Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study

Objective and subjective suicidal intent are differentially associated with attempt lethality based on age of onset of suicidal behavior

Predicting the medical seriousness, or lethality, of suicide attempts remains challenging for clinicians, as impulsive and planned attempts can both be fatal and risk may vary with age and suicidal intent. We investigated whether attempt lethality is driven by practical preparedness (objective suicidal intent) and/or psychological resolve (subjective suicidal intent) and whether these associations vary with age of onset of suicidal behavior. The study used a cross-sectional lifespan sample (N = 95; age range 16-76 years) with current depression and recent suicidal behavior (≤ 5 years). Linear regression models indicated that older age of onset of suicidal behavior (B = 0.86, SE = 0.20, p < 0.001), and both higher objective intent (B = 0.69, SE = 0.19, p < 0.001) and subjective intent (B = 0.50, SE = 0.20, p = 0.014) were associated with more severe lethality at the most recent attempt, although the association with subjective intent was driven by its shared portion with objective intent. The association between objective intent and lethality was stronger with older age of onset (interaction B = 0.75, SE = 0.20, p < 0.001), whereas the association between subjective intent and lethality was stronger with younger age of onset (interaction B = - 0.42, SE = 0.20, p = 0.036). Our findings suggest that contextualizing suicidal intentions with age of onset, rather than age at the current suicidal crisis, can help clinicians better appraise suicide risk.

Posttraumatic stress and growth in pulmonary patients recovered from COVID-19

The COVID-19 pandemic has profoundly affected mental health, with many survivors experiencing psychological challenges, including Post-Traumatic Stress Disorder (PTSD). This study assessed PTSD symptoms and Post-Traumatic Growth (PTG) among 62 individuals recovering from COVID-19 infection, all of whom were under the care of the Department of Pneumonology, Oncology, and Allergology at the Medical University of Lublin. Results revealed that 40.32% of participants exhibited PTSD symptoms. Key predictors of PTSD severity included cognitive symptoms and post-COVID self-rated health, with cognitive symptoms positively associated and self-rated health negatively associated with PTSD severity. A positive correlation was also found between PTSD severity and PTG, suggesting that while individuals endure significant psychological distress, they may also experience personal growth, such as enhanced resilience and a redefined life perspective. These findings highlight the dual psychological impact of COVID-19 infection, particularly for individuals with preexisting pulmonary conditions. They underscore the importance of holistic, integrated care that addresses both the reduction of PTSD symptoms and the promotion of meaningful psychological growth in COVID-19 survivors.

Brooding, reflection, and anger rumination in late life suicidal behavior

BACKGROUND

Current literature on age-specific risk factors for suicide in older adulthood is lacking. One risk factor for younger-life suicide, rumination, has not been extensively studied in older adults, but from prior research, may be more relevant to late-life vs. early life suicide. The current study investigated how multiple subtypes of rumination (i.e., brooding, reflection, and anger rumination) relate to suicidal ideation and recent suicidal behavior in late life.

METHODS

378 participants aged 50-90 (mean age 63.4, SD 7.5) were recruited into a case-control study examining suicide in older adults. Participants were recruited into three groups: 1) depressed adults who had made a recent (past two years) suicide attempt, 2) those with depression but no suicide attempt, and 3) a healthy comparison group. Among depressed groups, we examined relationships between rumination types, trait anger, depression, and suicidal ideation. Then, we conducted logistic regression to test which variables were related to having made a suicide attempt in the past two years among those with current suicidal ideation.

RESULTS

All forms of rumination were related to depression. Brooding was related to ideation severity, but only depression severity related to presence of ideation. Anger rumination and ideation severity each contributed unique variance in their prediction of recent suicide attempts.

LIMITATIONS

Our cross-section design does not allow for causal claims; future studies should consider using ecological momentary assessment approaches.

CONCLUSIONS

Treatments to decrease rumination without an intense cognitive component should be considered for late-life patients.

Brooding, Reflection, and Anger Rumination Relate to Suicidal Ideation through the Role of Thought Control

Despite the far-reaching impact of suicide on our communities, suicide prevention has historically focused on distally related risk factors for suicidality, which gives us an incomplete picture of how someone comes to make a suicide attempt. Instead, our focus needs to extend to research that explains the maintenance and progression from an emotional state to a suicidal crisis. One such factor, rumination, may create or worsen suicidal thinking by amplifying the distress associated with negative thoughts. Ruminative thoughts are often described as difficult to control, and people may think about suicide as an escape from these uncontrollable thoughts. The current study examined the relationship between severity of lifetime suicidal thinking and certain forms of rumination (i.e., brooding, reflection, anger rumination, and suicidal rumination) in a sample of 145 undergraduate students with suicidal thoughts. For each form of rumination that was related to suicidal thinking, we then examined whether that relationship was accounted for by perceived uncontrollability of one's own thoughts. We found that all forms of rumination were related to severity of lifetime suicidal thinking, as well as heightened perceived inability to control one's own thoughts. This thought control inability helped account for the relationships between brooding, reflection, and anger rumination with severity of suicidal thinking, but did not play a role in the relationship between suicidal rumination and suicidal ideation severity. Clinicians should be aware of the impact ruminative thoughts may have on suicidal thinking. More research needs to be done to replicate and extend these effects.

Analysis of Suicidal Behavior in Adult Inpatients with Anorexia Nervosa: Prevalence of Suicide Attempts and Non-Suicidal Self-Injury and Associated Factors-Data Before and After the COVID-19 Pandemic

Background/Objectives: Anorexia nervosa (AN) has a high mortality rate frequently related to suicidality; however, there are few studies on suicide attempts (SAs) and non-suicidal self-injuries (NSSIs) in adult inpatients with AN. This study aims to describe SA and NSSI prevalence and related clinical and sociodemographic factors in adult inpatients with AN. Methods: We retrospectively analyzed data on 298 inpatients hospitalized between 2014 and 2023. Suicidality and clinical and sociodemographic data were collected by experienced psychiatrists; then, the patients completed a battery of self-report questionnaires investigating eating-related and general psychopathology. Results: A total of 9.7% of the inpatients reported an SA in their lifetime, and 13.4% reported NSSI. The percentages were lower among patients with restricter-type AN (5.6% SA and 6.6% NSSI) and higher among patients with binge-purging AN (18% SA and 27% NSSI). SAs were associated with unemployment, binge-purging AN, personality disorders, and lifetime sexual abuse; NSSIs were correlated with family psychiatric disorders, binge-purging AN, personality disorders, body dissatisfaction, restriction, and eating-related concerns. No differences emerged in the frequency of reported suicidality between patients tested before and after the COVID-19 pandemic. Conclusions: Suicidality is a relevant issue in AN. Many factors in the history of the patients and their eating-related pathologies should be considered as potentially associated with SA and NSSI and carefully assessed.

Relations between worry, thought control, suicidal ideation and attempt history

BACKGROUND

Thought processes such as worries are often described as difficult to control and predict suicidal thoughts and behaviors (STBs). Due to their uncontrollable nature, worries may lead to STBs as people attempt to escape their own internal thought processes.

OBJECTIVE

Examine the indirect role of perceived uncontrollability of one's thoughts in the relationship between worry and STBs.

DESIGN AND METHOD

We used stepwise mediation models to examine the proposed relationship in a sample of 145 undergraduates with lifetime suicidal ideation. STBs were categorized into (1) severity of lifetime suicidal ideation, (2) likelihood and (3) severity of recent suicidal ideation, and (4) lifetime suicide attempt. The likelihood and severity of recent ideation were separated due to the skewed nature of suicidal thoughts, with many people reporting zero ideation.

RESULTS

Worry was related to the severity of lifetime ideation, the likelihood of reporting recent ideation, and the severity of recent ideation through lower levels of perceived ability to control one's thoughts. Worry was not related to a lifetime suicide attempt.

CONCLUSION

The perception that one's thoughts are uncontrollable may be a core feature of worry for the development and worsening of suicidal thinking. Interventions targeting internal perceptions of uncontrollability may be beneficial for suicidal ideation management.

Childhood trauma is associated with early-onset but not late-onset suicidal behavior in late-life depression

OBJECTIVES

To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults.

DESIGN

Cross-sectional study.

SETTING

Inpatient and outpatient psychiatric services in Pennsylvania.

PARTICIPANTS

Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38).

MEASUREMENTS

The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse.

RESULTS

Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups.

CONCLUSIONS

Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.

Is Late-Onset Suicidal Behavior a Distinct Subtype?

This clinical viewpoint article aims to draw attention to a yet unexplored factor influencing suicidal behavior: age of onset of suicidal behavior. To tackle the substantial heterogeneity among depressed older attempters, we suggest consideration of at least two distinct pathways to suicidal behavior in late life based on when the first suicidal crisis occurred. Specifically, we discuss the current state of research and the rationale behind the suggested early-late-onset categorization of late-life suicidal behavior. We summarize available evidence so far on early-onset and late-onset attempters, and the potential heterogeneity in the interplay of risk/precipitating factors. Certain risk factors for suicide, such as impulsivity and borderline traits, decrease with age, while memory and broader cognitive impairments increase with age. Research indicates that familial/social exposure to suicidal behavior, childhood trauma, impulsivity, maladaptive personality traits, longstanding interpersonal difficulties, and legal problems are found predominantly in attempters experiencing their first suicidal crisis between youth and early midlife. In contrast, dementia prodrome is one of the most promising but understudied candidates for late-onset suicide risk, especially in the context of other risk factors. Moreover, personality traits conferring increased vulnerability to late-onset suicidal behavior (such as high conscientiousness) are not the same as ones classically identified in younger attempters and in older suicide attempters who have early-onset suicidal behavior (such as neuroticism and Cluster B traits). We discuss methodological points about studying age of onset of suicidal behavior, outline clinical implications, share ideas for future directions, and call for research on this understudied topic.

Risk factors for suicidal attempts in a sample of outpatients with treatment-resistant depression: an observational study

Introduction

Treatment-resistant depression (TRD) is commonly defined as the failure of at least two trials with antidepressant drugs, given at the right dose and for an appropriate duration. TRD is associated with increased mortality, compared to patients with a simple major depressive episode. This increased rate was mainly attributed to death from external causes, including suicide and accidents. The aim of our study is to identify socio-demographic and psychopathological variables associated with suicidal attempts in a sample of outpatients with TRD.

Material and methods

We performed a monocentric observational study with a retrospective design including a sample of 63 subjects with TRD referred to an Italian outpatient mental health centre. We collected socio-demographic and psychopathological data from interviews and clinical records.

Results

77.8% of the sample (N=49) were females, the mean age was 49.2 (15.9). 33.3% (N=21) of patients had attempted suicide. 54% (N=34) of patients had a psychiatric comorbidity. Among the collected variables, substance use (p=0.031), psychiatric comorbidities (p=0.049) and high scores of HAM-D (p=0.011) were associated with the occurrence of suicide attempts. In the regression model, substance use (OR 6.779), psychiatric comorbidities (OR 3.788) and HAM-D scores (OR 1.057) were predictive of suicide attempts. When controlling for gender, only substance use (OR 6.114) and HAM-D scores (OR 1.057) maintained association with suicide attempts.

Conclusion

The integrated treatment of comorbidities and substance abuse, which involves different mental health services, is fundamental in achieving the recovery of these patients. Our study supports the importance of performing a careful clinical evaluation of patients with TRD in order to identify factors associated with increased risk of suicide attempts.

Entrapment and social problem-solving in suicidal behavior across the adult lifespan

BACKGROUND

Feelings of entrapment and deficits in social problem-solving skills have been associated with risk for suicidal behavior in the context of depression. However, few studies have examined the effect of age on the association between these risk factors and suicidal behavior across most of the adult lifespan.

METHODS

In a three-site study, we tested interactions of age with feelings of entrapment and social problem-solving style in 105 depressed patients with a recent suicide attempt, 95 depressed patients with no history of suicide attempt, and 97 demographically similar non-psychiatric participants (age 16-80). Attempter/non-attempter differences, age interactions, and the relative contribution of entrapment and social problem-solving style to past attempter were examined.

RESULTS

Entrapment significantly interacted with age such that it discriminated past attempters from depressed non-attempters better at older ages. Social Problem-Solving Inventory (SPSI) total score and most subscales did not distinguish past attempters, but the SPSI Impulsive Style Problem-Solving was an effective discriminator of past suicide attempts across the full adult lifespan and did not interact with age. In a multipredictor model, both the entrapment by age interaction and SPSI Impulsive Style Problem-Solving score were significant predictors for the classification of attempters.

LIMITATIONS

The cross-sectional nature of our research design limited conclusions that may be drawn about individual change over time or cohort effects.

CONCLUSIONS

Entrapment did not distinguish past attempters at younger ages but became a better discriminator in middle to late adulthood. An impulsive problem-solving style was associated with past suicide attempts across the full adult lifespan.

Spontaneous Thought Characteristics are Differentially Related to Heightened Negative Affect vs. Blunted Positive Affect in Adolescents: An Experience Sampling Study

Background

Mind-wandering has been linked to negative affect and depressive symptoms in adolescents. However, mind-wandering is an extremely broad and heterogenous cognitive construct. Some features of spontaneous thought may be related to increased negative affect, whereas others may improve affect, or have no emotional influence. We used ecological momentary assessment (EMA) to investigate the characteristics of spontaneous thoughts in adolescents and their differential relations with moment-to-moment affect.

Method

One-hundred and sixteen adolescents (ages 13-18; Typical Mood (TM) = 58; Low Mood (LM) = 58) completed 5 days (2-3 times/day) of EMA (total 1,037 surveys) assessing current positive and negative affect (PA and NA) and dimensions of spontaneous thought. Multilevel models tested the relation between thought characteristics and affect.

Results

Relative to the TM group, LM adolescents had a higher frequency of mind-wandering (38% vs. 56%) and negatively-valanced thoughts during episodes of mind-wandering (21% vs. 37%). Negatively-valenced, self-referential and past-oriented thoughts were each associated with higher NA, even when controlling for plausible confounds (e.g., engagement in an unpleasant activity or social interaction, depressive symptom severity). In contrast, task-focused and positively-valenced thoughts were uniquely linked to higher PA.

Conclusion

Characteristics of spontaneous thought - including temporal orientation, self-referential quality, and task-relatedness - were differentially related to NA vs. PA in adolescents. If replicated, these findings could inform more nuanced assessments of and targeted interventions for specific dimensions of mind-wandering contributing to high NA vs. blunted PA in teens.

The Relationship between Depressive Symptoms, Rumination, and Suicide Ideation in Patients with Depression

The relationship between suicide and rumination in depression is a recent topic of attention in mental health. The purpose of this study was to investigate the relationship between demographic variables, depressive symptoms, rumination, and suicide ideation in patients with depression, as well as the predictors of suicide ideation.

RESEARCH DESIGN

A cross-sectional study of 95 subjects with depression recruited intentionally from the psychiatric ward of Tzu Chi Hospital. The questionnaire included demographic data, the Beck Depression Inventory-II, the Ruminative Response Scale, and the Beck Scale for Suicide Ideation. Independent sample t-test, Pearson product difference correlation, and the stepwise regression test were adopted for data analysis.

RESULTS

Age (r = -0.41, p < 0.01), age at diagnosis (r = -0.34, p < 0.01), and sleep duration (r = -0.25, p < 0.05) were negatively correlated with rumination-reflection. The depressive symptoms (r = 0.72, p < 0.01) were positively correlated with rumination, whereas rumination (r = 0.57, p < 0.01) and suicide ideation were positively correlated. Depressive symptoms and rumination could predict suicide ideation, and the effective explanatory power reached 60%.

CONCLUSIONS

If the patient with depression was younger or the patient was diagnosed at a younger age, the depressive symptoms of the reflection subscale of rumination thinking and suicide ideation were more serious. Our results indicate that clinicians who care for patients with depression should be aware of rumination and its impact on suicide ideation, specifically in younger patients.

Depression and suicide attempts in Chinese adolescents with mood disorders: the mediating role of rumination

Mood disorders (MD) are often associated with a higher incidence of suicidal behavior, especially in adolescent patients. However, the mechanisms by which depression affects suicide attempts in adolescents with MD remain poorly elucidated. Therefore, the purpose of this study was to determine the incidence, risk factors, and clinical correlates of suicide attempts in Chinese adolescent patients with MD, as well as the inter-relationship between depressive symptoms, rumination, and suicide attempts, and the role of rumination in mediating depression and suicide attempts. A total of 331 MD adolescent patients aged 11 ~ 18 years were recruited from a psychiatric hospital. Suicide attempts were assessed with the MINI Suicide Scale. Depressed symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). To assess rumination, we used the 21-item Chinese version of the Ruminative Responses Scale (RRS). Overall, the percentage of suicide attempts among MD adolescents was 51.96%, with a higher percentage of females (58.62%) than males (36.36%). Compared to non-suicide attempters, suicide attempters had higher scores on PHQ-9, RRS, depression-related, brooding, and reflective pondering. Gender and RRS were independently associated with suicide attempts. Rumination played a fully mediating role between depression and suicide attempts. In addition, the mediating effect of depression between rumination and suicide attempts was not significant. The incidence of suicide attempts was higher in MD adolescents than in general adolescents. Gender and rumination were associated with suicide attempts in MD adolescents. Moreover, rumination mediated the correlation between depressive symptoms and suicide attempts, suggesting that rumination may be an important intervention component for clinical staff to prevent suicidal behavior in adolescents with MD.