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Le GH, Wong S, Au H, Badulescu S, Gill H, Vasudeva S, Teopiz KM, Rhee TG, Ho R, Kwan ATH, Mansur RB, Rosenblat JD, McIntyre RS. Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis. J Affect Disord 2024; 368:513-527. [PMID: 39303880 DOI: 10.1016/j.jad.2024.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 09/11/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Suicidal ideation and behaviors are a leading cause of disability worldwide. Approximately 90 % of suicide completers have a diagnosable mood disorder. Extant literature reports rumination mediates functional impairment across mood disorders. Herein, we report the association between rumination and suicidality amongst persons with psychiatric disorders and healthy controls. METHODS Our systematic review and meta-analysis included relevant articles retrieved from Web of Science, OVID and PubMed from inception to March 20, 2024. Random effects model was used to calculate the correlation between rumination, suicidal ideation and attempt. RESULTS A total of 27 eligible studies were included in our systematic review and meta-analysis. Rumination (r = 0.25 [95 % CI: -0.03, 0.49]), reflection (r = 0.15 [-0.71, 0.83]) and brooding (r = 0.13 [-0.58, 0.73]) were nonsignificantly correlated with suicidal ideation in mood disorders. Suicide attempt history was significantly associated with greater odds of rumination in persons with depressive disorders (OR = 1.13 [0.42, 3.02]). In healthy controls, rumination (r = 0.30 [0.21, 0.38]), reflection (r = 0.23 [0.13, 0.32]) and brooding (r = 0.24 [0.12, 0.36]) were significantly correlated with suicidal ideation. Rumination also predicted lifetime history of suicide attempts in healthy controls (OR = 1.70 [1.16, 2.49]). LIMITATIONS There were inadequate sample sizes of persons with different mood and psychiatric disorders which may have underpowered our ability to detect clinically meaningful associations. DISCUSSION Our study reports a transdiagnostic association between measures of rumination and suicidality. Future research vistas should parse the neurobiological substrates subserving rumination and identify targeted therapies and their association with general cognition and treatment response.
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Affiliation(s)
- Gia Han Le
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Sabrina Wong
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada.
| | - Hezekiah Au
- Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Sebastian Badulescu
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Hartej Gill
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Shreya Vasudeva
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada.
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Canada.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore; Division of Life Science (LIFS), Hong Kong University of Science and Technology, Hong Kong.
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Rodrigo B Mansur
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Joshua D Rosenblat
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada.
| | - Roger S McIntyre
- Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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Huang X, Fan B, Jiang Y, Li Y, Chen Y, Zhao H, Jiang Y, Wang W, Guo L, Chen Y, Liu Y, Li Z, Wong S, McIntyre RS, Han X, Lu C. Associations of rumination with suicidal ideation and suicide attempts amongst individuals with major depressive disorder: A 12-month longitudinal study in China. Compr Psychiatry 2024; 132:152472. [PMID: 38513451 DOI: 10.1016/j.comppsych.2024.152472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/17/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND This study aimed to explore the longitudinal associations of rumination with suicidal ideation and suicide attempts in individuals with major depressive disorder (MDD). METHODS Participants were derived from the Depression Cohort in China study (DCC). Those who completed at least one follow-up visit during the 12 months were included in the analysis. Dimensions of rumination including brooding and reflection were each measured using five items of the Ruminative Responses Scale. Suicidal ideation was assessed using the Beck Scale for Suicide Ideation. Suicide attempts were also assessed and all were analyzed with generalized estimating equations. RESULTS Our final sample included 532 participants aged 18 to 59 years (mean [SD], 26.91 [6.94] years) consisting of 148 (27.8%) males and 384 (72.2%) females. After adjusting for temporal trend and potential confounders, individuals with higher levels of reflection were more likely to report suicidal ideation (AOR =1.11, 95% CI:1.01-1.22). However, no statistically significant association was found between brooding and suicidal ideation (AOR =1.06, 95% CI:0.96-1.17). Conversely, individuals with higher levels of brooding were more likely to report suicide attempts (AOR =1.13, 95% CI:1.02-1.24), while no statistically significant association was observed between reflection and suicide attempts (AOR =0.91, 95% CI:0.82-1.01). CONCLUSION Rumination reflects a disturbance in cognitive emotional processing and manifests in different dimensions. Our findings suggest that high levels of reflection and brooding may be associated with a higher likelihood of having suicidal ideation and suicide attempts, respectively. However, it should be interpreted with caution, given that effect sizes are small.
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Affiliation(s)
- Xinyu Huang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yingcheng Jiang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yanzhi Li
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ya Chen
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hao Zhao
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yunbin Jiang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wanxin Wang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zehui Li
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Sabrina Wong
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China.
| | - Ciyong Lu
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China.
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Orson J, Pearson L, Parker S. 'I felt like I'd lost control of everything': An exploration of metacognition and masculinity in men experiencing suicidality. Psychol Psychother 2024. [PMID: 38284500 DOI: 10.1111/papt.12519] [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: 06/30/2023] [Revised: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Seventy-five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self-regulatory executive functioning (S-REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. AIMS To identify which aspects of the S-REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. METHOD Fifteen men experiencing suicidal ideation or behaviour were recruited from a home-based treatment team. Semi-structured interviews and self-report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. RESULTS The S-REF model was identified across three super-ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub-ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. CONCLUSION Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re-establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding.
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Affiliation(s)
- Jonothan Orson
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS FT, Manchester, UK
| | - Lydia Pearson
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS FT, Manchester, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS FT, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Tang H, Xiong T, Shi J, Chen Y, Liu X, Zhang S, Wang H, Lu Q, Yao Z. Global and reflective rumination are related to suicide attempts among patients experiencing major depressive episodes. BMC Psychiatry 2021; 21:117. [PMID: 33637053 PMCID: PMC7908759 DOI: 10.1186/s12888-021-03119-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent attention has focused on the role of rumination in suicidality, with evidence indicating that rumination may be positively related to suicidal ideation. There remains disagreement on the nature of the relationship between rumination and suicide attempts, especially in major affective disorders. This study was designed to identify whether rumination is a risk factor for attempted suicide. METHODS A total of 309 patients with major depressive episodes were recruited for this study, including 170 patients with major depression and 139 patients with bipolar disorder. All participants were categorized into two groups based on a series of clinical assessments: suicide attempters (n = 87) and non-suicide attempters (n = 222). Rumination was evaluated with the Ruminative Responses Scale. A binary logistic regression analysis was carried out to evaluate the relationship between rumination and suicide attempts. RESULTS Both global ruminative levels and the two subtypes of rumination, brooding and reflection, were significantly higher in the suicide attempters than the non-suicide attempters. After controlling for age, current depression and anxiety symptoms, and episode frequency, it was found that global rumination and reflection (but not brooding) were positively associated with suicide attempts. CONCLUSION These results suggest that rumination may be a risk factor for suicide attempts and highlight the maladaptive nature of reflection in patients with major depressive episodes.
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Affiliation(s)
- Hao Tang
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029 Jiangsu China
| | - Tingting Xiong
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029 Jiangsu China
| | - Jiabo Shi
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029 Jiangsu China
| | - Yu Chen
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029 Jiangsu China
| | - Xiaoxue Liu
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029 Jiangsu China
| | - Siqi Zhang
- grid.263826.b0000 0004 1761 0489School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou Road, Nanjing, 210096 Jiangsu China ,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Huan Wang
- grid.263826.b0000 0004 1761 0489School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou Road, Nanjing, 210096 Jiangsu China ,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou Road, Nanjing, 210096, Jiangsu, China. .,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China.
| | - Zhijian Yao
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China. .,School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou Road, Nanjing, 210096, Jiangsu, China. .,Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China.
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