Impulsivity and Suicidality in Adolescent Inpatients

A multi-level examination of impulsivity and links to suicide ideation among Native American youth

BACKGROUND

Despite preliminary evidence that links impulsivity to suicide risk among Native American youth, impulsivity has not been directly studied in relation to suicide ideation (SI) or behaviors in this population. We examined indexes of rapid-response impulsivity (RRI) across multiple levels of analysis (self-report, behavioral, neurobiological) and associations with SI among Native American youth ages 9-10 in the Adolescent Brain Cognitive Development Study.

METHODS

Data from the sample (n = 284) included self-report (UPPS-P), behavioral (Stop Signal Task), and neurobiological (right inferior frontal gyrus activation) indicators of RRI. RRI indicators were modeled using variable-centered (i.e., traditional multivariable regression) and person-centered (i.e., clustering analyses) approaches in measuring their association with SI.

RESULTS

Logistic regression analysis demonstrated that higher negative urgency was associated with higher odds of SI (Adjusted Odds Ratio = 1.23, p = 0.015). Latent profile analysis clustered youth into five profiles based on within-individual variation in RRI indicators. Youth with an elevated self-reported negative and positive urgency profile had higher odds of reporting SI than "normative" youth (Adjusted Odds Ratio = 2.38, p = 0.019).

LIMITATIONS

Limitations of this study include the modest sample size particularly regarding SI (14.1 %), potential bias in estimates of lifetime SI, and generalizability to youth from specific Native American communities.

CONCLUSIONS

Negative urgency may increase risk for SI among Native American youth in late childhood. Clinical implications, including the potential for person-centered RRI profiles to act as candidate markers of suicide risk and resilience in adolescence and inform safety assessments and planning, are discussed.

Variable Presence of an Evolutionarily New Brain Structure is Related to Trait Impulsivity

BACKGROUND

Impulsivity is a multidimensional construct reflecting poor constraint over one's behaviors. Clinical psychology research identifies separable impulsivity dimensions that are each unique transdiagnostic indicators for psychopathology. Yet, despite this apparent clinical importance, the shared and unique neuroanatomical correlates of these factors remain largely unknown. Concomitantly, neuroimaging research identifies variably present human brain structures implicated in cognition and disorder: the folds (sulci) of the cerebral cortex located in the latest developing and most evolutionarily expanded hominoid-specific association cortices.

METHODS

We tethered these two fields to test whether variability in one such structure in anterior cingulate cortex (ACC)-the paracingulate sulcus (PCGS)-was related to individual differences in trait impulsivity. 120 adult participants with internalizing or externalizing psychopathology completed a magnetic resonance imaging scan and the Three-Factor Impulsivity Index. Using precision imaging techniques, we manually identified the PCGS, when present, and acquired quantitative folding metrics (PCGS length and ACC local gyrification index).

RESULTS

Neuroanatomical-behavioral analyses revealed that participants with leftward or symmetrical PCGS patterns had greater severity of Lack of Follow Through (LFT)-which captures inattention and lack of perseverance-than those with rightward asymmetry. Neuroanatomical-functional analyses identified that the PCGS co-localized with a focal locus found in a neuroimaging meta-analysis on a feature underlying LFT. Both quantitative folding metrics did not relate to any impulsivity dimension.

CONCLUSIONS

This study advances understanding of the neuroanatomical correlates of impulsivity and establishes the notion that the topographical organization of distinct, hominoid-specific cortical expanses underlie separable impulsivity dimensions with robust, transdiagnostic implications for psychopathology.

Negative Urgency and Lack of Perseverance Predict Suicidal Ideation and Attempts Among Young Adolescents

OBJECTIVE

Impulsivity has been recognized as an important factor in suicidal thoughts and behaviors (STBs). However, previous research linking impulsivity to STBs has largely relied on cross-sectional designs, considered only a subset of impulsivity measures, and typically focused on middle-to-older adolescents. Here, we explored multiple measures of impulsivity and assessed their predictive relation to suicidal ideation and suicide attempts.

METHOD

In a sample of 10,286 adolescents (ages 9-12; 47.4% female, 76.4% White, 19.4% Black, 6.4% Asian, 3.5% American Indian/Alaskan Native, 0.6% Native Hawaiian/Pacific Islander, 6.4% Other, 19.4% Hispanic, 12.1% Mixed/Multiple Race) from the Adolescent Brain Cognitive Development℠ Study (ABCD Study®), we assessed impulsivity when youth were 9-10 years old, and suicidal ideation and attempts when youth were 11-12 years old. We measured impulsivity in three ways: a trait-like measure (UPPS-P Impulsive Behavior Scale), a behavioral measure (delay discounting task), and a neural measure (Cortical Delay Discounting [C-DD]). Suicidal ideation and attempts were assessed using the Kiddie Schedule for Affective Disorder and Schizophrenia (KSADS) suicide module.

RESULTS

Negative urgency and lack of perseverance (at ages 9-10) significantly predicted a higher likelihood of suicidal ideation (Negative Urgency: Odds Ratio [OR] = 1.254, p < .001; Lack of Perseverance: OR = 1.152, p = .035) and suicide attempts (Negative Urgency: OR = 1.328, p = .009; Lack of Perseverance: OR = 1.270, p = .009) when youth were 11-12 years old.

CONCLUSIONS

Negative urgency and lack of perseverance are robust predictors of future suicidal ideation and suicide attempts in young adolescents. These findings highlight the importance of assessing for and targeting these dimensions of impulsivity in clinical settings.

Emotion-related impulsivity is related to orbitofrontal cortical sulcation

BACKGROUND

Emotion-related impulsivity (ERI) describes the trait-like tendency toward poor self-control when experiencing strong emotions. ERI has been shown to be elevated across psychiatric disorders and predictive of the onset and worsening of psychiatric syndromes. Recent work has correlated ERI scores with the region-level neuroanatomical properties of the orbitofrontal cortex (OFC), but not posteromedial cortex (PMC). Informed by a growing body of research indicating that examining the morphology of specific cortical folds (sulci) can produce unique insights into behavioral outcomes, the present study modeled the association between ERI and the morphology of sulci within OFC and PMC, which is a finer scale than previously conducted.

METHODS

Analyses were conducted in a transdiagnostic sample of 118 adult individuals with a broad range of psychiatric syndromes. First, we manually defined over 4,000 sulci across 236 cerebral hemispheres. Second, we implemented a model-based LASSO regression to relate OFC sulcal morphology to ERI. Third, we tested whether effects were specific to OFC sulci, sulcal depth, and ERI (as compared to PMC sulci, sulcal gray matter thickness, and non-emotion-related impulsivity).

RESULTS

The LASSO regression revealed bilateral associations of ERI with the depths of eight OFC sulci. These effects were strongest for OFC sulci, sulcal depth, and ERI in comparison to PMC sulci, sulcal gray matter thickness, and non-emotion-related impulsivity. In addition, we identified a new transverse component of the olfactory sulcus in every hemisphere that is dissociable from the longitudinal component based on anatomical features and correlation with behavior, which could serve as a new transdiagnostic biomarker.

CONCLUSIONS

The results of this data-driven investigation provide greater neuroanatomical and neurodevelopmental specificity on how OFC is related to ERI. As such, findings link neuroanatomical characteristics to a trait that is highly predictive of psychopathology.

Variable Presence of an Evolutionarily New Brain Structure is Related to Trait Impulsivity

Background

Impulsivity is a multidimensional construct reflecting poor constraint over one's behaviors. Clinical psychology research identifies separable impulsivity dimensions that are each unique transdiagnostic indicators for psychopathology. Yet, despite this apparent clinical importance, the shared and unique neuroanatomical correlates of these factors remain largely unknown. Concomitantly, neuroimaging research identifies variably present human brain structures implicated in cognition and disorder: the folds (sulci) of the cerebral cortex located in the latest developing and most evolutionarily expanded hominoid-specific association cortices.

Methods

We tethered these two fields to test whether variability in one such structure in anterior cingulate cortex (ACC)-the paracingulate sulcus (PCGS)-was related to individual differences in trait impulsivity. 120 adult participants with internalizing or externalizing psychopathology completed a magnetic resonance imaging scan and the Three-Factor Impulsivity Index. Using precision imaging techniques, we manually identified the PCGS, when present, and acquired quantitative folding metrics (PCGS length and ACC local gyrification index).

Results

Neuroanatomical-behavioral analyses revealed that participants with leftward or symmetrical PCGS patterns had greater severity of Lack of Follow Through (LFT)-which captures inattention and lack of perseverance-than those with rightward asymmetry. Neuroanatomical-functional analyses identified that the PCGS co-localized with a focal locus found in a neuroimaging meta-analysis on a feature underlying LFT. Both quantitative folding metrics did not relate to any impulsivity dimension.

Conclusions

This study advances understanding of the neuroanatomical correlates of impulsivity and establishes the notion that the topographical organization of distinct, hominoid-specific cortical expanses underlie separable impulsivity dimensions with robust, transdiagnostic implications for psychopathology.

Urgency as a predictor of change in emotion dysregulation in adolescents

Introduction

Adolescence is a key developmental period characterized by increased maladaptive risky behaviors. Two related but distinct constructs, urgency (the tendency to act rashly in response to strong negative or positive emotions) and emotion dysregulation, are important risk factors for engaging in maladaptive risky behaviors. Thus far, research has largely agreed that these two risk factors are highly correlated. However, the causal direction between these constructs is less understood. The goal of the current study is to determine whether urgency predicts emotion dysregulation change among adolescents.

Method

This project is an analysis of 544 youth (49.8% female, Mage=14.22, SD=0.52). We tested whether urgency at baseline predicts change in emotion dysregulation over a nine-week period, and whether that relationship differs across boys and girls.

Results

Two multigroup latent change score path analyses found that negative, but not positive, urgency significantly predicted emotion dysregulation change (negative urgency: b= -0.57, p=0.001; positive urgency: b=0.22, p=0.06). There was no evidence of moderation by gender.

Discussion

This work provides initial evidence of a temporal relationship between higher negative urgency and increased emotion dysregulation. The next step is to determine whether negative urgency imparts risk for maladaptive behaviors through its effect on emotion dysregulation. The long-term goal of this program of research is to design and test interventions to reduce the impact of negative urgency for adolescent risk-taking.

Perceptions of Suicide among Pakistanis: Results of an Online Survey

OBJECTIVE

In Pakistan, a predominantly Muslim country, information on the patterning of suicidal thoughts and behaviors, as well as associated public perceptions and opinions, is limited. We sought to advance knowledge on suicide and self-harm in Pakistan with a large, online survey.

METHOD

Leveraging results from a twelve-item online survey (N = 5,157) circulated by the largest English language newspaper in Pakistan, we assessed personal experiences, opinions, and attitudes toward help-seeking in the context of suicide. We calculated proportions with 95% confidence intervals for endorsed responses and implemented binomial generalized linear models with odds ratios to assess differing response tendencies by age, gender, and urban/rural residence.

RESULTS

Personal experiences related to suicide and self-harm as well as encounters in social circles were common. Mental illness tended to be recognized as a high likelihood contributor to suicide death over and above nonviolent interpersonal problems. Most considered suicide a way to escape pain, and few considered suicide to be immoral. Barriers to help-seeking included social deterrents, inaccessibility, and unaffordability. Women and youth emerged as higher risk groups, though the status of rural Pakistanis remained unclear.

CONCLUSION

The survey provides a preliminary basis for considering the unique experiences and perspectives of the public in shaping suicide prevention and intervention efforts in Pakistan.

Acute Emotional Impact of Peer Suicide and Student-Related Factors

OBJECTIVE

This study explored the negative emotional impact of peer suicide on adolescent students during the early stages of becoming aware of suicide and examined the adverse effects of related environmental and mental health factors.

METHODS

This study was conducted from March 1, 2020 to December 31, 2021, targeting students enrolled in middle and high schools where student suicide occurred. Emotional impact was assessed using the Korean version of the Impact of Event Scale-Revised (IES-R-K), State-Trait Anxiety Inventory-X, Center for Epidemiologic Studies-Depression Scale (CES-D), and Beck's Scale for Suicide Ideation (SSI). χ2 test and Pearson's correlation analysis were performed to analyze subgroup differences and explore relationships between scale scores, respectively.

RESULTS

Of the 2,382 participants, 25.1% belonged to the post-traumatic stress disorder (PTSD) or PTSD tendency group on the IES-R-K, and 22.2% showed abnormalities in the State-Trait Anxiety Inventory-State. Students in the same class as the deceased student and those in the same grade but in different classes had higher risk rates than those in different grades. Boarding school students had 1.9 times higher odds of experiencing emotional impacts than non-boarding students. On the CES-D, 10.4% of the students showed potential depression, with 3.7 times higher odds of experiencing emotional impact than those with normal scores. Moreover, 4.5% of the students reported suicidal ideation on the SSI, with those experiencing mild suicidal ideation having 1.9 times higher odds of experiencing emotional impact than those with normal scores.

CONCLUSION

A significant proportion of students experienced negative impacts of peer suicide. Students in close-knit environments, such as the same class, grade, and boarding school as the deceased, or those with depression or anxiety experienced a more pronounced negative impact.

Negative and positive urgency as pathways in the intergenerational transmission of suicide risk in childhood

Introduction

Parental suicide attempts and suicide death increase suicide risk in their offspring. High levels of impulsivity have been observed in families at high risk for suicide. Impulsivity, a highly heritable trait that is especially elevated in childhood, is frequently measured with the UPPS-P Impulsive Behavior Scale, which includes negative urgency, positive urgency, sensation seeking, premeditation, and perseverance. Our study examined the association between the UPPS-P facets and suicide ideation (without suicide attempts) and suicide attempts at baseline and first-time endorsement within the next two years in childhood. We also examined how the UPPS-P facets mediated the association between parental suicide attempts and suicide death and offspring first-time suicide ideation and attempts at follow-up.

Methods

The sample was 9,194 children (48.4% female; 9-10 years old) from the Adolescent Brain Cognitive Development (ABCD) study, assessed yearly three times. At Time 1 (T1), caregivers reported on suicide attempts and suicide deaths (combined) of the biological parents. Caregivers and children reported on suicide ideation and attempts in the KSADS-PL DSM-5 at each time point, T1 and follow-up (T2 and/or T3). The Short UPPS-P Scale (child-report) assessed the impulsivity facets at T1, which were computed as latent variables.

Results

At T1, 6.7% of children had a parent who had attempted or died by suicide. Most UPPS-P facets were associated with suicide ideation and attempts at T1 and T2/T3. In adjusted models, parental suicide attempts and suicide death were associated with offspring negative and positive urgency. In mediation models, parental suicide attempts and suicide death had an indirect effect on offspring first-time suicide ideation at T2/T3 through negative urgency (OR = 1.04; 95% CI, 1.01-1.08) and positive urgency (OR = 1.03, 95% CI, 1.01-1.05). Similar results were found for first-time suicide attempts at T2/T3.

Discussion

Our findings support an impulsive pathway in the familial transmission of suicide risk. For all youth, interventions that target multiple UPPS-P facets may help prevent or reduce suicide risk. For offspring whose parents have attempted or died by suicide, clinicians should pay particular attention to children who impulsively act on extreme emotions, as they may be at higher suicide risk.

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.

Scoping Review: Transdiagnostic Measurement of Impulsivity Domains in Youth Using the UPPS Impulsive Behavior Scales

OBJECTIVE

Impulsivity contributes to many clinically relevant behaviors impacting youth. A scoping review was conducted to characterize existing research using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking (UPPS) Impulsive Behavior Scales in youth populations, to review the psychometric and validity data of UPPS, and to summarize findings related to sex/gender and diagnostic populations of youth.

METHOD

PubMed, Embase, and PsycNET databases were searched from January 1, 2001 (original UPPS publication) through October 2, 2022, according to PRISMA extension for Scoping Reviews guidelines. Articles were reviewed for inclusion/exclusion by 2 authors. Original research articles in English using any UPPS version or subscale in persons aged ≤21 years were included.

RESULTS

Inclusion criteria were met by 45 articles, with low bias and moderate-to-high quality. Most were cross-sectional studies; studies investigated diverse community and clinical samples. The UPPS demonstrated consistent factor structure, good reliability, and good external validity with other measures of impulsive behaviors and conditions associated with impaired impulse control. Some studies observed differences in UPPS domain scores between sex/gender groups or differential patterns in relationships between UPPS domains and clinical variables. UPPS subscale scores often differed in youth with attention-deficit/hyperactivity disorder, conduct disorders, substance use, and excess weight/obesity compared with control youth. UPPS domains commonly had interactions with sex/gender, sociodemographic, and diagnosis-related variables.

CONCLUSION

The current literature suggests that the UPPS has utility in measuring distinct components of impulsivity in clinical and nonclinical populations of youth. Specificity in discriminating diagnostic groups and predicting risk currently remains uncertain. Further research is needed to integrate UPPS measures with experimental models and additional neurobiological methods and to assess longitudinal developmental trajectories.

PLAIN LANGUAGE SUMMARY

Impulsivity contributes to many clinically relevant behaviors and mental health disorders that impact youth. The Urgency, Premeditation, Perseverance, Sensation Seeking (UPPS) Impulsive Behavior Scale has been increasingly used in research to measure deficits in impulse control. In this scoping review the authors examined 45 studies that used versions of the UPPS to measure different domains of impulsivity in youth aged 21 years and younger. The authors found evidence in the literature for the validity and reliability of the UPPS and its variants in measuring impulsivity in youth. Certain patterns of UPPS subscale scores corresponded with clinical behaviors and diagnoses including attention-deficit/hyperactivity disorder (ADHD), conduct disorder, substance use, and excessive weight/obesity. Despite this, there remain gaps in the literature regarding the stability of UPPS measures over time and ability of the UPPS to predict clinical outcomes.

Impulsive Decision-Making, Affective Experiences, and Parental History of Self-Injurious Thoughts and Behaviors within Parent-Adolescent Dyads

Impulsive decision-making, particularly during states of affective intensity, is associated with greater risk of engagement in self-injurious thoughts and behaviors (SITBs) during adolescence. The proximal (dyadic parent-adolescent affect and impulsivity) and distal (family history of SITBs) risk factors that occur within the family system could be relevant processes at stake in the intergenerational transmission of risk. The current study tests the interdependence of parent-adolescent factors associated with risk for SITBs and probes the extent to which parent-adolescent affective states influence their own (actor-effects) and each other's (partner-effects) impulsive decision-making, and further whether these relationships are moderated by a parent's history of SITBs. Participants included 212 (106 dyads) community parents and their adolescents who completed self-report and behavioral tasks related to positive and negative affective states, impulsive decision-making, and lifetime history of SITBs. Application of the Actor-Partner Interdependence Model (APIM) revealed a partner-effect where greater parent negative affect in the past week was associated with elevated adolescent impulsive decision-making among families with a history of SITBs (Estimate = 0.66, Standard Error = 0.13, p < 0.001). In addition, a significant actor-effect was observed where greater positive affect was associated with decreased impulsive decision-making among adolescents (Estimate = -0.21, Standard Error = 0.10, p = 0.03), however, moderating effects of parent history of SITBs were not detected. Findings from the present study shed light on the interdependence of affect and impulsivity within parent-adolescent dyads, and the extent to which these interactions may be particularly salient for families with known vulnerabilities for SITBs.

The relationship between suicidal behavior and perceived stress: The role of cognitive emotional regulation and problematic alcohol use in Spanish adolescents

Suicidal behavior has become an important public health problem, correlating with stress and emotional deficits in recent research. This study examined the relationship between perceived stress and suicidal behavior risk, testing the mediating roles of cognitive emotion regulation and impulsivity, and the moderating role of problematic alcohol use in stress-suicidal behavior association in a sample of 121 Spanish adolescents surveyed online. Results showed positive and significant associations between perceived stress and suicidal behavior risk, as well a mediation role of adaptive cognitive emotion regulation strategies and a moderation role of problematic alcohol use between perceived stress and suicidal behavior risk, supporting stress as an influential factor in suicidal behavior. Our findings emphasize adaptive emotional regulation strategies in stressful situations, as well as the importance of promoting responsible alcohol consumption to decrease suicide risk in adolescents. Additionally, they contribute to effective educational suicide prevention programs for young people.

Analysis of the Relationship Between Emotion Regulation Difficulties and Impulsivity and Cognitive/Metacognitive Skills in Adolescents Diagnosed with Major Depressive Disorder

Background

Major depressive disorder (MDD) is a significant psychiatric disorder among children and adolescents. It is important that the relationship with depression is analyzed in adolescents in which cognitive and metacognitive processes are different from adult individuals.

Methods

Forty-five patients and 44 healthy controls were included in our study. Participants were administered Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsivity Scale, Behavior Rating Inventory of Executive Function (BRIEF), and Stroop test.

Results

When the DERS total scores were evaluated, a statistically significant difference was found between the 2 groups in terms of DERS scores. In the healthy controls, the emotion regulation skills were significantly higher compared with the MDD group. In the Stroop test, particularly in the fifth section, the control group displayed a statistically significant better performance in both total duration and the number of mistakes made compared with the study group. In the BRIEF test a statistically significant difference was found between the control group and the study group in all 3 areas. In order to determine the efficient factors related to the statistical difference between the BRIEF scores, the multiple linear regression analysis was used.

Conclusion

It was found that depression scores and Stroop performance influence executive functions. Given that Stoop performance can overlap with executive functions, this outcome was expected. However, the impact of depression scores affecting executive functions is also anticipated, considering that these scores particularly affect attention among the cognitive and maladaptive cognitive processes, such as rumination.

Emotion-related impulsivity is related to orbitofrontal cortical sulcation

Background

Emotion-related impulsivity (ERI) describes the trait-like tendency toward poor self-control when experiencing strong emotions. ERI has been shown to be elevated across psychiatric disorders and predictive of the onset and worsening of psychiatric syndromes. Recent work has correlated ERI scores with the neuroanatomy of the orbitofrontal cortex (OFC). Informed by a growing body of research indicating that the morphology of cortical folds (sulci) can produce insights into behavioral outcomes, the present study modeled the association between ERI and the sulcal morphology of OFC at a finer scale than previously conducted.

Methods

Analyses were conducted in a transdiagnostic sample of 118 individuals with a broad range of psychiatric syndromes. We first manually defined over 2000 sulci across the 118 participants. We then implemented a model-based LASSO regression to relate OFC sulcal morphology to ERI and test whether effects were specific to ERI as compared to non-emotion-related impulsivity.

Results

The LASSO regression revealed bilateral associations of ERI with the depth of eight OFC sulci. These effects were specific to ERI and were not observed in non-emotion-related impulsivity. In addition, we identified a new transverse component of the olfactory sulcus in every hemisphere that is dissociable from the longitudinal component based on anatomical features and correlation with behavior, which could serve as a new transdiagnostic biomarker.

Conclusions

The results of this data-driven investigation provide greater neuroanatomical and neurodevelopmental specificity on how OFC is related to ERI. As such, findings link neuroanatomical characteristics to a trait that is highly predictive of psychopathology.

Cumulative ecological risk and nonsuicidal self-injury in adolescents: The mediation of depression and the moderation of impulsiveness

BACKGROUND

This study is based on the biosocial model of nonsuicidal self-injury (NSSI), to explore the effects of cumulative ecological risk on adolescents' NSSI, the mediating effect of depression between cumulative ecological risk and adolescents' NSSI, and the moderating role of impulsiveness in this mediating pathway.

METHODS

A total of 16 508 adolescents, with 7903 males (47.9%), participated in the study and completed the Cumulative Ecological Risk Questionnaire, the Short Form of the Center for Epidemiological Studies Depression Scale, the Impulsiveness assessment, and the Nonsuicidal Self-Injury Scale.

RESULTS

(1) There was a significant positive correlation between cumulative ecological risk, depression, impulsiveness, and NSSI; (2) cumulative ecological risk significantly predicted adolescents' NSSI; (3) depression had a mediating effect between cumulative ecological risk and adolescents' NSSI; and (4) impulsiveness moderated both the effects of cumulative ecological risk on adolescents' depression and NSSI and the effects of depression on NSSI in adolescents.

CONCLUSIONS

Impulsiveness and depression are risk factors for adolescent NSSI and play a crucial role between cumulative ecological risk and NSSI in adolescents.

Does Emotion-Related Impulsivity Relate to Specific ADHD Symptom Dimensions, and Do the Effects Generalize Across Comorbid Internalizing and Externalizing Syndromes?

BACKGROUND

Recent work highlights the role of emotion dysregulation in the pathology of Attention-Deficit/Hyperactivity Disorder (ADHD). As such, emotion-related impulsivity (ERI), the trait-like tendency toward disinhibited thoughts (Pervasive Influence of Feelings, PIF) and actions (Feelings Trigger Action, FTA) during heightened emotional states, may be particularly relevant. We explored whether Inattention (IN) and Hyperactivity/Impulsivity (HI), two core symptom dimensions of ADHD, would relate to distinct facets of ERI, and whether externalizing and internalizing symptoms would moderate these relations.

METHOD

Using structural equation modeling, we examined hypotheses among 364 adults recruited for high internalizing and externalizing symptoms.

RESULTS

We identified significant paths for FTA regressed on HI and PIF regressed on IN, supporting our hypotheses about main effects. Moderating paths were not significant.

CONCLUSIONS

IN and HI correlate with distinct forms of ERI, These effects appear to generalize across co-occurring internalizing and externalizing symptoms. Theoretical and clinical implications are discussed.

Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder

Introduction

Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood.

Methods

These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS).

Results

Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness.

Discussion

The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

Risky business: Considerations of emotion regulation and high-risk behaviors in anxious adolescents

A growing body of empirical literature connects anxiety symptoms and high-risk suicidal and self-harming behaviors in youth. Emotion regulation (ER) processes and deficits have been identified as important factors in the etiology, maintenance, and treatment of both youth anxiety and high-risk behaviors. The present study assessed the association between these variables using an acute, socio-demographically diverse clinical sample of youth presenting to an outpatient mental health clinic. Ninety-nine youth aged 12-20 years old completed measures of anxiety symptoms, ER difficulties, and lifetime history of high-risk behaviors including non-suicidal self-injury (NSSI) and suicide attempts. Unadjusted analyses show that more severe anxiety symptoms were associated with more ER difficulties and history of risk behavior. Multivariate linear regression models considering age, sex, race/ethnicity, and risk history show that more severe anxiety symptoms remained significantly associated with more ER difficulties (p < 0.0001) and positive suicide attempt history (p < 0.01). Findings highlight the importance of integrating considerations of ER into the case conceptualization and treatment planning of high-risk, anxious youth to inform evidenced-based care with this population. The need for targeted, ongoing risk assessment with anxious youth to identify and mitigate risk is also demonstrated.

Aberrant connectivity in the right amygdala and right middle temporal gyrus before and after a suicide attempt: Examining markers of suicide risk

Functional neuroimaging has the potential to help identify those at risk for self-injurious thoughts and behaviors, as well as inform neurobiological mechanisms that contribute to suicide. Based on whole-brain patterns of functional connectivity, our previous work identified right amygdala and right middle temporal gyrus (MTG) connectivity patterns that differentiated Veterans with a history of a suicide attempt (SA) from a Veteran control group. In this study, we aimed to replicate and extend our previous findings by examining whether this aberrant connectivity was present prior to and after a SA. In a trauma-exposed Veteran sample (92 % male, mean age = 34), we characterized if the right amygdala and right MTG connectivity differed between a psychiatric control sample (n = 56) and an independent sample of Veterans with a history of SA (n = 17), using fMRI data before and after the SA. Right MTG and amygdala connectivity differed between Veterans with and without a history of SA (replication), while MTG connectivity also distinguished Veterans prior to engaging in a SA (extension). In a second study, neither MTG or amygdala connectivity differed between those with current suicidal ideation (n = 27) relative to matched psychiatric controls (n = 27). These results indicate a potential stable marker of suicide risk (right MTG connectivity) as well as a potential marker of acute risk of or recent SA (right amygdala connectivity) that are independent of current ideation.

Understanding the association between spirituality and mental health outcomes in adolescents in two non-Western countries: Exploring self-control as a potential mediator

Empirical knowledge on what specific aspects of mental health are associated with spirituality is limited, and explanations for the mechanisms underlying this association is scarce. Furthermore, there is limited research on this association among individuals from non-Christian religious backgrounds and non-Western countries. The current study examined relations between spirituality and aspects of mental health in 1,544 adolescents from diverse religious backgrounds in two Eastern countries, India and the United Arab Emirates (UAE). Additionally, we examined mediating and moderating factors. Adolescents (58% female) ages 11-15 years completed a questionnaire on aspects of their mental health, spirituality, and self-control abilities. Results showed that spirituality had a significant positive association with life satisfaction and a significant negative association with internalizing problems, but a non-significant relation with externalizing problems, controlling for age, gender, and socioeconomic status. Self-control completely mediated the association between spirituality and life satisfaction, and this mediational relation was only present for adolescents from the UAE. Results support prior research suggesting positive associations between spirituality and adaptive mental health outcomes and extend these findings to adolescents from diverse religious backgrounds in non-Western countries. These findings have important clinical and policy implications for supporting the role of spirituality in an adolescent's life.

Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies

PURPOSE OF REVIEW

We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures.

RECENT FINDINGS

Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.

Impact of the lockdown by the COVID-19 pandemic on suicidal trend in the Colombian Coffee Region

Suicide is considered a Public Health issue. In 2019 the Colombian suicide rate was 5.8 per-100.000 inhabitant. Likewise, the Colombian Coffee Region has doubled the national average on these rates. On the other hand, the Pandemic COVID 19 socio-economic consequences are aggravating the risk factors that we've known about suicide.

Objective

To evaluate the suicidal trend in the population of the Colombian Coffee Region during the COVID-19 pandemic and compare it with a non-pandemic period.

Methods

The data were taken from the National Institute of Legal Medicine and Forensic Science for the suicidal events during the 2016-2020 period in the Colombian Coffee Region, and the Montecarlo Regression was applied using the JoinPoint Regression Program.

Results

We found 1022 cases, most of them were men. The mean age was 34 years. The most used method was hanging in both sexes. Half of them had at least a high school degree. Half of the suicides were committed by single people. One-third of the cases had a previous mental illness. There are significant differences in the suicidal trend between the lockdown period and the non-lockdown period with a P value < 0.05.

Conclusions

We found most suicidal cases between older men and an inversely proportional relationship between education and suicidal rate. Is interesting that the most applied method for suicide for both sexes was hanging. The suicidal trend was increasing until 2020, although in the lockdown we found a decrease. In the post-lockdown period for men was a posterior increase and for women the trend has a continued decrease.

Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions

OBJECTIVE

Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear.

METHOD

The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI).

RESULTS

The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions.

CONCLUSIONS

Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.

Correlates of Suicide Among Middle and High School Students in Ghana

PURPOSE

We know little about the epidemiology of suicide among middle school students in Ghana, including the years preceding high school. This study explores the onset, characteristics, and recent patterns of suicide among Ghanaian middle and high school students.

METHODS

This study used the World Health Organization Global School-based Student Health Survey (GSHS, 2012), which has self-reported measures on suicide ideation, plan, and attempt of middle and high school students in Ghana. Correlation and logistic regression analyses were performed using Statistical Package for the Social Sciences (SPSS version 25).

RESULTS

The study found prevalence of suicidal behaviors among the population as follows: ideation (19%), plan (22%), and attempt (25%). Suicide ideation significantly increased the risk for suicide plan (odds ratio [OR] = 9.14; 95% confidence interval [CI] = 7.57-11.02) and attempt (OR = 11.89; 95% CI = 9.82-14.38), whereas suicide plan significantly increased the odds of suicide attempt (OR = 12.64; 95% CI = 10.50-15.19). There was a higher prevalence of suicide ideation, plan, and attempts among middle school students than high school students although only suicide attempt differences were significant (28.4% > 22.3%; χ² = 17.1, p < .001).

DISCUSSION

The onset of suicide among Ghanaian students occurs at younger ages than previously thought, and there were increasing trends in suicide behaviors as age increases. This finding highlights a potential suicide crisis among preteens, which warrants attention. Additional studies are needed to observe these increasing trends, identify risk, protective, and precipitating factors to help prevent suicide among these children.

Circumstances Contributing to Suicide Among U.S. Adolescents Aged 10-19 Years With and Without a Known Mental Health Condition: National Violent Death Reporting System, 2013-2018

PURPOSE

Suicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death.

METHODS

Logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021).

RESULTS

Decedents with a known mental health condition were 1.2-1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death.

DISCUSSION

A comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.

Suicidal Thoughts and Behaviors Among Adolescent Psychiatric Inpatients

BACKGROUND

Given low base rates of suicidal thoughts and behaviors (STBs) in national samples of adolescents, clarifying the sociodemographic and clinical correlates among psychiatric inpatients may afford insights into potential risk factors that predict STBs onset.

METHOD

Adolescents (N = 970; ages 12-19 years) admitted for acute, psychiatric inpatient care completed baseline clinical interviews and self-report measures assessing demographics and early life adversity. Lifetime and 12-month STBs prevalence were obtained, allowing for the estimate of STBs persistence (i.e., rates of those with both current and past STBs) and transition rates (i.e., proportion of ideators that transition to plans or attempts). Univariate and multivariate logistic regression tested sociodemographic and clinical correlates of STBs.

RESULTS

Age-of-onset for STBs occurred in early adolescence. Most patients reported suicide ideation with nearly half of patients making a plan and one-third a suicide attempt. Although relatively modest, the strongest correlates of lifetime attempts were depressive disorders, physical abuse, and non-suicidal self-injury. Knowing a peer that had attempted suicide also increased the likelihood of a suicide attempt, especially among attempters who transitioned from ideation to planned attempts.

CONCLUSION

STBs are highly prevalent among adolescents admitted for acute psychiatric inpatient treatment. The modest effects suggest that correlates, particularly those related to suicide attempts, are widely distributed. As a history of physical abuse and knowing a peer with a suicide attempt history are related to transitioning from ideation to action, these may be critical factors to target in the deployment of future suicide prevention and treatment programs. HIGHLIGHTSOne-third of adolescent inpatients report a lifetime history of suicide attempts.Approximately 65% of adolescent inpatients with a lifetime plan attempt suicide.Knowing peers who attempt suicide may facilitate the transition from ideation to action.

Neuroanatomical Correlates of Emotion-Related Impulsivity

BACKGROUND

Emotion-related impulsivity (ERI) refers to chronically poor self-control during periods of strong emotion. ERI robustly predicts psychiatric disorders and related problems, yet its neuroanatomical correlates are largely unknown. We tested whether local brain morphometry in targeted brain regions that integrate emotion and control could explain ERI severity.

METHODS

One hundred twenty-two adults (ages 18-55 years) with internalizing or externalizing psychopathology completed a structural magnetic resonance imaging (MRI) scan, the Three-Factor Impulsivity Index, and the Structured Clinical Interview for DSM-5. The Three-Factor Impulsivity Index measures two types of ERI and a third type of impulsivity not linked to emotion. Cortical reconstruction yielded cortical thickness and local gyrification measurements. We evaluated whether morphometry in the orbitofrontal cortex (OFC), insula, amygdala, and nucleus accumbens was associated with ERI severity. Hypotheses and analyses were preregistered.

RESULTS

Lower cortical gyrification in the right lateral OFC was associated with high ERI severity in a full, preregistered model. Separate examinations of local gyrification and cortical thickness also showed a positive association between gyrification in the left lateral OFC and ERI. An integrated measure of hemispheric imbalance in lateral OFC gyrification (right < left) correlated with ERI severity. These findings were specific to ERI and did not appear with non-emotion-related impulsivity.

CONCLUSIONS

Local gyrification in the lateral OFC is associated with ERI severity. The current findings fit with existing theories of OFC function, strengthen the connections between the transdiagnostic literature in psychiatry and neuroscience, and may guide future treatment development.

Dimensions of the Hamilton Depression Rating Scale Correlate with Impulsivity and Personality Traits among Youth Patients with Depression

The heterogeneity of symptoms in young patients with major depression disorder makes it difficult to properly identify and diagnose. Therefore, the appropriate evaluation of mood symptoms is important in early intervention. The aim of this study was to (a) establish dimensions of the Hamilton Depression Rating Scale (HDRS-17) in adolescents and young adults and (b) perform correlations between the identified dimensions and psychological variables (impulsivity, personality traits). This study enrolled 52 young patients with major depression disorder (MDD). The severity of the depressive symptoms was established using the HDRS-17. The factor structure of the scale was studied using the principal component analysis (PCA) with varimax rotation. The patients completed the self-reported Barratt Impulsiveness Scale (BIS-11) and Temperament and Character Inventory (TCI). The three dimensions of the HDRS-17 identified as core in adolescent and young patients with MDD were (1) psychic depression/motor retardation, (2) disturbed thinking, and (3) sleep disturbances/anxiety. In our study, dimension 1 correlated with reward dependence and cooperativeness; dimension 2 correlated with non-planning impulsivity, harm avoidance, and self-directedness; and dimension 3 correlated with reward dependence. Conclusions: Our study supports the previous findings, which indicate that a certain set of clinical features (including the HDRS-17 dimensions, not only total score) may represent a vulnerability pattern that characterizes patients with depression.

Externalising Behaviours, Impulsivity, Alexithymia, and Emotional Dysregulation in Adolescents' Suicidality

Objective

suicide represents the second leading cause of death among adolescents (WHO, 2021). A deeper understanding of the characteristics that lead to it is crucial to increase the ability of clinicians in evaluating, treating, and preventing it. The objective of this study is to analyze the differences in impulsivity, externalizing behaviors, emotion dysregulation, and alexithymia between two groups of adolescents, the first presenting suicidal ideation (SI), the second presenting at least one suicide attempt (SA), in an ideation-to-action framework.

Method

we conducted a retrospective study with 190 adolescents (M= 14.5, SD _age = 1.63; SI: n = 97, SA: n = 93). All were hospitalized in the Complex Operative Child Neuropsychiatry Hospital Unit (UOC-NPI) of the Hospital-University of Padua. Data were collected using the Youth Self-Report (YSR 11-18), Barratt's Impulsiveness Scale (BIS-11) and the Toronto Alexithymia Scale (TAS-20) questionnaires.

Results

the SA group obtained higher clinical scores in the YSR "rule-breaking behavior" and "conduct problems" scales, and in total TAS-20.

Conclusions

the role of externalizing problems and alexithymia could open new frontiers in the understanding of suicide. These new data could be useful for the implementation of early screening protocols and for directing clinical interventions, promoting greater emotion regulation and anger management skills among patients.

Health-Related Cognitions and Metacognitions Indirectly Contribute to the Relationships Between Impulsivity, Fear of COVID-19, and Cyberchondria

The aim of the study was to converge a structural equation model to unfold the compositive relationships between trait impulsivity, health cognitions, metacognitions about health, fear of COVID-19 and cyberchondria, after controlling for gender, age, marital status, having a chronic illness and chronic illness among first-degree relatives. Six hundred fifty-one participants (423 females, 65%; 228 males, 35%) participated in the study. The Short UPPS-P Impulsive Behavior Scale (S-UPPS-P), Health Cognitions Questionnaire (HCQ), The Meta-Cognitions about Health Questionnaire (MCQ-HA), Cyberchondria Severity Scale -Short Form (CSS-12), and Fear of COVID-19 Scale (FCV-19 S) were completed by volunteered participants. The structural model showed that the S-UPPS-P directly and indirectly contributed to the HCQ, MCQ-HA, CSS-12, and FCV-19 S. The multi-group structural analysis by gender showed that the structural model had a partial measurement and factorial invariance. We concluded that the significant associations between impulsivity, fear of COVID-19 and cyberchondria were indirectly contributed by health-related cognitions and metacognitions.

Impulsivity, suicidal thoughts, psychological distress, and religiosity in adolescents and young adults

Background

Impulsivity is associated with suicidal acts and ideation, whereas higher religious commitment has been identified as a potential protective factor linked to lower suicidal ideation.

Objectives

We examined the extent to which higher religious commitment is associated with lower suicidal ideation and whether religious commitment modifies the relationship between impulsivity and suicidal ideation.

Methods

Adolescent and young adult males, with a prior history of suicidal act and ideations, completed standardized questionnaires [i.e., Beck Scale for Suicidal Ideation (BSS), Barratt Impulsivity Scale-II (BIS-II), Depression Anxiety Stress Scale (DASS), and Religious Commitment Inventory-10 (RCI-10)], to assess impulsivity, suicidal ideation, distress, and religious commitment. Regression and mediation analyses were performed to investigate the relationships among impulsivity, religious commitment, and suicidal ideation.

Results

Of the 747 study participants (mean age 18.8 years, SD = 4.1), 151 (20.2%) had a history of suicidal acts and 177 (23.7%) had a history of suicidal ideation. Non-planning impulsivity (predictor) was inversely associated with religious commitment (r = -0.33, p < 0.01), and religious commitment (mediator) was inversely related to suicidal ideation (outcome) (r = -0.32, p < 0.01). These findings remained statistically significant when controlling for either religious commitment or non-planning impulsivity, as appropriate. Higher religious commitment reduced the association between non-planning impulsivity and suicidal ideation (p < 0.01).

Conclusion

The findings highlight the potential for cultivating spirituality to buffer against higher suicidal ideation, and thus could be considered as an additional therapeutic strategy for individuals with higher levels of impulsivity and co-morbid suicidal ideation.

[Impulsivity and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode]

OBJECTIVE

To study the phenomenon of impulsivity, its components and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode.

MATERIAL AND METHODS

Forty-eight male patients (mean age 19.4±2.9 years) with the first depressive episode (ICD-10 F32.1, F32.2) with attenuated positive, negative and/or disorganized symptoms were examined. According to the severity of impulsivity, the patients were divided into the clinical group (n=26) with pathological impulsivity and the comparison group (n=27) without it. The control group consisted of 41 mentally healthy young men, students of higher education of 1-3 courses, (mean age 19.7±1.6 years). HDRS, SOPS, SANS, Barratt Impulsiveness Scale (BIS-11) and Buss Perry Aggression Questionnaire (BPAQ) were used. Statistical analysis was carried out using the Statistica 12 software.

RESULTS

The differences between the clinical group and the comparison group were determined by the total score of the subscale of general symptoms of SOPS at admission (53 [41.75; 56] and 45.5 [41.75; 51.25], respectively) (U=187.5; p=0.037) and at discharge (28 [19; 37] and 25 [17.75; 29.25] points respectively) (U=166.5; p=0.012), according to the total HDRS score at admission (35 [31; 38] and 29 [26; 34.25]) (U=191.0; p=0.046). In the clinical group, the motor component of impulsivity and the factor of general impulsivity on the BIS-11 correlated with the severity of aggression on the BPAQ (r=0.395, p<0.05 and r=0.635, p<0.05, respectively). Significant differences were revealed in the clinical group depending on the presence of negative symptoms on the corresponding SOPS subscale according to the total BPAQ score (p=0.01). Correlation analysis showed numerous connections: positive between the total aggressiveness score and the duration of depression (p<0.05), negative between the factors of self-control, consistency, attention, and total scores on the SANS and SOPS (p<0.05).

CONCLUSION

We identify the differences in the structure of impulsivity in patients at risk of developing schizophrenia at the stage of remission after the first depressive state, the comparison group and the control group, as well as the relationship of impulsivity factors with individual clusters of psychopathological disorders.

Comparison of Suicides Among Younger and Older Adolescents in Virginia, 2008-2017

Objective: Suicide is the second leading cause of death in youth and is of public health importance. Characteristics and precipitating circumstances may differ by adolescent age groups. Understanding these differences may inform prevention efforts that are population-specific. Therefore, we sought to compare suicides between younger and older adolescents in Virginia from 2008 to 2017.Methods: We used data from the Virginia Violent Death Reporting System (VVDRS), part of the National Violent Death Reporting System (NVDRS). We included suicides of all adolescents aged 10-17 who were residents of Virginia from 2008 to 2017. Descriptive statistics and unadjusted logistic regression were used to compare characteristics and circumstances between younger (10-14) and older (15-17) adolescents.Results: Three hundred and 24 (324) adolescents died by suicide between 2008 and 2017 in Virginia, of which 20% were younger adolescents, and 80% were older adolescents. Suicides of younger adolescents increased significantly over the 10-year period. Younger adolescent suicides seemed to occur after a crisis, while suicides among older adolescents occurred due to intimate partner problems and substance use. Mental health issues were common in both.Conclusions: Suicides may be more impulsive among younger adolescents and warrants further attention, while strategies to cope with intimate partner problems and substance use may be important for older adolescents and should be considered when implementing services and interventions. HIGHLIGHTSImpulsivity may be an issue among younger adolescents.Strategies for relationship and substance use issues may benefit older adolescents.Targeted interventions may be necessary for younger and older adolescents.

Theory of Mind and Suicidality: A Meta-Analysis

OBJECTIVE

Disturbances in interpersonal functioning are prevalent in individuals with suicidality. Foundational for interpersonal functioning is theory of mind (ToM), a social-cognitive ability that allows individuals to understand the thoughts and feelings of others. Recent work has begun to investigate ToM performance in individuals with suicidality, though no review has quantitatively aggregated findings from these varied studies. The current study investigated the relations between ToM and suicidality with meta-analysis.

METHOD

We identified and meta-analyzed 15 studies that presented data for 2,895 participants (617 of whom had reported at least one suicide attempt).

RESULTS

Results indicated a significant, negative relation between ToM and suicidality with a medium overall effect size (g = -.475). Moderator analyses revealed that this effect was consistent across age, sex, ToM content, and suicidal outcome.

CONCLUSION

Deficits in ToM associated with suicidality hold promise for risk-identification, treatment, and prevention work.HighlightsTheory of mind (ToM) abilities are critical for effective interpersonal functioning.Meta-analytics results indicate that ToM deficits are associated with suicidality.Identifying such suicidality-related ToM deficits may inform risk-identification, treatment, and prevention work.

Suicidal Ideation and Risky Behavior are Related through Impulsivity and Low Wish to Live

OBJECTIVE

Numerous studies have found support for the relationship between suicide and risky behavior. However, few studies have examined factors that may help explain the relationship between suicidal ideation (SI) and risky behavior. This preregistered study examined the relationship between SI and risky behavior and whether there is an indirect relationship through hopelessness, impulsivity, and low wish to live. These factors were selected due to their relationships with both SI and risky behavior.

METHODS

Participants recruited from Amazon Mechanical Turk completed measures of SI, risky behavior, hopelessness, impulsivity, and wish to live. Consistent with our preregistered methods, we analyzed data from 180 participants with valid data. Indirect effects were evaluated via bootstrapping with 5000 resamples of the a path x b path product.

RESULTS

Consistent with prior work, we found a significant positive association between SI and frequency of risky behavior (r = .49). We found significant indirect effects of SI on risky behavior through impulsivity and wish to live but not through hopelessness.

CONCLUSION

SI and risky behavior are associated with each other through impulsivity and wish to live. Though future longitudinal research is needed to determine causality, this has important implications for models of suicidal thoughts and behaviors and their relationship with risky behavior. The potential of future orientation to explain the results is discussed.

Suicidal Ideation in Adolescents: Understanding Results from Screening with the PHQ-9M and the PSC-17P

OBJECTIVE

The objective of the study was to help pediatricians understand and respond to suicidal ideation (SI) in adolescents based on data from 2 widely used screening measures that assessed SI and other psychosocial vulnerabilities in a large, national sample.

METHODS

Adolescents (ages 11-17 years) completed the Patient Health Questionnaire Modified for Teenagers (PHQ-9M) using the Comprehensive Health and Decision Information System software before their well-child visits. Question 9 asks about past 2-week SI. Their parents filled out the Pediatric Symptom Checklist (PSC-17P), which screens for a broad range of psychosocial problems. Chi-square analyses and one-way analysis of variances assessed the relationship between SI and psychosocial problems.

RESULTS

Among 5411 adolescents, 266 (4.9%) reported SI at least several days in the past 2 weeks. Among adolescents with SI, 187 (70.3%) reported moderate to very severe depression on the PHQ-9M (≥10), 68.1% were at risk on at least 1 PSC-17P problem subscale, 59.7% on the PSC-17P internalizing scale, 42.9% on PSC-17P overall, 20.6% on PSC-17P externalizing, and 18.5% on PSC-17P attention. Within the subsample endorsing SI nearly all days, 35.7% had a former suicide attempt.

CONCLUSION

The PHQ-9M identifies a clinically heterogeneous subset of approximately 5% of adolescents who report occasional to frequent SI. The PSC-17P corroborates their high degree of overall risk and offers additional information that can help pediatricians assess clinical severity and range of psychosocial problems. Given our limited knowledge of how to predict and prevent an individual adolescent's suicide, the focus of screening should be to identify and help the subset of patients with chronic psychosocial vulnerability of any type.

Emotion-related impulsivity and rumination: Unique and conjoint effects on suicidal ideation, suicide attempts, and nonsuicidal self-injury across two samples

INTRODUCTION

Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related impulsivity, though, are highly correlated, we consider their unique vs. conjoint influence on suicidal ideation and self-harm.

METHOD

Across two samples of adults (N's = 171 and 191), we examined how rumination and emotion-related impulsivity relate to suicidal ideation, suicide attempts, and NSSI. We assess the more general process of repetitive negative thinking and the more specific process of suicide-related rumination. Participants completed the Three-Factor Impulsivity Index and the self-report Columbia-Suicide Severity Rating Scale. Those in sample 1 completed the Perseverative Thinking Questionnaire and the Deliberate Self-Harm Inventory, and those in Sample 2 completed the Suicide Rumination Scale.

RESULTS

Emotion-related impulsivity and both forms of rumination showed robust bivariate correlations with suicidal ideation, suicide attempts, and NSSI. Neither rumination or impulsivity related to suicide attempts controlling for ideation or to NSSI. In multivariable analyses, emotion-related impulsivity but not general rumination was tied to suicidal ideation. In contrast, suicide-related rumination was more directly tied to suicidal ideation than was impulsivity.

CONCLUSIONS

Findings provide support for a more nuanced approach to the forms of impulsivity and rumination related to suicidal ideation.

Unraveling the Contribution of Serotonergic Polymorphisms, Prefrontal Alpha Asymmetry, and Individual Alpha Peak Frequency to the Emotion-Related Impulsivity Endophenotype

The unique contribution of the serotonin transporter-linked polymorphic region (5-HTTLPR), intronic region 2 (STin2), and monoamine oxidase A (MAO-A) genes to individual differences in personality traits has been widely explored, and research has shown that certain forms of these polymorphisms relate to impulsivity and impulsivity-related disorders. Humans showing these traits are also described as having an asymmetrical prefrontal cortical activity when compared to others. In this explorative study, we examine the relationship between serotonergic neurotransmission polymorphisms, cortical activity features (prefrontal alpha asymmetry, individual alpha peak frequency [iAPF]), emotion-related and non-emotion-related impulsivity in humans. 5-HTTLPR, MAO-A, and STin2 polymorphisms were assessed in blood taken from 91 participants with high emotion-related impulsivity levels. Sixty-seven participants completed resting electroencephalography and a more comprehensive impulsivity index. In univariate analyses, iAPF correlated with both forms of emotion-related impulsivity. In multiple linear regression models, 5-HTTLPR polymorphism (model 1, adj. R² = 15.2%) and iAPF were significant interacting predictors of emotion-related impulsivity, explaining a large share of the results’ variance (model 2, adj. R² = 21.2%). Carriers of the low transcriptional activity 5-HTTPLR and MAO-A phenotypes obtained higher emotion-related impulsivity scores than others did. No significant results were detected for non-emotion-related impulsivity or for a form of emotion-related impulsivity involving cognitive/motivational reactivity to emotion. Our findings support an endophenotypic approach to impulsivity, showing that tri-allelic 5-HTTLPR polymorphism, iAPF, and their interaction are relevant predictors of one form of emotion-related impulsivity.

Suicidal Behaviour Among Nigerian Undergraduates: Associations with Gambling Disorder and Emotional Dysregulation

Background: There is a high prevalence of suicidal behavior among Nigerian youths. However, the connections between suicidal behavior and precipitating factors, such as gambling disorder and emotional dysregulation (ED) in this population, are not well researched. Objectives: The present study examined the associations between gambling disorder, ED, and suicidal behavior in Nigerian university undergraduate students. Methods: This study was carried out during October 2020 - April 2021 on 1338 undergraduates with a mean ± SD age of 19.84 ± 3.22 years selected using random and purposive sampling for the universities and participants respectively. Participants responded to the Attitudes Towards Gambling Scale, Difficulties in Emotion Regulation Scale, and Redeemer's University Suicidality Scale. Descriptive statistics (simple percentages) and inferential statistics (Pearson’s correlation and regression analysis) were used for data analysis. Results: The Pearson's correlation revealed that suicidal behaviour had significant positive correlations with the nonacceptance of emotional responses or distress (r = 0.22, P = 0), difficulties engaging in goal-directed behaviours (r = 0.21, P = 0), difficulties in impulse control (r = 0.27, P = 0), the lack of emotional awareness (r = 0.14, P = 0), limited access to emotional regulation strategies (r = 0.33, P = 0), the lack of emotional clarity (r = 0.32, P = 0), and difficulties in emotional regulation (r = 0.4, P = 0). Problematic gambling (PG) independently predicted suicidal behavior, while PG and ED dimensions jointly predicted suicidal behavior. The ED dimensions contributed 15% incrementally to the prediction of suicidal behavior and beyond the 2% variance accounted for PG in undergraduates. Conclusions: Our results showed positive links between PG, ED, and suicidal behavior among Nigerian undergraduates. It suggests that the combination of PG and ED increases the severity of suicidal behavior among students.

The Indirect Effect of Prefrontal Gray Matter Volume on Suicide Attempts among Individuals with Major Depressive Disorder

Trait impulsivity is a known risk factor for suicidality, and the prefrontal cortex plays a key role in impulsivity and its regulation. However, the relationship between trait impulsivity, neural basis, and suicidality has been inconsistent. Therefore, this study aimed to explore the relationship between impulsivity and its structural correlates (prefrontal gray matter volume), suicidal ideation, and actual suicide attempts. A total of 87 individuals with major depressive disorder participated in study, and the gray matter volume of the prefrontal regions was extracted from T1 images based on region of interest masks. The variables for the mediation models were selected based on correlation analysis and tested for their ability to predict suicide attempts, with impulsivity and suicidal ideation as the mediation variables and gray matter volume as the independent variable. A significant correlation was observed between suicidal ideation and the left dorsolateral prefrontal cortex and right dorsomedial prefrontal cortex. The dual-mediation model revealed a significant indirect relationship between gray matter volume in both regions and suicide attempts mediated by motor impulsivity and suicidal ideation. The counterintuitive positive relationship between gray matter volume and suicidality was also discussed.

Dynamic Regulatory Processes in the Transition from Suicidal Ideation to Action in Adults Leaving Inpatient Psychiatric Care: An Intensive Longitudinal Study Protocol (Preprint)

Background

US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life.

Objective

This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, which are featured in most major suicide theories, will comprise a latent factor indicative of psychache (emotional pain), which will predict increases in suicidal thinking over time. Second, we hypothesize that poor inhibitory control in the context of negative affective stimuli, as well as emotion-related impulsivity, will predict the transition from suicidal thinking to suicidal behavior over time. Third, we hypothesize that short sleep duration will precede within-person increases in suicidal ideation as well as increased odds of suicidal behavior among those reporting suicidal thoughts.

Methods

The desired sample size is 130 adults with past-week suicidal thoughts or behaviors who are receiving inpatient psychiatric treatment. Participants will complete a battery of measures while on the inpatient unit to assess negative affective experiences, emotion-related impulsivity, inhibitory control, typical sleep patterns, and relevant covariates. After discharge from inpatient care, participants will complete 4 weeks of signal-contingent ecological momentary assessment surveys, as well as mobile behavioral measures of inhibitory control, while wearing an actigraphy device that will gather objective data on sleep. Participants will complete interviews regarding suicidal thoughts and behaviors at 4 and 8 weeks after discharge.

Results

The study was funded by the National Institutes of Health in November 2020. Recruitment began in April 2021. Data analysis will begin after completion of data collection.

Conclusions

This study will elucidate how affective, cognitive, and physiological risk factors contribute (or do not contribute) to within-person fluctuations in suicide risk in daily life, with important implications for extant theories of suicide. Of import, the examined risk factors are all modifiable; thus, the results will inform identification of key targets for just-in-time, flexible, personalized, digital interventions that can be used to decrease emotional distress and prevent suicide among those at highest risk.

International Registered Report Identifier (IRRID)

DERR1-10.2196/38582

Adolescents, Suicide, and the COVID-19 Pandemic

The coronavirus disease 2019 pandemic has vastly disrupted the lives of youth. Stressors related to the pandemic and related lockdown measures have increased the prevalence of adolescent depression, suicidal ideation, and suicide attempts, with their mental and psychosocial development making them highly vulnerable to isolating restrictions. Research has demonstrated increased loneliness and decreased social support among adolescents during the pandemic. Increased social media usage has further affected depression among adolescents. Pandemic-related stressors such as fear of illness or life changes have negatively affected adolescent mental well-being. Health care use during the pandemic has involved disruption in primary care suicide screening, patterns of suicide-related presentations in emergency departments, and access to mental health services. Health care providers can support adolescent mental health through consistent screening, effectively coordinating referral for mental health evaluation, and providing family guidance on resiliency, pandemic-related mental health risks, and suicide prevention. [Pediatr Ann. 2022;51(4):e144-e149.].

Emotion-related impulsivity predicts increased anxiety and depression during the COVID-19 pandemic

INTRODUCTION

Emotion-related impulsivity, defined by poor constraint in the face of emotion, is related to internalizing symptoms, cross-sectionally and longitudinally. Internalizing symptoms, though, are profoundly tied to stress reactivity, and little is known about how emotion-related impulsivity relates to stress reactivity.

METHOD

Taking advantage of a sample that had completed measures of depression, anxiety, suicidal ideation, and two forms of emotion-related impulsivity before the pandemic, we asked participants to complete three weekly follow-up internalizing assessments early in the pandemic.

RESULTS

Among the 150 participants, pre-pandemic emotion-related impulsivity scores predicted higher depression, anxiety, general distress, and suicidal ideation during the COVID-19 pandemic. Controlling for pre-pandemic scores, one form of emotion-related impulsivity (Feelings Trigger Action) predicted increased anxiety and general distress. We also examined how pre-pandemic emotion-related impulsivity was moderated by weekly COVID-related stress. One form of emotion-related impulsivity (Pervasive Influence of Feelings) predicted internalizing symptoms at low stress levels, and a different form (Feelings Trigger Action) predicted internalizing symptoms at higher stress levels.

LIMITATIONS

Limitations include the small sample size, the absence of repeat measures of impulsivity, the attrition of individuals with more internalizing symptoms, and the reliance on self-rated measures.

CONCLUSIONS

Forms of emotion-related impulsivity predict increases in anxiety and distress over time, but the interactions with stress levels appear to vary. Emotion-related impulsivity can be addressed with accessible intervention tools, suggesting the promise of broader screening for those at risk for internalizing symptoms during periods of high stress.

Emotion-related impulsivity: Testing a model of arousal effects on cognitive control

The trait-based tendency to respond rashly to emotions is robustly tied to many forms of psychopathology and poor behavioural outcomes, including aggression and suicidality. Researchers have found associations between response inhibition and emotion-related impulsivity; however, effect sizes are often small. Because emotion-related impulsivity emerges in the context of heightened positive and negative emotions, arousal is a candidate trigger of impulsivity. The goals of the present study were to (1) replicate the association between emotion-related impulsivity and response inhibition, and (2) test whether emotion-related impulsivity is associated with arousal-induced decays in response inhibition performance. Participants (N = 55) completed a self-report measure of emotion-related impulsivity, and then completed a computer-based response inhibition task (the antisaccade task, in which participants must make a rapid saccadic eye movement away from a cue rather than toward it) before and after a well-validated stress induction (the Trier Social Stress Test). Psychophysiological indices of arousal were measured throughout the session. Findings provide partial support for the association between emotion-related impulsivity and pre-stress response inhibition. Contrary to hypotheses, emotion-related impulsivity did not interact with arousal to predict post-stress response inhibition performance after controlling for pre-stress response inhibition performance. Future research is needed to consider clinical samples and to assess whether emotion-related impulsivity is related to deficits in other facets of cognitive control and decision-making.

Psychobiological risk factors for suicidal thoughts and behaviors in adolescence: a consideration of the role of puberty

Suicide is the second leading cause of death among adolescents. While clinicians and researchers have begun to recognize the importance of considering multidimensional factors in understanding risk for suicidal thoughts and behaviors (STBs) during this developmental period, the role of puberty has been largely ignored. In this review, we contend that the hormonal events that occur during puberty have significant effects on the organization and development of brain systems implicated in the regulation of social stressors, including amygdala, hippocampus, striatum, medial prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Guided by previous experimental work in adults, we also propose that the influence of pubertal hormones and social stressors on neural systems related to risk for STBs is especially critical to consider in adolescents with a neurobiological sensitivity to hormonal changes. Furthermore, facets of the pubertal transition, such as pubertal timing, warrant deeper investigation and may help us gain a more comprehensive understanding of sex differences in the neurobiological and psychosocial mechanisms underlying adolescent STBs. Ultimately, advancing our understanding of the pubertal processes that contribute to suicide risk will improve early detection and facilitate the development of more effective, sex-specific, psychiatric interventions for adolescents.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Structural Model of Suicidal Ideation and Behavior: Mediating Effect of Impulsivity

The present study aimed to establish the associations between hopelessness, depression and impulsivity with respect to suicidal ideation and behavior, and to explore the role that impulsivity plays in the mechanism that operates between depression and hopelessness. Through an empirical observational study, with an analytical scope based on a cross-sectional design for a sample of 228 university students and using The Inventory of Suicide Orientation (ISO-30); Beck Depression Inventory (BDI); Beck Hopelessness Scale (BHS); and Barratt Impulsiveness Scale (BIS-11). The results indicated a significant positives correlations between BDI, BHS, BIS and ISO-30. Regression analysis showed that depression, impulsivity and hopelessness explain between 57% and 67% of the variance in the risk of suicidal ideation and behavior. Through the analysis of structural equation modeling, three models were established showing that impulsivity mediates the relationship between depressive symptomatology and suicidal ideation and behavior. This study has implications for mental health intervention and research, in that it emphasizes the importance of impulsivity traits as factors that act as triggers in the association between the presence of depressive symptoms and suicidal behavior.

Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children's Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13-18. In the 13-18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000-2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.