in a sample of Korean community adults; and (2) compare clinical characteristics of the acute and non-acute suicidal intention groups. Among 1,675 community adults, data from 682 participants who reported a lifetime drastic increase in suicidal intent were analyzed. Results indicated that the ASADI-L has relevant reliability, validity, and a unidimensional factor structure. The acute suicidal intention group had higher ASAD symptoms as well as clinical symptoms than the non-acute group, but the two groups did not differ in history of suicide attempt. Overall, these findings suggest that the ASADI-L is a valid measure of acute and non-acute suicidal affective disturbance among Korean adults. Further investigation of the differences in acute and non-acute suicide risk is warranted.
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Doran N, Gress-Smith J, Raja P, Waddell JT, Davis L, De La Rosa S, Hurwitz V, Kratz K, Louis R, Moore J, Peoples L. Suicide Risk Among Military Veterans in the Southwestern United States Before and During the COVID-19 Pandemic. Mil Med 2022; 188:usac303. [PMID: 36226739 PMCID: PMC9620731 DOI: 10.1093/milmed/usac303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Military Veterans have an increased risk of suicide compared to the general population, but less is known about changes in risk with the onset of the COVID-19 pandemic, or whether any changes have been moderated by psychiatric or demographic factors. The primary objective was to test the hypothesis that the likelihood of suicide attempt or death by suicide was stable during the first year of the pandemic versus the preceding year for the full sample. A second objective was to test the hypothesis that, in contrast, risk increased for Veteran subgroups characterized by traditional risk factors (e.g., psychiatric diagnosis). MATERIALS AND METHODS We extracted electronic health record data for 771,570 Veterans who received one or more health care visits between March 13, 2019, and March 12, 2021, at eight VA hospitals across the southwestern United States. Primary outcome measures were suicide attempts and deaths by suicide. Predictor variables included psychiatric diagnoses and demographic factors. RESULTS Multivariable models indicated that the odds of death by suicide did not change during the first year of the COVID-19 pandemic, while the odds of making a suicide attempt declined. Veterans treated for major depression were at heightened risk for attempting suicide in both years, but the association was smaller during the pandemic than the year prior. In contrast, the relative risk of attempt for Veterans who were never married and Veterans treated for a non-alcohol, non-opioid substance-use disorder increased during the pandemic. CONCLUSIONS AND RELEVANCE The findings suggest that the pandemic has not led to an increase in suicidal behavior, which is consistent with other studies, although the degree of decline varied across diagnostic and demographic groups. Further longitudinal research is needed to evaluate whether the prolonged nature of COVID-19 may lead to changes in risk over time.
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Affiliation(s)
- Neal Doran
- VA San Diego Healthcare System and Department of Psychiatry, University of California, San Diego, CA 92161, USA
| | | | - Pushpa Raja
- VA Greater Los Angeles Healthcare System and Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA 90073, USA
| | | | - Luther Davis
- VA Loma Linda Healthcare System, 112021 Benton Street, Loma Linda, CA 92357, USA
| | | | | | - Kris Kratz
- VA Phoenix Healthcare System, Phoenix, AZ 85012, USA
| | - Ryan Louis
- Northern Arizona VA Healthcare System, Prescott, AZ 86301, USA
| | - Jeanie Moore
- VA New Mexico Healthcare System, Albuquerque, NM 87108, USA
| | - Lana Peoples
- VA Phoenix Healthcare System, Phoenix, AZ 85012, USA
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Khazem LR, Anestis JC, Rufino KA. Assessing the clinical utility of MMPI-2-RF interpersonal theory of suicide proxy indices in psychiatric hospitalization setting. Suicide Life Threat Behav 2022; 52:848-856. [PMID: 35438197 PMCID: PMC9790451 DOI: 10.1111/sltb.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF Ben-Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting. This study examined the performance of these proxy indices in identifying past-month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI-2-RF Suicide/Death Ideation (SUI) scale scores. METHOD Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C-SSRS and MMPI-2-RF upon admission, while the C-SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI-2-RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI-2-RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge. RESULTS Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge. CONCLUSION These results indicate a need to further examine these proxy indices in high acuity samples.
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Affiliation(s)
| | | | - Katrina A. Rufino
- Baylor College of MedicineThe Menninger ClinicUniversity of HoustonHoustonTexasUSA
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35
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Rogers ML, Bafna A, Galynker I. Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up. Suicide Life Threat Behav 2022; 52:866-875. [PMID: 35441411 DOI: 10.1111/sltb.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one-month follow-up. METHODS 382 psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide-related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI. RESULTS Rates of follow-up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI-with and without SCS-had higher levels of follow-up suicidal thoughts than those without SI. CONCLUSION The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.
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Affiliation(s)
- Megan L Rogers
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Anokhi Bafna
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
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Lowry NJ, Stanley IH, Mournet AM, Wharff EA, Sullivant SA, Teach SJ, Pao M, Horowitz LM, Bridge JA. Firearms Access among Pediatric Patients at Risk for Suicide. Arch Suicide Res 2022:1-10. [PMID: 35924876 PMCID: PMC9898460 DOI: 10.1080/13811118.2022.2106924] [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: 02/06/2023]
Abstract
BACKGROUND Approximately 2,900 youth who die by suicide each year in the United States use a firearm. To inform lethal means safety counseling efforts, this study aimed to describe firearm access among youth deemed at risk for suicide in pediatric medical settings. METHODS Youth who presented to one of four urban pediatric medical centers were screened for suicide risk and access to firearms. Suicide risk was determined by a positive screen on the Ask Suicide-Screening Questions (ASQ) tool. Firearm access was assessed via a structured questionnaire. RESULTS This secondary analysis analyzed data from 1065 youth aged 10 to 17 years. Overall, 110 (10.3%) participants screened positive for suicide risk. Among those at risk, 28% (31/110) reported guns kept in or around their home, 8% (9/110) had access to a firearm, and 5% (6/110) reported that bullets were not stored separately from the guns. CONCLUSIONS Over a quarter of youth at risk for suicide reported a firearm stored in or around their home. To ensure the safety of young people at risk for suicide, clinicians should assess whether youth have access to firearms and conduct lethal means safety counseling with youths, as developmentally appropriate, and their parent/caregivers.HIGHLIGHTS28% of pediatric patients deemed "at risk" for suicide in this study reported a firearm kept in or around their home.Among youth at risk for suicide, 8% reported having access to a firearm.These results add further evidence that it is important for clinicians to conduct lethal means safety counseling with patients and their families.
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Albury EA, Hom MA, Stanley IH, Joiner TE. Examining Factors Influencing the Differential Reporting of Suicide Attempt History Among Undergraduates at Elevated Suicide Risk. Arch Suicide Res 2022; 26:1302-1313. [PMID: 33749531 DOI: 10.1080/13811118.2021.1885535] [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: 10/21/2022]
Abstract
AIM Prior studies suggest that individuals may respond inconsistently to different assessments of suicide attempt (SA) history; yet, little is known regarding why inconsistent reporting of SA history may occur. The overarching goal of this study was to examine individuals' self-reported reasons for inconsistently responding to different self-report measures designed to assess SA history. METHODS Young adults who reported a lifetime history of suicidal ideation (N = 141) completed three different self-report measures of SA history: the (1) Beck Scale for Suicide Ideation (BSS), (2) Suicidal Behaviors Questionnaire-Revised (SBQ-R), and (3) Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF). All measures were administered in a randomized order to control for potential order effects. Descriptive statistics were used to test study aims. RESULTS Of the sample, 75% of participants denied an SA history across all three measures, 16% reported an SA history across all measures ("consistent responders"), and 9% responded inconsistently to SA history measures ("inconsistent responders"). Of the 9% (n = 12) of participants who inconsistently responded to SA history measures, the most commonly reported reasons for inconsistent reporting were that the definition of the term "attempt" was not made clear and that the participant did not read the SA history probes carefully. CONCLUSION Findings from this study underscore a need for increased efforts to improve SA history assessments.HIGHLIGHTSSome individuals may provide inconsistent responses across different suicide attempt measures.Confusion about the definition of a "suicide attempt" may lead to inconsistent responding.Further research is needed to improve our assessment of suicide attempt history.
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Rogers ML, Bloch-Elkouby S, Galynker I. Differential disclosure of suicidal intent to clinicians versus researchers: Associations with concurrent suicide crisis syndrome and prospective suicidal ideation and attempts. Psychiatry Res 2022; 312:114522. [PMID: 35378454 DOI: 10.1016/j.psychres.2022.114522] [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: 01/17/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
Several patient and setting characteristics have been found to predict disclosure of suicidality to clinicians versus researchers. Less understood, however, is whether differential disclosure of suicidality predicts concurrent indirect indicators of suicide risk and future suicide-related outcomes. The present study examined differential disclosure of suicidal intent in clinical versus research settings as a predictor of (1) concurrent symptoms of the Suicide Crisis Syndrome (SCS); and (2) suicidal ideation and attempts within one month in patients (n = 1039) and their clinicians (n = 144), who completed a battery of self-report and interview measures at baseline. Patients who reported suicidal intent to anyone had higher concurrent SCS symptoms than those who denied suicidal intent, with no differences between those who reported intent to clinicians versus researchers only. Severity of suicidal ideation and rates of suicide attempts at one-month follow-up were higher among those who disclosed suicidal intent to a research assistant than among those who did not-regardless of whether suicidal intent was disclosed to their clinician. Overall, an improved understanding of the factors contributing to differential disclosure will improve both scientific inquiry and patient safety.
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Tong B, Devendorf A, Panaite V, Miller R, Kashdan TB, Joiner T, Twenge J, Karver M, Janakiraman R, Rottenberg J. Future Well-Being Among U.S. Youth Who Attempted Suicide and Survived. Behav Ther 2022; 53:481-491. [PMID: 35473651 PMCID: PMC9046683 DOI: 10.1016/j.beth.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
Abstract
To what extent does a suicide attempt impair a person's future well-being? We estimated the prevalence of future well-being (FWB) among suicide attempt survivors using a nationally representative sample of 15,170 youths. Suicide attempt survivors were classified as having high FWB if they reported (a) a suicide attempt at Wave I, (b) no suicidal ideation or attempts over the past year at Wave III (7 years after), and (c) a well-being profile at or above the top quartile of nonsuicidal peers. Seventy-five of 574 suicide attempt survivors (∼13%) met criteria for FWB at Wave III, compared to 26% of nonsuicidal peers. Wave I well-being levels, not depressive symptoms, predicted the likelihood of FWB at Wave III (OR = 1.23, 95% CI [1.05, 1.44], p < .05). In conclusion, a nonfatal suicide attempt reduced but did not preclude FWB in a large national sample. The observation that a segment of the population of suicide attempt survivors achieves FWB carries implications for the prognosis of suicidal behavior and the value of incorporating well-being into investigations of suicide-related phenomena.
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Affiliation(s)
| | | | - Vanessa Panaite
- University of South Florida;,James A. Haley Veterans’ Hospital
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Capron DW, Bauer BW, Bryan CJ. When people die by suicide: Introducing unacceptable loss thresholds as a potential missing link between suicide readiness states and actively suicidal clinical states. Suicide Life Threat Behav 2022; 52:280-288. [PMID: 34854497 DOI: 10.1111/sltb.12820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Contemporary models of suicide have largely overlooked why a person at high risk for suicide attempts suicide at a specific time. We propose the construct of unacceptable loss thresholds (i.e., a person's tolerance limit for a negative life event, which if violated results in an increase in suicide risk), which addresses many paradoxes in the literature related to suicide triggers. The aim of this paper is to provide preliminary proof of concept and to stimulate replication and further empirical study. METHODS We recruited an online community sample of individuals with a suicide attempt history (n = 144). These individuals answered questions about the time leading up to their most recent suicide attempt. RESULTS The majority (70.8% yes; 18.1% cannot remember; 11.1% no) reported creating a threshold of unacceptable loss, and that relatively small events were enough to trigger feelings that life was not worth living (63.9% yes; 30.6% maybe; 5.6% no). Further, the majority (57.6% yes; 21.5% yes, but only if asked; 20.8% - no) reported they would be willing to tell their therapist/doctor about their thresholds of unacceptable loss. CONCLUSION The construct of unacceptable loss deserves further empirical inquiry. Individuals contemplating suicide set them and if the loss occurs, it may trigger suicidal action in suicide ready individuals. Thresholds could provide risk assessment and safety planning data currently being overlooked.
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Affiliation(s)
- Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Daurio AM, Ennis CR, Duffy ME, Taylor J. A comparative study of suicidal and nonsuicidal self-injury characteristics in heterosexual versus sexual minority females. Psychiatry Res 2022; 309:114421. [PMID: 35121340 DOI: 10.1016/j.psychres.2022.114421] [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: 05/12/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
Sexual minorities are at heightened risk for nonsuicidal self-injury (NSSI), suicidal ideation and attempts. We tested whether sexual minority and heterosexual females differ on these characteristics. Sexual minority females (n = 45) had higher lifetime frequency of NSSI and higher thwarted belonginess compared to heterosexual females (n = 47). These specific factors may contribute to the higher rates of suicide attempts among sexual minorities than heterosexual individuals.
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Affiliation(s)
| | - Chelsea R Ennis
- Southeast Louisiana Veterans Health Care System (SLVHCS), Florida; South Central Mental Illness Research, Education and Clinical Center (MIRECC), Florida
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Wigglesworth KR, Vigers T, Pyle L, Youngkin EM, Fay-Itzkowitz E, Tilden J, Raymond JK, Snell-Bergeon J, Sass A, Majidi S. Follow-Up Mental Health Care in Youth and Young Adults With Type 1 Diabetes After Positive Depression Screen and/or Suicidal Ideation. Clin Diabetes 2022; 40:449-457. [PMID: 36385972 PMCID: PMC9606559 DOI: 10.2337/cd21-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with type 1 diabetes have higher rates of depression and suicidal ideation than the general population, and symptoms of depression are often associated with higher A1C levels and complications. This study evaluated mental health follow-up rates in youth and young adults with type 1 diabetes who screened positive for depressive symptoms or suicidal ideation and identified differences between those who obtained follow-up mental health care and those who did not. Specifically, males were less likely to obtain follow-up, and those who had mental health follow-up had decreasing A1C over the following year. These findings suggest increased assistance and monitoring are needed to ensure follow-up mental health care is obtained.
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Affiliation(s)
- Kelly R.S. Wigglesworth
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Timothy Vigers
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Erin M. Youngkin
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ellen Fay-Itzkowitz
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer Tilden
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer K. Raymond
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy Sass
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, DC
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Schmid P, Steinert T, Czekaj A, Uhlmann C. [Case Report on the Treatment of Inner Restlessness with Biofeedback and Behavior Therapy]. PSYCHIATRISCHE PRAXIS 2021; 49:386-389. [PMID: 34921362 DOI: 10.1055/a-1681-1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inner restlessness is a frequently mentioned symptom in psychiatric-psychotherapeutic clinical practice, from which patients with various mental illnesses suffer. METHOD A patient with major depression was treated with a total of eight biofeedback sessions with the physiological parameter heart rate variability and three behavioral therapy sessions. Questionnaires were used to assess the symptom of inner restlessness and a possible success of the therapy. RESULTS Inner restlessness, ability to relax, disease burden and self-efficacy improved significantly over the 3-week treatment period. DISCUSSION Inner restlessness could be treated surprisingly successfully. CONCLUSION More importance should be given to the treatment of inner restlessness.
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Affiliation(s)
- Petra Schmid
- ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie der Universität Ulm (Weissenau)
| | - Tilman Steinert
- ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie der Universität Ulm (Weissenau)
| | - Agata Czekaj
- ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie der Universität Ulm (Weissenau)
| | - Carmen Uhlmann
- ZfP Südwürttemberg, Klinik I für Psychiatrie und Psychotherapie der Universität Ulm (Weissenau)
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Espeland K, Hjelmeland H, Loa Knizek B. A call for change from impersonal risk assessment to a relational approach: professionals' reflections on the national guidelines for suicide prevention in mental health care in Norway. Int J Qual Stud Health Well-being 2021; 16:1868737. [PMID: 33407039 PMCID: PMC7801051 DOI: 10.1080/17482631.2020.1868737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the study is to explore how professionals working with suicide prevention experience the influence of the national guidelines on mental healthcare, and to gather recommendations for which steps to take next. METHODS This is a qualitative study with an explorative design. We interviewed 22 professionals responsible for implementing suicide prevention action plans and guidelines, and/or conducting relevant research. We analysed the data by means of thematic analysis. RESULTS We found that the participants had an ambivalent view on risk assessment-it may be a tool, but it may also compromise other important aspects in prevention. Moreover, the possibility of liability has resulted in the need for self-protection. Instead, the participants recommended a relational approach to suicide prevention. CONCLUSIONS We found that the emphasis on standardized suicide risk assessment has negatively influenced suicide prevention in mental healthcare, and an approach emphasizing relational aspects is recommended. However, the prevailing objectifying concept of knowledge, the epistemological debate and the emergence of the New Public Management ideology may obstruct a fundamental emphasis on relationships. A paradigm shift in mental healthcare is called for with respect to the concept of knowledge, which forms our understandings and practices.
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Affiliation(s)
- Kristin Espeland
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Heidi Hjelmeland
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Birthe Loa Knizek
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Marlow NM, Xie Z, Tanner R, Jo A, Kirby AV. Association Between Disability and Suicide-Related Outcomes Among U.S. Adults. Am J Prev Med 2021; 61:852-862. [PMID: 34465506 DOI: 10.1016/j.amepre.2021.05.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 05/16/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Although research has analyzed the sociodemographic and socioeconomic risks for suicide, only recently has suicide risk for people with disabilities been examined. This study investigates the associations between disability and distinct suicide-related outcomes, including suicidal ideation, suicide planning, and suicide attempt. METHODS This nationally representative, cross-sectional study comprised secondary analyses of the 2015-2019 National Survey on Drug Use and Health conducted in 2020 (N=198,640, representing 229,556,289 U.S. adults). Disability status comprised the presence of any disability; hearing, vision, mobility, cognitive, complex activity, or ≥2 limitations; and 1, 2, 3, 4, or ≥5 limitations. Suicide-related outcomes in the past year included none, suicidal ideation only, suicide planning, and suicide attempt. Multivariable logistic regression was applied to estimate the AORs. RESULTS Overall, 19.8% reported any disability. Results showed that people with disabilities were significantly more likely than those without disabilities to report suicidal ideation (AOR=2.13, 95% CI=1.93, 2.36), suicide planning (AOR=2.66, 95% CI=2.27, 3.11), and suicide attempt (AOR=2.47, 95% CI=2.05, 2.98). Furthermore, individuals within each limitation count group were significantly more likely than people without disabilities to report suicide-related outcomes (p<0.001), with the largest magnitudes among those with ≥5 limitations for suicidal ideation (AOR=3.80, 95% CI=2.32, 6.23), suicide planning (AOR=6.45, 95% CI=3.52, 11.80), and suicide attempt (AOR=8.19, 95% CI=4.45, 15.07). CONCLUSIONS People with various types of functional disabilities had an elevated risk for suicide-related outcomes, compared with people without disabilities. The more limitations a person had progressively increased their risk. These findings call for focused attention to the mental health of people with disabilities, including suicide prevention efforts that accommodate their needs.
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Affiliation(s)
- Nicole M Marlow
- UF Health Services Research, Management & Policy, College of Public Health and Health Professions, UF Health, University of Florida, Gainesville, Florida.
| | - Zhigang Xie
- UF Health Services Research, Management & Policy, College of Public Health and Health Professions, UF Health, University of Florida, Gainesville, Florida
| | - Rebecca Tanner
- UF Health Services Research, Management & Policy, College of Public Health and Health Professions, UF Health, University of Florida, Gainesville, Florida
| | - Ara Jo
- UF Health Services Research, Management & Policy, College of Public Health and Health Professions, UF Health, University of Florida, Gainesville, Florida
| | - Anne V Kirby
- Department of Occupational and Recreational Therapies, U Health, The University of Utah, Salt Lake City, Utah
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46
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Rogers ML, Vespa A, Bloch-Elkouby S, Galynker I. Validity of the modular assessment of risk for imminent suicide in predicting short-term suicidality. Acta Psychiatr Scand 2021; 144:563-577. [PMID: 34333759 DOI: 10.1111/acps.13354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Modular Assessment of Risk for Imminent Suicide (MARIS) is a clinical assessment tool, consisting of four modules assessing (1) a pre-suicidal cognitive-affective state (Module 1); (2) patients' attitudes toward suicide (Module 2); (3) clinicians' assessment of suicide risk factors (Module 3); and (4) clinicians' emotional responses to patients (Module 4) that assesses short-term suicide risk. Initial evidence provided evidence for its reliability and concurrent validity. The present study extended these findings by examining the MARIS's predictive validity in relation to suicidal thoughts and behaviors at one-month follow-up. METHODS A sample of 1039 psychiatric patients (378 inpatients, 661 outpatients) and their clinicians (N = 144) completed a battery of measures at baseline; 670 patients completed the one-month follow-up assessment. RESULTS MARIS total scores predicted suicidal thoughts and behaviors at one-month follow-up, even after controlling for baseline suicidal thoughts and behaviors. Moreover, both Module 1 and the Distress subscale of Module 4 were uniquely associated with suicidal thoughts and behaviors at one-month follow-up, controlling for baseline suicidal thoughts and behaviors. Modules 2 and 3, on the other hand, exhibited poor internal consistency. CONCLUSION Overall, both patient- and clinician-rated indices are uniquely predictive of suicidal thoughts and behaviors at one-month follow-up, highlighting the need for integrating clinicians' emotional responses into suicide risk assessment. Pending replication and extension of these findings in external samples, a briefer, two-module version of MARIS (MARIS-2) may be such an integrative, psychometrically sound, and clinically useful instrument that can be utilized to assess short-term suicide risk.
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Affiliation(s)
- Megan L Rogers
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Allison Vespa
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | | | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, New York, USA
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Duffy ME, Smith AR, Joiner TE. Interoceptive dysfunction indicates presence and severity of self-injurious behaviors in a clinically severe transdiagnostic sample. Psychiatry Res 2021; 305:114210. [PMID: 34571405 DOI: 10.1016/j.psychres.2021.114210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/03/2021] [Accepted: 09/12/2021] [Indexed: 11/20/2022]
Abstract
Interoceptive dysfunction (ID) is associated with self-injurious behaviors, as disconnection from the body is thought to enable bodily harm. This study tested differences in ID among those with and without history of self-injurious behaviors, as well as the relationship between ID and lethality of past suicide attempts. Adults (N = 344; 61.3% female; mean age 27.68) seeking psychological treatment completed self-report measures and clinical interviews during intake at a community-based clinic. Overall symptom severity was substantial (e.g., approximately 40% reported current suicidal ideation and two-thirds met a clinical cut-off score of ≥ 16 on the Beck Depression Inventory). Orthogonal contrasts were used to test whether mean levels of ID differed across lifetime self-injurious behavior groups. Attempt lethality was regressed on interoceptive dysfunction, covarying depressive symptom severity, age, and gender. Participants with suicide attempt history demonstrated greater ID than those without. Participants who had engaged in non-suicidal self-injury demonstrated greater ID than those with no history of self-injurious behaviors. Greater ID was associated with higher lethality of past suicide attempt, above demographic and clinical covariates. ID may have transdiagnostic relevance for risk assessment and management of self-injurious behaviors.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, 1107W. Call Street, Tallahassee, FL 32306, USA.
| | - April R Smith
- Department of Psychology, Auburn University, 226 Thatch Hall, Auburn, AL 36849, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107W. Call Street, Tallahassee, FL 32306, USA
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Huppert TK, Fruhbauerova M, Kerbrat AH, DeCou CR, Comtois KA. Suicide Notes, Attempts, and Attempt Lethality During Episodes of Ideation Among Suicidal Soldiers and Marines. Arch Suicide Res 2021; 27:261-274. [PMID: 34657584 DOI: 10.1080/13811118.2021.1988785] [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: 10/20/2022]
Abstract
OBJECTIVE Suicide remains a significant public health problem among military personnel despite expanded suicide prevention efforts over the last two decades. It is important to understand the behavioral antecedents of suicide, including the writing of a suicide note, to inform efforts to identify imminent risk. However, the completion of a suicide note increasing the likelihood of making a suicide attempt (SA) and predicting a higher lethality SA during episodes of suicidality have not been evaluated. METHOD To determine whether or not the completion of a suicide note increased the likelihood of making a SA during a given episode of suicidal ideation (current or worst) and predicted a higher lethality SA, we conducted secondary data analysis with a sample of 657 help-seeking, active-duty U.S. Soldiers and Marines. We hypothesized that service members who completed a suicide note would be more likely to make a SA during that given episode of suicidality and make a higher lethality SA. RESULTS Completion of a suicide note increased the likelihood of making a SA in both current and worst episodes of suicidal ideation. Additionally, writing a suicide note predicted making a higher lethality SA during a service member's current episode of ideation but not their worst episode. CONCLUSIONS This is the first study to examine note-writing behavior during episodes of suicidal ideation rather than following a suicide death or attempt, demonstrating a non-trivial number (17%) had written a suicide note and this increased the likelihood of making a SA and a higher lethality SA.HIGHLIGHTSThe first study of suicide notes during periods of ideation regardless of attempt.A suicide note written during an episode of ideation predicted making an attempt.A suicide note predicted making a more lethal suicide attempt.
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Raising doubt about the anticipated consequences of suicidal behavior: Evidence for a new approach from laboratory and real-world experiments. Behav Res Ther 2021; 147:103971. [PMID: 34597872 DOI: 10.1016/j.brat.2021.103971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/13/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Converging evidence from basic science and experimental suicide research suggest that the anticipated consequences of suicide may have direct causal effects on suicidal behavior and accordingly represent a promising intervention target. Raising doubt about individuals' desirable anticipated consequences of suicide may be one means of disrupting this target. We tested this possibility across two complementary experimental studies. METHOD Study 1 tested the effects of raising doubt about desirable anticipated consequences on virtual reality (VR) suicide in the lab, randomizing 413 participants across four conditions. In Study 2, 226 suicidal adults were randomized to an anticipated consequence manipulation or control condition then re-assessed at 2- and 8-weeks post-baseline. RESULTS In Study 1, anticipating that engaging in VR suicide would guarantee a desirable outcome significantly increased the VR suicide rate; conversely, raising doubt about the desirable anticipated consequences significantly reduced the VR suicide rate. In Study 2, raising doubt about the anticipated consequences of attempting suicide by firearm significantly reduced the perceived lethality of firearms as well as self-predicted likelihood of future suicide attempts, with effects sustained at 2-week follow-up. CONCLUSIONS Findings suggest that raising doubt about desirable anticipated consequences of suicide merits further research as one potential approach to inhibit suicidal behavior.
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50
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Gallyer AJ, Dougherty SP, Burani K, Albanese BJ, Joiner TE, Hajcak G. Suicidal thoughts, behaviors, and event-related potentials: A systematic review and meta-analysis. Psychophysiology 2021; 58:e13939. [PMID: 34494671 DOI: 10.1111/psyp.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
Suicidal thoughts and behaviors (STBs) are thought to result from, at least in part, abnormalities in various neural systems. Event-related potentials (ERPs) are a useful method for studying neural activity and can be leveraged to study neural deficits related to STBs; however, it is unknown how effective ERPs are at differentiating various STB groups. The present meta-analysis examined how well ERPs can differentiate (a) those with and without suicidal ideation, (b) those with and without suicide attempts, (c) those with different levels of suicide risk, and (d) differences between those with suicide attempts versus those with suicidal ideation only. This meta-analysis included 208 effect sizes from 2,517 participants from 27 studies. We used a random-effects meta-analysis using a restricted maximum likelihood estimator with robust variance estimation. We meta-analyzed ERP-STB combinations that had at least three effect sizes across two or more studies. A qualitative review found that for each ERP and STB combination, the literature is highly mixed. Our meta-analyses largely did not find significant relationships between STBs and ERPs. We also found that the literature is likely severely underpowered, with most studies only being sufficiently powered to detect unrealistically large effect sizes. Our results provided little-to-no support for a reliable relationship between the ERPs assessed and STBs. However, the current literature is severely underpowered, and there are many methodological weaknesses that must be resolved before making this determination. We recommend large-scale collaboration and improvements in measurement practices to combat the issues in this literature.
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Affiliation(s)
- Austin J Gallyer
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Sean P Dougherty
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Kreshnik Burani
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Brian J Albanese
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, Florida, USA.,Department of Biomedical Sciences, Florida State University, Tallahassee, Florida, USA
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