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Gomes KD, Collette TL, Schlenk M, Judkins J, Sanchez-Cardona I, Channer B, Ross P, Fredrick G, Moore BA. Posttraumatic Stress Disorder, Suicidal ideation, and Stress: The Moderating Role of Dysfunctional and Recovery Cognitions. Arch Suicide Res 2024; 28:569-584. [PMID: 37073774 DOI: 10.1080/13811118.2023.2199798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Trauma and stressor-related behavioral health conditions are prevalent in military populations and have become a major public health concern in recent years. Individuals who commonly report suicidal ideation often have comorbid mental health diagnoses (i.e., posttraumatic stress disorder; PTSD). However, the mechanisms associated with stress, suicidal ideation, and PTSD are unclear. METHOD The present study examined the moderating role of dysfunctional and recovery cognitions between (i) PTSD and suicidal ideation, and (ii) stress and suicidal ideation in two distinct samples. Sample 1 was composed of civilians and military personnel (N = 322). Sample 2 was composed of (N = 377) student service members and veterans (SSM/Vs). RESULTS In Study 1, we found that low recovery cognitions at higher and moderate levels of PTSD symptoms were significantly associated with increased suicidal ideation. High dysfunctional cognitions were significantly associated with suicidal ideation at higher levels of PTSD symptoms. In Study 2, we found no differences in any level of recovery cognitions at low and moderate stress levels with suicidal ideation. Higher levels of stress were associated with high dysfunctional cognitions and suicidal ideation. CONCLUSION Promoting higher levels of recovery cognitions and reducing dysfunctional cognitions are important in addressing stress, suicidal ideation, and comorbid conditions such as PTSD. Future research should focus on examining the clinical utility of the Dispositional Recovery and Dysfunction Inventory (DRDI) in other populations (i.e., firefighters and paramedics). This could contribute to efforts of suicide prevention and the promotion of the well-being of individuals experiencing suicidal ideation.
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2
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Falkenstein MJ, Kelley KN, Martin HS, Kuckertz JM, Coppersmith D, Bezahler A, Narine K, Beard C, Webb CA. Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders. Psychiatry Res 2024; 333:115740. [PMID: 38237537 PMCID: PMC10922745 DOI: 10.1016/j.psychres.2024.115740] [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: 09/18/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.
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Affiliation(s)
- Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States.
| | - Kara N Kelley
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Heather S Martin
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | | | - Andreas Bezahler
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Kevin Narine
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Courtney Beard
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Christian A Webb
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
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3
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Toukhy N, Gvion Y, Barzilay S, Apter A, Haruvi-Catalan L, Bursztein-Lipsicas C, Shilian M, Mijiritsky O, Benaroya-Milshtein N, Fennig S, Hamdan S. Implicit Identification with Death, Clinician Evaluation and Suicide Ideation among Adolescent Psychiatric Outpatients-The Mediating Role of Depression. Arch Suicide Res 2023:1-13. [PMID: 37975170 DOI: 10.1080/13811118.2023.2282661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Implicit identification with death (i.e., subconsciously self-associating oneself with death), measured by the Death-Suicide Implicit Association Test (D/S-IAT), is associated with Suicide Ideation (SI). Our understanding of the mechanisms underlying this association is limited. The current study examined (1) the mediating role of depression between D/S-IAT and recent SI and (2) the association between SI, D/S-IAT, and clinician evaluation of SI among a clinical sample of adolescents. 148 adolescents aged 10-18 years (69.4% female) from two outpatient clinics were assessed at intake. Participants completed D/S-IAT and self-report measures for recent SI and depression during intake. Findings indicate that depression is a mediator between D/S-IAT and recent SI, controlling for gender, site differences, and past suicidal thoughts and behaviors. D/S-IAT and clinician evaluation were correlated with recent SI but not beyond depression. Our findings highlight the importance of examining the underlying psychological mechanisms regarding the association between D/S-IAT and suicide.
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Toukhy N, Barzilay S, Hamdan S, Grisaru-Hergas D, Haruvi-Catalan L, Levis Frenk M, Apter A, Benaroya-Milshtein N, Fennig S, Gvion Y. Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room. Suicide Life Threat Behav 2023. [PMID: 36942816 DOI: 10.1111/sltb.12958] [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: 08/08/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Implicit identification with death, measured by the Death-Suicide-Implicit Association Test (D/S-IAT), has been found to predict long-term suicide risk among adolescents. However, previous studies did not examine the predictive utility of D/S-IAT on short-term suicide risk trajectories among adolescents, especially during the critical period following discharge from the emergency room (ER) due to suicide behaviors. OBJECTIVE This study examined the ability of the D/S-IAT to discriminate and predict suicide risk trajectories during the month following initial suicide risk assessment, among adolescents recently discharged from the ER. METHODS One hundred and fifteen adolescents aged 9-18 years (77.4% female) were assessed at clinic intake. All participants completed D/S-IAT and self-report measures for suicide risk, depression, and anxiety during intake and 1-month follow-up. RESULTS The D/S-IAT distinguished and predicted participants with continued heightened suicide risk at follow-up, above and beyond depression, anxiety, and suicide risk level at intake. CONCLUSIONS Along with conventional measures, D/S-IAT may be utilized to predict short-term suicide risk during post-ER discharge.
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Affiliation(s)
- N Toukhy
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - S Barzilay
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - S Hamdan
- School of Behavioral Sciences, Academic College of Tel-Aviv Yaffo (MTA), Tel Aviv, Israel
| | - D Grisaru-Hergas
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - L Haruvi-Catalan
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - M Levis Frenk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - A Apter
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Reichman University, Herzliya, Israel
- Ruppin Academic Center, Emek Hefer, Israel
| | - N Benaroya-Milshtein
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Fennig
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Gvion
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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5
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The temporal dynamics of wish to live, wish to die, and their short-term prospective relationships with suicidal desire. Behav Ther 2023; 54:584-594. [PMID: 37088512 DOI: 10.1016/j.beth.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
The internal debate hypothesis (Kovacs & Beck, 1977) suggests that those at risk for suicidal thoughts and behaviors may experience fluctuations in both the wish to live (WTL) and wish to die (WTD). Previous research has investigated this hypothesis using various cross-sectional (Goods et al., 2019 [cf. Page & Stritzke, 2020]) and longitudinal methodologies (e.g., Bryan et al., 2016). No investigations have determined the within-day temporal dynamics of WTL and WTD using ecological moment assessment (EMA), however. N = 49 undergraduate university students recruited from a research participant pool from a large southeastern university in the United States with a lifetime history of suicide ideation completed the current 10-day EMA investigation. Results demonstrated that WTL, WTD, and resulting suicidal ambivalence (i.e., relatively equal WTL/WTD ratings) demonstrated similar within-person person variability; however, WTD scores appeared to demonstrate higher average variability compared to WTL and ambivalence scores. Although state WTL and WTD were concurrently related to state suicidal desire, only WTD prospectively predicted suicidal desire when controlling for the influence of the outcome variable at the previous timepoint. Ambivalence scores also prospectively predicted suicidal desire when controlling for suicidal desire at the previous timepoint. Results support the clinical and theoretical utility of separate WTL and WTD assessment. WTD was relatively stable within this sample but may be closely related to risk for future suicidal thinking. Changes in WTL may reduce state risk for suicidal desire but could be more trait-like in nature compared to WTD. Future research that investigates these hypotheses should consider the study limitations outlined.
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Oakey-Frost DN, Harris JA, Roberge EM, Andres WC, Rugo KF, Bryan AO, Bryan CJ. Verbal Response Latency as a Behavioral Indicator of Diminished Wish to Live in a Clinical Sample of Active Duty Army Personnel with Recent Suicidal Ideation. Arch Suicide Res 2022; 26:1046-1059. [PMID: 33275534 DOI: 10.1080/13811118.2020.1848670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Research on risk factors of suicide attempt has yielded little improvement in imminent risk detection for clinicians, due in part to the inherent limitations of self-report methodologies. Therefore, objective behavioral indicators of suicide risk that can be implemented practically with little cost in clinical settings are needed. METHOD The current study examined verbal response latency, measured as the length of time to answer a question asking about reasons for living (i.e., What are your reasons for living or not killing yourself?), as a potential indicator of suicide risk among 97 active duty Army personnel presenting to an emergency department or behavioral health clinic for current suicide ideation and/or a recent suicide attempt. RESULTS Verbal response latency was significantly correlated with diminished wish to live at the participant level but was not significantly correlated with wish to die or overall severity of suicidal ideation. CONCLUSION Verbal response latency may serve as an objective indicator of suicide risk. HighlightsResponse latency to a life construct may be an objective indicator of suicide riskDelayed response latency is indicative of diminished wish to livePathological mechanisms may manifest within dyadic interactions via verbal behaviors.
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Abstract
PURPOSE OF REVIEW Suicide risk assessment is a challenge in clinical practice. Implicit measures may present with advantages with respect to explicit methods, and therefore may be useful for the assessment of suicide risk. We conducted a systematic review of 2 databases (PubMed and EMBASE) about implicit tests that measure suicide risk to explore their validity and reliability. RECENT FINDINGS Initial research revealed 321 articles. After the selection process, 31 articles were included in the review. The most death-related implicit cognition test used was the Death/Suicide Implicit association test (D/S IAT), followed by the Suicide Stroop Task. The Suicide Affect Misattribution Procedure (S-AMP) and the Death version of the Implicit Relational Assessment Procedure (D-IRAP) were also used. We found that the measures reviewed were generally valid for the assessment of past and future suicidal thoughts and behaviors, with statistically significant results regarding retrospective and prospective associations.
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Scheunemann J, Jelinek L, Peth J, Runde A, Arlt S, Gallinat J, Kühn S. Do implicit measures improve suicide risk prediction? An 18-month prospective study using different tasks. Suicide Life Threat Behav 2021; 51:993-1004. [PMID: 34196996 DOI: 10.1111/sltb.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/12/2020] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6-month follow-up period in psychiatric populations. Building upon these results, we set out to expand the follow-up period and to investigate various implicit methods. METHODS Seventy-nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self-harm-Me/Others; Self-Harm-Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts. RESULTS In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow-up period. CONCLUSION Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long-term prediction of suicide plans or attempts using implicit measures seems limited.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Runde
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Lise-Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Sohn MN, McMorris CA, Bray S, McGirr A. The death-implicit association test and suicide attempts: a systematic review and meta-analysis of discriminative and prospective utility. Psychol Med 2021; 51:1789-1798. [PMID: 34030752 DOI: 10.1017/s0033291721002117] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Suicide risk assessment involves integrating patient disclosure of suicidal ideation and non-specific risk factors such as family history, past suicidal behaviour, and psychiatric symptoms. A death version of the implicit association test (D-IAT) has been developed to provide an objective measure of the degree to which the self is affiliated with life or death. However, this has inconsistently been associated with past and future suicidal behaviour. Here, we systematically review and quantitatively synthesize the literature examining the D-IAT and suicide attempts. We searched psychINFO, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until 9 February 2021 to identify publications reporting D-IAT scores and suicide attempts (PROSPERO; CRD42020194394). Using random-effects models, we calculated standardized mean differences (SMD) and odds ratios (ORs) for retrospective suicide attempts. We then calculated ORs for future suicide attempts. ORs were dichotomized using a cutoff of zero representing equipoise between self-association with life and death. Eighteen studies met our inclusion criteria (n = 9551). The pooled SMD revealed higher D-IAT scores in individuals with a history of suicide attempt (SMD = 0.25, 95% CI 0.15 to 0.35); however, subgroup analyses demonstrated heterogeneity with acute care settings having lower effect sizes than community settings. Dichotomized D-IAT scores discriminated those with a history of suicide attempt from those without (OR 1.38 95% CI 1.01 to 1.89) and predicted suicide attempt over a six-month follow-up period (OR 2.99 95% CI 1.45 to 6.18; six studies, n = 781). The D-IAT may have a supplementary role in suicide risk assessment; however, determination of acute suicide risk and related clinical decisions should not be based solely on D-IAT performance.
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Affiliation(s)
- Maya N Sohn
- Department of Psychiatry, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
- The Owerko Centre, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Signe Bray
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Child and Adolescent Imaging Research (CAIR) Program, University of Calgary, Calgary, Alberta, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
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Zeifman RJ, Ip J, Antony MM, Kuo JR. On loving thyself: Exploring the association between self-compassion, self-reported suicidal behaviors, and implicit suicidality among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:396-403. [PMID: 31662050 DOI: 10.1080/07448481.2019.1679154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/12/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
Suicide is a major public health concern. It is unknown whether self-compassion is associated with suicide risk above and beyond suicide risk factors such as self-criticism, hopelessness, and depression severity. Participants: Participants were 130 ethnically diverse undergraduate college students. Methods: Participants completed self-report measures of self-compassion, self-criticism, hopelessness, depression severity, and suicidal behaviors, as well as an implicit measure of suicidality. Results: Self-compassion was significantly associated with self-reported suicidal behaviors, even when controlling for self-criticism, hopelessness, and depression severity. Self-compassion was not significantly associated with implicit suicidality. Conclusions: The findings suggest that self-compassion is uniquely associated with self-reported suicidal behaviors, but not implicit suicidality, and that self-compassion is a potentially important target in suicide risk interventions. Limitations and future research directions are discussed.
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Affiliation(s)
| | - Jennifer Ip
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Janice R Kuo
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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Abstract
Suicide is a preventable health problem. Multiple definitions and inconsistent use of the term suicidality can result in failure to properly recognize suicide risk and behavior and confuses suicide research. Clarification of the suicidality concept is needed to facilitate the care for individuals at risk for suicide. Using Rodgers' evolutionary concept analysis method, this analysis describes the breadth and scope of the suicidality concept. Findings indicate suicidality covers a spectrum of suicidal risk and levels of emotional suffering and intent. The analysis does not draw definite conclusions, but outlines a direction for further research.
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Affiliation(s)
- Tamara Pike Keefner
- Nursing, South Dakota State University - College of Nursing, Rapid City, South Dakota, USA
| | - Thomas Stenvig
- Graduate Nursing, South Dakota State University - College of Nursing, Brookings, Rapid City, South Dakota, USA
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12
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Shahram SZ, Smith ML, Ben‐David S, Feddersen M, Kemp TE, Plamondon K. Promoting "Zest for Life": A Systematic Literature Review of Resiliency Factors to Prevent Youth Suicide. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:4-24. [PMID: 33665921 PMCID: PMC7986824 DOI: 10.1111/jora.12588] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Suicide is a leading cause of death among youth globally. In this critical interpretive synthesis, we examined literature on resiliency factors and suicidality. Systematic searches identified 474 articles, 37 of which were included. Results revealed internal (positive self-appraisal, zest for life, personal traits, and coping skills) and external factors (social support system and inclusive environments) contribute to resilience among youth, with age, sex and gender, and Indigenous identity as important intersecting considerations. Findings validated fostering resilience as primary suicide prevention among youth, with little explanation for how these factors may work to protect youth from suicidality. Continued research in this area requires a focus on how to promote resilience at the community and systems levels.
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13
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Ho TC, Teresib GI, Ojhac A, Walker JC, Kirshenbaum JS, Singh MK, Gotlib IH. Smaller caudate gray matter volume is associated with greater implicit suicidal ideation in depressed adolescents. J Affect Disord 2021; 278:650-657. [PMID: 33039875 PMCID: PMC9386733 DOI: 10.1016/j.jad.2020.09.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/13/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Objective biomarkers of cognitive vulnerabilities related to suicidal ideation (SI) may assist in early prevention in adolescents. Previously, we found that smaller gray matter volumes (GMVs) of the dorsal striatum prospectively predicted implicit SI, measured using a computerized implicit association test (IAT) assessing associations between "self" and "death," in a community sample of adolescents. Here, we sought to replicate these findings in an independent sample of depressed adolescents. METHODS 53 depressed adolescents who varied in severity of suicidal thoughts and behaviors completed high-resolution structural MRI. Caudate, putamen, and nucleus accumbens GMVs were estimated using FreeSurfer 6.0. Robust linear regressions were used to examine associations between striatal GMVs and implicit and explicit SI, covarying for sex, age, total intracranial volume, medication use, and depression severity. Significance was determined using Bonferroni correction. Finally, LASSO regression was used to identify which striatal GMV contributed most to prediction of implicit SI. RESULTS Smaller bilateral caudate and right nucleus accumbens GMVs were associated with higher IAT scores (all ps<0.001). Smaller putamen and nucleus accumbens GMVs were not associated with implicit or explicit SI. Our LASSO analysis indicated that right caudate GMV contributed most to the prediction of IAT scores. CONCLUSIONS This study is the first to demonstrate that caudate GMVs are significantly associated with implicit self-associations with death in a sample of depressed adolescents. When considered with our previous work, smaller caudate GMVs may be a robust biomarker of implicit SI in adolescents, with clinical implications for early identification of youth at risk for engaging in suicidal behaviors.
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Affiliation(s)
- Tiffany C. Ho
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA,Corresponding author.
| | | | - Amar Ojhac
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Manpreet K. Singh
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, CA
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14
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Moreno M, Porras-Segovia A, Lopez-Castroman J, Peñuelas-Calvo I, Díaz-Oliván I, Barrigón ML, Baca-García E. Validation of the Spanish version of the Death/Suicide Implicit Association Test for the assessment of suicidal behavior. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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15
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O’Shea BA, Glenn JJ, Millner AJ, Teachman BA, Nock MK. Decomposing implicit associations about life and death improves our understanding of suicidal behavior. Suicide Life Threat Behav 2020; 50:1065-1074. [PMID: 33463733 PMCID: PMC7689854 DOI: 10.1111/sltb.12652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/27/2022]
Abstract
The Death/Suicide Implicit Association Test (IAT) is effective at detecting and prospectively predicting suicidal thoughts and behaviors. However, traditional IAT scoring procedures used in all prior studies (i.e., D-scores) provide an aggregate score that is inherently relative, obfuscating the separate associations (i.e., "Me = Death/Suicide," "Me = Life") that might be most relevant for understanding suicide-related implicit cognition. Here, we decompose the D-scores and validate a new analytic technique called the Decomposed D-scores ("DD-scores") that creates separate scores for each category ("Me," "Not Me") in the IAT. Across large online volunteer samples (N > 12,000), results consistently showed that a weakened association between "Me = Life" is more strongly predictive of having a history of suicidal attempts than is a stronger association between "Me = Death/Suicide." These findings replicated across three different versions of the IAT and were observed when calculated using both reaction times and error rates. However, among those who previously attempted suicide, a strengthened association between "Me = Death" is more strongly predictive of the recency of a suicide attempt. These results suggest that decomposing traditional IAT D-scores can offer new insights into the mental associations that may underlie clinical phenomena and may help to improve the prediction, and ultimately the prevention, of these clinical outcomes.
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Affiliation(s)
- Brian A. O’Shea
- Harvard UniversityCambridgeMAUSA,University of AmsterdamAmsterdamThe Netherlands
| | - Jeffrey J. Glenn
- Durham Veterans Affairs Health Care SystemDurhamNCUSA,VA Mid‐Atlantic Mental Illness Research, Education, and Clinical CenterDurhamNCUSA
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Amini-Tehrani M, Sadeghi R, Nasiri M, Jalali T, Zamanian H. Suicide-related interpersonal needs of young Iranian people: A preliminary validation of thwarted belongingness and perceived burdensomeness constructs. Clin Psychol Psychother 2020; 28:422-437. [PMID: 32852132 DOI: 10.1002/cpp.2507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
The aim of the current study was to validate the Interpersonal Needs Questionnaire (INQ-15) and to test its reliability in Persian-speaking Iranian undergraduate students. In this cross-sectional study, 485 undergraduate students (age: 20.66 ± 1.42, 60% female) were assessed on the two subscales of perceived burdensomeness (PB) and thwarted belongingness (TB) and the Suicide Behavior Questionnaire-Revised (SBQ-R). Exploratory structural equation modelling (ESEM) confirmed the construct validity of INQ-14, excluding INQ#9. In addition, INQ#8, articulated in an equivalent Persian phrasing, loaded well on TB. The measurement model tested by confirmatory factor analysis (CFA) suggested INQ#11 to be eliminated, resulting in INQ-13-P to consist of PB and TB-7. The internal consistency and convergent/discriminant validity were established. The concurrent validity of PB was solidly established in terms of past year suicidal ideation (PY-SI) above and beyond anxiety, depression, prior suicidality, and TB-7. The effect of PB on PY-SI was stronger, where prior suicidality had already occurred or the perceived likelihood of future suicide (PLFS) was high. Moreover, TB-7 could only indicate PY-SI, where prior suicidality had already occurred or PLFS was high, albeit when PB was omitted. The interaction term was significant; however, beyond anxiety and depression, the effect of TB-7 on PY-SI was significant where PB was very high (n = 40, 8.25%). Therefore, future studies can utilize INQ-13-P as a valid and reliable instrument in Persian-speaking populations. However, further studies should examine the construct validity of TB and its relationship with suicide ideation in different populations.
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Affiliation(s)
- Mohammadali Amini-Tehrani
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.,Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raheleh Sadeghi
- Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasiri
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Tina Jalali
- Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Zamanian
- School of Health, Qom University of Medical Sciences, Qom, Iran
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17
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Wells TT, Tucker RP, Kraines MA, Smith LM, Unruh-Dawes E. Implicit bias for suicide persists after ideation resolves. Psychiatry Res 2020; 285:112784. [PMID: 32014309 DOI: 10.1016/j.psychres.2020.112784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 11/24/2022]
Abstract
Individuals with suicidal ideation (SI), demonstrate an association between suicide-related information and the self that is automatic and outside conscious control (i.e., implicit). However, it is unclear whether this implicit bias is a state-like processes that will resolve with the reduction of SI or whether it is more trait-like and enduring. Given that implicit bias has been proposed as an indirect measurement of SI, understanding its dynamic nature is important. To investigate this, we recruited 79 (22 with a history of, but no current, SI; 57 with no lifetime history of SI) young adults who completed a structured interview assessing current and past SI. Participants also completed the Suicide Affect Misattribution Procedure assessing implicit association with suicide-relevant, negative but not suicide relevant, positive, and neutral stimuli. Participants with a history of SI demonstrated greater implicit bias for suicide compared to participants with no lifetime history, but did not significantly differ in their responses to negative, positive, or neutral stimuli. This indicates that suicide-relevant implicit bias may be a trait-like process that endures after resolution of SI. This has important implications for the conceptualization of cognitive bias in suicide and the use of these biases as implicit markers of SI.
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Affiliation(s)
- Tony T Wells
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA.
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, 216 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Morganne A Kraines
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906, USA; Psychosocial Research Group, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA
| | - Logan M Smith
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Emma Unruh-Dawes
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
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18
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Chen JI, Osman A, Freedenthal SL, Gutierrez PM. An Examination of the Psychometric Properties of the Reasons for Living Inventory within a Male Veteran Clinical Sample. Arch Suicide Res 2020; 24:204-230. [PMID: 30636520 DOI: 10.1080/13811118.2018.1563576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elevated suicide risk among veteran populations remains a significant public health concern. However, few suicide assessment measures have been validated for veterans. The current study evaluated the reliability and validity of the Reasons for Living Inventory (RFL) scores among veteran populations. The participants included male veterans (N = 421) from a broad range of ages, combat exposures, and history of suicide attempts. Participants completed the RFL and a set of additional self-report measures of relevant constructs in a cross-sectional design. Estimates of internal consistency reliability were adequate for scores on all the original RFL subscale scores. Exploratory factor analysis (EFA) and exploratory bifactor (bi-factor EFA) analyses provided detailed information regarding the 6-factor solution from the original validation studies with the RFL. Additional analyses identified potential correlates for the RFL total and subscale scores. Secondary analyses showed support for evidence of known-groups validity for the RFL total scale score. Overall, this study provides initial support for the RFL as a reliable and valid measure of protective factors in veterans. Future studies may wish to consider further validation of the current findings.
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Affiliation(s)
- Jason I Chen
- VA Portland Health Care System, Portland, OR, USA
| | - Augustine Osman
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Stacey L Freedenthal
- Department of Psychology, University of Denver Graduate School of Social Work, Denver, CO, USA
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center at the Denver VA Medical Center, Aurora, CO, USA.,Department of Psychology, University of Colorado School of Medicine, Aurora, CO, USA
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19
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Amini-Tehrani M, Nasiri M, Jalali T, Sadeghi R, Ghotbi A, Zamanian H. Validation and psychometric properties of Suicide Behaviors Questionnaire-Revised (SBQ-R) in Iran. Asian J Psychiatr 2020; 47:101856. [PMID: 31704597 DOI: 10.1016/j.ajp.2019.101856] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/27/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Suicide is increasing in young Iranian population, which necessitates the employing of valid, yet abridged instruments assessing the constellation of suicide-related behaviors. The study aimed at validating Suicide Behavior Questionnaire-Revised (SBQ-R) among Iranian undergraduates. METHODS A total of 487 undergraduates were surveyed in 2018. Construct validity of SBQ-R was examined via confirmatory factor analysis (CFA), and Spearman's correlation with two single-item indices of suicide acceptability (SA) and lifetime suicidal ideation (LSI) was determined. Logistic regression and Kruskal-Wallis tests were used to examine the cut-off points (≥ 7 and ≥ 8) and categorizations as per item 1. RESULTS The mean SBQ-R score was 5.79 ± 3.55. Cut-off points ≥ 7 and ≥ 8 categorized 150 (30.8%) and 123 (25.2%) samples with suicide risk, respectively. Women obtained significantly higher scores on all indices, except items 1 and 4. CFA confirmed the model with sound goodness-of-fit, with factor loadings of 0.70 to 0.83. Composite reliability and average variance extracted were 0.87 and 0.63, respectively. The SBQ-R's correlation with SA and LSI confirmed its concurrent validity. Regression analysis confirmed the ability of both cut-off points to distinguish the participants with high SA and LSI; however, the cut-off point ≥ 8 produced better results regarding high LSI. Based on item 1, normal versus low- and high-risk samples were significantly different in terms of SA, LSI, and adjusted total score of SBQ-R (P < 0.0001). CONCLUSION SBQ-R is an economic and psychometrically sound tool, which can be utilized to identify suicide-related behaviors and risks in young Iranian population.
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Affiliation(s)
- Mohammadali Amini-Tehrani
- Department of Psychology and Education, University of Tehran, Tehran, Iran; Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasiri
- Department of Psychology and Education, University of Tehran, Tehran, Iran
| | - Tina Jalali
- Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raheleh Sadeghi
- Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Ghotbi
- Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Zamanian
- Health Psychology and Behavior Medicine Research Group, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Qom University of Medical Sciences, Qom, Iran.
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20
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Ballard ED, Reed JL, Szczepanik J, Evans JW, Yarrington JS, Dickstein DP, Nock MK, Nugent AC, Zarate CA. Functional Imaging of the Implicit Association of the Self With Life and Death. Suicide Life Threat Behav 2019; 49:1600-1608. [PMID: 30761601 PMCID: PMC6692253 DOI: 10.1111/sltb.12543] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A critical need exists to identify objective markers of suicide ideation. One potential suicide risk marker is the Suicide Implicit Association Task (S-IAT), a behavioral task that uses differential reaction times to compare the implicit association between the self and death to the implicit association between the self and life. Individuals with a stronger association between the self and death on the S-IAT are more likely to attempt suicide in the future. To better understand the neural underpinnings of the implicit association between self and either life or death, a functional magnetic resonance imaging (fMRI) version of the S-IAT was adapted and piloted in healthy volunteers. METHOD An fMRI version of the S-IAT was administered to 28 healthy volunteers (ages 18-65, 14F/14M). RESULTS Behavioral results were comparable to those seen in non-scanner versions of the task. The task was associated with patterns of neural activation in areas relevant to emotional processing, specifically the insula and right ventrolateral prefrontal cortex. CONCLUSIONS Performance on the S-IAT fMRI task may reflect scores obtained outside of the scanner. In future evaluations, this task could help assess whether individuals at increased risk of suicide display a different pattern of neural activation in response to self/death and self/life stimuli.
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Affiliation(s)
- Elizabeth D. Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
| | - Jessica L. Reed
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
| | - Joanna Szczepanik
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
| | - Jennifer W. Evans
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
| | - Julia S. Yarrington
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
| | - Daniel P. Dickstein
- PediMIND Program, Bradley Hospital, Division of Child/Adolescent Psychiatry, Brown University School of Medicine East Providence, RI
| | | | - Allison C. Nugent
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
| | - Carlos A. Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, 20892
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21
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Attentional bias and the Suicide Status Form: Behavioral perseveration of written responses. Behav Res Ther 2019; 120:103403. [DOI: 10.1016/j.brat.2019.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
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22
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Ho TC, Cichocki AC, Gifuni AJ, Catalina Camacho M, Ordaz SJ, Singh MK, Gotlib IH. Reduced dorsal striatal gray matter volume predicts implicit suicidal ideation in adolescents. Soc Cogn Affect Neurosci 2019; 13:1215-1224. [PMID: 30256980 PMCID: PMC6234322 DOI: 10.1093/scan/nsy089] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/23/2018] [Indexed: 11/20/2022] Open
Abstract
Suicidal ideation (SI), a potent risk factor for suicide attempts, increases in adolescence. While alterations in dopaminergic functioning have been implicated in suicidal acts—particularly in adults—we do not know whether morphological alterations in dopamine-rich regions of the brain, such as the striatum, are vulnerability factors for the emergence of SI in adolescents. At baseline, a community sample of 152 adolescents (89 female; mean age: 11.41 ± 1.01 years) completed a magnetic resonance imaging (MRI) scan that was used to estimate gray matter volumes (GMVs) of three striatal structures: caudate, nucleus accumbens and putamen. At a 24 month follow-up session, participants completed a self-report measure of SI frequency [Suicidal Ideation Questionnaire (SIQ)] and the death version of the Implicit Association Test (IAT). Robust linear regression models were conducted to predict SIQ and IAT scores from striatal GMV. Bilateral putamen and left caudate GMV significantly predicted IAT scores (all Ps < 0.03). No other associations were significant (all Ps > 0.05). Our finding of reduced dorsal striatal GMV predicting implicit SI may indicate that downstream dopaminergic dysfunction is implicated in the development of overt suicidal behaviors. Self-reported SI was not associated with striatal GMV, suggesting that biological correlates of suicide risk may correlate specifically with objective measurements of SI in adolescents.
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Affiliation(s)
- Tiffany C Ho
- Department of Psychology, Stanford University, Stanford, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Anna C Cichocki
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Anthony J Gifuni
- McGill University and Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Sarah J Ordaz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Manpreet K Singh
- University of Pittsburgh, Center for Neuroscience, Pittsburgh, PA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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23
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Cognition and self-injurious thoughts and behaviors: A systematic review of longitudinal studies. Clin Psychol Rev 2019; 69:97-111. [DOI: 10.1016/j.cpr.2018.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
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24
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Millner AJ, Augenstein TM, Visser KH, Gallagher K, Vergara GA, D'Angelo EJ, Nock MK. Implicit Cognitions as a Behavioral Marker of Suicide Attempts in Adolescents. Arch Suicide Res 2019; 23:47-63. [PMID: 29482489 DOI: 10.1080/13811118.2017.1421488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Using self-harm Implicit Association Tests (IATs), we sought to test whether (1) suicidal adolescents show implicit identification with self-harm and whether (2) IATs are reliable and sensitive to psychiatric change and (3) predict future suicide attempts. We administered 6 self-harm IATs to 71 adolescents from a psychiatric inpatient unit and assessed suicidal behaviors at admission, discharge and 3 months after discharge. Results were in the expected direction for each IAT but not statistically significant. After aggregating trials across IATs, suicide attempters showed increased implicit identification with self-harm, compared with non-suicidal controls. IATs showed good reliability and sensitivity to psychiatric change but did not prospectively predict suicide attempts. Adolescent suicide attempters may have stronger implicit associations with self-harm than non-suicidal controls.
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25
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Bryan CJ, Rozek DC. Suicide prevention in the military: a mechanistic perspective. Curr Opin Psychol 2018; 22:27-32. [DOI: 10.1016/j.copsyc.2017.07.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/15/2022]
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26
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Millner AJ, Coppersmith DDL, Teachman BA, Nock MK. The Brief Death Implicit Association Test: Scoring recommendations, reliability, validity, and comparisons with the Death Implicit Association Test. Psychol Assess 2018; 30:1356-1366. [PMID: 29781668 DOI: 10.1037/pas0000580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Assessing suicidal thoughts and behaviors is difficult because at-risk individuals often fail to provide honest or accurate accounts of their suicidal thoughts or intentions. Research has shown that the Death Implicit Association Test (D-IAT), a behavioral test that measures implicit (i.e., outside of conscious control) associations between oneself and death concepts, can differentiate among people with different suicidal histories, such as those with different severity or recency of suicidal behaviors. We report here on the development and evaluation of a shorter and simpler version of the D-IAT called the Death Brief Implicit Association Test (D-BIAT). We recruited large (ns > 1,500) samples of participants to complete the original D-IAT and shorter D-BIAT via a public web-based platform and evaluated different scoring approaches, assessed the reliability and validity of the D-BIAT and compared it with the D-IAT. We found that the D-BIAT was reliable, provided significant group differences with effect sizes on par with the D-IAT, as well as similarly sized classification metrics (i.e., receiver operator characteristics). Although the D-IAT was nonsignificantly better on most outcomes, the D-BIAT is 1-1[1/2] minutes shorter and provided larger effect sizes for distinguishing between past year and lifetime attempters. Thus, there is a trade-off between administration time and improved outcomes associated with increased data. The D-BIAT should be considered for use where time or participant burden needs to be minimized, such as in clinical settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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27
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Collins KRL, Stritzke WGK, Page AC, Brown JD, Wylde TJ. Mind full of life: Does mindfulness confer resilience to suicide by increasing zest for life? J Affect Disord 2018; 226:100-107. [PMID: 28968562 DOI: 10.1016/j.jad.2017.09.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/21/2017] [Accepted: 09/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mindfulness is a trainable skill that may enhance resilience to suicidality among vulnerable groups such as young people. The current study examined whether mindfulness protects against suicidal desire in the face of heightened risk and adversity by increasing zest for life in a sample of university students. METHODS In a prospective design, participants (N = 233) were assessed at two time points over eight weeks. Online surveys included the Mindful Attention and Awareness Scale, Zest for Life Scale, Interpersonal Needs Questionnaire, Kessler Psychological Distress Scale, and items assessing suicidal ideation and suicidal intent. RESULTS Baseline mindfulness was associated with lower suicidal ideation and intent at follow-up. Moderated mediation analyses confirmed the effects of mindfulness on ideation and intent were mediated by zest for life and these indirect effects were stronger at higher versus lower levels of general (psychological distress) and suicide-specific (perceived burdensomeness and thwarted belongingness) risk. LIMITATIONS Single item assessments of suicidal desire. CONCLUSIONS Findings suggest that mindfulness protects against suicidal desire in conditions of heightened risk and adversity by enhancing one's orientation towards a life worth living. Theories of suicide should consider the dynamic interplay between risk and life-sustaining resilience, while clinicians treating suicidality could use mindfulness strategies to strengthen the desire to (re)engage with life, thereby complementing direct amelioration of suicide risk factors.
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28
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Glenn CR, Kleiman EM, Coppersmith DDL, Santee AC, Esposito EC, Cha CB, Nock MK, Auerbach RP. Implicit identification with death predicts change in suicide ideation during psychiatric treatment in adolescents. J Child Psychol Psychiatry 2017; 58:1319-1329. [PMID: 28675456 PMCID: PMC5693711 DOI: 10.1111/jcpp.12769] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviors are major public health concerns in youth. Unfortunately, knowledge of reliable predictors of suicide risk in adolescents is limited. Promising research using a death stimuli version of the Implicit Association Test (Death IAT) indicates that stronger identification with death differs between adults with and without a history of suicidal thoughts and behaviors and uniquely predicts suicide ideation and behavior. However, research in adolescents is lacking and existing findings have been mixed. This study extends previous research by testing whether implicit identification with death predicts changes in suicide ideation during psychiatric treatment in adolescents. METHODS Participants included 276 adolescents, ages 13-19, admitted to a short-term residential treatment program. At hospital admission and discharge, adolescents completed the Death IAT and measures of recent suicidal thoughts. RESULTS At admission, implicit identification with death was associated with recent suicide ideation, but did not differ between those who engaged in prior suicidal behavior and those who did not. Prospectively, adolescents' implicit identification with death at admission significantly predicted their suicide ideation severity at discharge, above and beyond explicit suicide ideation. However, this effect only was significant for adolescents with longer treatment stays (i.e., more than 13 days). CONCLUSIONS Implicit identification with death predicts suicidal thinking among adolescents in psychiatric treatment. Findings clarify over what period of time implicit cognition about death may predict suicide risk in adolescents.
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29
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Naifeh JA, Nock MK, Ursano RJ, Vegella PL, Aliaga PA, Fullerton CS, Kessler RC, Wryter CL, Heeringa SG, Stein MB. Neurocognitive Function and Suicide in U.S. Army Soldiers. Suicide Life Threat Behav 2017; 47:589-602. [PMID: 27801502 PMCID: PMC5411316 DOI: 10.1111/sltb.12307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
This prospective cohort study used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine associations between neurocognitive functioning and subsequent suicidal events among Regular Army enlisted soldiers during the years 2004-2009. Cases were all soldiers who completed the Army's Automated Neuropsychological Assessment Metrics (ANAM) computerized testing battery prior to documented suicide attempt (n = 607), ideation (n = 955), or death (n = 57). Controls were an equal-probability sample of 9,893 person-months from other soldiers. Exploratory factor analysis of five ANAM tests identified a general neurocognitive factor that excluded the mathematic processing test (MTH). When examined separately in logistic regression analyses that controlled for sociodemographics and prior mental health diagnosis, both the general neurocognitive factor (logit [β] = -.197 to -.521; p < .01) and MTH (β = -.024 to -.064; p < .05) were associated with all outcomes. When both predictors were examined simultaneously, the general neurocognitive factor continued to be associated with all outcomes (β = -.164 to -.417; p < .05) and MTH continued to be associated with suicide attempt (β = -.015; p = .046) and ideation (β = -.014; p = .018). These small but robust associations suggest that future research must continue to examine the extent to which objective neurocognitive tests may enhance understanding and prediction of suicide risk.
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Affiliation(s)
- James A. Naifeh
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Matthew K. Nock
- Department of Psychology; Harvard University; Cambridge MA USA
| | - Robert J. Ursano
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Patti L. Vegella
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Pablo A. Aliaga
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Carol S. Fullerton
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Ronald C. Kessler
- Department of Health Care Policy; Harvard Medical School; Boston MA USA
| | - Christina L. Wryter
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | | | - Murray B. Stein
- Department of Psychiatry; University of California San Diego; La Jolla CA USA
- Department of Family Medicine and Public Health; University of California San Diego; La Jolla CA USA
- VA San Diego Healthcare System; La Jolla CA USA
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30
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Barnes SM, Bahraini NH, Forster JE, Stearns-Yoder KA, Hostetter TA, Smith G, Nagamoto HT, Nock MK. Moving Beyond Self-Report: Implicit Associations about Death/Life Prospectively Predict Suicidal Behavior among Veterans. Suicide Life Threat Behav 2017; 47:67-77. [PMID: 27387836 DOI: 10.1111/sltb.12265] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/19/2016] [Indexed: 11/30/2022]
Abstract
Reliance on self-report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6-month follow-up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15-3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.
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Affiliation(s)
- Sean M Barnes
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Departments of Physical Medicine and Rehabilitation and Biostatistics and Informatics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA
| | - Trisha A Hostetter
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA
| | - Geoffrey Smith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA
| | - Herbert T Nagamoto
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Chiurliza B, Hagan CR, Rogers ML, Podlogar MC, Hom MA, Stanley IH, Joiner TE. Implicit Measures of Suicide Risk in a Military Sample. Assessment 2016; 25:667-676. [PMID: 27821459 DOI: 10.1177/1073191116676363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Suicide has become an issue of great concern within the U.S. military in recent years, with recent reports indicating that suicide has surpassed combat related deaths as the leading cause of death. One concern regarding suicide risk in the military is that existing self-report measures allow service members to conceal or misrepresent current suicidal ideation or suicide plans and preparations. Implicit association tests (IATs) are computer-based, reaction time measures that have been shown to be resilient to such masking of symptoms. The death/suicide implicit association test (d/s-IAT) is an empirically supported IAT that is specific to death and suicide. The present study examined whether the performance of 1,548 U.S. military service members on the d/s-IAT significantly predicted lifetime suicidal ideation and depression. Zero-inflated negative binomial regression analyses were used to test these associations. Results indicated that the d/s-IAT was neither associated with history of suicidal ideation nor history of depression.
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Hussey I, Barnes-Holmes D, Booth R. Individuals with current suicidal ideation demonstrate implicit "fearlessness of death". J Behav Ther Exp Psychiatry 2016; 51:1-9. [PMID: 26613193 DOI: 10.1016/j.jbtep.2015.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/25/2015] [Accepted: 11/10/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Suicidal behaviour has proved to be difficult to predict, due in part to the particular limitations of introspection within suicidality. In an effort to overcome this, recent research has demonstrated the utility of indirect measures of "implicit" attitudes within the study of suicidality. However, research to date has focused predominantly on implicit self-evaluations and self-death associations. No work has examined implicit evaluations of death, despite the theoretical importance of such evaluations; "fearlessness of death" is central to both the Interpersonal Theory of Suicide and the Integrated Motivational-Volitional model of suicide.. METHODS Twenty-three psychiatric patients with current suicidal ideation and twenty-five normative university students completed two versions of the Implicit Relational Assessment Procedure (IRAP) that targeted evaluations of death. One task specified personal death (i.e., was self-focused) and the other targeted death in the abstract. RESULTS Self-focused evaluations of death reliably distinguished between the two groups, correctly classifying 74% of cases, but evaluations of death in the abstract did not. The suicidal group produced specific biases indicating a rejection of the negativity of death. Results are consistent with the definition of suicidality as involving a self-focused wish to die.. LIMITATIONS For ethical reason, suicidal behaviours were not assessed in the normative group. Groups were therefore not mutually exclusive. This may have decreased the specificity of the IRAP. CONCLUSIONS Suicidal ideation is associated with an implicit "fearlessness of death". The utility of implicit death-evaluations should therefore be considered alongside self-evaluations and self-death associations in the future..
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Affiliation(s)
| | | | - R Booth
- St Patrick's University Hospital, Ireland
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Life is Good, But Death Ain’t Bad Either: Counter-Intuitive Implicit Biases to Death in a Normative Population. PSYCHOLOGICAL RECORD 2015. [DOI: 10.1007/s40732-015-0142-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Restifo E, Kashyap S, Hooke GR, Page AC. Daily monitoring of temporal trajectories of suicidal ideation predict self-injury: A novel application of patient progress monitoring. Psychother Res 2015; 25:705-13. [PMID: 25732783 DOI: 10.1080/10503307.2015.1006707] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The interpersonal theory of suicide argues that suicidal ideation predicts self-injury. We hypothesized that distinct patterns of suicidal ideation could be identified and these ratings could allow early identification of self-injury. METHOD The sample consisted of 562 psychiatric inpatients who reported suicidal ideation. RESULTS Latent growth class analysis identified five classes of change in suicidal ideation. Patients who displayed prolonged suicidal ideation could be identified with improved sensitivity (89.66%) and negative predictive power (94%), compared to a model based on routine ratings of suicidality at admission (sensitivity = 50%; negative predictive power = 74%). These patients had a fourfold increased risk of self-injury. CONCLUSIONS Daily measurement of suicidal ideation may identify inpatients at risk and inform clinical decision-making.
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Affiliation(s)
- Emma Restifo
- a Department of Psychology , University of Western Australia , Perth , WA , Australia
| | - Shraddha Kashyap
- a Department of Psychology , University of Western Australia , Perth , WA , Australia
| | - Geoff R Hooke
- a Department of Psychology , University of Western Australia , Perth , WA , Australia.,b Perth Clinic , West Perth , WA , Australia
| | - Andrew C Page
- a Department of Psychology , University of Western Australia , Perth , WA , Australia
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