Active and passive problem solving: moderating role in the relation between depressive symptoms and future suicidal ideation varies by suicide attempt history

Perceived COVID-19 Stress and Suicidal Ideation Among College Students: Meditation Roles of Family Cohesion and Unmet Interpersonal Needs

Purpose: Few studies examined variables that might explain the link between perceived COVID-19 stress and suicidal ideation. The present study tested a multiple-sequence mediation model with family cohesion, thwarted belongingness, and perceived burdensomeness as mediators. Methods: The current study surveyed 1098 college students in China using questionnaires concerning perceived COVID-19 stress, family cohesion, unmet interpersonal needs, and suicide ideation. Results: Perceived COVID-19 stress was significantly associated with family cohesion, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Family cohesion, thwarted belongingness, and perceived burdensomeness mediated the relationship between perceived COVID-19 stress and suicidal ideation separately. These factors also had multiple sequence-mediated effects between perceived COVID-19 stress and suicidal ideation. Conclusion: The study revealed pathways from perceived COVID-19 stress to suicidal ideation and suggested that interventions to increase family cohesion and reduce one's unmet interpersonal needs were beneficial in decreasing individuals' suicidal ideation.

Prospective Relation between Ruminative Subtypes and Suicide Ideation: Moderating Role of Problem Solving

Background

Although reflection has been characterized as a more adaptive subtype of rumination than brooding, evidence suggests that reflection is associated with suicide ideation. The present longitudinal study investigated the mediating role of hopelessness and depressive symptoms and the moderating role of problem solving in explaining why reflection may lead to suicide ideation.

Methods

Two hundred ninety-four undergraduates participated in the study and were followed up every 6 months over 18 months. Participants completed measures of brooding and reflection, hopelessness, depressive symptoms, problem solving, and suicide ideation.

Results

Results revealed that after adjusting for baseline suicide ideation, the serial mediation path from brooding (but not reflection) to suicide ideation via hopelessness and depressive symptoms was significant. Baseline reflection predicted suicide ideation 18 months later through depressive symptoms at 12 months for people average in passive problem solving, and for those low or average in active problem solving. Brooding predicted suicide ideation through depressive symptoms, regardless of problem-solving.

Conclusions

Reflection may result in suicide ideation via depressive symptoms among people with poor problem-solving skills. Clinical and theoretical implications are discussed.

Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm

The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI (n = 49) and the second group with SSD (n = 57), comparing them with a third group of adolescents with SSD and NSSI (n = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11–18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.

Predicting the risk of suicide attempt in a depressed population: Development and assessment of an efficient predictive nomogram

The purpose of this study was to develop and validate a user-friendly suicide attempt risk nomogram in depression, supporting timely interventions by clinicians. We collected clinical data of 273 depressed patients from January 2020 to January 2021. Suicide attempt was assessed conducting the Mini International Neuropsychiatric Interview. First, optimized features were filtrated through the least absolute shrinkage and selection operator regression analysis. Subsequently, we selected variables with nonzero coefficients and entered them into multiple logistic regression model and nomogram function to construct a visual predicting suicide attempt model. Additionally, the C-index, calibration plot and decision curve analysis, were applied to assess discrimination, calibration, and clinical practicability. Finally, the bootstrapping validation was applied to assess internal validation. Finally, eleven clinical features are screened out in the prediction nomogram. The model presented tiptop calibration and pleasant discrimination with a C-index of 0.853. A towering C-index value, up to 0.799, could also be attained in the interval validation analysis. In addition, decision curve analysis exhibited that our predictive model is clinically effective when the threshold is no less than 1%. These results demonstrate this predictive model was helpful for clinicians assessing the inpatient's suicide attempt recently and implementing individualized treatment strategies.

Low Perceived Social Rank Increases the Impact of Mental Health Symptoms on Suicidal Ideation: Evidence among Young Adults from the Philippines

Studies on social factors that could influence the mental health-suicidal ideation link remain scarce, especially in non-Western contexts. This study examined the relationship between mental health symptoms (i.e., depression, anxiety, and stress) and suicidal ideation and whether one's perceived social rank moderates such a relationship. Data from 631 students from two universities in the Philippines collected between October to December 2018 was analyzed. Bivariate correlations show that greater symptoms of depression, anxiety, and stress are associated with increased suicidal ideation. Hierarchical linear regression models supported the direct relationship between mental health symptoms and suicidal ideation and demonstrated that perceived social rank significantly moderated such a relationship. Johnson-Neyman plots and simple slopes analyses further illustrate how mental health symptoms and perceived social rank interact to impact suicidal ideation. The results show that as one's perceived social rank lowers, the strength of the positive association between depression, anxiety, and stress symptoms to suicidal ideation strengthens. The results held while controlling for age, gender, college year level, and family income. The findings are discussed using the social rank theory and the Integrated Motivational-Volitional (IMV) model of suicide to view suicidal ideation from both an individual and a social perspective. We expound on the role of low perceived social rank on suicidal ideation among young adults.HIGHLIGHTSHigher depression, anxiety, and stress symptoms are associated with higher suicidal ideation.Perceived social rank moderates the link between mental health symptoms and suicidal ideation.One's perception of being inferior to others can exacerbate suicidal ideation.

Suicide Risk and Protective Factors: A Network Approach

OBJECTIVE

Suicide is a complex phenomenon, with numerous factors contributing to an individual's risk of suicide. The aim of the present study was to explore how risk and protective factors for suicide interact with one another in a network sense and to determine which factors were most central to a network of these factors.

METHOD

Using an online survey, cross-sectional data were collected from a sample of 515 individuals who lived in New Zealand, Australia, the United Kingdom, and the United States of America. Participants were recruited through either social media or Prolific Academic. A network of 18 risk and protective factors for suicide was estimated using network analysis. Analyses were preregistered on the Open Science Framework.

RESULTS

Factors that had the highest strength centrality were feeling depressed, feeling hopeless, perceived burdensomeness, self-esteem, and social support. Factors that were directly associated with suicidal ideation included feeling depressed, perceived burdensomeness, feeling hopeless, self-esteem, resilience, access to mental health services and a positive attitude toward these services.

CONCLUSION

This research demonstrates the importance of examining protective factors as well as risk factors when estimating an individual's suicide risk. The results suggest that interventions targeting depression may be particularly beneficial in reducing suicide risk, but further longitudinal research is required.HIGHLIGHTSThe network analyses estimated depression to be the most central risk factor.Depression and perceived burdensomeness were risk factors for suicidal ideation.Self-esteem and resilience were protective against suicidal ideation.

A review and conceptual model of the association of Type D personality with suicide risk

The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the psychological plausibility of Type D personality as distal risk factor and contributor to the transition from general to suicide distress. To support this aim, we performed a systematic review of existing studies on the association between Type D personality and suicidal distress. A systematic search yielded eight studies that reported on Type D personality and suicidal distress. Type D personality was robustly associated with suicidal thoughts and behaviors, across populations and countries. Type D was related to the level/frequency of suicidal ideation in seven studies, and suicide attempt in two studies. Our first theoretical model identifies intra-psychic (depression, alcohol misuse, posttraumatic stress) and interpersonal (low belonging, social isolation, lack of support) vulnerabilities of individuals with Type D that may fuel the development of suicidal thoughts and behaviors. Type D by itself will not account for why people become suicidal, but our second theoretical model suggests that the avoidant-passive tendencies of Type D individuals may result in persistent problem-solving deficits, and, eventually, feelings of entrapment that may contribute to the desire to escape from pain. We conclude that empirical evidence supports the hypothesized link between Type D personality, and suicidal thoughts and behaviors. Our conceptual models - albeit often supported by indirect evidence - further substantiate the plausibility of this link, and offer concrete guidance for future studies. Primarily, more longitudinal research is necessary.

The role of psychiatric symptoms and environmental vulnerability factors in explaining the relationship between child maltreatment and suicidality: A prospective investigation

BACKGROUND

Childhood maltreatment has been associated with suicide thoughts and attempts; however, few longitudinal studies have assessed risk of suicidality into adulthood. Fewer have examined potential mediators (psychiatric symptoms and environmental vulnerability factors).

METHODS

Prospective cohort design. Children with documented cases of maltreatment (N = 495, ages 0-11) were matched with non-maltreated children (N = 395) and followed up into adulthood. Psychiatric symptoms (depression, anxiety, dysthymia, post-traumatic stress,antisocial personality,and substance use) and environmental vulnerability (social isolation, physical disability/illness, and homelessness) were assessed at mean age 29 and suicide thoughts and attempts at 39. Structural equation models tested for mediation, controlling for age, sex, race, and IQ.

RESULTS

Childhood maltreatment predicted suicide attempts (Beta = 0.44, p<0.001), but not suicide thoughts only.Individuals with only suicide thoughts differed significantly from those with suicide attempts in psychiatric symptoms, physical disability/ illness, and homelessness. There were significant paths from child maltreatment to suicide attempts through psychiatric symptoms (0.18, p<0.001), ASPD (0.13, p<0.001), substance use (0.07, p<0.01), and homelessness (0.10, p<0.05).

LIMITATIONS

Court cases of child maltreatment may not generalize to middle- or upper- class and non-reported cases.Effect sizes were small but significant.

CONCLUSIONS

Psychiatric risk factors for suicide are well recognized. These new results provide strong evidence that environmental vulnerability factors, particularly homelessness, are associated with increased risk for suicide attempts and warrant attention.Although many people report suicide thoughts, maltreated children with more psychiatric symptoms and experience homelessness are more likely to attempt suicide and warrant targeted interventions.

Direct and Indirect Effects of Behavioral Inhibition/Activation Systems on Depression and Current Suicidal Ideation Through Rumination and Self-Reflection

This study aimed to evaluate direct and indirect effects of the behavioral inhibition system (BIS) and the behavioral activation system (BAS) on depression and current suicidal ideation through rumination and self-reflection in a sample of suicide attempters. Three hundred suicide attempters completed the Rumination/Reflection Questionnaire (RRQ), the Carver and White BIS/BAS scales, the Beck Scale for Suicide Ideation (BSSI), and the Beck Depression Inventory-II (BDI-II). Results revealed that the BAS and BIS had direct effects on suicidal ideation but not depression. Low BAS had an indirect effect on depression through decreased self-reflection. High BIS had an indirect effect on depression via increased rumination. Low BAS and high BIS had indirect effects on suicidal ideation through decreased self-reflection. The findings suggest that low BAS and high BIS may be associated with depression and suicidal ideation in suicide attempters who have decreased self-reflection and increased rumination. Also, increasing self-reflection and reducing rumination as respectively adaptive and maladaptive self-focused attention strategies may prohibit depression and suicidal ideation.

Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis

Importance

Children and young people's reports of experiences of adverse childhood events have increased in recent years, and this trend has been associated with an elevated risk for suicide behaviors. However, a systematic review and meta-analysis is needed to confirm the significance of this association in young people.

Objective

To quantify the association between core types of childhood maltreatment, including sexual, physical, and emotional abuse and/or neglect and suicide behaviors in children and young adults.

Data Sources

Medline, PsychInfo, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health) databases were searched from January 1, 1980, until December 31, 2019. The reference lists of all the included studies were also checked.

Study Selection

Quantitative studies that focused on the association between core types of childhood abuse and/or neglect and suicide ideation, plans, and attempts.

Data Extraction and Synthesis

Data were extracted by 2 independent raters. Publication bias and risk of bias across studies were assessed. Meta-analyses using random-effect models were applied, and heterogeneity was quantified using the I2 statistic. Data were analyzed from January to May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines.

Main Outcomes and Measures

The association between core types of childhood maltreatment and suicide behaviors.

Results

Seventy-nine studies with 337 185 young individuals (mean [SD] age, 15.67 [2.11] years; 63.19% female) were included. The findings demonstrated that sexual abuse (odds ratio [OR], 3.41; 95% CI, 2.90-4.00), physical abuse (OR, 2.18; 95% CI, 1.75-2.71), emotional abuse (OR, 2.21; 95% CI, 1.37-3.57), emotional neglect (OR, 1.93; 95% CI, 1.36-2.74), physical neglect (OR, 1.79; 95% CI, 1.27-2.53), and combined abuse (OR, 3.38; 95% CI, 2.09-5.47) were significantly associated with higher rates of suicide attempts. Core types of childhood maltreatment were also associated with as much as 2.5-fold greater odds for suicide ideation, and sexual abuse with a 4.0-fold increase for suicide plans. Studies based on community samples (β [SE] = -1.68 [0.79]; P = .04) or with lower methodological quality (β [SE] = -2.86 [1.30]; P = .03) were associated more strongly with suicide attempts in those reporting experiences of sexual abuse, whereas young age was associated with both suicide attempts (β [SE] = -0.59 [0.27]; P = .03) and ideation (β [SE] = -0.41 [0.18]; P = .03).

Conclusions and Relevance

These findings suggest that policy actions should focus on raising public awareness and offering proactive suicide prevention therapies for children and young adults who have experienced abuse and/or neglect.

Coping and Suicide in College Students

Background: Transitioning to college life in young adulthood can represent a challenging developmental period and college students are at heightened risk for engaging in suicidality. Aims: We aimed to investigate the roles dispositional optimism and coping strategies play in suicide risk (viz., suicidality) and suicide protection (viz., reasons for living) in college students. Method: A sample of 252 American college students were surveyed using anonymous questionnaires and hierarchical regression analyses were conducted to analyze the data. Results: Coping strategies, as a set, played an important role in both suicidality and reasons for living, after controlling for demographic factors (age and sex). When dispositional optimism was entered into the model, it was found to account for a significant amount of additional unique variance in both suicidality and reasons for living, even after accounting for coping. Limitations: It is unknown whether optimism remains meaningful in its association with suicide risk and protection beyond coping in other populations. Conclusion: Effective coping and optimism are associated with decreased suicide risk and increased suicide protection. Our findings point to the consistent role of dispositional optimism, over coping, in both suicide risk and protection.

Social problem solving in social anxiety disorder

Successful social problem solving requires both an adaptive orientation toward the problem and the necessary skills to generate relevant and effective solutions. Surprisingly few studies have examined social problem solving in the context of social anxiety. We examined social problem solving in 38 participants with social anxiety disorder (SAD) in comparison to 30 healthy control (HC) participants with no history of anxiety problems. Participants rated their problem solving attitudes and abilities (i.e., problem orientation) and then generated solutions to hypothetical interpersonal problems from both their own perspective and that of an objective other. These solutions were coded for effectiveness and relevance, as well as the degree to which the solution was active versus passive. Participants with SAD exhibited a more negative problem orientation than HC participants. Furthermore, although SAD and HC participants demonstrated no overall differences in generating relevant and effective solutions to interpersonal problems, utilizing a personal perspective facilitated the generation of more active solutions for HC participants, but less active solutions for those with SAD. Findings illuminate new research directions regarding social problem solving in social anxiety, with potential implications for applied intervention.

Cognition As a Therapeutic Target in the Suicidal Patient Approach

The current considerations about completed suicides and suicide attempts in different cultures call the attention of professionals to this serious public health problem. Integrative approaches have shown that the confluence of multiple biological and social factors modulate various psychopathologies and dysfunctional behaviors, such as suicidal behavior. Considering the level of intermediate analysis, personality traits and cognitive functioning are also of great importance for understanding the suicide phenomenon. About cognitive factors, we can group them into cognitive schemas of reality interpretation and underlying cognitive processes. On the other hand, different types of primary cognitive alterations are related to suicidal behavior, especially those resulting from changes in frontostriatal circuits. Among such cognitive mechanisms can be highlighted the attentional bias for environmental cues related to suicide, impulsive behavior, verbal fluency deficits, non-adaptive decision-making, and reduced planning skills. Attentional bias consists in the effect of thoughts and emotions, frequently not conscious, about the perception of environmental stimuli. Suicidal ideation and hopelessness can make the patient unable to find alternative solutions to their problems other than suicide, biasing their attention to environmental cues related to such behavior. Recent research efforts are directed to assess the possible use of attention bias as a therapeutic target in patients presenting suicide behavior. The relationship between impulsivity and suicide has been largely investigated over the last decades, and there is still controversy about the theme. Although there is strong evidence linking impulsivity to suicide attempts. Effective interventions address to reduce impulsivity in clinical populations at higher risk for suicide could help in the prevention. Deficits in problem-solving ability also seem to be distorted in patients who attempt suicide. Understanding cognitive changes in patients who attempt suicide open an important perspective in the approach of patients with mental disorders. Identifying cognitive deficits in these patients, along with personality traits, depressive symptoms, and suicidal cognitive schemas may indicate to the psychiatrist the need for emergency care. Behavioral and cognitive interventions have been associated with reductions in suicide ideation, as well as suicide attempts in different populations.

Emotion Reactivity, Comfort Expressing Emotions, and Future Suicidal Ideation in Emerging Adults

OBJECTIVE

Emotion reactivity and difficulties in expressing emotions have been implicated in risk for suicidal behavior. This study examined comfort in expressing emotions (positive vs. negative) and depressive symptoms as mediators of the prospective relation between emotion reactivity and suicidal ideation.

DESIGN

Emerging adults (N = 143; 72% female; 28% White) completed measures of emotion reactivity, comfort expressing emotions, and suicidal ideation at baseline and of depressive symptoms and suicidal ideation 12 months later.

RESULTS

Emotion reactivity predicted suicidal ideation at follow-up through depressive symptoms. Difficulty expressing love-but not happiness, sadness, and anger-partially mediated the relationship between emotion reactivity and suicidal ideation at follow-up before but not after adjusting for baseline ideation.

CONCLUSION

The relation between high emotion reactivity and suicidal ideation may be explained by discomfort in the expression of positive emotions and by depressive symptoms. Promotion of comfort in positive emotion expression may reduce vulnerability to suicidal ideation.