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Rogante E, Cifrodelli M, Sarubbi S, Costanza A, Erbuto D, Berardelli I, Pompili M. The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature. Healthcare (Basel) 2024; 12:169. [PMID: 38255058 PMCID: PMC10815449 DOI: 10.3390/healthcare12020169] [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: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.
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Affiliation(s)
- Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (E.R.); (S.S.)
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Psychiatry Unit, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (E.R.); (S.S.)
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1205 Geneva, Switzerland;
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.E.); (I.B.)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.E.); (I.B.)
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.E.); (I.B.)
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Lewin CDC, Leamy M, Palmer L. How do people conceptualize self-harm recovery and what helps in adolescence, young and middle adulthood? A qualitative meta-synthesis. J Clin Psychol 2024; 80:39-64. [PMID: 37610315 DOI: 10.1002/jclp.23588] [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: 11/11/2022] [Revised: 05/08/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Self-harm can be understood as any behavior individuals use to harm themselves, irrespective of motive. Evidence has extensively examined the epidemiology and function of self-harm to the individual, but less is known about the subjective processes underpinning recovery. Such insights could inform therapeutic interventions to better support individuals. The present aim was to synthesize qualitative themes from eligible literature to identify how adolescents, young adults, and those in middle adulthood conceptualize self-harm recovery and the factors impacting this process. METHODS Eleven studies were identified from a systematic search of five electronic research databases: PsycINFO, Embase, Medline, Global Health, and CINAHL. Studies were critically appraised using an adapted Critical Appraisal Skills Program tool for qualitative research. A meta-synthesis was conducted using reflexive thematic analysis to generate themes across the included studies. RESULTS Themes depicted recovery as a multidimensional, nonlinear, and subjective process, characterized by a "push and pull" between states of (re-)engagement and cessation/reduction. Transition between these states was influenced by intrapersonal and interpersonal factors which were embedded in a wider milieu of the meaning of self-harm to the individual. CONCLUSION Contemporary ideas of symptom eradication as the only marker of complete recovery may hinder individuals in the long-term, presenting an obstacle both to quality of life and therapeutic progress. Movement away from self-harm recovery as a uniform or singular phenomenon could enhance person-centered care.
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Affiliation(s)
- Caroline da Cunha Lewin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Laura Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Akbari M, Seydavi M, Firoozabadi MA, Babaeifard M. Distress tolerance and lifetime frequency of non-suicidal self-injury (NSSI): A systematic review and meta-analysis. Clin Psychol Psychother 2024; 31:e2957. [PMID: 38343352 DOI: 10.1002/cpp.2957] [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: 12/01/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
NSSI has recently been recognized as a significant health issue given its documented association with psychopathology and across a broad spectrum of psychiatric disorders. It has been found that individuals experiencing heightened emotions, which is referred to as an emotional cascade, are more likely to engage in self-injury behaviour due to low levels of distress tolerance (DT). The current meta-analysis using PRISMA guidelines sought to quantify the strength of the association between DT and lifetime frequency of NSSI using 22 eligible studies (N = 14,588; F = 60.7%; age = 23.35 ± 7.30), mainly from the United States. The correlation between emotional DT and NSSI was a small negative correlation (r = -.14), and it was non-significant for behavioural DT and NSSI (r = .02). Also, the effect-size was significant for studies that used interview-based measure of NSSI (r = -.24), and it was non-significant when self-report measures of NSSI (r = -.11) utilized. The association between DT and NSSI was significant and negative across the general population (r = -.47), university students (r = -.17), and inpatients (r = -.27); surprisingly, it was significant and positive among adolescents or high school students (r = .17). The observed effect-sizes were independent of publication year, mean age and its standard deviation, study quality, female proportion, DT, NSSI measures reliability, and clinical status. Future studies on NSSI should consider DT as a spectrum from distress intolerance to distress over-tolerance, given that it seems it has different functions when different samples (e.g., adolescents) are studied.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mahsa Akbarian Firoozabadi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Maryam Babaeifard
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
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Zhong J, Huang XJ, Wang XM, Xu MZ. The mediating effect of distress tolerance on the relationship between stressful life events and suicide risk in patients with major depressive disorder. BMC Psychiatry 2023; 23:118. [PMID: 36814223 PMCID: PMC9945729 DOI: 10.1186/s12888-023-04600-7] [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: 12/28/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Despite widespread acknowledgment of the impact of stressful life events on suicide risk, the understanding of the psychological mechanisms underlying the relationship between stressful life events and suicide risk in major depressive disorder (MDD) remain unclear. This study aim to examine whether the distress tolerance mediates the relationship between the stressful life events and suicide risk in patients with MDD. METHODS A cross-sectional study was carried out among 125 Chinese patients with MDD, mean age was 27.05 (SD=0.68) and 68.8% were females. The 17-item Hamilton Depression Rating scale (HAMD-17), the validated Chinese version of the Mini International Neuropsychiatric Interview (MINI) suicide module, Life Events Scale (LES) and Distress Tolerance Scale (DTS) were utilized to evaluate depressive symptoms, stressful life events, levels of distress tolerance, and suicide risk, respectively. Mediation analyses was used to test the mediation effect of distress tolerance on the relationship between stressful life events and suicide risk. RESULTS The ratio of suicide risk in patients with MDD was 75.2%. Pearson correlation analysis showed that stressful life events were positively correlated with suicide risk(r=0.182, p<0.05). Stressful life events(r=-0.323, p<0.01) and suicide risk(r=-0.354, p<0.01) were negatively correlated with distress tolerance. Mediation analyses showed that the direct path from stressful life events to suicide risk was not significant (B= 0.012, 95% confidence interval (CI) [-0.017, 0.042]). Stressful life events affected suicide risk indirectly through distress tolerance (B= 0.018, 95% CI [0.007, 0.031]), and the mediating effect accounted for 60.0% of the total effect. CONCLUSION Distress tolerance completely played a mediating role between stressful life events and suicide risk. Further suicide prevention and intervention strategies should focus on increasing levels of distress tolerance in patients with MDD.
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Affiliation(s)
- Jing Zhong
- grid.284723.80000 0000 8877 7471School of Public Health, Southern Medical University, Guangzhou, Guangdong People’s Republic of China ,grid.284723.80000 0000 8877 7471Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510120 Guangdong People’s Republic of China
| | - Xiao-Jie Huang
- grid.284723.80000 0000 8877 7471Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510120 Guangdong People’s Republic of China
| | - Xue-Mei Wang
- grid.411866.c0000 0000 8848 7685Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Ming-Zhi Xu
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, People's Republic of China. .,Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
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Hsu T, Thomas EBK, Welch EK, O'Hara MW, McCabe JE. Examining the Structure of Distress Tolerance: Are Behavioral and Self-Report Indicators Assessing the Same Construct? JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 27:143-151. [PMID: 36911144 PMCID: PMC9997101 DOI: 10.1016/j.jcbs.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Distress tolerance, or the ability to tolerate physically and emotionally aversive experiences, is a target of psychological intervention in contextual behavioral science. It has been conceptualized as a self-reported ability, as well as a behavioral tendency, and operationalized with a wide variability of questionnaires and behavioral tasks. The current study aimed to investigate whether behavioral tasks and self-report assessments of distress tolerance measure the same underlying dimension, two correlated dimensions, or whether method factors accounted for covariation above and beyond a general content dimension. A university student sample (N = 288) completed behavioral tasks associated with distress tolerance and self-report distress tolerance measures. Confirmatory factor analysis indicated that behavioral and self-report assessments of distress tolerance do not comprise a single dimension of distress tolerance, or two correlated dimensions of self-report or behavioral distress tolerance. Results also failed to support a bifactor conceptualization with a general distress tolerance dimension and domain-specific method dimensions for behavioral and self-report assessments. Findings suggest that more precision and attention to contextual factors are required in the operationalization and conceptualization of distress tolerance.
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Affiliation(s)
- Ti Hsu
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, U.S.A
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, U.S.A
| | - Emma K Welch
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, U.S.A
| | - Michael W O'Hara
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, U.S.A
| | - Jennifer E McCabe
- Department of Psychology, Western Washington University, Bellingham, WA, U.S.A
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Nagy LM, Shanahan ML, Seaford SP. Nonsuicidal self-injury and rumination: A meta-analysis. J Clin Psychol 2023; 79:7-27. [PMID: 35639994 PMCID: PMC10084048 DOI: 10.1002/jclp.23394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/06/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
Trait rumination is the tendency to overthink and focus on negative emotions and events and is related to a number of psychological disorders and maladaptive behaviors including nonsuicidal self-injury (NSSI). The purpose of this study was to conduct a meta-analysis of the relationship between trait rumination and NSSI behaviors. Results from 60 samples showed small effect sizes between trait rumination and NSSI engagement, NSSI frequency, and the number of methods used to self-injure in cross-sectional samples. Results from 13 samples showed small effect sizes between trait rumination and NSSI engagement and NSSI frequency in longitudinal samples. Moderator analyses indicated that this relationship is similar whether the type of rumination is depressive or not and is generally consistent across different ages, genders, and ethnicities. These results help clarify the role of trait rumination as a risk factor for NSSI.
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Affiliation(s)
- Laura M Nagy
- Department of Psychology, High Point University, High Point, North Carolina, USA
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Sara P Seaford
- Department of Psychology, High Point University, High Point, North Carolina, USA
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Kuehn KS, Dora J, Harned MS, Foster KT, Song F, Smith MR, King KM. A meta-analysis on the affect regulation function of real-time self-injurious thoughts and behaviours. Nat Hum Behav 2022; 6:964-974. [PMID: 35484208 PMCID: PMC9329197 DOI: 10.1038/s41562-022-01340-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Prominent theories suggest that self-injurious thoughts and behaviours are negatively reinforced by decreased negative affect. The present meta-analysis quantifies effects from intensive longitudinal studies measuring negative affect and self-injurious thoughts and behaviours. We obtained data from 38 of the 79 studies (48%, 22 unique datasets) involving N = 1,644 participants (80% female, 75% white). Individual-participant data meta-analyses revealed changes in affect pre/post self-injurious thoughts and behaviours. In antecedent models, results supported increased negative affect before nonsuicidal self-injurious behaviour (k = 14, 95% CI 0.09 to 0.31) and suicidal thoughts (k = 14, 95% CI 0.03 to 0.19). For consequence models, negative affect was reduced following nonsuicidal self-injurious thoughts (k = 6, 95% CI -0.79 to -0.44), nonsuicidal self-injurious behaviours (k = 14, 95% CI -0.73 to -0.19) and suicidal thoughts (k = 13, 95% CI -0.79 to -0.23). Findings, which were not moderated by sampling strategies or sample composition, support the affect regulation function of self-injurious thoughts and behaviours.
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Affiliation(s)
- Kevin S Kuehn
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Jonas Dora
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Melanie S Harned
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Frank Song
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele R Smith
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, WA, USA
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8
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Barrios L, Stamatovich SN, Simons RM, Simons JS. Reinforcement sensitivity and bulimia symptoms: the role of emotion regulation. Eat Weight Disord 2022; 27:1593-1602. [PMID: 34546555 DOI: 10.1007/s40519-021-01275-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Reinforcement Sensitivity Theory (RST) provides a theoretical foundation associated with various approach and avoidance behaviors and individual personality differences. Sensitivity to reward and punishment, two neural systems within the RST have been significantly associated with bingeing and purging behaviors. However, inconsistent findings are observed and specific factors mediating these relationships are not well understood. Deficits in emotion regulation may account for these relationships, as both negative urgency and distress tolerance have been independently associated with bulimia behaviors. Thus, this is an area that requires further investigation. METHOD The current study utilized various self-report inventories, including the Eating Disorder Inventory-3rd Edition to measure bulimia symptoms, as well as measures of negative affect, sensitivity to reward and punishment, distress tolerance, and negative urgency. These measures were used to assess whether distress tolerance and negative urgency mediated associations between sensitivity to reward and punishment and bulimia symptoms in a community sample of 394 young adults ranging from the ages of 18 to 25. RESULTS As expected, sensitivity to reward and punishment were significantly associated with decreased distress tolerance. Distress tolerance was also directly associated with greater negative urgency, which was significantly associated with increased bulimia symptoms. Consistent with hypotheses, indirect associations between sensitivity to reward and sensitivity to punishment to bulimia symptoms via distress tolerance and negative urgency were observed, controlling for gender and negative affect. DISCUSSION Results contribute to understanding specific contributions of risk factors within the relationship of sensitivity to reward and punishment and bulimia symptoms, measured by the EDI-3. Novel to existing literature, results indicate that reinforcement sensitivity significantly contributes to emotion regulation deficits. Thus, these findings may have important implications for understanding the development and treatment of bulimia symptoms. LEVEL OF EVIDENCE Level V, based on descriptive, cross-sectional data.
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Affiliation(s)
- Lindsey Barrios
- Department of Psychology, University of South Dakota, Vermillion, SD, USA.
| | | | - Raluca M Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
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Naifeh JA, Nock MK, Dempsey CL, Georg MW, Aliaga PA, Dinh HM, Fullerton CS, Mash HBH, Kao TC, Sampson NA, Wynn GH, Zaslavsky AM, Stein MB, Kessler RC, Ursano RJ. Association of emotion reactivity and distress intolerance with suicide attempts in U.S. Army soldiers. Suicide Life Threat Behav 2022; 52:289-302. [PMID: 34866228 PMCID: PMC10370465 DOI: 10.1111/sltb.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emotion reactivity (ER) and distress intolerance (DI) may be associated with increased suicide attempt (SA) risk among U.S. Army soldiers. METHOD In this case-control study, 74 soldiers recently hospitalized for SA (cases) were compared with 133 control soldiers from the same Army installations selected based on either propensity score matching (n = 103) or reported 12-month suicide ideation (SI) (n = 30). Controls were weighted to represent the total Army population at the study sites and the subpopulation of 12-month ideators. Participants completed questionnaires assessing ER, DI, and other psychosocial variables. Logistic regression analyses examined whether ER and DI differentiated SA cases from the general population and from 12-month ideators before and after controlling for additional important risk factors (sociodemographic characteristics, stressors, mental disorders). RESULTS In univariate analyses, ER differentiated SA cases from both the general population (OR = 2.5[95%CI = 1.7-3.6]) and soldiers with 12-month SI (OR = 2.5[95%CI = 1.3-4.6]). DI also differentiated cases from the general population (OR = 2.9[95%CI = 2.0-4.1]) and 12-month ideators (OR = 1.9[95%CI = 1.1-3.5]). These associations persisted after controlling for sociodemographic variables, stressors, and mental disorders. CONCLUSION Findings provide evidence that higher ER and DI are associated with increased risk of SA among soldiers, even after adjusting for known risk factors. Prospective research with larger samples is needed.
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Affiliation(s)
- James A Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Catherine L Dempsey
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Matthew W Georg
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Pablo A Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Hieu M Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Holly B Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Gary H Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, La Jolla, California, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Brausch AM, Clapham RB, Littlefield AK. Identifying Specific Emotion Regulation Deficits that Associate with Nonsuicidal Self-injury and Suicide Ideation in Adolescents. J Youth Adolesc 2022; 51:556-569. [PMID: 34686951 PMCID: PMC9554798 DOI: 10.1007/s10964-021-01525-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 01/04/2023]
Abstract
It is not known how emotion regulation deficits and strategies may differentially relate to nonsuicidal self-injury (NSSI) and suicide ideation in samples of community-based adolescents. The current study examined emotion regulation using comprehensive multi-method assessment to identify which specific deficits are uniquely related to NSSI and suicide ideation in a sample of high school students. Regarding specific deficits, it was expected that lack of emotional awareness, lack of access to emotion regulation strategies, poor cognitive reappraisal, and poorer automatic emotion processing would uniquely associate with past-year NSSI engagement. It was also predicted that lack of access to strategies, lack of impulse control, lack of awareness, and nonacceptance of emotion would uniquely associate with past-year presence of suicide ideation and suicide ideation severity. The sample included 696 adolescents (54.8% female; ages 14-17; mean age = 15.5) recruited from public high schools. Self-report measures were administered assessing suicide ideation, NSSI engagement, dimensions of emotion regulation, and automatic emotion processing (Emotion Stroop). Emotion suppression was the only unique and significant predictor of past-year NSSI engagement, and lack of access to emotion regulation strategies was the strongest predictor of both past-year presence of suicide ideation and recent suicide ideation severity when accounting for all deficits in the same model. Acquiring emotion regulation skills during the period of adolescence has great potential to buffer from occurrence of NSSI and severity of suicide ideation.
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Affiliation(s)
- Amy M. Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY, USA
| | - Rebekah B. Clapham
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY, USA
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11
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Angelakis I, Gooding P. Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis. Suicide Life Threat Behav 2021; 51:978-992. [PMID: 34184775 DOI: 10.1111/sltb.12784] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations. METHOD Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I2 statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations. RESULTS Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong. DISCUSSION The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.
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Affiliation(s)
- Ioannis Angelakis
- School of Psychology, University of South Wales, Pontypridd, Wales, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, Faculty of Biological, School of Health Sciences, Medical and Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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Abstract
Suicide and non-suicidal self-injury (NSSI) are prevalent in emerging adulthood and one possible commonality is emotion regulation deficits. Participants (N = 708) completed multiple self-report measures that assessed emotion regulation deficits, depression, past-year NSSI frequency, past-year suicide attempts, and recent suicide ideation severity. Controlling for depression, linear regression analyses found that the only significant association was between greater deficits in emotion regulation strategies and greater recent NSSI frequency and suicide ideation intensity. These results suggest some commonality in emotion regulation deficits across NSSI and suicide ideation. Prevention and intervention efforts should teach emotion regulation strategies to lower self-harm risk.
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Affiliation(s)
- Rebekah Clapham
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, USA
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, USA
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13
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Kyron MJ, Hooke GR, Page AC. Prediction and network modelling of self-harm through daily self-report and history of self-injury. Psychol Med 2021; 51:1992-2002. [PMID: 32264978 DOI: 10.1017/s0033291720000744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Self-harm is a significant public health issue, and both our understanding and ability to predict adverse outcomes are currently inadequate. The current study explores how preventative efforts could be aided through short-term prediction and modelling of risk factors for self-harm. METHODS Patients (72% female, Mage = 40.3 years) within an inpatient psychiatric facility self-reported their psychological distress, interpersonal circumstances, and wish to live and die on a daily basis during 3690 unique admissions. Hierarchical logistic regressions assessed whether daily changes in self-report and history of self-harm could predict self-harm, with machine learning used to train and test the model. To assess interrelationships between predictors, network and cross-lagged panel models were performed. RESULTS Increases in a wish to die (β = 1.34) and psychological distress (β = 1.07) on a daily basis were associated with increased rates of self-harm, while a wish to die on the day prior [odds ratio (OR) 3.02] and a history of self-harm (OR 3.02) was also associated with self-harm. The model detected 77.7% of self-harm incidents (positive predictive value = 26.6%, specificity = 79.1%). Psychological distress, wish to live and die, and interpersonal factors were reciprocally related over the prior day. CONCLUSIONS Short-term fluctuations in self-reported mental health may provide an indication of when an individual is at-risk of self-harm. Routine monitoring may provide useful feedback to clinical staff to reduce risk of self-harm. Modifiable risk factors identified in the current study may be targeted during interventions to minimise risk of self-harm.
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Affiliation(s)
- Michael J Kyron
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Geoff R Hooke
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
- Perth Clinic, West Perth, WA, Australia
| | - Andrew C Page
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
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14
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Raudales AM, Darosh AG, Contractor AA, Schatten HT, Dixon-Gordon KL, Weiss NH. Positive Emotion Dysregulation Identifies Trauma-Exposed Community Individuals at Risk for Suicide and Nonsuicidal Self-Injury. J Nerv Ment Dis 2021; 209:434-442. [PMID: 33660688 PMCID: PMC8159867 DOI: 10.1097/nmd.0000000000001316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Emotion dysregulation is associated with increased risk for suicidal thoughts and behaviors (STBs) and nonsuicidal self-injury (NSSI). However, research in this area has focused almost exclusively on dysregulation stemming from negative emotions. The present study aimed to address this gap in the literature by examining the associations between the specific domains of positive emotion dysregulation and both STBs and NSSI. Participants included 397 trauma-exposed community adults (Mage = 35.95; 57.7% female; 76.8% White). Results demonstrated significant associations between positive emotion dysregulation and both STBs and NSSI. In particular, higher levels of nonacceptance of positive emotions were found to be significantly related to risk for STBs (versus no risk), higher severity of STBs, and history of NSSI (versus no history). Findings suggest positive emotion dysregulation may play an important role in the etiology and treatment of both STBs and NSSI among trauma-exposed individuals.
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Affiliation(s)
| | | | | | - Heather T. Schatten
- Butler Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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15
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Interian A, Chesin M, Kline A, St. Hill L, King A, Miller R, Latorre M, Gara M, Stanley B. Coping with Suicidal Urges: An Important Factor for Suicide Risk Assessment and Intervention. Arch Suicide Res 2021; 25:224-237. [PMID: 31640477 PMCID: PMC11070950 DOI: 10.1080/13811118.2019.1678538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Suicide-related coping refers to strategies for adaptively managing suicidal urges and can be important an important factor for assessing risk and targeting intervention. The current study evaluated whether suicide-related coping predicted a suicidal event within 90-days, independently of other known risk factors. Veterans (N = 64) were evaluated shortly after a suicidal crisis and completed several assessments, including a measure of suicide-related coping. Multivariate analyses showed that suicide-related coping remained protective of a suicidal event (OR = 0.93; p = .047) after adjusting for suicidal ideation, previous suicide attempts, mood disorder, distress tolerance, and gender. Suicide-related coping may augment commonly assessed clinical factors in prediction of a suicidal event and is a suitable target for suicide prevention efforts.
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Affiliation(s)
- Alejandro Interian
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, New Jersey
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers—The State University of New Jersey, Piscataway, New Jersey
| | - Megan Chesin
- Department of Psychology, William Paterson University, Wayne, New Jersey
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers—The State University of New Jersey, Piscataway, New Jersey
| | - Lauren St. Hill
- War Related Illness and Injury Study Center, VA New Jersey Healthcare System, East Orange, New Jersey
| | - Arlene King
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, New Jersey
| | - Rachael Miller
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, New Jersey
| | - Miriam Latorre
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, New Jersey
| | - Michael Gara
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers—The State University of New Jersey, Piscataway, New Jersey
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, New York
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16
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Nagy LM, Shanahan ML, Baer RA. An experimental investigation of the effects of self-criticism and self-compassion on implicit associations with non-suicidal self-injury. Behav Res Ther 2021; 139:103819. [PMID: 33640591 DOI: 10.1016/j.brat.2021.103819] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. Individuals who self-injure often report doing so in order to punish the self or express self-hatred. Self-criticism, or thoughts marked by shame, self-consciousness, and inferiority, is associated with higher rates of NSSI while self-compassion, or the tendency to be sympathetic and caring with oneself, is negatively associated with NSSI. The aim of the present study was to determine whether experimentally-induced self-criticism would increase and self-compassion would decrease implicit identification with NSSI. Participants were randomly assigned to either a self-criticism induction, a self-compassion induction, or a neutral, control condition and completed a measure of strength of the automatic associations that a person holds between themselves and self-harming behaviors before and after the experimental induction. Study hypotheses were partially supported. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion condition did not significantly change. These results highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.
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Affiliation(s)
- Laura M Nagy
- Department of Psychology, University of Kentucky, United States.
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University, Purdue University Indianapolis, United States
| | - Ruth A Baer
- Department of Psychology, University of Kentucky, United States
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17
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Strauss JL, Miller LJ, Strickland S. Applying Research to Advance Suicide Prevention in Women Veterans. Med Care 2021; 59:S6-S8. [PMID: 33438875 DOI: 10.1097/mlr.0000000000001434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jennifer L Strauss
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Laura J Miller
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC
- Loyola University Stritch School of Medicine, Maywood, IL
| | - Susan Strickland
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC
- University of Georgia School of Social Work, Athens, GA
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18
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Hovrud L, Simons R, Simons J, Korkow J. Non-suicidal self-injury and bulimia: the role of emotion dysregulation and body dissatisfaction. Eat Weight Disord 2020; 25:1089-1097. [PMID: 31292855 PMCID: PMC7399667 DOI: 10.1007/s40519-019-00741-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/01/2019] [Accepted: 06/22/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Risk factors of negative affect, body dissatisfaction, distress tolerance, and negative urgency are independently associated with bulimia symptoms and non-suicidal self-injury (NSSI). However, relationships of these risk factors within comorbid presentations are not fully understood. The current study examined specific roles of these risk factors within this relationship. METHODS An at-risk community sample of young adults (N = 429) completed an online survey of negative affect, body dissatisfaction, distress tolerance, negative urgency, bulimia symptoms, and NSSI. RESULTS A hypothesized path model was a good fit to the data. Results indicated direct paths from body dissatisfaction, negative urgency, and distress tolerance to bulimia symptoms. Negative urgency, distress tolerance, and bulimia symptoms were directly associated with NSSI. Consistent with hypotheses, distress tolerance and negative urgency acted as vulnerability factors, increasing the strength of associations between bulimia symptoms and NSSI. Distress tolerance also strengthened associations between negative urgency and NSSI. In addition to the direct effect, negative urgency was indirectly associated with NSSI via body dissatisfaction bulimia. Hypothesized indirect effects through distress tolerance were not supported. CONCLUSIONS Results support etiological models of bulimia and NSSI, and suggest deficits in emotion regulation strengthen risk of comorbid presentations. Furthermore, individuals with greater impulsivity and difficulty tolerating distress are at increased risk of engaging in both bulimia behaviors and NSSI, providing targets for clinical intervention. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Lindsey Hovrud
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA.
| | - Raluca Simons
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA
| | - Jeffrey Simons
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA
| | - John Korkow
- University of South Dakota, 414 E Clark St, South Dakota Union Building, Vermillion, SD, 57069, USA
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19
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Lass ANS, Winer ES, Collins AC, Rokke PD. The Associations among Distress Tolerance, Unhelpful Coping Behaviors, and Symptoms of Depression: A Network Analysis. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10131-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Lass ANS, Winer ES. Distress tolerance and symptoms of depression: A review and integration of literatures. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alisson N. S. Lass
- Department of Psychology Mississippi State University Starkville Mississippi
| | - E. Samuel Winer
- Department of Psychology Mississippi State University Starkville Mississippi
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21
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Rugo KF, Tabares JV, Crowell SE, Baucom BR, Rudd MD, Bryan CJ. The role of depression and suicidal cognitions as contributors to suicide risk among active duty soldiers reporting symptoms of posttraumatic stress disorder. J Affect Disord 2020; 265:333-341. [PMID: 32090757 DOI: 10.1016/j.jad.2020.01.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/12/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military suicide rates have risen across all service branches, with the overall rate surpassing that of the general population for the first time in history in 2008. Service members with posttraumatic stress disorder (PTSD) are at a substantially higher risk for suicidal ideation, suicide attempts, and death by suicide than their peers without PTSD. While the link between PTSD and suicide is well established in the literature, less is known about the precise nature of that connection. Several constructs have been implicated as potential mediators of this relation, such as depression, alcohol use, suicidal cognitions, and sleep disturbance. Yet, to our knowledge, these constructs have never been examined simultaneously in a single model to determine mediational influence for suicide risk among soldiers with PTSD. METHODS A sample of 172 active duty Army soldiers completed a series of measures targeting the aforementioned constructs. Data were analyzed using mediation model analyses. RESULTS Suicidal cognitions fully mediated the relation between PTSD symptoms and current suicide risk severity. The indirect effect for suicidal cognitions was significantly larger than indirect effects for alcohol use, depression, and sleep disturbance. Exploratory analyses suggest serial mediation of the relation between PTSD and current suicide risk by depression and suicidal cognitions. LIMITATIONS These results should be interpreted within the context of study limitations, to include use of self-report data and inability to firmly establish temporal sequencing assumed in mediation. CONCLUSIONS Implications of this study include the improvement of suicide risk assessment and individualized treatment planning for suicidal military personnel with PTSD.
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Affiliation(s)
- Kelsi F Rugo
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
| | - Jeffrey V Tabares
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Brian R Baucom
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - M David Rudd
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
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22
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Pain perception, distress tolerance and self-compassion in Turkish young adults with and without a history of non-suicidal self-injury. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00634-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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23
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Rogers ML, Hom MA, Dougherty SP, Gallyer AJ, Joiner TE. Comparing Suicide Risk Factors Among Individuals with a History of Aborted, Interrupted, and Actual Suicide Attempts. Arch Suicide Res 2020; 24:57-74. [PMID: 30303461 DOI: 10.1080/13811118.2018.1522283] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recent standardized nomenclature has suggested distinctions among aborted, interrupted, and actual suicide attempts. This study examined differences in self-reported symptoms among individuals with a history of aborted, interrupted, and actual suicide attempts. 167 young adults with a history of suicidality completed self-report measures of suicide attempt history and current symptoms, a clinical interview assessing past suicidal behavior, and a pain tolerance task. Only 78.8% of participants who initially reported a suicide attempt history were classified as suicide attempters following the clinical interview. Individuals who reported only aborted attempts during the clinical interview reported less severe clinical symptoms than those reporting a history of at least one actual attempt. Individuals with a history of actual suicide attempts may represent a more clinically severe group than those with a history of aborted attempts only.
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24
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Bounoua N, Hayes JP, Sadeh N. Identifying Suicide Typologies Among Trauma-Exposed Veterans. CRISIS 2019; 41:288-295. [PMID: 31859563 DOI: 10.1027/0227-5910/a000637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Suicide among veterans has increased in recent years, making the identification of those at greatest risk for self-injurious behavior a high research priority. Aims: We investigated whether affective impulsivity and risky behaviors distinguished typologies of self-injurious thoughts and behaviors in a sample of trauma-exposed veterans. Method: A total of 95 trauma-exposed veterans (ages 21-55; 87% men) completed self-report measures of self-injurious thoughts and behaviors, impulsivity, and clinical symptoms. Results: A latent profile analysis produced three classes that differed in suicidal ideation, suicide attempts and nonsuicidal self-injury (NSSI): A low class that reported little to no self-injurious thoughts or behaviors; a self-injurious thoughts (ST) class that endorsed high levels of ideation but no self-harm behaviors; and a self-injurious thoughts and behaviors (STaB) class that reported ideation, suicide attempts and NSSI. Membership in the STaB class was associated with greater affective impulsivity, disinhibition, and distress/arousal than the other two classes. Limitations: Limitations include an overrepresentation of males in our sample, the cross-sectional nature of the data, and reliance on self-report measures. Conclusion: Findings point to affective impulsivity and risky behaviors as important characteristics of veterans who engage in self-injurious behaviors.
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Affiliation(s)
- Nadia Bounoua
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Jasmeet P Hayes
- Department of Psychology, National Center for PTSD at VA Boston Healthcare System, The Ohio State University, Columbus, OH, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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25
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Martin RL, Bauer BW, Ramsey KL, Green BA, Capron DW, Anestis MD. How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample. Suicide Life Threat Behav 2019; 49:1318-1331. [PMID: 30368865 DOI: 10.1111/sltb.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the general suicide rate within the military being comparable to the general population when comparing peers, there are certain branches of the military that have elevated risk. Specifically, the U.S. National Guard has suicide rates that are constantly higher than other military branches and civilian peers. The National Guard are a unique military population in which they frequently transition between military and civilian life. With these unique experiences and heightened risk, military suicide prevention efforts may benefit from further research within this population. Posttraumatic stress disorder (PTSD) is another concern amongst military personnel and has been linked to suicidal behavior. METHODS The current study examined the indirect effects that distress tolerance, a protective factor against suicide, has on the relationship between PTSD and constructs within a well-validated theory for suicide (the Interpersonal-Psychological Theory for suicidal behaviors) in a sample of U.S. Army National Guard personnel. RESULTS Results indicated that distress tolerance had a significant indirect effect on the relationship between PTSD and thwarted belongingness, perceived burdensomeness, and capability for suicide. CONCLUSIONS These findings are consistent with previous literature examining the relationship between distress tolerance and our outcome variables. These results could have important clinical implications, mainly that intervention strategies targeting distress tolerance could have significant impacts on suicide-relate thoughts.
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Affiliation(s)
- Rachel L Martin
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kathleen L Ramsey
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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26
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Eaddy M, Zullo L, Horton SE, Hughes JL, Kennard B, Diederich A, Emslie GJ, Schuster L, Stewart SM. A Theory-Driven Investigation of the Association Between Emotion Dysregulation and Suicide Risk in a Clinical Adolescent Sample. Suicide Life Threat Behav 2019; 49:928-940. [PMID: 29745436 DOI: 10.1111/sltb.12472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Emotion dysregulation has been consistently linked to suicide ideation and attempt, but an explanatory model for this relationship has not been adequately investigated in adolescents. This study examined the concurrent relationship among emotion dysregulation, variables from the Interpersonal-Psychological Theory of Suicide (IPTS), and suicide risk (operationalized as a continuous variable that increases in intensity from nonspecific to active suicide ideation to suicide ideation with a plan) in a clinical adolescent sample. METHOD A total of 151 adolescents (aged 12-17) were recruited from an inpatient psychiatry unit. Cross-sectional analyses were conducted to determine whether the relationship between emotion dysregulation and suicide risk was explained by the variables of perceived burdensomeness (PB), thwarted belongingness, and capability for suicide, as proposed by the IPTS. RESULTS As hypothesized, the relationship between emotion dysregulation and suicide risk was explained by PB and capability for suicide. Depressive symptoms had an independent relationship with suicide risk after controlling for IPTS variables. CONCLUSIONS The results from this study suggest that effective treatment strategies that reduce negative cognition tied to PB and depressive symptoms would address the most proximal variables related to suicide risk in adolescents. Enhancing emotion management would serve to maintain low levels of proximal influences on risk.
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Affiliation(s)
- Michael Eaddy
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Lucas Zullo
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Sarah E Horton
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | | | - Betsy Kennard
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Andrew Diederich
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Graham J Emslie
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Lisa Schuster
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Sunita M Stewart
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
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27
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Worden B, Levy HC, Das A, Katz BW, Stevens M, Tolin DF. Perceived emotion regulation and emotional distress tolerance in patients with hoarding disorder. J Obsessive Compuls Relat Disord 2019; 22:100441. [PMID: 32818134 PMCID: PMC7430655 DOI: 10.1016/j.jocrd.2019.100441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emotional distress tolerance (EDT) and emotion regulation (ER) appear to be highly relevant to hoarding pathology, as excessive saving and/or acquiring may be motivated by emotional avoidance or other attempts to regulate negative affect. While findings with nonclinical samples have suggested and EDT/ER predicts hoarding symptoms, there is little data on clinical samples. The aim of the current study was to examine several self-report measures of EDT and ER in individuals with HD (n = 87) and age-matched nonclinical controls (n = 46), and to explore whether this was predictive of treatment compliance and/or outcome in group CBT for HD. Results suggested that, the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) total score, DERS goals and awareness subscales, and Intolerance of Uncertainty Scale (IUS; Buhr & Dugas, 2002) were predictive of hoarding severity. However, EDT/ER did not change with treatment, did not mediate treatment outcome, and did not predicted treatment retention, compliance, or outcome. Results suggest that some EDT/ER constructs, such as uncertainty intolerance, difficulty persisting in goal behaviors when upset, and low emotional awareness, may explain significant variance in HD symptoms, although they did not appear to be mechanisms of change in CBT for HD.
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Affiliation(s)
| | | | | | | | - Michael Stevens
- Institute of Living, Hartford, CT
- Yale University School of Medicine
| | - David F. Tolin
- Institute of Living, Hartford, CT
- Yale University School of Medicine
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28
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Brausch AM, Woods SE. Emotion Regulation Deficits and Nonsuicidal Self-Injury Prospectively Predict Suicide Ideation in Adolescents. Suicide Life Threat Behav 2019; 49:868-880. [PMID: 29900570 PMCID: PMC6294703 DOI: 10.1111/sltb.12478] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between emotion regulation deficits and nonsuicidal self-injury (NSSI) is well established. Many studies have documented the strong relationship between NSSI and suicidal thoughts and behaviors. The relationship between emotion regulation deficits and suicide is less understood, but recent studies indicate a moderate association. This study aimed to examine the relationship between emotion regulation deficits, NSSI behavior, and suicide ideation in an unselected community sample of adolescents. It was expected that NSSI history would moderate the relationship between emotion regulation and future suicide ideation. METHODS Data were collected from 367 unselected, community adolescents (mean age = 13). Self-report questionnaires assessed NSSI behavior, emotion regulation deficits, and suicide ideation at two time points, 6 months apart. RESULTS After controlling for suicide ideation at baseline, emotion regulation deficits (experiential avoidance and interoceptive deficits) significantly predicted suicide ideation severity at follow-up, and interactions with NSSI engagement showed support for moderation. CONCLUSIONS Results of this study provide insight into the mechanisms of these relationships and have significant clinical implications for the identification of adolescents at risk for suicide behaviors.
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Affiliation(s)
- Amy M. Brausch
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd., Bowling Green, KY, 42101
| | - Sherry E. Woods
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd., Bowling Green, KY, 42101,Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 441 Tobin Hall, Amherst, MA, 01003
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29
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Doorley JD, Kashdan TB, Alexander LA, Blalock DV, McKnight PE. Distress tolerance in romantic relationships: A daily diary exploration with methodological considerations. MOTIVATION AND EMOTION 2019. [DOI: 10.1007/s11031-019-09751-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Impulse control difficulties while distressed: A facet of emotion dysregulation links to Non-Suicidal Self-Injury among psychiatric inpatients at military treatment facilities. Psychiatry Res 2018; 269:419-424. [PMID: 30195229 DOI: 10.1016/j.psychres.2018.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 01/22/2023]
Abstract
Links between emotion dysregulation, suicide ideation, and suicidal versus non-suicidal self-injury (NSSI) are poorly understood within military samples. United States service members and beneficiaries (N = 186), psychiatrically hospitalized following a suicidal crisis, completed the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and reported lifetime suicide ideation, attempts, and NSSI. We expected that emotion dysregulation would positively associate with worst lifetime suicide ideation, multiple suicide attempt status, and lifetime NSSI. Suicide ideation severity and multiple suicide attempts did not associate with DERS components. Notably, difficulties with impulse control (feeling out of control while distressed) was positively associated with NSSI history. Theoretical models that clearly describe the role of emotion dysregulation in suicidal thoughts, its progression to suicidal actions, and NSSI are needed to advance clinical care for this highly vulnerable group. Longitudinal and micro-longitudinal study designs require further investigation.
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Affiliation(s)
- Margaret M Baer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Joy C Browne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Helena O Hassen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, MD, USA
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA.
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Slabbert A, Hasking P, Boyes M. Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury. Psychiatry Res 2018; 269:309-315. [PMID: 30172188 DOI: 10.1016/j.psychres.2018.08.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
Non-Suicidal Self-Injury (NSSI) is the deliberate damage to one's bodily tissue without suicidal intent. The Emotional Cascade Model proposes NSSI functions as a distraction from 'cascades' of intense affect and rumination. Low distress tolerance is one factor thought to potentially amplify these cascades but has yet to be empirically tested. Using the Emotional Cascade Model as a framework, we investigated the moderating roles of rumination and distress tolerance in the relationship between affect intensity and NSSI. A sample of 400 university students between the ages of 17 and 62 years (M = 21.02, SD = 5.32) completed well-validated measures of NSSI, affect intensity, rumination, and distress tolerance. As expected, rumination was associated with history of NSSI but only among individuals who reported high levels of distress tolerance. Further, affect intensity was positively associated with NSSI frequency, but only at low levels of rumination and distress tolerance. These results provide promising insight into potential prevention and intervention initiatives that may target rumination and distress tolerance to reduce the likelihood and frequency of self-injury.
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Affiliation(s)
- A Slabbert
- School of Psychology, Curtin University, Perth, Australia
| | - P Hasking
- School of Psychology, Curtin University, Perth, Australia.
| | - M Boyes
- School of Psychology, Curtin University, Perth, Australia
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Lin MP, You J, Wu YW, Jiang Y. Depression Mediates the Relationship Between Distress Tolerance and Nonsuicidal Self-Injury Among Adolescents: One-Year Follow-Up. Suicide Life Threat Behav 2018; 48:589-600. [PMID: 28833395 DOI: 10.1111/sltb.12382] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Abstract
Through a one-year follow-up design, this study examined whether distress tolerance would increase the risk for nonsuicidal self-injury (NSSI), mediated through depression in a representative sample of adolescents. Participants (N = 2,170) were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1,832 students were followed-up one year later (T2). Structure equation modeling results revealed that after controlling NSSI measured at T1, NSSI (T2) was significantly predicted by distress tolerance (T1) and fully mediated through depression (T2). The mediating role of depression in the relationship between distress tolerance and NSSI are discussed.
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Affiliation(s)
- Min-Pei Lin
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan
| | - Jianing You
- Center for Studies of Psychological Application and School of Psychology, South China Normal University, Guangzhou, Guangdong, China
| | - Yung Wei Wu
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yongqiang Jiang
- Center for Studies of Psychological Application and School of Psychology, South China Normal University, Guangzhou, Guangdong, China
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Kang N, Jiang Y, Ren Y, Gong T, Liu X, Leung F, You J. Distress Intolerance Mediates the Relationship between Child Maltreatment and Nonsuicidal Self-Injury among Chinese Adolescents: A Three-Wave Longitudinal Study. J Youth Adolesc 2018; 47:2220-2230. [PMID: 29942987 DOI: 10.1007/s10964-018-0877-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/26/2018] [Indexed: 10/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. Identifying risk factors of NSSI is important to effectively prevent or reduce such behavior. Child maltreatment is one of the most widely recognized risk factors for NSSI. How child maltreatment and NSSI is related, however, is still unclear. The present study tested the temporal relationship between physical and emotional abuse and NSSI, with distress intolerance as the potential mediator. Potential gender differences on these associations were also tested. We assessed all study variables among 2259 Chinese adolescents (53.8% females; Mage = 15.11 years, SD = 1.57) for three times at 6-month intervals. The results showed that distress intolerance only mediated the relationship between emotional abuse and NSSI, but not between physical abuse and NSSI. In addition, this mediation effect of distress intolerance was significant only for females. The findings of this study can help researchers and practitioners understand pathways by which child maltreatment impacts adolescent NSSI. Implications for preventions and interventions of NSSI were discussed.
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Affiliation(s)
- Nan Kang
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China
| | - Yongqiang Jiang
- School of Psychology, Beijing Normal University, 100875, Beijing, People's Republic of China
| | - Yaxuan Ren
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China
| | - Tieying Gong
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China
| | - Xiaoliu Liu
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Freedom Leung
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Jianing You
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, 510631, Guangzhou, People's Republic of China.
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Speed KJ, Drapeau CW, Nadorff MR. Differentiating Single and Multiple Suicide Attempters: What Nightmares Can Tell Us That Other Predictors Cannot. J Clin Sleep Med 2018; 14:829-834. [PMID: 29734974 DOI: 10.5664/jcsm.7116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 02/09/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although nightmares have been associated with suicidal behavior beyond well-known risk factors, the association between nightmares and multiple suicide attempts remains largely unexplored. This study addressed this gap in the literature by examining whether nightmares differentiated between individuals who reported single versus multiple suicide attempts. The individual contributions of nightmare frequency, distress/severity, and chronicity were also investigated to determine which variable contributed the most variance. METHODS Participants (n = 225) were recruited as part of a larger data collection through Amazon Mechanical Turk, an online crowdsourcing venue. Participants reported attempting suicide once (n = 107 individuals), multiple times (n = 118), or never (n = 791). Nightmare frequency, distress, and chronicity were assessed with the Disturbing Dreams and Nightmares Severity Index. RESULTS Nightmare frequency differentiated multiple from single suicide attempters, even after controlling for symptoms of depression, posttraumatic stress disorder, insomnia, nightmare severity/distress, nightmare chronicity, and age (P = .019). Comparison participants, those not reporting suicide attempts, reported a significantly lower level of nightmare frequency than those reporting single or multiple suicide attempts. CONCLUSIONS Inconsistent with past research, this study showed that nightmare frequency, and not nightmare chronicity or severity/distress, differentiated between single and multiple suicide attempters. This outcome suggests that the number of nightmares experienced may be more pertinent in predicting repeat suicide attempts than their duration or perceived severity. Study limitations include a cross-sectional design, a convenience sampling approach, a lack of control for previous treatment or length of time since last attempt, and a retrospective nightmare measure.
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Affiliation(s)
| | - Christopher W Drapeau
- Mississippi State University, Starkville, Mississippi.,Valparaiso University, Valparaiso, Indiana
| | - Michael R Nadorff
- Mississippi State University, Starkville, Mississippi.,Baylor College of Medicine, Houston, Texas
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Abstract
PURPOSE OF REVIEW The definition of psychological pain is complex. It is a lasting unpleasant and unsustainable feeling characterized by a perception of inability or deficiency of the self, as well as frustrated psychological needs and social disconnection. The aim of our review was to summarize the most recent and updated findings supporting the role of psychological pain in the pathophysiology of depression and suicidal behavior. We also explored the relationship between psychological and physical pain in depression and suicide. RECENT FINDINGS Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. Conversely, higher tolerance to physical pain is associated with suicidal behavior. A better understanding of the pathophysiology of pain processing in depression and suicide offers new therapeutic options for the treatment of depression through the use of analgesic drugs.
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Xie W, Li H, Zou Y, Sun X, Shi C. A suicidal mind tends to maintain less negative information in visual working memory. Psychiatry Res 2018; 262:549-557. [PMID: 28967442 DOI: 10.1016/j.psychres.2017.09.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/20/2017] [Accepted: 09/17/2017] [Indexed: 12/17/2022]
Abstract
The motivation to avoid psychological pain may characterize a suicidal mindset. This study examines how this motivational manifestation of suicidal ideation modulates the maintenance of affective information in visual working memory (WM). Forty-five outpatients with major depressive disorder (MDD) and twenty-five healthy participants performed visual WM change localization tasks with emotional (e.g., positive or negative schematic facial expressions) and non-emotional (e.g., colors) stimuli. The number of items that participants retained in WM (i.e., capacity) for each of those stimuli was measured. Based on the Beck Scale for Suicide Ideation, MDD patients were categorized into high and low suicidal ideation groups. These two groups had comparable depression levels. In addition to showing a smaller overall WM capacity for emotionally neutral information (colors), MDD patients with high suicidal ideation retained fewer negative schematic facial stimuli in WM. This disproportional reduction in the amount of negative information held in visual WM was correlated with levels of suicidal ideation and psychological pain across participants. Together, these results reveal the impact of pain avoidance motivation on information processing in WM and provide a novel perspective to understand aberrant cognitive patterns that are potentially driven by maladaptive affective processing in individuals with higher suicide risk.
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Affiliation(s)
- Weizhen Xie
- Department of Psychology, University of California, Riverside, CA, USA; Department of Psychology, Renmin University of China, Beijing, China.
| | - Huanhuan Li
- Department of Psychology, Renmin University of China, Beijing, China.
| | - Yingmin Zou
- Department of Psychology, Renmin University of China, Beijing, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Xuemei Sun
- Department of Psychology, Renmin University of China, Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Beijing, China
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Rogers ML, Joiner TE. Suicide-Specific Rumination Relates to lifetime suicide attempts above and beyond a variety of other suicide risk factors. J Psychiatr Res 2018; 98:78-86. [PMID: 29304348 DOI: 10.1016/j.jpsychires.2017.12.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
Suicide-specific rumination, defined as a mental fixation on one's suicidal thoughts, intentions, and plans, may be an important predictor of suicidal behavior. To date, suicide-specific rumination has demonstrated convergence with, yet distinction from, a variety of suicide risk factors, and differentiated suicide attempters from ideators. However, no research has examined whether suicide-specific rumination is associated with lifetime suicide attempts above and beyond the presence of a host of other relevant suicide risk factors. The present study tested this hypothesis in samples of students (N = 300) and community members recruited via Amazon's MTurk (N = 209) who reported a lifetime history of suicidal ideation. Results indicated that suicide-specific rumination was associated with the presence of a lifetime suicide attempt, above and beyond a variety of other commonly-cited risk factors for suicidal thoughts and behaviors in both samples, including suicidal ideation, general rumination, interpersonal theory variables, emotion-relevant factors (dysregulation, experiential avoidance, distress tolerance, negative affect), symptoms of depression and anxiety, and overarousal. Overall, though limited by the use of non-clinical samples and a cross-sectional study design, that suicide-specific rumination outperformed all other suicide risk factors in predicting the presence of a lifetime suicide attempt suggests the potential potency of this relatively understudied risk factor in understanding transitions to suicidal behavior.
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38
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Heffer T, Willoughby T. The role of emotion dysregulation: A longitudinal investigation of the interpersonal theory of suicide. Psychiatry Res 2018; 260:379-383. [PMID: 29247924 DOI: 10.1016/j.psychres.2017.11.075] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/12/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
Emotion dysregulation is considered to be transdiagnostic in nature, given its association with a variety of problem behaviors. Of concern, emotion dysregulation also may be associated with key components of the Interpersonal Theory of Suicide (ITS), namely suicidal desire and acquired capability for suicide (ACS; heightened fearlessness toward death and pain tolerance). ITS suggests that experiencing suicidal desire in conjunction with ACS leads to greater risk for suicide attempts. The present 4-wave longitudinal study tested bidirectional associations among emotion dysregulation, NSSI, ACS, and suicidal desire. Emotion dysregulation was associated with both desire and capability for suicide over time. Specifically, emotion dysregulation was associated with (1) higher levels of suicidal desire, (2) higher levels of NSSI, which in turn predicted higher ACS, and (3) lower ACS, suggesting that individuals with emotion dysregulation may find thoughts of death and pain more aversive. Thus, there are two separate paths for how emotion regulation leads to ACS, one path in which emotion dysregulation indirectly leads to ACS through NSSI, and one path in which emotion dysregulation protects against the development of ACS (note that higher levels of ACS alone are not sufficient to lead to a suicide attempt - suicidal desire also is required).
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Affiliation(s)
- Taylor Heffer
- Department of Psychology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, Canada L2S 3A1.
| | - Teena Willoughby
- Department of Psychology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, Canada L2S 3A1
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Posttraumatic Stress and Suicidality Among Firefighters: The Moderating Role of Distress Tolerance. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9892-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Ammerman BA, Olino TM, Coccaro EF, McCloskey MS. Predicting Nonsuicidal Self-Injury in Borderline Personality Disorder Using Ecological Momentary Assessment. J Pers Disord 2017; 31:844-855. [PMID: 28072044 DOI: 10.1521/pedi_2017_31_278] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is a highly comorbid disorder, and these comorbidities increase the impairment associated with BPD. For example, depression, which occurs in the majority of individuals with BPD, increases the likelihood of an individual with BPD to engage in nonsuicidal self-injury (NSSI). Little research, however, has investigated potential mechanisms of NSSI engagement in this population. The current study aimed to fill this gap by examining momentary experiences, levels of distress tolerance, and NSSI among 51 individuals meeting current diagnostic criteria for BPD and a comorbid depressive disorder. Using data from an ecological momentary assessment across 7 days, it was found that daily urges to hurt oneself and impulsive urges, but not daily negative affect or aggressive urges, predicted NSSI occurrence. Furthermore, low levels of distress tolerance was a stronger predictor of NSSI behavior than daily experiences. These findings have important implications with regard to state versus trait dispositions in NSSI engagement among those with BPD and depression.
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Houtsma C, Anestis MD. Practical capability: The impact of handgun ownership among suicide attempt survivors. Psychiatry Res 2017; 258:88-92. [PMID: 28992551 DOI: 10.1016/j.psychres.2017.09.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 11/24/2022]
Abstract
Suicide is a leading cause of death and represents a serious public health concern. However, our ability to predict its occurrence has not improved over the last 50 years and we continue to rely on past suicidal behavior as the most robust predictor of future suicidal behavior. Recent theories have emphasized the role of contextual factors that increase capability to act on suicidal thoughts, including access to and familiarity with lethal means. We sought to examine the impact of handgun ownership, a component of practical capability as defined by the Three-Step Theory, on the relationship between past week suicidal ideation and perceived likelihood of making a future suicide attempt within a community sample of previous suicide attempters. Results indicate that, among suicide attempt survivors who are currently suicidal, handgun ownership increases the likelihood of predicting engagement in future suicidal behavior. As self-reported predictions about suicidal behavior have been found to be uniquely predictive of actual suicidal behavior, handgun ownership may facilitate the transition from ideation to action. The relevance of these findings to means safety strategies is discussed.
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Affiliation(s)
- Claire Houtsma
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA.
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Skinner KD, Rojas SM, Veilleux JC. Connecting Eating Pathology with Risk for Engaging in Suicidal Behavior: The Mediating Role of Experiential Avoidance. Suicide Life Threat Behav 2017; 47:3-13. [PMID: 27038144 DOI: 10.1111/sltb.12249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
Individuals with eating pathology, particularly those with diagnosed eating disorders, are at high risk for suicide. It is less clear whether undiagnosed eating pathology and subsyndromal eating disorders carry the same risk and, if so, what mechanisms may explain why higher levels of eating pathology yield greater risk for engaging in suicidal behaviors. The indirect relationship between disordered eating and risk for suicidal behaviors via facets of experiential avoidance was tested using a multiple-mediator model. The model was tested using bootstrapping estimates of indirect effects in a sample of 218 noncollege student adults (Mage = 32.33, 66.1% women) with a history of suicidal attempt and/or history of nonsuicidal self-injury (NSSI). Results revealed that disordered eating indirectly predicted risk for suicidal behaviors, distress aversion (i.e., negative attitudes or dislike of distress), and procrastination (i.e., delaying engagement with distressing activities). Results suggest that targeting experiential avoidance and helping those who have a history of engaging in suicidal behaviors and/or NSSI develop regulation strategies to use during times of distress may be of utmost importance for treatment and prevention of eating pathology.
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Examining the Impact of Suicide Attempt Function and Perceived Effectiveness in Predicting Reattempt for Emergency Medicine Patients. Behav Ther 2017; 48:45-55. [PMID: 28077220 DOI: 10.1016/j.beth.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
While previous studies have examined motivational aspects of self-directed violence, few studies have included specific motivations in predictive models for future suicide attempts. The current study utilized a sample of 160 individuals treated in an acute emergency setting following a suicide attempt who completed an interview battery that included an assessment of functional aspects of the index suicide attempt. A follow-up interview was conducted at 6 months to ascertain subsequent suicide attempts. The functional domains of suicide attempts were labeled as reduction-of-distress, communication, perceived better alternative to living, and self-loathing. Above and beyond other known risk factors, including history and highest lethality of previous self-injury, suicide attempts that served a communication function (OR = 0.18, p = .02, CI = 0.04, 0.73) and higher ratings of clinical dysfunction (OR = 3.41, p = .05, CI = 1.02, 11.36) were associated with a significant reduction in likelihood to engage in a suicide attempt during the 6-month follow-up window. Including the perceived effectiveness of the index suicide attempt in getting one's needs met strengthened the overall model predicting a suicide attempt in the follow-up window and was an independent risk factor above and beyond other variables in the model OR = 1.75, p = .04, CI = 1.02, 3.01). Assessment of functional aspects of suicide attempt is feasible and may improve formulation of risk in a population where typical risk factors for suicide are ubiquitous.
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Khazem LR, Anestis MD. Thinking or doing? An examination of well-established suicide correlates within the ideation-to-action framework. Psychiatry Res 2016; 245:321-326. [PMID: 27575650 DOI: 10.1016/j.psychres.2016.08.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/24/2022]
Abstract
Limited research has examined differences in well-established suicide correlates between individuals with various histories of suicidality within the ideation to action framework. We hypothesized that individuals without a history of elevated suicidality would exhibit lowest levels of suicide correlates (perceived burdensomeness, thwarted belongingness, emotion dysregulation, depressive symptoms), and group differences would not be present between those with a history of suicidal ideation relative to those with a history of suicide attempts on variables not theorized to contribute to the capability for suicide. Lastly, we hypothesized that those with a prior history of suicide attempt(s) would exhibit higher levels of lifetime painful and provocative events and fearlessness about death relative to those with a history of ideation only. A community sample of adults (N=378) recruited in part on the basis of a history of suicidality completed self-report questionnaires online. The results were largely consistent with our hypotheses. However, there were no differences in fearlessness about death between those with a history of suicidal ideation and those with a history of attempts. Many variables considered robust correlates of suicide may only directly relate to suicidal ideation rather than suicide attempts, thereby limiting their utility in understanding the transition from ideation to action.
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Affiliation(s)
- Lauren R Khazem
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA.
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Jarvi SM, Hearon BA, Batejan KL, Gironde S, Björgvinsson T. Relations Between Past-Week Physical Activity and Recent Nonsuicidal Self-Injury in Treatment-Seeking Psychiatric Adults. J Clin Psychol 2016; 73:479-488. [PMID: 27391124 DOI: 10.1002/jclp.22342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This research study examines the relationship between past-week physical activity and recent (i.e., within the past 30 days) nonsuicidal self-injury (NSSI) in a sample of treatment-seeking adults. METHOD: Participants included 353 (49.29% female; mean age = 35.16 years) adults attending a partial hospitalization program for acute psychiatric issues. Data were extracted from the program's admission battery of computer-based self-report measures completed by each participant on the first treatment day. RESULTS Participants with a recent history of NSSI (i.e., within the past 30 days) engaged in significantly less past-week physical activity than those without a history of NSSI. Group differences remained significant while controlling for anxiety, but not depression. CONCLUSION Results suggest that, on average, individuals who have never engaged in NSSI exercise more in the week prior to entering the partial hospital program than those who have a recent history of NSSI. Regular physical activity may be an interesting area of study to explore as a promising adjunctive intervention for NSSI (e.g., vigorous exercise as a way to tolerate distress and manage urges to self-injure).
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46
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Kranzler A, Fehling KB, Anestis MD, Selby EA. Emotional dysregulation, internalizing symptoms, and self-injurious and suicidal behavior: Structural equation modeling analysis. DEATH STUDIES 2016; 40:358-66. [PMID: 26808092 DOI: 10.1080/07481187.2016.1145156] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This study used structural equation modeling to examine the relationships between emotion dysregulation, internalizing symptoms, nonsuicidal self-injury (NSSI), and suicide. One hundred forty-eight undergraduates completed a brief structured interview and self-report measures of emotion dysregulation, internalizing symptoms, and NSSI and suicidal behaviors. Results indicated a significant indirect effect of emotion dysregulation on NSSI via internalizing symptoms and on suicide attempts via NSSI. Findings provide a more nuanced understanding of the indirect association between emotion dysregulation and NSSI and suicidal behaviors. Implications for the potential utility of targeting internalizing symptoms as well as emotion dysregulation in interventions addressing NSSI and suicidal behaviors are discussed.
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Affiliation(s)
- Amy Kranzler
- a Department of Psychology, Rutgers , The State University of New Jersey , Piscataway , New Jersey , USA
| | - Kara B Fehling
- a Department of Psychology, Rutgers , The State University of New Jersey , Piscataway , New Jersey , USA
| | - Michael D Anestis
- b Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Edward A Selby
- a Department of Psychology, Rutgers , The State University of New Jersey , Piscataway , New Jersey , USA
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47
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Wester KL, Ivers N, Villalba JA, Trepal HC, Henson R. The Relationship Between Nonsuicidal Self-Injury and Suicidal Ideation. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kelly L. Wester
- Department of Counseling and Educational Development; University of North Carolina at Greensboro
| | | | - José A. Villalba
- Faculty Recruitment, Diversity, and Inclusion; Wake Forest University
| | | | - Robert Henson
- Department of Educational Research Methodology; University of North Carolina at Greensboro
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Hashoul-Andary R, Assayag-Nitzan Y, Yuval K, Aderka IM, Litz B, Bernstein A. A Longitudinal Study of Emotional Distress Intolerance and Psychopathology Following Exposure to a Potentially Traumatic Event in a Community Sample. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9730-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Selby EA, Kranzler A, Fehling KB, Panza E. Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles. Clin Psychol Rev 2015; 38:79-91. [DOI: 10.1016/j.cpr.2015.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/25/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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Law KC, Khazem LR, Anestis MD. The role of emotion dysregulation in suicide as considered through the ideation to action framework. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.01.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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