Perceived burdensomeness, but not thwarted belongingness, mediates the impact of PTSD symptom clusters on suicidal ideation modeled longitudinally

Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis

BACKGROUND

Firefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea.

METHODS

A total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership.

RESULTS

The LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities.

LIMITATIONS

The cross-sectional design and usage of self-reported questionnaires are limitations of this study.

CONCLUSIONS

The severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.

Evidence-based treatment for posttraumatic stress disorder decreases suicidal ideation by reducing perceived burdensomeness among veterans in an outpatient program

Evidenced-based posttraumatic stress disorder (PTSD) treatments generally reduce suicidal ideation (SI), and the interpersonal theory of suicide (ITS) may theoretically account for this finding. The ITS posits that SI stems from feeling like a burden (i.e., perceived burdensomeness) and a lack of belonging (i.e., thwarted belongingness). Previous research suggests that change in PTSD severity has a significant indirect effect on change in SI through changes in perceived burdensomeness, but not thwarted belongingness, among patients receiving residential PTSD treatment in a Veterans Affairs (VA) medical center; however, no research has investigated these associations in an outpatient VA setting with fewer confounding factors that might affect ITS constructs. Therefore, the current sample included veterans (N = 126) who completed PTSD treatment and pre- and posttreatment assessments in a VA outpatient clinic. Results from parallel models of multiple indirect effects suggest that change in PTSD severity was indirectly associated with change in SI through changes in perceived burdensomeness, B = 0.35, p < .001; β = .36, p < .001, SE = .10, 95% CI [.15, .54], but not thwarted belongingness, B = 0.14, p = .146; β = .14, p = .161, SE = .10, 95% CI [-.05, .33]. Additional models were examined using PTSD cluster scores for exploratory purposes. The results indicate that PTSD treatment reduces the perceived and objective burden of PTSD to decrease SI. Study findings support the importance of access to evidence-based care to treat PTSD and alleviate burdensomeness for suicide prevention.

Perceived abusive supervision and graduate students' suicidal ideation: from the perspective of interpersonal psychological theory of suicide

BACKGROUND

In recent years, the issue of suicide caused by the stress of a contradictory relationship between graduate students and academic supervisors has aroused heated discussion in society. Based on the interpersonal psychological theory of suicide, this study aims to examine the influence of the perceived abusive supervision on graduate students' suicidal ideation and the parallel mediating roles of thwarted belongingness and perceived burdensomeness.

METHODS

We conducted a cross-sectional online survey measuring perceived abusive supervision, interpersonal psychological needs and suicidal ideation among 232 Chinese graduate students. A structural equation model was constructed to test the hypothesis.

RESULTS

The results showed that abusive supervision directly exacerbated suicidal ideation (β = 0.160, 95% CI = [0.038, 0.281], p = 0.009) and indirectly influenced suicidal ideation through thwarted belongingness (β = 0.059, 95% CI = [0.008, 0.110], p = 0.019) and perceived burdensomeness (β = 0.102, 95% CI = [0.013, 0.191], p = 0.018). The indirect effect accounted for 50.15% of the overall effect.

CONCLUSIONS

These findings enrich our understanding of the influence of supervisor-student relationship by integrating the literatures on educational and organizational behaviour, and provide practical insights for psychosocial interventions from the perspective of the interpersonal psychological theory of suicide.

Toward an integrative model of transdiagnostic risk factors and suicide: A network comparison of psychiatric outpatients

Predictive models using traditional statistical methods have largely failed to describe suicide etiology. Network theory, which conceptualizes factors as mutually interacting, reinforcing elements of a complex outcome, can model relationships between transdiagnostic and neurocognitive vulnerability factors. The present study used a network approach to produce an atheoretical model of psychological factors and their interrelationships within a population of ideators and non-ideators. We developed two network models (i.e., suicidal ideators and psychiatric controls) describing the relationships between a diverse set of risk factors and symptom measures for a population of psychiatric outpatients. We compared networks using three measures of network structure (i.e., network structure invariance, global strength invariance, edge invariance) and described the differences. Network structures for ideators (N = 229) and non-ideators (N = 454) were stable and accurate. In non-ideators, cognitive-affective depression symptoms (Expected Influence [EI]: 2.06), trauma avoidance (EI: 1.08), and negative affect (EI: 0.81) were most influential to the psychological network. In ideators, cognitive-affective depression symptoms (EI: 1.77), intolerance of uncertainty-negative self-referent implications (EI: 1.29), and negative affect (EI: 1.19) were most influential. Invariance testing did not indicate significant differences in overall network structure between ideators and non-ideators (p = .111), but did indicate significant differences in node strength (p = .013). Significant differences in node EI were detected for intolerance of uncertainty-negative self-referent implications, anxiety sensitivity physical concerns, thwarted belongingness, worry, and negative affect. These findings indicated differences in network structures for suicidal psychiatric outpatients and provide crucial directions for future research on therapeutic targets for suicidal thoughts and behaviors.

An investigation into the bidirectional relationship between post-traumatic stress disorder and suicidal ideation: A nine year study

Suicide is the second leading cause of death in adolescents; a frequent precursor of suicide is suicidal ideation (SI). Literature indicates that Post-Traumatic Stress Disorder (PTSD) and SI are robust cross-sectional correlates of one another, with PTSD often being conceptualized as a risk factor (i.e., conferring risk) for SI. Indeed, PTSD is a well-established risk factor for SI; however, SI is an understudied risk factor for PTSD. It is possible that, yet unknown if, PTSD and SI promote each other over time in a bidirectional fashion. We investigated the bidirectional longitudinal associations between PTSD and SI in a large, diverse sample, who at baseline were adolescents. Participants were interviewed between 1995 and 1998 and again between 2004 and 2008. We hypothesized that PTSD and SI would be cross-sectionally, longitudinally, and bidirectionally related and that the number of traumas endorsed at baseline would be positively associated with PTSD and SI at baseline and follow-up. Indeed, PTSD and SI were cross-sectionally correlated at baseline, but not follow-up. PTSD predicted SI over nine years; however, SI during adolescence did not predict PTSD in adulthood. Finally, poly-trauma endorsed at baseline was associated with increased risk of SI, but not PTSD, over nine years.