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Martinez BS, Rowland JA, Shura RD, Magnante AT, Morey RA, Martindale SL. Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans. J Psychiatr Res 2024; 172:411-419. [PMID: 38458113 DOI: 10.1016/j.jpsychires.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. METHOD Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. RESULTS There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). CONCLUSIONS Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
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Affiliation(s)
- Brandy S Martinez
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
| | - Jared A Rowland
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert D Shura
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna T Magnante
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rajendra A Morey
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Sarah L Martindale
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Raudales AM, Carosa CL, Weiss NH, Schatten HT, Armey MF. Emotion dysregulation as a mechanism linking posttraumatic stress disorder to subsequent suicidal thoughts and behaviors following inpatient psychiatric discharge. J Psychiatr Res 2023; 161:34-39. [PMID: 36893669 DOI: 10.1016/j.jpsychires.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/05/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a well-known risk factor for suicidal thoughts and behaviors (STBs). However, there is a scarcity of longitudinal studies exploring underlying pathways. This study sought to examine the mechanistic role of emotion dysregulation in the relations between PTSD and STBs following discharge from psychiatric inpatient treatment, a particularly high-risk period for suicide. Participants were 362 trauma-exposed psychiatric inpatients (45% female, 77% white, Mage = 40.37). PTSD was assessed via a clinical interview (Columbia Suicide Severity Rating Scale) during hospitalization, emotion dysregulation was assessed via self-report 3-weeks post-discharge, and STBs were assessed via a clinical interview 6-months post-discharge. St'1ructural equation modeling showed that emotion dysregulation significantly mediated the relation between PTSD and suicidal thoughts (β = 0.10, SE = 0.04, p = .01, 95%CI [0.04, 0.39]) but not suicide attempts (β = 0.04, SE = 0.04, p = .29, 95%CI [-0.03, 0.12]) post-discharge. Findings highlight a potential clinical utility of targeting emotion dysregulation among individuals with PTSD to prevent suicidal thoughts following discharge from psychiatric inpatient treatment.
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Affiliation(s)
- Alexa M Raudales
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Heather T Schatten
- Butler Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael F Armey
- Butler Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA.
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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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