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Douglas RD, Alli JO, Gaylord-Harden N, Opara I, Gilreath T. Examining the integrated model of the interpersonal-psychological theory of suicide and intersectionality theory among Black male adolescents. Suicide Life Threat Behav 2024. [PMID: 38411036 DOI: 10.1111/sltb.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/01/2024] [Accepted: 02/10/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Guided by Opara et al.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation. METHOD Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self-report surveys. RESULTS As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence. CONCLUSION These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression.
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Affiliation(s)
- Robyn D Douglas
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Jasmine O Alli
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Noni Gaylord-Harden
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Ijeoma Opara
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Tamika Gilreath
- School of Public Health, Texas A&M University, College Station, Texas, USA
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2
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Picou P, Moscardini EH, Perkins K, Tucker RP, Hill RM. Negative Urgency, (Lack of) Premeditation, and Sensation Seeking: Indirect Relationships with Suicidal Ideation through Thwarted Interpersonal Needs. Arch Suicide Res 2024; 28:358-371. [PMID: 36786540 DOI: 10.1080/13811118.2023.2176271] [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: 02/15/2023]
Abstract
OBJECTIVE Differences in how impulsivity is conceptualized, along with a myopic focus on impulsivity's relationship with historical suicidal behaviors, have resulted in limited implications made from prior research regarding impulsivity and suicidal thoughts and behaviors. The current study investigated the indirect effect facets of impulsivity may have on suicidal ideation, specifically, through thwarted interpersonal needs. METHODS Participants were N = 424 undergraduate students who completed a cross-sectional survey. Participants completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS), the Adult Suicide Ideation Questionnaire (ASIQ), and the Interpersonal Needs Questionnaire (INQ). Parallel mediation models were run to examine the relation between facets of impulsivity, perceived burdensomeness, thwarted belongingness, and suicidal ideation. RESULTS Thwarted belonginess and perceived burdensomeness significantly accounted for the variance in the relation between negative urgency and suicidal ideation. Neither thwarted belongingness nor perceived burdensomeness significantly explained variance in the relation between (lack of) premeditation and suicidal ideation. Conversely, perceived burdensomeness and thwarted belonginess significantly explained the inverse relation between sensation seeking and suicidal ideation (i.e., greater sensation seeking was related to lower perceived burdensomeness and thwarted belongingness and in turn lower suicidal ideation). CONCLUSION Negative urgency, in particular, is related to suicidal ideation through thwarted interpersonal needs. Future research should continue to differentiate between various types of impulsivity and its relationship with both suicidal ideation and behaviors utilizing both cross-sectional and ambulatory assessments of these constructs.HIGHLIGHTSNegative urgency is related to suicidal ideation.Negative urgency is related to thwarted interpersonal needs.Thwarted interpersonal needs partially explain the relation between negative urgency and suicidal ideation.
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Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
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Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Riddle DB, Guzick A, Minhajuddin A, Smárason O, Armstrong GM, Slater H, Mayes TL, Goodman LC, Baughn DL, Martin SL, Wakefield SM, Blader J, Brown R, Goodman WK, Trivedi MH, Storch EA. Obsessive-compulsive disorder in youth and young adults with depression: Clinical characteristics of comorbid presentations. J Obsessive Compuls Relat Disord 2023; 38:100820. [PMID: 37521713 PMCID: PMC10373162 DOI: 10.1016/j.jocrd.2023.100820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Obsessive-compulsive disorder (OCD), anxiety disorders, and depressive disorders are highly comorbid, and each contribute to significant functional impairment for affected youth. Comorbid anxiety disorders in depressed youth have been associated with greater depressive symptom severity and impairment, but the impact of comorbid OCD in this population remains unclear. Accordingly, the present study examined the differential clinical characteristics of youth with depression and comorbid OCD relative to age/gender matched depressed youth with no such comorbidity and to those with depression and a comorbid (non-OCD) anxiety disorder. A sample of 797 youth and young adults ages 8-20 years who met diagnostic criteria for depression alone, depression with co-occurring OCD or any anxiety disorder were included in the present study. Rates of comorbid anxiety and OCD were very high (60.5% and 15.5%, respectively). Relative to youth with only depression, depressed youth with comorbid OCD or anxiety had greater severity of depression, suicidality, and overall impairment in social, physical, and emotional functioning. These results highlight the contribution of OCD or anxiety comorbidity in more complex clinical presentations for depressed youth.
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Affiliation(s)
- David B Riddle
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Orri Smárason
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabrielle M Armstrong
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Holli Slater
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lynnel C Goodman
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Denise L Baughn
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah L Martin
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Joseph Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Brown
- Department of Psychiatry and Behavioral Sciences, University of Texas, Austin, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Madhukar H Trivedi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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5
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Benster LL, Weissman CR, Daskalakis ZJ. Suicidal Ideation and Obsessive-Compulsive Disorder: Links and Knowledge. Psychol Res Behav Manag 2022; 15:3793-3807. [PMID: 36573087 PMCID: PMC9789712 DOI: 10.2147/prbm.s368585] [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: 09/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Suicidal ideation (SI) is understudied in obsessive-compulsive disorder (OCD). Nonetheless, evidence suggests increased risk for SI in individuals with OCD compared to the general population. Understanding the relationship between SI and OCD involves investigating risk factors associated with SI. Furthering knowledge of links is essential for enhancing outcomes and decreasing experiences of SI through improving treatment interventions. Additionally, increasing awareness of factors that lead SI to suicide attempts (SA) is vital. To best illustrate the current state of knowledge, this scoping review examines risk factors for SI, including symptom profiles or phenotypes, comorbid diagnoses, sociodemographic and lifestyle factors, childhood trauma, and genetic and familial contributions. Important treatment considerations for targeting SI within the context of OCD are detailed with respect to the current evidence for psychotherapy, pharmacology, brain stimulation, and neurosurgery. Gaps in the literature and future directions are identified, broadly with respect to studies examining the treatment of SI within the context of OCD, particular OCD phenotypes, and factors influencing SI in pediatric OCD. Due to the relative novelty of this area of exploration, many unknowns persist regarding onset of SI in OCD, factors contributing to the maintenance of SI in OCD, and relevant treatment protocols. Findings suggest that individuals with previous SI or SA, history of childhood trauma, significant life stress, and psychiatric comorbidities, particularly depression, should be closely monitored and screened for SI.
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Affiliation(s)
- Lindsay L Benster
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA,Correspondence: Lindsay L Benster, Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, 6363 Alvarado Ct, San Diego, CA, 92120, USA, Tel +1206 230 0707, Email
| | - Cory R Weissman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
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6
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Pagsberg AK, Uhre C, Uhre V, Pretzmann L, Christensen SH, Thoustrup C, Clemmesen I, Gudmandsen AA, Korsbjerg NLJ, Mora-Jensen ARC, Ritter M, Thorsen ED, Halberg KSV, Bugge B, Staal N, Ingstrup HK, Moltke BB, Kloster AM, Zoega PJ, Mikkelsen MS, Harboe GS, Larsen KF, Clemmesen LKH, Lindschou J, Jakobsen JC, Engstrøm J, Gluud C, Siebner HR, Thomsen PH, Hybel K, Verhulst F, Jeppesen P, Jepsen JRM, Vangkilde S, Olsen MH, Hagstrøm J, Lønfeldt NN, Plessen KJ. Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial). BMC Psychiatry 2022; 22:204. [PMID: 35305587 PMCID: PMC8933964 DOI: 10.1186/s12888-021-03669-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. METHODS This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included. DISCUSSION In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention. TRIAL REGISTRATION ClinicalTrials.gov : NCT03595098, registered July 23, 2018.
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Affiliation(s)
- Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Camilla Uhre
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Valdemar Uhre
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Linea Pretzmann
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Heidenheim Christensen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Christine Thoustrup
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Iben Clemmesen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Amanda Aaen Gudmandsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Nicoline Løcke Jepsen Korsbjerg
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Anna-Rosa Cecilie Mora-Jensen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ritter
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Emilie D. Thorsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Klara Sofie Vangstrup Halberg
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Birgitte Bugge
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Nina Staal
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Helga Kristensen Ingstrup
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Birgitte Borgbjerg Moltke
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Anne Murphy Kloster
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Pernille Juul Zoega
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Marie Sommer Mikkelsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Gitte Sommer Harboe
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Katrin Frimann Larsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Line Katrine Harder Clemmesen
- grid.5170.30000 0001 2181 8870Applied Mathematics and Computer Science, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Jane Lindschou
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Engstrøm
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Hartwig Roman Siebner
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark ,grid.411702.10000 0000 9350 8874Department of Neurology, Copenhagen University Hospital Bispebjerg and Fredriksberg, Copenhagen, Denmark
| | - Per Hove Thomsen
- grid.154185.c0000 0004 0512 597XDepartment of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Copenhagen, Denmark
| | - Katja Hybel
- grid.154185.c0000 0004 0512 597XDepartment of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Copenhagen, Denmark
| | - Frank Verhulst
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Pia Jeppesen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.480615.e0000 0004 0639 1882Child and Adolescent Psychiatric Department, Region Zealand Psychiatry, Research Unit, Roskilde, Denmark
| | - Jens Richardt Møllegaard Jepsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Signe Vangkilde
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, Faculty Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus Harboe Olsen
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.475435.4Department of Neuroanaesthesiology, The Neuroscience Centre, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Julie Hagstrøm
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Nicole Nadine Lønfeldt
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.8515.90000 0001 0423 4662Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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7
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Krebs G, Mataix-Cols D, Rijsdijk F, Rück C, Lichtenstein P, Lundström S, Larsson H, Eley TC, Fernández de la Cruz L. Concurrent and prospective associations of obsessive-compulsive symptoms with suicidality in young adults: A genetically-informative study. J Affect Disord 2021; 281:422-430. [PMID: 33359955 PMCID: PMC7843953 DOI: 10.1016/j.jad.2020.10.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has been linked with elevated risk of suicidality. However, most previous studies have been cross-sectional, and little is known about the aetiology of the association between obsessive-compulsive symptoms (OCS) and suicidality in young adults. METHODS Participants were members of the Child and Adolescent Twin Study in Sweden, at ages 18 (n = 9,162) and 24 (n = 3,466). Twins completed self-report measures, including assessment of OCS, suicidal ideation, and suicidal attempts. Logistic regression models tested concurrent and prospective associations of total OCS and OCS dimensions with suicidality, with and without adjustment for depression and anxiety symptoms. Genetic models tested the extent to which the main phenotypic associations were accounted for by genetic and environmental influences. RESULTS Total OCS were significantly associated with concurrent reports of suicidality at age 18 and 24, even when controlling for depressive and anxiety symptoms. Taboo obsessions (e.g., sexual and aggressive thoughts) were more robustly associated with suicidality than other OCS dimensions, and prospectively predicted suicidality symptoms over time, even when controlling for baseline suicide attempts. Genetic factors accounted for most of the concurrent and longitudinal covariance between OCS and suicidality, with substantial non-shared environmental influences. LIMITATIONS We relied on self-report measures and did not include diagnostic assessment of OCD. CONCLUSIONS OCS, particularly taboo obsessions, are associated with significantly elevated risk of suicidality in late adolescence and early adulthood. This relationship is explained by a combination of common genetic liability and non-shared environmental effects, suggesting that effective OCS treatment might reduce suicidality risk in this group.
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Affiliation(s)
- Georgina Krebs
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Frühling Rijsdijk
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics, Law and Mental Health, University of Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Thalia C. Eley
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,Corresponding author: Professor Thalia Eley, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO80, De Crespigny Park, London SE5 8AF, UK
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Vellozo AP, Fontenelle LF, Torresan RC, Shavitt RG, Ferrão YA, Rosário MC, Miguel EC, Torres AR. Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates. J Clin Med 2021; 10:jcm10020274. [PMID: 33451078 PMCID: PMC7828517 DOI: 10.3390/jcm10020274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
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Affiliation(s)
- Aline P. Vellozo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
- D’Or Institute for Research and Education & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Correspondence: ; Tel.: +61-3-990-29755
| | - Ricardo C. Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Roseli G. Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Ygor A. Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90570-080, Brazil;
| | - Maria C. Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil;
| | - Euripedes C. Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
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9
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Pellegrini L, Maietti E, Rucci P, Casadei G, Maina G, Fineberg NA, Albert U. Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2020; 276:1001-1021. [PMID: 32750613 DOI: 10.1016/j.jad.2020.07.115] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/21/2020] [Accepted: 07/18/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION There is controversy on the magnitude of suicide risk in OCD and on the psychopathological features that raise the risk. This systematic review and meta-analysis aims to estimate the pooled prevalence of suicide attempts and suicidal ideation (current/lifetime) in subjects with OCD and identify sociodemographic and clinical factors associated with greater risk. METHODS We conducted a literature search in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases up to June 20, 2019, according to PRISMA guidelines. Stata statistical software (Version 15) was used to obtain forest plots, execute subgroup analyses and perform univariate and multivariate meta-regressions. RESULTS We found 61 eligible studies including OCD patients: 52 investigated suicide attempts and reported a pooled prevalence of 0.135 (95% CI 0.123-0.147); 26 explored current suicidal ideation and reported a pooled prevalence of 0.273 (95% CI 0.214-0.335); 22 researched lifetime suicidal ideation and reported a pooled prevalence of 0.473 (95% CI 0.397-0.548). Severity of obsessions, comorbid substance use and depressive/anxious symptoms increased the risk, whereas compulsions had a comparatively protective effect. LIMITATIONS Owing to the small number of studies reporting completed suicide rates, this metric was not included in the meta-analysis. The degree of heterogeneity between the studies was high. CONCLUSION Clinicians should keep in mind that one out of ten patients with OCD attempts suicide during his/her lifetime, about one third has current suicidal ideation and about half has had suicidal ideation in the past. Several clinical features are associated with increased risk and should be factored into clinical risk management.
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Affiliation(s)
- Luca Pellegrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Carlo Pepoli, 5, 40123, Bologna (BO), Italy; Highly Specialized Service for OCD and BDD, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Hatfield, United Kingdom.
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Carlo Pepoli, 5, 40123, Bologna (BO), Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Carlo Pepoli, 5, 40123, Bologna (BO), Italy
| | - Giacomo Casadei
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Carlo Pepoli, 5, 40123, Bologna (BO), Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Italy
| | - Naomi A Fineberg
- Highly Specialized Service for OCD and BDD, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Hatfield, United Kingdom; University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Giuliano-Isontina - ASUGI, Italy
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10
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Velloso P, Piccinato C, Ferrão Y, Aliende Perin E, Cesar R, Fontenelle L, Hounie A, do Rosário M. The suicidality continuum in a large sample of obsessive–compulsive disorder (OCD) patients. Eur Psychiatry 2020; 38:1-7. [DOI: 10.1016/j.eurpsy.2016.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 01/24/2023] Open
Abstract
AbstractBackgroundObsessive–compulsive disorder (OCD) has a chronic course leading to huge impact in the patient’s functioning. Suicidal thoughts and attempts are much more frequent in OCD subjects than once thought before.AimTo empirically investigate whether the suicidal phenomena could be analyzed as a suicidality severity continuum and its association with obsessive–compulsive (OC) symptom dimensions and quality of life (QoL), in a large OCD sample.MethodsCross-sectional study with 548 patients diagnosed with OCD according to the DSM-IV criteria, interviewed in the Brazilian OCD Consortium (C-TOC) sites. Patients were evaluated by OCD experts using standardized instruments including: Yale-Brown Obsessive–Compulsive Scale (YBOCS); Dimensional Yale-Brown Obsessive–Compulsive Scale (DYBOCS); Beck Depression and Anxiety Inventories; Structured Clinical Interview for DSM-IV (SCID); and the SF-36 QoL Health Survey.ResultsThere were extremely high correlations between all the suicidal phenomena. OCD patients with suicidality had significantly lower QoL, higher severity in the “sexual/religious”, “aggression” and “symmetry/ordering” OC symptom dimensions, higher BDI and BA scores and a higher frequency of suicide attempts in a family member. In the regression analysis, the factors that most impacted suicidality were the sexual dimension severity, the SF-36 QoL Mental Health domain, the severity of depressive symptoms and a relative with an attempted suicide history.ConclusionsSuicidality could be analyzed as a severity continuum and patients should be carefully monitored since they present with suicidal ideation. Lower QoL scores, higher scores on the sexual dimension and a family history of suicide attempts should be considered as risk factors for suicidality among OCD patients.
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11
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Albert U, De Ronchi D, Maina G, Pompili M. Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review. Curr Neuropharmacol 2020; 17:681-696. [PMID: 29929465 PMCID: PMC7059158 DOI: 10.2174/1570159x16666180620155941] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported. OBJECTIVE To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD. METHODS We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality. RESULTS In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness. CONCLUSION Overall, suicidality appears a relevant phenomenon in OCD.
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Affiliation(s)
- Umberto Albert
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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12
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Sørensen JØ, Rasmussen A, Roesbjerg T, Pagsberg AK. Clinician compliance to recommendations regarding the risk of suicidality with selective serotonin reuptake inhibitors in the treatment of children and adolescents. Eur Child Adolesc Psychiatry 2020; 29:707-718. [PMID: 31701374 PMCID: PMC7250792 DOI: 10.1007/s00787-019-01435-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 10/31/2019] [Indexed: 11/24/2022]
Abstract
Meta-analyses of randomized-controlled trials have established a heightened risk of suicidality for children and adolescents treated with selective serotonin reuptake inhibitors (SSRIs). The present study examined to what extent daily clinical practice complied with specific recommendations regarding the risk of suicidality when treating children and adolescents with SSRIs. All in- and outpatients aged 0-17 years at the Child and Adolescent Mental Health Services, Capital Region of Denmark with a prescription for SSRI on January 1st, 2016 were identified. Data were obtained for n = 365 patients regarding the level of clinician compliance to deliver pre-consent information about adverse effects, monitor for suicidality, and provide non-pharmacological interventions. 81.7% (n = 298) of patients received pre-consent information about adverse effects. 67.7% (n = 247) were monitored for suicidality within 6 weeks after SSRI initiation. Children (0-13 years) were less likely to be monitored for suicidality compared to adolescents (14-17 years) (49.6% vs. 77.5%, p < 0.001). Patients with depression as indication for SSRI treatment were more likely to be monitored for suicidality than patients with other indications (OR = 3.4, p = 0,002) and more likely to receive information specifically about suicidality (34.7% vs. 19.7%, p = 0.002). Respectively, 89.3% (n = 326) and 93.4% (n = 341) of all SSRI-treated patients were treated with non-pharmacological interventions prior to and in parallel with SSRI treatment. For the majority of cases, treatment of children and adolescents with SSRI complied with recommendations from clinical guidelines. However, patients of younger age and/or with indications for SSRIs other than depression were less likely to be managed according to recommendations.
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Affiliation(s)
- Johanne Østerby Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences and Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and University of Copenhagen, Kildegaardsvej 28, Opgang 3A, 1 sal, 2900 Hellerup, Denmark
| | - Annette Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences and Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and University of Copenhagen, Kildegaardsvej 28, Opgang 3A, 1 sal, 2900 Hellerup, Denmark
| | - Troels Roesbjerg
- Mental Health Services, Capital Region of Denmark, Kristineberg 3, 2100 Copenhagen Ø, Denmark
| | - Anne Katrine Pagsberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences and Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and University of Copenhagen, Kildegaardsvej 28, Opgang 3A, 1 sal, 2900, Hellerup, Denmark.
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13
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Carter T, Walker GM, Aubeeluck A, Manning JC. Assessment tools of immediate risk of self-harm and suicide in children and young people: A scoping review. J Child Health Care 2019; 23:178-199. [PMID: 30058359 DOI: 10.1177/1367493518787925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
There are increasing numbers of children presenting to paediatric hospital settings in mental health crisis. Typically, non-mental health professionals are responsible for the initial assessment of these children and are required to identify immediate physical and emotional health needs. To ensure the safety of these children, immediate risk of suicide and self-harm should be assessed. However, no standardized assessment tool is used in clinical practice, and for those tools that are used, their validity and reliability is unclear. A scoping review was conducted to identify the existing assessment tools of immediate self-harm and suicide risk. Searches of electronic databases and relevant reference lists were undertaken. Twenty-two tools were identified and most assessed acute risk of suicide with only four tools incorporating a self-harm assessment. The tools varied in number of items (4-146), subscales (0-11) and total scores (16-192). Half incorporated Likert-type scales, and most were completed via self-report. Many tools were subject to limited psychometric testing, and no single tool was valid or reliable for use with children presenting in mental health crisis to non-mental health settings. As such, a clinically appropriate, valid and reliable tool that assesses immediate risk of self-harm and suicide in paediatric settings should be developed.
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Affiliation(s)
- Tim Carter
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Gemma M Walker
- 2 Nottingham Children's Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals, Nottingham, UK
| | - Aimee Aubeeluck
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Joseph C Manning
- 1 School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.,2 Nottingham Children's Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals, Nottingham, UK.,3 Children and Families Research, Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
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14
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Kim HHS. Parental overprotection and youth suicide behavior in low- and middle-income countries: a multilevel analysis of cross-national data. Int J Public Health 2018; 64:173-184. [PMID: 30406419 DOI: 10.1007/s00038-018-1169-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Research on youth suicide behavior has emphasized parent-child relations as a critical protective factor. This study investigates whether "too much" regulation of children, i.e., overprotection, may actually increase the likelihoods of youth suicide intent and plan. METHODS Data are drawn from the subset of the Global School-based Student Health Survey (2000-2012), consisting of children living in 48 low- and middle-income countries. Two-level hierarchical linear models are fitted to examine the potential curvilinear (U-shaped) association between parental monitoring and suicide behavior among youth. RESULTS Adjusting for individual- and country-level covariates, significant support is found for non-monotonicity specifically among boys: Greater parental involvement in male children's lives lowers both suicide ideation and suicide plan to some extent but, after certain thresholds, increases the odds of both outcomes. Results for girls, however, are much less pronounced. CONCLUSIONS In resource-poor countries marked by some of the highest teenage suicide rates in the world, overprotective parenting style is found to have negative and gendered consequences on the mental health of youth. More research is needed to confirm its replicability in economically more developed societies.
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Affiliation(s)
- Harris Hyun-Soo Kim
- Department of Sociology, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 120-750, Republic of Korea.
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15
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Skapinakis P, Caldwell D, Hollingworth W, Bryden P, Fineberg N, Salkovskis P, Welton N, Baxter H, Kessler D, Churchill R, Lewis G. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess 2018; 20:1-392. [PMID: 27306503 DOI: 10.3310/hta20430] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. OBJECTIVES To determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults. DATA SOURCES We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014. REVIEW METHODS We undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale-Brown Obsessive-Compulsive Scale or its children's version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; see www.openbugs.net ). RESULTS We included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive-behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias. LIMITATIONS The majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents. CONCLUSIONS In adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions. STUDY REGISTRATION The study is registered as PROSPERO CRD42012002441. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Peter Bryden
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naomi Fineberg
- University of Hertfordshire and Hertfordshire Partnerships Mental Health Trust, Hatfield, UK
| | | | - Nicky Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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Prevalence and Clinical Differences of Suicidal Thoughts and Behaviors in a Community Sample of Youth Receiving Cognitive-Behavioral Therapy for Anxiety. Child Psychiatry Hum Dev 2017; 48:705-713. [PMID: 27832342 PMCID: PMC5425323 DOI: 10.1007/s10578-016-0696-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined the incidence of suicidal thoughts and behaviors in youth with anxiety before initiating cognitive behavioral therapy, as well as the emergence of suicidal thoughts and behaviors during treatment. Overall, 30% of youth experienced suicidal thoughts and behaviors. Prior to treatment, 24% reported suicidal thoughts and behaviors, and 13.1% endorsed suicidal thoughts and behaviors during treatment. More than half who endorsed suicidal thoughts and behaviors during treatment were newly identified cases not detected prior to treatment. Disagreement among parent- and child-report measures of suicidality was found at baseline. Youth who experienced suicidal thoughts and behaviors had higher levels of loneliness, depressive symptoms, overt peer victimization, functional impairment, and externalizing symptoms. Findings suggest that the assessment of suicidality at a single time-point and from one informant is not sufficient to identify at-risk youth. Ongoing assessment of suicidal risk during treatment is important in this population.
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17
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Anxiety and Shame as Risk Factors for Depression, Suicidality, and Functional Impairment in Body Dysmorphic Disorder and Obsessive Compulsive Disorder. J Nerv Ment Dis 2016; 204:832-839. [PMID: 26998694 PMCID: PMC5026856 DOI: 10.1097/nmd.0000000000000498] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Body dysmorphic disorder (BDD) and obsessive compulsive disorder (OCD) are associated with elevated depression, suicidality, functional impairment, and days housebound, yet little research has identified risk factors for these outcomes. Using path analysis, the present study examined anxiety and shame as risk factors for these outcomes across Internet-recruited self-report groups (BDD [n = 114], OCD [n = 114], and healthy control [HC; n = 133]). Paths from anxiety and shame to outcomes were similar and mostly significant across BDD and OCD, compared to non-significant paths for HCs, with one exception: the path from shame to depression was significant in the BDD group (b = 0.32) but non-significant in the OCD group (b = 0.07). Findings underscore similarities in BDD and OCD, supporting their reclassification into the same Obsessive Compulsive Related Disorders category. Results emphasize the importance of targeting shame, in addition to anxiety, in treatments for BDD and OCD.
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Ching THW, Williams M, Siev J. Violent obsessions are associated with suicidality in an OCD analog sample of college students. Cogn Behav Ther 2016; 46:129-140. [PMID: 27659199 DOI: 10.1080/16506073.2016.1228084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.
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Affiliation(s)
- Terence H W Ching
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Monnica Williams
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Jedidiah Siev
- b Psychology Department , Swarthmore College , Swarthmore , PA , USA
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Storch EA, Hanks CE, Mink JW, McGuire JF, Adams HR, Augustine EF, Vierhile A, Thatcher A, Bitsko R, Lewin AB, Murphy TK. SUICIDAL THOUGHTS AND BEHAVIORS IN CHILDREN AND ADOLESCENTS WITH CHRONIC TIC DISORDERS. Depress Anxiety 2015; 32:744-53. [PMID: 25711415 PMCID: PMC4547888 DOI: 10.1002/da.22357] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Despite evidence of elevated risk factors for suicidal thoughts and behavior in youth with Tourette syndrome and chronic tic disorders (CTD), few studies have actually examined that relationship. This study documented the frequency and clinical correlates of suicidal thoughts and behaviors in a sample of children and adolescents with CTD (N = 196, range 6-18 years old). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control. METHOD Youth and parents completed a battery of measures that assessed co-occurring psychiatric diagnoses, child emotional and behavioral symptoms, and impairment due to tics or co-occurring conditions. RESULTS A structured diagnostic interview identified that 19 youths with CTD (9.7%) experienced suicidal thoughts and/or behaviors, which was elevated compared to 3 youths (3%) who experienced these thoughts in a community control sample (N = 100, range 6-18 years old, P = .03). For youth with CTD, suicidal thoughts and behaviors were frequently endorsed in the context of anger and frustration. The Child Behavior Checklist (CBCL) anxious/depressed, withdrawn, social problems, thought problems, and aggressive behavior subscales, as well as the total internalizing problems scale, were associated with the presence of suicidal thoughts and/or behaviors. Suicidal thoughts and/or behaviors were significantly associated with tic symptom severity; tic-related impairment; and obsessive-compulsive, depressive, anxiety, and attention-deficit/hyperactivity disorders' symptom severity. CBCL anxiety/depression scores mediated the relationship between tic severity and suicidal thoughts and behaviors. CONCLUSIONS Findings suggest that about 1 in 10 youth with CTD experience suicidal thoughts and/or behaviors, which are associated with a more complex clinical presentation and often occur in the presence of anger and frustration.
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Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida, Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Department of Health Policy and Management, University of South Florida, Rogers Behavioral Health – Tampa Bay, All Children's Hospital – Johns Hopkins Medicine
| | | | - Jonathan W. Mink
- Department of Neurology, University of Rochester, Department of Pediatrics, University of Rochester, Department of Neurobiology & Anatomy, University of Rochester, Department of Brain & Cognitive Sciences, University of Rochester
| | | | | | - Erika F. Augustine
- Department of Neurology, University of Rochester, Department of Pediatrics, University of Rochester
| | - Amy Vierhile
- Department of Neurology, University of Rochester
| | | | | | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, Department of Psychiatry & Behavioral Neurosciences, University of South Florida
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida, Department of Psychiatry & Behavioral Neurosciences, University of South Florida, All Children's Hospital – Johns Hopkins Medicine
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