Separate and interactive contributions of weak inhibitory control and threat sensitivity to prediction of suicide risk

Differentiation between suicide attempt and suicidal ideation in patients with major depressive disorder using cortical functional network

Studies exploring the neurophysiology of suicide are scarce and the neuropathology of related disorders is poorly understood. This study investigated source-level cortical functional networks using resting-state electroencephalography (EEG) in drug-naïve depressed patients with suicide attempt (SA) and suicidal ideation (SI). EEG was recorded in 55 patients with SA and in 54 patients with SI. Particularly, all patients with SA were evaluated using EEG immediately after their SA (within 7 days). Graph-theory-based source-level weighted functional networks were assessed using strength, clustering coefficient (CC), and path length (PL) in seven frequency bands. Finally, we applied machine learning to differentiate between the two groups using source-level network features. At the global level, patients with SA showed lower strength and CC and higher PL in the high alpha band than those with SI. At the nodal level, compared with patients with SI, patients with SA showed lower high alpha band nodal CCs in most brain regions. The best classification performances for SA and SI showed an accuracy of 73.39%, a sensitivity of 76.36%, and a specificity of 70.37% based on high alpha band network features. Our findings suggest that abnormal high alpha band functional network may reflect the pathophysiological characteristics of suicide and serve as a clinical biomarker for suicide.

Impact of handgun ownership and biological sex on startle reactivity to predictable and unpredictable threats

Extant literature suggests that many individuals obtain firearms because they perceive the world as unsafe and believe that firearm ownership increases physical protection. Converging evidence suggests that firearm owners are vulnerable to uncertainty and experience chronic anticipatory anxiety in daily life; however, biological sex is thought to potentially moderate this association. Studies have yet to examine this hypothesis using objective markers of anticipatory anxiety. The present study therefore examined the impact of handgun ownership and biological sex on psychophysiological reactivity to predictable (P-) and unpredictable (U-) threat (N = 133). Male and female adult participants were classified into two groups: a) individuals who do not currently own any handguns (n = 52), and b) individuals who currently own one or more handguns (n = 81). Startle eyeblink potentiation was recorded as an index of aversive reactivity during a well-validated threat-of-shock paradigm designed to probe anticipatory anxiety (during U-threat) and fear (during P-threat). Results revealed no main effect of group on startle reactivity to P- or U-threat. Females displayed greater startle reactivity to threat (P- and U-) compared with males. The main effect was qualified by a significant group x biological sex interaction. Male handgun owners exhibited greater startle to U-threat, but not P-threat, relative to non-handgun owners. There was no effect of group on startle reactivity in females. Findings revealed that biological sex and threat type influenced threat reactivity. Male handgun owners displayed increased sensitivity to stressors that are uncertain, which may reflect an objective mechanism related to firearm ownership.

Inhibitory control deficits in patients with mesial temporal lobe epilepsy: an event-related potential analysis based on Go/NoGo task

Objective

Neuropsychiatric comorbidities are common among patients with mesial temporal lobe epilepsy (MTLE). One of these comorbidities, impulsivity, can significantly impact the quality of life and prognosis. However, there have been few studies of impulsivity in these patients, and the existing findings are inconsistent. The present study investigates impulsivity in MTLE patients from the perspective of inhibitory control and its underlying processes using event-related potentials (ERPs) initiated using a Go/NoGo task.

Methods

A total of 25 MTLE patients and 25 age-, gender-, and education-matched healthy controls (HCs) completed an unequal visual Go/NoGo task. Different waveforms as well as behavioral measures were analyzed between Go and NoGo conditions (N2d and P3d). Impulsivity was also assessed using self -rating scales, and clinical variables that may be related to ERPs were explored.

Results

Compared with HCs, MTLE patients exhibited significantly longer reaction time (RT) (p = 0.002) and lower P3d especially at the frontal electrode sites (p = 0.001). In the MTLE group, the seizure frequency (p = 0.045) and seizure types (p < 0.001) were correlated with the P3d amplitude. A self-rated impulsivity assessment revealed that MTLE patients had higher non-planning (p = 0.017) and total scores (p = 0.019) on the BIS-11 as well as higher DI (p = 0.010) and lower FI (p = 0.007) on the DII.

Conclusion

The findings demonstrate that the presence of inhibitory control deficits in patients with MTLE are characterized by deficits in the late stage of inhibition control, namely the motor inhibition stage. This study improves our understanding of impulsivity in MTLE patients and suggests that ERPs may constitute a sensitive means of detecting this trait.

Psychopathic Traits in a Swedish Court-Ordered Forensic Sample: Preferential Associations of Boldness, Meanness, and Disinhibition

The construct validity of the triarchic psychopathy model has yet to be evaluated in the Swedish forensic psychiatric context. We examined associations between the three phenotypic constructs of the triarchic model of psychopathy (i.e., boldness, meanness, disinhibition), self-assessed empathy and anxiety, and clinical variables in 91 individuals undergoing pretrial forensic psychiatric evaluation in Sweden. Participants completed the Triarchic Psychopathy Measure (TriPM) and self-report measures of empathy and anxiety. Clinical variables, including psychiatric diagnoses and criminal behavior, were collected from the forensic psychiatric evaluations (FPE). All three subscales of the TriPM displayed significant and predominantly anticipated correlations with empathy and trait anxiety measures. TriPM Disinhibition was the only subscale with significant associations with the clinical variables collected from the FPEs. The results provide evidence for the reliability and construct validity of the Swedish translation of the TriPM in a pretrial forensic setting.

Suicidal thoughts and behaviours among military veterans: protocol for a prospective, observational, neuroimaging study

INTRODUCTION

This study's overarching goal is to examine the relationship between brain circuits and suicidal thoughts and behaviours (STBs) in a transdiagnostic sample of US military veterans. Because STBs have been linked with maladaptive decision-making and disorders linked to impulsivity, this investigation focuses on valence and inhibitory control circuits.

METHODS AND ANALYSIS

In this prospective, observational study, we will collect functional MRI (fMRI), cognitive and clinical data from 136 veterans (target sample size) recruited from the Providence VA Health System (PVAHS): 68 with STBs and 68 matched controls. Behavioural data will be collected using standardised measures of STBs, psychiatric symptoms, cognition, functioning and medical history. Neuroimaging data will include structural, task and resting fMRI. We will conduct follow-up interviews and assessments at 6, 12 and 24 months post-enrolment. Primary analyses will compare data from veterans with and without STBs and will also evaluate whether activation and connectivity within circuits of valence and inhibition covary with historical and prospective patterns of suicidal ideation and behaviour.

ETHICS AND DISSEMINATION

The PVAHS Institutional Review Board approved this study (2018-051). Written informed consent will be obtained from all participants. Findings from this study will be published in peer-reviewed journals and presented at local, regional, national and international conferences.Nauder Namaky, Ph.D.* nauder_namaky@brown.edu.

Impaired behavioral inhibitory control of self-injury cues between adolescents with depression with self-injury behavior and those without during a two-choice oddball task: an event-related potential study

Background

This study aimed to objectively evaluate the severity of impulsivity [behavior inhibitory control (BIC) impairment] among adolescents with depression. In particular, those involved in non-suicidal self-injury (NSSI) behaviors, compared with those engaged in suicidal behaviors and adolescents without any self-injury behavior, using event-related potentials (ERPs) and event-related spectral perturbation (ERSP) within the two-choice oddball paradigm.

Methods

Participants with a current diagnosis of major depressive disorder (MDD) engaged in repetitive NSSI for five or more days in the past year (n = 53) or having a history of at least one prior complete suicidal behavior (n = 31) were recruited in the self-injury group. Those without self-injury behavior were recruited in the MDD group (n = 40). They completed self-report scales and a computer-based two-choice oddball paradigm during which a continuous electroencephalogram was recorded. The difference waves in P3d were derived from the deviant minus standard wave, and the target index was the difference between the two conditions. We focused on latency and amplitude, and time-frequency analyses were conducted in addition to the conventional index.

Results

Participants with self-injury, compared to those with depression but without self-injury, exhibited specific deficits in BIC impairment, showing a significantly larger amplitude. Specifically, the NSSI group showed the highest value in amplitude and theta power, and suicidal behavior showed a high value in amplitude but the lowest value in theta power. These results may potentially predict the onset of suicide following repetitive NSSI.

Conclusion

These findings contribute to substantial progress in exploring neuro-electrophysiological evidence of self-injury behaviors. Furthermore, the difference between the NSSI and suicide groups might be the direction of prediction of suicidality.

Threat-induced alterations in cognition and associations with dysregulated behavior

Previous literature suggests that threat disrupts cognitive control, especially for those prone to engaging in dysregulated behaviors (i.e., maladaptive attempts at regulating stress). However, this relationship is not well understood and has yet to be directly examined. The current study extends previous literature by examining the link between individual differences in dysregulation and threat-related alterations in neurocognitive and behavioral indicators of cognitive control. Using a diverse community sample (N = 143), we recorded participants' brain activity during a flanker task under conditions of predictable, unpredictable, and no threat-of-shock. Findings revealed a nuanced relationship, whereby predictable threat, relative to unpredictable threat, was associated with larger N2 to flankers, perhaps at the expense of a reduced later P3. We also found a relationship between proneness toward dysregulated behaviors and threat-induced alterations of cognitive control, with those higher in dysregulation showing reduced conflict P3 differentiation and accuracy interference during threat vs. no threat conditions. This research expands what is known about how threat can modulate cognition in everyday life and linked it to dysregulated behaviors with high societal burden.

The Synergistic Effects of Neuroticism and Extraversion on Suicidal Ideation, Single Attempts, and Multiple Attempts in an Inpatient Sample

The current study sought to investigate the differential risk/protective factors of neuroticism and extraversion among individuals with only suicide ideation, those with a single suicide attempt, and those with multiple attempts. We hypothesized that extraversion would moderate the relation between neuroticism and suicide attempts (single and multiple) but not ideation. Patients in a private facility (N = 3343) completed measures assessing suicide history and general personality traits. Four moderation analyses were conducted with extraversion moderating the relationship between neuroticism and suicide ideation, single attempt (compared to zero attempts), and multiple attempts (compared to zero attempts and to single attempts). Extraversion moderated neuroticism only when comparing individuals with multiple suicide attempts to those with no attempts. Individuals who were low in both neuroticism and extraversion had higher levels of attempts than individuals with low neuroticism and high extraversion, highlighting the importance of considering biological predispositions as risk factors for suicide.

Psychopathy: Current Knowledge and Future Directions

Research on psychopathy has progressed considerably in recent years against the backdrop of important advances in the broader field of clinical psychological science. My major aim in this review is to encourage integration of investigative work on dispositional, biobehavioral, and developmental aspects of psychopathy with counterpart work on general psychopathology. Using the triarchic model of psychopathy as a frame of reference, I offer perspective on long-standing debates pertaining to the conceptualization and assessment of psychopathy, discuss how dispositional facets of psychopathy relate to subdimensions of internalizing and externalizing psychopathology, and summarize findings from contemporary biobehavioral and developmental research on psychopathy. I conclude by describing a systematic strategy for coordinating biobehavioral-developmental research on psychopathy that can enable it to be informed by, and help inform, ongoing research on mental health problems more broadly. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Electrophysiological Changes Between Patients With Suicidal Ideation and Suicide Attempts: An Event-Related Potential Study

INTRODUCTION

Inhibitory control is regarded as an important ability related to the transition from suicidal ideation to suicide attempts. In event-related potential, patients with dysfunction of inhibitory control demonstrate a reduction in the no-go amplitude. This study aimed to determine the association between the no-go event-related potential component and suicidal behaviors among suicide attempters and ideators who never attempted suicide.

METHODS

Overall, 150 patients who visited the emergency room by suicide attempts or patients who visited the psychiatric department with suicidal ideation were recruited and instructed to perform a go/no-go task during electroencephalography recording. The Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale, Difficulties in Emotional Regulation Scale, and Acquired Capability for Suicide Scale were used. Individuals were divided into two groups: those with suicide attempt group) and with suicidal ideation (SI group) without SA. The psychological characteristics and event-related potentials of the two groups were compared. Correlation analyses were conducted to test the association between the clinical characteristics and event-related potentials.

RESULTS

The SA group had significantly decreased no-go P3 amplitudes at all electrodes compared to the SI group. In the correlation analysis between the clinical measurements and event-related potentials in all the participants, no-go P3 amplitudes in whole electrode sites were negatively correlated with the scores of the acquired capability for the suicide scale.

CONCLUSIONS

This study revealed that suicide attempters have dysfunction in controlling inhibition compared to suicide ideators reflected in the no-go P3. Our findings suggested that no-go P3 can be a biomarker associated suicide attempts in suicide ideators.

Dispositional characteristics in firearm ownership and purchasing behavior during the 2020 purchasing surge

RATIONALE

In 2020 the U.S. saw a firearm purchasing surge that was synchronous with the onset of the SARS-CoV-2 (COVID-19) pandemic and notable community unrest. Extant literature has highlighted a potential cohort effect among 2020 firearm purchasers and the importance of characterizing these individuals to inform policy and interventions. Dispositional traits have received minimal attention in the firearm literature overall, despite research that indicates dispositional traits impact intervention interest, access, and effectiveness.

OBJECTIVE

The current study examined two dispositional traits indicated as important in firearm research - threat sensitivity (THT) and disinhibition (DIS). We hypothesized that 1) firearm owners overall would have lower THT and higher DIS relative to non-firearm owners, 2) mean levels of DIS (but not THT) would be higher among firearm owners who purchased during the 2020 purchasing surge relative to firearm owners who did not and non-firearm owners, and 3) DIS (but not THT) would be related to future plans for purchasing such that mean levels of DIS would be highest amongst those who have plans.

METHODS

This study used an online-recruited sample (N = 3500) matched to 2010 US Census data.

RESULTS

Firearm owners demonstrated lower THT and higher DIS than non-firearm owners. 2020 firearm purchasers had higher DIS compared to non-firearm owners and non-purchasing firearm owners, while firearm owners who did not purchase had lower THT compared to non-owners and 2020 purchasers. Plans to purchase in the next 12 months was associated with higher DIS relative to those undecided or without plans.

CONCLUSIONS

In combination with prior research, findings suggest elevated DIS may drive purchasing as a danger and distress management strategy, while low THT may protect against emotion-based firearm purchasing. Further research is needed to clarify the directionality of these relationships and to identify other dispositional characteristics of those purchasing firearms in 2020.

Examining the Association Between the MMPI-2-RF Triarchic Psychopathy Scales and Suicidality in a Criminal Defendant Sample

Prior research has shown that psychopathic personality traits are differentially related to suicide risk, and limited literature also suggests the potential that such risk manifests differently across sex. The current study sought to examine whether sex moderated associations between domains from the triarchic model of psychopathy, a comprehensive perspective of psychopathy, and various suicide variables. Our sample included 1,064 criminal defendants (760 males, 304 females), who had been administered the MMPI-2-RF, from which triarchic psychopathy scales were scored. Suicide-related variables, including current suicidal ideation during interview, history of previous suicide attempts, and number of previous suicide attempts, were reliably obtained from clinical records. The MMPI-2-RF SUI (Suicide/Death Ideation) scale was also examined as a psychometric operationalization of suicidality. Results provided evidence for the general association between psychopathy-related traits and suicide-related outcomes in a manner consistent with the literature. However, these associations did not differ as a function of sex.

Psychopathic traits, inhibition, and positive and negative emotion: Results from an emotional Go/No-Go task

Difficulty stopping unwanted or inappropriate actions (i.e., inhibitory control) is implicated in antisocial behaviors, which are common in people high in psychopathic traits. Recent research indicates that, for those with antisocial personality, inhibitory control is impaired under negative emotional contexts; however, it is unclear whether this impairment extends to persons with psychopathic traits and to impairments under positive emotional contexts. Identifying some of these distinctions can point to therapeutics that target negative emotion specifically or emotion dysregulation broadly. We sought to identify unique relationships between distinct facets of psychopathy and inhibitory control in the context of positive, negative, and neutral stimuli. Using a community sample (N = 117), event-related potentials were recorded during an emotional-linguistic Go/No-Go task. Results indicated distinct cognition-emotion relationships for each psychopathy facet. Higher interpersonal facet scores related to reciprocal interference between cognition and emotion. Higher callous affect facet scores related to reduced inhibitory and emotional processing, except when stimuli were most engaging (emotional No-Go trials). Higher erratic lifestyle facet scores related to increased effort required to process both emotion and inhibition cues. Finally, higher antisocial facet scores related to poorer behavioral inhibition overall. This research challenges the theoretical accounts of psychopathy focused on specific deficits in negative emotion, such as fearlessness, while offering some support for theories related to attentional dysfunction. Results also highlight the importance of facet-level theorizing, as results varied by facet. This study may inform efforts to reduce disinhibited behaviors, particularly in emotional contexts, among those high in certain psychopathic traits.

The Pathways of Aggression - Differential Indirect Associations Between Anxiety Sensitivity Cognitive Concerns and Suicidality

Background: Suicide prevention efforts have focused on risk factors that help identify people with an increased risk for suicide. One risk factor related to suicide risk is anxiety sensitivity cognitive concerns (ASCC), which is the "fear of going crazy." The association between ASCC and suicidal ideation is hypothesized to result from the depression-distress amplification model, which postulates that ASCC exacerbates feelings of depression and concurrent distress. Furthermore, there is evidence for associations between ASCC/dysregulated anger and dysregulated anger/suicidal ideation. We hypothesized that aggression may provide pathways from ASCC to suicidality. The current study examined how facets of aggression (described as elevated agitation) meditated the association between ASCC and suicidality. Aims: The current study aimed to extend prior research by examining how different facets of aggression mediate the association between ASCC and suicidality. Method: Participants were 440 adults recruited online, 32.7% of whom endorsed experiencing lifetime suicidal ideation. Results: Our hypotheses were partially supported with two significant indirect effects. Results indicated that physical aggression and hostility provided significant indirect effects; however, verbal aggression and anger did not. Limitations: The study was cross-sectional in nature, limiting causal interpretations about the indirect effects. The sample included primarily White participants. Conclusion: Specific facets of aggression provide pathways through which ASCC is associated with suicidality. Aggression may be a catalyst for individuals to progress to suicidality. The current study provides foundational research for continued examination of physical aggression as a catalyst for suicide attempts.

Differences in Behavioral Inhibitory Control in Response to Angry and Happy Emotions Among College Students With and Without Suicidal Ideation: An ERP Study

Suicidal ideation is one of the strongest predictors of suicide. A large number of studies have illustrated the important effect of impulsivity on suicidal ideation, and behavioral inhibitory control (BIC) is a specific manifestation of impulsivity. The goal of the present study is to evaluate the difference in BIC in response to happy and angry emotions between individuals with or without suicidal ideation to reveal the underlying mechanism of the effect of impulsivity on suicidal ideation when accounting for the effect of emotion. Combining the ERP technique and the two-choice oddball paradigm, a total of 70 college students were recruited to participate in this study. The Beck Scale for Suicidal Ideation–Chinese Version was used to identify whether the participants had suicidal ideation. There were 30 participants in the risky-suicidal ideation (SI) group and 19 participants in the non-suicidal ideation (NSI) group. The results showed that the reaction time of the SI group was longer than that of the NSI group for happy emotions. At the electrophysiological level, the P3 amplitude of the NSI group was larger than that of the SI group regardless of the electrode sites and valence, and the P3 component elicited by angry faces was larger than those elicited by happy faces in the SI group. These findings suggest that individuals without suicidal ideation have better BIC, and the SI group has more difficulty controlling their responses to happy emotions than their responses to angry emotions.

Suicide Ideation Among Male Prisoners: Preliminary Evidence That Psychopathic Traits are Indirectly Linked to Suicide Ideation Through Thwarted Interpersonal Needs

BACKGROUND

The relation between psychopathic traits and suicide ideation (SI) is frequently discussed but little research has examined potential mechanisms underlying this association. The interpersonal theory of suicide (ITS) proposes two mechanisms in the pathogenesis of suicidal desire: thwarted belongingness (TB) and perceived burdensomeness (PB). This study cross-sectionally tested TB and PB as possible explanatory links in the relation between psychopathic traits and SI.

METHOD

Archival data from 784 male U.K. prisoners (Mage  = 37.21, SD = 9.97) were analyzed using structural equation modeling.

RESULTS

Psychopathic traits were indirectly associated with SI through more specific suicide-promoting processes - namely TB and PB. More specifically, results indicated that Egocentricity and Stimulus Seeking were indirectly associated with SI through PB and TB in combination. However, results indicated specific indirect effects of TB in the relations between the Antisocial Behavior, Egocentricity, and Stimulus Seeking facets, and SI, whereas specific indirect effects for PB were only significant in the relations between Egocentricity and Stimulus Seeking facets and SI.

CONCLUSION

Preliminary results are consistent with the ITS and suggest that psychopathic traits may be distal risk markers for SI and provide direction for future research that could inform suicide prevention efforts among male prisoners high in such traits.

Indirect effects of the early childhood Family Check-Up on adolescent suicide risk: The mediating role of inhibitory control

This study investigates suicide risk in late childhood and early adolescence in relation to a family-centered intervention, the Family Check-Up, for problem behavior delivered in early childhood. At age 2, 731 low-income families receiving nutritional services from Women, Infants, and Children programs were randomized to the Family Check-Up intervention or to a control group. Trend-level main effects were observed on endorsement of suicide risk by parents or teachers from ages 7.5 to 14, with higher rates of suicide risk endorsement in youth in the control versus intervention condition. A significant indirect effect of intervention was also observed, with treatment-related improvements in inhibitory control across childhood predicting reductions in suicide-related risk both at age 10.5, assessed via diagnostic interviews with parents and youth, and at age 14, assessed via parent and teacher reports. Results add to the emerging body of work demonstrating long-term reductions in suicide risk related to family-focused preventive interventions, and highlight improvements in youth self-regulatory skills as an important mechanism of such reductions in risk.

Comparing the Triarchic and Five-Factor Trait Models: Relations With Psychopathy and Other Clinical Criteria in an Incarcerated Offender Sample

This study compared how normative personality dimensions of the Five-Factor Model (FFM) and neurobehavioral traits of the triarchic model relate to psychopathic tendencies and clinical outcomes in an incarcerated sample of 277 Italian male offenders. Associations between triarchic model traits, measured using the TriPM and the FFM dimensions, measured using the NEO-FFI, were consistent with prior studies. Scores on the TriPM, particularly the Disinhibition scale, were associated with substance abuse and self-harm behavior over and above the presence of psychopathy, and beyond the personality dimensions indexed by the NEO-FFI. By contrast, the Neuroticism and Extraversion scales showed incremental validity, over and above psychopathy and TriPM scores, in predicting depressive tendencies. Lastly, both NEO-FFI and TriPM scales contributed to prediction of staff ratings of behavior in prison and prognosis for release, above and beyond psychopathy. These findings highlight potential advantages of the FFM and triarchic trait models for predicting clinical outcomes.

Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example

Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.

Modeling Relations Between Triarchic Biobehavioral Traits and DSM Internalizing Disorder Dimensions

The biobehavioral traits of the triarchic model of psychopathy have well-known correlates with externalizing psychopathology. Although evidence also suggests associations with internalizing disorders, research has yet to formally model relationships between dimensions of internalizing psychopathology and triarchic traits. Employing a sample of 218 adults (50.2% female), the current study used confirmatory factor analysis to characterize how triarchic trait dimensions-delineated using different scale operationalizations-relate to internalizing when modeled as a single broad factor, and as distinct fear and distress subfactors. Findings demonstrated (a) robust opposing relations for triarchic boldness (+) and disinhibition (-), and an interactive association for the two, with general internalizing, along with a modest negative relationship for meanness; and (b) distinct associations for the three triarchic trait dimensions with fear and distress subfactors of internalizing. This work clarifies how facets of psychopathy relate to the internalizing psychopathology spectrum and provides a means for interfacing this spectrum with biological variables.

Modeling the Structure of the Triarchic Psychopathy Measure: Conceptual, Empirical, and Analytic Considerations

This study sought to characterize the factor structure of the Triarchic Psychopathy Measure (TriPM) using data from a sample of 1,082 community-dwelling Italian adults. Exploratory structural equation modeling (ESEM) was used to compare the fit of a bifactor model for each TriPM scale, in which specific-content factors were specified along with a general factor, with the fit of a single, general-factor model. Robust weighted least square (WLSMV) ESEM supported a bifactor latent structure of the TriPM items for all individual scales. When we jointly factor analyzed the 58 TriPM items, a WLSMV ESEM three-factor structure showed adequate fit; the three ESEM factors were akin to TriPM Boldness, Meanness, and Disinhibition theoretical dimensions, respectively, and could be effectively replicated across gender subgroups. Our findings support the three-factor structure of TriPM items, at least in Italian community-dwelling adults, and provide further evidence for the construct validity of the TriPM.

Psychopathy and Internalizing Psychopathology: A Triarchic Model Perspective

Methodological and conceptual differences across studies have impeded our understanding of the relationship between psychopathy and internalizing psychopathology. To shed further light on this question, we undertook correlational and structural-modeling analyses of data from two samples to characterize how facets of psychopathy relate to internalizing psychopathology when assessed using multidimensional measures of each construct (i.e., Triarchic Psychopathy Measure, Inventory of Depression and Anxiety Symptoms). Participants for Study 1 were 470 undergraduates and community-dwelling adults who completed these measures in self-report form; participants for Study 2 were 301 community-dwelling adults who completed informant-rating versions of these measures (as applied to a known-other). Across samples, analyses revealed sharply contrasting associations for the three triarchic-model facets with internalizing psychopathology and its subdomains, with boldness relating negatively in most cases, disinhibition relating positively in most cases, and meanness exhibiting mostly null associations. Results provide a nuanced picture of associations between psychopathic symptomatology and internalizing problems.

Understanding Emotion Inflexibility in Risk for Affective Disease: Integrating Current Research and Finding a Path Forward

Emotion-related disorders (e.g., depression, anxiety, stress, eating, substance and some personality disorders) include some of the most common, burdensome, and costly diseases worldwide. Central to many, if not all of these disorders, may be patterns of rigid or inflexible emotion responses. Indeed, theorists point to emotion in-flexibility as a potential cause or maintaining factor in emotion-related diseases. Despite the increasing prominence of emotion inflexibility in theories of affective disease, a comprehensive review of the developing empirical literature has not yet been conducted. Accordingly, this review will examine the three dominant lines of inquiry assessing emotion flexibility. These include: (1) the capacity to use and vary deliberate emotion regulation strategies, (2) the context sensitivity of spontaneous emotional responses, and (3) flexibility in the appraisal of emotional events and experiences. Moreover, current evidence suggests that each of these three lines of research may converge to suggest the interplay of two key biological dimensions in emotion inflexibility, threat sensitivity, and cognitive control, known to be impaired in patients with affective disorders. In short, this developing body of work suggests a path by which future research could explicate and even exploit the ties between emotion inflexibility and affective disease, contributing to the development of improved models of risk, assessment, and intervention, with broad implications for psychological health.

An Examination of Triarchic Psychopathy Constructs in Female Offenders

This study sought to expand scientific knowledge on psychopathic personality traits in female offenders by evaluating the relationship between MMPI-2-RF triarchic scales and self-reported external variables in a sample of 205 female offenders. Results indicated that boldness was inversely related to internalizing dysfunction, including suicidal behavior, psychosis, youth conduct problems, problems stemming from alcohol use, and a history of outpatient mental health treatment. Meanness was positively related to internalizing dysfunction as well as youth conduct problems, anger, prison disciplinary reports, and psychosis. Disinhibition was associated with a history of abuse in childhood, suicidal behavior, internalizing dysfunction, problems associated with alcohol and drug use, family history of mental illness, prison disciplinary reports for violence, number of previous criminal charges, and anger. Consistent with views of psychopathy as a configural condition, interactive effects of boldness with disinhibition and meanness were observed for multiple key external variables (e.g., conduct problems, substance use, nonsuicidal self-injurious behavior). This study provides further evidence for the triarchic conceptualization of psychopathy in female offenders and lends additional support for the validity of MMPI-2-RF triarchic psychopathy scales.

Psychopathic personality traits as a form of dispositional capability for suicide

The capability to enact lethal self-harm has recently been highlighted as a critical risk factor for suicidal behavior. Klonsky and May's (2015) three step theory of suicide (3ST) expanded upon the construct of the capability for suicide by dividing it into categories: dispositional, acquired, and practical. The current study examined constructs of Patrick and colleagues' (2009) triarchic model of psychopathy as indicators of dispositional capability in gun owners, a sample at heightened risk for death by suicide (Anestis and Houtsma, 2017). We anticipated that specific psychopathic traits would exhibit robust associations with other components of the capability for suicide. In a sample of 300 gun-owning adults, Boldness was uniquely related to all indicators of practical capability in both male and female gun owners, and a Boldness*Meanness interaction predicted the highest levels of some capability components. These results are consistent with theoretical conceptualizations of the triarchic model. Our findings indicate that, among US gun owners, dispositional factors may impact comfort with and aptitude with guns, which may enhance our understanding of which gun owners are at the greatest risk of gun suicide should they develop suicidal thoughts.

Extending the Construct Network of Trait Disinhibition to the Neuroimaging Domain: Validation of a Bridging Scale for Use in the European IMAGEN Project

Trait disinhibition, a clinical-liability construct, has well-established correlates in the diagnostic, self-rating, task-behavioral, and brain potential response domains. Recently, studies have begun to test for neuroimaging correlates of this liability factor, but more work of this type using larger data sets is needed to clarify its brain bases. The current study details the development and validation of a scale measure of trait disinhibition composed of questionnaire items available in the IMAGEN project, a large-scale longitudinal study of factors contributing to substance abuse that includes clinical interview, self-report personality, task-behavioral, neuroimaging, and genomic measures. Using a construct-rating and psychometric refinement approach, a scale was developed that evidenced: (a) positive relations with interview-assessed psychopathology in the IMAGEN sample, both concurrently and prospectively and (b) positive associations with scale measures of disinhibition and reported psychopathology, and a robust negative correlation with P3 brain response, in a separate adult sample ( M_age = 19.5). These findings demonstrate that a common scale measure can index this construct from adolescence through to early adulthood, and set the stage for systematic work directed at identifying neural and genetic biomarkers of this key liability construct using existing and future data from the IMAGEN project.

Psychoneurometric assessment of dispositional liabilities for suicidal behavior: phenotypic and etiological associations

BACKGROUND

Can core genetic liabilities for suicidal behavior be indexed using psychological and neural indicators combined? The current work addressed this question by examining phenotypic and genetic associations of two biobehavioral traits, threat sensitivity (THT) and disinhibition (DIS) - operationalized as psychoneurometric variables (i.e., composites of psychological-scale and neurophysiological measures) - with suicidal behaviors in a sample of adult twins.

METHODS

Participants were 444 identical and fraternal twins recruited from an urban community. THT was assessed using a psychological-scale measure of fear/fearlessness combined with physiological indicators of reactivity to aversive pictures, and DIS was assessed using scale measures of disinhibitory tendencies combined with indicators of brain response from lab performance tasks. Suicidality was assessed using items from structured interview and questionnaire protocols.

RESULTS

THT and DIS each contributed uniquely to prediction of suicidality when assessed psychoneurometrically (i.e., as composites of scale and neurophysiological indicators). In addition, these traits predicted suicidality interactively, with participants high on both reporting the greatest degree of suicidal behaviors. Biometric (twin-modeling) analyses revealed that a high percentage of the predictive association for each psychoneurometric trait (83% for THT, 68% for DIS) was attributable to genetic variance in common with suicidality.

CONCLUSIONS

Findings indicate that psychoneurometric assessments of biobehavioral traits index genetic liability for suicidal behavior, and as such, can serve as innovative targets for research on core biological processes contributing to severe psychopathology, including suicidal proclivities and actions.

Alcohol-induced disinhibition is associated with impulsivity, depression, and suicide attempt: A nationwide community sample of Korean adults

BACKGROUND

Alcohol-induced disinhibition (AID) is defined as a "loss of restraint over some form of behavior after drinking alcohol regardless of its amount". Although many previous studies have investigated on alcohol use disorder and suicide attempt, few studies have focused on AID and suicide.

METHODS

A total of 9461 adults who had a history of drinking completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) with the Suicide Module, and Barratt Impulsiveness Scale 11 (BIS-11). In this study, we defined the AID group as those who had been involved with the two antisocial behaviors, including fights, being arrested or dangerous driving, according to the K-CIDI.

RESULTS

Among 9461 subjects, 564 were classified as the AID group (5.96%). The AID group had a significantly higher number of lifetime suicidal ideation, plan, attempt, and multiple attempts, and higher BIS-11 scores than non-AID group. The total scores of BIS-11 of the AID group reported the highest score compared with other psychiatric disorders. The AID group experienced more frequently three types of alcohol withdrawal symptoms, including nervousness, heart beating fast, and feeling weak. Compared with subjects without both AID and MDD, subjects with both AID and MDD showed significant association with a lifetime suicide attempt (AOR = 6.86, p < 0.001) and showed stronger association with multiple attempts (AOR = 10.38, p < 0.001).

CONCLUSION

AID was associated with suicide attempt and impulsivity, and the both AID and MDD showed much stronger association with lifetime suicide attempt and multiple attempts.

Distinguishing Levels of Suicide Risk in Depressed Male Veterans: The Role of Internalizing and Externalizing Psychopathology as Measured by the MMPI-2-RF

Suicide occurs at high rates among veterans, underscoring a need for improved identification of veterans at risk of engaging in suicidal behavior. Considering dimensions of psychopathology in the context of an ideation-to-action framework, the present study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form in distinguishing depressed, psychiatrically hospitalized male veterans ( N = 430) at varying levels of suicide risk. Analysis of variance and hierarchical logistic regression analyses indicated that internalizing scales differentiated depressed ideators ( n = 147) and depressed controls ( n = 143); and in line with expectations, both broad and narrowly focused externalizing scales provided incremental validity in distinguishing depressed attempters ( n = 140) from depressed ideators. Interactions between Suicidal/Death Ideation and externalizing scale scores were found to differentiate only depressed ideators from depressed controls. Clinical implications in the areas of suicide risk assessment and therapeutic interventions with suicidal veterans are discussed.

Interpersonal-Psychological Theory, Alexithymia, and Personality Predict Suicide Ideation among Maladjusted Soldiers in Taiwan

This case-control study enrolled 226 maladjusted soldiers and 229 controls to investigate the impact of the interpersonal-psychological theory of suicide, alexithymia, personality, and childhood trauma on suicide risk among Taiwanese soldiers. Assessments included the Toronto Alexithymia Scale, Eysenck Personality Inventory, Mini-International Neuropsychiatric Interview, and Brief Symptom Rating Scale. In addition to thwarted belongingness and perceived burdensomeness, other risks included less extraversion with higher neuroticism, higher alexithymia, poor academic performance, domestic violence, and life-threatening events. Our study demonstrates the interaction of the interpersonal-psychological theory and other suicide risk factors in Taiwanese soldiers.

Trait liabilities and specific promotive processes in psychopathology: The example of suicidal behavior

BACKGROUND

The RDoC matrix framework calls for investigation of mental health problems through analysis of core biobehavioral processes quantified and studied across multiple domains of measurement. Critics have raised concerns about RDoC, including overemphasis on biological concepts/measures and disregard for the principle of multifinality, which holds that identical biological predispositions can give rise to differing behavioral outcomes. The current work illustrates an ontogenetic process approach to addressing these concerns, focusing on biobehavioral traits corresponding to RDoC constructs as predictors, and suicidal behavior as the outcome variable.

METHOD

Data were collected from a young adult sample (N=105), preselected to enhance rates of suicidality. Participants completed self-report measures of traits (threat sensitivity, response inhibition) and suicide-specific processes.

RESULTS

We show that previously reported associations for traits of threat sensitivity and weak inhibitory control with suicidal behavior are mediated by more specific suicide-promoting processes-namely, thwarted belongingness, perceived burdensomeness, and capability for suicide.

LIMITATIONS

The sample was relatively small and the data were cross-sectional, limiting conclusions that can be drawn from the mediation analyses.

CONCLUSIONS

Given prior research documenting neurophysiological as well as psychological bases to these trait dispositions, the current work sets the stage for an intensive RDoC-oriented investigation of suicidal tendencies in which both traits and suicide-promoting processes are quantified using indicators from different domains of measurement. More broadly, this work illustrates how an RDoC research approach can contribute to a nuanced understanding of specific clinical problems, through consideration of how general biobehavioral liabilities interface with distinct problem-promoting processes.

Evidence of a prominent genetic basis for associations between psychoneurometric traits and common mental disorders

Threat sensitivity (THT) and weak inhibitory control (or disinhibition; DIS) are trait constructs that relate to multiple types of psychopathology and can be assessed psychoneurometrically (i.e., using self-report and physiological indicators combined). However, to establish that psychoneurometric assessments of THT and DIS index biologically-based liabilities, it is important to clarify the etiologic bases of these variables and their associations with clinical problems. The current work addressed this important issue using data from a sample of identical and fraternal adult twins (N=454). THT was quantified using a scale measure and three physiological indicators of emotional reactivity to visual aversive stimuli. DIS was operationalized using scores on two scale measures combined with two brain indicators from cognitive processing tasks. THT and DIS operationalized in these ways both showed appreciable heritability (0.45, 0.68), and genetic variance in these traits accounted for most of their phenotypic associations with fear, distress, and substance use disorder symptoms. Our findings suggest that, as indices of basic dispositional liabilities for multiple forms of psychopathology with direct links to neurophysiology, psychoneurometric assessments of THT and DIS represent novel and important targets for biologically-oriented research on psychopathology.

Interpersonal-psychological theory and parental bonding predict suicidal ideation among soldiers in Taiwan

INTRODUCTION

Suicide is an important issue among military personnel, who have higher suicide rates compared with the general population. The interpersonal-psychological theory of suicide (IPTS) might provide an empirical explanation of this phenomenon, and parental bonding influences social adjustment and suicide. To investigate the relevance of IPTS and parental bonding for suicide among Taiwanese soldiers, a case-control study was conducted.

METHODS

Using a suicide-reporting system in a teaching general hospital in Southern Taiwan, 226 at-risk maladjusted soldiers and 229 well-adjusted controls were enrolled. We collected basic information, and participants answered four IPTS-based questions. Suicide risk was assessed using the Brief Symptom Rating Scale item 6. A four-factor model of the Parental Bonding Instrument assessed parental bonding. All participants were interviewed using the Mini International Neuropsychiatric Interview for primary screening and to recheck the accuracy of the Brief Symptom Rating Scale item 6 score.

RESULTS

A parsimonious model obtained by regression analysis of risk factors indicated that poor academic performance, conduct-related issues in childhood, and exposure to life-threatening situations are risk factors for suicide intention. Maladjusted suicidal soldiers showed a sense of thwarted belongingness (β = 0.145; P < 0.001), higher perceived burdensomeness (β = 0.311; P < 0.001), less fear of death (β = 0.124; P < 0.05), lower paternal autonomy (β = -0.122; P < 0.05), and higher maternal indifference (β = 0.162; P < 0.0001).

DISCUSSION

Interpersonal-psychological theory of suicide, accompanied by an assessment of parental bonding, could be used for assessing suicide risk and preventing suicide attempts.

Methodological issues in the use of individual brain measures to index trait liabilities: The example of noise-probe P3

Recent research initiatives have called for an increased use of biological concepts and measures in defining and studying mental health problems, but important measurement-related challenges confront efforts in this direction. This article highlights some of these challenges with reference to an intriguing measure of neural reactivity: the probe P3 response, a mid-latency brain potential evoked by an intense, unexpected acoustic-probe stimulus. Using data for a large adult sample (N=418), we report evidence that amplitude of probe P3 response to unwarned noise bursts occurring in a picture-viewing task exhibits robust, independent associations with two distinct trait constructs: weak inhibitory control (or disinhibition; DIS) and threat sensitivity (THT). Additionally, we report a selective association for THT with attentional suppression of probe P3 response during viewing of aversive pictures compared to neutral. These results point to separable elements of variance underlying the probe P3 response, including one element reflecting DIS-related variations in cognitive-elaborative processing, and others reflecting THT-related variations in aversive foreground engagement and abrupt defensive reorientation. Key measurement issues are considered in relation to these specific findings, and methodological and statistical approaches for addressing these issues are discussed in relation to advancement of a quantitatively sound, biologically informed science of psychopathology.

Psychoneurometric operationalization of threat sensitivity: Relations with clinical symptom and physiological response criteria

The National Institute of Mental Health's Research Domain Criteria (RDoC) initiative calls for the incorporation of neurobiological approaches and findings into conceptions of mental health problems through a focus on biobehavioral constructs investigated across multiple domains of measurement (units of analysis). Although the constructs in the RDoC system are characterized in "process terms" (i.e., as functional concepts with brain and behavioral referents), these constructs can also be framed as dispositions (i.e., as dimensions of variation in biobehavioral functioning across individuals). Focusing on one key RDoC construct, acute threat or "fear," the current article illustrates a construct-oriented psychoneurometric strategy for operationalizing this construct in individual difference terms-as threat sensitivity (THT+). Utilizing data from 454 adult participants, we demonstrate empirically that (a) a scale measure of THT+ designed to tap general fear/fearlessness predicts effectively to relevant clinical problems (i.e., fear disorder symptoms), (b) this scale measure shows reliable associations with physiological indices of acute reactivity to aversive visual stimuli, and (c) a cross-domain factor reflecting the intersection of scale and physiological indicators of THT+ predicts effectively to both clinical and neurophysiological criterion measures. Results illustrate how the psychoneurometric approach can be used to create a dimensional index of a biobehavioral trait construct, in this case THT+, which can serve as a bridge between phenomena in domains of psychopathology and neurobiology. Implications and future directions are discussed with reference to the RDoC initiative and existing report-based conceptions of psychological traits.

Further Validation of Triarchic Psychopathy Scales From the Multidimensional Personality Questionnaire: Setting the Stage for Large-Sample Etiological Studies

Psychopathy as conceptualized by the triarchic model encompasses three distinct dispositional constructs: boldness, meanness, and disinhibition. The current study sought to further validate triarchic (Tri) construct scales composed of items from the Multidimensional Personality Questionnaire (MPQ) as a foundation for advancing research on the etiology of psychopathy using existing large-scale longitudinal studies. MPQ-Tri scales were examined in three samples: mixed-gender undergraduate students ( N = 346), male offenders from a residential substance abuse treatment facility ( N = 190), and incarcerated female offenders ( N = 216). Across these three samples, the MPQ-Tri scales demonstrated high internal consistency and clear convergent and discriminant associations with criterion measures of psychopathy and other psychopathology outcomes. Gender comparisons revealed relatively few differences in relationships with criterion measures. Findings are discussed in terms of their implications for further investigation of the causal bases of psychopathy and other forms of psychopathology utilizing data from large etiologically informative studies.

Factors of psychopathy and electrocortical response to emotional pictures: Further evidence for a two-process theory

The Two-Process theory of psychopathy posits that distinct etiological mechanisms contribute to the condition: (a) a weakness in defensive (fear) reactivity related to affective-interpersonal features, and (b) impaired cognitive-executive functioning, marked by reductions in brain responses such as P3, related to impulsive-antisocial features. The current study examined relations between psychopathy factors and electrocortical response to emotional and neutral pictures in male offenders (N = 139) assessed using the Psychopathy Checklist-Revised (PCL-R). Impulsive-antisocial features of the PCL-R (Factor 2) were associated with reduced amplitude of earlier P3 brain response to pictures regardless of valence, whereas the affective-interpersonal dimension (Factor 1) was associated specifically with reductions in late positive potential response to aversive pictures. Findings provide further support for the Two-Process theory and add to a growing body of evidence linking the impulsive-antisocial facet of psychopathy to the broader construct of externalizing proneness. Findings are discussed in terms of current initiatives directed at incorporating neuroscientific concepts into psychopathology classification. (PsycINFO Database Record