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LaCroix JM, Baggett CMR, Lee-Tauler SY, Carter SP, Vileta S, Neff LC(RDR, Finton LB, Bottema MGSJ, Bowling SM(RE, Hosack TSME, Grammer J, Stivers M, Darmour CA, Ghahramanlou-Holloway M. Special Operations Cognitive Agility Training (SOCAT) for Special Operations Forces and spouses. MILITARY PSYCHOLOGY 2024; 36:266-273. [PMID: 38661465 PMCID: PMC11057656 DOI: 10.1080/08995605.2021.1981709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 09/08/2021] [Indexed: 10/19/2022]
Abstract
Increasingly complex and unpredictable personnel and operational demands require Special Operations Forces (SOF) members and their families to remain flexible, adaptive, and resilient within ever-changing circumstances. To mitigate the impact of these stressors on psychological health and fitness, researchers and educators at the Uniformed Services University of the Health Sciences (USUHS) developed Special Operations Cognitive Agility Training (SOCAT), a cognitive performance optimization program supported by the United States Special Operations Command (USSOCOM) Preservation of the Force and Family (POTFF). The goal of SOCAT is to enhance cognitive agility, defined as the ability to deliberately adapt cognitive processing strategies in accordance with dynamic shifts in situational and environmental demands, in order to facilitate decision making and adapt to change. Overall, SOCAT emphasizes optimal cognitive performance across different contexts - as well as across various stages of the military lifecycle - to serve as a buffer against biopsychosocial vulnerabilities, environmental and social stressors, military operational demands, and behavioral health problems, including suicide. This paper reviews foundational research behind SOCAT, mechanisms through which SOCAT is anticipated to build psychological resilience, and describes the process of developing and tailoring SOCAT for active duty SOF members and spouses. Limitations and future directions, including an ongoing, randomized controlled program evaluation, are discussed.
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Affiliation(s)
- Jessica M. LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Su Yeon Lee-Tauler
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sarah P. Carter
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Staci Vileta
- Headquarters United States Special Operations Command, Preservation of the Force and Family, MacDill Air Force Base, Tampa, Florida, USA
| | | | | | | | | | - Tech Sergeant Meagan E. Hosack
- Headquarters United States Special Operations Command, Preservation of the Force and Family, MacDill Air Force Base, Tampa, Florida, USA
| | - Joseph Grammer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Max Stivers
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Charles A. Darmour
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Perry AE, Zawadzka M, Lapinski P, Moore K, Rychlik J, Nowak B. Cultural adaptation of a UK evidence-based problem-solving intervention to support Polish prisoners at risk of suicidal behaviour: a cross-sectional survey using an Ecological Validity Model. BMJ Open 2023; 13:e069252. [PMID: 37423634 DOI: 10.1136/bmjopen-2022-069252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To complete a cultural adaptation of a UK evidence-based problem-solving intervention to support Polish prisoners at risk of suicidal behaviour. DESIGN A cross-sectional survey participatory design using an Ecological Validity Model. SETTING The study was a collaboration between: the Academy of Justice, in Warsaw, the University of Lodz, two Polish prisons (ZK Raciborz and ZK Klodzko) and the University of York (UK). METHODS The adaptation process included an examination of the use of language, metaphors and content (ie, culturally appropriate and syntonic language), the changing of case study scenarios (relevance and acceptability) and maintenance of the theoretical underpinning of the problem-solving model (intervention comprehensibility and completeness). Four stages used: (1) a targeted demonstration for Polish prison staff, (2) a wider audit of the skills with Polish prison staff and students, (3) forward and back-translation of the adapted package, and (4) two iterative consultations with participants from stages (1) and (2) and prison officers from two Polish prisons. PARTICIPANTS Self-selecting volunteer participants included: targeted prison staff (n=10), prison staff from the wider Polish penitentiary system (n=39), students from the University of Lodz (n=28) and prison officers from two Polish prisons (n=12). MAIN OUTCOMES AND MEASURES Acceptability and feasibility of the training package, reported in a series of knowledge user surveys. RESULTS The recognised benefits of using the skills within the training package included: enhancing communication, reflective development, collaborative working, changing behaviour, empowering decision-making, relevance to crisis management situations and use of open-ended questions. The skills were endorsed to be used as part of future penitentiary training for prison officers in Poland. CONCLUSIONS The skills had widespread appeal for use across the Polish penitentiary system. The materials were deemed relevant while adhering to the comprehensibility of the intervention. Further evaluation of the intervention should be explored using a randomised controlled trial design.
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Affiliation(s)
- Amanda E Perry
- Department of Health Sciences, University of York, York, UK
| | | | - Piotr Lapinski
- Department of Occupational Therapy, University of Physical Education in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
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Kappes JR, Huber DA, Kirchebner J, Sonnweber M, Günther MP, Lau S. Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:352-372. [PMID: 34861802 DOI: 10.1177/0306624x211062139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.
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Affiliation(s)
| | | | | | | | | | - Steffen Lau
- Psychiatric University Hospital Zurich, Switzerland
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Kim J, Phillips JG, Ogeil RP. Nowhere else to go: Help seeking online and maladaptive decisional styles. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2021.107103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alvi MH, Shiri T, Iqbal N, Husain MO, Chaudhry I, Shakoor S, Ansari S, Kiran T, Chaudhry N, Husain N. Cost-Effectiveness of a Culturally Adapted Manual-Assisted Brief Psychological Intervention for Self-Harm in Pakistan: A Secondary Analysis of the Culturally Adapted Manual-Assisted Brief Psychological Randomized Controlled Trial. Value Health Reg Issues 2021; 27:65-71. [PMID: 34844061 DOI: 10.1016/j.vhri.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Self-harm is a serious public health problem. A culturally adapted manual-assisted problem-solving training (C-MAP) intervention improved and sustained a reduction in suicidal ideation, hopelessness, and depression compared with treatment as usual (TAU) alone. Here, we evaluate its cost-effectiveness. METHODS Patients admitted after an episode of self-harm were randomized individually to either C-MAP plus TAU or TAU alone in Karachi. Improvement in health-related quality-adjusted life-years (QALYs) was measured using the EQ-5D with 3 levels instrument at baseline, 3 months, and 6 months after randomization. The primary economic outcome was health service cost per QALY gained as the incremental cost-effectiveness ratio, based on 2019 US$ and a 6-month time horizon. Nonparametric bootstrapping was used to assess uncertainties and sensitivity analysis to examine the impact of hospitalization costs. RESULTS A total of 108 and 113 participants were enrolled among the intervention and standard arms, respectively. The intervention resulted in 0.04 (95% confidence interval [CI] 0.00-0.08) more QALYs 6 months after enrolment. The mean cost per participant in the intervention arm was $1001 (95% CI 968-1031), resulting in an incremental cost of the intervention of $640 (95% CI 595-679). The incremental cost-effectiveness ratio for the C-MAP intervention versus TAU was $16 254 (95% CI 7116-99 057) per QALY gained. The probability that C-MAP is cost-effective was between 66% and 83% for cost-effective thresholds between $20 000 and $30 000. Cost-effectiveness results remained robust to sensitivity analyses. CONCLUSIONS C-MAP may be a valuable self-harm intervention. Further studies with longer follow-up and larger sample sizes are needed to draw reliable conclusions.
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Affiliation(s)
- Mohsin H Alvi
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tinevimbo Shiri
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK; International Public Health, Liverpool School of Tropical Medicine, Liverpool, England, UK.
| | - Nasir Iqbal
- Pakistan Institute of Development Economics, Islamabad, Pakistan
| | - Mohammed Omair Husain
- Pakistan Institute of Learning and Living, Karachi, Pakistan; School of Biological Sciences, University of Manchester, Manchester, England, UK
| | - Imran Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan; School of Biological Sciences, University of Manchester, Manchester, England, UK; Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Sami Ansari
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK
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Alvi MH, Shiri T, Iqbal N, Husain MO, Chaudhry I, Shakoor S, Ansari S, Kiran T, Chaudhry N, Husain N. Cost-Effectiveness of a Culturally Adapted Manual-Assisted Brief Psychological Intervention for Self-Harm in Pakistan: A Secondary Analysis of the Culturally Adapted Manual-Assisted Problem-Solving Training Randomized Controlled Trial. Value Health Reg Issues 2021; 25:150-156. [PMID: 34198122 DOI: 10.1016/j.vhri.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Self-harm is a serious public health problem. A culturally adapted manual-assisted problem-solving training (C-MAP) intervention improved and sustained the reduction in suicidal ideation, hopelessness, and depression compared with treatment as usual (TAU) alone. Here, we evaluate its cost-effectiveness. METHODS Patients admitted after an episode of self-harm were randomized individually to either C-MAP plus TAU or TAU alone in Karachi. Improvement in health-related quality-adjusted life years (QALYs) was measured using the Euro Qol-5D-3L instrument at baseline and at 3 months and 6 months after randomization. The primary economic outcome was health service cost per QALY gained as the incremental cost-effectiveness ratio, based on 2019 US dollars and a 6-month time horizon. Nonparametric bootstrapping was used to assess uncertainties, and sensitivity analysis to examine the impact of hospitalization costs. RESULTS A total of 108 and 113 participants were enrolled among the intervention and standard arms, respectively. The intervention resulted in 0.04 more QALYs (95% confidence interval [CI] 0.00-0.08) 6 months after enrolment. The mean cost per participant in the intervention arm was US $1001 (95% CI 968-1031), resulting in an incremental cost of the intervention of US $640 (95% CI 595-679). The incremental cost-effectiveness ratio for the C-MAP intervention versus TAU was US $16 254 (95% CI 7116-99 057) per QALY gained. The probability that C-MAP is cost-effective was between 66% and 83% for cost-effective thresholds between US $20 000 and US $30 000. Cost-effectiveness results remained robust to sensitivity analyses. CONCLUSIONS C-MAP may be a valuable self-harm intervention. Further studies with longer follow-up and larger sample sizes are needed to draw reliable conclusions.
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Affiliation(s)
- Mohsin H Alvi
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tinevimbo Shiri
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK; International Public Health, Liverpool School of Tropical Medicine, Liverpool, England, UK.
| | - Nasir Iqbal
- Pakistan Institute of Development Economics, Islamabad, Pakistan
| | | | - Imran Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan; School of Biological Sciences, University of Manchester, Manchester, England, UK; Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
| | - Suleman Shakoor
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Sami Ansari
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK
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Perry AE, Waterman MG, Dale V, Moore K, House A. The effect of a peer-led problem-support mentor intervention on self-harm and violence in prison: An interrupted time series analysis using routinely collected prison data. EClinicalMedicine 2021; 32:100702. [PMID: 33681733 PMCID: PMC7910675 DOI: 10.1016/j.eclinm.2020.100702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Levels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison. METHODS An existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. Delivery of the intervention took two forms: (i) promotion of the intervention to fellow prisoners, offering support and raising awareness of the intervention but not delivering the skills and (ii) delivery of the problem-solving therapy skills to selected individual prisoners. Training and intervention adherence was measured using mentor log books. We used an Interrupted Time Series (ITS) design utilizing prison data over a 31 month period. Three ITS models and sensitivity analyses were used to address the impact across the whole prison and in the two groups by intervention delivery. Outcomes included self-harm and violent behaviour. Routine data were collected at monthly intervals 16 months pre-, 10 months during and six months post-intervention. Qualitative data measured the acceptability, feasibility, impact and sustainability of the intervention. A matched case-control study followed people after release to assess the feasibility of formal evaluation of the impact on re-offending up to 16 months. FINDINGS Our causal map identified that mental health and wellbeing in the prison were associated with environmental and social factors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. No significant reduction was found for incidence of violent behaviour. INTERPRETATION Universal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons. FUNDING Research Champions Fund and the Economic and Social Research Council Impact Acceleration Account Fund, University of York, UK.
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Affiliation(s)
- Amanda E. Perry
- Department of Health Sciences, University of York, York YO10 5DD, UK
- Corresponding author.
| | | | - Veronica Dale
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | | | - Allan House
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
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Hatcher S, Heisel M, Ayonrinde O, Campbell JK, Colman I, Corsi DJ, Edgar NE, Gillett L, Kennedy SH, Hunt SL, Links P, MacLean S, Mehta V, Mushquash C, Raimundo A, Rizvi SJ, Saskin R, Schaffer A, Sidahmed A, Sinyor M, Soares C, Taljaard M, Testa V, Thavorn K, Thiruganasambandamoorthy V, Vaillancourt C. The BEACON study: protocol for a cohort study as part of an evaluation of the effectiveness of smartphone-assisted problem-solving therapy in men who present with intentional self-harm to emergency departments in Ontario. Trials 2020; 21:925. [PMID: 33187542 PMCID: PMC7663866 DOI: 10.1186/s13063-020-04424-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/16/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients who present to emergency departments after intentional self-harm are at an increased risk of dying by suicide. This applies particularly to men, who represent nearly two-thirds of those who die by suicide in Ontario. One way of potentially addressing this gap is to offer a course of blended problem-solving therapy, comprised of a brief course of evidence-based psychotherapy for individuals at risk for suicide, facilitated by the use of a patient-facing smartphone application and a clinician-facing "dashboard." This approach has the potential to combine the benefits of face-to-face therapy and technology to create a novel intervention. METHODS This is a cohort study nested within a larger pragmatic multicentre pre- and post-design cluster randomised trial. Suicidal ideation assessed by the Beck Scale for Suicide Ideation is the primary outcome variable. Secondary outcome measures include depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder 7-item scale), post-traumatic stress disorder (Primary Care PTSD Screen), health-related quality of life (EuroQol 5-dimension 5-level questionnaire), meaning in life (Experienced Meaning in Life Scale), perceived social supports (Multidimensional Scale of Perceived Social Support), alcohol use (Alcohol Use Disorders Identification Test), drug use (Drug Abuse Screening Test Short Form 10), problem-solving skills (Social Problem-Solving Inventory-Revised Short Form), and self-reported healthcare costs, as well as health service use measured using Ontario administrative health data. A process evaluation will also be conducted following study completion. DISCUSSION The cohort study will test whether better adherence to the intervention results in better outcomes. The value of the cohort study design is that we can examine in more detail certain subgroups or other variables that are not available in the larger cluster randomised trial. This trial will aim to improve standards by informing best practice in management of men who self-harm and present to hospitals in Ontario. TRIAL REGISTRATION ClinicalTrials.gov , NCT03473535 . Registered on March 22, 2018.
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Affiliation(s)
- Simon Hatcher
- Ottawa Hospital Research Institute, Ottawa, Canada.
- University of Ottawa, Ottawa, Canada.
| | - Marnin Heisel
- Lawson Health Research Institute, London, Canada
- Western University, London, Canada
| | - Oyedeji Ayonrinde
- Queen's University, Kingston, Canada
- Kingston Health Sciences Centre, Kingston, Canada
| | | | | | - Daniel J Corsi
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | | | - Lindsay Gillett
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Sidney H Kennedy
- St. Michael's Hospital, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | - Sarah MacLean
- Ottawa Hospital Research Institute, Ottawa, Canada
- Carleton University, Ottawa, Canada
| | | | | | - Alicia Raimundo
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Sakina J Rizvi
- St. Michael's Hospital, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ayal Schaffer
- University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | | | - Mark Sinyor
- University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - Claudio Soares
- Queen's University, Kingston, Canada
- Kingston Health Sciences Centre, Kingston, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Valerie Testa
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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Sunnqvist C, Rämgård M, Örmon K. Time Geography, a Method in Psychiatric Nursing Care. Issues Ment Health Nurs 2020; 41:1004-1010. [PMID: 32585121 DOI: 10.1080/01612840.2020.1757795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients' life history is of primary interest in psychiatric nursing care. Our aim was to illustrate how we used time geography as a method to identify individuals' patterns in relation to certain situations in place. We have used interviews and diaries to construct life charts by hand and with a computer software program. By using time geography, we provide a rich amount of information, which can generate a broader picture of a person's life, to identify stressful as well as social aspects of a person's life. Patients with mental ill health need and value the therapeutic relationship using time geography.
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Affiliation(s)
- Charlotta Sunnqvist
- Malmo University, Faculty of Health and Society, Care Sciences, Malmo, Sweden
| | - Margareta Rämgård
- Malmo University, Faculty of Health and Society, Care Sciences, Malmo, Sweden
| | - Karin Örmon
- Malmo University, Faculty of Health and Society, Care Sciences, Malmo, Sweden
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Rajalin M, Hirvikoski T, Renberg ES, Åsberg M, Jokinen J. Exposure to Early Life Adversity and Interpersonal Functioning in Attempted Suicide. Front Psychiatry 2020; 11:552514. [PMID: 33093835 PMCID: PMC7527599 DOI: 10.3389/fpsyt.2020.552514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Early life adversity (ELA) may lead to an increased risk for mental health problems including suicidal behavior. ELA alters biological stress systems that affect behavior and control within the individual that in turn will affect interpersonal behavior. Strained relations and interpersonal conflicts leading to rejection and isolation have been shown to be factors for suicidal behavior. Difficulties in interpersonal relationships are a common reason for seeking help in psychiatric care. In the present study, we examined relationship between different types of interpersonal problems and adverse childhood experiences in patients with a recent suicide attempt. METHOD The study included 181 recent suicide attempters. We assessed early life adversity and specific interpersonal problems by using the Karolinska Interpersonal Violence Scale and the Inventory of Interpersonal problems respectively. RESULTS Suicide attempters with high levels of early life adversity expressed a more socially avoidant, non-assertive, and exploitable personal style even after adjustment for comorbidities with personality disorder and substance use disorder. CONCLUSIONS Patients with a recent suicide attempt with high levels of early life adversity tend to isolate themselves, of being introvert, and having difficulties to open up and confide in others. They report low self-confidence and self-esteem and problems with feeling and expressing anger. These behaviors complicate interaction with others and make establishment of solid relationships more difficult. In regards to detection of suicidal communication and treatment of suicidal patients, this may lead to misinterpretations and difficulties to fully benefit from treatment given or for professionals to provide the appropriate treatment. Clinicians should closely investigate the presence of early life adversity in suicidal patients and pay attention to their personal style and their difficulties in interpersonal exchange.
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Affiliation(s)
- Mia Rajalin
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
- Centre for Psychiatry Research, Stockholm, Stockholm County Council, Stockholm, Sweden
| | - Tatja Hirvikoski
- Paediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | | | - Marie Åsberg
- Department of Clinical Sciences, Danderyd Hospital (KI DS), Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
- Centre for Psychiatry Research, Stockholm, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder. Harv Rev Psychiatry 2020; 27:217-232. [PMID: 31219881 DOI: 10.1097/hrp.0000000000000212] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross's extended process model of ER and Linehan's updated theoretical account on the development of emotion dysregulation.
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Perry A, Waterman MG, House A, Wright-Hughes A, Greenhalgh J, Farrin A, Richardson G, Hopton AK, Wright N. Problem-solving training: assessing the feasibility and acceptability of delivering and evaluating a problem-solving training model for front-line prison staff and prisoners who self-harm. BMJ Open 2019; 9:e026095. [PMID: 31585968 PMCID: PMC6797432 DOI: 10.1136/bmjopen-2018-026095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/24/2019] [Accepted: 06/13/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Problem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study. DESIGN AND SETTING A mixed-methods design used routinely collected data, individual outcome measures, an economic protocol and qualitative interviews at four prisons in Yorkshire and Humber, UK. PARTICIPANTS (i) Front-line prison staff, (ii) male and female prisoners with an episode of self-harm in the previous 2 weeks. INTERVENTION The intervention comprised a 1 hour staff training session and a 30 min prisoner session using adapted workbooks and case studies. OUTCOMES We assessed the study processes-coverage of training; recruitment and retention rates and adequacy of intervention delivery-and available data (completeness of outcome data, integrity of routinely collected data and access to the National Health Service (NHS) resource information). Prisoner outcomes assessed incidence of self-harm, quality of life and depression at baseline and at follow-up. Qualitative findings are presented elsewhere. RESULTS Recruitment was higher than anticipated for staff n=280, but lower for prisoners, n=48. Retention was good with 43/48 (89%) prisoners completing the intervention, at follow-up we collected individual outcome data for 34/48 (71%) of prisoners. Access to routinely collected data was inconsistent. Prisoners were frequent users of NHS healthcare. The additional cost of training and intervention delivery was deemed minimal in comparison to 'treatment as usual'. Outcome measures of self-harm, quality of life and depression were found to be acceptable. CONCLUSIONS The intervention proved feasible to adapt. Staff training was delivered but on the whole it was not deemed feasible for staff to deliver the intervention. A large-scale study is warranted, but modifications to the implementation of the intervention are required.
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Affiliation(s)
| | | | - Allan House
- Academic Unit of Psychiatry, University of Leeds, Leeds, UK
| | | | | | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Nat Wright
- Spectrum Community Health CIC, Wakefield, UK
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Perry AE, Waterman MG, House AO, Greenhalgh J. Implementation of a problem-solving training initiative to reduce self-harm in prisons: a qualitative perspective of prison staff, field researchers and prisoners at risk of self-harm. HEALTH & JUSTICE 2019; 7:14. [PMID: 31368051 PMCID: PMC6717963 DOI: 10.1186/s40352-019-0094-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Social problem-solving is one technique used to help reduce incidence of self-harm. Our study evaluated the feasibility and acceptability of the adaptation and implementation of a brief Problem-Solving Training (PST) intervention to reduce self-harm in prisons. METHODS The process involved i) adaptation of the training materials using focus groups with prison staff and prisoners, ii) training frontline prison staff to use the skills, and iii) implementation of the skills with prisoners at risk of self-harm. Qualitative interviews were conducted with prison staff, prisoners and field researchers and were analysed using a thematic framework to produce a model of the barriers and facilitators to the process. RESULTS We conducted 43 interviews across three prison sites. The interviews included 19 prison staff, 18 prisoners and six field researcher meetings. The adaptation to the training and intervention materials were well received. The findings identified the need to support training using a collaborative and flexible approach. Prisoner engagement was affected by their own personal circumstances and by a range of contextual issues relating to the prison environment. Implementation of the skills by prison staff were hindered by resource constraints, the prison environment and staff attitudes. CONCLUSIONS We found that it was feasible to adapt an existing intervention and contextualise it within the prison environment. Although we could train large numbers of staff it was deemed unfeasible for staff to implement the problem-solving skills to prisoners at risk of self-harm. Prisoners who engaged with the intervention reported a range of benefits. Alternative implementation mechanisms to tackle the contextual barriers proposed by staff and prisoners included delivery of the intervention using an educational setting and/or use of a prisoner peer-led scheme.
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Affiliation(s)
- Amanda E. Perry
- Department of Health Sciences, University of York, Fulford, York, YO10 5DD UK
| | | | - Allan O. House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Joanne Greenhalgh
- Sociology and Social Policy, Faculty of Education and Social Science and Law, University of Leeds, Leeds, LS2 9JT UK
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Spitzer C, Armbrust M, Aalderink T, Dreyße K, Masuhr O, Jaeger U, Euler S. Dialektisch-Behaviorale Therapie bei Männern mit Borderline-Persönlichkeitsstörung. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0348-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Improving Health-Related Quality of Life and Reducing Suicide in Primary Care: Can Social Problem–Solving Abilities Help? Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-0019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Carbajal JM, Gamboa JL, Moore J, Smith F, Ann Eads L, Clothier JL, Cáceda R. Response to unfairness across the suicide risk spectrum. Psychiatry Res 2017; 258:365-373. [PMID: 28888697 DOI: 10.1016/j.psychres.2017.08.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022]
Abstract
Suicidal behavior is frequently triggered by social crises, such as familial, romantic, social or work-related conflict. A variety of cognitive and social functioning impairments has been associated with suicidal thoughts and acts. One of the precipitating and perpetuating factors of social conflict is the desire for retribution after a perceived offense, even at one's own detriment. We utilized the Ultimatum Game-a behavioral economic task which examines the behavioral response to perceived unfairness-in order to characterize the response to unfairness across the acute suicide risk spectrum. We examined five groups of adult individuals of both genders (n = 204): High- and Low-Lethality recent Suicide Attempters, Suicidal Ideators, Non-Suicidal Depressed Patients; and Healthy Controls. We also measured demographic and clinical variables. Even though all depressed groups showed similar rejection rates in the Ultimatum Game, there was a higher likelihood of rejecting offers in the low stakes condition in all acutely suicidal groups compared with healthy controls. Stake size, offer, education, and gender of the proposer were significantly associated with rejection rates. Acutely suicidal patients may be more vulnerable to adverse interpersonal interactions. Further characterization of social behavior may provide targets for secondary and tertiary prevention for high-risk individuals.
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Affiliation(s)
| | - Jorge L Gamboa
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jordan Moore
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Favrin Smith
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lou Ann Eads
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey L Clothier
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ricardo Cáceda
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Lu J, Huffman K. A Meta-Analysis of Correlations between Trait Mindfulness and Impulsivity: Implications for Counseling. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2017. [DOI: 10.1007/s10447-017-9302-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fazakas-DeHoog LL, Rnic K, Dozois DJA. A Cognitive Distortions and Deficits Model of Suicide Ideation. EUROPES JOURNAL OF PSYCHOLOGY 2017; 13:178-193. [PMID: 28580021 PMCID: PMC5450979 DOI: 10.5964/ejop.v13i2.1238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/21/2017] [Indexed: 12/22/2022]
Abstract
Although cognitive distortions and deficits are known risk factors for the development and escalation of suicide ideation and behaviour, no empirical work has examined how these variables interact to predict suicide ideation. The current study proposes an integrative model of cognitive distortions (hopelessness and negative evaluations of self and future) and deficits (problem solving deficits, problem solving avoidance, and cognitive rigidity). To test the integrity of this model, a sample of 397 undergraduate students completed measures of deficits, distortions, and current suicide ideation. A structural equation model demonstrated excellent fit, and findings indicated that only distortions have a direct effect on suicidal thinking, whereas cognitive deficits may exert their effects on suicide ideation via their reciprocal relation with distortions. Findings underscore the importance of both cognitive distortions and deficits for understanding suicidality, which may have implications for preventative efforts and treatment.
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Affiliation(s)
- Laura L Fazakas-DeHoog
- St. Joseph's Health Care - Regional Mental Health Care St. Thomas, St. Thomas, Ontario, Canada.,Department of Psychology, The University of Western Ontario, London, Ontario, Canada
| | - Katerina Rnic
- Department of Psychology, The University of Western Ontario, London, Ontario, Canada
| | - David J A Dozois
- Department of Psychology, The University of Western Ontario, London, Ontario, Canada
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Rajalin M, Hirvikoski T, Salander Renberg E, Åsberg M, Jokinen J. Family history of suicide and interpersonal functioning in suicide attempters. Psychiatry Res 2017; 247:310-314. [PMID: 27951478 DOI: 10.1016/j.psychres.2016.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/25/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Abstract
Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters' interpersonal problems is of importance to lower their distress.
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Affiliation(s)
- Mia Rajalin
- Department of Clinical Sciences, Umeå University, Umeå, Sweden.
| | - Tatja Hirvikoski
- Department of Women's and Children's Health, Paediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden; Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | | | - Marie Åsberg
- Department of Clinical Sciences, Danderyd Hospital (KI DS), Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences, Umeå University, Umeå, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Comparison of Clinical Characteristics between Single and Repeated Suicide Attempters Admitted to Emergency Room. ACTA ACUST UNITED AC 2016. [DOI: 10.4306/jknpa.2016.55.3.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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McAuliffe C, McLeavey BC, Fitzgerald T, Corcoran P, Carroll B, Ryan L, O'Keeffe B, Fitzgerald E, Hickey P, O'Regan M, Mulqueen J, Arensman E. Group problem-solving skills training for self-harm: randomised controlled trial. Br J Psychiatry 2015; 204:383-90. [PMID: 24434070 DOI: 10.1192/bjp.bp.111.101816] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services. AIMS To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services. METHOD A total of 433 participants (aged 18-64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up. RESULTS The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group. CONCLUSIONS This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.
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Affiliation(s)
- Carmel McAuliffe
- Carmel McAuliffe, BA, HDip, MPhil, MA, PhD, Health Service Executive South/National Suicide Research Foundation, Cork, and Department of Epidemiology & Public Health, University College Cork, Ireland; Breda C. McLeavey, BSc, MA, PhD, Health Service Executive South, Department of Psychiatry, Cork University Hospital, Ireland; Tony Fitzgerald, BSc, MSc, MS, ScD, Department of Epidemiology and Public Health, University College Cork, Ireland; Paul Corcoran, BSc, MSc, PhD, National Suicide Research Foundation, Cork, Ireland; Bernie Carroll, BSc, Louise Ryan, BSc, Health Service Executive West, St Joseph's Hospital, Limerick, Ireland; Brian O'Keeffe, BA, DipClinPsychol, Health Service Executive West, Tevere Day Hospital, Limerick, Ireland; Eva Fitzgerald, BA, HDipPsychol, Portia Hickey, BSc, Mary O'Regan, BA, MPhil, National Suicide Research Foundation, Cork, Ireland; Jillian Mulqueen, BA, Health Service Executive West, St Joseph's Hospital, Limerick, Ireland; Ella Arensman, MSc, PhD, National Suicide Research Foundation, and Department of Epidemiology & Public Health, University College Cork, Ireland
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Jahn DR, Cukrowicz KC, Mitchell SM, Poindexter EK, Guidry ET. The Mediating Role of Perceived Burdensomeness in Relations Between Domains of Cognitive Functioning and Indicators of Suicide Risk. J Clin Psychol 2015; 71:908-19. [PMID: 26016884 DOI: 10.1002/jclp.22190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Psychiatric inpatients are at elevated risk for suicide, but there are mixed findings regarding cognitive functioning (i.e., executive functioning and problem-solving abilities) and suicide risk in this population. We hypothesized that a mediating variable (i.e., perceived burdensomeness) may explain these mixed findings. METHOD This hypothesis was tested in a sample of psychiatric inpatients admitted for suicide-related concerns (N = 110; 58.18% female, M(age) = 36.45) using a nonparametric bootstrapping procedure. RESULTS Perceived burdensomeness did not act as a mediator between any domain of cognitive functioning and current suicide ideation nor presence of recent suicide attempts. However, perceived burdensomeness was the strongest predictor of suicide ideation and mediated the relation between objective problem-solving skill and suicide risk (a weighted variable comprising current ideation and previous attempts). CONCLUSIONS Perceived burdensomeness may be associated with elevated suicide ideation, suggesting that perceived burdensomeness should be assessed to inform suicide risk decisions.
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Hagen EH, Watson PJ, Hammerstein P. Gestures of Despair and Hope: A View on Deliberate Self-harm From Economics and Evolutionary Biology. ACTA ACUST UNITED AC 2015. [DOI: 10.1162/biot.2008.3.2.123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Quiñones V, Jurska J, Fener E, Miranda R. Active and passive problem solving: moderating role in the relation between depressive symptoms and future suicidal ideation varies by suicide attempt history. J Clin Psychol 2015; 71:402-12. [PMID: 25760651 DOI: 10.1002/jclp.22155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research suggests that being unable to generate solutions to problems in times of distress may contribute to suicidal thoughts and behavior, and that depression is associated with problem-solving deficits. This study examined active and passive problem solving as moderators of the association between depressive symptoms and future suicidal ideation among suicide attempters and nonattempters. METHOD Young adults (n = 324, 73% female, mean age = 19, standard deviation = 2.22) with (n = 78) and without (n = 246) a suicide attempt history completed a problem-solving task, self-report measures of hopelessness, depression, and suicidal ideation at baseline, and a self-report measure of suicidal ideation at 6-month follow-up. RESULTS Passive problem solving was higher among suicide attempters but did not moderate the association between depressive symptoms and future suicidal ideation. Among attempters, active problem solving buffered against depressive symptoms in predicting future suicidal ideation. CONCLUSIONS Suicide prevention should foster active problem solving, especially among suicide attempters.
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Husain N, Afsar S, Ara J, Fayyaz H, Rahman RU, Tomenson B, Hamirani M, Chaudhry N, Fatima B, Husain M, Naeem F, Chaudhry IB. Brief psychological intervention after self-harm: randomised controlled trial from Pakistan. Br J Psychiatry 2014; 204:462-70. [PMID: 24676964 DOI: 10.1192/bjp.bp.113.138370] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-harm is a major risk factor for completed suicide. AIMS To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU). METHOD The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation. RESULTS A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU. CONCLUSIONS The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.
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Affiliation(s)
- Nusrat Husain
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Salahuddin Afsar
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Jamal Ara
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Hina Fayyaz
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Raza Ur Rahman
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Barbara Tomenson
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Munir Hamirani
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Nasim Chaudhry
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Batool Fatima
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Meher Husain
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Farooq Naeem
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Imran B Chaudhry
- Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
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Sunnqvist C, Persson U, Westrin A, Träskman-Bendz L, Lenntorp B. Grasping the dynamics of suicidal behaviour: combining time-geographic life charting and COPE ratings. J Psychiatr Ment Health Nurs 2013; 20:336-44. [PMID: 22591326 DOI: 10.1111/j.1365-2850.2012.01928.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY • A primary aim of suicide research is to gain a profound knowledge of the suicidal individual so preventive strategy can be formulated. • Time-geographic life charting used in combination with the pattern of coping strategies may be helpful when assessing risk of suicidal behaviour. • It can also be a therapeutic intervention to look back and to reflect coping styles. ABSTRACT The aim of this study is to explore whether a time-geographic life charting, combined with a survey of a person's coping capacities over time, elucidates the pathway to suicidal behaviour, and therefore could be useful in suicide prevention. Twenty-three patients were recruited shortly after a suicide attempt. A time-geographic life charting and COPE inventory ratings were used separately and in combination. According to COPE ratings, the participants could be divided into three groups using different coping strategies: (1) adaptive, (2) maladaptive, and (3) both adaptive and maladaptive coping. Within these subgroups, three different pathways to suicidal behaviour were described and illustrated. We conclude that time-geographic life charting used in combination with the pattern of coping strategies may be helpful when assessing risk of suicidal behaviour, because this approach strengthens the comprehensive picture of the patient's life situation.
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Affiliation(s)
- C Sunnqvist
- Senior Lecturer, Faculty for Health and Society/Nursing Sciences, Malmö University, Malmö Research Assistant Associate Professor Professor, Department of Clinical Sciences, Psychiatry, Lund University Hospital, Lund Professor Emeritus, Department of Human Geography, Stockholm University, Stockholm, Sweden
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Wupperman P, Fickling M, Klemanski DH, Berking M, Whitman JB. Borderline personality features and harmful dysregulated behavior: the mediational effect of mindfulness. J Clin Psychol 2013; 69:903-11. [PMID: 23460412 DOI: 10.1002/jclp.21969] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The current preliminary study investigated whether deficits in mindfulness (awareness, attentiveness, and acceptance of the present experience) may underlie the relationship of borderline personality disorder (BPD) features to self-injury and overall acts of harmful dysregulated behavior. METHOD Nonparametric bootstrapping procedures were used to examine theoretical relationships among variables in a psychiatric sample of adults (N = 70). Participants were asked to imagine themselves in distress-inducing situations and then write what they would actually do to decrease distress in such situations. RESULTS As hypothesized, mindfulness statistically mediated the relationship of BPD features to reported acts of (a) self-injury and (b) overall harmful dysregulated behaviors. CONCLUSIONS Difficulties in the ability to be aware, attentive, and accepting of ongoing experience may play a role in the relationship of BPD features to harmful dysregulated behaviors. Future research should clarify potential reciprocal effects between BPD features and mindfulness with prospective, multioccasion designs.
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Sunnqvist C, Träskman-Bendz L, Westrin Å. Coping strategies used by suicide attempters and comparison groups. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpsych.2013.32024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ghahramanlou-Holloway M, Bhar SS, Brown GK, Olsen C, Beck AT. Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Psychol Med 2012; 42:1185-1193. [PMID: 22008384 DOI: 10.1017/s0033291711002169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive therapy has been found to be effective in decreasing the recurrence of suicide attempts. A theoretical aim of cognitive therapy is to improve problem-solving skills so that suicide no longer remains the only available option. This study examined the differential rate of change in problem-solving appraisal following suicide attempts among individuals who participated in a randomized controlled trial for the prevention of suicide. METHOD Changes in problem-solving appraisal from pre- to 6-months post-treatment in individuals with a recent suicide attempt, randomized to either cognitive therapy (n = 60) or a control condition (n = 60), were assessed by using the Social Problem-Solving Inventory-Revised, Short Form. RESULTS Improvements in problem-solving appraisal were similarly observed for both groups within the 6-month follow-up. However, during this period, individuals assigned to the cognitive therapy condition demonstrated a significantly faster rate of improvement in negative problem orientation and impulsivity/carelessness. More specifically, individuals receiving cognitive therapy were significantly less likely to report a negative view toward life problems and impulsive/carelessness problem-solving style. CONCLUSIONS Cognitive therapy for the prevention of suicide provides rapid changes within 6 months on negative problem orientation and impulsivity/carelessness problem-solving style. Given that individuals are at the greatest risk for suicide within 6 months of their last suicide attempt, the current study demonstrates that a brief cognitive intervention produces a rapid rate of improvement in two important domains of problem-solving appraisal during this sensitive period.
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Affiliation(s)
- M Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Linda WP, Marroquín B, Miranda R. Active and passive problem solving as moderators of the relation between negative life event stress and suicidal ideation among suicide attempters and non-attempters. Arch Suicide Res 2012; 16:183-97. [PMID: 22852781 DOI: 10.1080/13811118.2012.695233] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined whether active problem solving would buffer against, whereas passive problem solving would exacerbate, the association of negative life stress with suicidal ideation. Young adult college students (73 females, M(age) = 19.0) from a diverse urban public university, with (n = 37) and without (n = 59) a suicide attempt history completed measures of life stress, problem solving, hopelessness, depression, and suicidal ideation. Hierarchical linear regressions were conducted to test moderating roles of active and passive problem solving, along with suicide attempt history, on the relation between negative life event stress and suicidal ideation. There was a weaker relation between life stress and suicidal ideation at high and average levels of relevant problem solving than at low levels, and this was the case primarily for suicide attempters but not for non-attempters. Individuals with a past attempt produced more passive solutions than non-attempters, but among attempters, even passive problem solving buffered the association of life stress with suicidal ideation. Relevant problem solving in the face of life stress may be especially important for individuals vulnerable to suicidal ideation due to an attempt history. Among such at-risk individuals, generating even passive solutions in the face of life stress may be more adaptive than generating few solutions. Thus, clinical interventions with suicide attempters that focus on generating solutions to problems, even if these are initially passive, may help mitigate the effect of life stress on suicidal ideation.
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Affiliation(s)
- Wendy P Linda
- Department of Psychology , Hunter College, City University of New York, NY, USA
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Gravesteijn C, Diekstra R, Sklad M, de Winter M. The Effects of a Dutch School-Based Social and Emotional Learning Programme (SEL) on Suicidality in Adolescents. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2011. [DOI: 10.1080/14623730.2011.9715664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McAuliffe C, Corcoran P, Hickey P, McLeavey BC. Optional thinking ability among hospital-treated deliberate self-harm patients: A 1-year follow-up study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 47:43-58. [PMID: 17681111 DOI: 10.1348/014466507x230958] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate the association between optional thinking (the ability to generate alternative solutions to interpersonal problems) in deliberate self-harm (DSH) patients and repeated self-harm. DESIGN A prospective study of the association between optional thinking in interpersonal problem solving and repeated DSH within 12 months. METHOD A non-consecutive sample (N=152) of DSH patients presenting to the Accident and Emergency department of an acute hospital in Cork city, Ireland, was assessed using a structured interview schedule including the Suicide Intent Scale, the Hopelessness Scale, and the Optional Thinking Test. Repetition within 1 year was established by checking Accident and Emergency records at all three city hospitals. Participants were categorized as repeaters if they engaged in at least one further hospital-treated DSH episode, or non-repeaters. RESULTS Approximately two-thirds (63.1%) of the sample had engaged in at least one act of DSH prior to their index episode. During follow-up 31 individuals (20.4%) repeated. History of self-harm was significantly associated with prospective repetition when considered alongside all the other predictor variables. Among first evers, low scores on the optional thinking test were significantly associated with the increased risk of repetition within 12 months. Among those with previous DSH, there was no evidence of an association between optional thinking and repetition within 12 months. CONCLUSIONS Poor optional thinking is associated with increased risk of repeated deliberate self-harm in those who present with a first self-harm episode. Interventions to improve optional thinking skills, delivered soon after a first DSH presentation, may be useful in preventing repetition.
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Moorey S. Managing the unmanageable: Cognitive behaviour therapy for deliberate self-harm. PSYCHOANALYTIC PSYCHOTHERAPY 2010. [DOI: 10.1080/02668731003708061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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O'Connor SS, Jobes DA, Lineberry TW, Michael Bostwick J. An investigation of emotional upset in suicide ideation. Arch Suicide Res 2010; 14:35-43. [PMID: 20112142 DOI: 10.1080/13811110903479029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Suicide Upsetness Assessment (SUA) was used to measure the phenomenological experience of emotional upset during active states of suicidal ideation. Forty-nine inpatients with a history of suicide-related behaviors at a Midwestern inpatient psychiatric hospital completed a battery of assessments during their inpatient hospital stay. After reviewing theories regarding suicidality by the research team, 6 separate categories related to suicidal ideation were created, which were then subdivided into groups. Chi-Square and Fisher Exact Tests provided information regarding characteristics of emotional upset most often associated with such suicide-related behaviors as frequency and lethality of past attempts. Emotional upset is a heterogeneous construct in suicidal individuals, the properties of which may provide for a more thorough risk assessment.
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Gibbs LM, Dombrovski AY, Morse J, Siegle GJ, Houck PR, Szanto K. When the solution is part of the problem: problem solving in elderly suicide attempters. Int J Geriatr Psychiatry 2009; 24:1396-404. [PMID: 19405045 PMCID: PMC3044335 DOI: 10.1002/gps.2276] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Depression, loss, and physical illness are associated with suicide in the elderly. However, the nature of individual vulnerability remains poorly understood. Poor problem solving has been suggested as a risk factor for suicide in younger adults. Unresolved problems may create an accumulation of stressors. Thus, those with perceived deficits in problem-solving ability may be predisposed to suicidal behavior. To test this hypothesis, we investigated whether elderly suicide attempters perceived their problem solving as deficient. METHODS Sixty-four individuals aged 60 and older participated in the study including depressed suicide attempters, depressed non-attempters, and non-depressed controls. The social problem solving inventory-revised: short-version was used to measure participants' perceived social problem solving, assessing both adaptive problem-solving dimensions (positive problem orientation and rational problem solving) and dysfunctional dimensions (negative problem orientation, impulsivity/carelessness, and avoidance). RESULTS Depressed elderly who had attempted suicide perceived their overall problem solving as deficient, compared to non-suicidal depressed and non-depressed elderly. Suicide attempters perceived their problems more negatively and approached them in a more impulsive manner. On rational problem solving and avoidant style sub-scales, suicide attempters did not differ from non-suicidal depressed. However, both depressed groups reported lower rational problem solving and higher avoidance compared to non-depressed controls. CONCLUSIONS A perception of life problems as threatening and unsolvable and an impulsive approach to problem solving appear to predispose vulnerable elderly to suicide attempts.
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Affiliation(s)
| | | | | | | | | | - Katalin Szanto
- Correspondence to: Dr K. Szanto, Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, 100 N Bellefield Ave, Pittsburgh, PA 15213, USA.
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van Beek W, Kerkhof A, Beekman A. Future oriented group training for suicidal patients: a randomized clinical trial. BMC Psychiatry 2009; 9:65. [PMID: 19811638 PMCID: PMC2767345 DOI: 10.1186/1471-244x-9-65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 10/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In routine psychiatric treatment most clinicians inquire about indicators of suicide risk, but once the risk is assessed not many clinicians systematically focus on suicidal thoughts. This may reflect a commonly held opinion that once the depressive or anxious symptoms are effectively treated the suicidal symptoms will wane. Consequently, many clients with suicidal thoughts do not receive systematic treatment of their suicidal thinking. There are many indications that specific attention to suicidal thinking is necessary to effectively decrease the intensity and recurrence of suicidal thinking. We therefore developed a group training for patients with suicidal thoughts that is easy to apply in clinical settings as an addition to regular treatment and that explicitly focuses on suicidal thinking. We hypothesize that such an additional training will decrease the frequency and intensity of suicidal thinking.We based the training on cognitive behavioural approaches of hopelessness, worrying, and future perspectives, given the theories of Beck, McLeod and others, concerning the lack of positive expectations characteristic for many suicidal patients. In collaboration with each participant in the training individual positive future possibilities and goals were challenged. METHODS/DESIGN We evaluate the effects of our program on suicide ideation (primary outcome measure). The study is conducted in a regular treatment setting with regular inpatients and outpatients representative for Dutch psychiatric treatment settings. The design is a RCT with two arms: TAU (Treatment as Usual) versus TAU plus the training. Follow up measurements are taken 12 months after the first assessment. DISCUSSION There is a need for research on the effectiveness of interventions in suicidology, especially RCT's. In our treatment program we combine aspects and interventions that have been proven to be useful in the treatment of suicidal thinking and behavior. TRIAL REGISTRATION ISRCTN56421759.
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Affiliation(s)
| | - Ad Kerkhof
- Vrije Universiteit, Dpt Clinical Psychology, Amsterdam; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Vrije Universiteit, Dpt Psychiatry, Amsterdam; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Abstract
This study investigated whether deficits in mindfulness (attention, awareness, and acceptance of the present moment) underlie variability in borderline personality disorder (BPD) features and related impairments in interpersonal functioning, impulsivity, and emotion regulation. A path analytic approach was used to examine the relationships of trait mindfulness with BPD features, interpersonal effectiveness, impulsive and passive emotion-regulation, and neuroticism in a psychiatric sample of adults (N = 70). As hypothesized, mindfulness was associated inversely with BPD features and core areas of dysfunction, and these associations continued when controlling for neuroticism. Furthermore, mindfulness deficits continued to predict BPD features even when interpersonal effectiveness, passive and impulsive emotion-regulation, and neuroticism were controlled. These findings suggest that mindfulness may be a unique predictor for the expression of BPD pathology. An emphasis on mindfulness may thus be crucial in enhancing the formulation and treatment of BPD.
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Williams JMG, Pollock LR. Factors mediating suicidal behaviour: Their utility in primary and secondary prevention. J Ment Health 2009. [DOI: 10.3109/09638239309016951] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Relationship Between Problem-Solving and Autobiographical Memory in Parasuicide Patients. Behav Cogn Psychother 2009. [DOI: 10.1017/s1352465800018397] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The relationship between effectiveness of interpersonal problem-solving and specificity of autobiographical memory was examined for 35 patients admitted to an inner-city District General Hospital following a deliberate drug-overdose. The results replicated those of Evans, Williams, O'Loughlin and Howells (1992) in finding a significant correlation between ineffective problem-solving and the over-general retrieval of autobiographical memories, giving further support to the suggestion that an over-general memory database may underpin the problem-solving deficits characteristic of parasuicide patients. However, the correlation coefficient computed was notably lower than in the Evans et al. study and an attempt is made to explain this discrepancy on the basis of differences in the levels of psychopathology between the patients involved in each study.
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Abstract
Recent developments in the understanding, assessment and treatment of suicidal behaviour are reviewed. The accumulated social and demographic knowledge of suicidal populations has proved to be clinically useful in shaping the general level of concern, but at the individual level an understanding of the psychological processes involved in suicidal behaviour is required. Studies examining psychological processes involved in suicidal behaviour is required. Studies examining psychological processes in parasuicidal groups have revealed a number of deficits, including poor interpersonal problem solving, hopelessness about the future, and reduced ability to regulate affect. Research has also begun to look at some of the processes underlying these deficits, such as over-general retrieval of autobiographical memories and reduced anticipation of specific positive experiences. The clinical picture is now more optimistic, with therapies, such as Dialectical Behaviour Therapy, which focus on using problem solving strategies with those clients who are most vulnerable to repeat parasuicide episodes, producing demonstrable delays in parasuicide and reduced risk of repetition. The importance of the relationship between research and clinical practice is emphasized.
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Oldershaw A, Grima E, Jollant F, Richards C, Simic M, Taylor L, Schmidt U. Decision making and problem solving in adolescents who deliberately self-harm. Psychol Med 2009; 39:95-104. [PMID: 18570698 DOI: 10.1017/s0033291708003693] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthy adolescents, and adults who engage in reward-driven, risky behaviours, demonstrate poor decision-making ability. Decision making in deliberate self-harm (DSH), a reward-driven, high-risk behaviour, has received little attention. This study assessed decision making and problem solving in adolescents with current or past SH. METHOD Decision making and problem solving were assessed using the Iowa Gambling Task (IGT) and the Means-Ends Problem-Solving Procedure (MEPS) respectively in 133 adolescents (57 healthy and 22 depressed controls with no SH history and 54 with SH history). A second analysis separated the SH group into current (n=30) and past (n=24) SH. RESULTS The collective performance of adolescents with SH history did not differ from depressed or healthy adolescents on the IGT. However, current self-harming adolescents had a trend towards more high-risk choices (p=0.06) than those with previous SH history and were the only group not to significantly improve over time, persisting with high-risk strategy throughout. Those who no longer self-harmed learnt to use a low-risk strategy similar to healthy and depressed controls. Recency of last SH episode correlated with IGT performance. Depressed participants performed well on the IGT but poorly on the MEPS. By contrast, both collective and divided SH groups had comparable MEPS scores to healthy controls, all performing better than depressed participants. CONCLUSION Poor decision making is present in adolescents who currently self-harm but not in those with previous history; improvement in decision-making skills may therefore be linked to cessation of self-harm. Depressed adolescents who do and do not self-harm may have distinct characteristics.
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Affiliation(s)
- A Oldershaw
- King's College London, Institute of Psychiatry, London, UK.
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High Suicide Risk After the Development of Cognitive and Working Memory Deficits Caused by Cannabis, Cocaine and Ecstasy Use. Subst Abus 2008; 28:25-30. [DOI: 10.1300/j465v28n01_04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Johnson J, Gooding P, Tarrier N. Suicide risk in schizophrenia: explanatory models and clinical implications, The Schematic Appraisal Model of Suicide (SAMS). Psychol Psychother 2008; 81:55-77. [PMID: 17919360 DOI: 10.1348/147608307x244996] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The objective of this paper was to evaluate the Cry of Pain model of suicide behaviour as applied to psychosis and to derive theoretically driven guidelines for prevention. Suicide risk in psychotic patients is a serious but poorly understood clinical and social problem. There is a dearth of psychological models to explain suicidal behaviour and to guide effective preventative clinical interventions. Understanding suicidal behaviour in psychosis may be facilitated by utilizing models from depression. The 'Cry of Pain' model of suicide is founded on an evolutionary approach to understanding suicidal behaviour in depression. METHODS The model was critically evaluated and relevant literature reviewed. RESULTS Although strengths of the model were identified, lack of clarity regarding the concepts of defeat, entrapment, and lack of rescue appeared to limit its theoretical and clinical utility. We suggest a modification to this model which replaces concepts of defeat, entrapment, and lack of rescue with a four-stage appraisal process in conjunction with information-processing biases and suicidal schema. CONCLUSIONS Methods of testing this model are suggested and guidelines for a clinical intervention (Cognitive Behavioural Suicide Prevention for Psychosis; CBSPp) are outlined.
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Affiliation(s)
- Judith Johnson
- School of Psychological Sciences, University of Manchester, Manchester, UK
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Sutherland K, Bryant RA. Social problem solving and autobiographical memory in posttraumatic stress disorder. Behav Res Ther 2008; 46:154-61. [PMID: 18022601 DOI: 10.1016/j.brat.2007.10.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 09/30/2007] [Accepted: 10/10/2007] [Indexed: 11/28/2022]
Affiliation(s)
- Kylie Sutherland
- School of Psychology, University of New South Wales, NSW, Australia
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Une approche psychothérapique méconnue: la résolution de problèmes sociaux. ANNALES MEDICO-PSYCHOLOGIQUES 2007. [DOI: 10.1016/j.amp.2006.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cho H, Hallfors DD, Iritani BJ. Early initiation of substance use and subsequent risk factors related to suicide among urban high school students. Addict Behav 2007; 32:1628-39. [PMID: 17210230 PMCID: PMC3744891 DOI: 10.1016/j.addbeh.2006.11.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 09/15/2006] [Accepted: 11/10/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between onset of substance use and risk factors related to suicide. METHOD 1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt. RESULTS In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors. CONCLUSIONS The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences.
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Affiliation(s)
- Hyunsan Cho
- The Pacific Institute for Research and Evaluation, 1516 E. Franklin St. Suite 200, Chapel Hill, NC 27514,
| | - Denise Dion Hallfors
- The Pacific Institute for Research and Evaluation, 1516 E. Franklin St. Suite 200, Chapel Hill, NC 27514,
| | - Bonita J. Iritani
- The Pacific Institute for Research and Evaluation, 1516 E. Franklin St. Suite 200, Chapel Hill, NC 27514,
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Bolton C, Gooding P, Kapur N, Barrowclough C, Tarrier N. Developing psychological perspectives of suicidal behaviour and risk in people with a diagnosis of schizophrenia: We know they kill themselves but do we understand why? Clin Psychol Rev 2007; 27:511-36. [PMID: 17229508 DOI: 10.1016/j.cpr.2006.12.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
People with a diagnosis of schizophrenia are at increased risk of suicidal behaviour yet little is understood of the psychological underpinnings of this vulnerability. The biopsychosocial 'Cry of Pain' model [Williams, J.M.G. (1997). Cry of pain. Harmondsworth: Penguin.] provides a broad framework from which to understand suicidal behaviour. However, the utility of the model in relation to suicide in schizophrenia has not yet been explored. This was the primary goal of this paper. Six components of the 'Cry of Pain' model were identified and evaluated with respect to whether they contributed to i. common transdiagnostic factors underlying suicide, ii. factors relating to co-morbid depression which account for suicidal behaviour, or iii. factors which are specific to schizophrenia and underlie suicide risk. The potential for applying the model to clinical management of suicide in schizophrenia is illustrated.
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Hirsch JK, Conner KR. Dispositional and explanatory style optimism as potential moderators of the relationship between hopelessness and suicidal ideation. Suicide Life Threat Behav 2006; 36:661-9. [PMID: 17250470 DOI: 10.1521/suli.2006.36.6.661] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To test the hypothesis that higher levels of optimism reduce the association between hopelessness and suicidal ideation, 284 college students completed self-report measures of optimism and Beck scales for hopelessness, suicidal ideation, and depression. A statistically significant interaction between hopelessness and one measure of optimism was obtained, consistent with the hypothesis that optimism moderates the relationship between hopelessness and suicidal ideation. Hopelessness is not inevitably associated with suicidal ideation. Optimism may be an important moderator of the association. The development of treatments to enhance optimism may complement standard treatments to reduce suicidality that target depression and hopelessness.
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Affiliation(s)
- Jameson K Hirsch
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, NY 14642-8409, USA.
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Brezo J, Paris J, Turecki G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand 2006; 113:180-206. [PMID: 16466403 DOI: 10.1111/j.1600-0447.2005.00702.x] [Citation(s) in RCA: 339] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. METHOD We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. RESULTS Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. CONCLUSION Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.
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Affiliation(s)
- J Brezo
- McGill Group for Suicide Studies, Douglas Hospital Research Center, McGill University, Montreal, Canada
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Kremers I, Spinhoven P, Van der Does A, Van Dyck R. Social problem solving, autobiographical memory and future specificity in outpatients with borderline personality disorder. Clin Psychol Psychother 2006. [DOI: 10.1002/cpp.484] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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