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Höller I, Forkmann T, Glaesmer H, Teismann T, Spangenberg L, Schreiber D, Hallensleben N, Kraiss J. Torn between living or dying-analyses of influencing factors on suicide ambivalence and its longitudinally impact on suicidal ideation and behavior in a high-risk sample. Suicide Life Threat Behav 2024. [PMID: 38758343 DOI: 10.1111/sltb.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Findings on the role of suicide ambivalence, an individual's wish to live (WL), and wish to die (WD) in the development of suicidality have been heterogenous. The main goal of this study was to examine associations of these constructs within the past week with sociodemographic factors and to longitudinally investigate their predictive power for suicidal ideation (SI) and suicide attempts (SA). METHODS N = 308 patients (54% female; M = 36.92 years, SD = 14.30), admitted to a psychiatric ward due to suicidality, were assessed for all constructs after admission, after six, nine, and 12 months. Data were analyzed with univariate fixed-effect models and lagged mixed-effect regression models. RESULTS Decreased, WL increased post-baseline. Gender showed no significant link to ambivalence, WD, and WL. Ambivalence and WD correlated negatively with age and positively with depressiveness. More participants in a relationship showed a WL compared with single/divorced/widowed participants. More single participants or those in a relationship showed ambivalence than divorced/widowed participants. More single participants showed a WD than participants in a relationship/divorced/widowed. Longitudinally, ambivalence and WD predicted SI and SA. CONCLUSION The findings underscore the importance of taking suicide ambivalence and WD into account in risk assessment and treatment.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Psychology and Psychotherapy, Charlotte Fresenius Hochschule, Düsseldorf, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Psychology and Psychotherapy, Charlotte Fresenius Hochschule, Düsseldorf, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University of Bochum, Bochum, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Psychology and Psychotherapy, Charlotte Fresenius Hochschule, Düsseldorf, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Jannis Kraiss
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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Teismann T, Siebert AM, Forkmann T. Suicidal ambivalence: A scoping review. Suicide Life Threat Behav 2024. [PMID: 38709556 DOI: 10.1111/sltb.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Suicidal ambivalence is considered a characteristic condition of suicidal individuals. At the same time, there is a lack of a uniform definition, conception and assessment of suicidal ambivalence. On this background, the current scoping review aims to explore the extent, range, and nature of research activity on suicidal ambivalence and to summarize research findings. METHODS A systematic literature search was conducted in four different databases (PubMed, Psychinfo, Web of Science, and Google Scholar) using an array of search terms (e.g., ambivalence, internal suicide debate, reasons for living and reasons for dying, wish to live and wish to die). RESULTS In total, 28 articles published between 1977 and 2023 were included in the scoping review. The study situation lacks a clear definition, conceptualization and operationalization of suicidal ambivalence. Nonetheless, suicidal ambivalence is a common experience in persons contemplating suicide and suicidal ambivalence seems to be present before, during and after a suicide attempt. Suicidal ambivalence is associated with diverse markers of negative/positive mental health as well as suicidal ideation and behavior. CONCLUSION Results point to the relevance of suicidal ambivalence. At the same time, there are large gaps in knowledge about the development, impact and therapeutic responsiveness of suicidal ambivalence.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University, Bochum, Germany
| | | | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg, Essen, Germany
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Teismann T, Forkmann T, Glaesmer H, Alpers GW, Brakemeier EL, Brockmeyer T, Christiansen H, Fehm L, Glombiewski J, Heider J, Hermann A, Hoyer J, Kaiser T, Klucken T, Lincoln TM, Lutz W, Margraf J, Pedersen A, Renneberg B, Rubel J, Rudolph A, Schöttke H, Schwartz B, Stark R, Velten J, Willutzki U, Wilz G, In-Albon T. Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment. J Affect Disord 2024; 351:971-976. [PMID: 38346649 DOI: 10.1016/j.jad.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.
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Affiliation(s)
- T Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - T Forkmann
- Clinical Psychology and Psychotherapy, Universität Duisburg-Essen, Germany.
| | - H Glaesmer
- Medical Psychology and Medical Sociology, Universität Leipzig, Germany.
| | - G W Alpers
- Otto Selz Institute & Department of Psychology, School of Social Sciences, University of Mannheim, Germany.
| | - E L Brakemeier
- Clinical Psychology and Psychotherapy, Universität Greifswald, Germany.
| | - T Brockmeyer
- Clinical Psychology and Psychotherapy, University of Goettingen, Germany.
| | - H Christiansen
- Clinical Child and Adolescent Psychology, Philipps-Universität Marburg, Germany.
| | - L Fehm
- Institute for Psychology, Humboldt-Universität zu Berlin, Germany.
| | - J Glombiewski
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Germany.
| | - J Heider
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Germany.
| | - A Hermann
- Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Germany.
| | - J Hoyer
- Faculty of Psychology, Technische Universität Dresden, Germany.
| | - T Kaiser
- Methods and Evaluation/Quality Assurance, Freie Universität Berlin, Germany.
| | - T Klucken
- Clinical Psychology and Psychotherapy, Universität Siegen, Germany.
| | - T M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Germany.
| | - W Lutz
- Clinical Psychology and Psychotherapy, Universität Trier, Germany.
| | - J Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - A Pedersen
- Clinical Psychology and Psychotherapy, Kiel University, Germany.
| | - B Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Germany.
| | - J Rubel
- Clinical Psychology and Psychotherapy of Adulthood, Universität Osnabrück, Germany.
| | - A Rudolph
- Clinical Psychology and Psychotherapy, Universität Leipzig, Germany.
| | - H Schöttke
- Clinical Psychology and Psychotherapy, Universität Osnabrück, Germany.
| | - B Schwartz
- Clinical Psychology and Psychotherapy, Universität Trier, Germany.
| | - R Stark
- Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Germany.
| | - J Velten
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - U Willutzki
- Clinical Psychology and Psychotherapy, Faculty of Health, University Witten/Herdecke, Germany.
| | - G Wilz
- Counseling and Clinical Intervention, Department of Psychology, Friedrich-Schiller Universität Jena.
| | - T In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-, Landau, Germany.
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Spahn C, Spangenberg L, Teismann T, Forkmann T, Schönfelder A, Schreiber D, Paashaus L, Stengler K, Glaesmer H. [Utilization of Outpatient Psychotherapy and Outpatient Psychiatric Treatment by Men and Women after Inpatient Treatment due to Suicide Attempt or Acute Suicidal Crisis]. Psychiatr Prax 2024; 51:99-103. [PMID: 37813362 DOI: 10.1055/a-2163-1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The strongest predictor of suicide attempts is a previous suicide attempt. Individuals hospitalized for suicidal ideation and behavior face an increased risk of suicide following discharge. This study investigates the extent to which outpatient treatment services are utilized the first 6 months after discharge and whether men and women differ in this regard. METHOD The study examines data of 124 individuals (with suicide attempts (lifetime), 59.7% female) on the use of outpatient treatment services in the 6 months after inpatient treatment. RESULTS 37.9% (N=47) of individuals reported not having used any treatment services at all. Men were significantly less likely to make use of the services. CONCLUSION Members of a group with an increased risk of suicide, to a large extent, fail to make use of outpatient treatment services. Discharge management should increasingly focus on (gender-specific) barriers and pave the way for treatment in outpatient.
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Affiliation(s)
- Cora Spahn
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
| | - Lena Spangenberg
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
| | - Tobias Teismann
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Fakultät für Psychologie, Ruhr-Universität Bochum
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Duisburg-Essen
| | - Antje Schönfelder
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
| | - Dajana Schreiber
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Duisburg-Essen
| | - Laura Paashaus
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Duisburg-Essen
| | | | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
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Melzer L, Forkmann T, Teismann T. Suicide Crisis Syndrome: A systematic review. Suicide Life Threat Behav 2024. [PMID: 38411273 DOI: 10.1111/sltb.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The objective of this systematic review is to describe the scientific evidence for the Suicide Crisis Syndrome (SCS), a presuicidal cognitive and affective state consisting of five symptomatic dimensions: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The aim of this article is to summarize the emerging literature on the SCS and to assess the extent to which a uniform syndrome can be assumed. METHODS A systematic literature search was conducted in three different databases (PubMed, PsycInfo, and Google Scholar) using the search terms "Suicide Crisis Inventory," "Suicide Crisis Syndrome," "Narrative Crisis Model of Suicide," and "Suicide Trigger State." RESULTS In total, 37 articles from 2010 to 2022 were identified by search criteria. Twenty-one articles published between 2017 and 2022 were included in the systematic review. All but three studies were conducted in the United States and examined clinical samples of adult high-risk psychiatric in- and outpatients. Sample sizes ranged from N = 170 to 4846. The findings confirm the unidimensional structure of the proposed disorder and support the predictive validity for short-term suicidal behavior above and beyond suicidal ideation. CONCLUSION Despite the promising predictive validity of the SCS, a precise prediction of future suicidal behavior remains difficult.
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Affiliation(s)
- Laura Melzer
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Conrad K, Forkmann T, Schreiber D, Teismann T, Glaesmer H, Spangenberg L, Schönfelder A, Hallensleben N, Paashaus L, Juckel G, Höller I. Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire. PLoS One 2023; 18:e0293026. [PMID: 37956124 PMCID: PMC10642825 DOI: 10.1371/journal.pone.0293026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct. METHOD Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation. RESULTS Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation. CONCLUSION Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.
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Affiliation(s)
- Katharina Conrad
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Tobias Teismann
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-University of Bochum, Bochum, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Laura Paashaus
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Psychology and Psychotherapy, Charlotte Fresenius Hochschule, Düsseldorf, Germany
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Mehrabi A, Naghavi A, Afsharzada ME, Friedrich S, Forkmann T, Glaesmer H, Teismann T. Validation of the Farsi version of the Suicide Ideation and Behavior Scale. Front Psychiatry 2023; 14:1201193. [PMID: 37736059 PMCID: PMC10509848 DOI: 10.3389/fpsyt.2023.1201193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Objective Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS). Methods Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted. Results The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity. Discussion The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.
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Affiliation(s)
- Ali Mehrabi
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Azam Naghavi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | | | - Sören Friedrich
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Duisburg, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Forkmann T, Höller I. Instability matters. Lancet Psychiatry 2023; 10:307-308. [PMID: 36966786 DOI: 10.1016/s2215-0366(23)00101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen 45141, Germany.
| | - Inken Höller
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen 45141, Germany
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Forkmann T, Knorr A, Gerdes C, Vüst B, Hamacher D, Teismann T. Metacognitions about suicidal thoughts. J Psychiatr Res 2023; 161:199-205. [PMID: 36933446 DOI: 10.1016/j.jpsychires.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs. METHODS Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; Mage = 24.9, SDage = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; Mage = 33.2, SDage = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively. RESULTS Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions. CONCLUSION Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.
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Affiliation(s)
- Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany.
| | - Anna Knorr
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Christiane Gerdes
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Björn Vüst
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Dennis Hamacher
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
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Spangenberg L, Friedrich M, Forkmann T, Hallensleben N, Schönfelder A, Rath D, Paashaus L, Teismann T, Glaesmer H. Phenotyping suicidal ideation and behavior: Comparing clinical characteristics and future suicide attempts between suicidal subtypes in two clinical samples. Int J Methods Psychiatr Res 2023; 32:e1940. [PMID: 36056837 PMCID: PMC9976598 DOI: 10.1002/mpr.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To further validate the concept of suicidal subtypes distinguished by indicators of suicidal thinking and behavior with regard to clinical characteristics and past and future suicide attempts. METHODS Psychiatric inpatients were assessed (study 1: ecological momentary assessments in 74 depressed inpatients with suicidal ideation; study 2: clinical assessments in 224 inpatients after a suicide attempt and over a 12-month follow-up period). Subtypes were identified using latent profile analysis (based on indicators of real-time suicide ideation) and latent class analysis (based on features of past suicide ideation and suicide attempt characteristics). Comparisons between subtypes included clinical characteristics (depression, suicidal ideation, trait impulsivity, childhood trauma) as well as past (study 1) and future (study 2) suicide attempts. RESULTS Suicidal subtypes emerged that are characterized by suicidal ideation means and stability and features of past suicidal behavior (four in study 1, three in study 2). The subtypes differed in terms of depression/suicidal ideation, but not in terms of trait impulsivity/childhood trauma. Although not significant, the subtypes "high-stable" and "low-moderate stable" reported multiple re-attempts more frequently during follow-up than the "low-stable" subtype in study 2. CONCLUSION Differences in clinical variables (and by trend in future suicide attempts) clearly point to the clinical relevance of suicidal subtypes (with variability of suicidal thoughts playing a particularly important role).
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Affiliation(s)
| | | | | | | | | | - Dajana Rath
- University of Duisburg-Essen, Essen, Germany
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Dienst F, Forkmann T, Schreiber D, Höller I. Attachment and need to belong as moderators of the relationship between thwarted belongingness and suicidal ideation. BMC Psychol 2023; 11:50. [PMID: 36803642 PMCID: PMC9942329 DOI: 10.1186/s40359-023-01080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND In the Interpersonal Theory of Suicide, thwarted belongingness is presented as a main predictor for suicidal ideation. Studies only partially support this prediction. The aim of this study was to examine whether the heterogenous results are due to moderating effects of attachment and the need to belong on the association between thwarted belongingness and suicidal ideation. METHODS Four hundred forty-five participants (75% female) from a community sample aged 18 to 73 (M = 29.90, SD = 11.64) filled out online questionnaires about romantic attachment, their need to belong, thwarted belongingness, and suicidal ideation cross-sectionally. Correlations and moderated regression analyses were conducted. RESULTS The need to belong significantly moderated the relationship between thwarted belongingness and suicidal ideation and was associated with higher levels of anxious attachment and avoidant attachment. Both attachment dimensions were significant moderators of the relationship between thwarted belongingness and suicidal ideation. CONCLUSION Anxious and avoidant attachment as well as a high need to belong are risk factors for suicidal ideation in people with thwarted belongingness. Therefore, attachment style and need to belong should both be considered in suicide risk assessment and therapy.
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Affiliation(s)
- Franziska Dienst
- Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstraße 2, 45141, Essen, Germany.
| | - Thomas Forkmann
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstraße 2, 45141 Essen, Germany
| | - Dajana Schreiber
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstraße 2, 45141 Essen, Germany
| | - Inken Höller
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstraße 2, 45141 Essen, Germany
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Höller I, Forkmann T, Hündlings A, Specka M, Scherbaum N. [Need of Help and Social Support of Parents with a Mental Disorder]. Psychiatr Prax 2023; 50:20-28. [PMID: 35081630 DOI: 10.1055/a-1704-6391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Studies could already show that parents with a mental disorder have a high need for social support but the use of offered help is scarce. The main goal of this study was therefore to assess the need of help as well as the extent of social support of parents with mental illness. N = 100 psychiatric inpatients (49 % female) with underaged children were assessed for need of help, use of help and social support. 99 % of patients reported to have received help. 53 % of patients reported to have further need for social support. 36 % of patients reported a below-average extent of social support. There were sociodemographic differences in the extent of social support. Even though, parents with mental illness make use of offered help, they do not experience social support in the extent that they need it. This underlines the high need as well as the importance of social support for parents with mental illness.
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Affiliation(s)
- Inken Höller
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen
| | - Andrea Hündlings
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen
| | - Michael Specka
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen
| | - Norbert Scherbaum
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen
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Søholm U, Broadley M, Zaremba N, Divilly P, Nefs G, Carlton J, Mader JK, Baumann PM, Gomes M, Martine-Edith G, Pollard DJ, Rath D, Heller S, Pedersen-Bjergaard U, McCrimmon RJ, Renard E, Evans M, de Galan B, Forkmann T, Amiel SA, Hendrieckx C, Speight J, Choudhary P, Pouwer F. Psychometric properties of an innovative smartphone application to investigate the daily impact of hypoglycemia in people with type 1 or type 2 diabetes: The Hypo-METRICS app. PLoS One 2023; 18:e0283148. [PMID: 36930585 PMCID: PMC10022775 DOI: 10.1371/journal.pone.0283148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the acceptability and psychometric properties of the Hypo-METRICS (Hypoglycemia MEasurement, ThResholds and ImpaCtS) application (app): a novel tool designed to assess the direct impact of symptomatic and asymptomatic hypoglycemia on daily functioning in people with insulin-treated diabetes. MATERIALS AND METHODS 100 adults with type 1 diabetes mellitus (T1DM, n = 64) or insulin-treated type 2 diabetes mellitus (T2DM, n = 36) completed three daily 'check-ins' (morning, afternoon and evening) via the Hypo-METRICs app across 10 weeks, to respond to 29 unique questions about their subjective daily functioning. Questions addressed sleep quality, energy level, mood, affect, cognitive functioning, fear of hypoglycemia and hyperglycemia, social functioning, and work/productivity. Completion rates, structural validity, internal consistency, and test-retest reliability were explored. App responses were correlated with validated person-reported outcome measures to investigate convergent (rs>±0.3) and divergent (rs<±0.3) validity. RESULTS Participants' mean±SD age was 54±16 years, diabetes duration was 23±13 years, and most recent HbA1c was 56.6±9.8 mmol/mol. Participants submitted mean±SD 191±16 out of 210 possible 'check-ins' (91%). Structural validity was confirmed with multi-level confirmatory factor analysis showing good model fit on the adjusted model (Comparative Fit Index >0.95, Root-Mean-Square Error of Approximation <0.06, Standardized Root-Mean-square Residual<0.08). Scales had satisfactory internal consistency (all ω≥0.5), and high test-retest reliability (rs≥0.7). Convergent and divergent validity were demonstrated for most scales. CONCLUSION High completion rates and satisfactory psychometric properties demonstrated that the Hypo-METRICS app is acceptable to adults with T1DM and T2DM, and a reliable and valid tool to explore the daily impact of hypoglycemia.
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Affiliation(s)
- Uffe Søholm
- Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- * E-mail:
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Natalie Zaremba
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Patrick Divilly
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Giesje Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | | | - Mikel Gomes
- Digital Therapeutics, Scientific Modelling, Novo Nordisk A/S, Søborg, Denmark
| | - Gilberte Martine-Edith
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Daniel J. Pollard
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rory J. McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Mark Evans
- Welcome Trust-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Stephanie A. Amiel
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Pratik Choudhary
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
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Spahn C, Kranz S, Teismann T, Forkmann T, Schönfelder A, Rath D, Paashaus L, Stengler K, Glaesmer H. Gender-Specific Aspects of Suicide-Related Communication in a High Risk Sample of Psychiatric Inpatients. J Mens Health 2022. [DOI: 10.31083/j.jomh1809188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Höller I, Kremers A, Schreiber D, Forkmann T. Trapped in my inner prison—Cross-sectional examination of internal and external entrapment, hopelessness and suicidal ideation. PLoS One 2022; 17:e0270985. [PMID: 35852991 PMCID: PMC9295950 DOI: 10.1371/journal.pone.0270985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Amelie Kremers
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
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16
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Höller I, Schreiber D, Bos F, Forkmann T, Teismann T, Margraf J. The Mereology of Depression-Networks of Depressive Symptoms during the Course of Psychotherapy. Int J Environ Res Public Health 2022; 19:ijerph19127131. [PMID: 35742380 PMCID: PMC9222343 DOI: 10.3390/ijerph19127131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022]
Abstract
(1) Background: Research has shown that it is important to examine depressive symptoms in the light of the mereology (the ratio between one symptom and the whole disorder). The goal of this study was to examine changes in the symptom interrelations of patients undergoing cognitive behavioral therapy treatment (CBT) via network analyses. (2) Method: Outpatients with depressive symptoms (N = 401) were assessed with the Beck Depression Inventory three times (pretreatment, after 12 sessions, and post-treatment) during CBT. Gaussian graphical models were used to estimate the relationships among symptoms. (3) Results: The severity of depressive symptoms significantly decreased over the course of therapy, but connectivity in the networks significantly increased. Communities of symptoms changed during treatment. The most central and predictable symptom was worthlessness at baseline and after 12 sessions, and loss of energy and self-dislike at post-treatment. (4) Conclusion: The results indicate that the severity of depressive symptoms decreased during cognitive behavior therapy, while network connectivity increased. Furthermore, the associations among symptoms and their centrality changed during the course of therapy. Future studies may investigate individual differences and their impact on the planning of psychotherapeutic treatment.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (D.S.); (T.F.)
- Correspondence: ; Tel.: +49-201-183-6117
| | - Dajana Schreiber
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (D.S.); (T.F.)
| | - Fionneke Bos
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands;
- Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, 9401LA Assen, The Netherlands
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (D.S.); (T.F.)
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany; (T.T.); (J.M.)
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany; (T.T.); (J.M.)
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Lucht L, Spangenberg L, Forkmann T, Hallensleben N, Rath D, Strauss M, Glaesmer H. Association of real-time assessed mood, affect and suicidal ideation in psychiatric inpatients with unipolar depression. Clin Psychol Psychother 2022; 29:1580-1586. [PMID: 35383387 DOI: 10.1002/cpp.2741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Previous research provided preliminary support of a potential reinforcing effect of suicidal ideation demonstrating reduced negative affect and increased positive affect after thinking about suicide. The present study therefore sought to investigate the role of mood and affect as a proximal risk factor of suicidal ideation in a high-risk sample. Seventy-four psychiatric inpatients (72% female) with unipolar depression and current and/or lifetime suicidal ideation aged 18 to 85 years (M = 37.6, SD = 14.3) took part in an ecological momentary assessment (EMA) over 6 days. Multilevel analyses were calculated. Analyses revealed negative valence of mood and low positive affect to be predictors of subsequent intensity of suicidal ideation (active, passive) as well as predictors of change in suicidal ideation (active, passive) since the last measurement. High negative affect only predicted intensity of passive suicidal ideation. Suicidal ideation (active, passive) was prospectively associated with subsequent negative valence of mood and lower positive affect as well as with higher intensity of negative affect. Suicidal ideation (active, passive) also predicted the change in valence of mood, positive affect and negative affect since the last measurement. Mood and affect should be taken into account as important proximal risk factors of active and passive suicidal ideation. The results do not support the idea of a reinforcing effect of suicidal ideation. In fact, they show a pattern of reduced subsequent positive affect, negative valence of mood and increased negative affect. Replication studies with larger samples and longer EMA follow-ups are needed.
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Affiliation(s)
- Luise Lucht
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - Maria Strauss
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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Forkmann T, Schwitzky S, Plein L, Rath D, Teismann T, Höller I. Die deutsche Version der Interpersonal Hopelessness Scale (IHS). Verhaltenstherapie 2022. [DOI: 10.1159/000522304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Angesichts des angenommenen Einflusses interpersonaler Hoffnungslosigkeit für die Entstehung aktiver Suizidgedanken, wie von der Interpersonalen Theorie Suizidalen Verhaltens [Joiner. Why people die by suicide. 2005] postuliert, zielt diese Studie darauf ab, erstmals eine deutsche Version der Interpersonalen Hoffnungslosigkeitsskala [IHS; Tucker et al. Psychiatry Res. 2018;259:427–32], die IHS-d, vorzustellen und psychometrisch zu überprüfen. <b><i>Material und Methoden:</i></b> <i>N</i> = 437 Teilnehmende (75.1% weiblich) zwischen 18 und 71 Jahren (M = 29.75, SD = 11.25) nahmen an einer querschnittlichen Online-Studie teil. Die Faktorstruktur der IHS-d wurde mittels konfirmatorischer Faktorenanalyse überprüft. Zusätzlich wurden Konstruktvalidität und Reliabilität evaluiert. <b><i>Ergebnis:</i></b> Es ergab sich eine signifikant bessere Datenpassung für ein 2-Faktor-Modell als für das 1-Faktor-Modell. Die identifizierten Subskalen (Interpersonale Hoffnungslosigkeit hinsichtlich perceived burdensomeness und hinsichtlich thwarted belongingness) erzielten hohe Faktorladungen ≥0.75; Inter-Item-Korrelationen, <i>r</i> ≥ 0.60, Item-Skala-Korrelationen, <i>r</i><sub><i>it</i></sub> ≥ 0.71 und interne Konsistenzen, <i>α</i><sub><i>PB</i></sub> = 0.93; <i>α</i><sub><i>TB</i></sub> = 0.92. <b><i>Diskussion:</i></b> Die postulierte einfaktorielle Struktur der englischen Version konnte für die IHS-d nicht reproduziert werden. Die beiden identifizierten Subskalen zeigten jedoch gute psychometrische Eigenschaften. <b><i>Schlussfolgerung:</i></b> Der Einsatz der IHS-d erweitert die Möglichkeiten der Messung des wichtigen Konstrukts Hoffnungslosigkeit und kann daher die Suizidrisikoabschätzung sinnvoll ergänzen.
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Kanzler S, Krabbe J, Forkmann T, Tolba RH, Steitz J. Animal experiments in biomedical research: Knowledge, self-evaluation and attitudes of biology and medical students. Lab Anim 2022; 56:455-465. [PMID: 35264039 DOI: 10.1177/00236772221080833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Animal experiments in biomedical research are debated in public, within the scientific community and among students. Despite increased efforts to reduce, refine and replace animal experiments, they remain integral components of the job of a biomedical scientist. In Germany, persons must have a university degree and adequate education and training to perform and direct animal experiments. Therefore, training courses such as FELASA (Federation of European Laboratory Animal Science Associations) courses are provided. However, in our experience, students become aware of this very late in their studies when decisions about their future careers have already been made. We initiated this study to have a better understanding of when and how animal experiments should be discussed during university education. We evaluated the knowledge, self-evaluation and attitudes of biology and medical students of different semesters regarding animal experiments at the RWTH Aachen University, Germany. An online survey was conducted to assess demographic information, knowledge about animal experiments, self-evaluation and attitudes towards animal experiments. Students of both fields showed limited knowledge of animal experiments. Biology students showed significantly better knowledge and self-evaluated their knowledge higher than medical students. The field of the study correlated with their knowledge and self-evaluation but did not predict participants' attitudes towards animal experiments. In conclusion, the current study showed that there is still room for improvement to raise awareness about laboratory animal science in the biomedical research field.
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Affiliation(s)
- Stephanie Kanzler
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany.,Institute of Pharmacology and Toxicology, Faculty of Medicine, RWTH Aachen University, Germany
| | - Julia Krabbe
- Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, RWTH Aachen University, Germany
| | - Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, RWTH Aachen University, Germany.,Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - René H Tolba
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
| | - Julia Steitz
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
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Höller I, Forkmann T, Natrop L, Hündlings A, Specka M, Scherbaum N. [Psychological Abnormalities in Children from the Perspective of Parents with a Mental Disorder]. Psychother Psychosom Med Psychol 2022; 72:362-373. [PMID: 35259768 DOI: 10.1055/a-1725-8324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is increased risk for children with a mentally ill parent to get a mental illness. In Germany, it is assumed that the risk for psychological abnormalities in children with a mentally ill parent is increased by a factor of 2,4. The aim of this study was to give an overview of psychological abnormalities in children with mentally ill parents. METHODS Patients were asked about their children and possible psychological abnormalities in their children during their stay in a psychiatric ward. Data of n=118 children (51,7%) of psychiatric inpatients could be used for analyses. RESULTS One-fourth of the children showed psychological abnormalities. According to their parent, one fourth was also in psychotherapeutic/psychiatric treatment. There were no differences in the abnormalities associated with sociodemographic factors of the parent. CONCLUSION Our results show that children of a mentally ill parent also suffer from psychological abnormalities. More explicit analyses of the care situation of these children as well as data from direct interviews with them are needed.
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Affiliation(s)
- Inken Höller
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen, Essen, Deutschland
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen, Essen, Deutschland
| | - Lisa Natrop
- Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen, LVR-Klinikum Essen, Essen, Deutschland
| | - Andrea Hündlings
- Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen, LVR-Klinikum Essen, Essen, Deutschland
| | - Michael Specka
- Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen, LVR-Klinikum Essen, Essen, Deutschland
| | - Norbert Scherbaum
- Klinik für Psychiatrie und Psychotherapie sowie Klinik für Abhängiges Verhalten und Suchtmedizin, Kliniken der Universität Duisburg-Essen, LVR-Klinikum Essen, Essen, Deutschland
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Drueke B, Gauggel S, Weise L, Forkmann T, Mainz V. Metacognitive judgements and abilities in patients with affective disorders. Curr Psychol 2022. [DOI: 10.1007/s12144-022-02838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Objectives
Cognitive and metacognitive deficits depict important factors in depression, but the relationship between these concepts remains to be elucidated. The present study investigated the difference between patients with depression and controls in metacognitive judgements regarding the domain of attention. Furthermore, the associations between different metacognitive abilities, depressiveness and confidence were investigated, as well as in how far the derived correlates would predict depression.
Methods
Thirty patients with a major depressive episode and 30 healthy participants were enrolled in the current study. Attention and executive functioning ability were assessed including metacognitive judgements of performance and confidence with regard to the test performance in the Stroop test. To examine further aspects related to (meta-)cognitive abilities, decentering skills, aspects of self-conscious attention, self-assessed intelligence and metacognitive beliefs, judgements and monitoring tendencies were assessed.
Results
Albeit groups’ metacognitive judgements of performance did not differ, patients indicated to be significantly less confident in their judgements. Depressive patients showed less decentering abilities compared to healthy participants and there was a significant association between decentering and confidence ratings. Moreover, depressiveness was associated with dysfunctional self-consciousness and low cognitive confidence. Finally, lower decentering skills and higher dysfunctional self-attention were the best predictors for depressiveness.
Conclusions
Results favor the assumption that patients’ metacognitive abilities regarding the domain of attention are not generally deficient. Rather, the lower confidence in their judgements and dysfunctional (meta-)cognitive abilities, like decentering, metacognitive beliefs and aspects of self-conscious attention and intelligence, seem to mirror the patients’ impairments.
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Höller I, Rath D, Teismann T, Glaesmer H, Lucht L, Paashaus L, Schönfelder A, Juckel G, Forkmann T. Defeat, entrapment, and suicidal ideation: Twelve-month trajectories. Suicide Life Threat Behav 2022; 52:69-82. [PMID: 34142739 DOI: 10.1111/sltb.12777] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/02/2021] [Accepted: 04/12/2021] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg, Essen, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg, Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University of Bochum, Bochum, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Luise Lucht
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg, Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg, Essen, Germany
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Brüdern J, Hallensleben N, Höller I, Spangenberg L, Forkmann T, Rath D, Strauß M, Kersting A, Glaesmer H. Sleep disturbances predict active suicidal ideation the next day: an ecological momentary assessment study. BMC Psychiatry 2022; 22:65. [PMID: 35086519 PMCID: PMC8793208 DOI: 10.1186/s12888-022-03716-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sleep disturbances are an underestimated risk factor for suicidal ideation and behavior. Previous research provided preliminary support of a temporal relationship between sleep disturbances and suicidal ideation. The present study therefore sought to investigate the prospective association between sleep disturbances, passive and active suicidal ideation, and further psychological risk factors, such as state impulsivity and depression. METHODS Seventy-three psychiatric inpatients (71% female) with unipolar depressive disorder and current or lifetime suicidal ideation took part in an ecological momentary assessment (EMA). Participants filled out a baseline assessment and data were collected via smartphones over a 6-days period. Multilevel analyses with sleep disturbance as predictor for active and passive suicidal ideation, state impulsivity, and depression were carried out. RESULTS Patients with sleep disturbance experienced more active suicidal ideation, but no passive suicidal ideation, the following day. Of the four state impulsivity items, one item was significantly associated with sleep disturbance. Sleep disturbance had no effect on next-day depression. Limiting factors are the small and homogeneous sample along with the rather short observation period in an inpatient setting. CONCLUSIONS The micro-longitudinal study provides preliminary support for sleep disturbance as a proximal risk factor for next-day active suicidal ideation. Clinically, results indicate to consider the evaluation and treatment of sleep disturbances for an improved risk assessment and prevention of suicide.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Nina Hallensleben
- grid.9647.c0000 0004 7669 9786Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Inken Höller
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstrasse 2, 45141 Essen, Germany
| | - Lena Spangenberg
- grid.9647.c0000 0004 7669 9786Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Thomas Forkmann
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstrasse 2, 45141 Essen, Germany
| | - Dajana Rath
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Universitätsstrasse 2, 45141 Essen, Germany
| | - Maria Strauß
- grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Anette Kersting
- grid.9647.c0000 0004 7669 9786Clinic and Policlinic of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Heide Glaesmer
- grid.9647.c0000 0004 7669 9786Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Roland L, Höller I, Forkmann T, Glaesmer H, Paashaus L, Schönfelder A, Teismann T, Juckel G, Rath D. Suicidal behavior in the social environment: Does exposure moderate the relationship between an individual's own suicidal ideation and behavior? Clin Psychol Psychother 2022; 29:1309-1320. [PMID: 35005811 DOI: 10.1002/cpp.2709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Suicidal behavior still cannot be sufficiently predicted. Exposure to suicidal behavior in the personal social environment is assumed to moderate the individual's transition from suicidal ideation to suicidal behavior within the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV-model). This study aimed to investigate this moderating effect in a German high-risk sample. METHODS We interviewed 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.9, SD = 14.30) admitted after attempted suicide (53%) or due to an acute suicidal crisis (47%) regarding exposure events in their social environment. Four types of exposure events were analyzed using moderation analyses: familial suicides/suicide attempts, non-familial suicides/suicide attempts. Additionally, the numbers of reported exposure events were compared between patients with and without a recent suicide attempt as well as between patients with lifetime suicide attempts and lifetime suicidal ideation. RESULTS Neither moderating effects of exposure events on the relationship between lifetime suicidal ideation and recent suicidal behavior nor group differences between suicidal ideators and suicide attempters regarding the exposure events were found. CONCLUSIONS Exposure events might have differential and possibly protective effects on suicidal behavior - depending on type and quality (intensity, personal relevance, and recency) of event - and on the outcome (suicide vs. suicide attempt).
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Affiliation(s)
- Lea Roland
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
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Höller I, Teismann T, Forkmann T. Perseverative Thinking about Suicide Questionnaire (PTSQ): Validation of a new measure to assess suicide-specific rumination. Compr Psychiatry 2022; 112:152287. [PMID: 34781079 DOI: 10.1016/j.comppsych.2021.152287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Suicide-specific rumination has been shown to be associated with lifetime suicide attempts as well as suicide intent and might be an important risk factor for the transition from suicidal ideation to suicidal behavior. Based on this background, the wording of the items of an often-used self-report measure assessing core characteristics of rumination was adapted to assess specifically suicide-specific rumination. METHODS The entire study sample comprised N = 1689 participants from the German healthcare sector. A total of 721 participants with a history of suicidal ideation (68% female; Mage = 30.63, SDage = 8.41, range: 18-81 years) who had completed five measures assessing suicide-specific rumination, suicidal ideation, depression, hopelessness, and resilience were included for the present examination. Factorial validity (Exploratory [EFA] to determine the appropriate number of factors and confirmatory factor analyses [CFA] after randomly splitting of the sample to validate the EFA solution), construct validity, and reliability were evaluated. RESULTS The EFA revealed a one-factor solution consisting of four items, which could be confirmed within a CFA (RMSR = 0.006; RMSEA = 0.039; CFI = 0.999; TLI = 0.998). Internal consistency was excellent with Cronbachs α = 0.93. Construct validity was given with moderate to high positive correlations with suicidal ideation (0.76), depression (0.55), and hopelessness (0.38) and negative correlation with resilience (-0.31). Participants with recent suicidal ideation and/or lifetime suicide attempt reported significantly more suicide-specific rumination than those with only lifetime suicidal ideation. CONCLUSION A new 4-item measure for suicide-specific rumination was developed and could be shown to be a reliable and valid instrument in a large German sample. Results emphasize the potential importance of suicide-specific rumination for the understanding of trajectories of suicidal ideation and suicide risk assessments.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
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Höller I, Forkmann T. Ambivalent heroism? - Psychological burden and suicidal ideation among nurses during the Covid-19 pandemic. Nurs Open 2022; 9:785-800. [PMID: 34792286 PMCID: PMC8661563 DOI: 10.1002/nop2.1130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
AIM During the Covid-19 pandemic, the risk for nurses' mental health has rapidly increased. The two main goals of this study were the examination of (1) the psychological burden and (2) of suicidal ideation and its associated risk factors one year after the Covid-19 pandemic begun. DESIGN This was a cross-sectional online survey. METHODS N = 1311 nurses (96.9% female) aged 18-63 years (M = 30.96, SD = 8.48) were assessed for various symptoms of psychological burden, suicidal ideation and behaviour and its risk factors. RESULTS Almost half of participants (41.5%) reported heightened levels of depressive symptoms, 691 (52.7%) reported a medium to high risk for burnout. One fifth of participants (21.7%) reported suicidal ideation in the past 4 weeks. The direct contact to people with Covid-19 was not related to the extent of the psychological burden. Depression, agitation, perceived burdensomeness and previous suicide attempt were associated with suicidal ideation.
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Affiliation(s)
- Inken Höller
- Department of Clinical PsychologyUniversity of Duisburg‐EssenEssenNorthrine‐WestphaliaGermany
| | - Thomas Forkmann
- Department of Clinical PsychologyUniversity of Duisburg‐EssenEssenNorthrine‐WestphaliaGermany
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Teismann T, Forkmann T, Sander LB, Glaesmer H. [Dealing With Suicidal Thoughts and Behavior in Clinical Research]. Psychother Psychosom Med Psychol 2021; 71:423-424. [PMID: 34624900 DOI: 10.1055/a-1542-9753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Zusammenfassung. Suizidales Erleben und Verhalten ist in klinischen Kontexten sehr verbreitet. Während international diverse Messinstrumente zur Erfassung von Suizidalität entwickelt und validiert wurden, gibt es nur wenige deutsche Messinstrumente. In der vorliegenden Studie wurde die neu entwickelte Skala Suizidales Erleben und Verhalten (SSEV) in fünf Stichproben mit insgesamt N = 1 099 Proband_innen im Hinblick auf ihre psychometrischen Eigenschaften untersucht. Die faktorenanalytische Untersuchung (explorative und konfirmatorische Faktorenanalyse) ergab eine eindimensionale Struktur des Fragebogens. Die interne Konsistenz der SSEV ist hoch und es zeigten sich erwartungsgemäß positive Zusammenhänge zu diversen Maßen aktueller Theoriemodelle suizidalen Erlebens und Verhaltens, sowie zu Depressivität, Angst und Stress. Weitere Analysen zeigten erwartungskonform negative Zusammenhänge mit sozialer Unterstützung und positiver mentaler Gesundheit. Insgesamt verweisen die Ergebnisse darauf, dass es sich beim SSEV um ein reliables und valides Instrument zur Erfassung von akutem suizidalem Erleben und Verhalten handelt, welches in der Forschung und der klinischen Praxis angewendet werden kann.
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Affiliation(s)
- Tobias Teismann
- Arbeitseinheit für Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen
| | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
| | - Georg Juckel
- Abteilung für Psychiatrie, LWL-Universitätsklinik, Ruhr-Universität Bochum
| | - Jan C. Cwik
- Abteilung für Klinische Psychologie und Psychotherapie, Universität zu Köln
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Rath D, Teismann T, Hoeller I, Glaesmer H, Paashaus L, Schönfelder A, Juckel G, Forkmann T. Predicting suicidal ideation in a longitudinal high-risk sample: Multilevel analyses and 12-month trajectories. J Clin Psychol 2021; 77:2353-2369. [PMID: 34126652 DOI: 10.1002/jclp.23159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Interpersonal Theory of Suicide states that suicidal ideation (SI) results from perceived burdensomeness (PB) and thwarted belongingness (TB). Cross-sectional studies found associations with SI. This study examined the prospective prediction of SI. METHODS Three hundred and eight inpatients reporting severe SI or a recent suicide attempt were assessed four times within 12 months. The prediction of SI was examined using multilevel analyses, group comparisons, and logistic regression analyses. RESULTS Cross-sectionally, PB and TB were associated with SI. Prospectively, neither PB nor TB predicted SI. We found no autocorrelation of SI over time. Patients with persistent and fluctuating SI reported higher PB at T0. PB predicted the persistence of SI over 12 months. CONCLUSION Results emphasize cross-sectional associations between PB, TB, and SI. PB and TB could not predict the intensity of SI over time. SI did not predict itself over time. PB was associated with a persistent trajectory of SI over 12 months.
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Affiliation(s)
- Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Inken Hoeller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
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Abstract
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.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrine-Westphalia, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrine-Westphalia, Germany
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Schönfelder A, Rath D, Forkmann T, Paashaus L, Lucht L, Teismann T, Stengler K, Juckel G, Glaesmer H. Child abuse and suicidality in the context of the Interpersonal Psychological Theory of Suicide: A network analysis. Br J Clin Psychol 2021; 60:425-442. [PMID: 33949706 DOI: 10.1111/bjc.12293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES While there is evidence for an association of child abuse with suicidality in the course of life, the underlying mechanisms remain unclear. The Interpersonal Psychological Theory of Suicide (IPTS) provides a theoretical framework to investigate this relationship. The present study examines how different subtypes of child abuse are related to suicidal ideation and to attempts in the context of the IPTS. METHODS 146 psychiatric inpatients (M = 37.9 years, 62% female) with an acute suicidal crisis (n = 71) or a recent suicide attempt (n = 74) were examined at baseline (T0) and six (T1) months later. We measured emotional, physical, and sexual abuse, the constructs of the IPTS (thwarted belongingness, perceived burdensomeness, and capability for suicide) and suicidal ideation as well as suicide attempts. Using the statistics program R, a network analysis of all named constructs was conducted. Centrality measures were computed. RESULTS Emotional abuse was the most central kind of abuse in the network and had a direct relationship with suicide attempts and an indirect relationship with suicidal ideation via perceived burdensomeness. Physical and sexual abuse showed no significant relations with the different constructs of the IPTS. CONCLUSION The major limitation of this study was the modest sample size which reduced the number of variables able to be included in the network. Regarding child abuse, the results underline that emotional abuse plays a central role in this network and may be important for suicide risk assessment. Future research should address this topic in a larger sample. PRACTITIONER POINTS Emotional abuse was the most central kind of abuse in this network analysis. Sexual abuse was the only kind of abuse with a direct relation to suicidal ideation. Capability for suicide had just a marginal position in the network analysis. Early interventions addressing the effects of child abuse are recommended. Replications in larger samples and with more relevant variables are needed.
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Affiliation(s)
- Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Laura Paashaus
- Department of Clinical Psychology and Psychotherapy, Ruhr-University Bochum, Germany
| | - Luise Lucht
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Tobias Teismann
- Department of Clinical Psychology and Psychotherapy, Ruhr-University Bochum, Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-University Bochum, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
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Höller I, Stenzel JS, Rath D, Forkmann T. Listen to Your Heart-Ecological Momentary Assessment of Interoceptive Accuracy, Awareness and Sensibility: A Pilot Study. Int J Environ Res Public Health 2021; 18:4893. [PMID: 34064438 PMCID: PMC8124337 DOI: 10.3390/ijerph18094893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (J.-S.S.); (D.R.); (T.F.)
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Forkmann T, Glaesmer H, Paashaus L, Rath D, Schönfelder A, Juckel G, Gauggel S, Beginn-Göbel U, Teismann T. Testing the Four Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality. Behav Ther 2021; 52:626-638. [PMID: 33990238 DOI: 10.1016/j.beth.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18-81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility-at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.
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Affiliation(s)
| | | | | | - Dajana Rath
- University of Duisburg-Essen; Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH, Aachen
| | | | - Georg Juckel
- LWL-University Hospital, Ruhr-Universität Bochum
| | - Siegfried Gauggel
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH, Aachen
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Rath D, Teismann T, Schmitz F, Glaesmer H, Hallensleben N, Paashaus L, Spangenberg L, Schönfelder A, Juckel G, Forkmann T. Predicting suicidal behavior by implicit associations with death? Examination of the death IAT in two inpatient samples of differing suicide risk. Psychol Assess 2021; 33:287-299. [DOI: 10.1037/pas0000980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Paashaus L, Forkmann T, Glaesmer H, Juckel G, Rath D, Schönfelder A, Teismann T. From decision to action: Suicidal history and time between decision to die and actual suicide attempt. Clin Psychol Psychother 2021; 28:1427-1434. [PMID: 33687121 DOI: 10.1002/cpp.2580] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 11/07/2022]
Abstract
A substantial proportion of suicide attempts seem to be realized in a sudden manner. However, it is unclear how suicide attempters showing a rapid transition from the decision to die to acting differ from suicide attempters showing a slower transition regarding their suicidal history. The main aim of this study was to determine the proportion of suicide attempters, who reported a rapid transition (≤5, ≤10, ≤180 min) between their decision to die and their actual attempt. Furthermore, attempter groups (≤ vs. >5, ≤ vs. >10 and ≤ vs. >180 min) were compared regarding suicidal history (ideation, plans, and number of lifetime as well as 12 month suicide attempts) as well as depression, hopelessness and trait impulsivity. In total, 118 inpatients (62.7% female; age: M = 38.71, SD = 14.71) hospitalized due to a recent suicide attempt were assessed using structured clinical interview measures assessing suicidal history and self-report instruments. Thirty-six percent reported a time period of ≤5 min, 44% a time period of ≤10 min and 73% a time period of ≤180 min between their decision to die and their attempt. Participants with a rapid transition (≤5, ≤10, ≤180 min) did not differ from participants with a slower transition (>5, >10, >180 min) regarding suicidal history, depression, hopelessness and trait impulsivity. Taken together, a rapid transition seems common, but nevertheless, rapidly realized suicide attempts cannot necessarily be characterized as impulsive.
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Affiliation(s)
- Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany.,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Wannemueller A, Forkmann T, Glaesmer H, Juckel G, Paashaus L, Rath D, Schönfelder A, Moser D, Kumsta R, Teismann T. The role of the 5-HTTLPR polymorphism in acquired capability for suicide. Suicide Life Threat Behav 2020; 50:1121-1126. [PMID: 32706152 DOI: 10.1111/sltb.12660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE According to the Interpersonal Psychological Theory of Suicide, capability for suicide comprises two dimensions: fearlessness about death and elevated pain tolerance. The short (S) allelic variant of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) has repeatedly been associated with more violent and lethal suicide methods and lethality of suicide attempts. The current study aimed to investigate whether 5-HTTLPR allelic variants are associated with fearlessness about death and pain tolerance/persistence and whether it moderates the relationship between childhood maltreatment and acquired capability for suicide. METHOD A cohort of 208 inpatients hospitalized due to a recent suicide attempt or severe suicidal ideation was genotyped for the 5-HTTLPR and assessed for childhood maltreatment. Subjective pain tolerance and fearlessness about death as well as objective pain persistence was assessed using a pressure algometer. RESULTS Fearlessness about death, pain tolerance, and pain persistence did not differ between 5-HTTLPR genotypes. However, there was a significant correlation between self-reported childhood maltreatment and fearlessness about death that emerged exclusively in homozygous S-allele carriers. CONCLUSION Results suggest that there are no "high-risk"-alleles that generally increase capability for suicide. However, in terms of future suicide-related behaviors exposure to childhood maltreatment events could exert a particularly negative influence on homozygous S-allele carriers by increasing their fearlessness about death.
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Affiliation(s)
- Andre Wannemueller
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Laura Paashaus
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Dajana Rath
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Dirk Moser
- Department of Genetic Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Robert Kumsta
- Department of Genetic Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Tobias Teismann
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Forkmann T, Glaesmer H, Paashaus L, Rath D, Schönfelder A, Stengler K, Juckel G, Assion HJ, Teismann T. Interpersonal theory of suicide: prospective examination. BJPsych Open 2020; 6:e113. [PMID: 32958092 PMCID: PMC7576651 DOI: 10.1192/bjo.2020.93] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies. AIMS To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design. METHOD Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18-81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted. RESULTS The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59-3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01). CONCLUSIONS The results challenge the theoretical validity of the IPTS and its clinical utility - at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.
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Affiliation(s)
- Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Katharina Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Germany
| | | | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
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38
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Lucht L, Höller I, Forkmann T, Teismann T, Schönfelder A, Rath D, Paashaus L, Stengler K, Juckel G, Glaesmer H. Validation of the motivational phase of the integrated motivational-volitional model of suicidal behavior in a German high-risk sample. J Affect Disord 2020; 274:871-879. [PMID: 32664028 DOI: 10.1016/j.jad.2020.05.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Integrated Motivational-Volitional (IMV) model of suicidal behavior proposes in its motivational phase that perceptions of defeat and entrapment (total, internal and external entrapment) lead to the development of suicidal ideation and that thwarted belongingness and perceived burdensomeness moderate this process. The aim of this study was to test the motivational phase of the IMV model cross-sectionally in a German sample of psychiatric inpatients. METHODS A total of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) were included in the study and investigated within 14 days after psychiatric admission due to suicide attempt (53%) or acute suicidal crisis (47%). Statistical analyses included a mediation analysis and moderation analyses. RESULTS Results demonstrate a simple mediation of defeat via entrapment (total, internal and external entrapment) on suicidal ideation. The interaction between thwarted belongingness and perceived burdensomeness was confirmed as a motivational moderator. LIMITATIONS Limiting factors of the present study are the cross-sectional design and the retrospective assessment of suicidal ideation. CONCLUSION The main assumptions of the motivational phase of the IMV model could empirically be confirmed. Perceptions of defeat, internal and external entrapment, thwarted belongingness, and perceived burdensomeness should be taken into account with regard to prevention, risk assessment and interventions of suicidal ideation and attempts. However, future investigations based on prospective data are warranted.
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Affiliation(s)
- L Lucht
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig 04103, Germany.
| | - I Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - T Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - T Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - A Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig 04103, Germany
| | - D Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - L Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Duisburg, Germany
| | - K Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Leipzig, Germany
| | - G Juckel
- Research Department of Neuroscience, Ruhr-University of Bochum, Bochum, Germany
| | - H Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig 04103, Germany
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Schönfelder A, Rath D, Forkmann T, Paashaus L, Stengler K, Teismann T, Juckel G, Glaesmer H. Is the relationship between child abuse and suicide attempts mediated by nonsuicidal self‐injury and pain tolerance? Clin Psychol Psychother 2020; 28:189-199. [DOI: 10.1002/cpp.2501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Antje Schönfelder
- Department of Medical Psychology and Medical Sociology University of Leipzig Leipzig Germany
| | - Dajana Rath
- Institute of Medical Psychology and Medical Sociology University Hospital of RWTH Aachen University Aachen Germany
- Department of Clinical Psychology, Institute of Psychology University of Duisburg‐Essen Essen Germany
| | - Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology University Hospital of RWTH Aachen University Aachen Germany
- Department of Clinical Psychology, Institute of Psychology University of Duisburg‐Essen Essen Germany
| | - Laura Paashaus
- Department of Clinical Psychology and Psychotherapy Ruhr‐University Bochum Bochum Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy Helios Park Hospital Leipzig Leipzig Germany
| | - Tobias Teismann
- Department of Clinical Psychology and Psychotherapy Ruhr‐University Bochum Bochum Germany
| | - Georg Juckel
- Department of Psychiatry, LWL‐University Hospital Ruhr‐University Bochum Bochum Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology University of Leipzig Leipzig Germany
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Cwik JC, Forkmann T, Glaesmer H, Paashaus L, Schönfelder A, Rath D, Prinz S, Juckel G, Teismann T. Validation of the German capability for suicide questionnaire (GCSQ) in a high-risk sample of suicidal inpatients. BMC Psychiatry 2020; 20:412. [PMID: 32819313 PMCID: PMC7439651 DOI: 10.1186/s12888-020-02812-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The German Capability for Suicide Questionnaire (GCSQ) was developed to measure fearlessness of death and pain tolerance - two constructs central to the Interpersonal Theory of Suicide. Initial scale development, definition of the factor structure and confirmation of the two-dimensional factor structure was performed in samples suffering from relatively low levels of suicide ideation/behavior. The present study aimed to validate the German Capability for Suicide Questionnaire (GCSQ) in a high-risk sample of suicidal inpatients. METHODS Factor structure, reliability and validity were investigated in a sample of inpatients (N = 296; 53.0% female; age in years: M = 36.81, SD = 14.27) admitted to a hospital due to a recent suicide attempt or an acute suicidal crisis (in immediate need of inpatient treatment). To establish convergent validity, interview-based assessments of lifetime suicide attempts and non-suicidal self-injury as well as questionnaire-based assessments of painful and provocative events were used. Finally, stability of GCSQ-scores over a follow-up period of 12 months was assessed. RESULTS Results indicated good psychometric properties, and provided additional evidence for construct validity and stability of the subscales over a one-year period, and demonstrated adequate fit of the data with respect to the original factor structure. CONCLUSIONS Results suggest that the GCSQ is a brief, reliable, and valid measure of capability for suicide that can be used in clinic assessment and research.
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Affiliation(s)
- Jan C. Cwik
- grid.6190.e0000 0000 8580 3777Department of Clinical Psychology and Psychotherapy, Universität zu Köln, Cologne, Germany
| | - Thomas Forkmann
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Heide Glaesmer
- grid.9647.c0000 0004 7669 9786Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Laura Paashaus
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Antje Schönfelder
- grid.9647.c0000 0004 7669 9786Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Dajana Rath
- grid.5718.b0000 0001 2187 5445Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Sarah Prinz
- grid.5570.70000 0004 0490 981XMental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstrasse 11, 44787 Bochum, Germany
| | - Georg Juckel
- grid.5570.70000 0004 0490 981XDepartment of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstrasse 11, 44787, Bochum, Germany.
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Upegui-Arango LD, Forkmann T, Nielsen T, Hallensleben N, Glaesmer H, Spangenberg L, Teismann T, Juckel G, Boecker M. Psychometric evaluation of the Interpersonal Needs Questionnaire (INQ) using item analysis according to the Rasch model. PLoS One 2020; 15:e0232030. [PMID: 32745104 PMCID: PMC7398530 DOI: 10.1371/journal.pone.0232030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/10/2020] [Indexed: 11/29/2022] Open
Abstract
The Interpersonal Needs Questionnaire (INQ) assesses Thwarted Belongingness (TB) and Perceived Burdensomeness (PB), two predictors of suicidal thoughts. Up to now, the use of item response theory (IRT) for the evaluation of the INQ has been restricted to a single study with clinically depressed and suicidal youth. Therefore, the psychometric properties of the two INQ-15-subscales TB and PB were now evaluated in a general population sample (N = 2508) and a clinical adult population sample (N = 185) using IRT, specifically the Rasch model (RM) and the graphical log-linear Rasch model (GLLRM). Of special interest was whether the INQ-subscales displayed differential item functioning (DIF) across the two different samples and how well the subscales were targeted to the two sample populations. For the clinical sample, fit to a GLLRM could be established for the PB-subscale and fit to a RM was established for a five-item version of the TB-subscale. In contrast, for the general population sample fit to a GLLRM could only be achieved for the PB-subscale. Overall, there was strong evidence of local dependence (LD) across items and of some age- and gender-related DIF. Both subscales exhibited massive DIF related to the sample, indicating that they don’t work the same across the general population and clinical sample. As expected, targeting of both INQ-subscales was much better for the clinical population. Further investigations of the INQ-15 under the Rasch approach in a large clinical population are recommended to determine and optimize the scale performance.
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Affiliation(s)
- Luz Dary Upegui-Arango
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Tine Nielsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Maren Boecker
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
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Conrad K, Teismann T, Rath D, Forkmann T. [Fears in Dealing with Suicidal Patients: A Comparative Examination of Licensed Psychotherapists and Psychotherapeutic Trainees]. Psychother Psychosom Med Psychol 2020; 71:9-17. [PMID: 32634838 DOI: 10.1055/a-1153-9187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE A patient's suicide is the most frequently mentioned occupational fear of psychotherapists. In the present study, fears in dealing with suicidal patients shall be specified - regarding licensed psychotherapists (LP) as well as psychotherapeutic trainees (PT). The results were compared to an analogous examination from 1996. METHODS N=271 psychologists, thereof n=90 licensed psychotherapists and n=181 psychotherapeutic trainees, participated in an online survey. Fears in dealing with suicidal patients and occupational experiences with suicidal patients were investigated using a German Questionnaire of Capturing Therapists' Fears with Suicidal Patients by Dorrmann (2016). Furthermore, suicide-linked knowledge was examined with a short self-designed test. The following hypotheses were investigated: (1) LP have less fears in dealing with suicidal patients than PT, (2) PT and LP differ from each other regarding their suicide-linked knowledge and occupational experience, (3) the results of the current survey show less fears in dealing with suicidal patients than the results of a preceding survey by Dorrmann (1996). Eventually, the following exploratory issue was considered: Does the status (LP vs. PT) have impact on the fears while being mediated by the occupational experience as well as the suicide-linked knowledge? RESULTS The following fears are most commonly mentioned by therapists: fear of feelings of guilt/self-blame after a suicide/attempted suicide, fear of misjudgment and the associated consequences, fear of legal consequences after a suicide/attempted suicide and fear of accusations by others (relatives of the patient/colleagues) after a suicide/attempted suicide. Psychotherapeutic trainees report higher fears dealing with suicidal patients than approbated psychotherapists. Professional experience mediates the correlation between professional status and fears. In comparison, therapists today report less fears than 20 years ago. CONCLUSION Therapists are mainly afraid of the consequences of a suicide/attempted suicide. However, in total, fears are represented in a more moderate form and seem to be less distinctive than 20 years ago. It can be assumed that an increasing professionalization of the therapeutic interaction with suicidal patients has led to a reduction of therapists' fears.
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Affiliation(s)
- Katharina Conrad
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen, Essen
| | - Tobias Teismann
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Dajana Rath
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen, Essen
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen, Essen
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Stenzel JS, Höller I, Rath D, Hallensleben N, Spangenberg L, Glaesmer H, Forkmann T. Do Feelings of Defeat and Entrapment Change over Time? An Investigation of the Integrated Motivational-Volitional Model of Suicidal Behaviour Using Ecological Momentary Assessments. Int J Environ Res Public Health 2020; 17:E4685. [PMID: 32610667 PMCID: PMC7369950 DOI: 10.3390/ijerph17134685] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
(1) Background. Defeat and entrapment have been highlighted as major risk factors of suicidal ideation and behavior. Nevertheless, little is known about their short-term variability and their longitudinal association in real-time. Therefore, this study aims to investigate whether defeat and entrapment change over time and whether defeat predicts entrapment as stated by the integrated motivational-volitional model of suicidal behavior. (2) Methods. Healthy participants (n = 61) underwent a 7-day smartphone-based ecological momentary assessment (EMA) on suicidal ideation/behavior and relevant risk factors, including defeat and entrapment and a comprehensive baseline (T0) and post (T2) assessment. (3) Results. Mean squared successive differences (MSSD) and intraclass correlations (ICC) support the temporal instability as well as within-person variability of defeat and entrapment. Multilevel analyses revealed that during EMA, defeat was positively associated with entrapment at the same measurement. However, defeat could not predict entrapment to the next measurement (approximately two hours later). (4) Conclusion. This study provides evidence on the short-term variability of defeat and entrapment highlighting that repeated measurement of defeat and entrapment-preferably in real time-is necessary in order to adequately capture the actual empirical relations of these variables and not to overlook significant within-person variability. Further research-especially within clinical samples-seems warranted.
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Affiliation(s)
- Jana-Sophie Stenzel
- Institute of Experimental Psychology, Heinrich-Heine University Düsseldorf, Düsseldorf, 40225 Düsseldorf, Germany;
| | - Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (I.H.); (D.R.)
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (I.H.); (D.R.)
| | - Nina Hallensleben
- Department of Medical Psychology, University of Leipzig, 4109 Leipzig, Germany; (N.H.); (L.S.); (H.G.)
| | - Lena Spangenberg
- Department of Medical Psychology, University of Leipzig, 4109 Leipzig, Germany; (N.H.); (L.S.); (H.G.)
| | - Heide Glaesmer
- Department of Medical Psychology, University of Leipzig, 4109 Leipzig, Germany; (N.H.); (L.S.); (H.G.)
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (I.H.); (D.R.)
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Glaesmer H, Spangenberg L, Forkmann T, Teismann T. [Suicidality: Theoretical Concepts, Risk Assessment and Treatment Options]. Psychother Psychosom Med Psychol 2020; 70:252-261. [PMID: 32516814 DOI: 10.1055/a-1112-7365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Compared to other mental disorders the evidence about clinical management of patients with suicidality is rather limited. Nevertheless, in the past few years a very positive development occured concerning the development and validation of psychological theories on suicidality as well as the development of specific treatment programs. An overview about the current state of knowledge is presented in the article.
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45
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Spangenberg L, Teismann T, Forkmann T, Rath D, Schönfelder A, Paashaus L, Juckel G, Stengler K, Glaesmer H. Psychometrische Eigenschaften und Faktorstruktur der deutschen
Version der Beck-Suizidgedanken-Skala (BSS): Validierung an einer Stichprobe
psychiatrischer Patienten. Psychother Psychosom Med Psychol 2020; 70:405-411. [DOI: 10.1055/a-1119-6884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Zusammenfassung
Ziel der Studie Dimensionalität, Reliabilität und
konvergente Validität der deutschsprachigen Beck Scale for Suicidal
Ideation (BSS) sollen erstmalig in einer klinischen Stichprobe untersucht
warden.
Methodik 308 stationäre Patienten nach Suizidversuch/mit
akuter Suizidalität wurden rekrutiert (53,6% weiblich); 224
füllten die vollständige BSS sowie weitere Fragebögen
für Depression (DESC), Hoffnungslosigkeit (BHS), interpersonale
Variablen (INQ) und Defeat (DS-d)/Entrapment (ES-d) aus. Neben
konfirmatorischen Faktoranalysen (CFA, Prüfung von Modellen mit 1, 2, 3
und 5 Faktoren) zur Dimensionalitätsprüfung wurden
Pearson-Korrelationen zur Bestimmung der konvergenten Validität
berechnet.
Ergebnisse Insgesamt erzielt das 5-Faktoren-Modell den besten Fit; ohne
Berücksichtigung des RMSEA-Wertes ist der Modell-Fit zwischen den
verschiedenen Modellen allerdings vergleichbar. Im Rahmen der mehrfaktoriellen
Modelle entstehen inhaltlich vergleichbare Subskalen. Akzeptable interne
Konsistenzen zeigen sich nur für die Subskalen, die passive
Todeswünsche (α>0,80), aktive Suizidgedanken
(α>0,73) und suizidhandlungsbezogene Items
(α>0,70) erfassen. Der BSS-Summenscore sowie die Subskalen, die
passive bzw. aktive Suizidgedanken abbilden, korrelieren moderat mit DESC, BHS,
INQ und DS-d/ ES-d (r zwischen 0,25 und 0,66), während die
handlungsbezogene Subskala keine (INQ, Thwarted Belongingness) bzw. geringe
Assoziationen zeigt (r zwischen 0,14 und 0,27).
Schlussfolgerung Die CFAs liefern keinen eindeutigen Hinweis für
eine ein- oder mehrdimensionale Struktur der BSS. So ist die Auswertung
über den BSS-Summenwert trotz Hinweisen auf dessen Reliabilität
und konvergente Validität aus empirischer Sicht kritisch zu
bewerten.
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Affiliation(s)
- Lena Spangenberg
- Abteilung für Medizinische Psychologie und Medizinische
Soziologie, Universität Leipzig
| | - Tobias Teismann
- Abteilung für Klinische Psychologie und Psychotherapie,
Ruhr-Universität Bochum
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie, Universität
Duisburg-Essen, Essen
| | - Dajana Rath
- Abteilung für Klinische Psychologie, Universität
Duisburg-Essen, Essen
| | - Antje Schönfelder
- Abteilung für Medizinische Psychologie und Medizinische
Soziologie, Universität Leipzig
| | - Laura Paashaus
- Abteilung für Klinische Psychologie, Universität
Duisburg-Essen, Essen
| | - Georg Juckel
- Abteilung für Psychiatrie, LWL-Universitätskrankenhaus,
Ruhr-Universität Bochum
| | - Katarina Stengler
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie,
Helios Park-Klinikum Leipzig
| | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische
Soziologie, Universität Leipzig
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Paashaus L, Forkmann T, Glaesmer H, Juckel G, Rath D, Schönfelder A, Teismann T. Pain persistence and lethality of suicide attempts. Clin Psychol Psychother 2020; 27:542-547. [DOI: 10.1002/cpp.2438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Laura Paashaus
- Mental Health Research and Treatment Center, Department of Psychology Ruhr‐Universität Bochum Bochum Germany
- Department of Clinical Psychology University of Duisburg‐Essen Essen Germany
| | - Thomas Forkmann
- Department of Clinical Psychology University of Duisburg‐Essen Essen Germany
- Institute of Medical Psychology and Medical Sociology University Hospital of RWTH Aachen University Aachen Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology University of Leipzig Leipzig Germany
| | - Georg Juckel
- Department of Psychiatry, LWL‐University Hospital Ruhr‐Universität Bochum Bochum Germany
| | - Dajana Rath
- Institute of Medical Psychology and Medical Sociology University Hospital of RWTH Aachen University Aachen Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology University of Leipzig Leipzig Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology Ruhr‐Universität Bochum Bochum Germany
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Höller I, Teismann T, Cwik JC, Glaesmer H, Spangenberg L, Hallensleben N, Paashaus L, Rath D, Schönfelder A, Juckel G, Forkmann T. Short defeat and entrapment scale: A psychometric investigation in three German samples. Compr Psychiatry 2020; 98:152160. [PMID: 32036078 DOI: 10.1016/j.comppsych.2020.152160] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/18/2019] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The present study aimed to validate the German version of the Short Defeat and Entrapment Scale (SDES). METHODS Validity and reliability were established in an online (N = 480), an outpatient (N = 277) and an inpatient sample (N = 296). Statistical analyses included confirmatory factor analyses (CFA) and group differences in defeat and entrapment. RESULTS For the online and the inpatient sample, the CFA indicated a two-factor solution, whereas for the outpatient sample both one- and two-factor solutions fitted the data equally well. Scale properties for the two-factor solution (defeat and entrapment subscale) were excellent. Thus, further analyses were based on this solution. For the online and the outpatient sample, suicidal ideators and suicide attempters scored significantly higher in defeat and entrapment than non-ideators and non-attempters. LIMITATIONS Limiting factors of the study were the different measures across the samples and the cross-sectional design of the study. CONCLUSION Though results were partly mixed, we found support for a two-factor solution of the instrument showing excellent psychometric properties in all three samples. The two-factor solution is further expected to have higher clinical utility than a one-factor solution. Suicidal ideators and suicide attempters in the online and outpatient sample showed higher scores in defeat and entrapment than non-ideators and non-attempters, emphasizing these two concepts as predictors for suicidal ideation. All in all, the present study supports the general validity and reliability of the SDES. However, future investigations based on prospective data are warranted.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrhine-Westphalia, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-University of Bochum, Bochum, Northrhine-Westphalia, Germany
| | - Jan Christopher Cwik
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Northrhine-Westphalia, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Saxony, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Saxony, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Saxony, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrhine-Westphalia, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrhine-Westphalia, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Saxony, Germany
| | - Georg Juckel
- Research Department of Neuroscience, Ruhr-University of Bochum, Bochum, Northrhine-Westphalia, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrhine-Westphalia, Germany
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Hadzic A, Spangenberg L, Hallensleben N, Forkmann T, Rath D, Strauß M, Kersting A, Glaesmer H. The association of trait impulsivity and suicidal ideation and its fluctuation in the context of the Interpersonal Theory of Suicide. Compr Psychiatry 2019; 98:152158. [PMID: 32004858 DOI: 10.1016/j.comppsych.2019.152158] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/11/2019] [Accepted: 12/21/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although the relationship of trait impulsivity and suicidal behavior is well established, its relationship with suicidal ideation and its fluctuation still remains unclear. Our aim is to examine (1) the relationship of trait impulsivity and suicidal ideation and behavior in the context of the Interpersonal Psychological Theory of Suicide (IPTS) and (2) the association of trait impulsivity with the fluctuation of suicidal ideation in an inpatient sample with unipolar depression. METHOD Eighty-four inpatients with unipolar depression and current and/or lifetime suicidal ideation were assessed with a baseline assessment including trait impulsivity, suicidal ideation, suicidal behavior and the constructs of the IPTS. Seventy-four of these patients underwent a 6-day ecological momentary assessment (EMA) with 10 assessments per day across six days assessing passive and active suicidal ideation. Mean squared successive differences (MSSD) across EMA assessments of suicidal ideation were calculated to test fluctuation as an indicator of temporal variability. Correlation analyses were conducted to test the associations. RESULTS There were no associations of trait impulsivity with suicidal ideation, thwarted belongingness and perceived burdensomeness, except the rather low but significant association between thwarted belongingness and the attention subdomain of trait impulsivity (r = 0.23*, p ≤ 0.05). Moreover, trait impulsivity showed a significant positive correlation with capability for suicide but not with the two subdomains of capability for suicide. The only significant but rather low correlation was identified between the motor aspect of trait impulsivity and fearlessness about death (r = 0.26, p ≤ 0.01). Suicidal behavior showed a positive correlation with trait impulsivity, but not with the different subdomains of trait impulsivity. Trait impulsivity showed a significant correlation with the MSSD of passive suicidal ideation (r = 0.26, p ≤ 0.05), but not with active suicidal ideation. Furthermore, the motor aspect of trait impulsivity (BIS motor) showed a significant correlation (r = 0.32, p ≤ 0.01) with the MSSD of passive suicidal ideation, but not with active suicidal ideation or the MSSD total score. CONCLUSION Overall the findings are in line with our assumptions and the IPTS and underline that trait impulsivity is related to suicidal behavior and the fluctuation of suicidal ideation, but not to suicidal ideation itself. Thus, trait impulsivity seems to act as a distal risk factor via capability for suicide and it seems to play a role for the dynamics of suicidal ideation. The results have to be investigated in larger samples, with a higher risk of suicide and in prospective studies. Moreover, the role of the fluctuation of suicidal ideation for the prediction of suicide risk should be investigated in future studies.
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Affiliation(s)
- Asim Hadzic
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany.
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Germany.
| | - Maria Strauß
- Department of Psychiatry and Psychotherapy, University of Leipzig, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Germany.
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
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Spangenberg L, Glaesmer H, Hallensleben N, Rath D, Forkmann T. (In)stability of Capability for Suicide in Psychiatric Inpatients: Longitudinal Assessment Using Ecological Momentary Assessments. Suicide Life Threat Behav 2019; 49:1560-1572. [PMID: 30834576 DOI: 10.1111/sltb.12547] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study examines the temporal stability of capability for suicide (i.e., its state-like component), because it has been recently discussed that capability for suicide may be subject to shift over time. METHOD Seventy-four psychiatric inpatients with an unipolar depressive disorder were included in the study (mean age 37.9 years, 71.6% female, 32.4% with a history of suicide attempt). After a baseline assessment with several self-report questionnaires, ecological momentary assessments were applied over six consecutive days using smartphones. Capability for suicide was rated with three items once a day. For daily capability for suicide, descriptive and variability statistics and associations with baseline clinical characteristics (depression, suicidal ideation, childhood maltreatment, and history of suicide attempt) were analyzed. The prospective association of daily level of active suicidal ideation and daily capability was investigated by multilevel analysis. RESULTS Indicators of within-person variability and temporal instability supported considerable fluctuation in daily capability for suicide. Yet the degree of temporal instability showed individual differences. Baseline and daily suicidal ideation were positively associated with daily fearlessness about death and perceived capability. CONCLUSION The results provide first evidence that capability for suicide includes a dynamic short-term component that is linked to clinical variables such as suicidal ideation.
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Affiliation(s)
- Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Dajana Rath
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany.,Department of Clinical Psychology, Institute of Psychology, University Duisburg-Essen, Duisburg-Essen, Germany
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50
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Rath D, de Beurs D, Hallensleben N, Spangenberg L, Glaesmer H, Forkmann T. Modelling suicide ideation from beep to beep: Application of network analysis to ecological momentary assessment data. Internet Interv 2019; 18:100292. [PMID: 31828015 PMCID: PMC6889482 DOI: 10.1016/j.invent.2019.100292] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
•EMA data were analyzed using network analysis (e.g., temporal networks).•Suicidal ideation at t was predicted by itself and perceived burdensomeness at t - 1.•Suicidal ideation at t - 1 predicted perceived burdensomeness, depression etc. at t.•At the same beep, suicidal ideation was related to all variables in the network.•Patients with higher average suicidal ideation had higher average hopelessness.
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Affiliation(s)
- Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | | | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
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