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An S, Lee H, Lee J. How people react to suicidal ideation: The effect of suicide literacy, suicide stigma, and expressive suppression. J Clin Psychol 2024; 80:1949-1961. [PMID: 38742986 DOI: 10.1002/jclp.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The purpose of this study is to understand the role of suicide literacy and suicide stigma in laypeople's intention to recommend professional help in Korea. Additionally, the study focuses on the role of expressive suppression as a sociocultural factor. METHODS Participants read vignettes depicting either subclinical distress or suicidal ideation and answered questions measuring suicide literacy, stigma, and expressive suppression. Mediated moderation analyses were used to examine the interactions between these factors. RESULTS The result found the significant effect of expressive suppression. The mediating effect of suicide stigma on the relationship between suicide literacy and recommendation of professional help was significant for those who do not suppress their emotions. This result indicates that when individuals were not hesitant to express negative emotions, high suicide literacy lowered suicide stigma and led to more willingness to recommend professional help. CONCLUSIONS The results showed that expressive suppression acts as a barrier deterring Koreans from professional help for their mental health. The findings underscore the importance of sociocultural factors such as expressive suppression in developing suicide prevention strategies.
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Affiliation(s)
- Soontae An
- Department of Communication and Media, Ewha Womans University, Seoul, South Korea
| | - Hannah Lee
- Ewha Institute for Age Integration Research, Ewha Womans University, Seoul, South Korea
| | - Jiyoon Lee
- Department of Communication and Media, Ewha Womans University, Seoul, South Korea
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Ye Y, Chen B, Zhen R, Li Y, Liu Z, Zhou X. Childhood maltreatment patterns and suicidal ideation: mediating roles of depression, hope, and expressive suppression. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02442-6. [PMID: 38642118 DOI: 10.1007/s00787-024-02442-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
Childhood maltreatment has long-term negative effects on individuals' physical and mental well-being, and may increase the risk for suicidal ideation. However, how different patterns of childhood maltreatment affect subsequent suicidal ideation and the underlying mediating mechanisms remain unclear, particularly among Chinese adolescents. This study used latent profile analysis to identify patterns of childhood maltreatment among adolescents and explored how these patterns predicted subsequent suicidal ideation via depression, hope, and expressive suppression. This study used a two-wave, 1-year longitudinal design and included 2156 adolescents (Mage = 13.97 years, SDage = 1.61 years; 49.6% females). We identified three patterns of childhood maltreatment: low maltreatment, high psychological neglect, and high maltreatment. Compared with the low maltreatment group, the high maltreatment group indirectly predicted subsequent suicidal ideation 1 year later via depression through hope and expressive suppression, whereas the direct effect on suicidal ideation was not significant. Compared with the low maltreatment group, the high psychological neglect group had a significant direct effect on subsequent suicidal ideation and indirectly predicted suicidal ideation through depression or hope. Identifying patterns of childhood maltreatment among adolescents will assist mental health workers in developing targeted interventions to effectively alleviate suicidal ideation.
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Affiliation(s)
- Yingying Ye
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Bo Chen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, 311121, China
| | - Rui Zhen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, 311121, China
| | - Yifan Li
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Zhengyi Liu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China.
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Elwyn R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 2023; 11:2. [PMID: 36604749 PMCID: PMC9815687 DOI: 10.1186/s40337-022-00729-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
The ethical approach to treatment non-response and treatment refusal in severe-enduring anorexia nervosa (SE-AN) is the source of significant ethical debate, particularly given the risk of death by suicide or medical complications. A recent article proposed criteria to define when anorexia nervosa (AN) can be diagnosed as 'terminal' in order to facilitate euthanasia or physician-assisted suicide (EAS), otherwise known as medical assistance in dying, for individuals who wish to be relieved of suffering and accept treatment as 'futile'. This author utilises their personal lived experience to reflect on the issues raised, including: treatment refusal, iatrogenic harm, suicidality and desire to end suffering, impact of diagnosis/prognosis, schemas, alexithymia, countertransference, ambivalence, and holding on to hope. Within debates as critical as the bioethics of involuntary treatment, end-of-life and EAS in eating disorders, it is crucial that the literature includes multiple cases and perspectives of individuals with SE-AN that represent a wide range of experiences and explores the complexity of enduring AN illness, complex beliefs, communication patterns and relational dynamics that occur in SE-AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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Colmenero-Navarrete L, García-Sancho E, Salguero JM. Relationship Between Emotion Regulation and Suicide Ideation and Attempt in Adults and Adolescents: A Systematic Review. Arch Suicide Res 2022; 26:1702-1735. [PMID: 34821201 DOI: 10.1080/13811118.2021.1999872] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Suicide is one of the main causes of death in adults and adolescents, so research focused on identifying risk factors for suicidal behavior is needed. In recent years, emotion regulation, mainly the presence of difficulties regulating one's own negative emotions, has been associated with negative mental health outcomes. OBJECTIVE The purpose of this study was to systematically review the available evidence on the association between emotion regulation and suicide (ideation and attempt) in both adults and adolescents. METHOD A systematic search of scientific articles published in English and Spanish was carried out through the databases PsycINFO, MEDLINE, Scopus, and the Cochrane Library. RESULTS We identified 76 eligible studies, of which 70 reported that people with difficulties in emotion regulation reported higher levels of suicide ideation and more suicide attempts. The results were consistent in adolescents and adults, in clinical and general population samples, and when studies assessed both emotion regulation processes and strategies. However, few studies were longitudinal and most of them were with women. CONCLUSIONS We discuss the theoretical implications of the results, suggesting that actual psychological models might benefit from considering individual differences in ER in understanding why people engage in suicide behavior. Clinical implications are also discussed.HIGHLIGHTSDifficulties regulating one's emotions is associated with suicide behavior (SI and SA).Consistent results at all the ages and in the clinical and general population.Individual differences in ER could help researchers to understand suicide.
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Romano KA, Heron KE, Everhart RS. Family meals, positive versus negative emotion suppression, and emotional eating: examining adolescent-parent dyadic associations. Eat Weight Disord 2022; 27:1491-1504. [PMID: 34468974 DOI: 10.1007/s40519-021-01292-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The present study aimed to extend existing research by examining adolescent-parent dyadic associations among adaptive and maladaptive family meal characteristics, positive and negative emotion suppression, and emotional eating. METHOD Participants included a community-based sample of adolescents and parents (N = 1646 dyads) who participated in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating Study. Dyad members both completed measures assessing family meal characteristics (family meal importance beliefs, family mealtime television watching), emotion suppression, and emotional eating via online surveys. Actor-partner interdependence models were used to examine dyadic associations among the assessed family meal characteristics, positive and negative emotion suppression, and emotional eating. RESULTS Multiple within-person (e.g., adolescent-adolescent, parent-parent), cross-dyad member (e.g., adolescent-parent, parent-adolescent), and divergent adolescent versus parent dyadic effects were identified that differed based on the extent to which participants suppressed positive versus negative affect. For example, whereas adolescents' stronger beliefs in the importance of frequent family meals were associated with lower levels of their own suppression of positive emotions and, in turn, lower levels of both their own and their parents' emotional eating, these mediational associations were only identified at the within-person (not cross-dyad member) level among parents. CONCLUSIONS Collectively, these findings attest to the complexity of associations among the assessed risk and protective family meal characteristics, the suppression of differentially valenced emotions, and emotional eating that manifest at the adolescent-parent dyadic level. Findings also support the continued use of a family-based perspective to further the understanding of factors that are associated with emotional eating. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA. .,Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA.
| | - Kristin E Heron
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA.,Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA
| | - Robin S Everhart
- Virginia Commonwealth University, 808 West Franklin Street, Richmond, VA, 23284, USA
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Expressive suppression a mediating variable between stress and procrastination in eating behavior disorder. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns3.6325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Eating disorders (EDs) are psychiatric illnesses in which emotions play an important role in their development and maintenance. These disorders are associated with expressive suppression, stress, and procrastination. The purpose of this work was to explain eating disorders from stress and procrastination, with expressive suppression as a mediating variable. It was attended by 918 students from three universities in Ecuador. The information was collected through four instruments: inventory of eating disorders, perceived stress scale, Tuckman procrastination scale and emotional regulation questionnaire. The data was analyzed through a mediational analysis in the Jasp program, version 15. The independent variables were: procrastination and stress, the dependent variable was risk of experiencing bulimia (REB) and the mediating variable was expressive suppression. Procrastination and stress, mediated by expressive suppression, were found to have no statistically significant effect on EBR. Procrastination has a direct effect on REB, although stress does not, and the model between expressive suppression and REB explains a good percentage of the variance.
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Ji L, Wang J, Zhu B, Qiao X, Jin Y, Si H, Wang W, Bian Y, Wang C. Expressive suppression and rumination mediate the relationship between frailty and depression among older medical inpatients. Geriatr Nurs 2021; 43:293-298. [PMID: 34974398 DOI: 10.1016/j.gerinurse.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Frailty is common among older medical inpatients and has been found to be an independent risk factor for depression. However, few studies have explored the underlying mechanisms of the frailty-depression relationship. The present study was aimed to examine emotional regulation strategies as mediators in the frailty-depression relationship based on the process model of emotional regulation. METHODS Older medical inpatients (N=684) completed questionnaires and tests on frailty, emotional regulation strategies, and depressive symptoms. RESULTS Structural equation models showed that expressive suppression and rumination, but not cognitive reappraisal, mediated the relationship between frailty and depressive symptoms (RMSEA = 0.059, CFI = 0.963, TLI = 0.957). CONCLUSIONS Frail older medical inpatients habitually use expressive suppression and rumination in their daily lives, which may lead to more psychological disturbance. Interventions targeting expressive suppression and rumination might be effective in reducing the detrimental effect of frailty on psychological well-being among older medical inpatients.
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Affiliation(s)
- Lili Ji
- School of Nursing, Peking University, 100191 Beijing, China; School of Nursing, Weifang Medical University, 261042 Weifang, China
| | - Jinrong Wang
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Baoqi Zhu
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, 100191 Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
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Hayatbini N, Knauft K, Kalia V. Cognitive reappraisal moderates the relationship between perfectionism and cognitive flexibility. J Clin Psychol 2021; 77:1685-1699. [PMID: 33608882 DOI: 10.1002/jclp.23124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Characterized by setting high standards for performance, perfectionism is a transdiagnostic process implicated in the development and maintenance of psychopathology. In contrast, cognitive flexibility is associated with enhanced mental health. Yet, the relationship between perfectionism and cognitive flexibility is understudied. We examined the relationship between perfectionism and cognitive flexibility, and whether emotion regulation strategies moderated the association between them. METHOD Adult participants (N = 486) were recruited online and completed questionnaires on perfectionism, emotion regulation and cognitive flexibility. RESULTS Perfectionism negatively correlated with one of the two aspects of cognitive flexibility assessed. Reappraisal, but not suppression, moderated the relationship between perfectionism and flexibility. CONCLUSIONS Results indicate that perfectionism is associated with inflexible appraisal of everyday challenges. Additionally, cognitive reappraisal attenuates the negative relationship between perfectionism and cognitive flexibility; except in individuals with high narcissistic perfectionism for whom the debilitating relationship between the two variables is enhanced by reappraisal.
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Affiliation(s)
| | | | - Vrinda Kalia
- Psychology Department, Miami University, Oxford, Ohio
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Ortiz SN, Forrest LN, Smith AR. Correlates of suicidal thoughts and attempts in males engaging in muscle dysmorphia or eating disorder symptoms. J Clin Psychol 2020; 77:1106-1115. [PMID: 33378580 DOI: 10.1002/jclp.23102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Despite the high rates of suicidality in body dysmorphic disorder and eating disorders (EDs), research on suicidality in a related disorder, muscle dysmorphia (MD), is essentially nonexistent. Thus, this study tested relations between suicidal thoughts and behaviors and MD and ED symptoms in an online male community sample. METHOD A total of 464 males (Mage = 40.3; 85% Caucasian) recruited from Amazon's Mechanical Turk completed measures that evaluated ED symptoms, MD symptoms, current suicidal ideation, and past suicide attempts. RESULTS Most MD and ED symptoms were correlated with current suicidal ideation and previous suicide attempts. In multivariate regression models, vomiting and appearance intolerance remained significantly related to suicidal ideation, while hard exercise and lower functional impairment were significantly related to prior suicide attempts. CONCLUSION Results indicate that appearance dissatisfaction, a core MD criterion, and hard exercise, a common behavioral symptom of MD, are associated with suicidality.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | - Lauren N Forrest
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio, USA
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Kalia V, Knauft K. Emotion regulation strategies modulate the effect of adverse childhood experiences on perceived chronic stress with implications for cognitive flexibility. PLoS One 2020; 15:e0235412. [PMID: 32589644 PMCID: PMC7319341 DOI: 10.1371/journal.pone.0235412] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/15/2020] [Indexed: 12/22/2022] Open
Abstract
Exposure to early life adversity is associated with chronic stress and a range of stress-related health problems in adulthood. Since chronic stress debilitates activity in the prefrontal cortex (pFC), maladaptive regulatory strategies in response to stress have been proposed as one explanation for the impact of early life adversity on health outcomes in adulthood. We conducted a study to examine the impact of adverse childhood experiences (ACEs) on cognitive flexibility, a key executive function implicated in activity in the pFC, in a sample of adults (N = 486). Additionally, we investigated whether perceptions of chronic stress in adulthood would mediate the influence of ACEs on cognitive flexibility. However, stress is a subjective experience, and emotion regulation strategies can attenuate the stress response. So, we also examined if individual differences in emotion regulation strategies would modulate the relationship between ACEs and chronic stress. Our results demonstrate that early life adversity, as characterized by ACEs, is associated with decreased cognitive flexibility in adulthood. Additionally, number of ACEs was positively correlated with perceived stress, which in turn was negatively correlated with cognitive flexibility. But, individual differences in the habitual use of emotion regulation strategies moderated the influence of ACEs on chronic stress. Specifically, habitual use of cognitive reappraisal attenuated the stress levels whereas habitual use of expressive suppression exacerbated stress levels. Overall, our study highlights the importance of examining emotion regulation in individuals who have experienced early life adversity.
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Affiliation(s)
- Vrinda Kalia
- Department of Psychology, Miami University, Oxford, Ohio, United States of America
| | - Katherine Knauft
- Department of Psychology, Miami University, Oxford, Ohio, United States of America
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