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Coppersmith DDL, Kleiman EM, Millner AJ, Wang SB, Arizmendi C, Bentley KH, DeMarco D, Fortgang RG, Zuromski KL, Maimone JS, Haim A, Onnela JP, Bird SA, Smoller JW, Mair P, Nock MK. Heterogeneity in suicide risk: Evidence from personalized dynamic models. Behav Res Ther 2024; 180:104574. [PMID: 38838615 DOI: 10.1016/j.brat.2024.104574] [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: 08/24/2022] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
Most theories of suicide propose within-person changes in psychological states cause suicidal thoughts/behaviors; however, most studies use between-person analyses. Thus, there are little empirical data exploring current theories in the way they are hypothesized to occur. We used a form of statistical modeling called group iterative multiple model estimation (GIMME) to explore one theory of suicide: The Interpersonal Theory of Suicide (IPTS). GIMME estimates personalized statistical models for each individual and associations shared across individuals. Data were from a real-time monitoring study of individuals with a history of suicidal thoughts/behavior (adult sample: participants = 111, observations = 25,242; adolescent sample: participants = 145, observations = 26,182). Across both samples, none of theorized IPTS effects (i.e., contemporaneous effect from hopeless to suicidal thinking) were shared at the group level. There was significant heterogeneity in the personalized models, suggesting there are different pathways through which different people come to experience suicidal thoughts/behaviors. These findings highlight the complexity of suicide risk and the need for more personalized approaches to assessment and prediction.
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Affiliation(s)
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, Department of Psychology, USA
| | - Alexander J Millner
- Harvard University, Department of Psychology, USA; Franciscan Children's, Mental Health Research, USA
| | | | - Cara Arizmendi
- Duke University School of Medicine, Department of Population Health Sciences, USA
| | - Kate H Bentley
- Harvard University, Department of Psychology, USA; Massachusetts General Hospital, Department of Psychiatry, USA
| | | | - Rebecca G Fortgang
- Harvard University, Department of Psychology, USA; Massachusetts General Hospital, Department of Psychiatry, USA
| | | | | | - Adam Haim
- National Institute of Mental Health, USA
| | - Jukka-Pekka Onnela
- Harvard T. H. Chan School of Public Health, Department of Biostatistics, USA
| | - Suzanne A Bird
- Massachusetts General Hospital, Department of Psychiatry, USA
| | | | - Patrick Mair
- Harvard University, Department of Psychology, USA
| | - Matthew K Nock
- Harvard University, Department of Psychology, USA; Franciscan Children's, Mental Health Research, USA; Massachusetts General Hospital, Department of Psychiatry, USA
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Kuehn KS, Piccirillo ML, Kuczynski AM, King KM, Depp CA, Foster KT. Person-specific dynamics between negative emotions and suicidal thoughts. Compr Psychiatry 2024; 133:152495. [PMID: 38728844 DOI: 10.1016/j.comppsych.2024.152495] [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] [Received: 01/12/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Recent technology has enabled researchers to collect ecological momentary assessments (EMA) to examine within-person correlates of suicidal thoughts. Prior studies examined generalized temporal dynamics of emotions and suicidal thinking over brief periods, but it is not yet known how variable these processes are across people. METHOD We use data EMA data delivered over two weeks with youth/young adults (N = 60) who reported past year self-injurious thoughts/behaviors. We used group iterative multiple model estimation (GIMME) to model group- and person-specific associations of negative emotions (i.e., fear, sadness, shame, guilt, and anger) and suicidal thoughts. RESULTS 29 participants (48.33%) reported at least one instance of a suicidal thought and were included in GIMME models. In group level models, we consistently observed autoregressive effects for suicidal thoughts (e.g., earlier thoughts predicting later thoughts), although the magnitude and direction of this link varied from person-to-person. Among emotions, sadness was most frequently associated with contemporaneous suicidal thoughts, but this was evident for less than half of the sample, while other emotional correlates of suicidal thoughts broadly differed across people. No emotion variable was linked to future suicidal thoughts in >14% of the sample, CONCLUSIONS: Emotion-based correlates of suicidal thoughts are heterogeneous across people. Better understanding of the individual-level pathways maintaining suicidal thoughts/behaviors may lead to more effective, personalized interventions.
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Affiliation(s)
- Kevin S Kuehn
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America.
| | - Marilyn L Piccirillo
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America
| | - Adam M Kuczynski
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Ave E, Seattle, WA, 98102, United States of America
| | - Kevin M King
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, 3120 Biomedical Sciences Way, La Jolla, CA, 92093, Untied States of America
| | - Katherine T Foster
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America; Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, United States of America
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Zhu X, Yang Y, Xiao Z, Pooley A, Ozdemir E, Speyer LG, Leung M, Thurston C, Kwok J, Li X, Eisner M, Ribeaud D, Murray AL. Daily life affective dynamics as transdiagnostic predictors of mental health symptoms: An ecological momentary assessment study. J Affect Disord 2024; 351:808-817. [PMID: 38320660 DOI: 10.1016/j.jad.2024.01.269] [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: 07/28/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Affective dynamics have been identified as a correlate of a broad span of mental health issues, making them key candidate transdiagnostic factors. However, there remains a lack of knowledge about which aspects of affective dynamics - especially as they manifest in the course of daily life - relate to a general risk for mental health issues versus specific symptoms. METHODS We leverage an ecological momentary assessment (EMA) study design with four measures per day over a two-week period to explore how negative affect levels, inertia, lability, and reactivity to provocation and stress in the course of daily life relate to mental health symptoms in young adults (n = 256) in the domains of anxiety, depression, psychosis-like symptoms, behaviour problems, suicidality, and substance use. RESULTS Dynamic structural equation modelling (DSEM) suggested that negative affect levels in daily life were associated with depression, anxiety, indirect and proactive aggression, psychosis, anxiety, and self-injury; negative affective lability was associated with depression, physical aggression, reactive aggression, suicidal ideation, and ADHD symptoms; negative affective inertia was associated with depression, anxiety, physical aggression, and cannabis use; and emotional reactivity to provocation was related to physical aggression. LIMITATIONS The cross-sectional design, the limited span of mental health issues included, and the convenience nature and small size of the sample are limitations. CONCLUSIONS Findings suggest that a subset of mental health symptoms have shared negative affective dynamics patterns. Longitudinal research is needed to rigorously examine the directionality of the effects underlying the association between affective dynamics and mental health issues.
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Affiliation(s)
- Xinxin Zhu
- Department of Psychology, University of Edinburgh, UK
| | - Yi Yang
- Department of Psychology, University of Edinburgh, UK
| | - Zhuoni Xiao
- Department of Psychology, University of Edinburgh, UK
| | - Abby Pooley
- Department of Psychology, University of Edinburgh, UK
| | - Ercan Ozdemir
- School of Health in Social Science, University of Edinburgh, UK
| | - Lydia Gabriela Speyer
- Department of Psychology, University of Edinburgh, UK; Department of Psychology, Lancaster University, UK
| | | | | | - Janell Kwok
- Department of Psychology, University of Edinburgh, UK
| | - Xuefei Li
- Department of Psychology, University of Edinburgh, UK
| | - Manuel Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland; Institute of Criminology, University of Cambridge, UK
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland
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Kleiman EM, Glenn CR, Liu RT. The use of advanced technology and statistical methods to predict and prevent suicide. NATURE REVIEWS PSYCHOLOGY 2023; 2:347-359. [PMID: 37588775 PMCID: PMC10426769 DOI: 10.1038/s44159-023-00175-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 08/18/2023]
Abstract
In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearables, digital phenotyping and machine learning) might become solutions to this problem. In this Review, we aim to strike a balance between the pessimistic picture presented by these meta-analyses and the optimistic picture presented by review and commentary papers about the promise of advanced technological and statistical methods to improve the ability to understand, predict and prevent suicide. We divide our discussion into two broad categories. First, we discuss the research aimed at assessment, with the goal of better understanding or more accurately predicting suicidal thoughts and behaviours. Second, we discuss the literature that focuses on prevention of suicidal thoughts and behaviours. Ecological momentary assessment, wearables and other technological and statistical advances hold great promise for predicting and preventing suicide, but there is much yet to do.
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Affiliation(s)
- Evan M. Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | | | - Richard T. Liu
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Alon N, Perret S, Segal R, Torous J. Clinical Considerations for Digital Resources in Care for Patients With Suicidal Ideation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:160-165. [PMID: 37201138 PMCID: PMC10172563 DOI: 10.1176/appi.focus.20220073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Smartphone apps offer accessible new tools that may help prevent suicide and that offer support for individuals with active suicidal ideation. Numerous smartphone apps for mental health conditions exist; however, their functionality is limited, and evidence is nascent. A new generation of apps using smartphone sensors and integrating real-time data on evolving risk offers the potential of more personalized support, but these apps present ethical risks and currently remain more in the research domain than in the clinical domain. Nevertheless, clinicians can use apps to benefit patients. This article outlines practical strategies to select safe and effective apps for the creation of a digital toolkit that can augment suicide prevention and safety plans. By creating a unique digital toolkit for each patient, clinicians can help ensure that the apps selected will be most relevant, engaging, and effective.
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Affiliation(s)
- Noy Alon
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sarah Perret
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Rebecca Segal
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - John Torous
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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Coppersmith DDL, Wang SB, Kleiman EM, Maimone JS, Fedor S, Bentley KH, Millner AJ, Fortgang RG, Picard RW, Beck S, Huffman JC, Nock MK. Real-time digital monitoring of a suicide attempt by a hospital patient. Gen Hosp Psychiatry 2023; 80:35-39. [PMID: 36566615 PMCID: PMC9884520 DOI: 10.1016/j.genhosppsych.2022.12.005] [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: 07/28/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Suicide is among the most devastating problems facing clinicians, who currently have limited tools to predict and prevent suicidal behavior. Here we report on real-time, continuous smartphone and sensor data collected before, during, and after a suicide attempt made by a patient during a psychiatric inpatient hospitalization. We observed elevated and persistent sympathetic nervous system arousal and suicidal thinking leading up to the suicide attempt. This case provides the highest resolution data to date on the psychological, psychophysiological, and behavioral markers of imminent suicidal behavior and highlights new directions for prediction and prevention efforts.
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Affiliation(s)
| | - Shirley B Wang
- Harvard University, Department of Psychology, United States of America
| | - Evan M Kleiman
- Rutgers University, Department of Psychology, United States of America
| | - Joseph S Maimone
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Szymon Fedor
- Massachusetts Institute of Technology, Media Lab, United States of America
| | - Kate H Bentley
- Harvard University, Department of Psychology, United States of America; Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Alexander J Millner
- Harvard University, Department of Psychology, United States of America; Franciscan Children's Hospital, Mental Health Research, United States of America
| | - Rebecca G Fortgang
- Harvard University, Department of Psychology, United States of America; Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Rosalind W Picard
- Massachusetts Institute of Technology, Media Lab, United States of America
| | - Stuart Beck
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Jeff C Huffman
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Matthew K Nock
- Harvard University, Department of Psychology, United States of America; Massachusetts General Hospital, Department of Psychiatry, United States of America; Franciscan Children's Hospital, Mental Health Research, United States of America
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Brüdern J, Glaesmer H, Berger T, Spangenberg L. Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments. Front Psychiatry 2022; 13:899500. [PMID: 36518367 PMCID: PMC9742465 DOI: 10.3389/fpsyt.2022.899500] [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: 03/18/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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