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Puno A, Kim J, Bhatia A, Jeong J, Kim R. Violence Against Children, Self-Harm, and Suicidal Behaviors: A Pooled and Country-Specific Analysis of Eight Low- and Middle-Income Countries. J Adolesc Health 2024; 75:60-68. [PMID: 38739049 DOI: 10.1016/j.jadohealth.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE This study assessed associations between experiences of physical or sexual violence in childhood and self-harm, suicidal ideation, and suicide attempts among young people in low- and middle-income countries (LMICs) and whether these associations varied by sex and perpetrator identity. METHODS We used nationally representative data from the Violence Against Children and Youth Surveys in eight LMICs (2017-2019). The analytic sample included 33,381 young men and women (ages 13-24 years). Multivariable logistic regressions with country-fixed effects were used to estimate the associations between childhood physical and sexual violence and the three outcomes. Stratified analyses were performed by country, participant's sex, and type of perpetrator (parent/caregiver, other adults, peers, and intimate partner). RESULTS About 40% of the participants reported physical childhood violence, and 10% experienced childhood sexual violence. Childhood violence was associated with increased odds of self-harm (physical violence: adjusted odds ratio [aOR]: 2.2, 95% confidence interval [CI]: 2.0-2.4; sexual violence: aOR: 2.7, 95%, CI: 2.3-3.0), suicidal ideation (physical: aOR: 3.0, 95% CI: 2.7-3.3; sexual: aOR: 4.0, 95%, CI: 3.6-4.5), and suicide attempts (physical: aOR: 3.6, 95% CI: 3.2-4.1; sexual: aOR: 4.9, 95%, CI: 4.3-5.7). Consistent findings were observed in country-specific analyses. The odds of all outcomes were highest among those who experienced childhood physical violence by intimate partners and childhood sexual violence by parents or caregivers. Young women who experienced childhood sexual violence had higher odds for all outcomes than young men. DISCUSSION Violence prevention and mental health programs for young people in LMICs should consider the types of violence experienced, the perpetrator, and the sex of the survivor.
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Affiliation(s)
- Abigail Puno
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea; Division of Biological Sciences, University of the Philippines Visayas, Iloilo, Philippines
| | - Jinseo Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Amiya Bhatia
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea; Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
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Shi X, Meng Y, Cheng B, Long L, Yin L, Ye A, Yi X, Ran M. Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants. Psychiatry Res 2024; 333:115762. [PMID: 38310687 DOI: 10.1016/j.psychres.2024.115762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
Traumatic events have significant negative impacts throughout one's life. We aimed to comprehensively examine the early associations between traumatic events and suicidality among adolescents. In a cross-sectional sample of 260,423 adolescents in Deyang, China in September 2021, we assessed individual traumatic events, cumulative types, and patterns, alongside suicide risk scores and ideation, attempts, or plans. Linear and Poisson regression models adjusted for demographic confounders evaluated the association. Robust associations existed between interpersonal violence-related traumatic events and higher suicidality, with physical abuse demonstrating the strongest correlation. Moreover, suicide risk scores displayed a clear trend, indicating a progressively stronger association with suicidality as cumulative traumatic event types increased. Four distinct traumatic patterns emerged, including low traumas, high physical abuse, high death/serious injuries of a loved one, and multiple traumas, with the latter showing the strongest association with suicidality. Notably, the stratified analysis showed these associations were more pronounced in females, urban residents, only children, left-behind children, and those aged 13-15, while weaker in participants from families with intact parental relationships and middle socioeconomic status. Understanding the role of demographic factors and traumatic patterns in identifying at-risk youth can enable early detection and targeted interventions for suicide-related concerns.
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Affiliation(s)
- Xinyi Shi
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lu Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Li Yin
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Anhong Ye
- Mental Health Center, Zigong Hospital Affiliated to Southwest Medical University, Zigong, Sichuan, PR China
| | - Xingjian Yi
- Department of Psychosomatic Medicine, Dazhou Yuanda United Hospital, Dazhou, Sichuan, PR China
| | - Maosheng Ran
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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Maddah Z, Negarandeh R, Rahimi S, Pashaeypoor S. Challenges of living with veterans with post-traumatic stress disorder from the perspective of spouses: a qualitative content analysis study. BMC Psychiatry 2024; 24:151. [PMID: 38383353 PMCID: PMC10882771 DOI: 10.1186/s12888-024-05572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The needs and characteristics of veterans with post-traumatic stress disorder (PTSD) create significant challenges in family life, particularly for spouses. Identifying the nature of these challenges from the perspective of spouses leads to a more comprehensive and profound understanding of their existing problems and can be used for targeted interventions. Therefore, this research was conducted to explore the challenges of living with veterans suffering from PTSD from the perspective of their spouses. METHODS This qualitative study used conventional content analysis to explore Challenges of spouses of veterans with post-traumatic stress disorder. Fifteen spouses of veterans with PTSD from the Veterans Affairs Center in Iran between June 2022 and January 2023, were purposively selected to participate in the study. Semi-structured in-depth interviews were conducted to collect data. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using the method proposed by Graneheim and Lundman content analysis method with the support of MAXQDA 2020 software. RESULTS The mean age of the participants was 56.74 ± 6.43 years. Through data analysis, seven main categories and sixteen subcategories were identified. These categories included burnout (sleep disturbances, feelings of exhaustion), apathy towards self-care and caring for the veteran (neglecting self-care, lack of interest in continuing care), depression (feelings of hopelessness and being at the end of the line, decreased self-confidence ( Crushed and ignored (being mistreated, having multiple roles), relationship disturbances (Dissatisfaction with marital relationship,isolation and limited social interactions, disconnection from God), financial burden (heavy costs of care, lack of insurance support), and declining social status (negative attitude of the society, suffering from discrimination and inequality). CONCLUSION The consequences of PTSD-related injuries in veterans directly and indirectly affect the overall living conditions of their spouses. These spouses experience emotional detachment and constant rejection, leading to a decrease in their resilience against existing stressors and exposing them to disruptive and challenging issues in individual, family, and social dimensions of life that affect their physical and mental well-being. Therefore, these spouses require empowerment and access to social support in dimensions of educational, caregiving, therapeutic, and supportive. It is recommended that health policymakers pay special attention to designing up-to-date interventions to enhance the health of these spouses in physical, mental, spiritual, and social dimensions.
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Affiliation(s)
- Zahra Maddah
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing & Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Rahimi
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
- Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics 2024; 153:e2023064800. [PMID: 38073403 DOI: 10.1542/peds.2023-064800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/02/2024] Open
Abstract
Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.
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Affiliation(s)
- Liwei L Hua
- Division of Integrated Behavioral Health, South Bend Clinic, South Bend, Indiana
| | - Janet Lee
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maria H Rahmandar
- Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric J Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado
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Núñez D, Gaete J, Guajardo V, Libuy N, Araneda AM, Contreras L, Donoso P, Ibañez C, Mundt AP. Brief Report: The Association of Adverse Childhood Experiences and Suicide-Related Behaviors Among 10th-Grade Secondary School Students. Arch Suicide Res 2024; 28:399-410. [PMID: 36330838 DOI: 10.1080/13811118.2022.2134067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The association between adverse childhood experiences and suicide-related behaviors (SRB) of adolescents has been widely studied in Western high-income countries, but not yet in Latin America. The aim of this study was to determine this association and to explore a dose-response relationship between adverse childhood experiences and SRB in Chile. We conducted a cross-sectional survey to assess adverse childhood experiences up to 1 year prior to the survey and SRB (suicide ideation and attempts) in a sample of secondary school students. Multilevel and multivariable logistic regressions were run with SRB as dependent and adverse childhood experiences as independent variables, adjusted by self-esteem, general mental health, friend and parental support, and the age at onset of cannabis and alcohol use. We included 7,458 adolescents (48.7% girls), mean age = 16.0 (SD = 0.7), and found a prevalence of 78.1% for at least one adverse childhood experience. The 6-month prevalence of suicidal ideation was 18.1% (95% confidence interval [CI]: 17.2%-19.0%), and the prevalence of suicide attempts was 5.0% (95% CI: 4.6-5.6). Among all adverse childhood experiences, only sexual abuse was a risk factor for both SRB. We also found an independent effect of the total number of adverse childhood experiences on suicidal ideation (p < .001) and on suicide attempts (p < .001). Additionally, ages at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively. This is the first study exploring the influence of adverse childhood experiences on suicide-related behaviors in adolescents from Latin America.HIGHLIGHTSSexual abuse is associated with suicidal ideation and suicide attempts in 10th-grade secondary school studentsThere is a dose-response effect between adverse childhood experiences and suicide-related behaviorAges at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively.
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Chen P, Zhang L, Feng Y, An FR, Su Z, Cheung T, Lok KI, Ungvari GS, Jackson T, Xiang YT, Zhang Q. Prevalence and network structure of post-traumatic stress symptoms and their association with suicidality among Chinese mental health professionals immediately following the end of China's Dynamic Zero-COVID Policy: a national survey. Transl Psychiatry 2023; 13:395. [PMID: 38102131 PMCID: PMC10724192 DOI: 10.1038/s41398-023-02680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
Studies on post-traumatic stress symptoms (PTSS) among mental health professionals (MHPs) are limited, particularly since restrictions due to coronavirus disease (COVID-19) have been lifted such as the recent termination of China's Dynamic Zero-COVID Policy. The current study filled this gap by exploring the prevalence, correlates, and network structure of PTSS as well as its association with suicidality from a network analysis perspective. A cross-sectional, national survey was conducted using a convenience sampling method on MHPs between January 22 and February 10, 2023. PTSS were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian version, while suicidality was assessed using standardized questions related to ideation, plans, and attempts. Univariate and multivariate analyses examined correlates of PTSS. Network analysis explored the structure of PTSS and suicidality. The centrality index of "Expected influence" was used to identify the most central symptoms in the network, reflecting the relative importance of each node in the network. The "flow" function was adopted to identify specific symptoms that were directly associated with suicidality. A total of 10,647 MHPs were included. The overall rates of PTSS and suicidality were 6.7% (n = 715; 95% CI = 6.2-7.2%) and 7.7% (n = 821; 95% CI = 7.2-8.2%), respectively. Being married (OR = 1.523; P < 0.001), quarantine experience (OR = 1.288; P < 0.001), suicidality (OR = 3.750; P < 0.001) and more severe depressive symptoms (OR = 1.229; P < 0.001) were correlates of more PTSS. Additionally, higher economic status (e.g., good vs. poor: OR = 0.324; P = 0.001) and health status (e.g., good vs. poor: OR = 0.456; P < 0.001) were correlates of reduced PTSS. PCL6 ("Avoiding thoughts"; EI = 1.189), PCL7 ("Avoiding reminders"; EI = 1.157), and PCL11 ("Feeling emotionally numb"; EI = 1.074) had the highest centrality, while PCL12 ("Negative belief"), PCL 16 ("Hypervigilance") and PCL 14 ("Irritability") had the strongest direct, positive associations with suicidality. A high prevalence of lingering PTSS was found among MHPs immediately after China's "Dynamic Zero-COVID Policy" was terminated. Avoidance and hyper-arousal symptoms should be monitored among at-risk MHPs after the COVID-19 pandemic and serve as potential targets for the prevention and treatment of PTSS in this population.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ka-In Lok
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Hennefield L, Whalen DJ, Tillman R, Barch DM, Luby JL. Preschool-Onset Major Depressive Disorder as a Strong Predictor of Suicidal Ideation and Behaviors Into Preadolescence. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02236-0. [PMID: 38070867 PMCID: PMC11156793 DOI: 10.1016/j.jaac.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/28/2023] [Accepted: 11/30/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence. METHOD Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews. RESULTS By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p < .001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p = .012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p = .005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p = .018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence. CONCLUSION PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions.
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Affiliation(s)
| | - Diana J Whalen
- Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca Tillman
- Washington University School of Medicine, St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine, St. Louis, Missouri; Washington University in St Louis, St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine, St. Louis, Missouri
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Liu A, Liu M, Ren Y, Lin W, Wu X. Exploring gender differences in the relationships among childhood maltreatment, PTSD, and depression in young adults through network analysis. CHILD ABUSE & NEGLECT 2023; 146:106503. [PMID: 37922615 DOI: 10.1016/j.chiabu.2023.106503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVES College students who have experienced childhood maltreatment commonly exhibit adverse psychological consequences such as post-traumatic stress disorder (PTSD) and depression. The aim of this study is to use network analysis to investigate the gender differences in complex connections among various types of childhood maltreatment, PTSD, and depression. METHODS This study involved 481 participants (M = 19.25 years, 54.5 % female) who were selected from a larger sample of 5231 college students. These participants had experienced childhood maltreatment and exhibited significant clinical symptoms of PTSD and depression. The participants completed validated measures that assessed childhood trauma, PTSD, and depression. RESULTS The network analysis performed on the entire sample revealed robust connections among various types of childhood maltreatment, symptom clusters of PTSD, and depression. The most central symptom that emerged was negative alterations in cognitions and mood (NACM), with emotional abuse displaying the highest centrality measure among the various types of childhood maltreatment. Upon comparing the subnetworks, the centrality analysis identified significant gender differences in nodes such as sexual abuse, physical neglect, emotional neglect, and avoidance. CONCLUSIONS The study's findings confirm that various forms of childhood abuse have intricate and multifaceted connections with depression and PTSD symptoms in adulthood. The study suggests that NACM could be the most significant symptom, and emotional abuse may play a vital role in adverse psychological outcomes. Furthermore, notable gender discrepancies were identified in the relationship between various forms of maltreatment and psychopathological symptoms.
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Affiliation(s)
- Aiyi Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Mingxiao Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Yizhen Ren
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Wenzhou Lin
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
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Kangaslampi S, Zijlmans J. MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02310-9. [PMID: 37814082 DOI: 10.1007/s00787-023-02310-9] [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] [Received: 07/01/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.
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Affiliation(s)
- Samuli Kangaslampi
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland.
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Josjan Zijlmans
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam University Medical Center, Mental Health, Amsterdam, The Netherlands
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Zhao H, Li Y, Luo T, Chou W, Sun T, Liu H, Qiu H, Zhu D, Chen D, Gu Y. Preventing Post-Traumatic Stress Disorder (PTSD) in rats with pulsed 810 nm laser transcranial phototherapy. Transl Psychiatry 2023; 13:281. [PMID: 37580354 PMCID: PMC10425462 DOI: 10.1038/s41398-023-02583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating condition that occurs following exposure to traumatic events. Current treatments, such as psychological debriefing and pharmacotherapy, often have limited efficacy and may result in unwanted side effects, making early intervention is a more desirable strategy. In this study, we investigated the efficacy of a single dose of pulsed (10 Hz) 810 nm laser-phototherapy (P-PT) as an early intervention for preventing PTSD-like comorbidities in rats induced by single inescapable electric foot shock following the single prolonged stress (SPS&S). As indicated by the results of the open filed test, elevated plus maze test, and contextual fear conditioning test, P-PT prevented the development of anxiety and freezing behaviors in rats exposed to the SPS&S. We also compared the effects of P-PT and continuous wave 810 nm laser-phototherapy (CW-PT) in preventing PTSD-like comorbidities in rats. The results revealed that P-PT was effective in preventing both freezing and anxiety behavior in stressed rats. In contrast, CW-PT only had a preventive effect on freezing behavior but not anxiety. Additionally, P-PT significantly reduced the c-fos expression in cingulate cortex area 1(Cg1) and infralimbic cortex (IL) of stressed rats, while CW-PT had no significant effects on c-fos expression. Taken together, our results demonstrate that P-PT is a highly effective strategy for preventing the occurrence of PTSD-like comorbidities in rats.
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Affiliation(s)
- Hongyou Zhao
- School of Medical Technology, Beijing Institute of Technology, Beijing, China.
| | - Yi Li
- Department of Laser Medicine, the First Medical Center of the PLA General Hospital, Beijing, China
| | - Ting Luo
- Moores Cancer Center, University of California San Diego, San Diego, USA
| | - Wenxin Chou
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Tianzhen Sun
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Haolin Liu
- No.965 Hospital, Joint Logistics Support Force of Chinese PLA, Jilin, China
| | - Haixia Qiu
- Department of Laser Medicine, the First Medical Center of the PLA General Hospital, Beijing, China
| | - Dan Zhu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Defu Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China.
| | - Ying Gu
- Department of Laser Medicine, the First Medical Center of the PLA General Hospital, Beijing, China.
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Gaylord-Harden NK, Gilreath T, Burnside A, Mintah P, Lindsey MA. Profiles of Suicidal Ideation Among Black Male Adolescents: Examination of Individual and Socioecological Predictors. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-15. [PMID: 37418319 DOI: 10.1080/15374416.2023.2222395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVE The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms. METHOD A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms. RESULTS Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another. CONCLUSIONS The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.
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Affiliation(s)
| | - Tamika Gilreath
- Center for Health Equity and Evaluation Research, Texas A&M University
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12
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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13
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Yin Y, Han S, Guan J, Wang D, Wang H, Yuan TF, Yang Y. Posttraumatic stress disorder symptoms among healthcare workers during the Omicron era. Front Psychiatry 2023; 14:1140511. [PMID: 37293404 PMCID: PMC10244510 DOI: 10.3389/fpsyt.2023.1140511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Background The COVID-19 pandemic has caused significant psychological stress among healthcare workers. This study aimed to clarify the factors that influenced health workers' posttraumatic stress disorder (PTSD) symptoms. Method A total of 443 healthcare workers from eight Mental Health Centers in Shandong were recruited to attend an online survey. Participants completed self-evaluation measures of exposure to the COVID-19 environment and PTSD symptoms, as well as measures of potential protective factors such as euthymia and perceived social support. Results About 45.37% of healthcare workers had severe symptoms of PTSD symptoms. Healthcare workers with more serious PTSD symptoms were significantly related to higher exposure to COVID-19 (r = 0.177, p < 0.001), as well as lower levels of euthymia (r = -0.287, p < 0.001) and perceived social support (r = -0.236, p < 0.001). The structural equation model (SEM) further revealed that the impact of exposure to COVID-19 on PTSD symptoms was partially mediated by euthymia, and moderated by perceived social support, especially from others (e.g., friends, leaders, relatives and colleagues). Conclusion These findings suggested that improving the state of euthymia, getting social support from others could alleviate PTSD symptoms among healthcare workers during the COVID-19.
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Affiliation(s)
- YuanYuan Yin
- Shandong Mental Health Center, Jinan, Shandong, China
- Wenzhou Medical University, School of Mental Health, Wenzhou, Zhejiang, China
| | - Sizhu Han
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoqiong Guan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - DuanWei Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - HaiRong Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Ying Yang
- Shandong Mental Health Center, Jinan, Shandong, China
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14
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McClelland H, Evans JJ, O'Connor RC. The association of family, social and romantic loneliness in relation to suicidal ideation and self-injurious behaviours. J Psychiatr Res 2023; 158:330-340. [PMID: 36638623 DOI: 10.1016/j.jpsychires.2022.12.022] [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] [Received: 09/02/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Over 703,000 people die by suicide every year. The association between loneliness and self-injurious thoughts and behaviours has received increasing amounts of attention, with a significant link consistently being identified. However the impact that different types of loneliness have on physical and mental health remains under-researched. The current study aimed to explore how different forms of loneliness might be associated with self-injury, based on findings from existing theory-driven research. This cross-sectional online study investigated three types of loneliness (family, romantic, social) as well as loneliness as a unidimensional construct (global loneliness) in relation to suicidal ideation and several established variables associated with suicidal ideation (defeat, entrapment and depression). 582 participants (age 18-70 years) completed the survey between May and October 2021. Results showed that all forms of loneliness were associated with suicidal ideation, and all loneliness measures significantly, independently, moderated the association between entrapment and suicidal ideation. Furthermore, depression significantly mediated between family, romantic and global loneliness and suicidal ideation, but not social loneliness. The findings suggest that the quality and/or quantity of family, romantic and global relationships, should be explored when considering loneliness as a possible risk factor for suicidal ideation and may have a significant impact on mental and physical health. In particular, romantic loneliness may have a particularly adverse association with negative affect and suicidal ideation. Future work would benefit from replicating these findings longitudinally.
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Affiliation(s)
- Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Jonathan J Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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15
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Sabawoon A, Keyes KM, Karam E, Kovess-Masfety V. Associations between traumatic event experiences, psychiatric disorders, and suicidal behavior in the general population of Afghanistan: findings from Afghan National Mental Health Survey. Inj Epidemiol 2022; 9:31. [PMID: 36203184 PMCID: PMC9535941 DOI: 10.1186/s40621-022-00403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The role of traumatic event exposure and psychiatric disorders as central risk factors for suicidal behavior has been established, but there are limited data in high conflict regions with significant trauma exposures such as Afghanistan. Methods A nationally representative, cross-sectional survey was conducted through systematic stratified random sampling in 8 regions of Afghanistan in 2017 (N = 4474). Well-validated instruments were used to establish trauma exposure, psychiatric disorders. Death preference, suicidal ideation, plan, and attempts were assessed. Results In the total sample, 2.2% reported suicidal ideation in the past 12 months, and 7.1% of respondents reported that they had suicidal ideation at some point in their lives; 3.4% reported a suicide attempt. Women were at higher risk than men. All traumatic event exposures were strongly associated with suicidal behavior. Respondents who reported experiencing sexual violence were 4.4 times more likely to report lifetime suicide attempts (95% CI 2.3–8.4) and 5.8 times more likely to report past 12-month suicidal ideation (95% CI 2.7–12.4). Associations were strong and significant for all psychiatric disorders related to suicidal behavior. Respondents who met criteria for major depressive episodes (OR = 7.48; 95% CI 4.40–12.72), generalized anxiety disorder (OR = 6.61; 95% CI 3.54–12.33), and PTSD (OR = 7.26; 95% CI 4.21–12.51) had the highest risk of past 12-month suicidal ideation. Conclusion Traumatic event exposures and psychiatric disorders increase risk of suicidal behavior in the Afghan general population; women are at high risk. Interventions to reduce trauma exposure, including expansion of a mental health workforce in the region, are critically important.
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Affiliation(s)
- Ajmal Sabawoon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Elie Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon.,Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St. George Hospital University Medical Center University of Balamand, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Université de Paris, LPPS, Boulogne-Billancourt, France.,Department of Psychiatry, McGill University, Montreal, Canada
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16
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McRae E, Stoppelbein L, O’Kelley S, Smith S, Fite P. Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:715-725. [PMID: 35958716 PMCID: PMC9360295 DOI: 10.1007/s40653-022-00439-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 05/12/2023]
Abstract
Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.
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Affiliation(s)
- Elizabeth McRae
- The University of Alabama at Birmingham, Birmingham, Alabama US
| | | | - Sarah O’Kelley
- The University of Alabama at Birmingham, Birmingham, Alabama US
| | - Shana Smith
- Jacksonville State University, Jacksonville, Alabama US
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17
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Wang Y, Luo B, Hong B, Yang M, Zhao L, Jia P. The relationship between family functioning and non-suicidal self-injury in adolescents: A structural equation modeling analysis. J Affect Disord 2022; 309:193-200. [PMID: 35472474 DOI: 10.1016/j.jad.2022.04.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous research has suggested that depressive symptoms, emotional competence, and posttraumatic stress symptoms (PTSS) may mediate the association between family functioning and non-suicidal self-injury (NSSI). Therefore, this study aimed to evaluate the mediation effects of depressive symptoms, emotional competence, and COVID-related PTSS on the relationship between family functioning and NSSI in adolescents. METHOD A sample of 5854 adolescents was recruited from June 16 to July 8, 2020. The data for family functioning, depressive symptoms, emotional competence, COVID-related PTSS, and NSSI behavior of adolescents were collected via self-reported questionnaires. A structural equation model was constructed to examine the relationship, and a bootstrap analysis was conducted to evaluate the mediation effects. RESULTS The reporting rate of adolescent NSSI was 30.2%. The poor family functioning was positively associated with adolescent NSSI (β = 0.130, 95% CI = 0.093-0.182), which was mediated by depression with effect size of 0.231 (95% CI = 0.201-0.257). The pathway coefficients between emotional competence and NSSI, and depression, COVID-related PTSS and NSSI, though statistically significant were unlikely to be clinically meaning with values of 0.057 and 0.015. There was no mediating effect by COVID-related PTSS. The pathways initially constructed between family functioning and COVID-related PTSS, emotional capacity and COVID-related PTSS were not been verified. LIMITATIONS It was unclear whether this mediational effect would be supported in a longitudinal design. The application and extension of this model toward other regions and countries, and different ages need to be further explored. CONCLUSION The interventions of adolescent NSSI should focus on both the family level and individual levels. Improving family environment, screening depressive symptoms, enhancing emotional competence and lessening COVID-related PTSS may reduce NSSI.
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Affiliation(s)
- Yan Wang
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Binxue Hong
- Department of Health Policy and Management, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Min Yang
- Department of Health Policy and Management, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China; West China Research Centre for Rural Health Development, Sichuan University, Chengdu, China; Faculty of Health, Art and Design, Swinbune Technology University, Melbourne, Australia
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China; West China Research Centre for Rural Health Development, Sichuan University, Chengdu, China.
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
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18
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Naghavi A, Afsharzada MS, Brailovskaia J, Teismann T. Mental health and suicidality in Afghan students after the Taliban takeover in 2021. J Affect Disord 2022; 307:178-183. [PMID: 35390352 DOI: 10.1016/j.jad.2022.04.001] [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] [Received: 01/30/2022] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND On the 15th of August 2021, Kabul was captured by the Taliban, leading to the fall of the Islamic Republic of Afghanistan. The present study investigated PTSD symptoms, depression, suicide risk and facets of positive mental health in the immediate aftermath of the Taliban take-over. METHODS A total of 214 Afghan university students (73.7% women; age in years: M(SD) = 23.92 (5.77)) took part in this cross-sectional study between August and November 2021. Self-report measures of PTSD, depression, suicide ideation/behavior, positive mental health, social support, and posttraumatic growth were used. RESULTS Severe posttraumatic stress disorders symptoms were reported by 70%, clinically relevant depression symptoms were reported by 69.7% and significant suicide ideation/behavior was reported by 38.6% of the sample. Posttraumatic growth moderated the impact of depression on suicide risk. No interaction effects were found for positive mental health and social support. LIMITATION The study focused on a specific group of highly educated and predominantly female Afghan students limiting the generalizability of the findings. CONCLUSION PTSD symptoms, depression and suicidality show an alarmingly high prevalence in this specific sample of Afghan students. Various protective factors seem to be insufficient to buffer the association between PTSD, depression and suicide risk.
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Affiliation(s)
- Azam Naghavi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Iran
| | | | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
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19
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Teismann T, Naghavi A, Asgari Z, Grundei L, Brailovskaia J. Posttraumatic stress disorder symptoms and suicidal ideation/behavior: The moderating effects of positive mental health and social support among Iranian and German students. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractSuicidal ideation and behavior are common in those suffering from Posttraumatic Stress Disorder (PTSD). The present study investigated factors buffering the association between PTSD symptoms and suicidal ideation/behavior. A total of 571 Iranian students and 421 German students took part in the investigation. Social support and positive mental health (PMH) were considered as resilience factors moderating the association between PTSD symptoms and suicide ideation/behavior within both samples. PMH moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian and German students. Social support moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian students only. Positive mental health and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.
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20
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Spitzer EG, Benfer N, Zuromski KL, Marx BP, Witte TK. Examining unique and prospective relationships among self-injurious thoughts and behaviors and posttraumatic stress disorder: a network analysis in two trauma-exposed samples. Psychol Med 2022; 52:664-674. [PMID: 32605688 DOI: 10.1017/s0033291720002263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND As self-injurious thoughts and behaviors (SITB) remain a pressing public health concern, research continues to focus on risk factors, such as posttraumatic stress disorder (PTSD). Network analysis provides a novel approach to examining the PTSD-SITB relationship. This study utilized the network approach to elucidate how individual PTSD symptoms may drive and maintain SITB. METHODS We estimated cross-sectional networks in two samples of trauma-exposed adults (Sample 1: N = 349 adults; Sample 2: N = 1307 Veterans) to identify PTSD symptoms that may act as bridges to SITB. Additionally, we conducted a cross-lagged panel network in Sample 2 to further clarify the temporal relationship between PTSD symptoms and SITB during a 2-year follow-up. Finally, in both samples, we conducted logistic regressions to examine the utility of PTSD symptoms in prospectively predicting SITB, over a 15-day period (Sample 1) and over a 2-year period (Sample 2), allowing us to examine both short- and long-term prediction. RESULTS Two PTSD symptoms (i.e. negative beliefs and risky behaviors) emerged as highly influential on SITB in both cross-sectional networks. In the cross-lagged panel network, distorted blame emerged as highly influential on SITB over time. Finally, risky behaviors, unwanted memories, and psychological distress served as the strongest predictors of SITB across the two samples. CONCLUSIONS Overall, our results suggest that treatments targeting negative beliefs and risky behaviors may prevent SITB in community and Veteran populations, whereas treatments targeting distorted blame and unwanted memories may help reduce SITB for individuals with a history of combat trauma.
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Affiliation(s)
- Elizabeth G Spitzer
- Department of Psychology, Auburn University, Auburn, Alabama, USA
- National Center for PTSD at Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Natasha Benfer
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD at Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tracy K Witte
- Department of Psychology, Auburn University, Auburn, Alabama, USA
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21
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Ramos B, Dion J, Bőthe B, Girouard A, Hébert M, Wong E, Bergeron S. Cumulative interpersonal childhood adversity and post-traumatic stress symptoms across heterosexual, cisgender and gender and sexually diverse adolescents: The mediating role of emotion regulation. CHILD ABUSE & NEGLECT 2022; 124:105454. [PMID: 34991013 DOI: 10.1016/j.chiabu.2021.105454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emotion regulation has been identified as an explanatory factor in the association between interpersonal childhood adversity and post-traumatic stress symptoms (PTSS). However, most studies focused on adults or older adolescents, neglecting youth from the community, especially gender and sexually diverse (GSD) adolescents, who have a higher risk for exposure to adverse events and psychological difficulties, compared to their heterosexual, cisgender (HC) peers. OBJECTIVE The present cross-sectional study aimed to examine the mediating role of emotion regulation difficulties in the association between cumulative interpersonal childhood adversity and PTSS across HC and GSD adolescents. METHODS A sample of 2904 ninth grade students (Mage = 14.53, SD = 0.61) completed a self-report survey. Multigroup path analyses were conducted to examine the proposed mediation model in all groups, and comparisons were made using chi-square difference tests. RESULTS Greater difficulties in emotion regulation mediated the association between greater cumulative interpersonal childhood adversity (β = 0.36, p < .001) and greater PTSS (β = 0.35, p < .001) - regardless of HC or GSD status - although the direct association between cumulative interpersonal childhood adversity and PTSS was significantly stronger among GSD boys (β = 0.36, p < .001) and GSD girls (β = 0.35, p < .001) than among HC boys (β = 0.21, p < .001) and HC girls (β = 0.25, p < .001). CONCLUSIONS Findings offer a modifiable target for prevention and/or intervention among middle adolescents, as emotion regulation difficulties may partially explain the presence of PTSS following cumulative interpersonal childhood adversity.
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Affiliation(s)
- Brenda Ramos
- Université de Montréal, Département de psychologie, C. P. 6128 succursale Centre-Ville, Montréal, Québec H3C 3J7, Canada.
| | - Jacinthe Dion
- Université du Québec à Chicoutimi, Département des sciences de la santé, 555 boulevard de l'Université, Chicoutimi, Québec G7H 2B1, Canada.
| | - Beáta Bőthe
- Université de Montréal, Département de psychologie, C. P. 6128 succursale Centre-Ville, Montréal, Québec H3C 3J7, Canada.
| | - Alice Girouard
- Université de Montréal, Département de psychologie, C. P. 6128 succursale Centre-Ville, Montréal, Québec H3C 3J7, Canada.
| | - Martine Hébert
- Université du Québec à Montréal, Département de sexologie, C. P. 8888, succursale Centre-Ville, Montréal, Québec H3C 3P8, Canada.
| | - Eric Wong
- Université de Montréal, Département de psychologie, C. P. 6128 succursale Centre-Ville, Montréal, Québec H3C 3J7, Canada.
| | - Sophie Bergeron
- Université de Montréal, Département de psychologie, C. P. 6128 succursale Centre-Ville, Montréal, Québec H3C 3J7, Canada.
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22
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Marr MC, Gerson R, Lee M, Storfer-Isser A, Horwitz SM, Havens JF. Trauma Exposure and Suicidality in a Pediatric Emergency Psychiatric Population. Pediatr Emerg Care 2022; 38:e719-e723. [PMID: 35100769 DOI: 10.1097/pec.0000000000002391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The increasing rates of depression and suicidality in children and adolescents are reflected in the increasing number of mental health-related visits to emergency departments. Despite the high rates of traumatic exposure experienced by high-acuity children and adolescents and a known link to suicidal ideation, the systematic review of trauma history is not a consistent part of emergency department assessments for suicide ideation or attempt. In the present study, we examined the prevalence of suicidality as well as traumatic exposures in children and adolescents presenting to a dedicated pediatric psychiatric emergency department. METHODS Suicide ideation, suicide attempts, and trauma exposure history were identified through a retrospective chart review of youth (n = 861) who presented to a dedicated child psychiatric emergency department during a 1-year period. Bivariate analyses comparing demographic and trauma history for children with and without suicidality and a multivariable logistic regression were performed. RESULTS Childhood adversity was common, with 52% of youth reporting at least one type of trauma exposure. Emotional abuse, physical abuse, and sexual abuse/assault were associated with suicidality. Any trauma exposure and the total number of different trauma exposures were associated with reported suicide attempt. After adjusting for sociodemographic characteristics, children who reported a history of emotional abuse had 3.2-fold increased odds of attempted suicide. Children who reported a history of being a victim of bullying had 1.9-fold increased odds of current suicidal ideation. CONCLUSIONS Traumatic experiences were common in youth presenting with suicidality. Traumatic experiences are frequently underrecognized in treatment settings because they are not part of routine evaluations and are often overlooked when trauma-related symptoms are not the presenting problem. Addressing traumatic experiences underlying depression and suicidal ideation is a necessary step in effective treatment. Emergency departments need to implement routine screening for traumatic exposures in children presenting with suicidal ideation or attempt.
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Affiliation(s)
- Mollie C Marr
- From the Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Ruth Gerson
- Department of Child and Adolescent Psychiatry, New York University School of Medicine
| | - Mia Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY
| | | | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine
| | - Jennifer F Havens
- Department of Child and Adolescent Psychiatry, New York University School of Medicine
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Fischer A, Rosner R, Renneberg B, Steil R. Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients. Borderline Personal Disord Emot Dysregul 2022; 9:1. [PMID: 34974844 PMCID: PMC8722304 DOI: 10.1186/s40479-021-00172-8] [Citation(s) in RCA: 1] [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: 08/10/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. Although evidence-based interventions exist, some therapists are concerned that trauma-focused psychotherapy with exposure-based elements may lead to the deterioration of associated dysfunctional behaviors in adolescents and young adults. Therefore, we examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment. METHODS Daily assessments from a randomized controlled trial (RCT) of Developmentally adapted Cognitive Processing Therapy (D-CPT) were analyzed to test for differences in the stated dysfunctional behaviors between the four treatment phases. We conducted multilevel modeling and repeated measure ANOVAs. RESULTS We did not find any significant differences between the treatment phases concerning the stated dysfunctional behaviors, either at the level of urge or at the level of actual actions. On the contrary, in some primary outcomes (self-injury, aggressive behavior), as well as secondary outcomes (distress caused by trauma, joy), we observed significant improvements. DISCUSSION Overall, during D-CPT, adolescents and young adults showed no deterioration in dysfunctional behaviors, while even showing improvements in some, suggesting that trauma-focused treatment preceded by skills building was not deleterious to this population. Hence, the dissemination of effective interventions such as D-CPT should be fostered, whilst the concerns of the therapists regarding exposure-based components need to be addressed during appropriate training. Nevertheless, further studies with momentary assessment, extended measurement methods, a control group and larger sample sizes are needed to confirm our preliminary findings. TRIAL REGISTRATION The trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787 .
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Affiliation(s)
- Anne Fischer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany.
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
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Schafer KM, Clancy KJ, Joiner T. An investigation into the bidirectional relationship between post-traumatic stress disorder and suicidal ideation: A nine year study. J Anxiety Disord 2022; 85:102510. [PMID: 34864539 PMCID: PMC10423636 DOI: 10.1016/j.janxdis.2021.102510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 11/03/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022]
Abstract
Suicide is the second leading cause of death in adolescents; a frequent precursor of suicide is suicidal ideation (SI). Literature indicates that Post-Traumatic Stress Disorder (PTSD) and SI are robust cross-sectional correlates of one another, with PTSD often being conceptualized as a risk factor (i.e., conferring risk) for SI. Indeed, PTSD is a well-established risk factor for SI; however, SI is an understudied risk factor for PTSD. It is possible that, yet unknown if, PTSD and SI promote each other over time in a bidirectional fashion. We investigated the bidirectional longitudinal associations between PTSD and SI in a large, diverse sample, who at baseline were adolescents. Participants were interviewed between 1995 and 1998 and again between 2004 and 2008. We hypothesized that PTSD and SI would be cross-sectionally, longitudinally, and bidirectionally related and that the number of traumas endorsed at baseline would be positively associated with PTSD and SI at baseline and follow-up. Indeed, PTSD and SI were cross-sectionally correlated at baseline, but not follow-up. PTSD predicted SI over nine years; however, SI during adolescence did not predict PTSD in adulthood. Finally, poly-trauma endorsed at baseline was associated with increased risk of SI, but not PTSD, over nine years.
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Romanelli M, Sheftall AH, Irsheid SB, Lindsey MA, Grogan TM. Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:73-84. [PMID: 34482517 PMCID: PMC8792183 DOI: 10.1007/s11121-021-01295-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 01/03/2023]
Abstract
The current study examined demographic, psychosocial, and substance use factors associated with distinct patterns of past 12-month suicide thoughts, plans, and attempts among adolescents drawn from a nationally representative sample of high schoolers. Data were from the 2015, 2017, and 2019 National Youth Risk Behavior Survey. Four mutually exclusive 12-month suicidal behavior patterns were identified: suicide thoughts only (pattern 1), suicide thoughts and plans without suicide attempt (pattern 2), suicide attempt with thoughts and/or plans (pattern 3), and suicide attempt without thoughts or plans (pattern 4). Multinomial logistic regression analyses were conducted to examine factors correlated with these distinct patterns. Psychosocial and substance use factors were modeled as independent predictors, controlling for demographic characteristics, as well as simultaneously to represent the potential for co-occurrence. The analytic sample included 7491 respondents. About 24% (n = 1734) of youth endorsed pattern 1, 38% (n = 2779) pattern 2, 35% (n = 2716) pattern 3, and 3% (n = 262) pattern 4. All psychosocial and substance use factors measured were individually associated with greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Black and male youth were at greater odds of suicide attempts without thoughts or plans (pattern 4) than all other patterns. When modeled simultaneously, respondents who were bullied online, sad or hopeless, had a history of sexual violence, used cigarettes, and misused prescription opiates retained greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Findings suggest screening for suicidal behaviors should include factors that differentiate between varying suicidal expressions and that may cue providers to intervene in the absence of suicide thoughts and plans.
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Affiliation(s)
- Meghan Romanelli
- School of Social Work, University of Washington, 4101 15th Avenue NE, WA, 98105-6250, Seattle, USA.
| | - Arielle H Sheftall
- Department of Pediatrics, Center for Suicide Prevention and Research, The Abigail Wexner Research Institute At Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sireen B Irsheid
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Michael A Lindsey
- Silver School of Social Work, NYU McSilver Institute for Poverty Policy and Research, New York University, New York, NY, USA
| | - Tracy M Grogan
- NYU McSilver Institute for Poverty Policy and Research, New York, NY, USA
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Yan H, Ding Y, Guo W. Suicidality in patients with premenstrual dysphoric disorder-A systematic review and meta-analysis. J Affect Disord 2021; 295:339-346. [PMID: 34488087 DOI: 10.1016/j.jad.2021.08.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/03/2021] [Accepted: 08/25/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Whether premenstrual dysphoric disorder (PMDD) is correlated with the risk of suicidality and the extent of its effect on suicidality are unclear. The present study was conducted to elucidate the association between PMDD and suicidality from relevant studies. METHODS Four electronic databases, namely, Scopus, Embase, PubMed, and Web of Science, were searched from inception to November 15, 2020. Quality assessment, data synthesis, and sensitivity analysis were performed on the included studies. RESULTS Six studies with 8 532 participants were included in this meta-analysis. PMDD was associated with an increased risk of suicidal ideation (odds ratio [OR]=2.34, 95% confidence interval [CI]=1.50-3.18, I2=0.0%, p=0.99, k=4). Patients with PMDD had a greater risk of experiencing suicide attempt (OR=2.13, 95% CI=1.05-3.21, I2=0.0%, p=0.81, k=5). PMDD was associated with an increased risk of suicidal plan (OR=2.24, 95% CI=1.03-3.45, I2=0.0%, p=0.96, k=2). LIMITATIONS The diagnosis of PMDD should be considered "provisional" in all the included studies. CONCLUSIONS Among PMDD sufferers there would be a group of particularly suicidal women. Clinicians who treat patients with PMDD should be vigilant for signs of suicidal ideation and behavior to implement better treatment and preventive measures.
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Affiliation(s)
- Haohao Yan
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yudan Ding
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Wenbin Guo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Department of Psychiatry, The Third People's Hospital of Foshan, Foshan 528000, Guangdong, China.
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27
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An Y, Shi J, Chuan-Peng H, Wu X. The symptom structure of posttraumatic stress disorder and co-morbid depression among college students with childhood abuse experience: A network analysis. J Affect Disord 2021; 293:466-475. [PMID: 34256208 DOI: 10.1016/j.jad.2021.06.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are highly co-morbid among individuals with childhood abuse history, while the mechanism of the co-morbidity is highly debated. This study sought to extent the work among college students with network analysis, which is a novel method that sees the co-morbidity from a symptom interacting perspective. METHODS Data was collected from 476 college students who were assessed to have childhood abuse history, PTSD and depression at the same time, using Childhood Trauma Questionnaire- Short Form, PTSD Checklist for DSM-5 and The Center for Epidemiological Studies Depression. We created a Graphical Gaussian Model (GGM) network to show associations between symptom pairs and a Directed Acyclic Graph (DAG) to estimate potential casual relationships among symptoms. RESULTS The GGM network was reliably stable, feeling sad (Depression) and trouble experiencing positive feelings (PTSD) were the most central nodes. Trouble experiencing positive feelings and several negative affect symptoms, sleep problems and difficulty in concentrating were acting as important bridging nodes. The DAG network suggested the key triggering roles of exaggerated startle (PTSD) and several re-experiencing symptoms. LIMITATIONS The study used cross-sectional data and self-reported measures. Results from network analysis could be affected by scale factors and contain spurious correlations. CONCLUSIONS In the childhood-abuse-related co-morbid structure, several negative affect symptoms both in PTSD and depression have pivotal roles, hyper-arousal symptoms and re-experiencing symptoms could trigger the co-morbid structure. Illustrating the strength and limitations of network analysis, this study help target the potentially influential symptoms for better clinical intervention.
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Affiliation(s)
- Yuanyuan An
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou Distinct, Nanjing, PR China
| | - Junyi Shi
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou Distinct, Nanjing, PR China
| | - Hu Chuan-Peng
- Leibniz Institute for Resilience Research, 55131 Mainz, Germany
| | - Xinchun Wu
- Faculty of Psychology, Beijing Normal University, No.19 Xinjiekou Wai Street, Beijing, PR China; Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, No.19 Xinjiekou Wai Street, Beijing, PR China.
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28
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Bryan CJ, Bryan AO. Delayed reward discounting and increased risk for suicide attempts among U.S. adults with probable PTSD. J Anxiety Disord 2021; 81:102414. [PMID: 33962144 DOI: 10.1016/j.janxdis.2021.102414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/16/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND PTSD is an established risk factor for suicide attempts and suicide death, but the mechanisms underlying this association remain unknown. The present study examined associations among delayed reward discounting-the balance between smaller immediate available rewards versus larger delayed rewards-self-reported PTSD symptoms, and recent suicide attempts among individuals reporting suicide ideation within the past year. METHODS A cross-sectional survey of U.S. adults completed the Primary Care PTSD Screen for DSM-5, the 21-item Monetary Choice Questionnaire, and the Self-Injurious Thoughts and Behaviors Interview-Revised. Analyses of variance and multinomial regression models were used to test associations among variables. RESULTS Among participants reporting suicide ideation within the past year, discount rates were significantly higher among those reporting more PTSD symptoms and a past-year suicide attempt, suggesting these participants expressed a preference for immediately available rewards. CONCLUSIONS Choice behavior among individuals reporting many PTSD symptoms and a recent suicide attempt is influenced to a greater degree by immediately available rewards. Sensitivity to immediate rewards at the expense of larger delayed rewards may reflect a vulnerability for suicidal behavior among individuals screening positive for PTSD.
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Affiliation(s)
- Craig J Bryan
- The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, 1670 Upham Dr., Columbus, OH, 43210, United States.
| | - AnnaBelle O Bryan
- The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, 1670 Upham Dr., Columbus, OH, 43210, United States
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29
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Ensink JBM, Keding TJ, Henneman P, Venema A, Papale LA, Alisch RS, Westerman Y, van Wingen G, Zantvoord J, Middeldorp CM, Mannens MMAM, Herringa RJ, Lindauer RJL. Differential DNA Methylation Is Associated With Hippocampal Abnormalities in Pediatric Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1063-1070. [PMID: 33964519 DOI: 10.1016/j.bpsc.2021.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent findings in neuroimaging and epigenetics offer important insights into brain structures and biological pathways of altered gene expression associated with posttraumatic stress disorder (PTSD). However, it is unknown to what extent epigenetic mechanisms are associated with PTSD and its neurobiology in youth. METHODS In this study, we combined a methylome-wide association study and structural neuroimaging measures in a Dutch cohort of youths with PTSD (8-18 years of age). We aimed to replicate findings in a similar independent U.S. cohort. RESULTS We found significant methylome-wide associations for pediatric PTSD (false discovery rate p < .05) compared with non-PTSD control groups (traumatized and nontraumatized youths). Methylation differences on nine genes were replicated, including genes related to glucocorticoid functioning. In both cohorts, methylation on OLFM3 gene was further associated with anterior hippocampal volume. CONCLUSIONS These findings point to molecular pathways involved in inflammation, stress response, and neuroplasticity as potential contributors to neural abnormalities and provide potentially unique biomarkers and treatment targets for pediatric PTSD.
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Affiliation(s)
- Judith B M Ensink
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Academic Centre for Child and Adolescent Psychiatry, De Bascule, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Taylor J Keding
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Peter Henneman
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Andrea Venema
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ligia A Papale
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Reid S Alisch
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yousha Westerman
- Academic Centre for Child and Adolescent Psychiatry, De Bascule, Amsterdam, the Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Jasper Zantvoord
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Christel M Middeldorp
- Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Marcel M A M Mannens
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Ramon J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Academic Centre for Child and Adolescent Psychiatry, De Bascule, Amsterdam, the Netherlands
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30
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Understanding the influence of the perceived risk of the coronavirus disease (COVID-19) on the post-traumatic stress disorder and revisit intention of hotel guests. JOURNAL OF HOSPITALITY AND TOURISM MANAGEMENT 2021; 46:327-335. [PMCID: PMC7816886 DOI: 10.1016/j.jhtm.2021.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 05/18/2023]
Abstract
This study examines consumers' perceived risks of COVID-19 to develop a solid theoretical framework that explains their behavioral intentions relating to COVID-19. It also explores the influence of four sub-factors of perceived risk relating to COVID-19 and the effects of post-traumatic stress disorder and revisit intention. This study finds that the perceived risk from COVID-19 and post-traumatic stress disorder have severely negative impacts on revisit intention for hotels, with emotion regulation ability found to play a moderating role in this process. Because hotels are used by a diverse group of people in terms of race, nationality, age, and culture, they can rapidly transit epidemics such as COVID-19. Therefore, hotel managers must identify the risks of COVID-19 as perceived by hotel guests, potential development of PTSD, and influence of such negative phenomena on guests’ behavioral intentions to formulate a variety of strategies.
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Carmassi C, Bertelloni CA, Dell'Oste V, Luperini C, Marazziti D, Rossi R, Dell'Osso L. PTSD and Suicidal Behaviors Amongst L'Aquila 2009 Earthquake Young Survivors. Front Public Health 2021; 9:590753. [PMID: 33643987 PMCID: PMC7902690 DOI: 10.3389/fpubh.2021.590753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is one of the most frequent and severe psychiatric consequences of natural disasters, frequently associated with suicidality. The aim of this study was at examining the possible relationships between suicidal behaviors and full-blown or partial PTSD, in a sample of young earthquake survivors. The second aim was at investigating the specific role of PTSD symptoms on suicidality. Methods: A total of 475 young adults who survived the L'Aquila 2009 earthquake, one of the most severe Italian disasters of the last decades, were recruited and assessed after 21 months from the catastrophe. Participants were evaluated by two questionnaires assessing subthreshold psychopathology, the Trauma and Loss Spectrum Self-Report (TALS-SR) to investigate both full and partial PTSD, and two specific Mood Spectrum Self-Report (MOODS-SR) sub-domains exploring suicidality, namely suicidal ideation and suicide attempts. Results: The ensuing findings showed that suicidal ideation and suicide attempts were present, respectively, in 40 (8.4%) and 11 (2.3%) survivors. Rates of suicidal ideation were significantly more elevated in full-blown PTSD subjects (group 1), as compared with those suffering from partial (group 2) or no PTSD (group 3). Interestingly, group 2 subjects showed significantly more suicidal ideation than healthy individuals, and less than those of group 1, while the frequency of suicide attempts was similar across the three groups. Suicidal ideation was associated with higher scores in the following TALS-SR domains: grief-reactions, re-experiencing, avoidance and numbing, maladaptive coping, and personal characteristics/risk factor. Conclusions: The results of the present study support and extend previous findings on the role of PTSD symptoms in suicidality after a severe earthquake. However, as compared with available literature, they also highlight the significant impact of sub-threshold PTSD manifestations in increasing the suicide risk in survivors of a mass disaster.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Chiara Luperini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Kao CY, Bradshaw T, Mazarakis T. Gender differences in the association between social support and caregiver alcohol use in posttraumatic stress disorder of east Taiwan adolescents. Tzu Chi Med J 2021; 33:188-194. [PMID: 33912418 PMCID: PMC8059466 DOI: 10.4103/tcmj.tcmj_123_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/29/2020] [Accepted: 08/01/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives: This study investigates traumatic experiences in a sample of high-risk Taiwanese adolescents in rural areas of Taiwan; correlation with psychosocial factors is assessed with focus on social support and caregiver alcohol use. Materials and Methods: This was a cross-sectional study using stratified cluster sampling. Structured questionnaires were used to collect demographic characteristics, social support (Taiwan Relationship Inventory for Children and Adolescents), and posttraumatic stress disorder (PTSD) symptoms (Chinese version of UCLA-PTSD Reaction Index) from a sample of 751 adolescents (54.6% females) with 61.2% response rate in high schools in Hualien County, Taiwan. Results: Girls with trauma experiences manifested significantly higher PTSD scores, concurrent with higher number of traumatic events (TE), while the likelihood of reporting trauma and subsequent PTSD symptoms was similar in both genders. Increased risk of reported trauma and PTSD in adolescent Taiwanese is strongly associated with caregiver alcohol use and lack of social support, particularly in girls. Conclusion: We found that girls reported higher numbers of TE which was concurrent with significantly higher PTSD scores. Early detection of alcohol use disorders among caregivers as well as assessment of quality of family interaction would benefit at risk adolescents through specifically tailored interventions to address these factors.
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Affiliation(s)
- Ching-Yi Kao
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Tyler Bradshaw
- Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Theodoris Mazarakis
- Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
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Jahangiri K, Yousefi K, Mozafari A, Sahebi A. The Prevalence of Suicidal Ideation after the Earthquake: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:2330-2338. [PMID: 34178739 PMCID: PMC8215057 DOI: 10.18502/ijph.v49i12.4815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Disasters have many health consequences such as suicide ideation as one of the relatively common psychological consequences after natural disasters, especially earthquakes. This study aimed to determine the prevalence of post-earthquake suicidal ideation in affected people. Methods: Related keywords of this systematic review and meta-analysis in English and their Persian equivalents were searched in the data resources including Google Scholar, SID, Magiran, Scopus, PubMed, and Web of Science from Jan 2014 to May 2019. The STROBE checklist was used to evaluate the quality of the articles. The I2 index was used to determine the heterogeneity and the random-effects model was used in meta-analysis. Statistical analysis was conducted in the STATA software version 14. Results: Overall, 14347 subjects including 6662 males and 7715 females with the mean age of 23.88 ± 15.81yr old were assessed. The prevalence of post-earthquake suicidal ideation was 20.34% (95% CI: 13.60–27.08, P<0.001, I2=99.1). The prevalence of suicidal ideation showed a decreasing trend based on the year of the study and the duration of post-earthquake follow-up. Conclusion: Although the prevalence of post-earthquake suicidal ideation showed a decreasing trend, the probability of incidence of these thoughts in the long-term is still noticeable. Therefore, implementing a surveillance system is recommended to monitor the mental health status of earthquakes survivors for the possibility of suicidal thoughts in the short and long term recovery phase.
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Affiliation(s)
- Katayoun Jahangiri
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kosar Yousefi
- Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Aliashraf Mozafari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sahebi
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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34
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López R, Defayette AB, Whitmyre ED, Williams CA, Esposito-Smythers C. Posttraumatic stress disorder symptom clusters, suicidal ideation, and social support in a clinical adolescent sample. DEATH STUDIES 2020; 46:1814-1822. [PMID: 33245681 PMCID: PMC8155111 DOI: 10.1080/07481187.2020.1852629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a risk factor for adolescent suicidal ideation (SI). This study explored the relation between PTSD symptom clusters and SI, and whether social support moderates this association, in a cross-sectional, adolescent, clinical sample (N = 125). We hypothesized that each cluster would be positively associated with SI severity and that social support would buffer these associations. Only the persistent avoidance cluster was significantly associated with SI severity. Further, social support moderated this association. Results highlight the positive association between persistent avoidance symptoms of PTSD and SI and suggest that bolstering social support serves a protective function.
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35
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Fulginiti A, Rhoades H, Mamey MR, Klemmer C, Srivastava A, Weskamp G, Goldbach JT. Sexual Minority Stress, Mental Health Symptoms, and Suicidality among LGBTQ Youth Accessing Crisis Services. J Youth Adolesc 2020; 50:893-905. [PMID: 33206318 DOI: 10.1007/s10964-020-01354-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022]
Abstract
Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways.
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Affiliation(s)
- Anthony Fulginiti
- Graduate School of Social Work, University of Denver, 2148S. High St., Denver, CO, 80208, USA.
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Mary Rose Mamey
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Cary Klemmer
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Ankur Srivastava
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Garrett Weskamp
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Jeremy T Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
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36
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Baldaçara L, Rocha GA, Leite VDS, Porto DM, Grudtner RR, Diaz AP, Meleiro A, Correa H, Tung TC, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. ACTA ACUST UNITED AC 2020; 43:525-537. [PMID: 33111773 PMCID: PMC8555650 DOI: 10.1590/1516-4446-2020-0994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/21/2020] [Indexed: 12/28/2022]
Abstract
Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Gislene A Rocha
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil.,Serviço Especializado em Reabilitação em Deficiência Intelectual, Associação de Pais e Amigos dos Excepcionais, Montes Claros, MG, Brazil
| | - Verônica da S Leite
- Universidade Federal do Tocantins, Palmas, TO, Brazil.,Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria Municipal de Saúde de Palmas, Palmas, TO, Brazil
| | - Deisy M Porto
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Catarinense de Psiquiatria, Florianópolis, SC, Brazil
| | - Roberta R Grudtner
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Núcleo de Dor e Neuromodulação, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Secretaria Estadual da Saúde, Porto Alegre, RS, Brazil
| | - Alexandre P Diaz
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Humberto Correa
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Teng C Tung
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.,Serviços de Pronto Socorro e Interconsultas, IPq, HCFMUSP, São Paulo, SP, Brazil
| | - João Quevedo
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Antônio G da Silva
- Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Asociación Psiquiátrica de América Latina (APAL)
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Holliday R, Borges LM, Stearns-Yoder KA, Hoffberg AS, Brenner LA, Monteith LL. Posttraumatic Stress Disorder, Suicidal Ideation, and Suicidal Self-Directed Violence Among U.S. Military Personnel and Veterans: A Systematic Review of the Literature From 2010 to 2018. Front Psychol 2020; 11:1998. [PMID: 32982838 PMCID: PMC7479813 DOI: 10.3389/fpsyg.2020.01998] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 01/02/2023] Open
Abstract
Rates of suicide and posttraumatic stress disorder remain high among United States military personnel and veterans. Building upon prior work, we conducted a systematic review of research published from 2010 to 2018 regarding: (1) the prevalence of suicidal ideation, suicide attempt, and suicide among United States military personnel and veterans diagnosed with posttraumatic stress disorder; (2) whether posttraumatic stress disorder was associated with suicidal ideation, suicide attempt, and suicide among United States military personnel and veterans. 2,106 titles and abstracts were screened, with 48 articles included. Overall risk of bias was generally high for studies on suicidal ideation or suicide attempt and low for studies on suicide. Across studies, rates of suicidal ideation, suicide attempt, and suicide widely varied based on study methodology and assessment approaches. Findings regarding the association between posttraumatic stress disorder diagnosis with suicidal ideation and suicide were generally mixed, and some studies reported that posttraumatic stress disorder was associated with lower risk for suicide. In contrast, most studies reported significant associations between posttraumatic stress disorder and suicide attempt. These findings suggest complex associations between posttraumatic stress disorder and suicidal ideation, suicide attempt, and suicide, which are likely influenced by other factors (e.g., psychiatric comorbidity). In addition, most samples were comprised of veterans, rather than military personnel. Further research is warranted to elucidate associations between posttraumatic stress disorder and suicidal ideation, suicide attempt, and suicide, including identification of moderators and mediators of this relationship. Addressing this among United States military personnel, by gender, and in relation to different trauma types is also necessary.
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Affiliation(s)
- Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lauren M. Borges
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kelly A. Stearns-Yoder
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Adam S. Hoffberg
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, United States
| | - Lisa A. Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lindsey L. Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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38
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Paizanis E, Crotti M, Petit A, Règue M, Beray-Berthat V, Noble F, Lanfumey L, Mongeau R. Effects of Alcohol and Cocaine in a Mutant Mouse Model of Predisposition to Post-Traumatic Stress Disorder. Front Pharmacol 2020; 11:623. [PMID: 32477119 PMCID: PMC7232567 DOI: 10.3389/fphar.2020.00623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/20/2020] [Indexed: 01/14/2023] Open
Abstract
Comorbidity between drug abuse and post-traumatic stress disorder (PTSD), a stress-related dysregulation of fear responses, is very high. While some drugs are known to increase fear and anxiety, there are only few data regarding interactions between voluntary drug consumption and fear memory. The spontaneous chronic consumption of either alcohol or cocaine under a 3-week free-choice progressive paradigm of alcohol (3/6/10%) or cocaine (0.2/0.4/0.6 mg/ml), was assessed in VGV transgenic mice, having full 5-HT2C receptor editing and displaying PTSD-like behaviors. The consequences of these drug consumptions on the potentiated contextual and cued fear conditioning responses of VGV mice were assessed. The effects of drugs on hippocampal brain-derived neurotrophic factor (Bdnf) mRNA were measured as its expression was previously found to be decreased in VGV mice. Chronic alcohol consumption was similar in WT and VGV mice. In the alcohol condition, fear acquisition was not different at the end of the learning session and cue-fear extinction was facilitated. Regarding cocaine, in contrast to WT mice, VGV mice did not increase their drug consumption along with increasing doses, an effect that might be related with enhanced drug stimuli discrimination via increased 5-HT2C receptors. Cocaine-intake VGV mice did not display the contextual fear generalization usually observed in control VGV mice. In addition, Bdnf expression was upregulated after either chronic alcohol or cocaine intake. Altogether, these results suggest that both chronic alcohol and cocaine voluntary oral consumptions can exert some therapeutic-like effects in a mutant model of PTSD predisposition.
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Affiliation(s)
- Eleni Paizanis
- University of Caen Normandy, INSERM U1075 COMETE, Caen, France
| | - Michela Crotti
- CNRS ERL 3649 «Pharmacologie et thérapies des addictions» Université Paris Descartes, Inserm UMR-S 1124, Paris, France
| | - Anthony Petit
- IPNP-Université Paris Descartes, INSERM UMR-1266, Paris, France
| | - Mathilde Règue
- IPNP-Université Paris Descartes, INSERM UMR-1266, Paris, France
| | - Virginie Beray-Berthat
- CNRS ERL 3649 «Pharmacologie et thérapies des addictions» Université Paris Descartes, Inserm UMR-S 1124, Paris, France
| | - Florence Noble
- CNRS ERL 3649 «Pharmacologie et thérapies des addictions» Université Paris Descartes, Inserm UMR-S 1124, Paris, France
| | | | - Raymond Mongeau
- CNRS ERL 3649 «Pharmacologie et thérapies des addictions» Université Paris Descartes, Inserm UMR-S 1124, Paris, France
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39
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Eskander N, Vadukapuram R, Zahid S, Ashraf S, Patel RS. Post-traumatic Stress Disorder and Suicidal Behaviors in American Adolescents: Analysis of 159,500 Psychiatric Hospitalizations. Cureus 2020; 12:e8017. [PMID: 32528756 PMCID: PMC7279690 DOI: 10.7759/cureus.8017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives Our main goal is to understand the demographics and psychiatric comorbidities and to evaluate the risk of suicidal behaviors in post-traumatic stress disorder (PTSD) adolescents. Methods We included 159,500 adolescents (age, 12 to 18 years) with a primary psychiatric diagnosis from the Nationwide Inpatient Sample from January to December 2014 and grouped them by a diagnosis of PTSD (N = 21,230 [13.3%]). A logistic regression model was used to measure the odds ratio (OR) for suicidal behaviors in PTSD versus non-PTSD cohorts. Results A higher proportion of PTSD adolescents were females (75.7%) and whites (63.6%). The most prevalent psychiatric comorbidities in PTSD inpatients (vs. non-PTSD) were anxiety disorders (100% vs. 31.9%) and mood disorders (89.4% vs. 84.7%). About 48.7% of PTSD inpatients had suicidal behaviors and had a higher risk (OR 1.23; 95% CI: 1.19-1.26; P < 0.001) compared to that seen in 43.6% of the non-PTSD cohort. Conclusions Diagnosis of PTSD is prevalent in adolescents, especially females and whites, with anxiety and mood disorders being the most prevalent comorbidities. There exists a significant association between PTSD and suicidal behaviors, with an increased risk of 23% in adolescents.
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Affiliation(s)
- Noha Eskander
- Psychiatry, Ain Shams University Hospital, Cairo, EGY
| | - Ramu Vadukapuram
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Shaheer Zahid
- Psychiatry, Saint James School of Medicine, Park Ridge, USA
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40
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Giovanna G, Damiani S, Fusar-Poli L, Rocchetti M, Brondino N, de Cagna F, Mori A, Politi P. Intranasal oxytocin as a potential therapeutic strategy in post-traumatic stress disorder: A systematic review. Psychoneuroendocrinology 2020; 115:104605. [PMID: 32088633 DOI: 10.1016/j.psyneuen.2020.104605] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/12/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
Treatment options for Posttraumatic Stress Disorder (PTSD) are limited in terms of available drugs and the success of psychotherapeutic interventions. Oxytocin is a peptide involved in the modulation of social cognition, emotional skills and the reward system, all deficient in PTSD, and thus it has been suggested as a promising pharmacological target. In this systematic review, the potential effects of intranasal OT (INOT) administration on core symptoms in PTSD patients are discussed, as well as neurobiological correlates in functional imaging supporting its clinical evidence. The fourteen studies included in the present review provide tentative evidence that INOT could be a safe pharmacological intervention, although the results were mixed and insufficient to quantify the effectiveness of this intervention. Specifically, the primary outcome measures differed consistently between studies, and the sample sizes were usually small. Considering the neurobiological and clinical evidences, tentative hypotheses can be made on the possible role of INOT in facilitating socially- and goal-oriented cognition and behaviour, thus promoting a better therapeutic alliance and treatment outcome. Such strategies need to be further supported by literature. For instance, only one study to date has directly investigated the use of INOT as an augmentation strategy for psychotherapy (namely, Prolonged Exposure therapy) and for a limited time, nevertheless providing promising results for the efficacy and the medium-term tolerability of this drug after multiple administrations.
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Affiliation(s)
- Gianluca Giovanna
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy.
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy; Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, via Santa Sofia 78, 95123, Catania, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Francesca de Cagna
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Alessia Mori
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100, Pavia, Italy
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Valles NL, Billups D, Sampson T, Harris TB. Management of Suicidal Adolescents Presenting to the Emergency Department. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666190730094236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Increasingly, adolescents are presented to hospital emergency departments
with suicidal ideation (SI) and depression. Even among those who come in with
other complaints, depression and SI are common. Emergency personnel are placed in the default
position of providing care for these patients, but often lack sufficient knowledge and
skills to do this effectively.
Objective:
The aim of this paper is to offer guidance to emergency personnel and describe
goals and strategies for screening and brief interventions.
Method:
We review risk factors, assessment tools and evidence-based interventions that can
be utilized by mental health professionals working in EDs and by ED staff in the absence of
mental health professionals.
Conclusion:
Emergency departments can serve a critical role in risk management and treatment
of adolescent depression and suicidal ideation. All patients presenting to the ED should
be screened for current and past depression and suicidal ideation or attempts. Brief interventions
can be delivered in the ED that can increase the likelihood that patients will receive follow-
up care.
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Affiliation(s)
| | - Dana Billups
- Baylor College of Medicine, Houston, TX 77030, United States
| | - Topaz Sampson
- Baylor College of Medicine, Houston, TX 77030, United States
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42
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Lengvenyte A, Conejero I, Courtet P, Olié E. Biological bases of suicidal behaviours: A narrative review. Eur J Neurosci 2019; 53:330-351. [PMID: 31793103 DOI: 10.1111/ejn.14635] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/05/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ismael Conejero
- Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France.,Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
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43
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Cramer RJ, Rasmussen S, Tucker RP. An examination of the Entrapment Scale: Factor structure, correlates, and implications for suicide prevention. Psychiatry Res 2019; 282:112550. [PMID: 31522892 DOI: 10.1016/j.psychres.2019.112550] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/21/2019] [Accepted: 08/31/2019] [Indexed: 02/08/2023]
Abstract
Entrapment is an emerging theoretical and empirical factor associated with suicide. The current study expanded our understanding of entrapment by examining the Entrapment Scale factor structure, demographic correlates, and association with suicidal thoughts and behaviors (STBs). Data from an online cross-national study of suicide were analyzed from two samples of young adults aged 18-34 (United Kingdom [U.K.] sample N = 418; United States [U.S.] N = 414). Primary findings included: (1) factor-analytic support for a two factor (i.e., internal and external) Entrapment Scale structure; (2) variation in external entrapment subscale factor loadings by sample; (3) significant demographic correlates of elevated entrapment of younger age, female gender, and U.S. sample; (4) significant convergent positive associations for both entrapment types with cognitive (e.g., perceived burdensomeness), mental health (e.g., anxiety), and STB correlates; and (5) significant, robust associations of internal entrapment and perceived burdensomeness with STBs in the U.K. sample. Implications are reviewed for suicide prevention theory, research and practice.
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Affiliation(s)
- Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, CHHS Building 354, 9201 University City Blvd., Charlotte, NC 28223, USA.
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Facer-Irwin E, Blackwood NJ, Bird A, Dickson H, McGlade D, Alves-Costa F, MacManus D. PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours. PLoS One 2019; 14:e0222407. [PMID: 31557173 PMCID: PMC6762063 DOI: 10.1371/journal.pone.0222407] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/28/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose Prevalence rates of PTSD are higher in the prison population than in the community. We sought to systematically review the extent to which this disorder is associated with other mental health disorders and problematic suicidal or aggressive behaviours in the prison population. Methods Studies reporting a relationship between PTSD and comorbid mental disorders and/or problematic behaviours in imprisoned adolescent and adult populations were identified from four bibliographic indexes. Primary studies involving clinical interviews, validated instruments leading to DSM or ICD diagnoses, or validated self-report questionnaires such as the PTSD checklist were included. Random-effects meta-analysis was conducted where possible. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results This review identified 36 studies, with a combined sample of 9594 participants, (6478 male and 2847 female prisoners) from 11 countries. Thirty-four of the identified studies employed a cross-sectional design. We identified significant associations between PTSD and comorbid mental disorders including depression (OR = 3.4, 95% confidence interval (CI): 2.3–4.9), anxiety (OR = 2.9, 95% confidence interval (CI): 1.8–4.7) and substance use (OR = 1.9, 95% confidence interval (CI): 1.5–2.4). We also identified significant associations between PTSD and suicidality (OR = 3, 95% confidence interval (CI): 2.4–3.8) and aggressive behaviours (this latter finding was not subject to meta-analysis). Significant methodological heterogeneity was identified between studies. Conclusions High rates of psychiatric comorbidity among prisoners with PTSD, and links to suicidal behaviour, self-harm and aggressive behaviour, provide further support for the need for trauma-informed treatment approaches in prisons. However, significant gaps in the current evidence were apparent. In particular, a lack of large, longitudinal studies meant that the temporal relationships between PTSD and relevant outcomes cannot currently be determined.
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Affiliation(s)
- Emma Facer-Irwin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- * E-mail:
| | - Nigel J. Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Annie Bird
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Daniel McGlade
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Filipa Alves-Costa
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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Feldmann J, Puhan MA, Mütsch M. Characteristics of stakeholder involvement in systematic and rapid reviews: a methodological review in the area of health services research. BMJ Open 2019; 9:e024587. [PMID: 31420378 PMCID: PMC6701675 DOI: 10.1136/bmjopen-2018-024587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Engaging stakeholders in reviews is considered to generate more relevant evidence and to facilitate dissemination and use. As little is known about stakeholder involvement, we assessed the characteristics of their engagement in systematic and rapid reviews and the methodological quality of included studies. Stakeholders were people with a particular interest in the research topic. DESIGN Methodological review. SEARCH STRATEGY Four databases (Medline, Embase, Cochrane database of systematic reviews, databases of the University of York, Center for Reviews and Dissemination (CRD)) were searched based on an a priori protocol. Four types of reviews (Cochrane and non-Cochrane systematic reviews, rapid and CRD rapid reviews) were retrieved between January 2011 and October 2015, pooled by potential review type and duplicates excluded. Articles were randomly ordered and screened for inclusion and exclusion criteria until 30 reviews per group were reached. Their methodological quality was assessed using AMSTAR and stakeholder characteristics were collected. RESULTS In total, 57 822 deduplicated citations were detected with potential non-Cochrane systematic reviews being the biggest group (56 986 records). We found stakeholder involvement in 13% (4/30) of Cochrane, 20% (6/30) of non-Cochrane, 43% (13/30) of rapid and 93% (28/30) of CRD reviews. Overall, 33% (17/51) of the responding contact authors mentioned positive effects of stakeholder involvement. A conflict of interest statement remained unmentioned in 40% (12/30) of non-Cochrane and in 27% (8/30) of rapid reviews, but not in Cochrane or CRD reviews. At most, half of non-Cochrane and rapid reviews mentioned an a priori study protocol in contrast to all Cochrane reviews. CONCLUSION Stakeholder engagement was not general practice, except for CRD reviews, although it was more common in rapid reviews. Reporting factors, such as including an a priori study protocol and a conflict of interest statement should be considered in conjunction with involving stakeholders.
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Affiliation(s)
- Jonas Feldmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Margot Mütsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Brown LA, Belli G, Suzuki N, Capaldi S, Foa EB. Reduction in Suicidal Ideation from Prolonged Exposure Therapy for Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:651-659. [PMID: 31150295 DOI: 10.1080/15374416.2019.1614003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Adolescents with posttraumatic stress disorder (PTSD) are at higher risk for suicide compared to adolescents without PTSD. This study aimed to explore whether PTSD treatment reduces suicidal ideation in adolescents and whether the degree of reduction in PTSD was associated with reduction in suicidal ideation. METHODS Adolescent females with PTSD from a sexual assault (55% Black, 15.3 years, SD = 1.5) were randomized to either prolonged exposure therapy for adolescents (PE-A, n= 31) or client-centered therapy (CCT, n = 30). They reported on suicidal ideation, depression and PTSD at pre- and post-treatment, every therapy session, and follow-up, and about 40% endorsed suicidal ideation at baseline. RESULTS There was a significant reduction in a single-item measure of suicidal ideation during treatment across all participants. The Time in Treatment × Condition interaction was significant (p < .05, d = 0.52), indicating a significantly steeper reduction in suicidal ideation in PE-A compared to in CCT. The degree of reduction in PTSD (ps < .05, d = 0.26-0.54) and depression symptoms (ps < .05, d= 0.54-0.81) in treatment and follow-up was associated with the speed of suicidal ideation reduction in treatment and follow-up. CONCLUSIONS Adolescents randomized to PE-A had significantly faster reductions in suicidal ideation compared to those randomized to CCT. Greater reduction in PTSD and depression symptoms were associated with faster reduction in suicidal ideation. Clinically, this study demonstrates that adolescents who have suicidal ideation without current intent may benefit from PE-A.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, University of Pennsylvania
| | - Gina Belli
- Department of Psychiatry, University of Pennsylvania
| | - Noah Suzuki
- Department of Psychiatry, University of Pennsylvania
| | - Sandy Capaldi
- Department of Psychiatry, University of Pennsylvania
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania
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Increased 5-HT2C receptor editing predisposes to PTSD-like behaviors and alters BDNF and cytokines signaling. Transl Psychiatry 2019; 9:100. [PMID: 30792491 PMCID: PMC6384909 DOI: 10.1038/s41398-019-0431-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 12/16/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a trauma- and stress-related disorder with dysregulated fear responses and neurobiological impairments, notably at neurotrophic and inflammation levels. Understanding the mechanisms underlying this disease is crucial to develop PTSD models that meet behavioral and neurobiological validity criteria as well as innovative therapeutic approaches. Serotonin 2C receptors (5-HT2CR) are known for their important role in anxiety, and mice having only the fully edited VGV isoform of 5-HT2CR, which thereby overexpressed brain 5-HT2CR, are of special interest to study PTSD predisposition. Innate and conditioned fear-related behaviors were assessed in VGV and wild-type mice. mRNA expression of brain-derived neurotrophic factor (BDNF), tissue-plasminogen activator (tPA), and pro-inflammatory cytokines (IL-6, IL-1β, and calcineurin) were measured by qRT-PCR. The effect of acute and chronic paroxetine was evaluated on both behavior and gene expression. VGV mice displayed greater fear expression, extensive fear extinction deficits, and fear generalization. Paroxetine restored fear extinction in VGV mice when administered acutely and decreased innate fear and fear generalization when administered chronically. In parallel, Bdnf, tPA, and pro-inflammatory cytokines mRNA levels were dysregulated in VGV mice. Bdnf and tPA mRNA expression was decreased in the hippocampus but increased in the amygdala, and chronic paroxetine normalized Bdnf mRNA levels both in the amygdala and the hippocampus. Amygdalar calcineurin mRNA level in VGV mice was also normalized by chronic paroxetine. VGV-transgenic mice displayed behavioral and neurobiological features that could be accessory to the investigation of PTSD and its treatment. Furthermore, these data point out to the role of 5-HT2CR in neuroplasticity and neuroinflammation.
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Lenz AS, Luo Y. Differential Estimation of Treatment Effect Between Clinician-Administered and Self-Reported PTSD Assessments. JOURNAL OF COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jcad.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A. Stephen Lenz
- Department of Counseling and Educational Psychology, Texas A&M University-Corpus Christi
| | - Ye Luo
- Department of Counseling and Educational Psychology, Texas A&M University-Corpus Christi
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Wilker S, Schneider A, Conrad D, Pfeiffer A, Boeck C, Lingenfelder B, Freytag V, Vukojevic V, Vogler C, Milnik A, Papassotiropoulos A, J.-F. de Quervain D, Elbert T, Kolassa S, Kolassa IT. Genetic variation is associated with PTSD risk and aversive memory: Evidence from two trauma-Exposed African samples and one healthy European sample. Transl Psychiatry 2018; 8:251. [PMID: 30467376 PMCID: PMC6250662 DOI: 10.1038/s41398-018-0297-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 09/26/2018] [Accepted: 10/18/2018] [Indexed: 11/11/2022] Open
Abstract
The probability to develop posttraumatic stress disorder (PTSD), characterized by vivid, intrusive emotional memories of the encountered traumatic events, depends - among other factors - on the number of previous traumatic experiences (traumatic load) and individual genetic vulnerability. So far, our knowledge regarding the biological underpinnings of PTSD is relatively sparse. Genome-wide association studies (GWAS) followed by independent replication might help to discover novel, so far unknown biological mechanisms associated with the development of traumatic memories. Here, a GWAS was conducted in N = 924 Northern Ugandan rebel war survivors and identified seven suggestively significant single nucleotide polymorphisms (SNPs; p ≤ 1 × 10-5) for lifetime PTSD risk. Of these seven SNPs, the association of rs3852144 on chromosome 5 was replicated in an independent sample of Rwandan genocide survivors (N = 370, p < .01). While PTSD risk increased with accumulating traumatic experiences, the vulnerability was reduced in carriers of the minor G-allele in an additive manner. Correspondingly, memory for aversive pictures decreased with higher number of the minor G-allele in a sample of N = 2698 healthy Swiss individuals. Finally, investigations on N = 90 PTSD patients treated with Narrative Exposure Therapy indicated an additive effect of genotype on PTSD symptom change from pre-treatment to four months after treatment, but not between pre-treatment and the 10-months follow-up. In conclusion, emotional memory formation seems to decline with increasing number of rs3852144 G-alleles, rendering individuals more resilient to PTSD development. However, the impact on therapy outcome remains preliminary and further research is needed to determine how this intronic marker may affect memory processes in detail.
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Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Ulm University, Ulm, Germany.
| | - Anna Schneider
- Clinical & Biological Psychology, Ulm University, Ulm, Germany.
| | - Daniela Conrad
- Clinical & Biological Psychology, Ulm University, Ulm, Germany. .,Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany.
| | - Anett Pfeiffer
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Christina Boeck
- 0000 0004 1936 9748grid.6582.9Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Birke Lingenfelder
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Virginie Freytag
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Vanja Vukojevic
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Christian Vogler
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Annette Milnik
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dominique J.-F. de Quervain
- 0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
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Tang W, Xu D, Li B, Lu Y, Xu J. The relationship between the frequency of suicidal ideation and sleep disturbance factors among adolescent earthquake victims in China. Gen Hosp Psychiatry 2018; 55:90-97. [PMID: 30448743 DOI: 10.1016/j.genhosppsych.2018.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to examine the frequency of suicidal ideation (SI) and identify exposure variables, mental health, and sleep-related risk factors of SI among adolescents following the 2013 Ya'an earthquake. METHODS Participants consisted of 5563 adolescent students selected through random sampling from 11 primary and high schools in the counties most severely affected by the earthquake. They were asked to complete the Pittsburgh Sleep Quality Index, Children's Revised Impact of Event Scale-13, Short Mood and Feelings Questionnaire, and Screen for Child Anxiety-Related Emotional Disorders. Multinomial logistic analysis was used to identify possible relationships between SI and psychopathology, sleep problems, earthquake exposures or demographic characteristics. The mediation analysis was used to identify direct and indirect effects among sleep problems, psychopathology, earthquake exposures and SI. RESULTS Our findings suggest that 29.5% of the sample experienced SI during the past year (12.9% once, 11.9% twice, 2.6% on 3-4 occasions and 2.1% on at least 5 occasions). Multiple sleeping problems, including trouble falling asleep, shorter sleep duration, and daytime dysfunction, showed independent associations with SI. The mediation analysis suggested that depression and anxiety mainly mediated the association of sleep with SI. LIMITATIONS This study was cross-sectional and did not include controls. No baseline data were collected prior to the earthquake. CONCLUSION SI can be a serious problem among adolescents following a major earthquake, especially those who are older, who live in one-child households, or who are female. Years after a disaster, we found that exposure severity, psychopathology and sleep impairment all contributed to SI, and that earthquake exposure may have disrupted sleep and worsened mood, which in turn may have impacted SI. By enhancing teenagers' sleep management and shaping their activities, post-disaster intervention programs may help prevent SI among Chinese adolescents.
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Affiliation(s)
- Wanjie Tang
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China; Centre for Educational and Health Psychology, Sichuan University, Chengdu, China; Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Dun Xu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China
| | - Bin Li
- Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Lu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China
| | - Jiuping Xu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China.
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