Do Feelings of Defeat and Entrapment Change over Time? An Investigation of the Integrated Motivational-Volitional Model of Suicidal Behaviour Using Ecological Momentary Assessments

Childhood trauma and suicide risk: Investigating the role of adult attachment

BACKGROUND

Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population.

METHODS

481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days.

RESULTS

Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance.

LIMITATIONS

The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases.

CONCLUSIONS

Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.

A prospective examination of sleep chronotype and future suicide intent among adults in the United Kingdom: A test of the integrated motivational volitional model of suicide

OBJECTIVES/BACKGROUND

Prior research identified a connection between evening chronotype and suicidality, but the mechanism underlying that connection is not well understood. The Integrated Motivational Volitional (IMV) Model of Suicide may provide a theoretical explanation for this link. The current project includes a three-time point longitudinal survey to examine whether 1) suicide intent likelihood varies across time, 2) chronotype affects suicide intent likelihood prospectively, and 3) defeat and entrapment explain the association between chronotype and suicide intent likelihood.

PATIENTS/METHODS

Participants (n = 187 UK adults) completed a baseline survey (demographics, chronotype (morning-eveningness; MEQ), defeat and entrapment, and perceived intent to make a future suicide attempt), and follow-up surveys (MEQ and suicide intent likelihood) 3 and 6 months later.

RESULTS

Results indicated that suicidal intent at 6-month follow-up was lower than baseline or 3-month follow-up. It was also found that strong evening chronotype at baseline is associated with increased suicidal intent 6 months later, and that defeat mediates this relationship.

CONCLUSION

Our theoretically informed findings shed light on the psychological mechanisms linking chronotype (i.e., eveningness) and future suicide intent by highlighting the role of defeat and entrapment. We propose that feelings of defeat might be derived from evening types' experiences of social jetlag (resulting from conflict between biologically driven sleep schedules and externally dictated social schedules), which consequently drives entrapment and greater future suicide intent. Within this context, defeat and entrapment may be good transdiagnostic and modifiable target variables for future intervention development.

Examining aspects of psychological flexibility within the integrated motivational-volitional model of suicidal behavior: A prospective investigation

BACKGROUND

According to the integrated motivational-volitional model of suicide, feelings of entrapment are related to the emergence of suicidal ideation (SI). However, this relation can be moderated by certain protective factors.

METHODS

This study examined whether aspects of psychological flexibility (i.e., experiential avoidance, experiential acceptance, harnessing) moderated the relation between aspects of entrapment and SI severity in college students experiencing SI (N = 553) both cross-sectionally and when SI severity was measured 1 week later (N = 247).

RESULTS

At baseline, experiential acceptance, but not experiential avoidance or harnessing, significantly moderated the relation between external entrapment and SI severity and internal entrapment and SI severity. No aspects of psychological flexibility prospectively moderated relations between entrapment and SI severity.

CONCLUSIONS

Aspects of psychological flexibility may influence immediate vulnerability to SI severity among young adults experiencing feelings of entrapment. Implications for clinical interventions influencing changes in psychological flexibility are discussed.

Examining state self-criticism and self-efficacy as factors underlying hopelessness and suicidal ideation

INTRODUCTION

When people feel hopeless, they are more likely to think about suicide. Prior work has shown that both hopelessness and suicidal ideation fluctuate over time; however, there are likely other contextual factors underlying increased hopelessness and suicidal ideation in moments of time.

METHOD

In two studies using retrospective recall of a real event (Study 1, n = 268) and an experimental imaginal vignette design (Study 2, n = 356), we examined self-criticism and self-efficacy for self-regulation as crucial factors underlying hopelessness in people vulnerable to suicidal ideation.

RESULTS

In both studies, greater state self-criticism and lower state self-efficacy were associated with greater hopelessness. In Study 2, we also measured suicidal ideation, and found that higher self-criticism and lower self-efficacy for self-regulation scores were associated with greater suicidal ideation, even when controlling for negative affect. Evidence of an interaction between self-criticism and self-efficacy was found with scores in Study 2 but not in Study 1; specifically, lower self-efficacy was associated with greater ideation when self-criticism was high but not when self-criticism was low.

CONCLUSION

Overall, results support self-criticism and self-efficacy as important contextual factors underlying hopelessness and suicidal ideation and attending to the potential interactive effect between self-criticism and self-efficacy.

Entrapment and Defeat Scales: Factor Structure Assessment and Variation by Gender and Sexual Identity among Adults in the United Kingdom

Entrapment and defeat are empirically-supported suicide risk factors. Their measurement is the subject of some debate, however. Also, limited work exists examining sexual and gender minority (SGM) differences in these suicide risk factors despite overall elevated rates of suicidal thoughts and behaviors (STBs) for SGM persons. The present study examined (1) entrapment and defeat differences by sexual orientation and gender identity, (2) factor structure and criterion validity of the Entrapment Scale (E-Scale) and the Defeat Scale (D-Scale), and (3) measurement invariance by sexual orientation (subsamples were too small for gender identity). A sample of 1,027 adults living in the United Kingdom completed a cross-sectional online questionnaire assessing mental health. Analysis of Variance and Kruskal-Wallis testing revealed: (1) all sexual minority (i.e., gay/lesbian, bisexual, and other SM) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to their heterosexual counterparts, and; (2) gender minority (i.e., transgender and gender diverse) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to cisgender persons. Supported by suicide theory, confirmatory factor analysis showed modest support for a two-factor E-Scale (internal and external), and a one-factor D-Scale. All entrapment and defeat scores displayed significant moderate positive correlations with suicidal ideation. E- and D-scale scores displayed high intercorrelation, tempering confidence in conclusions regarding the facture structure findings. Item threshold-level responding varied by sexual orientation for the D-Scale but not the E-Scale. Results are discussed with respect to suicide theory and measurement, public health, and clinical practice.

Frequency and predictors of virtual hope box use in individuals experiencing suicidal ideation: An ecological momentary assessment investigation

INTRODUCTION

The Virtual Hope Box (VHB) is a smartphone application designed to support emotion regulation when one is distressed, in a crisis, or experiencing suicidal ideation (SI). Initial proof of concept studies indicate that individuals are more likely to use the VHB than traditional hope boxes, and find it both easy to setup and helpful. To our knowledge, no studies have harnessed ambulatory assessment methodology to assess VHB use as it relates to incidence of suicidal thinking.

METHODS

As such, we recruited N = 50 undergraduates who endorsed SI either the past year or past 2 weeks to complete a 10-day investigation. At baseline, participants were oriented to the VHB and instructed on how to use the application. Over the next 10 days, participants responded to prompts five times per day on their personal smartphones regarding their current experiences of SI and stress as well as VHB usage.

RESULTS

Results found that most participants used the VHB at least once, rated its usefulness as high, and rated their perceived likelihood of future use as high. In addition, increases in state SI severity were related to subsequent VHB use.

CONCLUSION

The VHB may be a useful tool for managing crises in undergraduates experiencing suicidal thoughts.

Study protocol for a feasibility study of microinterventions in smartphone-based assessments to reduce depressive rumination

INTRODUCTION

Depression as well as suicidal ideation and behaviours share several precipitating and maintaining factors and are subject to the influence of overlapping constructs. One of these transdiagnostic constructs is rumination. For the treatment of rumination, a variety of interventions are already available. However, not everyone with a need receives psychotherapeutic treatment. And even if they do: implementing learnt strategies alone at home can be challenging for patients. Therefore, this study aims to test the feasibility of delivering microinterventions for the reduction of rumination in a smartphone-based setting with the goal to make these interventions accessible to a larger number of people and support their use in everyday life.

METHODS AND ANALYSIS

The study's design is an uncontrolled-within-group design. Participants with at least mild depressive symptoms and reported rumination will be included and recruited via outpatient clinics as well as in the general population. The aim is to recruit at least N=70 participants. Participants first undergo a short telephone screening, a baseline assessment, a 7-day smartphone-based assessment including microinterventions in case participants report rumination and a postassessment. For feasibility purposes, primary outcomes relate to participants' compliance, their evaluation of the smartphone-based assessment as well as the microinterventions delivered during the assessment. As a secondary goal, clinical utility will be examined. Clinical outcomes (eg, depressive symptoms, rumination) will be measured at baseline and postassessment.

ETHICS AND DISSEMINATION

The ethics committee of the institute of psychology of the university of Duisburg-Essen and University of Leipzig has approved the study. Study results will be disseminated to healthcare communities, in peer-reviewed science journals and at conferences.

TRIAL REGISTRATION NUMBER

DRKS00031743.

Examination of real-time variation in interpersonal hopelessness and suicidal desire in a college student sample reporting past-2-week suicidal ideation

INTRODUCTION

Interpersonal hopelessness (IH), as outlined in the Interpersonal Theory of Suicide, is theorized to include two correlated, distinct constructs: hopelessness about one's thwarted belongingness (IH-TB) and about perceived burdensomeness on others (IH-PB). Few studies have explored IH, and none have explored its temporal stability or prospective prediction of suicidal desire.

METHODS

Undergraduates (N = 43) selectively recruited for past-2-week suicidal ideation completed five ecological momentary assessment surveys per day for 10-days. Intraclass correlations, root mean square of successive differences, and multilevel models were used to examine the data and test relationships among predictor variables.

RESULTS

IH-TB and IH-PB demonstrated greater temporal stability than general hopelessness. IH-TB, IH-PB, and their interaction were significant predictors of suicidal desire concurrently and prospectively. IH-PB was no longer significantly predictive of suicidal desire when adjusting for general hopelessness. Post-hoc models showed that suicidal desire was not predictive of IH-TB, IH-PB, or their interaction suggesting the relationship is not recursive.

CONCLUSION

Results showed that interventions aimed at decreasing one's hopelessness specific to TB and PB may be beneficial for decreasing suicidal desire. Future research should seek to replicate these results in larger and more diverse samples and consider the use of shorter ambulatory assessment intervals.

Perceived entrapment predicts first-onset suicidal ideation: A longitudinal study among medical students in China

Introduction

The prevalence of suicidal ideation among medical students is high. Evidence indicates that feelings of entrapment are a predictor of suicidal ideation. In this study, we aimed to (1) investigate the prevalence of first-onset suicidal ideation among Chinese medical students and (2) explore the predictive effects of perceived entrapment on first-onset suicidal ideation.

Methods

This longitudinal study was conducted between 2018 and 2019 among 211 newly enrolled medical students in Shanghai. Using an anonymous questionnaire, we collected information on sociodemographic (sex, major, parents' income, and academic performance) and psychological (entrapment, depression, loneliness, defeat, social support, and interpersonal needs) variables as well as suicidal ideation. Participants were divided into four subgroups based on their exposure to entrapment (control, new-onset, reduced, and persistent). The primary outcome, first-onset suicidal ideation, was defined as suicidal ideation absent at baseline but present at follow-up.

Results

In total, 54.98% of participants (116/211) were women, and 76.78% (162/211) majored in clinical medicine. In the follow-up survey, 6.16% of participants (16/211) reported first-onset suicidal ideation, 17.54% (37/211) reported new-onset entrapment, and 12.80% (27/211) reported persistent entrapment during follow-up. Compared with the control group who reported no perceived entrapment at baseline and follow-up, participants who reported new-onset entrapment had the highest risk of new-onset suicidal ideation [odds ratio (OR) = 14.700, 95% confidence interval (CI) = 2.906-74.364; adjusted OR = 8.798; 95% CI = 1.588-48.757; multivariate OR = 8.238, 95% CI = 1.394-48.693).

Conclusion

New-onset entrapment can significantly predict suicidal ideation. Therefore, greater attention is needed for new-onset entrapment, such as intervention for suicidal ideation.

Structural validity of the Persian version of the Suicide Capacity Scale among Iranian college students

OBJECTIVES

This study was the first step in translating the Suicide Capacity scale (SCS-3) from English to Persian and then determining its structural validity in a sample of Iranian students.

METHODS

The sample consisted of 600 participants selected by the convenience sampling method and answered the questionnaires of the Suicide Behaviors Questionnaire-Revised (SBQ-R) Depressive Symptom Index-Suicidality Subscale (DSI-SS), suicide attempt, and suicidal capacity(SCS-3).

RESULTS

The single-group factor analysis suggested that the three-factor model shows the goodness of fit with the data.

PRACTICAL IMPLICATIONS

Suicide capacity is a psychometric tool that can be included in public health studies, health psychology, and empirical research to identify suicide-related behaviors in different populations.

Trapped in my inner prison—Cross-sectional examination of internal and external entrapment, hopelessness and suicidal ideation

Background

Within the integrated motivational-volitional model of suicidal behavior, entrapment that consecutively leads to hopelessness is considered as a proximal risk factor for suicidal ideation. Entrapment can refer to both external and internal circumstances whereby results of recent studies indicate that internal entrapment plays a more important role than external entrapment in the development of suicidal ideation. It has been considered that to escape internal entrapment might be more complicated than to change external circumstances. However, it remains unclear whether the greater effect of internal entrapment on suicidal ideation is due to greater feelings of hopelessness. Therefore, the aim of this study was to address this research gap and to examine the effects of internal and external entrapment on hopelessness and suicidal ideation.

Methods

N = 454 participants from a community sample (75% female) aged between 18 and 73 years (M = 29.91, SD = 11.56) conducted a cross-sectional online survey. All participants were assessed for suicidal ideation, hopelessness, and internal as well as external entrapment. Pearson product-moment correlations and two mediation analyses were conducted.

Results

All constructs were significantly correlated. For both internal and external entrapment, an effect on suicidal ideation was found. Both effects were partially mediated by hopelessness, this mediation was larger for external entrapment. The completely standardized indirect effect used to compare the mediation models was larger for external entrapment than for internal entrapment.

Conclusions

Hopelessness mediated the association between external entrapment as well as internal entrapment and suicidal ideation. This effect was larger for external entrapment.

The temporal relationships between defeat, entrapment and suicidal ideation: ecological momentary assessment study

BACKGROUND

Psychological models of suicidal experiences are largely based on cross-sectional or long-term prospective data with follow-up intervals typically greater than 1 year. Recent time-series analyses suggest that these models may not account for fluctuations in suicidal thinking that occur within a period of hours and/or days.

AIMS

We explored whether previously posited causal relationships between defeat, entrapment and suicidal ideation accounted for temporal associations between these experiences at small time intervals from 3 to 12 h.

METHOD

Participants (N = 51) completed an ecological momentary assessment (EMA) study, comprising repeated assessments at semi-random time points up to six times per day for 1 week, resulting in 1852 completed questionnaires. Multilevel vector autoregression was used to calculate temporal associations between variables at different time intervals (i.e. 3 to 12 h between measurements).

RESULTS

The results showed that entrapment severity was temporally associated with current and later suicidal ideation, consistently over these time intervals. Furthermore, entrapment had two-way temporal associations with defeat and suicidal ideation at time intervals of approximately 3 h. The residual and contemporaneous network revealed significant associations between all variables, of which the association between entrapment and defeat was the strongest.

CONCLUSIONS

Although entrapment is key in the pathways leading to suicidal ideation over time periods of months, our results suggest that entrapment may also account for the emergence of suicidal thoughts across time periods spanning a few hours.

Were self-described introverts "immune" to increased drug use and entrapment during the pandemic?

Background

Methods

Results

Conclusions

Perfectionism and Suicidal Ideation

Background: The integrated motivational-volitional (IMV) model of suicidal behavior posits that defeat leads to suicidal ideation through increased vulnerability for feelings of entrapment. One potentially important vulnerability factor for the development of feelings of defeat is socially prescribed perfectionism. Aims: The current study investigated these relationships in a sample of 313 US adults. Method: Mediation and parallel mediation analyses were conducted to determine the relationships between defeat, entrapment, social prescribed perfectionism, negative social comparison, and rejection sensitivity. Results: Findings indicated that socially prescribed perfectionism was significantly related to defeat through both negative social comparison and rejection sensitivity even when controlling for depression symptoms. Negative social comparison and rejection sensitivity were related to entrapment through feelings of defeat. This relationship was strongest when analyzing externalized (vs. internalized) entrapment. Limitations: The findings were limited by the cross-sectional study design as well as the relatively homogeneous sample. Implications and future directions are discussed.

Defeat, entrapment, and suicidal ideation: Twelve-month trajectories

BACKGROUND

Defeat and entrapment have been highlighted in the development of suicidal ideation within the Integrated Motivational-Volitional model of suicidal behavior. Research suggests that entrapment has to be differentiated into internal and external entrapment. The aim of this study was to investigate the associations between defeat, internal, external entrapment, and suicidal ideation within and prospectively over measurements.

METHODS

A sample of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) was assessed for the four constructs after admission to a psychiatric ward and six, nine, and twelve months later. Multilevel analyses were conducted to examine associations.

RESULTS

Defeat was associated with (a change in) internal and external entrapment. Defeat predicted a change in internal entrapment over time. Defeat and internal, but not external, entrapment were associated with (a change in) suicidal ideation. Internal entrapment was able to predict suicidal ideation. Internal entrapment and defeat predicted a change in suicidal ideation over time.

CONCLUSION

Results highlight the importance to distinguish between internal and external entrapment, and their specific association with suicidal ideation. Perceptions of internal entrapment are of central relevance when experiencing suicidal ideation and should be considered in clinical practice.

Study Protocol for an Ecological Momentary Assessment Study: TempRes "Temporal Variability of Risk and Resilience Factors for Suicidal Ideation"

Suicide prevention is an important public mental health issue that can be significantly brought forward by recent advances in psychological research methods and assessment. The project "TempRes" aims to harness the power of Ecological Momentary Assessment (EMA) to investigate the transdiagnostic risk and resilience factors associated with suicidal ideation drawn from the most recent research in suicide prevention and personality assessment. Participants will comprise the general population (planned: N = 100) and a risk group (patients currently in psychosomatic or psychiatric treatment) (planned: N = 50). After a comprehensive baseline assessment, they will complete up to ten short assessments per day over the course of 10 days at roughly equidistant intervals. In detail, the project examines the interplay of biography (previous suicidal behavior, experiences of childhood maltreatment), individual differences (level of personality functioning), and time-varying factors (entrapment, loneliness, mood) with respect to the emergence and fluctuation of suicidal ideation. There are two main research foci: First, the project will provide an operationalization and empirical verification of a core assumption of the integrated motivational-volitional model of suicide (IMV model). It will test whether the interaction of the time-varying predictors entrapment with loneliness (as a motivational moderator) explains reports of suicidal ideation over time. Second, it will be the first to examine personality functioning (a transdiagnostic, psychodynamically grounded conceptualization of vulnerability to psychological crises over the life span) as a time-invariant predictor of suicidal ideation assessed within an intensive longitudinal study design. The main analyses will be built on linear mixed models. The overarching aim of the project is to gain a better understanding of the psychological dynamics underlying suicidal ideation in different populations by bringing together concepts from different theoretical traditions. This will inform prevention efforts geared toward the general public as well as intervention in clinical populations.

Evaluating the validity and reliability of the Chinese entrapment scale and the relationship to depression among men who have sex with men in Shanghai, China

BACKGROUND

Perception of entrapment can emerge when someone feels trapped in an aversive situation and incapable of escape. Depression is closely related to the construct of entrapment. In China, men who have sex with men (MSM) have a high prevalence of depression; therefore, a tool to evaluate entrapment in this population is needed. We evaluated the validity and reliability of the Chinese version of the entrapment scale (ES) and the relationship to depression among MSM in Shanghai, China.

METHODS

We recruited 304 MSM from four districts in Shanghai, China. Participants completed health behavior questionnaires that included baseline information and psychological measurements such as the ES and Patient Health Questionnaire (PHQ-9). The sample was randomly divided into two groups for exploratory factor analysis (n = 143) and confirmatory factor analysis (n = 161). Criterion validity was tested to explore the correlation between the ES and PHQ-9 scores. The reliability of the ES was evaluated with internal consistency reliability (Cronbach's α coefficient) and split-half reliability (Spearman-Brown coefficient). We performed hierarchical regression analysis to determine the variance explained of entrapment to predicting depressive symptoms after adjusting for sociodemographic factors. Finally, receiver operator characteristic curve analysis was performed to measure the optimal ES cut-off value for predicting depression.

RESULTS

Factor analysis showed the ES had one principal component, and one-dimensional scale had more acceptable model fit indices than two-dimensional model. The correlation coefficient between the ES and PHQ-9 scores was 0.756 (P < 0.01). The Cronbach's α coefficient was 0.970 and the Spearman-Brown coefficient was 0.976. ES scores significantly predicted an additional 45.1% of depressive symptoms after controlling for sociodemographic characteristics in the MSM population (β = 0.689, P < 0.001). The optimum cut-off value was 23, which had a sensitivity of 70% and a specificity of 85.4%.

CONCLUSIONS

The Chinese version of the ES has good validity and reliability in the MSM population in Shanghai, and can be used to evaluate perception of entrapment among MSM. The findings confirmed an association between entrapment and depression.

Brief Self-Report Measure of Agitation: A Psychometric Investigation in a German Sample

To perform repeated measurements in clinical practice without putting unnecessary strain on patients, short instruments are needed. The Brief Self-Report Measure of Agitation (BAM) is a short measure assessing agitation, which has been associated with suicidal ideation and behavior. However, its reliability and validity have not been examined in an independent sample. A non-clinical sample of N = 429 participants aged between 18-81 (M = 27.36, SD = 9.67; 82.3% female) was surveyed online. A confirmatory factor analysis was conducted and reliability was investigated. The validity of the BAM was examined by calculating correlations and an ANOVA for differences in BAM scores between subgroups. BAM items significantly loaded onto one factor (factor loadings: ≥ .62) and the measure was found to have good reliability (Cronbach's α = .83) and convergent/discriminant validity. Participants with recent suicidal ideation and those with recent suicidal ideation and lifetime suicide attempts had significantly higher BAM scores than participants without suicidal ideation/suicide attempt. Results indicate good validity and reliability for the measurement of agitation with the German version of the BAM in the present sample. Thereby, we introduce a brief instrument in German for repeated assessment of agitation in research and clinical practice.

Listen to Your Heart-Ecological Momentary Assessment of Interoceptive Accuracy, Awareness and Sensibility: A Pilot Study

Background: Interoception is a multi-facetted phenomenon including interoceptive accuracy, awareness and sensibility. Deficits in interoception have been associated with psychological distress. However, little is known about the course of interoception over time. The present study aimed at examining interoception in an ecological momentary assessment (EMA)-setting. Methods: A seven-day smartphone-based EMA was conducted in a community sample of sixty-one participants (age: M = 24.1, SD = 7.00, n = 54 female (88.5%)). To control for potential practice effects of repeated assessments during the EMA phase, participants were randomly assigned to a control (n = 30) and an interoception (n = 31) group. The latter was assessed for interoceptive accuracy, awareness and sensibility. Before and after the EMA phase, all participants were assessed for interoception in the laboratory. Results: Multilevel analyses revealed significant fluctuations for all three interoceptive facets, around 50% of variance was due to within-person variability. There were only practice effects for the subscale "Attention Regulation", measuring interoceptive sensibility. Conclusion: The facets of interoception can be assessed in an EMA-setting. Repeated interoceptive assessments do not necessarily lead to an improvement of participants' interoceptive abilities. It could be shown that all interoceptive facets fluctuate, which should be considered in future research.