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Bozzay ML, Hughes CD, Eickhoff C, Schatten H, Armey MF. Identifying momentary suicidal ideation using machine learning in patients at high-risk for suicide. J Affect Disord 2024; 364:57-64. [PMID: 39142570 PMCID: PMC11366307 DOI: 10.1016/j.jad.2024.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 07/18/2024] [Accepted: 08/11/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation. METHODS A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification. RESULTS Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly. LIMITATIONS Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified. CONCLUSIONS Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies.
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Affiliation(s)
- M L Bozzay
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States; Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210, United States.
| | - C D Hughes
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States; Department of Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, United States
| | - C Eickhoff
- School of Medicine, University of Tübingen, Schaffhausenstr. 77, 72072 Tübingen, Germany
| | - H Schatten
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States; Department of Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, United States
| | - M F Armey
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States; Department of Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, United States
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Moro L, Sicotte R, Joober R, Malla A, Lepage M, Orri M. Trajectories of suicidality during a 2-year early-intervention program for first-episode psychosis: A longitudinal study. Psychiatry Res 2024; 340:116148. [PMID: 39178562 DOI: 10.1016/j.psychres.2024.116148] [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: 01/17/2024] [Revised: 07/19/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024]
Abstract
Little is known about the individual course of suicidal ideations and attempts (i.e., suicidality) after treatment initiation. We examined the trajectories of suicidality and associated risk factors over a 2-year early intervention program for first-episode psychosis in 450 patients (age range 18-35 years at admission) consecutively admitted from 2003 to 2017. Suicidality was assessed via systematic file review, while sociodemographic and clinical variables were assessed at admission. Latent class growth modelling identified three trajectories: low (69.6 %), initially high (22.9 %), and persistently high (7.6 %) suicidality. Patients who were younger, lived alone and were diagnosed with affective psychosis were significantly more likely to follow the initially high trajectory. Patients who attempted suicide up to 3 months before admission, lived alone and presented lower levels of the PANSS excited factor were significantly more likely to follow the persistently high trajectory. Attempting suicide up to 3 months before admission distinguished persistently high and initially high suicidality trajectories. Suicide risk during early intervention program for first-episode psychosis is heterogenous, with acute and enduring suicidal risk, suggesting the need to adapt suicide prevention strategies to these different risk profiles.
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Affiliation(s)
- Laura Moro
- Department of Psychology, University of Montreal, Montreal, Canada; Douglas Research Centre, Montreal, Canada
| | | | - Ridha Joober
- Douglas Research Centre, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ashok Malla
- Douglas Research Centre, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Martin Lepage
- Douglas Research Centre, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Massimiliano Orri
- Douglas Research Centre, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada; McGill Group for Suicide Studies, Douglas Research Centre, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.
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Choo TH, Wall M, Brodsky BS, Herzog S, Mann JJ, Stanley B, Galfalvy H. Temporal prediction of suicidal ideation in an ecological momentary assessment study with recurrent neural networks. J Affect Disord 2024; 360:268-275. [PMID: 38795778 PMCID: PMC11296397 DOI: 10.1016/j.jad.2024.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/04/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Ecological Momentary Assessment (EMA) holds promise for providing insights into daily life experiences when studying mental health phenomena. However, commonly used mixed-effects linear statistical models do not fully utilize the richness of the ultidimensional time-varying data that EMA yields. Recurrent Neural Networks (RNNs) provide an alternative data analytic method to leverage more information and potentially improve prediction, particularly for non-normally distributed outcomes. METHODS As part of a broader research study of suicidal thoughts and behavior in people with borderline personality disorder (BPD), eighty-four participants engaged in EMA data collection over one week, answering questions multiple times each day about suicidal ideation (SI), stressful events, coping strategy use, and affect. RNNs and mixed-effects linear regression models (MEMs) were trained and used to predict SI. Root mean squared error (RMSE), mean absolute percent error (MAPE), and a pseudo-R2 accuracy metric were used to compare SI prediction accuracy between the two modeling methods. RESULTS RNNs had superior accuracy metrics (full model: RMSE = 3.41, MAPE = 42 %, pseudo-R2 = 26 %) compared with MEMs (full model: RMSE = 3.84, MAPE = 56 %, pseudo-R2 = 16 %). Importantly, RNNs showed significantly more accurate prediction at higher values of SI. Additionally, RNNs predicted, with significantly higher accuracy, the SI scores of participants with depression diagnoses and of participants with higher depression scores at baseline. CONCLUSION In this EMA study with a moderately sized sample, RNNs were better able to learn and predict daily SI compared with mixed-effects models. RNNs should be considered as an option for EMA analysis.
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Affiliation(s)
- Tse-Hwei Choo
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States of America; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
| | - Melanie Wall
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States of America; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Beth S Brodsky
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - J John Mann
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - Hanga Galfalvy
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States of America; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
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Xu Z, Li N, Kong Y, Lin L, Liu Y, Zhang H, He Y, Zhao S. Nonsuicidal self-injury as the gateway and consequence of suicidal ideation among adolescents: a cross-lagged regression analysis. Front Psychiatry 2024; 15:1434191. [PMID: 39211538 PMCID: PMC11358082 DOI: 10.3389/fpsyt.2024.1434191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
Background There is a consensus that both nonsuicidal self-injury (NSSI) and suicidal ideation as risk factors for suicidal behavior have a strong connection. However, a lack of longitudinal information has limited the clarification of the concrete relationship between them. Aims This study aimed to examine the specific mechanism between NSSI and suicidal ideation over time, during adolescence. Method A longitudinal study was conducted with 193 Chinese adolescents. NSSI and suicidal ideations were examined over the course of a 1year followed-up, and three waves of data were collected. Results The NSSI at time T1 significantly positively predicted suicidal ideation at time T2; Suicidal ideation at time T2 also significantly positively predicted NSSI at time T3. Limitations Given that the small number of participants with suicidal ideation and NSSI, the findings of the study should be interpreted with caution and a lager sample is needed in the future. Conclusion It was suggested that NSSI may occur before suicidal ideation, which in turn would strengthen NSSI, so interventions should be carried out from two aspects (behaviors and thoughts) to improve adolescents' mental health.
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Affiliation(s)
- Zhansheng Xu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
- Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Nianqin Li
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
- Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Yaxin Kong
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
- Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Lin Lin
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
- Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Yu Liu
- Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, Zhejiang, China
- Department of Psychology, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Huan Zhang
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
- Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, China
| | - Yunfeng He
- Liaoning Key Laboratory of Psychological Testing and Behavior Analysis, Liaoning University, Shenyang, China
| | - Song Zhao
- Liaoning Key Laboratory of Psychological Testing and Behavior Analysis, Liaoning University, Shenyang, China
- Liao Ning University Judicial Authentication Center, Liaoning University, Shenyang, China
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Rogers ML, Bozzay ML, Hughes CD, Schatten HT, Armey MF. Examining the predictive utility of suicidal ideation characteristics in relation to real-time monitoring of suicidal ideation and suicide attempts at follow-up. Suicide Life Threat Behav 2024. [PMID: 38888350 DOI: 10.1111/sltb.13103] [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: 12/12/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Several characteristics of suicidal ideation, including frequency, duration, perceived controllability, and intensity, have been identified. The present study examined whether these characteristics of baseline suicidal ideation uniquely predicted (1) the severity, variability, and frequency of suicidal ideation assessed through real-time monitoring; and (2) suicide attempts at 3-week and 6-month follow-up among recently discharged psychiatric inpatients. METHODS A sample of 249 adults (Mage = 40.43, 55.1% female, 91.4% White) completed a baseline assessment of their suicidal ideation characteristics during psychiatric hospitalization, five daily ecological momentary assessments (EMA) for 21 days following discharge, and follow-up assessments of suicide-related outcomes at 3-week and 6-month follow-up. RESULTS Perceived controllability of suicidal thoughts was uniquely associated with the variability of EMA-assessed suicidal ideation and the presence of suicide attempts at 3-week, but not 6-month follow-up. No other characteristic of baseline suicidal ideation was uniquely associated with EMA-assessed suicidal ideation or the presence of suicide attempts at follow-up. CONCLUSIONS Given links between the perceived controllability of suicidal ideation and (1) momentary variability of suicidal ideation and (2) suicide attempts over the subsequent 3 weeks, perceived controllability of suicidal thinking may be a useful marker of short-term risk that may be malleable to clinical intervention.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Melanie L Bozzay
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher D Hughes
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Heather T Schatten
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael F Armey
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Fartacek C, Fartacek R, Schiepek GK, Sturm J, Aichhorn W, Plöderl M. Dynamic association between suicidal ambivalence and suicide risk among individuals with a history of suicide attempts. Suicide Life Threat Behav 2024. [PMID: 38837423 DOI: 10.1111/sltb.13096] [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: 12/31/2023] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Suicide risk is highly fluctuating. There is a need for predictors of short-term change in suicide risk to optimize risk assessment and treatment, especially among individuals who already attempted suicide. METHODS Based on 1776 daily assessments of 16 former psychiatric inpatients with a history of suicide attempts, we examined how suicidal ambivalence and, respectively, wish to die (WTD) and wish to live (WTL) predicted same-day and change in perceived suicide risk (i.e., next-day perceived suicide risk, controlled for same-day perceived suicide risk) in multilevel regression models. Additionally, based on the assumptions of nonlinear dynamics, we examined the associations between levels of fluctuations in the WTD/WTL and perceived suicide risk within the same time period. RESULTS Suicidal ambivalence, WTD, and a WTL significantly correlated with same-day suicide risk. Suicidal ambivalence and WTD significantly predicted change in suicide risk. Fluctuations in WTD were significantly associated with concurrent suicide risk. CONCLUSION The results suggest that suicidal ambivalence and WTD are drivers of suicide risk among individuals who already attempted suicide. The association between fluctuations in WTD and suicide risk was small and warrants further investigation on the practical utility as a warning sign.
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Affiliation(s)
- Clemens Fartacek
- Center for Inpatient Psychotherapy and Crisis Intervention, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Institute of Clinical Psychology, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Institute of Synergetics and Psychotherapy Research, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Reinhold Fartacek
- St. Veit Regional Clinic, University Hospital Salzburg, Salzburg, Austria
| | - Günter K Schiepek
- Institute of Synergetics and Psychotherapy Research, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Josef Sturm
- Medical Center Bad Vigaun, Salzburg, Austria
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Martin Plöderl
- Center for Inpatient Psychotherapy and Crisis Intervention, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Institute of Clinical Psychology, Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
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Yoon NY, Yun I, Jung YH, Park EC, Jang SI. Associations between the type of help after sexual harm and adolescents' suicidal ideation. J Adolesc 2024; 96:684-695. [PMID: 36895155 DOI: 10.1002/jad.12160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/09/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION This cross-sectional study aimed to determine the association between receiving external help after sexual harm and suicidal ideation among Korean adolescents. The help received was classified into professional and nonprofessional to test the strength of the association according to the type of help. METHODS Using data from the 2017-2019 Korean children and youth rights study, we analyzed a total of 18,740 middle and high school students. The dependent variable was suicidal ideation; the primary and secondary independent variable was experience of sexual harm and receiving help after sexual harm, respectively. Data were analyzed using χ2 tests and multivariable logistic regression analyses. RESULTS Experience of sexual harm was significantly associated with higher suicidal ideation, and receiving help after sexual harm was significantly associated with lower suicidal ideation compared with not receiving help, regardless of gender. Furthermore, lower suicidal ideation was more strongly associated with receiving professional help in female adolescents, and receiving nonprofessional help in male adolescents. CONCLUSIONS Receiving help after sexual harm was negatively associated with suicidal ideation, and the strength of this association varied with gender and the type of help received. These results can aid the development of evidence-based crisis intervention for victims of sexual harm.
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Affiliation(s)
- Na-Young Yoon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Yun Hwa Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sun S, Liu Q, Wang Z, Huang YY, Sublette ME, Dwork AJ, Rosoklija G, Ge Y, Galfalvy H, Mann JJ, Haghighi F. Brain and blood transcriptome profiles delineate common genetic pathways across suicidal ideation and suicide. Mol Psychiatry 2024; 29:1417-1426. [PMID: 38278992 PMCID: PMC11189724 DOI: 10.1038/s41380-024-02420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
Human genetic studies indicate that suicidal ideation and behavior are both heritable. Most studies have examined associations between aberrant gene expression and suicide behavior, but behavior risk is linked to the severity of suicidal ideation. Through a gene network approach, this study investigates how gene co-expression patterns are associated with suicidal ideation and severity using RNA-seq data in peripheral blood from 46 live participants with elevated suicidal ideation and 46 with no ideation. Associations with the presence of suicidal ideation were found within 18 co-expressed modules (p < 0.05), as well as in 3 co-expressed modules associated with suicidal ideation severity (p < 0.05, not explained by severity of depression). Suicidal ideation presence and severity-related gene modules with enrichment of genes involved in defense against microbial infection, inflammation, and adaptive immune response were identified and investigated using RNA-seq data from postmortem brain that revealed gene expression differences with moderate effect sizes in suicide decedents vs. non-suicides in white matter, but not gray matter. Findings support a role of brain and peripheral blood inflammation in suicide risk, showing that suicidal ideation presence and severity are associated with an inflammatory signature detectable in blood and brain, indicating a biological continuity between ideation and suicidal behavior that may underlie a common heritability.
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Affiliation(s)
- Shengnan Sun
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Qingkun Liu
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Zhaoyu Wang
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Yung-Yu Huang
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Andrew J Dwork
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Gorazd Rosoklija
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Yongchao Ge
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Hanga Galfalvy
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Fatemeh Haghighi
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA.
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Benight CC, Hurd JA, Morison M, Ricca BP. Big ideas series: self-regulation shift theory: trauma, suicide, and violence. ANXIETY, STRESS, AND COPING 2024; 37:1-15. [PMID: 37555655 DOI: 10.1080/10615806.2023.2242281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/14/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Traumatic stress, suicide, and impulsive violence arguably are three of the most consequential problems facing societies today. Self-regulation shift theory is introduced to capture the underlying coping dynamics involved in these three grave challenges. OBJECTIVES Self-regulation shift theory, based in a nonlinear dynamical systems framework, focuses on critical psychological self-regulation thresholds and the role of cognitive self-appraisals in human adaptation to help understand these three significant societal challenges. METHODS This essay reviews existing evidence within the posttraumatic adaptation process utilizing SRST for understanding dynamic self-regulation. This is followed by integrating SRST within existing current theoretical models for suicidal behaviors and violent outbursts. CONCLUSIONS The essay concludes with methodological suggestions for future research applying SRST and how this research offers important opportunities to develop early warning systems that promote hope when hope seems impossible.
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Affiliation(s)
- Charles C Benight
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, USA
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Julie A Hurd
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Margaret Morison
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Bernard P Ricca
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, USA
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Bryan CJ, Daruwala SE, Tabares JV, Butner JE, Coccaro EF, Gorka SM. Heightened threat perceptions and reduced stability in anxiety and fear among U.S. adults who carry handguns. J Anxiety Disord 2023; 99:102764. [PMID: 37597342 PMCID: PMC10543589 DOI: 10.1016/j.janxdis.2023.102764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
Firearm carrying is often motivated to provide safety and is correlated with increased anxiety related to elevated perceptions of the world as a dangerous place. No studies have investigated affective states among firearm owners as they occur in their natural environments. This study used ecological momentary assessment (EMA) to examine cognitive-affective states among firearm owners who carry handguns outside their home (n = 35), firearm owners who do not carry (n = 47), and non-firearm owners (n = 62). Participants completed a self-report questionnaire at baseline followed by EMA surveys of mood state with the Positive and Negative Affect Scale (PANAS) 6 times per day for 28 consecutive days. Carry handgun owners reported significantly higher threat perceptions, measured with the negative cognitions about the world subscale of the shortened Posttraumatic Cognitions Inventory (PTCI), than no-carry handgun owners (Mdiff=2.0, 95% CI=0.8-2.0, d=0.45, p = .001) and non-owners (Mdiff=1.8, 95% CI=0.6-2.9, d=0.42, p = .003). Groups did not significantly differ in mean momentary mood ratings assessed via EMA but stability in high-arousal negative arousal was significantly reduced among carry handgun owners (F(2, 150)= 3.7, p = .026). Results suggest firearm owners who carry handguns view the world as especially dangerous, are more likely to experience shifts in anxiety and fear, and take longer to recover from periods of elevated anxiety and fear.
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Affiliation(s)
- Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States.
| | - Samantha E Daruwala
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
| | - Jeffrey V Tabares
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
| | - Jonathan E Butner
- Department of Psychology, The University of Utah, 380 1530 E, Salt Lake City, UT 84112, United States
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH 43214, United States
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11
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Moller CI, Badcock PB, Hetrick SE, Rice S, Berk M, Witt K, Chanen AM, Dean OM, Gao C, Cotton SM, Davey CG. Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety. Aust N Z J Psychiatry 2023; 57:1150-1162. [PMID: 36629043 DOI: 10.1177/00048674221144262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Depression and suicidal ideation are closely intertwined. Yet, among young people with depression, the specific factors that contribute to changes in suicidal ideation over time are uncertain. Factors other than depressive symptom severity, such as comorbid psychopathology and personality traits, might be important contributors. Our aim was to identify contributors to fluctuations in suicidal ideation severity over a 12-week period in young people with major depressive disorder receiving cognitive behavioural therapy. METHODS Data were drawn from two 12-week randomised, placebo-controlled treatment trials. Participants (N = 283) were 15-25 years old, with moderate to severe major depressive disorder. The primary outcome measure was the Suicidal Ideation Questionnaire, administered at baseline and weeks 4, 8 and 12. A series of linear mixed models was conducted to examine the relationship between Suicidal Ideation Questionnaire score and demographic characteristics, comorbid psychopathology, personality traits and alcohol use. RESULTS Depression and anxiety symptom severity, and trait anxiety, independently predicted higher suicidal ideation, after adjusting for the effects of time, demographics, affective instability, non-suicidal self-injury and alcohol use. CONCLUSIONS Both state and trait anxiety are important longitudinal correlates of suicidal ideation in depressed young people receiving cognitive behavioural therapy, independent of depression severity. Reducing acute psychological distress, through reducing depression and anxiety symptom severity, is important, but interventions aimed at treating trait anxiety could also potentially be an effective intervention approach for suicidal ideation in young people with depression.
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Affiliation(s)
- Carl I Moller
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul B Badcock
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah E Hetrick
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Katrina Witt
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M Chanen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Olivia M Dean
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Caroline Gao
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sue M Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
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12
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Mohamad Farok NH, Mahmud N. A Bibliometric Analysis of Global Research Trends on Suicidal Ideation. Malays J Med Sci 2023; 30:48-60. [PMID: 37655154 PMCID: PMC10467595 DOI: 10.21315/mjms2023.30.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/03/2022] [Indexed: 09/02/2023] Open
Abstract
Suicide cases have increased drastically over the years, while the upsurge has inevitably spiked society's concerns. Suicidal behaviours such as suicidal ideation have received special attention from professionals due to the harmful and irreversible consequences of possible suicide attempts. There is increasing concern that a more complete understanding of suicidal ideation trends is necessary to achieve scientific insights into suicidal behaviours through future integrated advanced research efforts. Thus, this paper aims to observe research patterns through publication outputs and co-authorships among authors and affiliated countries, besides co-occurrences of author keywords from the Scopus database. Using 'suicidal ideation' as the keyword on Scopus, this bibliometric analysis explored the global pattern of suicidal ideation research published between 1960 and 2020 and retrieved 3,061 records. Seven out of 15 most productive universities from the world's top 100 best universities were found in the leading countries lists. The United States was found as dominating the research area with 80% of the publications. In conclusion, the study found that researchers have made significant progress in the research area of suicidal ideation over the years; however, the topic still warrants further analysis to understand suicidality from a broader perspective.
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Affiliation(s)
- Nurul Hidayah Mohamad Farok
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Norashikin Mahmud
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
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13
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Kleiman EM, Glenn CR, Liu RT. The use of advanced technology and statistical methods to predict and prevent suicide. NATURE REVIEWS PSYCHOLOGY 2023; 2:347-359. [PMID: 37588775 PMCID: PMC10426769 DOI: 10.1038/s44159-023-00175-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 08/18/2023]
Abstract
In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearables, digital phenotyping and machine learning) might become solutions to this problem. In this Review, we aim to strike a balance between the pessimistic picture presented by these meta-analyses and the optimistic picture presented by review and commentary papers about the promise of advanced technological and statistical methods to improve the ability to understand, predict and prevent suicide. We divide our discussion into two broad categories. First, we discuss the research aimed at assessment, with the goal of better understanding or more accurately predicting suicidal thoughts and behaviours. Second, we discuss the literature that focuses on prevention of suicidal thoughts and behaviours. Ecological momentary assessment, wearables and other technological and statistical advances hold great promise for predicting and preventing suicide, but there is much yet to do.
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Affiliation(s)
- Evan M. Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | | | - Richard T. Liu
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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14
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Sun S, Liu Q, Wang Z, Huang YY, Sublette M, Dwork A, Rosoklija G, Ge Y, Galfalvy H, Mann JJ, Haghighi F. Functional Architecture of Brain and Blood Transcriptome Delineate Biological Continuity Between Suicidal Ideation and Suicide. RESEARCH SQUARE 2023:rs.3.rs-2958575. [PMID: 37398042 PMCID: PMC10312911 DOI: 10.21203/rs.3.rs-2958575/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Human genetic studies indicate that suicidal ideation and behavior are both heritable. Most studies have examined associations between aberrant gene expression and suicide behavior, but behavior risk is linked to severity of suicidal ideation. Through a gene network approach, this study investigates how gene co-expression patterns are associated with suicidal ideation and severity using RNA-seq data in peripheral blood from 46 live participants with elevated suicidal ideation and 46 with no ideation. Associations with presence and severity of suicidal ideation were found within 18 and 3 co-expressed modules respectively (p < 0.05), not explained by severity of depression. Suicidal ideation presence and severity-related gene modules with enrichment of genes involved in defense against microbial infection, inflammation, and adaptive immune response were identified, and tested using RNA-seq data from postmortem brain that revealed gene expression differences in suicide decedents vs. non-suicides in white matter, but not gray matter. Findings support a role of brain and peripheral blood inflammation in suicide risk, showing that suicidal ideation presence and severity is associated with an inflammatory signature detectable in blood and brain, indicating a biological continuity between ideation and suicidal behavior that may underlie a common heritability.
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15
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Laghaei M, Mehrabizadeh Honarmand M, Jobson L, Abdollahpour Ranjbar H, Habibi Asgarabad M. Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms. BMC Psychiatry 2023; 23:295. [PMID: 37118697 PMCID: PMC10148382 DOI: 10.1186/s12888-023-04699-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 03/20/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Suicidal ideation is a clinical exigency heightening the risk of suicide at different levels of suicidal behavior. This study sought to explore crucial correlates of this phenomenon with a structural equation modeling approach. Accordingly, the mediating role of depressive symptoms and difficulties in emotion regulation between childhood trauma and suicidal ideation were explored. METHOD The sample consisted of 372 university students (57.3% females, M = 20.75, SD = 2.25) who completed self-report measures examining experiences of childhood trauma, depressive symptoms, difficulties in emotion regulation, and suicidal ideation. Structural equation modeling was employed, and mediation analysis was conducted. Confirmatory factor analysis was used to test the measurement model of each construct before evaluating the conceptual mediated model. RESULTS Findings indicate that depressive symptoms with difficulties in emotion regulation had the strongest association (r = 0.60, P = 0.001), then depressive symptoms and suicidal ideation (r = 0.58, P = 0.001), suicidal ideation with difficulties in emotion regulation (r = 0.45, P = 0.001) then suicidal ideation with childhood trauma (r = 0.39, P = 0.001), difficulties in emotion regulation with childhood trauma (r = 0.36 P = 0.001) and finally depressive symptoms and childhood trauma (r = 0.35, P = 0.001). Regarding indirect paths, difficulties in emotion regulation and depression function together (in a sequential path) to mediate the association between childhood trauma and suicidal ideation ( χ2(68) = 216.86, P < 0.01, CFI = 0.95, TLI = 0.93, RMSE = 0.077, CI [0.066 to 0.089], SRMR = 0.049). CONCLUSION Results demonstrate that childhood trauma, depressive symptoms, and difficulties in emotion regulation are linked to suicidal ideation, highlighting the necessity of recognizing and addressing suicidal ideation as well as the factors that contribute to suicidal ideation. Emotion regulation interventions can be effective in reducing the negative effects of childhood trauma and lowering the risk of suicide. These interventions can help in reducing depressive symptoms and improve overall mental well-being, leading to a lower risk of suicide.
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Affiliation(s)
- Marziyeh Laghaei
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | | | - Laura Jobson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | | | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Psychology, Norwegian University of Science and Technology, Dragvoll, 7491, Trondheim, Norway.
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
- Positive Youth Development Lab, Human Development & Family Sciences, Texas Tech University, Texas, USA.
- Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran.
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16
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Bryan CJ, Allen MH, Wastler HM, Bryan AO, Baker JC, May AM, Thomsen CJ. Rapid intensification of suicide risk preceding suicidal behavior among primary care patients. Suicide Life Threat Behav 2023. [PMID: 36912126 DOI: 10.1111/sltb.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Approximately half of those who attempt suicide report experiencing suicidal ideation and suicidal planning in advance; others deny these experiences. Some researchers have hypothesized that rapid intensification is due to past suicidal ideation and/or behaviors that are "mentally shelved" but remain available for rapid access later. METHOD To evaluate this hypothesis, we examined (a) temporal sequencing of suicidal ideation, suicidal planning, and suicidal behavior, and (b) speed of emergence of suicidal behavior in a prospective cohort study of 2744 primary care patients. RESULTS Of 52 patients reporting suicidal behavior during follow-up, 20 (38.5%) reported suicidal ideation and planning prior to their suicidal behavior, 23 (44.2%) reported suicidal ideation but not planning, and nine (17.3%) denied both suicidal ideation and planning. Over half (n = 30, 57.7%) reported the onset of suicidal ideation and/or planning on the same day as or after their suicidal behavior (i.e., rapid intensification). Rapid intensification was not associated with increased likelihood of reporting recent or past suicidal ideation, planning, or behaviors, suggesting rapid intensification does not depend on prior experience with suicidal ideation and/or behaviors. CONCLUSION Detecting primary care patients at risk for this form of suicidal behavior may be limited even with universal suicide risk screening.
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Affiliation(s)
- Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael H Allen
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Heather M Wastler
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - AnnaBelle O Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Justin C Baker
- Department of Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alexis M May
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
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17
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Sander LB, Spangenberg L, La Sala L, Van Ballegooijen W. Editorial: Digital suicide prevention. Front Digit Health 2023; 5:1148356. [PMID: 36937249 PMCID: PMC10020690 DOI: 10.3389/fdgth.2023.1148356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Lasse Bosse Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Correspondence: Lasse Bosse Sander
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Louise La Sala
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Wouter Van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology & Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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18
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Wang X, Xie R, Ding W, Jiang M, Kayani S, Li W. You Hurt Me, so I Hurt Myself and Others: How Does Childhood Emotional Maltreatment Affect Adolescent Violent Behavior and Suicidal Ideation? JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22647-NP22672. [PMID: 35130779 DOI: 10.1177/08862605211072177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Violent behavior and suicidal ideation are two major public health problems, with the former representing outward attack and the latter characterizing inward attack. The effects of emotional maltreatment in childhood will continue into adolescence. This study explores the impact of childhood emotional maltreatment on adolescent violent behavior/suicidal ideation and its mechanism. Participants were 3,600 adolescents (average age is 16.21 ± 0.99) from the middle east of China. They completed questionnaires measuring emotional maltreatment in childhood, deviant peer affiliation, depression, violent behavior, and suicidal ideation in adolescence. After controlling for demographic variables, we found that deviant peer affiliation and depression mediated between childhood emotional maltreatment and adolescent violent behavior/suicidal ideation. Multi-group analysis results showed that males' deviant peer affiliation would contribute to their violent behaviors. Among female groups, deviant peer affiliation and depression were risk factors for violent behavior and suicidal ideation. a) cross-sectional design was used in this study; b) all the measures were self-reported. Preventing emotional maltreatment in childhood can help reduce violent behavior and suicidal ideation by reducing deviant peer affiliation and depression in adolescence. Males who experienced emotional maltreatment in childhood are more likely to show violent behaviors shaped by external factors such as deviant peer affiliation. In contrast, females' interpersonal orientation and internalizing factors both influence their external and internal aggressive behaviors.
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Affiliation(s)
- Xiaoyue Wang
- 66344Parent Education Research Center in Zhejiang Normal University, Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Jinhua, China
| | - Ruibo Xie
- 66344Parent Education Research Center in Zhejiang Normal University, Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Jinhua, China
| | - Wan Ding
- 66344Parent Education Research Center in Zhejiang Normal University, Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Jinhua, China
| | - Min Jiang
- 66344Parent Education Research Center in Zhejiang Normal University, Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Jinhua, China
| | - Sumaira Kayani
- 66344Parent Education Research Center in Zhejiang Normal University, Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Jinhua, China
| | - Weijian Li
- 66344Parent Education Research Center in Zhejiang Normal University, Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Jinhua, China
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19
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Fortune S, Hetrick S. Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly? Aust N Z J Psychiatry 2022; 56:1529-1534. [PMID: 35786014 DOI: 10.1177/00048674221107316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.
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Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Suicide Prevention Office, Auckland, New Zealand
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20
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Silva C, Cero I, Ricci N, Pérez A, Conwell Y, Van Orden K. The feasibility and acceptability of using smartphones to assess suicide risk among Spanish-speaking adult outpatients. Suicide Life Threat Behav 2022; 52:918-931. [PMID: 35674249 PMCID: PMC9588541 DOI: 10.1111/sltb.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/14/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hispanic/Latino adults, particularly Spanish speakers, are underserved in mental healthcare, and little is known about the day-to-day variation in their suicide risk. Smartphones have the potential to overcome geographical and linguistic barriers to mental health assessment and intervention. The purpose of the current study was to examine (a) the feasibility/acceptability of smartphone-based ecological momentary assessment (EMA) to assess suicide ideation and suicide risk factors among high-risk Spanish-speaking adults and (b) the degree of within-person variation of suicide ideation and suicide risk in this population. METHOD Sixteen primary Spanish-speaking psychiatry outpatients completed EMA measures of suicide ideation and suicide risk factors four times a day for 14 days. RESULTS A majority of participants consented to active and passive remote assessments and reported the acceptability of study procedures. Adherence to EMA was high and not associated with symptom severity. EMA instances completed were not associated with symptom severity at follow-up. Average point-to-point variability in suicide ideation and risk factors were moderate to high, respectively. EMA captured more dramatic changes than standard baseline and follow-up assessments. CONCLUSIONS Results provide preliminary support for the feasibility and acceptability of using smartphones to assess suicide risk in a real-time and real-world setting among high-risk Spanish-speaking adults.
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Affiliation(s)
- Caroline Silva
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Ian Cero
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Nilsa Ricci
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Alessandra Pérez
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Yeates Conwell
- University of Rochester School of Medicine, Rochester, New York, USA
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21
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Czyz EK, Koo HJ, Al-Dajani N, Kentopp SD, Jiang A, King CA. Temporal profiles of suicidal thoughts in daily life: Results from two mobile-based monitoring studies with high-risk adolescents. J Psychiatr Res 2022; 153:56-63. [PMID: 35797815 PMCID: PMC9811520 DOI: 10.1016/j.jpsychires.2022.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 01/07/2023]
Abstract
Advancements in mobile technology offer new possibilities to examine fine-grained processes underlying suicidal ideation in everyday, real-world conditions. Across two samples, this study examined temporal changes in near-term suicidal ideation in high-risk adolescents' daily life, and whether these dynamic experiences follow distinct longitudinal trajectories. Using latent process mixed modeling for multivariate outcomes, we investigated near-term changes in two parameters of suicidal thoughts (frequency and intensity) among adolescents who completed four-daily ecological momentary assessments (EMAs) during inpatient hospitalization (Sample 1: N = 61; 843 observations) or daily surveys for four weeks after discharge (Sample 2: N = 78; 1621 observations). Proximally assessed suicidal thoughts followed three trajectories characterized by low (Sample 1: 65.6%; Sample 2: 54%), declining (Sample 1: 4.9%; Sample 2: 15%), or persistently high (Sample 1: 29.5%; Sample 2: 31%) ideation in terms of frequency and urge severity. The persistent trajectory also showed consistently high within-person variability. The persistent group was differentiated by higher hopelessness and lower coping self-efficacy compared to the declining trajectory, and by an overall more severe clinical presentation relative to the low ideation trajectory. Suicidal thoughts in everyday life, across two contexts and regardless of data resolution (EMA and daily surveys), are not homogeneous and instead follow distinct longitudinal profiles. Findings point to the importance of closely monitoring suicidal ideation to identify patterns indicative of unrelenting suicidal thinking. Addressing high hopelessness and low self-efficacy may aid in reducing persistent ideation. Improving our understanding of how suicidal ideation unfolds in real-time may be critical to optimizing timely assessment and support.
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Affiliation(s)
- Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Hyun Jung Koo
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Nadia Al-Dajani
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Shane D Kentopp
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Jiang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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22
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Bloomfield-Clagett B, Greenstein DK, Zarate CA, Ballard ED. The association between variability, intensity, and persistence of suicidal ideation and prospective suicidal behavior in the systematic treatment enhancement program for bipolar disorder (STEP-BD) study. Int J Bipolar Disord 2022; 10:17. [PMID: 35773558 PMCID: PMC9247121 DOI: 10.1186/s40345-022-00263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study sought to examine the association between prospective suicidal behavior and variability, intensity, and persistence of suicidal ideation (SI) in bipolar disorder (BD). Methods Data were drawn from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a naturalistic study of 4360 outpatients 15 years or older with BD. In separate models, logistic regressions with suicidal behavior (first attempt or death by suicide) as the outcome variable and SI variability (fluctuating levels of SI over time, measured as ordinal dispersion of SI score), intensity (median SI score over time in study), or persistence (number of visits with reported SI) as the explanatory variables were used to examine the relationship between SI characteristics and odds of future suicidal behavior events. Results After adjusting for possible confounders, the odds of prospective suicidal behavior were 1.2 times greater per 10% increase in SI variability. SI persistence was not associated with suicidal behavior. For SI intensity, a median SI score of ‘rare/fleeting’ or ‘several days’ of SI was not associated with suicidal behavior, but the odds of prospective suicidal behavior were nearly five times greater for participants with the highest observed median SI intensity score of ‘nearly every day’. Conclusions The findings suggest that, in BD participants, monitoring SI variability may be clinically useful for assessing suicide risk. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00263-7.
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Affiliation(s)
- Bartholt Bloomfield-Clagett
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA
| | - Dede K Greenstein
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA.
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Marks RB, Wee JY, Jacobson SV, Hashimoto K, O’Connell KL, Golden SA, Baker PM, Law KC. The Role of the Lateral Habenula in Suicide: A Call for Further Exploration. Front Behav Neurosci 2022; 16:812952. [PMID: 35359586 PMCID: PMC8964288 DOI: 10.3389/fnbeh.2022.812952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Despite decades of significant effort in research, policy, and prevention, suicide rates have continued to rise to the current peak of 14.6 per 100,000 deaths. This has resulted in a concerted effort to identify biomarkers associated with suicidal behavior in the brain, to provide predictions that are better than the chance of discerning who will die by suicide. We propose that the lateral habenula (LHb), and its dysfunction during a suicidal crisis, is a critical component of the transition from suicidal ideations to self-harm. Moreover, the LHb—a key functional node in brain reward circuitry—has not been ascribed a contributory role in suicidal behavior. We argue that the LHb anchors a “suicide circuit” and call for suicide researchers to directly examine the role of the LHb, and its long-term modulation, in response to the negative affect in suicidal behavior. Discerning the neural mechanisms of this contribution will require the collaboration of neuroscientists and psychologists. Consequently, we highlight and discuss research on LHb as it relates to suicidal ideation, suicidal behavior, or death by suicide. In so doing we hope to address the bench-to-bedside translational issues currently involved in suicide research and suggest a developmental framework that focuses on specific structures motivated by theoretical anchors as a way to incorporate neurobiological findings within the context of clinical theory.
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Affiliation(s)
- Rocky B. Marks
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
- Correspondence: Rocky B. Marks Keyne Catherine Law
| | - Janelle Y. Wee
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Samantha V. Jacobson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Kimi Hashimoto
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Katherine L. O’Connell
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Sam Adler Golden
- Department of Biological Structure, University of Washington, Seattle, WA, United States
| | | | - Keyne Catherine Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
- Correspondence: Rocky B. Marks Keyne Catherine Law
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Ammerman BA, Law KC. Using intensive time sampling methods to capture daily suicidal ideation: A systematic review. J Affect Disord 2022; 299:108-117. [PMID: 34718039 DOI: 10.1016/j.jad.2021.10.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There has been an increased emphasis on understanding suicidal thoughts and behaviors as they occur in real-time, resulting in a proliferation of studies utilizing intensive time sampling methods. Given the continued growth in this area, there is a need to synthesize the feasibility of these methods in capturing suicidal ideation at the daily level, in addition to an examination of study factors that may impact suicidal ideation detection, to guide future research. METHOD Online databases (i.e., PsychINFO, ERIC, PubMed, MEDLINE) were systematically searched for articles published through December 2020 that assessed suicidal ideation at the daily level. RESULTS Twenty-six articles presenting data from sixteen independent datasets met inclusion criteria. Across included articles, suicidal ideation detection ranged from approximately 1-92% of participant-completed surveys, with 18-100% of unique study participants reporting suicidal ideation during the study period. Assessment-based factors (i.e., number of daily assessments, duration of daily assessment period) did not appear to be meaningfully associated with suicidal ideation detection rates. Rather, participant characteristics (i.e., baseline suicide risk history, inclusion criteria) were better indicators of a study's ability to capture suicidal ideation at the daily level. CONCLUSIONS Findings highlights the impact of targeting participants with elevated suicide risk at study enrollment.
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Affiliation(s)
- Brooke A Ammerman
- University of Notre Dame, Department of Psychology, 390 Corbett Family Hall, Notre Dame, IN 46556, United States.
| | - Keyne C Law
- Seattle Pacific University, Department of Psychology, 3307 3rd Ave. W., Seattle, WA 98119, United States.
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25
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Kyron MJ, Hooke GR, Bryan CJ, Page AC. Distress tolerance as a moderator of the dynamic associations between interpersonal needs and suicidal thoughts. Suicide Life Threat Behav 2022; 52:159-170. [PMID: 34741322 DOI: 10.1111/sltb.12814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Identifying the interaction between dispositional and dynamic risk factors is necessary in understanding, predicting, and managing suicide risk. Interpersonal factors have consistently been linked to suicidal ideation over short-term periods. Additionally, distress tolerance may be a relevant dispositional protective factor against stressful events. METHODS Seven hundred and seventeen psychiatric inpatients (Male = 30.31%, Average Age = 40.71 years, Min = 14, Max = 82) self-reported their distress tolerance at hospital admission, and interpersonal needs and suicidal ideation on a daily basis. Dynamic structural equation modelling was used to examine whether within-level dynamics were moderated by distress tolerance. RESULTS Both perceived burdensomeness and thwarted belongingness were significantly associated with same-day suicidal ideation. Higher distress tolerance was associated with weaker daily associations between suicidal ideation and both perceived burdensomeness and thwarted belongingness. Distress tolerance was also associated with lower variability in suicidal ideation. Moderating effects were also evident when lifetime suicide attempts were added as a covariate, which was associated with stronger associations between interpersonal dysfunction and suicidal ideation, and higher variability in ideation. CONCLUSIONS Distress tolerance may be important to consider when examining the dynamic relationships between suicidal ideation and proximal factors. Psychotherapy that specifically targets distress tolerance may be effective in reducing reactivity to interpersonal stressors.
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Affiliation(s)
- Michael J Kyron
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia.,Graduate School of Education, University of Western Australia, Crawley, WA, Australia
| | - Geoff R Hooke
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia.,Perth Clinic, Perth, WA, Australia
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew C Page
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
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26
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Dombrovski AY, Hallquist MN. Search for solutions, learning, simulation, and choice processes in suicidal behavior. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2022; 13:e1561. [PMID: 34008338 PMCID: PMC9285563 DOI: 10.1002/wcs.1561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/06/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value-based choices. Can individual-level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case-control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision-making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood-congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case-control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real-time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis. This article is categorized under: Economics > Individual Decision-Making Psychology > Emotion and Motivation Psychology > Learning Neuroscience > Behavior.
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Affiliation(s)
| | - Michael N. Hallquist
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNorth CarolinaUSA
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27
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Rudd MD, Bryan CJ. Finding Effective and Efficient Ways to Integrate Research Advances Into the Clinical Suicide Risk Assessment Interview. Front Psychiatry 2022; 13:846244. [PMID: 35280175 PMCID: PMC8913708 DOI: 10.3389/fpsyt.2022.846244] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/02/2022] [Indexed: 11/27/2022] Open
Abstract
Research in clinical suicidology continues to rapidly expand, much of it with implications for day-to-day clinical practice. Clinicians routinely wrestle with how best to integrate recent advances into practice and how to do so in efficient and effective fashion. This article identifies five critical domains of recent research findings and offers examples of simple questions that can easily be integrated into a clinician's existing suicide risk assessment interview and related protocol helping inform the risk formulation process.
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Affiliation(s)
- M David Rudd
- Department of Psychology, University of Memphis, Memphis, TN, United States
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Science, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Coppersmith DDL, Dempsey W, Kleiman EM, Bentley KH, Murphy SA, Nock MK. Just-in-Time Adaptive Interventions for Suicide Prevention: Promise, Challenges, and Future Directions. Psychiatry 2022; 85:317-333. [PMID: 35848800 PMCID: PMC9643598 DOI: 10.1080/00332747.2022.2092828] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The suicide rate (currently 14 per 100,000) has barely changed in the United States over the past 100 years. There is a need for new ways of preventing suicide. Further, research has revealed that suicidal thoughts and behaviors and the factors that drive them are dynamic, heterogeneous, and interactive. Most existing interventions for suicidal thoughts and behaviors are infrequent, not accessible when most needed, and not systematically tailored to the person using their own data (e.g., from their own smartphone). Advances in technology offer an opportunity to develop new interventions that may better match the dynamic, heterogeneous, and interactive nature of suicidal thoughts and behaviors. Just-In-Time Adaptive Interventions (JITAIs), which use smartphones and wearables, are designed to provide the right type of support at the right time by adapting to changes in internal states and external contexts, offering a promising pathway toward more effective suicide prevention. In this review, we highlight the potential of JITAIs for suicide prevention, challenges ahead (e.g., measurement, ethics), and possible solutions to these challenges.
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29
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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30
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Butner JE, Bryan CJ, Tabares JV, Brown LA, Young-McCaughan S, Hale WJ, Mintz J, Litz BT, Yarvis JS, Fina BA, Foa EB, Resick PA, Peterson AL. Temporal-dimensional examination of the Scale for Suicidal Ideation in a cohort of service members in treatment for PTSD. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2021; 13:793-801. [PMID: 34723567 DOI: 10.1037/tra0001030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Failing to account for temporal dynamics can hinder our understanding of suicidal ideation and the potential mechanisms underlying increased risk for suicide death and suicide attempts associated with posttraumatic stress disorder (PTSD). To address these limitations, this study used an analytic approach based on Dynamical Systems Theory to describe temporal patterns associated with multiple dimensions of suicidal ideation in a treatment-seeking sample of military personnel diagnosed with PTSD. METHOD We performed a secondary analysis of archived data from 742 active-duty military personnel (90% male, 57% white, mean age = 33 ± 7.4 years) enrolled in three clinical trials to examine the dimensional measurement properties of the first 5 items of the Scale for Suicidal Ideation (SSI). RESULTS Findings indicated two change dynamics for suicidal ideation: homeostatic (i.e., the tendency for suicidal ideation to return to a stable point) and cyclical (i.e., the tendency for suicidal ideation to switch back and forth between higher and lower values). Cycling was the dominant dynamic and was related to variables other from suicidal ideation. CONCLUSION The cyclic nature of suicidal ideation suggests that assessment timing and context could influence observed associations with other variables. Analytic approaches and clinical methods that do not account for the temporal dynamics of suicide risk could miss these properties, thereby hindering efforts to identify mechanisms underlying the relationship between PTSD and suicidal thoughts and behaviors and limiting opportunities for proactive and timely intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences
| | - Brett T Litz
- Departments of Psychiatry and Psychological and Brain Sciences
| | | | | | - Edna B Foa
- Center for the Treatment and Study of Anxiety
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31
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Oquendo MA, Galfalvy HC, Choo TH, Kandlur R, Burke AK, Sublette ME, Miller JM, Mann JJ, Stanley BH. Highly variable suicidal ideation: a phenotypic marker for stress induced suicide risk. Mol Psychiatry 2021; 26:5079-5086. [PMID: 32576966 PMCID: PMC7755748 DOI: 10.1038/s41380-020-0819-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
Suicidal behavior (SB) can be impulsive or methodical; violent or not; follow a stressor or no obvious precipitant. This study tested whether childhood trauma, affective lability, and aggressive and impulsive traits predicted greater SI variability. We also assessed whether affective lability, aggressive or impulsive traits explain childhood trauma's effects on SI variability and whether those with highly variable SI respond to stressful events with increases in SI. Finally, we assessed variable SI's trajectory over 2 years. Depressed participants (n = 51) had ecological momentary assessments (EMA) over 7 days at baseline, 3, 6, 12, 18, and 24 months. SI variability was assessed using the square Root of the Mean Square of Successive Deviations. Mixed Effects Models were fit as appropriate. Childhood trauma was associated with subsequent aggression. Physical abuse predicted both aggression and affective lability as well as SI variability, but not impulsivity. In two-predictor models, physical abuse's effect on SI variability was no longer significant, when controlling for the effect of higher aggression and impulsivity. Those with high SI variability exhibited greater increases in SI after stressors compared with those with less variability. We did not find that SI variability changed over time, suggesting it might be trait-like, at least over 2 years. Variable SI predisposes to marked SI increases after stressful events and may be a trait increasing risk for impulsive SB, at least over 2 years.
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Affiliation(s)
- Maria A Oquendo
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Hanga C Galfalvy
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tse-Hwei Choo
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Ainsley K Burke
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - M Elizabeth Sublette
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeffrey M Miller
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - J John Mann
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Barbara H Stanley
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
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32
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Law KC, Anestis MD. Testing Whether Suicide Capability Has a Dynamic Propensity: The Role of Affect and Arousal on Momentary Fluctuations in Suicide Capability. Front Psychol 2021; 12:590187. [PMID: 34385942 PMCID: PMC8353180 DOI: 10.3389/fpsyg.2021.590187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
To prevent suicidal behaviors, it is crucial to understand the mechanisms and processes that enable an individual to act on suicidal thoughts. Suicide capability, which involves an increased pain tolerance and fearlessness of death, is a critical factor that enables an individual to endure the physical pain necessary to make a lethal suicide attempt. Extant research has largely conceptualized suicide capability as developing linearly in response to painful and provocative experiences, but the emerging literature on the temporal dynamics of suicide has been challenging the notion of linearity in suicide risk. Few studies have directly measured and compared changes in suicide capability in response to rumination on different affective states. We sought to experimentally test if rumination in the context of low vs. high arousal emotions will prompt distinct changes in two core components of suicide capability: pain tolerance and fearlessness of death on two undergraduate student samples. In both studies, participants provided measures of subjective emotional state as well as pain threshold, tolerance, and persistence before and after completing experimental manipulations which included both emotion and rumination induction procedures. In the second study, measures of fearlessness about death and physiological arousal (heart rate) were added to the experimental procedures. We found significant decreases in pain threshold, tolerance, and persistence following the experimental manipulations but found no main effects of rumination or suicide risk. These findings suggest that suicide capability can fluctuate but these changes may occur through a different mechanism and/or differ between individuals at varying levels of suicide risk.
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Affiliation(s)
- Keyne C Law
- Department of Clinical Psychology, School of Psychology, Family, and Community, Seattle Pacific University, Seattle, WA, United States
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, New Brunswick, NJ, United States.,Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ, United States
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Barredo J, Bozzay ML, Primack JM, Schatten HT, Armey MF, Carpenter LL, Philip NS. Translating Interventional Neuroscience to Suicide: It's About Time. Biol Psychiatry 2021; 89:1073-1083. [PMID: 33820628 PMCID: PMC8603185 DOI: 10.1016/j.biopsych.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
Despite significant advances in psychiatric and psychological treatment over the last 30 years, suicide deaths have increased. Unfortunately, neuroscience insights have yielded few translational interventions that specifically target suicidal thoughts and behaviors. In our view, this is attributable to two factors. The first factor is our limited integration of neurocircuitry models with contemporary suicide theory. The second challenge is inherent to the variable nature of suicide risk over time. Few interventional neuroscience studies evaluate how temporal fluctuations in risk affect treatment, despite evidence that temporality is a key component distinguishing suicide phenotypes. To wit, individual variability in risk trajectories may provide different treatment targets to engage as a patient moves between suicidal ideation and attempt. Here, we first review contemporary ideation-to-action theories of suicide from a neurobiological perspective, focusing on valence and executive function circuits and the key role of state-induced (e.g., within stressful contexts) functional modulation on longitudinal risk trajectories. We then describe neural correlates of suicide reduction following various interventions, ranging from circuit specific (i.e., transcranial magnetic stimulation) to broader pharmacological (i.e., ketamine, lithium) to psychological (i.e., brief cognitive therapy). We then introduce novel strategies for tracking risk in naturalistic settings and real time using ecological momentary interventions. We provide a critical integration of the literature focusing on the intersection between targets and temporality, and we conclude by proposing novel research designs integrating real-time and biologically based interventions to generate novel strategies for future suicide reduction research.
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Affiliation(s)
- Jennifer Barredo
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island.
| | - Melanie L Bozzay
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer M Primack
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Linda L Carpenter
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
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Oakey-Frost N, Trachik B, Ganulin ML, LoPresti ML, Dretsch MN, Tucker RP. Indirect effects of soldier healthy eating and physical activity on suicidal ideation through psychological health symptoms in active-duty military. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1902180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nicolas Oakey-Frost
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
| | - Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Michelle L. Ganulin
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Mathew L. LoPresti
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Michael N. Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
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Macintyre VG, Mansell W, Pratt D, Tai SJ. The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness. Front Psychol 2021; 12:588683. [PMID: 33815194 PMCID: PMC8012495 DOI: 10.3389/fpsyg.2021.588683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives This paper aims to identify potential areas for refinement in existing theoretical models of suicide, and introduce a new integrative theoretical framework for understanding suicide, that could inform such refinements. Methods Literature on existing theoretical models of suicide and how they contribute to understanding psychological processes involved in suicide was evaluated in a narrative review. This involved identifying psychological processes associated with suicide. Current understanding of these processes is discussed, and suggestions for integration of the existing literature are offered. Results Existing approaches to understanding suicide have advanced the current knowledge of suicide in various ways. They have guided valuable research in the following areas: motivations for suicide and the psychological distress which influences suicide attempts; ambivalence about suicide; suicidal individuals’ focus of attention; and ways in which individuals who contemplate suicide differ from individuals who attempt suicide. We outline a new theoretical framework as a means to integrating all of these concepts into the three principles of control, conflict, and awareness. Within this framework, suicide is regarded as occurring due to a long standing conflict between an individual’s personal goals, culminating in an episode of acute loss of control. The new framework posits that the individual then strives to regain control through the means of suicide because of a narrowed awareness of consequences of their actions on other valued goals. This psychological mechanism of limited awareness is posited to be the common pathway by which individuals make a suicide attempt, regardless of which risk factors are present. Conclusion This article introduces a theoretical framework that generates several hypotheses for future research, and focuses on psychological processes occurring during immediate crisis. One of the key hypotheses resulting from our predictions on how individuals progress from contemplating to attempting suicide will be tested in an ongoing program of research: Individuals who attempt suicide have a significantly reduced awareness of consequences of suicide, which would negatively impact on their important life goals, values, principles, or ideals, compared to individuals who contemplate suicide. Therapy guided by the new framework may be more flexible, immediate, and client-focused than other therapies for suicidal individuals.
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Affiliation(s)
- Vanessa G Macintyre
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Warren Mansell
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sara J Tai
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Wang SB, Coppersmith DDL, Kleiman EM, Bentley KH, Millner AJ, Fortgang R, Mair P, Dempsey W, Huffman JC, Nock MK. A Pilot Study Using Frequent Inpatient Assessments of Suicidal Thinking to Predict Short-Term Postdischarge Suicidal Behavior. JAMA Netw Open 2021; 4:e210591. [PMID: 33687442 PMCID: PMC7944382 DOI: 10.1001/jamanetworkopen.2021.0591] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The weeks following discharge from psychiatric hospitalization are the highest-risk period for suicide attempts. Real-time monitoring of suicidal thoughts via smartphone prompts may be more indicative of short-term risk than a single, cross-sectional assessment. OBJECTIVE To test whether modeling dynamic changes in real-time suicidal thoughts during psychiatric hospitalization can improve predictions of postdischarge suicide attempts vs using only baseline (ie, admission) data or using the mean level of real-time suicidal thoughts during hospitalization. DESIGN, SETTING, AND PARTICIPANTS In this prognostic study, 83 adults recruited from the inpatient psychiatric unit at Massachusetts General Hospital completed ecological momentary assessment surveys of suicidal thinking 4 to 6 times per day during hospitalization as well as brief follow-up surveys assessing suicide attempts at 2 and 4 weeks after discharge. Participants completed at least 3 real-time monitoring surveys. Inclusion criteria included hospitalization for suicidal thoughts and/or behaviors and English fluency. Data were collected from January 2016 to December 2018 and analyzed from January to December 2020. MAIN OUTCOMES AND MEASURES The primary outcome was suicide attempt in the month after discharge. RESULTS Of 83 participants (mean [SD] age, 38.4 [13.6] years; 43 [51.8%] male participants; 69 [83.1%] White individuals), 9 (10.8%) made a suicide attempt in the month after discharge. Mean cross-validated AUC for elastic net models revealed predictive accuracy was fair for the model using baseline data (area under the curve [AUC], 0.71; first to third quartile, 0.55-0.88), good for the model using the mean level of real-time suicidal thoughts during hospitalization (AUC, 0.81; first to third quartile, 0.67-0.91), and best for the model using dynamic changes in real-time suicidal thoughts during hospitalization (AUC, 0.89; first to third quartile, 0.81-0.97); this pattern of results held for other classification metrics (eg, accuracy, positive predictive value, Brier score) and when using different cross-validation procedures. Features assessing rapid fluctuations in suicidal thinking emerged as the strongest predictors of posthospital suicide attempts. A final set of models incorporating percentage missingness further improved both the mean (mean AUC, 0.93; first to third quartile, 0.90-1.00) and dynamic feature (mean AUC, 0.93; first to third quartile, 0.88-1.00) models. CONCLUSIONS AND RELEVANCE In this study, collecting real-time data about suicidal thinking during the course of hospitalization significantly improved short-term prediction of posthospitalization suicide attempts. Models including dynamic changes in suicidal thinking over time yielded the best prediction; features that captured rapid changes in suicidal thoughts were particularly strong predictors. Survey noncompletion also emerged as an important predictor of posthospitalization suicide attempts.
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Affiliation(s)
- Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | | | - Evan M. Kleiman
- Department of Psychology, Rutgers University, New Brunswick, New Jersey
| | - Kate H. Bentley
- Department of Psychology, Harvard University, Cambridge, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Alexander J. Millner
- Department of Psychology, Harvard University, Cambridge, Massachusetts
- Mental Health Research, Franciscan Children’s, Brighton, Massachusetts
| | - Rebecca Fortgang
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Mental Health Research, Franciscan Children’s, Brighton, Massachusetts
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Butner JE, Bryan CJ, Munion AK, Tabares JV. A dynamical systems approach to examining the efficacy of suicide-focused interventions. Suicide Life Threat Behav 2021; 51:97-114. [PMID: 33624876 DOI: 10.1111/sltb.12675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Suicide risk is a nonlinear temporal process, but the ways in which suicide-focused interventions have statistically examined risk effects have ignored these nonlinearities. This paper highlights the potential benefits of using data analytic methods that account for nonlinear change patterns. METHOD Using a dynamical systems perspective, interventions are framed in terms of attractor dynamics. An attractor has three primary qualities where an intervention can have an effect. These correspond to contextual differences, shifts in the underlying temporal patterns, and changes in the stability of the temporal pattern. RESULTS/CONCLUSIONS It is argued that the ideal effect is one in which there is both an observed change in stability and a shift in the underlying temporal pattern toward less risk. Other types of intervention effects can have alternate explanations that are less desirable. Mean, variance, and growth differences are discussed within a systems context, and an example model is provided using Latent Change Score Modeling (McArdle, Annual Review of Psychology, 60, 2009, 577-605).
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Affiliation(s)
- Jonathan E Butner
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Craig J Bryan
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA.,National Center for Veterans Studies, Salt Lake City, UT, USA
| | - Ascher K Munion
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Jeffrey V Tabares
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA.,National Center for Veterans Studies, Salt Lake City, UT, USA
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Elucidating the chronic, complex nature of suicidal ideation: A national qualitative study of veterans with a recent suicide attempt. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Britton PC, Conner KR, Maisto SA. The Living Ladder: Introduction and Validity Over 6-Month Follow-Up of a One-Item Measure of Readiness to Continue Living in Suicidal Patients. Suicide Life Threat Behav 2020; 50:1025-1040. [PMID: 32222007 DOI: 10.1111/sltb.12635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The ability to predict suicide outcomes is limited by the lack of consideration of protective factors. This study examined the validity of the Living Ladder, a measure of readiness to continue living among individuals thinking of suicide. METHODS The Living Ladder consists of one item that assesses an individual's readiness to continue living when thinking about suicide. Participants (N = 130) completed the Living Ladder in-person at baseline and by-phone at 1-, 3-, and 6-month follow-up. The prospective association of the Living Ladder with suicidal ideation and risk for a suicide attempt was examined using models adjusting for baseline ideation and suicide attempts, respectively. RESULTS Each rung on the Living Ladder was associated with 18% lower likelihood of suicidal ideation, OR (95% CI) = 0.82 (0.68, 0.96), and less severe suicidal ideation among those with ideation. Scores >2, indicating contemplation of living, were associated with 64% lower risk for a suicide attempt, HR (95% CI) = 0.36 (0.13, 0.98). Findings for suicidal ideation were replicated when administered by-phone. CONCLUSIONS The Living Ladder is a one-item measure that is prospectively associated with suicidal ideation and suicide attempts. Findings support the relevance of motivation to live to suicide outcomes.
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Affiliation(s)
- Peter C Britton
- Department of Veterans Affairs, Finger Lakes Healthcare System, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Department of Veterans Affairs, Center for Integrated Healthcare, Syracuse Medical Center, Syracuse, NY, USA
| | - Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephen A Maisto
- Department of Veterans Affairs, Center for Integrated Healthcare, Syracuse Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
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40
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Swee G, Shochet I, Cockshaw W, Hides L. Emotion Regulation as a Risk Factor for Suicide Ideation among Adolescents and Young Adults: The Mediating Role of Belongingness. J Youth Adolesc 2020; 49:2265-2274. [PMID: 32772329 DOI: 10.1007/s10964-020-01301-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022]
Abstract
Thwarted belongingness is an established predictor of suicide ideation. Emerging theory suggests belongingness may be a crucial pathway through which risk factors such as dysfunctional emotion regulation influence suicide ideation. This study examined whether belongingness mediated the relationship between emotion regulation and suicide ideation in young people (16-25 years). Participants (n = 1699; 63.6% females, M = 20.24 years, SD = 2.45 years) completed measures of these constructs, including the emotion regulation domains of internal-functional, internal-dysfunctional, external-functional, and external-dysfunctional. Belongingness mediated over half of the association between three emotion regulation domains and suicide ideation (internal-functional: 55.6%, internal-dysfunctional: 54.1%, and external-functional: 64.8%). Consistent with current etiological suicidality models, results suggest low belongingness is an important precursor to suicide ideation in young people, and that there is an inter-relationship between emotional regulation styles and belongingness.
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Affiliation(s)
- Genevieve Swee
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Ian Shochet
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Wendell Cockshaw
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.,School of Health & Biomedical Sciences, RMIT University, Bundoora, VIC, 3000, Australia
| | - Leanne Hides
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.,School of Psychology and Counselling, Institute of Health & Biomedical Innovation, The University of Queensland, St Lucia, QLD, 4072, Australia
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Naifeh JA, Nock MK, Dempsey CL, Georg MW, Bartolanzo D, Ng THH, Aliaga PA, Dinh HM, Fullerton CS, Mash HBH, Kao TC, Sampson NA, Wynn GH, Zaslavsky AM, Stein MB, Kessler RC, Ursano RJ. Self-injurious thoughts and behaviors that differentiate soldiers who attempt suicide from those with recent suicide ideation. Depress Anxiety 2020; 37:738-746. [PMID: 32291817 DOI: 10.1002/da.23016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/05/2020] [Accepted: 03/22/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Risk for suicide attempt (SA) versus suicide ideation (SI) is clinically important and difficult to differentiate. We examined whether a history of self-injurious thoughts and behaviors (SITBs) differentiates soldiers with a recent SA from nonattempting soldiers with current/recent SI. METHODS Using a unique case-control design, we administered the same questionnaire (assessing the history of SITBs and psychosocial variables) to representative U.S. Army soldiers recently hospitalized for SA (n = 132) and soldiers from the same Army installations who reported 30-day SI but did not make an attempt (n = 125). Logistic regression analyses examined whether SITBs differentiated attempters and ideators after controlling for previously identified covariates. RESULTS In separate models that weighted for systematic nonresponse and controlled for gender, education, posttraumatic stress disorder, and intermittent explosive disorder, SA was positively and significantly associated with the history of suicide plan and/or intention to act (odds ratio [OR] = 12.1 [95% confidence interval {CI} = 3.6-40.4]), difficulty controlling suicidal thoughts during the worst week of ideation (OR = 3.5 [95% CI = 1.1-11.3]), and nonsuicidal self-injury (NSSI) (OR = 4.9 [95% CI = 1.3-18.0]). Area under the curve was 0.87 in a full model that combined these SITBs and covariates. The top ventile based on predicted risk had a sensitivity of 24.7%, specificity of 99.8%, and positive predictive value of 97.5%. CONCLUSIONS History of suicide plan/intention, difficult to control ideation, and NSSI differentiate soldiers with recent SA from those with current/recent SI independent of sociodemographic characteristics and mental disorders. Longitudinal research is needed to determine whether these factors are prospectively associated with the short-term transition from SI to SA.
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Affiliation(s)
- James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew W Georg
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Danielle Bartolanzo
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Hieu M Dinh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Gary H Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.,VA San Diego Healthcare System, San Diego, California
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Bryan CJ, Butner JE, May AM, Rugo KF, Harris J, Oakey DN, Rozek DC, Bryan AO. Nonlinear change processes and the emergence of suicidal behavior: a conceptual model based on the fluid vulnerability theory of suicide. NEW IDEAS IN PSYCHOLOGY 2020; 57:10.1016/j.newideapsych.2019.100758. [PMID: 32123464 PMCID: PMC7050543 DOI: 10.1016/j.newideapsych.2019.100758] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although ideation-to-action theories of suicide aim to explain the emergence of suicidal behaviors, researchers have primarily focused on the content of underlying mechanisms (i.e., who dies by suicide). Much less attention has focused on the temporal dynamics of suicide risk (i.e., when suicide occurs). The fluid vulnerability theory conceptualizes suicide as an inherently dynamic construct that follows a nonlinear time course. Newer research implicates the existence of multiple nonlinear change processes among suicidal individuals, some of which appear to be associated with the emergence of suicidal behavior. The cusp catastrophe model provides a useful model for conceptualizing these change processes and provides a foundation for explaining a number of poorly understood phenomena including sudden emergence of suicidal behavior without prior suicidal planning. The implications of temporal dynamics for suicide-focused theory, practice, and research are discussed.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies & The University of Utah
| | | | | | - Kelsi F Rugo
- National Center for Veterans Studies & The University of Utah
| | - Julia Harris
- National Center for Veterans Studies & The University of Utah
| | - D Nicolas Oakey
- National Center for Veterans Studies & The University of Utah
| | - David C Rozek
- National Center for Veterans Studies & The University of Utah
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Smith NB, Sippel LM, Rozek DC, Spangler PT, Traber D, Straud C, Hoff R, Harpaz-Rotem I. Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder. Depress Anxiety 2020; 37:273-284. [PMID: 31951318 PMCID: PMC7054126 DOI: 10.1002/da.22993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. METHODS A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self-report measures at admission and discharge were included. RESULTS The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre-posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma-focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. CONCLUSIONS Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.
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Affiliation(s)
- Noelle B. Smith
- VA Northeast Program Evaluation Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Lauren M. Sippel
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, NH, USA
| | - David C. Rozek
- UCF RESTORES & Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Patricia T. Spangler
- Center for the Study of Traumatic Stress, Uniformed Service University, Bethesda, MD, USA
| | - Delphine Traber
- Université Grenoble Alpes, Université Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Casey Straud
- University of Texas Health Science Center San Antonio, Department of Psychiatry, San Antonio, TX, USA
| | - Rani Hoff
- VA Northeast Program Evaluation Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- VA Northeast Program Evaluation Center, West Haven, CT, USA
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
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Ivbijaro G, Kolkiewicz L, Goldberg D, Riba MB, N'jie INS, Geller J, Kallivayalil R, Javed A, Švab I, Summergrad P, Laher S, Enum Y. Preventing suicide, promoting resilience: Is this achievable from a global perspective? Asia Pac Psychiatry 2019; 11:e12371. [PMID: 31709743 DOI: 10.1111/appy.12371] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022]
Abstract
Suicide continues to be a major health concern globally despite many initiatives to identify risk factors and methods for suicide prevention. We have carried out a detailed narrative review of the literature from 2016 to 2019 using the headings of Personal resilience (P1), People (P2), Places (P3), Prevention (P4), Promoting collaboration (P5), and Promoting research (P6) in order to support an integrated approach to suicide prevention and the promotion of personal and population resilience. We have made 10 key recommendations on how this can be moved forward.
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Affiliation(s)
- Gabriel Ivbijaro
- Faculdade de Ciências Médicas, NOVA Medical School Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,Faculty of Management, Law and Social Sciences, University of Bradford, UK.,World Federation for Mental Health.,The World Dignity Project
| | - Lucja Kolkiewicz
- Faculdade de Ciências Médicas, NOVA Medical School Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.,East London NHS Foundation Trust, London, UK
| | | | - Michelle B Riba
- Depression Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Jeffrey Geller
- World Federation for Mental Health.,American Psychiatric Association, USA.,Psychiatry, University of Massachusetts Medical School, USA
| | - Roy Kallivayalil
- World Association of Social Psychiatry.,Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Afzal Javed
- World Psychiatric Association.,Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Igor Švab
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Slovenia
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, USA.,Tufts Medical Center, Boston, MA, USA
| | - Sumaya Laher
- Department of Psychology, University of the Witwatersrand, South Africa
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Abstract
Globally, close to 800,000 individuals die by suicide each year. A scientific understanding of suicidal thoughts and behaviors have been slow to emerge owing to a number of challenges including low base rates, complexity and nonlinearity, low precision and accuracy of identification and detection methods, and variability across social and environmental contexts. To overcome these challenges, researchers have developed increasingly innovative and creative methods to overcome these challenges. These innovations hold considerable promise for advancing the science of suicide via large leaps forward rather than incremental steps. In this special issue of Behaviour Research and Therapy, we highlight several such efforts.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, United States; The University of Utah, Salt Lake City, UT, United States
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