Suicidal ideation and sex differences in relation to 18 major psychiatric disorders in college and university students: anonymous web-based assessment

Examining the effects of response monitoring instructions on endorsements of suicidal ideation in an online study

INTRODUCTION

It is common practice for researchers to monitor responses to items assessing suicidal ideation and follow-up with high-risk participants, when their identities are known. However, it is becoming increasingly common for researchers to administer fully anonymous online surveys that do not allow for follow-ups with participants at higher risk. The aim of the current study was to investigate whether these two different approaches-monitoring and follow-up versus no monitoring or follow-up-affect the willingness of participants to endorse suicidal ideation.

METHODS

The sample included N = 555 undergraduate students, who were randomly assigned to the monitoring (n = 275) or anonymous (n = 280) instruction conditions, with the monitoring condition shifting to anonymous, non-monitored responses at Time 2.

RESULTS

There were no significant differences in self-reported suicidal ideation between those in the monitoring and anonymous condition at Time 1. At Time 2, no significant interaction was identified between condition and time, suggesting that the change in instructions across timepoints for the monitoring condition had no impact on endorsement of suicidal ideation.

CONCLUSION

Findings indicate that both monitoring and anonymous instruction methods should elicit the same pattern of endorsements of suicidal ideation.

Investigating two mobile just-in-time adaptive interventions to foster psychological resilience: research protocol of the DynaM-INT study

BACKGROUND

Stress-related disorders such as anxiety and depression are highly prevalent and cause a tremendous burden for affected individuals and society. In order to improve prevention strategies, knowledge regarding resilience mechanisms and ways to boost them is highly needed. In the Dynamic Modelling of Resilience - interventional multicenter study (DynaM-INT), we will conduct a large-scale feasibility and preliminary efficacy test for two mobile- and wearable-based just-in-time adaptive interventions (JITAIs), designed to target putative resilience mechanisms. Deep participant phenotyping at baseline serves to identify individual predictors for intervention success in terms of target engagement and stress resilience.

METHODS

DynaM-INT aims to recruit N = 250 healthy but vulnerable young adults in the transition phase between adolescence and adulthood (18-27 years) across five research sites (Berlin, Mainz, Nijmegen, Tel Aviv, and Warsaw). Participants are included if they report at least three negative burdensome past life events and show increased levels of internalizing symptoms while not being affected by any major mental disorder. Participants are characterized in a multimodal baseline phase, which includes neuropsychological tests, neuroimaging, bio-samples, sociodemographic and psychological questionnaires, a video-recorded interview, as well as ecological momentary assessments (EMA) and ecological physiological assessments (EPA). Subsequently, participants are randomly assigned to one of two ecological momentary interventions (EMIs), targeting either positive cognitive reappraisal or reward sensitivity. During the following intervention phase, participants' stress responses are tracked using EMA and EPA, and JITAIs are triggered if an individually calibrated stress threshold is crossed. In a three-month-long follow-up phase, parts of the baseline characterization phase are repeated. Throughout the entire study, stressor exposure and mental health are regularly monitored to calculate stressor reactivity as a proxy for outcome resilience. The online monitoring questionnaires and the repetition of the baseline questionnaires also serve to assess target engagement.

DISCUSSION

The DynaM-INT study intends to advance the field of resilience research by feasibility-testing two new mechanistically targeted JITAIs that aim at increasing individual stress resilience and identifying predictors for successful intervention response. Determining these predictors is an important step toward future randomized controlled trials to establish the efficacy of these interventions.

Online Psychosis Screening: Characterizing an Underexamined Population to Improve Access and Equity

OBJECTIVE

Online resources represent an important avenue to identify and support individuals who may be experiencing symptoms of psychosis but have yet to engage in care. Understanding the experiences and needs of this group is critical to inform outreach for early psychosis and improve outcomes by addressing barriers to early treatment.

METHODS

The authors conducted a retrospective, explorative, cross-sectional analysis by using data collected by Mental Health America as part of their online psychosis screening and support program. Data included scores from the Prodromal Questionnaire-Brief, basic demographic information, and respondents' plans for next steps.

RESULTS

Of 120,937 respondents, most (82.1%) reported distressing psychosis-like experiences at levels sufficient to merit a referral to specialty care for additional evaluation. However, only 17.1% planned to seek treatment as a next step, with most (53.6%) wanting instead more information. Higher distress was only weakly associated with the plan to seek treatment. In the multivariable analysis, respondents who were younger; lesbian, gay, bisexual, transgender, or queer; or Native American or who had lower income reported the greatest symptom-related distress. Younger and higher-income respondents were less likely to plan to seek treatment next. Across race-ethnicity, African Americans were most likely to plan to seek treatment.

CONCLUSIONS

Most respondents reported that psychosis-like experiences caused significant distress, but they did not plan to seek treatment next. Addressing this treatment gap requires careful consideration regarding what services individuals want, how services should be presented, and what barriers may limit help seeking. These steps are critical to improve access to early intervention for individuals with psychosis spectrum disorders.

Promoting University Students' Mental Health: A Systematic Literature Review Introducing the 4M-Model of Individual-Level Interventions

Objective: The purpose of this study is to systematically review recently published individual student-level interventions aimed at alleviating the burden of mental health challenges faced by the students and/ or at equipping them with coping mechanism that will foster their resilience. Methods: This study relied on a systematic literature review. PubMed dataset was used; the search was confined to the following period: July 2016-December 2020. Results: A total of 1,399 records were identified by the electronic search, out of which 40 studies were included in this study. The authors inductively identified four overlapping categories of interventions across all included articles, and coded them as follows: Mindfulness, Movement, Meaning, and Moderator. Accordingly, each study was linked to at least one of four overlapping categories based on the nature of the intervention(s) under investigation, leading to differing assortments of categories. Conclusions: The 4M-Model generated by this study encourages focusing on devising holistic, university-based interventions that embrace the individuality of students to improve their mental health through elements of mindfulness, movement, meaning, and moderator. Through this focused approach, university counselors are enabled to design interventions that address students' physical, psychological, emotional, and social needs.

The mediating effect of trauma and stressor related symptoms and ruminations on the relationship between autistic traits and mood spectrum

An increasing number of studies highlighted significant correlations between autistic traits (AT) and mood spectrum symptoms. Moreover, recent data showed that individuals with high AT are likely to develop trauma and stressor-related disorders. This study aims to investigate the relationship between AT and mood symptoms among university students, focusing in particular on how AT interact with ruminations and trauma-related symptomatology in predicting mood symptoms. 178 students from three Italian Universities of excellence were assessed with The Structured Clinical Interview for DSM-5 (SCID-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Trauma and Loss Spectrum (TALS) and the Moods Spectrum (MOODS). Considering the AdAS Spectrum total scores, 133 subjects (74.7%) were categorized as "low scorers" and 45 subjects (25.3%) as "high scorers". Students in the high scorer group showed significantly higher scores on RRS, TALS-SR and MOOD-SR total scores. Total and direct effects of AdAS Spectrum total score on MOODS-SR total score were both statistically significant. AdAS Spectrum total score also showed a significant indirect effect on MOODS-SR total score through TALS and RRS total scores. Results showed a significant relationship between AT and mood spectrum, which is partially mediated by ruminations and trauma/stressor-related symptomatology.

Cognitive-Affective Correlates of Suicide Ideation and Attempt: Mindfulness is Negatively Associated with Suicide Attempt History but not State Suicidality

The objective of this study was to test whether 3 cognitive-affective correlates,--mindfulness, emotion reactivity, and depressive symptom severity-have different associations with current suicidal ideation (SI), a history of suicide attempt (SA) and SA + SI among emerging adults. Whether impulsive-aggression (IA) moderated associations between cognitive-affective correlates of suicidal behavior and suicidality was also tested. Survey data on current SI, SA history, mindfulness, emotion reactivity, depressive symptom severity, and IA were collected from 780 emerging adults. Results from multinomial logistic regression analysis showed greater depressive symptom severity among emerging adults with current SI, regardless of SA history. Those with a history of SA reported greater depressive symptom severity and less mindfulness than controls. IA did not moderate relationships of SI and/or SA and mindfulness, emotion reactivity, or depressive symptom severity. Mindfulness is a marker of SA, and depressive symptom severity is associated with current SI and SA history in emerging adults. IA does not moderate these associations. To the extent that a history of SA is indicative of elevated trait-like suicide risk and SI indicates state suicidality, our findings suggest that mindfulness protects against longer-term vulnerability to suicide while depressive symptom severity is associated with suicide state-trait risk.

Correlates of suicidal ideation in college women with eating disorders

OBJECTIVE

To identify the correlates of suicidal ideation (SI) in a large sample of college women with eating disorders (EDs).

METHOD

A total of 690 female college students from 28 US colleges who screened positive for an ED, with the exception of anorexia nervosa, were assessed for SI. Univariate logistic regression analyses were performed to determine independent correlates of SI. Measures included: ED psychopathology, ED behaviors (i.e., binge eating, vomiting, laxatives, compulsive exercise), current co-morbid psychopathology (i.e., depression, anxiety, insomnia), weight/shape concerns, ED-related clinical impairment, and body mass index (BMI). All significant variables were included in a backward binary multivariate logistic regression model to determine which variables were most strongly associated with SI.

RESULTS

A total of 25.6% of the sample reported SI. All variables examined were significantly independently associated with SI, with the exception of compulsive exercise. Depression, anxiety, and vomiting remained as significant correlates of SI in the multivariate logistic regression model.

DISCUSSION

ED screening on college campuses should assess for suicidality, and prevention and treatment efforts should target vomiting and co-morbid depression and anxiety symptoms to reduce risk of SI for high-risk individuals.

Evaluating Implicit Emotions of Chinese University Students With Different Levels of Social Adjustment: Implicit Measurement Based on the Go/No-go Association Task

In this study, 60 university students were selected as research participants based on the Chinese Student Adjustment Scale. Participants were divided into two groups: high level of social adjustment and low level of social adjustment. Then using the Go/No-go Association Task as the implicit association experimental paradigm, implicit emotions were evaluated by having participants respond to different facial expressions as quickly as possible. The group of participants with higher levels of social adjustment performed better when responding to self-concepts with positive facial expressions, compared to responding to non-self-concepts with either positive or negative facial expressions. Thus, they showed an implicit preference for processing information about self with positive emotions. The group of participants with lower levels of social adjustment did not show the same benefit when responding to self-concepts. Instead, they performed better when responding to other-related concepts with different facial expressions, irrespective of the emotional content. Thus, they manifested an implicit preference for processing information about others with different emotions, suggesting a deficiency in processing their own emotions. In addition, the results validated the objectivity of the Chinese Student Adjustment Scale as an assessment tool.

Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN)

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.

Intergenerational transmission of disordered eating: Direct and indirect maternal communication among grandmothers, mothers, and daughters

The current study explored disordered eating (i.e., dieting, bulimia and food preoccupation, and oral control) among grandmothers, their daughters, and their granddaughters, and also explored specific direct (i.e., maternal commentary) and indirect (i.e., maternal modeling) communication behaviors as mechanisms by which disordered eating is intergenerationally transmitted. A sample of 242 grandmother-mother-daughter triads provided self-reports of their own disordered eating and perceptions of their mothers' weight-related behaviors. Results revealed that only mothers' and daughters' reports of disordered eating were related, but not grandmothers' and mothers' nor grandmothers' and daughters'. However, a number of indirect effects were observed through maternal commentary and maternal modeling, including an indirect effect of grandmothers' reports of maternal communication on their granddaughters' disordered eating. Data from three generations of women illustrate the intergenerational transmission of disordered eating within families, specific communication variables that may propagate this relationship, and possible cohort and age effects within the sample.

Acute Trauma Factor Associations With Suicidality Across the First 5 Years After Traumatic Brain Injury

OBJECTIVE

To determine whether severity of head and extracranial injuries (ECI) is associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI).

DESIGN

Factors associated with SI and SA were assessed in this inception cohort study using data collected 1, 2, and 5 years post-TBI from the National Trauma Data Bank and Traumatic Brain Injury Model Systems (TBIMS) databases.

SETTING

Level I trauma centers, inpatient rehabilitation centers, and the community.

PARTICIPANTS

Participants with TBI from 15 TBIMS Centers with linked National Trauma Data Bank trauma data (N=3575).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last year was assessed via interview. ECI was measured by the Injury Severity Scale (nonhead) and categorized as none, mild, moderate, or severe.

RESULTS

There were 293 (8.2%) participants who had SI without SA and 109 (3.0%) who had SA at least once in the first 5 years postinjury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (odds ratio=2.73; 95% confidence interval, 1.55-4.82; P=.001). Drug use at time of injury was also associated with SI (odds ratio=1.69; 95% confidence interval, 1.11-2.86; P=.015). Severity of ECI was not associated with SA.

CONCLUSIONS

Severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI.

Attempted Suicide Among Students and Young Adults in Montreal, Quebec, Canada: A Retrospective Cross-Sectional Study of Hospitalized and Nonhospitalized Suicide Attempts Based on Chart Review

OBJECTIVE

We conducted a chart review to identify postsecondary students and nonstudents in the same age range who presented to the emergency department following a suicide attempt to (1) compare demographic characteristics and suicide risk factors and (2) determine factors associated with more serious attempts requiring hospitalizations.

METHOD

The study was conducted in 1 tertiary trauma hospital and 1 community hospital affiliated with McGill University, Montreal, Quebec, Canada, between January 1, 2009, and March 31, 2010. Charts of patients with potential suicide attempts were identified from medical records using ICD-10 codes that indicated traumatic injury, intentional self-harm, poisoning, and psychiatric or perception/cognition disorders and from the emergency department triage file using keywords that indicated suicidality or self-harm at presentation.

RESULTS

In multivariable logistic regression models (odds ratio, 95% CI), students were younger (per 5-year increase: 0.22, 0.12-0.41), less likely to be born in Canada (0.17, 0.06-0.44), and more likely to use less violent methods (laceration, poisoning, other, multiple methods) versus more violent methods (collision, jump, fire burns, firearm, hanging) in their attempt. Fewer students had a history of substance abuse (0.12, 0.02-0.94) but were not different from nonstudents on history of other mental disorders. Less students attempted suicide in the winter/spring (January-April) versus fall (September-December) semester (0.32, 0.11-0.91). Students who attempted suicide were more likely to have family/social support. Those who attempted suicide in the previous year were more likely to require hospitalization for their current suicide attempt.

CONCLUSIONS

Knowledge of specific factors associated with suicide attempts in young people can help inform and guide suicide prevention efforts in both academic and community settings. Specific to the findings of this study regarding the method of suicide attempt used, for example, limiting access to dangerous substances or large quantities of medications may help prevent or reduce suicide attempts in this population.