1
|
Lee DW, Kim K, Hyun J, Jung SJ. Depressive symptoms and neuroticism mediate the association between traumatic events and suicidality - A latent class mediation analysis of UK Biobank Database. J Affect Disord 2024; 356:13-21. [PMID: 38588726 DOI: 10.1016/j.jad.2024.03.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Mental disorders that follow traumatic experience may increase risk of suicidality, but a comprehensive approach to understand how these mental disorders mediate the association between psychological traumatic experience and suicidality should be elucidated. In this study, we attempted to provide comprehensive evidence on how depressive symptoms and neuroticism can mediate the association between psychological traumatic experiences and suicidal behaviours including suicidal ideation, suicidal planning, and suicide attempts. METHODS We analyzed 111,931 participants from UK Biobank who had completed mental health web-based questionnaire from 2016 to 2017. "Self-harm and suicidal behaviour and ideation (SSBI) score" was calculated by the response from suicidal behaviours and self-harm questionnaires. Conducting multivariate linear regression, depressive symptoms, anxiety symptoms, and neuroticism were selected as potential mediators. We constructed a latent class mediation model estimated direct effect of psychological traumatic events on suicidality and indirect effect of psychological traumatic events mediated by depressive symptoms and neuroticism. RESULTS Psychological traumatic events were positively associated with suicidal behaviours. Depressive symptoms and neuroticism significantly mediated the effect of psychological traumatic events on suicidality. Anxiety symptoms did not mediate the association between psychological traumatic events and suicidality. CONCLUSION Psychological traumatic events, irrespective of life stage of occurrence, are associated with suicidality. The association between psychological traumatic events and suicidality can be partially explained by depressive symptoms and neuroticism of those who were exposed to psychological trauma.
Collapse
Affiliation(s)
- Doo Woong Lee
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jinhee Hyun
- Department of Social Welfare, College of Social Sciences, Daegu University, Gyeongsan, Republic of Korea
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Kim JM, Kim JW, Kang HJ, Jang H, Kim JC, Chun BJ, Lee JY, Kim SW, Shin IS. Moderating role of functioning level on the association between suicidal ideation and delayed-onset post-traumatic stress disorder. J Psychosom Res 2024; 181:111680. [PMID: 38642530 DOI: 10.1016/j.jpsychores.2024.111680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES This study aimed to investigate the relationship between suicidal ideation at baseline and the development of post-traumatic stress disorder (PTSD) in individuals who have experienced physical injuries, with a specific focus on how this relationship is moderated by the patient's functioning level. METHODS Participants were consecutively recruited from a trauma center and prospectively followed for two years. At baseline, suicidal ideation was assessed using the Brief Psychiatric Rating Scale, and functioning level was evaluated using the Social and Occupational Functioning Assessment Scale. During the follow-up, PTSD diagnosis was established using the Clinician-Administered PTSD Scale for DSM-5. Binary and multinomial logistic regression analyses were employed to examine the associations between suicidal ideation, functioning level, and PTSD. RESULTS Of the 1014 participants analyzed, 114 (11.2%) developed PTSD, with early-onset observed in 79 (7.8%) and delayed-onset in 35 (3.5%) cases. Suicidal ideation at baseline was significantly associated with both early- and delayed-onset PTSD. Notably, higher functioning individuals with baseline suicidal ideation had an increased likelihood of developing delayed-onset PTSD, while this association was not significant in lower functioning individuals, with significant interaction terms. Additionally, suicidal ideation was a consistent predictor of early-onset PTSD across all functioning levels. CONCLUSION The impact of baseline suicidal ideation on PTSD varies depending on the individual's functioning level, with higher functioning individuals being more vulnerable to delayed-onset PTSD. These findings underscore the importance of considering functional status in the assessment and intervention of PTSD following physical trauma.
Collapse
Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Jung-Chul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Byung Jo Chun
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
3
|
Kim JM, Kim JW, Kang HJ, Jang H, Kim JC, Chun BJ, Lee JY, Kim SW, Shin IS. Impact of suicidality on delayed-onset post-traumatic stress disorder is modified by age: A two-year longitudinal study. J Affect Disord 2024; 354:51-54. [PMID: 38471635 DOI: 10.1016/j.jad.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES This study aimed to investigate the relationship between early suicidality and post-traumatic stress disorder (PTSD) onset in patients with physical injuries, focusing on age as a modifying factor. METHODS At baseline, 1014 patients were evaluated for suicidality, age divided into younger (<60 years) vs. older (≥60 years) groups, and potential covariates. PTSD was diagnosed at follow-up at 3, 6, 12, and 24 months, and then were categorized into early-onset (within the first six months after trauma) and delayed-onset (more than six months after trauma). Logistic regression models were used after adjusting for covariates. RESULTS Presence of suicidality at baseline was significantly associated with delayed-onset PTSD in older but not younger patients with significant interaction terms, whereas it was significantly associated with early-onset PTSD across all age groups. CONCLUSION Age-specific associations were found between suicidality and PTSD onset. The findings highlight the importance of early suicidality assessment, especially in older patients for ongoing monitoring and support, and underscore the critical need for early PTSD identification and intervention for all ages.
Collapse
Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Jung-Chul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Byung Jo Chun
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
4
|
Rønning L, Anyan F, Hjemdal O, Bøe HJ, Espetvedt Nordstrand A, Herberman Mash HB, Naifeh JA. Exploring heterogeneity in PTSD symptoms and associated predictors and outcomes in Afghanistan veterans: A latent profile analysis. MILITARY PSYCHOLOGY 2024:1-12. [PMID: 38709219 DOI: 10.1080/08995605.2024.2345580] [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: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Research on posttraumatic stress symptoms (PTSS) typically focuses on diagnosis or symptom severity, however, this overlooks the variety of symptom patterns that exist. Latent profile analysis was used to explore PTSS profiles in a sample of Norwegian Afghanistan veterans (n = 4052, 91.7% males). Multinomial logistic regression analyses were conducted to examine predictors and outcomes associated with PTSS profile membership. Three profiles emerged: Low Symptoms profile (85%); High Numbing and Arousal profile (13%); and High Symptoms profile (2%). Being female, lower number of deployments, barriers to disclose war-related experiences, and higher number of potentially morally injurious events (PMIEs) were associated with belonging to the High Symptoms profile compared to the High Numbing and Arousal (Male gender: OR = 0.37, p < .05; Number of deployments: OR = 0.68, p < .05; Barriers to disclose: OR = 1.39, p < .001; PMIEs: OR = 1.15. p < .05), or Low Symptoms profile (Male gender: OR = 0.36, p < .05; Number of deployments: OR = 0.67, p < .01; Barriers to disclose: OR = 1.80, p < .001; PMIEs: OR = 1.32. p < .001). Participants in the High Symptoms profile had the highest probability of mental health service use (0.37) and endorsing suicidal ideation (0.38), compared to the two other profiles (p < .01). Participants in the High Numbing and Arousal profile had a higher probability of seeking professional mental health care (0.17), endorsing suicidal ideation (0.16), and reporting more suicide attempts compared to the Low Symptom profile (0.02 vs. 0.00, p < .001). These findings highlight the importance of considering the heterogeneity of PTSS profiles and understanding the predictors and responses of individuals who exhibit elevated PTSS symptoms.
Collapse
Affiliation(s)
- Line Rønning
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frederick Anyan
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans Jakob Bøe
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Andreas Espetvedt Nordstrand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway
| | - Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| |
Collapse
|
5
|
Tesfaye AH, Sendekie AK, Kabito GG, Engdaw GT, Argaw GS, Desye B, Angelo AA, Aragaw FM, Abere G. Post-traumatic stress disorder and associated factors among internally displaced persons in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0300894. [PMID: 38557637 PMCID: PMC10984478 DOI: 10.1371/journal.pone.0300894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Internally displaced people (IDPs), uprooted by conflict, violence, or disaster, struggle with the trauma of violence, loss, and displacement, making them significantly more vulnerable to post-traumatic stress disorder (PTSD). Therefore, we conducted a systematic review and meta-analysis to assess the prevalence and associated factors of PTSD among IDPs in Africa. METHODS A comprehensive search of electronic databases was conducted to identify relevant studies published between 2008 and 2023. The search included electronic databases such as PubMed, CABI, EMBASE, SCOPUS, CINHAL, and AJOL, as well as other search sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted using Microsoft Excel, and analysis was performed using STATA 17 software. The quality of the included studies was assessed using the JBI quality appraisal tool. A random-effects model was used to estimate the pooled prevalence of PTSD and its associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics was used to assess heterogeneity. The protocol for this review has been registered with PROSPERO (ID: CRD42023428027). RESULTS A total of 14 studies with a total of 7,590 participants met the inclusion criteria. The pooled prevalence of PTSD among IDPs in Africa was 51% (95% CI: 38.-64). Female gender (OR = 1.99, 95% CI: 1.65-2.32), no longer married (OR = 1.93, 95% CI: 1.43-2.43), unemployment (OR = 1.92, 95% CI: 1.17-2.67), being injured (OR = 1.94, 95% CI: 1.50-1.50), number of traumatic events experienced [4-7(OR = 2.09, 95% CI: 1.16-3.01), 8-11 (OR = 2.09, 95% CI: 2.18-4.12), 12-16 (OR = 5.37, 95% CI: 2.61-8.12)], illness without medical care (OR = 1.92, 95% CI: 1.41-2.29), being depressed (OR = 2.97, 95% CI: 2.07-3.86), and frequency of displacement more than once (OR = 2.13, 95% CI: 1.41-2.85) were significantly associated with an increased risk of PTSD. CONCLUSIONS The findings of this systematic review and meta-analysis highlight the alarming prevalence of PTSD among IDPs in Africa. Female gender, marital status, number of traumatic events, ill health without medical care, depression, and frequency of displacement were identified as significant risk factors for PTSD. Effective interventions and the development of tailored mental health programs are needed to prevent PTSD among IDPs, focusing on the identified risk factors.
Collapse
Affiliation(s)
- Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebisa Guyasa Kabito
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Shibeshi Argaw
- Department of Nursing, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Belay Desye
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abiy Ayele Angelo
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Giziew Abere
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Blalock ZN, Wu GWY, Lindqvist D, Trumpff C, Flory JD, Lin J, Reus VI, Rampersaud R, Hammamieh R, Gautam A, Doyle FJ, Marmar CR, Jett M, Yehuda R, Wolkowitz OM, Mellon SH. Circulating cell-free mitochondrial DNA levels and glucocorticoid sensitivity in a cohort of male veterans with and without combat-related PTSD. Transl Psychiatry 2024; 14:22. [PMID: 38200001 PMCID: PMC10781666 DOI: 10.1038/s41398-023-02721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Circulating cell-free mitochondrial DNA (ccf-mtDNA) is a biomarker of cellular injury or cellular stress and is a potential novel biomarker of psychological stress and of various brain, somatic, and psychiatric disorders. No studies have yet analyzed ccf-mtDNA levels in post-traumatic stress disorder (PTSD), despite evidence of mitochondrial dysfunction in this condition. In the current study, we compared plasma ccf-mtDNA levels in combat trauma-exposed male veterans with PTSD (n = 111) with those who did not develop PTSD (n = 121) and also investigated the relationship between ccf mt-DNA levels and glucocorticoid sensitivity. In unadjusted analyses, ccf-mtDNA levels did not differ significantly between the PTSD and non-PTSD groups (t = 1.312, p = 0.191, Cohen's d = 0.172). In a sensitivity analysis excluding participants with diabetes and those using antidepressant medication and controlling for age, the PTSD group had lower ccf-mtDNA levels than did the non-PTSD group (F(1, 179) = 5.971, p = 0.016, partial η2 = 0.033). Across the entire sample, ccf-mtDNA levels were negatively correlated with post-dexamethasone adrenocorticotropic hormone (ACTH) decline (r = -0.171, p = 0.020) and cortisol decline (r = -0.149, p = 0.034) (viz., greater ACTH and cortisol suppression was associated with lower ccf-mtDNA levels) both with and without controlling for age, antidepressant status and diabetes status. Ccf-mtDNA levels were also significantly positively associated with IC50-DEX (the concentration of dexamethasone at which 50% of lysozyme activity is inhibited), a measure of lymphocyte glucocorticoid sensitivity, after controlling for age, antidepressant status, and diabetes status (β = 0.142, p = 0.038), suggesting that increased lymphocyte glucocorticoid sensitivity is associated with lower ccf-mtDNA levels. Although no overall group differences were found in unadjusted analyses, excluding subjects with diabetes and those taking antidepressants, which may affect ccf-mtDNA levels, as well as controlling for age, revealed decreased ccf-mtDNA levels in PTSD. In both adjusted and unadjusted analyses, low ccf-mtDNA levels were associated with relatively increased glucocorticoid sensitivity, often reported in PTSD, suggesting a link between mitochondrial and glucocorticoid-related abnormalities in PTSD.
Collapse
Affiliation(s)
- Zachary N Blalock
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Gwyneth W Y Wu
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Daniel Lindqvist
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Janine D Flory
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Victor I Reus
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ryan Rampersaud
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Aarti Gautam
- Integrative Systems Biology, US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Marti Jett
- Integrative Systems Biology, US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
| |
Collapse
|
7
|
Xie S, Cheng Q, Tan S, Li H, Huang T, Xiang Y, Zhou X. The efficacy and acceptability of group trauma-focused cognitive behavior therapy for the treatment of post-traumatic stress disorder in children and adolescents: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 86:127-134. [PMID: 38219423 DOI: 10.1016/j.genhosppsych.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Group trauma-focused cognitive behavior therapy (TF-CBT) is widely used to treat post-traumatic stress disorder (PTSD) in children and adolescents. However, the available evidence remains unclear. METHOD PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations, LILACS, and international trial registers were searched from database inception to April 30, 2022. We included randomized controlled trials (RCTs) that compared TF-CBT with any control condition for treating children and adolescents with PTSD. Analyses were performed using Review Manager version 5.3 and Stata 16.0. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. This study was registered with PROSPERO (CRD42020206096). RESULTS Eleven RCTs involving 1942 patients were included. Group TF-CBT was significantly more effective than other treatments at post-treatment (standardized mean difference [SMD]: -0.43, 95% confidence interval [CI]: -0.65 to -0.22), follow-up (SMD: -0.33, 95% CI: -0.52 to -0.13), and in relieving depressive symptoms (SMD: -0.29, 95% CI: -0.49 to -0.09), but not in terms of acceptability. Subgroup analyses showed that group TF-CBT was superior to other treatments in studies including children with post-traumatic stress symptoms (PTSS) (SMD: -0.54, 95% CI: -0.79 to -0.28) and psychiatric comorbidities (SMD: -0.48, 95% CI: -0.72 to -0.23). LIMITATIONS The small sample sizes of identified studies limited some findings. CONCLUSION When considering effectiveness at post-treatment and follow-up or the reduction of depressive symptoms, group TF-CBT could be a good choice for children and adolescents with PTSD. Among these patients, those with PTSS or psychiatric comorbidities may benefit the most.
Collapse
Affiliation(s)
- Siyu Xie
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; College of Pediatrics, Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qisheng Cheng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Shiyu Tan
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Haomiao Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Tengyue Huang
- The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Yajie Xiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
8
|
Fox H, Preston TJ, Morabito D, Schmidt NB, Albanese BJ. The interactive effects of AS and trauma exposure on suicide capability and suicide risk. J Psychiatr Res 2023; 167:100-107. [PMID: 37862905 DOI: 10.1016/j.jpsychires.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/04/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Trauma exposure has been linked with heightened suicide risk purportedly through habituation to threatening stimuli, thereby reducing fear of suicide. However, no research has examined variables that may influence this process. Anxiety sensitivity (AS) is one cognitive-affective factor that may strengthen the relationship between trauma exposure and reduced fear of suicide by amplifying traumatic reactivity. The present study evaluated this by examining the interaction of AS and trauma exposure type (e.g., direct vs. witnessed) predicting fear of suicide and self-reported suicide risk. METHODS Participants (n = 124) were recruited for a long-term (∼3-4 years) follow-up after participation in a clinical trial targeting suicide risk factors and were asked to complete self-report measures of trauma history, AS, fear of suicide, and suicide risk. RESULTS Significant interactions emerged such that a greater number of direct traumasexperienced predicted lower fear of suicide and greater suicide risk among those with greater AS. The interactive effect of witnessed traumas and AS predicting suicidality was insignificant. Results remained even after including relevant covariates. DISCUSSION The current findings suggest that AS augments the effects of repeated trauma exposure on fear of suicide and suicide risk. It is plausible these painful and provocative events are more potent among those with high AS due to the amplification of traumatic affective responses, though future research examining the longitudinal relations is needed to confirm this process.
Collapse
Affiliation(s)
- Hailey Fox
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Thomas J Preston
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Danielle Morabito
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Brian J Albanese
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
| |
Collapse
|
9
|
Dell'Aquila A, Berle D. Predictors of alcohol and substance use among people with post-traumatic stress disorder (PTSD): findings from the NESARC-III study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1509-1522. [PMID: 37133523 PMCID: PMC10460312 DOI: 10.1007/s00127-023-02472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/30/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD. METHODS We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms. RESULTS Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD. CONCLUSIONS Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.
Collapse
Affiliation(s)
- Adriana Dell'Aquila
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - David Berle
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.
- School of Medicine and Psychology, Australian National University, Canberra, Australia.
| |
Collapse
|
10
|
Sala-Hamrick KJ, Braciszewski JM, Yeh HH, Zelenak L, Westphal J, Beebani G, Frank C, Simon GE, Owen-Smith AA, Rossom RC, Lynch F, Lu CY, Waring SC, Harry ML, Beck A, Daida YG, Ahmedani BK. Diagnosed Posttraumatic Stress Disorder and Other Trauma-Associated Stress Disorders and Risk for Suicide Mortality. Psychiatr Serv 2023; 74:936-942. [PMID: 37143334 PMCID: PMC10497061 DOI: 10.1176/appi.ps.202100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Strong evidence exists for posttraumatic stress disorder (PTSD) as a risk factor for suicidal thoughts and behaviors across diverse populations. However, few empirical studies have examined PTSD and other trauma-associated stress disorders as risk factors for suicide mortality among health system populations. This study aimed to assess trauma-associated stress diagnoses as risk factors for suicide mortality in a U.S. health system population. METHODS This case-control, matched-design study examined individuals who died by suicide between 2000 and 2015 and had received care from nine U.S. health systems affiliated with the Mental Health Research Network (N=3,330). Individuals who died by suicide were matched with individuals from the general health system population (N=333,000): 120 individuals with PTSD who died by suicide were matched with 1,592 control group members, 84 with acute reaction to stress were matched with 2,218 control individuals, and 331 with other stress reactions were matched with 8,174 control individuals. RESULTS After analyses were adjusted for age and sex, individuals with any trauma-associated stress condition were more likely to have died by suicide. Risk was highest among individuals with PTSD (adjusted OR [AOR]=10.10, 95% CI=8.31-12.27), followed by those with other stress reactions (AOR=5.38, 95% CI=4.78-6.06) and those with acute reaction to stress (AOR=4.49, 95% CI=3.58-5.62). Patterns of risk remained the same when the analyses were adjusted for any comorbid psychiatric condition. CONCLUSIONS All trauma-associated stress disorders are risk factors for suicide mortality, highlighting the importance of health system suicide prevention protocols that consider the full spectrum of traumatic stress diagnoses.
Collapse
Affiliation(s)
- Kelsey J Sala-Hamrick
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Logan Zelenak
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ganj Beebani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances Lynch
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa L Harry
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| |
Collapse
|
11
|
Jannini TB, Longo L, Rossi R, Niolu C, Siracusano A, Di Lorenzo G. Complex post-traumatic stress disorder (cPTSD) and suicide risk: A multigroup mediation analysis exploring the role of post-traumatic symptomatology on hopelessness. J Psychiatr Res 2023; 165:165-169. [PMID: 37506411 DOI: 10.1016/j.jpsychires.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Complex post-traumatic stress disorder (cPTSD) is a clinical condition that features not only PTSD symptoms, but also disturbances in self-organization. Patients with cPTSD have a higher incidence of psychiatric comorbidities, including suicidality. A key construct tightly related to suicidality is hopelessness, described as a feeling of despair, with a state of mind giving low or negative expectancies regarding one's future. Since there is a paucity of studies investigating the link between cPTSD and hopelessness as a risk factor for suicidality, the aim of this study was to examine the role of post-traumatic symptomatology as the primary driver of suicidality, as measured by hopelessness. 211 patients were enrolled and divided into two groups: PTSD (143 patients) and cPTSD (78 patients). A set of standardized measures was administered to study post-traumatic symptomatology, depression, and hopelessness. The results showed that compared to PTSD, cPTSD patients experienced more severe symptoms in all clinical outcomes (p < 0.001). The mediation analysis revealed a significant positive association between post-traumatic symptomatology and hopelessness in the cPTSD group, which was not significant in the PTSD group. Among PTSD patients, depression mediated 43.37% of the impact of post-traumatic symptomatology on suicidal ideation. Our results contribute to a better understanding of complex post-traumatic symptomatology, further highlighting its role in the pathogenesis of suicidality. Hence, these findings have important clinical implications, suggesting that targeted, trauma-focused interventions might effectively prevent hopelessness and therefore suicide risk in patients with cPTSD.
Collapse
Affiliation(s)
- Tommaso B Jannini
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Lucia Longo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
| | - Cinzia Niolu
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy; IRCCS, Fondazione Santa Lucia, Rome, Italy
| |
Collapse
|
12
|
Soupene VA, Davis J, Fogner A, Casteel C. Circumstances Contributing to Installation, Maintenance, and Repair Worker Death by Suicide. J Occup Environ Med 2023; 65:394-400. [PMID: 36727910 PMCID: PMC10175102 DOI: 10.1097/jom.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine risk factors related to death by suicide among installation, maintenance, and repair (IMR) workers compared with workers in other occupational groups. METHODS The National Violent Death Reporting System (NVDRS) data for the years 2013 to 2018 was used to identify suicide deaths. Circumstance variables were used to examine differences between IMR workers and other workers. RESULTS Having a physical health problem (1.13; 95% confidence interval [CI], 1.03 to 1.23) or a diagnosis of posttraumatic stress disorder (1.24; 95% CI, 1.03 to 1.50) was more likely to contribute to IMR worker suicide compared with other occupations. Installation, maintenance, and repair workers were less likely to receive treatment for a mental health diagnosis or substance use disorder (0.88; 95% CI, 0.81 to 0.94). CONCLUSIONS Additional support for physical health problems, posttraumatic stress disorder diagnoses, and mental health care access among IMR workers may reduce suicide deaths.
Collapse
Affiliation(s)
- Victor A. Soupene
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Epidemiology, Iowa City, IA, USA
| | - Jonathan Davis
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Occupational and Environmental Health, Iowa City, IA, USA
| | - Andrew Fogner
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Epidemiology, Iowa City, IA, USA
| | - Carri Casteel
- University of Iowa College of Public Health, Iowa City, IA, USA
- University of Iowa Department of Occupational and Environmental Health, Iowa City, IA, USA
| |
Collapse
|
13
|
Akbar R, Arya V, Conroy E, Wilcox HC, Page A. Posttraumatic stress disorder and risk of suicidal behavior: A systematic review and meta-analysis. Suicide Life Threat Behav 2023; 53:163-184. [PMID: 36385705 DOI: 10.1111/sltb.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI). METHODS The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity. RESULTS A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts. CONCLUSION This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.
Collapse
Affiliation(s)
- Rahat Akbar
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Vikas Arya
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth Conroy
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Holly C Wilcox
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| |
Collapse
|
14
|
[Latent posttraumatic stress disorder in psychiatry at the Mohammed VI university hospital in Oujda]. L'ENCEPHALE 2023; 49:50-56. [PMID: 34887079 DOI: 10.1016/j.encep.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) is a severe psychiatric disorder following exposure to a traumatic event. It is rarely diagnosed alone. High comorbidity has been observed between PTSD and other psychiatric disorders. OBJECTIVES The purpose of this work is to evaluate the prevalence of latent PTSD in a population followed in a service of psychiatry and to describe the associated factors. MATERIALS AND METHODS It is a descriptive cross-sectional study of 300 patients treated for psychiatric disorders, using a hetero-questionnaire containing sociodemographic data, personal and family history, clinical and therapeutic data, and characteristics of the traumatic event. The MINI was used to screen for PTSD and assess suicidal risk. RESULTS Exposure to a traumatic event is reported by 46.7% of patients, and PTSD by 19.7%. The suicidal risk is 47.7% in the presence of this comorbidity. An ESPT is significantly associated with a schizoaffective disorder and significant suicidal risk. The recentness of the traumatic event, the presence of a state of acute stress and the absence of family psychological support are significantly associated with the occurrence of PTSD. CONCLUSION A significant number of patients with a psychiatric disorder have undiagnosed PTSD, thus explaining their clinical deterioration. Screening and treatment of the underlying PTSD would help to improve their management.
Collapse
|
15
|
Vega L, Johnson-DeLeon CC, Kohalmi A, Howell B, Miller S, LeDuc T. Firefighter Suicide: A Theoretical Model for a Population Specific Behavioral Autopsy Program. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231151278. [PMID: 36633959 DOI: 10.1177/00302228231151278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Some research suggests that firefighters are possibly at greater risk than other at-risk first responder/public service populations for suicidality (e.g., police, Veterans, active duty military non-deployed males; Martin et al., 2017; Stanley et al., 2015; Stanley et al., 2016). Behavioral autopsies have been utilized to elucidate the clinical picture of other at-risk populations; however, to date there is no proposed or applied model for a suicide behavior autopsy in fire personnel. Developing a standardized suicide behavior autopsy will allow for a comprehensive understanding of firefighters who die by suicide and highlight potential areas for intervention. The aim of this paper is to integrate best practices for autopsy procedures from other high-risk populations into a comprehensive theoretical model for a proposed behavioral health autopsy for firefighters. Our recommended protocol is presented along with relevant limitations, clinical implications, and recommendations for future research.
Collapse
Affiliation(s)
- Luzimar Vega
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Affairs' Hospital, Tampa, FL, USA
- International Association of Fire Service Behavioral Health, Tampa, FL, USA
| | - Candice C Johnson-DeLeon
- International Association of Fire Service Behavioral Health, Tampa, FL, USA
- VISN 5 Clinical Resource Hub in the National Suicide Prevention Telehealth Program, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Alicia Kohalmi
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Affairs' Hospital, Tampa, FL, USA
- International Association of Fire Service Behavioral Health, Tampa, FL, USA
| | - Brittany Howell
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Affairs' Hospital, Tampa, FL, USA
- International Association of Fire Service Behavioral Health, Tampa, FL, USA
| | - Stephanie Miller
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Affairs' Hospital, Tampa, FL, USA
| | - Todd LeDuc
- Life Scan Wellness Centers, Tampa, FL, USA
- International Association of Fire Chiefs, Safety, Health & Survival Section, Chantilly, VA, USA
| |
Collapse
|
16
|
Tahernejad S, Ghaffari S, Ariza-Montes A, Wesemann U, Farahmandnia H, Sahebi A. Post-traumatic stress disorder in medical workers involved in earthquake response: A systematic review and meta-analysis. Heliyon 2023; 9:e12794. [PMID: 36685451 PMCID: PMC9850193 DOI: 10.1016/j.heliyon.2023.e12794] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/01/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023] Open
Abstract
Introduction Medical workers involved in responding to the earthquake are exposed to frightening scenes and witness dead bodies and severely injured moaning people, predisposing them to multiple mental health consequences. This study was aimed to determine the prevalence of Post-Traumatic Stress Disorder (PTSD) after earthquakes among medical workers using a systematic review and meta-analysis. Materials and methods The review study was performed following PRISMA guidelines, and the study's protocol was registered in PROSPERO with the code CRD42022333069. The data resources of Google Scholar, Science Direct, Web of Science, PubMed, and Scopus were searched to specify the related studies. To perform meta-analysis, the random effects model was utilized, and the I2 index was considered to assess heterogeneity between studies. The STATA software was used for data analysis. Results In the initial data resources search, 1399 articles were identified. From these articles, 13 were finally chosen for meta-analysis and quality assessment. The meta-analysis results indicated that the prevalence of post-earthquake PTSD among medical workers involved in the earthquake response was 16.37% (95% CI: 11.63-21.11, I2 = 97.33%, p = 0 < 0.001). Conclusion The medical workers involved in response to the earthquake have a relatively high risk of PTSD in the short and long term. Therefore, medical workers involved in response to disasters should undergo screening for mental health disorders before and after disasters and receive the necessary training with regard to stress management, psychological resilience, and how to express their feelings and emotions.
Collapse
Affiliation(s)
- Somayeh Tahernejad
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sina Ghaffari
- Department of Occupational Health Engineering and Safety at Work, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Berlin, Germany
| | - Hojjat Farahmandnia
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Sahebi
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran,Corresponding author.
| |
Collapse
|
17
|
Reduced working memory performance in PTSD and suicide among veterans presenting for treatment. J Psychiatr Res 2022; 156:299-307. [PMID: 36283133 DOI: 10.1016/j.jpsychires.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022]
Abstract
Suicide is among the leading causes of death in the United States, underscoring the continued need to understand the mechanisms underlying suicide risk. A growing body of research has examined the role of working memory deficits in suicidal thoughts and behaviors (STBs), yet little research has evaluated putative pathways via which working memory impairments may heighten suicide risk. Elevated posttraumatic stress symptoms (PTSS) represent one plausible mechanism through which poor working memory performance may increase STBs. The present study utilized data from 140 treatment-seeking veterans who presented for an intake evaluation in the PTSD Clinical Team of a large VA Medical Center. Veterans completed self-report measures, a semi-structured PTSD evaluation, and a digit span working memory test. In addition to concurrent suicidal ideation assessed during the intake, additional information regarding past suicide attempts, presence of a safety plan, documentation of past suicidal behaviors, and engagement with suicide crisis lines were collected via electronic medical records. Consistent with hypotheses, a significant indirect path emerged such that poor working memory performance predicted greater suicidal ideation, greater likelihood of a past suicide attempt, and greater latent suicide risk via increased PTSS. However, no direct effect of working memory on STBs or indirect paths of PTSS on STBs via working memory emerged. These findings suggest that the relation between working memory and STBs may be explained by PTSS severity.
Collapse
|
18
|
Opie E, Werbeloff N, Hayes J, Osborn D, Pitman A. Suicidality in patients with post-traumatic stress disorder and its association with receipt of specific secondary mental healthcare treatments. Int J Psychiatry Clin Pract 2022:1-10. [PMID: 36369845 DOI: 10.1080/13651501.2022.2140679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments. METHODS We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample's sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission. RESULTS Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 - 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 - 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 - 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 - 4.45). CONCLUSION In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide.KEY POINTSNICE guidelines recommend psychological therapy be first line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication.Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics.The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations.Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.
Collapse
Affiliation(s)
- Elena Opie
- UCL Division of Psychiatry, University College London, UK
- Whittington Health, London, UK
| | - Nomi Werbeloff
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Tel Aviv, Israel
| | - Joseph Hayes
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - David Osborn
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
19
|
Leighton SC, Nieforth LO, O’Haire ME. Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis. PLoS One 2022; 17:e0274960. [PMID: 36129950 PMCID: PMC9491613 DOI: 10.1371/journal.pone.0274960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Psychiatric assistance dogs for military veterans with posttraumatic stress disorder (PTSD) currently make up over 19% of assistance dog partnerships globally. We conducted a systematic review of the literature relating to these partnerships, with specific aims to (1) summarize their characteristics, (2) evaluate the quality of existing evidence, and (3) summarize outcomes. A total of 432 records were independently screened (Cohen's kappa = 0.90). Of these, 41 articles (29 peer-reviewed publications and 12 unpublished dissertations) met inclusion criteria. Data extraction was conducted to address the research aims, including a meta-analysis (quantitative outcomes) and meta-synthesis (qualitative outcomes). All peer-reviewed publications on the topic of psychiatric assistance dogs for veterans with PTSD were published within the last five years. The majority of included articles were quantitative (53%), 41% were qualitative, and 6% employed mixed methods. Mean methodological rigor scores were 80% for peer reviewed articles and 71% for dissertations, where higher scores represent more rigorous methodology. Quantitative articles reported significant improvements in the domains of PTSD severity, mental health, and social health. Impacts on physical health and global quality of life appear inconclusive. Meta-analysis (9 articles) revealed that partnership with an assistance dog had a clinically meaningful, significant, and large effect on PTSD severity scores (g = -1.129; p<0.0001). Qualitative meta-synthesis identified two third order constructs: (1) Impact on the individual: mental & physical health and (2) Impact beyond the individual: building relationships & connection. This synthesis of increasingly prevalent research on assistance dogs for veterans with PTSD provides support for the impact of this complementary and integrative health intervention on PTSD symptom severity, and signs of meaningful improvements in adjacent domains including mental and social health. Gaps between quantitative and qualitative findings, along with the need to report greater demographic detail, highlight key opportunities for future research.
Collapse
Affiliation(s)
- Sarah C. Leighton
- Center for the Human-Animal Bond, Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States of America
| | - Leanne O. Nieforth
- College of Veterinary Medicine, University of Arizona, Oro Valley, AZ, United States of America
| | - Marguerite E. O’Haire
- College of Veterinary Medicine, University of Arizona, Oro Valley, AZ, United States of America
| |
Collapse
|
20
|
Alleaume C, Peretti-Watel P, Beck F, Leger D, Vaiva G, Verger P. Incidence of PTSD in the French population a month after the COVID-19 pandemic-related lockdown: evidence from a national longitudinal survey. BMC Public Health 2022; 22:1500. [PMID: 35932014 PMCID: PMC9356417 DOI: 10.1186/s12889-022-13880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In view of experts' warnings about the potential negative mental health consequences of the sudden nationwide lockdowns implemented in many countries to limit the spread of the COVID-19 pandemic, we sought to study the incidence of posttraumatic stress disorder (PTSD) after traumatic events related to this unprecedented lockdown in the French general population. METHODS This longitudinal study among adults (aged =18) consisted of two surveys: the first during the last days of the lockdown and the second a month later. We estimated PTSD incidence with the PCL-5 and ran multiple Poisson regression models to identify factors associated with PTSD. RESULTS Among the 1736 participants, 30.1% reported at least one traumatic event. PTSD incidence was 17.5% (95% confidence interval CI = 15.7-19.3). It was higher in participants who reported multiple traumatic events, who had high COVID-19-related media use, who had general anxiety disorder (GAD-7) during the lockdown, and who had GAD, depression (PHQ-9), or sleep problems 1 month later. In addition, 43.1% of people with PTSD reported suicidal thoughts. CONCLUSIONS These results should help clinicians to target people who are at high risk of developing PTSD after a pandemic-related lockdown and could benefit from preventive measures. Collaboration between the media and mental health professionals could be envisioned to inform the population about care resources. Follow-up recommendations should also be disseminated to general practitioners to facilitate PTSD screening and ensure that they are aware of the appropriate management.
Collapse
Affiliation(s)
- Caroline Alleaume
- Southeastern Health Regional Observatory (ORS Paca), Faculté des Sciences Médicales et Paramédicales, 27 Bd Jean Moulin 13385, CEDEX 5, Marseille, France.
| | - Patrick Peretti-Watel
- Southeastern Health Regional Observatory (ORS Paca), Faculté des Sciences Médicales et Paramédicales, 27 Bd Jean Moulin 13385, CEDEX 5, Marseille, France.,Aix-Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - François Beck
- CESP, University Paris Sud, Faculté de médecine UVSQ, Inserm, University Paris-Saclay, Villejuif, France
| | - Damien Leger
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP- Hôtel-Dieu, Centre du sommeil et de la Vigilance, Paris, France
| | - Guillaume Vaiva
- U1172 INSERM Lille Neurosciences & Cognitions, Centre National de Ressources & Résilience pour les psychotraumatismes (Lille - Paris), Lille, France
| | - Pierre Verger
- Southeastern Health Regional Observatory (ORS Paca), Faculté des Sciences Médicales et Paramédicales, 27 Bd Jean Moulin 13385, CEDEX 5, Marseille, France
| | | |
Collapse
|
21
|
Ghazali SR, Chen YY, Mohamad M, Yein LP, Razali ZA, Pauzi N, Majani AF. Lifetime trauma, symptoms of psychological disturbance, and suicidal ideation among university students in Malaysia. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
22
|
Teismann T, Naghavi A, Asgari Z, Grundei L, Brailovskaia J. Posttraumatic stress disorder symptoms and suicidal ideation/behavior: The moderating effects of positive mental health and social support among Iranian and German students. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractSuicidal ideation and behavior are common in those suffering from Posttraumatic Stress Disorder (PTSD). The present study investigated factors buffering the association between PTSD symptoms and suicidal ideation/behavior. A total of 571 Iranian students and 421 German students took part in the investigation. Social support and positive mental health (PMH) were considered as resilience factors moderating the association between PTSD symptoms and suicide ideation/behavior within both samples. PMH moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian and German students. Social support moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian students only. Positive mental health and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.
Collapse
|
23
|
Ingram J, Lyford B, McAtamney A, Fitzpatrick S. Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff. Int J Ment Health Syst 2022; 16:24. [PMID: 35562790 PMCID: PMC9107234 DOI: 10.1186/s13033-022-00534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Refugees and asylum seekers are exposed to a unique set of circumstances and experiences that are associated with an increased suicide risk. Suicide prevention training has been recognised as a central component supporting a comprehensive approach to suicide prevention. Limited literature exists exploring the role of suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Methods To determine the impact suicide prevention training for health staff may have in supporting refugee and asylum seeker suicide prevention, researchers undertook a rapid literature review exploring what elements should be considered when developing suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Results Results of academic and grey literature screening identified 14 studies exploring suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Findings of the literature review suggest suicide prevention training for health and support staff working with refugee and asylum seekers should consider the inclusion of content which increases participant competence and confidence to identify and respond to suicide risk; provide staff with an understanding of cultural differences and its impact on refugees and asylum seekers recognition of mental health and suicide as a health matter; highlight the importance trauma informed practices in care and consider the lived experience of refugees and asylum seekers. Conclusions Inclusion of specific content in refugee and asylum seeker suicide prevention training may provide health and support staff increased competence and confidence to identify and respond to suicide risk in refugees and asylum seekers.
Collapse
Affiliation(s)
| | - Bronte Lyford
- Everymind, 72 Watt St, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, University of Newcastle, College of Health, Medicine and Wellbeing, NSW, 2308, Callaghan, Australia
| | | | - Sally Fitzpatrick
- Everymind, 72 Watt St, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, University of Newcastle, College of Health, Medicine and Wellbeing, NSW, 2308, Callaghan, Australia
| |
Collapse
|
24
|
Huang T, Li H, Tan S, Xie S, Cheng Q, Xiang Y, Zhou X. The efficacy and acceptability of exposure therapy for the treatment of post-traumatic stress disorder in children and adolescents: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:259. [PMID: 35413848 PMCID: PMC9006570 DOI: 10.1186/s12888-022-03867-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 03/18/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is common among children and adolescents who have experienced traumatic events. Exposure therapy (ET) has been shown to be effective in treating PTSD in adults. However, its efficacy remains uncertain in children and adolescents. AIMS To evaluate the efficacy and acceptability of ET in children and adolescents with PTSD. METHOD We searched PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest, LILACS, and international trial registries for randomized controlled trials (RCTs) assessed ET in children and adolescents (aged ≤18 years) with PTSD up to August 31, 2020. The primary outcomes were efficacy (the endpoint score from PTSD symptom severity rating scales) and acceptability (all-cause discontinuation), secondary outcomes included efficacy at follow-up (score from PTSD scales at the longest point of follow-up), depressive symptoms (end-point score on depressive symptom severity rating scales) and quality of life/social functioning (end-point score on quality of life/social functioning rating scales). This study was registered with PROSPERO (CRD42020150859). RESULT A total of 6 RCTs (278 patients) were included. The results showed that ET was statistically more efficacious than control groups (standardized mean differences [SMD]: - 0.47, 95% confidence interval [CI]: - 0.91 to - 0.03). In subgroup analysis, exposure therapy was more efficacious for patients with single type of trauma (SMD: - 1.04, 95%CI: - 1.43 to - 0.65). Patients with an average age of 14 years and older, ET was more effective than the control groups (SMD: - 1.04, 95%CI: - 1.43 to - 0.65), and the intervention using prolonged exposure therapy (PE) (SMD: - 1.04, 95%CI: - 1.43 to - 0.65) was superior than control groups. Results for secondary outcomes of efficacy at follow-up (SMD: - 0.64, 95%CI: - 1.17 to - 0.10) and depressive symptoms (SMD: - 0.58, 95%CI: - 0.93 to - 0.22) were similar to the previous findings for efficacy outcome. No statistically significant effects for acceptability and quality of life/social functioning were found. CONCLUSION ET showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD. Patients with single type of trauma may benefit more from ET. And ET is more effective in patients 14 years or older. Moreover, PE could be a better choice.
Collapse
Affiliation(s)
- Tengyue Huang
- grid.203458.80000 0000 8653 0555Chongqing Medical University, Chongqing, China ,grid.452206.70000 0004 1758 417XDepartment of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haomiao Li
- grid.203458.80000 0000 8653 0555Chongqing Medical University, Chongqing, China ,grid.452206.70000 0004 1758 417XDepartment of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiyu Tan
- grid.203458.80000 0000 8653 0555Chongqing Medical University, Chongqing, China ,grid.452206.70000 0004 1758 417XDepartment of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siyu Xie
- grid.203458.80000 0000 8653 0555Chongqing Medical University, Chongqing, China ,grid.452206.70000 0004 1758 417XDepartment of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qisheng Cheng
- grid.203458.80000 0000 8653 0555Chongqing Medical University, Chongqing, China ,grid.452206.70000 0004 1758 417XDepartment of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yajie Xiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
25
|
Schafer KM, Daurio A, French JE, Rogers ML, Meltzer AL, Cougle JR, Joiner TE. The relationship between anger and suicidal ideation: Investigations in two samples. J Clin Psychol 2022; 78:1866-1877. [PMID: 35195280 DOI: 10.1002/jclp.23331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Suicidal ideation (SI) nearly always precedes lethal suicide attempts. Anger may play a role in SI, but this appears to vary by gender and nuances in this relationship are unclear. METHOD We investigated whether levels of (a) anger and (b) SI vary by gender, (c) the cross-sectional relationship between anger and SI, and (d) if gender moderates that relationship in two samples: adults seeking care for excessive anger (Study 1) and undergraduates endorsing previous suicide attempt (Study 2). RESULTS In Study 1, anger was more commonly endorsed in women; however, in Study 2, anger did not vary by gender. In both studies, SI did not vary by gender. Further, in both studies, anger and SI were positively related. The relationship between anger and SI did not vary by gender in either study. CONCLUSIONS The strength of the relationship between anger and SI did not vary by gender.
Collapse
Affiliation(s)
| | - Allison Daurio
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Juliana E French
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Megan L Rogers
- Icahn School of Medicine, Mount Sinai Beth Israel, New York City, New York, USA
| | - Andrea L Meltzer
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
26
|
Rasheduzzaman M, al-Mamun F, Hosen I, Akter T, Hossain M, Griffiths MD, Mamun MA. Suicidal behaviors among Bangladeshi university students: Prevalence and risk factors. PLoS One 2022; 17:e0262006. [PMID: 35025905 PMCID: PMC8758040 DOI: 10.1371/journal.pone.0262006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Bangladeshi university students are considered to be highly suicide-prone compared to other populations and cohorts. However, no prior epidemiological studies have assessed the suicidality (i.e., past-year suicidal ideation [SI], lifetime suicide plan [SP], and lifetime suicide attempt [SA]) among Bangladeshi students, including the variables such as past-year stressful life events and family mental health history. This is arguably a major knowledge gap in the country. Therefore, the present study investigated the prevalence and associated risk factors for suicidal behaviors among Bangladeshi university students. Methods A cross-sectional study was conducted utilizing a convenience sampling method among a total of 1844 university students between October and November 2019. Data were collected based on the information related to socio-demographics, perceived health-related questions, past-year stressful life events, family mental health history, and suicidal behaviors (i.e., SI, SP, and SA). Chi-square tests and binary logistic regressions were used to analyze the data utilizing SPSS statistical software. Results The prevalence of past-year suicidal ideation, lifetime suicide plans, and suicide attempts were 13.4%, 6.0%, and 4.4%, respectively. Females reported significantly higher suicidal behavior than males (i.e., 20.6% vs.10.2% SI; 9% vs. 4.6% SP; and 6.4% vs.3.6% SA). Risk factors for SI were being female, year of academic study, residing in an urban area, using psychoactive substances, experiencing both past year physical and mental illness, experiencing any type of stressful past-year life events, experiencing campus ragging (i.e., senior students abusing, humiliating and/or harassing freshers or more junior students), experiencing family mental illness history, and having family suicide attempt history. SP was associated with several factors including being female, year of academic study, using psychoactive substance, experiencing both past-year physical and mental illness, and experiencing any type of stressful past-year life events. Risk factors for SA were being female, year of academic study, using psychoactive substances, experiencing past-year mental illness, experiencing any type of stressful past-year life events, and having family suicide attempt history. Conclusions University students appear to be a vulnerable group for experiencing suicidal behaviors. The present findings warrant rigorous action and early intervention programs such as counseling and other mental health professional services by university authorities. Longitudinal studies are highly recommended involving countrywide representative samples.
Collapse
Affiliation(s)
- M. Rasheduzzaman
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, Bangladesh
| | - Firoj al-Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Ismail Hosen
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Tahmina Akter
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Moazzem Hossain
- Institute of Allergy and Clinical Immunology of Bangladesh, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
- * E-mail: (MAM); (MDG)
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- * E-mail: (MAM); (MDG)
| |
Collapse
|
27
|
Oakey-Frost DN, Harris JA, May AM, Bryan AO, Tucker RP, Bryan CJ. Internal entrapment and fearlessness about death as precipitants of suicidal thoughts and planning in the context of post-traumatic stress disorder. Suicide Life Threat Behav 2022; 52:147-158. [PMID: 34738655 DOI: 10.1111/sltb.12815] [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: 04/10/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between post-traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD). METHOD The cross-sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N = 2690). RESULTS Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past-month SI, and past-month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self-rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD. CONCLUSIONS Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE.
Collapse
Affiliation(s)
| | - Julia A Harris
- College of Social and Behavioral Sciences, The University of Utah, Salt Lake City, Utah, USA
| | - Alexis M May
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - AnnaBelle O Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
28
|
Karnick AT, Boska RL, Caulfield NM, Winchell R, Capron DW. Suicide and self-injury outcomes for patients with comorbid psychiatric and physical health conditions. Psychiatry Res 2022; 308:114345. [PMID: 34954501 DOI: 10.1016/j.psychres.2021.114345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
Suicide is a transdiagnostic public health issue that affects nearly all psychiatric disorders, individuals without a mental health diagnosis, and individuals with physical health issues. We assessed the relationship between these variables and suicide outcomes using a novel epidemiological research paradigm. Data were collected from the National Trauma Data Bank. Participants included patients admitted to trauma units for suicide and self-injury (n = 13,422). Patients were classified to one of four comorbid condition groups: no comorbidity, comorbid physical condition, comorbid major psychiatric condition, or multimorbidity (comorbid physical and psychiatric conditions). Multivariable logistic regression measured associations between comorbid condition and mortality and multivariable linear regression measured associations between comorbidity and injury severity. Mortality in patients with physical health comorbidity was not significant, but patients with psychiatric comorbidity or multimorbidity had significantly lower mortality than patients without either. No association between injury severity and comorbidity was detected. There were no differences in suicide mortality for individuals with a physical health comorbidity, but mortality was lower for individuals with a comorbid major psychiatric illness or multimorbidity. Since physical health conditions and psychiatric illness are associated with eventual suicide mortality, prevention strategies could target these populations at trauma units for suicide and self-injury admissions.
Collapse
Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA.
| | - Rachel L Boska
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort hill Avenue, Canandaigua, NY, 14424; Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Blvd., Rochester, NY, 14642
| | - Nicole M Caulfield
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| | - Robert Winchell
- Department of Surgery, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| |
Collapse
|
29
|
Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. J Trauma Stress 2021; 34:1080-1098. [PMID: 34881461 DOI: 10.1002/jts.22782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.
Collapse
Affiliation(s)
- Kelsi F Rugo-Cook
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| |
Collapse
|
30
|
Whiteman SE, Witte TK, Cero I, Kramer LB, Weathers FW. Posttraumatic Stress Disorder and Suicidal Ideation: The Moderating Effect of Posttraumatic Cognitions. J Trauma Stress 2021; 34:1178-1187. [PMID: 33025677 DOI: 10.1002/jts.22598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/02/2023]
Abstract
Although individuals with posttraumatic stress disorder (PTSD) are at an increased risk for suicidal ideation (SI), it is unclear what factors might influence this association. Investigators have hypothesized that posttraumatic cognitions (PTCs), such as self-blame (SB) or negative cognitions about the self (NCAS) or world (NCAW), would play a role, but this has not been investigated empirically. Accordingly, we evaluated a model in which the association between PTSD symptoms and SI was moderated by PTCs in a sample of trauma-exposed undergraduate students (N = 410). To identify the specific source of this hypothesized moderation effect, we ran the moderation model separately for PTSD total severity, PTSD total severity without the cognition-related items, and each of four DSM PTSD symptom clusters in combination with each of three types of PTCs (i.e., NCAS, NCAW, SB), accounting for quadratic effects. The results revealed that NCAW moderated the positive association between all six of the PTSD variables and SI, f2 s < .01 to .04. Analyses of simple slopes generally revealed strong positive associations between PTSD symptoms with SI at high levels of NCAW, no associations at moderate levels, and negative associations at low levels. We also found one statistically significant quadratic effect when examining avoidance and NCAW. In contrast, neither NCAS nor SB emerged as a significant moderator in any of our regression models. These findings highlight the importance of addressing PTCs-particularly NCAW-in trauma survivors.
Collapse
Affiliation(s)
- Sarah E Whiteman
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Tracy K Witte
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Ian Cero
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lindsay B Kramer
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Frank W Weathers
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| |
Collapse
|
31
|
Abstract
Abstract. Studies in patient or community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing disorder classification systems. This affects older people with traumatic experiences, who in their senescence report multiple mental disturbances and reduced quality of life. Thus, there is a need to develop age-appropriate diagnostic criteria for posttraumatic stress disorder (PTSD). To date, the new ICD-11 has done this only in a very rudimentary way. This article gives a brief historical overview and names the reasons for these diagnostic problems. Subsequently, it proposes six plus one (male-only) features to be dominant and life-stage specific in older adults: posttraumatic nightmares and reenactments, impaired sleep, painful memories of traumatically lost close persons, hypervigilance including elevated startle response, weakness or asthenia, somatoform pain or chronic primary pain, and in males only: reckless or self-destructive behavior. Finally, it outlines future steps to improve the adequate recognition of clinical presentations of trauma sequelae.
Collapse
|
32
|
Raman U, Bonanno PA, Sachdev D, Govindan A, Dhole A, Salako O, Patel J, Noureddine LR, Tu J, Guevarra-Fernández J, Leto A, Nemeh C, Patel A, Nicheporuck A, Tran A, Kennedy CA. Community Violence, PTSD, Hopelessness, Substance Use, and Perpetuation of Violence in an Urban Environment. Community Ment Health J 2021; 57:622-630. [PMID: 32737673 DOI: 10.1007/s10597-020-00691-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/18/2020] [Indexed: 11/26/2022]
Abstract
We investigated the relationships among chronic violence exposure, post-traumatic stress disorder (PTSD) symptom severity, hopelessness, substance use, and perpetuation of violence to facilitate the development of trauma-related interventions for residents of Newark, NJ. A convenience sample of Newark residents (N = 153) was recruited from community centers during various events in 2016-2017. Anonymous, self-report survey measures included a PTSD screen (PCL-C), Beck's Hopelessness Scale, the CAGE questionnaire, and a CDC Health Behavior Scale. Descriptive statistics, Pearson's correlations, Chi square analyses, logistic, and linear regressions were used for analysis. Thirty percent (95% CI [22.7, 37.4]) of our sample screened positive for PTSD. Drug and alcohol use, fighting, and hopelessness were related to severity of PTSD symptoms (p < 0.05). Female gender, CAGE scores, and hopelessness predicted the severity of PTSD symptoms (R2 = 0.354, p < 0.05). Our data has informed the development of a resilience support group currently in the pilot stage for community members.
Collapse
Affiliation(s)
- Uma Raman
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA.
- , Philadelphia, PA, USA.
| | - Philip A Bonanno
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Devika Sachdev
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Aparna Govindan
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Atharva Dhole
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | | | - Jay Patel
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Lama R Noureddine
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Jessica Tu
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | | | - Ashley Leto
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Christopher Nemeh
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Aesha Patel
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Alexis Nicheporuck
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Ashley Tran
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Cheryl A Kennedy
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| |
Collapse
|
33
|
Arenson M, Bernat E, De Los Reyes A, Neylan TC, Cohen BE. Social support, social network size, and suicidal ideation: A nine-year longitudinal analysis from the Mind Your Heart Study. J Psychiatr Res 2021; 135:318-324. [PMID: 33545566 DOI: 10.1016/j.jpsychires.2021.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Substantial research has investigated the impact of social support on the development and course of suicidal thoughts and behaviors. However, its measurement has been inconsistent, and different facets of social support may have differential effects on suicidal ideation (SI). The present study used data from 743 veterans recruited between 2008 and 2010 as part of the Mind Your Heart Study to investigate the relationship between two aspects of social support (social network size and perceived social support) and SI over 9 years. Using the 9th item of the PHQ-9, we created two composite scores: (1, chronicity) the proportion of years the participant endorsed SI and (2, severity) the severity of SI across the follow-up period. We found that, when modeled individually, both larger social network size and greater perceived social support predicted lower SI chronicity (β=-.16, β = -0.19 respectively; ps < .001) and lower SI severity (β=-0.15 and β = -0.19, respectively; ps < .001). However, when modeled together and controlling for PTSD and depression symptoms, increased social network size but not perceived social support predicted lower SI chronicity (β=-0.09, p = .01 and β = 0.02, p = .48, respectively) and SI severity (β=-0.07, p = .045 and β = 0.01, p = .71, respectively). These findings suggest that social network size may be an important target for intervention, and that future work is needed to better delineate the effect of different features of social support on risk for suicide.
Collapse
Affiliation(s)
- Melanie Arenson
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA; San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA.
| | - Edward Bernat
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA
| | - Andres De Los Reyes
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA
| | - Thomas C Neylan
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA; University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Beth E Cohen
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA; University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| |
Collapse
|
34
|
Carmassi C, Bertelloni CA, Dell'Oste V, Luperini C, Marazziti D, Rossi R, Dell'Osso L. PTSD and Suicidal Behaviors Amongst L'Aquila 2009 Earthquake Young Survivors. Front Public Health 2021; 9:590753. [PMID: 33643987 PMCID: PMC7902690 DOI: 10.3389/fpubh.2021.590753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is one of the most frequent and severe psychiatric consequences of natural disasters, frequently associated with suicidality. The aim of this study was at examining the possible relationships between suicidal behaviors and full-blown or partial PTSD, in a sample of young earthquake survivors. The second aim was at investigating the specific role of PTSD symptoms on suicidality. Methods: A total of 475 young adults who survived the L'Aquila 2009 earthquake, one of the most severe Italian disasters of the last decades, were recruited and assessed after 21 months from the catastrophe. Participants were evaluated by two questionnaires assessing subthreshold psychopathology, the Trauma and Loss Spectrum Self-Report (TALS-SR) to investigate both full and partial PTSD, and two specific Mood Spectrum Self-Report (MOODS-SR) sub-domains exploring suicidality, namely suicidal ideation and suicide attempts. Results: The ensuing findings showed that suicidal ideation and suicide attempts were present, respectively, in 40 (8.4%) and 11 (2.3%) survivors. Rates of suicidal ideation were significantly more elevated in full-blown PTSD subjects (group 1), as compared with those suffering from partial (group 2) or no PTSD (group 3). Interestingly, group 2 subjects showed significantly more suicidal ideation than healthy individuals, and less than those of group 1, while the frequency of suicide attempts was similar across the three groups. Suicidal ideation was associated with higher scores in the following TALS-SR domains: grief-reactions, re-experiencing, avoidance and numbing, maladaptive coping, and personal characteristics/risk factor. Conclusions: The results of the present study support and extend previous findings on the role of PTSD symptoms in suicidality after a severe earthquake. However, as compared with available literature, they also highlight the significant impact of sub-threshold PTSD manifestations in increasing the suicide risk in survivors of a mass disaster.
Collapse
Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Chiara Luperini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| |
Collapse
|
35
|
Bürgin D, Boonmann C, Schmeck K, Schmid M, Tripp P, Nishimi K, O’Donovan A. Compounding Stress: Childhood Adversity as a Risk Factor for Adulthood Trauma Exposure in the Health and Retirement Study. J Trauma Stress 2021; 34:124-136. [PMID: 33200440 PMCID: PMC7887022 DOI: 10.1002/jts.22617] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
Childhood adversity (CA) and adulthood traumatic experiences (ATEs) are common and unequally distributed in the general population. Early stressors may beget later stressors and alter life-course trajectories of stressor exposure. Gender differences exist regarding the risk of specific stressors. However, few studies have examined the associations between specific types of CA and ATEs. Using a large-scale sample of older adults, we aimed to (a) determine if specific or cumulative CA increased the risk for specific or cumulative ATEs and (b) examine whether these associations were moderated by gender. In a sample from the U.S. Health and Retirement Study (N = 15,717; Mage = 67.57 years, SD = 10.54), cross-sectional Poisson and logistic regression models were fitted to assess the specific and cumulative associations between CA and ATEs. Overall, cumulative CA was associated with a larger risk ratio of ATEs, adjusted for covariates: aRRRs = 1.28, 1.63, and 1.97 for 1, 2, and 3-4 adverse events in childhood, respectively. Cumulative CA was particularly strongly associated with adulthood physical attacks, aOR = 5.66, and having a substance-abusing spouse or child, aOR = 4.00. Childhood physical abuse was the strongest independent risk factor for cumulative ATEs, aRRR = 1.49, and most strongly associated with adulthood physical attacks, aOR = 3.41. Gender moderated the association between cumulative CA and cumulative ATEs, with slightly stronger associations between cumulative CA and ATEs for women than men. Given that CA and ATEs perpetuate health disparities worldwide, reducing their incidence and effects should be major priorities for public health.
Collapse
Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Paige Tripp
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kristen Nishimi
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Aoife O’Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| |
Collapse
|
36
|
Stanley IH, Marx BP, Keane TM, Vujanovic AA. PTSD symptoms among trauma-exposed adults admitted to inpatient psychiatry for suicide-related concerns. J Psychiatr Res 2021; 133:60-66. [PMID: 33310501 PMCID: PMC7856162 DOI: 10.1016/j.jpsychires.2020.12.001] [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] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Abstract
Individuals admitted to inpatient psychiatry for suicide-related concerns are at increased risk of suicide post-discharge, necessitating an understanding of factors, such as posttraumatic stress disorder (PTSD), that are associated with suicide-related hospitalizations. In this study, we examined if individuals admitted for suicide-related concerns were more likely than those admitted for other reasons to have elevated PTSD symptoms or a probable PTSD diagnosis. We also examined the moderating role of impulsivity. Participants were 188 trauma-exposed adult psychiatric inpatients (M [SD]age = 33.6 y [11.7 y], 63.3% male, 46.3% white). We used the Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, Beck Scale for Suicide Ideation, and Barratt Impulsiveness Scale-11 to assess trauma exposure, PTSD symptoms, suicidal ideation severity, and impulsivity, respectively. We controlled for trauma load, number of psychiatric diagnoses, and comorbid depressive and substance use disorders. Patients admitted for suicide-related concerns (55.3%; n = 104), compared with those admitted for other reasons (44.7%; n = 84), had more severe PTSD symptoms, corresponding to medium-to-large effect sizes; associations were stronger at higher levels of impulsivity. Additionally, patients admitted for suicide-related concerns were nearly four times more likely than their counterparts to screen positive for a provisional PTSD diagnosis. Among the subset of individuals admitted for suicide-related concerns, greater PTSD symptoms were associated with more severe suicidal ideation. In sum, PTSD symptoms are elevated among psychiatric inpatients admitted for suicide-related concerns, and among this subgroup, greater PTSD symptom severity covaries with suicidal ideation severity. Screening for and treating PTSD, and attending to cooccurring impulsivity, in psychiatric inpatients may reduce suicide risk.
Collapse
Affiliation(s)
- Ian H Stanley
- Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA.
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, USA; National Center for PTSD, VA Boston Healthcare System, USA
| | | |
Collapse
|
37
|
Kwon A, Lee HS, Lee SH. The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD. Front Psychiatry 2021; 12:613735. [PMID: 33841200 PMCID: PMC8032896 DOI: 10.3389/fpsyt.2021.613735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis. Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide. Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression. Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.
Collapse
Affiliation(s)
- Aeran Kwon
- Department of Social Welfare and Counseling, Chodang University, Muan, South Korea
| | - Hyun Seo Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, South Korea.,Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, South Korea
| |
Collapse
|
38
|
Morabito DM, Boffa JW, Bedford CE, Chen JP, Schmidt NB. Hyperarousal symptoms and perceived burdensomeness interact to predict suicidal ideation among trauma-exposed individuals. J Psychiatr Res 2020; 130:218-223. [PMID: 32841904 DOI: 10.1016/j.jpsychires.2020.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
The association between posttraumatic stress disorder (PTSD) and suicidal ideation is well-established and recent prospective studies have demonstrated the unique role of hyperarousal symptoms. In particular, over-arousal may elevate suicide risk in the presence of interpersonal vulnerability factors including thwarted belongingness, perceived burdensomeness, and acquired capability. Therefore, the current study sought to examine the differential associations between PTSD symptom clusters and suicidality and the impact of interpersonal risk factors. Trauma-exposed adults (N = 247) completed a questionnaire battery at baseline and three-month follow-up, as part of a larger randomized controlled trial of computerized interventions for suicide risk. Given the focus of the current study, treatment condition was controlled for in all analyses. Results indicated that hyperarousal symptoms significantly predict suicidality, while reexperiencing and avoidance symptoms do not. Specifically, greater hyperarousal symptoms predicted increased suicidal ideation among individuals with high perceived burdensomeness. Although the interaction effect was not significant, hyperarousal symptoms were also pertinent among individuals with high acquired capability. Taken together, findings suggest that assessment of hyperarousal symptoms and perceived burdensomeness may serve to identify trauma-exposed individuals at greater risk for suicide. Additionally, these factors may serve as effective intervention targets.
Collapse
Affiliation(s)
- Danielle M Morabito
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA.
| | - Joseph W Boffa
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA
| | - Carter E Bedford
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA
| | - Jimmy P Chen
- Furman University, 3300 Poinsett Hwy, Greenville, SC, USA, 29613
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306, USA
| |
Collapse
|
39
|
Nichter B, Hill M, Norman S, Haller M, Pietrzak RH. Associations of childhood abuse and combat exposure with suicidal ideation and suicide attempt in U.S. military veterans: a nationally representative study. J Affect Disord 2020; 276:1102-1108. [PMID: 32777648 DOI: 10.1016/j.jad.2020.07.120] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Military veterans with a history of childhood abuse are at increased risk for suicidality. To date, however, little research has examined whether exposure to childhood abuse may heighten veterans' susceptibility to the effects of combat exposure and increase risk for suicidal behavior. This study examined whether childhood abuse has an additive or interactive effect on the association between combat exposure and suicide-related outcomes in a national sample of veterans. METHODS Data were from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 3,157). Analyses compared veterans with/without current suicidal ideation and lifetime suicide attempts (SI/SA) on sociodemographic, military, and clinical characteristics; and examined the unique contribution of childhood physical and sexual abuse and combat exposure, and their interaction, with SI/SA. RESULTS After adjusting for sociodemographic characteristics and lifetime trauma burden, a significant interaction emerged between childhood sexual abuse and combat exposure predicting SI, such that combat-exposed veterans with histories of abuse were nearly three times more likely to currently be contemplating suicide relative to those without such histories. Childhood sexual abuse predicted lifetime suicide attempt, above and beyond sociodemographic characteristics, lifetime trauma burden, and combat exposure. LIMITATIONS Cross-sectional design precludes causal inference. CONCLUSIONS Results indicate that childhood sexual abuse exposure may operate both independently and synergistically with combat exposure to increase risk for suicidality among veterans. Findings suggest that veterans who experience childhood sexual abuse represent a subgroup that may be especially vulnerable to experiencing suicidal ideation following combat exposure.
Collapse
Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California, San Diego, CA 92093, United States.
| | - Melanie Hill
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Sonya Norman
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; National Center for PTSD, White River Junction, VT, United States; VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States
| | - Moira Haller
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
40
|
Stange JP, Jenkins LM, Pocius S, Kreutzer K, Bessette KL, DelDonno SR, Kling LR, Bhaumik R, Welsh RC, Keilp JG, Phan KL, Langenecker SA. Using resting-state intrinsic network connectivity to identify suicide risk in mood disorders. Psychol Med 2020; 50:2324-2334. [PMID: 31597581 PMCID: PMC7368462 DOI: 10.1017/s0033291719002356] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the neural substrates of suicide risk in mood disorders. Improving the identification of biomarkers of suicide risk, as indicated by a history of suicide-related behavior (SB), could lead to more targeted treatments to reduce risk. METHODS Participants were 18 young adults with a mood disorder with a history of SB (as indicated by endorsing a past suicide attempt), 60 with a mood disorder with a history of suicidal ideation (SI) but not SB, 52 with a mood disorder with no history of SI or SB (MD), and 82 healthy comparison participants (HC). Resting-state functional connectivity within and between intrinsic neural networks, including cognitive control network (CCN), salience and emotion network (SEN), and default mode network (DMN), was compared between groups. RESULTS Several fronto-parietal regions (k > 57, p < 0.005) were identified in which individuals with SB demonstrated distinct patterns of connectivity within (in the CCN) and across networks (CCN-SEN and CCN-DMN). Connectivity with some of these same regions also distinguished the SB group when participants were re-scanned after 1-4 months. Extracted data defined SB group membership with good accuracy, sensitivity, and specificity (79-88%). CONCLUSIONS These results suggest that individuals with a history of SB in the context of mood disorders may show reliably distinct patterns of intrinsic network connectivity, even when compared to those with mood disorders without SB. Resting-state fMRI is a promising tool for identifying subtypes of patients with mood disorders who may be at risk for suicidal behavior.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Runa Bhaumik
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - K. Luan Phan
- University of Illinois at Chicago, Chicago, IL, USA
| | | |
Collapse
|
41
|
Favril L, Stoliker B, Vander Laenen F. What Differentiates Prisoners Who Attempt Suicide from Those Who Experience Suicidal Ideation? A Nationally Representative Study. Suicide Life Threat Behav 2020; 50:975-989. [PMID: 32364639 DOI: 10.1111/sltb.12638] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/23/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Many people who think about suicide do not engage in suicidal behavior. Identifying risk factors implicated in the process of behavioral enaction is crucial for suicide prevention, particularly in high-risk groups such as prisoners. METHOD Cross-sectional data were drawn from a nationally representative sample of 17,891 prisoners (79% men) in the United States. We compared prisoners who attempted suicide (attempters; n = 2,496) with those who thought about suicide but never made an attempt (ideators; n = 1,716) on a range of established risk factors. RESULTS More than half (59%) of participants who experienced suicidal ideation had also attempted suicide. Violent offending, trauma, brain injury, alcohol abuse, and certain mental disorders distinguished attempters from ideators. CONCLUSION Our results fit within recent ideation-to-action theories that emphasize the role of a capability for suicide in the transition from thoughts to acts of suicide.
Collapse
Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Bryce Stoliker
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | | |
Collapse
|
42
|
Cooper SA, Szymanski BR, Bohnert KM, Sripada RK, McCarthy JF. Association Between Positive Results on the Primary Care-Posttraumatic Stress Disorder Screen and Suicide Mortality Among US Veterans. JAMA Netw Open 2020; 3:e2015707. [PMID: 32880649 PMCID: PMC7489804 DOI: 10.1001/jamanetworkopen.2020.15707] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Suicide rates are higher among veterans compared with nonveterans, and the prevalence of posttraumatic stress disorder (PTSD) is higher among veterans compared with the general adult population in the US. To date, no study has examined the association between PTSD screening results and suicide mortality among veterans. OBJECTIVE To examine whether veterans receiving care in the US Veterans Health Administration (VHA) health system who had positive results on the Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD) had a greater risk of suicide mortality compared with those who had negative results and to assess whether such risk decreased over time. DESIGN, SETTING, AND PARTICIPANTS Multivariable proportional hazards regression models were used to evaluate suicide mortality risk through December 31, 2016, among a cohort of veterans who received the PC-PTSD in the VHA health system. The VHA administers the PC-PTSD to patients nationwide, and screening results are routinely documented in the VHA Corporate Data Warehouse. The PC-PTSD includes 4 questions regarding PTSD symptoms, to which patients respond with either a positive (yes) or negative (no) answer. All patients who completed the PC-PTSD in 2014 and who did not have a diagnosis of PTSD in the year before screening were included in the analysis. A score of 3 or 4 on the PC-PTSD indicated a positive result, and a score of 0, 1, or 2 indicated a negative result. Data collection and analyses were performed from November 13, 2018, to June 18, 2019. EXPOSURES Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD). MAIN OUTCOMES AND MEASURES Suicide mortality risk, as assessed through data obtained from the US Veterans Affairs/Department of Defense Mortality Data Repository. RESULTS A total of 1 693 449 PC-PTSDs were completed by 1 552 581 individual veteran patients in 2014. Most of the patients were White (73.9%), married (52.2%), male (91.1%), 55 years or older (62.5%), and had completed only 1 PC-PTSD (92.1%). In multivariable analyses, positive PC-PTSD results (ie, total scores of 3 or 4) were associated with a 58% increase in the risk of suicide mortality at 1 day after screening (hazard ratio [HR], 1.58; 95% CI, 1.19-2.10) and a 26% increase in the risk of suicide mortality at 1 year after screening (HR, 1.26; 95% CI, 1.07-1.48). A positive response on item 4 ("felt numb or detached from others, activities, or your surroundings") of the PC-PTSD was associated with a 70% increase in suicide mortality risk at 1 day after screening (HR, 1.70; 95% CI, 1.27-2.28). CONCLUSIONS AND RELEVANCE Positive PC-PTSD results, and specifically reports of feeling numb or detached, were associated with increases in the risk of suicide mortality. These associations decreased over time. The findings of this study can inform interpretation of PC-PTSD responses and suggest the importance of recent improvements made to the VHA suicide risk assessment.
Collapse
Affiliation(s)
- Samantha A. Cooper
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Benjamin R. Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Kipling M. Bohnert
- Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Rebecca K. Sripada
- Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - John F. McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, Michigan
- Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan, Ann Arbor
| |
Collapse
|
43
|
Stanley IH, Hom MA, Marx BP, Reger MA. Post‐traumatic stress disorder and firearm ownership, access, and storage practices: A systematic review. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Real-Time Stress Assessment Using Sliding Window Based Convolutional Neural Network. SENSORS 2020; 20:s20164400. [PMID: 32784531 PMCID: PMC7472011 DOI: 10.3390/s20164400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023]
Abstract
Mental stress has been identified as a significant cause of several bodily disorders, such as depression, hypertension, neural and cardiovascular abnormalities. Conventional stress assessment methods are highly subjective and tedious and tend to lack accuracy. Machine-learning (ML)-based computer-aided diagnosis systems can be used to assess the mental state with reasonable accuracy, but they require offline processing and feature extraction, rendering them unsuitable for real-time applications. This paper presents a real-time mental stress assessment approach based on convolutional neural networks (CNNs). The CNN-based approach afforded real-time mental stress assessment with an accuracy as high as 96%, the sensitivity of 95%, and specificity of 97%. The proposed approach is compared with state-of-the-art ML techniques in terms of accuracy, time utilisation, and quality of features.
Collapse
|
45
|
Liu A, Wang W, Wu X. Understanding the Relation Between Self-Compassion and Suicide Risk Among Adolescents in a Post-disaster Context: Mediating Roles of Gratitude and Posttraumatic Stress Disorder. Front Psychol 2020; 11:1541. [PMID: 32765352 PMCID: PMC7378767 DOI: 10.3389/fpsyg.2020.01541] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background The suicide risk among adolescents post-earthquake remains an important issue in trauma psychology. While existing studies and theories suggest that factors such as self-compassion, gratitude, and posttraumatic stress disorder (PTSD) play roles in the risk of suicide, few studies have combined these factors to explore the relationship between them. Objective This study examined the mediating roles of gratitude and PTSD in the relationship between self-compassion and suicide risk among Chinese adolescents after the Ya’an earthquake. Methods Four and a half years after the Ya’an earthquake, 499 middle school students in Lushan County were assessed using the following systems: Measures of Self-Compassion Scale, Gratitude Questionnaire, PTSD Checklist for DSM-5, and Child Behavior Problems Questionnaire. Results When we controlled for gender, age, and traumatic exposure, in the direct effect model, positive self-compassion had a negative effect on suicide risk, and negative self-compassion had a positive effect on suicide risk. In the indirect effects model, both positive self-compassion and negative self-compassion had no significant direct effect on suicide risk. Moreover, we found an indirect and negative effect of positive self-compassion on suicide risk via gratitude and PTSD, as well as via an indirect path from gratitude to PTSD. On the other hand, we also found an indirect and positive effect of negative self-compassion on suicide risk via gratitude and PTSD, as well as via an indirect path from gratitude to PTSD. Conclusion Positive self-compassion reduces the risk of suicide, while negative self-compassion increases the risk of suicide. Gratitude and PTSD play significant mediating role between self-compassion and suicide risk.
Collapse
Affiliation(s)
- Aiyi Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| |
Collapse
|
46
|
Dillon KH, Van Voorhees EE, Dennis PA, Glenn JJ, Wilks CR, Morland LA, Beckham JC, Elbogen EB. Anger mediates the relationship between posttraumatic stress disorder and suicidal ideation in veterans. J Affect Disord 2020; 269:117-124. [PMID: 32250864 PMCID: PMC7234813 DOI: 10.1016/j.jad.2020.03.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Theoretical models and cross-sectional empirical studies of suicide indicate that anger is a factor that may help explain the association between posttraumatic stress disorder (PTSD) and suicide, but to date no longitudinal studies have examined this relationship. The current study used longitudinal data to examine whether changes in anger mediated the association between changes in PTSD symptomatology and suicidal ideation (SI). METHODS Post 9/11-era veterans (N = 298) were assessed at baseline, 6-months, and 12-month time points on PTSD symptoms, anger, and SI. Analyses covaried for age, sex, and depressive symptoms. Multilevel structural equation modeling was used to examine the three waves of data. RESULTS The effect of change in PTSD symptoms on SI was reduced from B = 0.02 (p = .008) to B = -0.01 (p = .67) when change in anger was added to the model. Moreover, the indirect effect of changes in PTSD symptoms on suicidal ideation via changes in anger was significant, B = 0.02, p = .034. The model explained 31.1% of the within-person variance in SI. LIMITATIONS Focus on predicting SI rather than suicidal behavior. Sample was primarily male. CONCLUSIONS Findings suggest that the association between PTSD and SI is accounted for, in part, by anger. This study further highlights the importance of anger as a risk factor for veteran suicide. Additional research on clinical interventions to reduce anger among veterans with PTSD may be useful in reducing suicide risk.
Collapse
Affiliation(s)
- Kirsten H Dillon
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States.
| | - Elizabeth E Van Voorhees
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| | - Paul A Dennis
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| | - Jeffrey J Glenn
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States
| | | | - Leslie A Morland
- University of California, San Diego, La Jolla, CA, United States; National Center for PTSD, Pacific Islands Division, Honolulu, HI, United States
| | - Jean C Beckham
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| | - Eric B Elbogen
- Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, United States; Duke University Medical Center, Durham, NC, United States
| |
Collapse
|
47
|
Lieberman L, Funkhouser CJ, Gorka SM, Liu H, Correa KA, Berenz EC, Phan KL, Shankman SA. The Relation Between Posttraumatic Stress Symptom Severity and Startle Potentiation to Predictable and Unpredictable Threat. J Nerv Ment Dis 2020; 208:397-402. [PMID: 32053566 PMCID: PMC10627509 DOI: 10.1097/nmd.0000000000001138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aberrant threat reactivity has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD); however, the literature on this association is mixed. One factor that may contribute to this inconsistent association is differences in severity of posttraumatic stress symptoms (PTSSs) across studies, but no studies have tested this hypothesis. The relation between PTSD and threat reactivity may also differ between unpredictable threats (U-threats) and predictable threats (P-threats), given burgeoning evidence to support a particular role for aberrant responding to U-threat in PTSD. The present study examined how PTSS severity relates to startle potentiation to U-threat and P-threat in a trauma-exposed community sample (N = 258). There was a negative linear, but not quadratic, relation between PTSS severity and startle potentiation to U-threat, but not P-threat. Blunted defensive responding to U-threat may therefore contribute to higher levels of PTSSs and may represent a novel treatment target for higher levels of PTSSs.
Collapse
Affiliation(s)
- Lynne Lieberman
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
| | | | - Stephanie M. Gorka
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
| | - Huiting Liu
- Department of Psychology, University of Illinois-Chicago
| | | | - Erin C. Berenz
- Department of Psychology, University of Illinois-Chicago
| | - K. Luan Phan
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
- Anatomy and Cell Biology and the Graduate Program in Neuroscience, University of Illinois-Chicago
- Jesse Brown VA Medical Center, Mental Health Service Line
| | - Stewart A. Shankman
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
| |
Collapse
|
48
|
Jankovic J, Bremner S, Bogic M, Lecic-Tosevski D, Ajdukovic D, Franciskovic T, Galeazzi G, Kucukalic A, Morina N, Popovski M, Schützwohl M, Priebe S. Trauma and suicidality in war affected communities. Eur Psychiatry 2020; 28:514-20. [DOI: 10.1016/j.eurpsy.2012.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 05/12/2012] [Accepted: 06/05/2012] [Indexed: 11/15/2022] Open
Abstract
AbstractPurposeThe aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered.Materials and methodsIn the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed.ResultsIn the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%).Discussion and conclusionsNumber of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war.
Collapse
|
49
|
Baer MM, Tull MT, Forbes CN, Richmond JR, Gratz KL. Methods Matter: Nonsuicidal Self-Injury in the Form of Cutting is Uniquely Associated with Suicide Attempt Severity in Patients with Substance Use Disorders. Suicide Life Threat Behav 2020; 50:397-407. [PMID: 31621951 PMCID: PMC7148192 DOI: 10.1111/sltb.12596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the robust relation between nonsuicidal self-injury (NSSI) and suicidal behaviors, there is considerable heterogeneity in NSSI characteristics that may have implications for the strength of the NSSI-suicide attempt relation. Past research highlights the relevance of both more severe NSSI methods and NSSI in the form of cutting in particular to suicide attempts. To further explore the relations of specific NSSI methods to suicide attempts, this study examined relations between different NSSI methods (i.e., those involving cutting, burning, blunt force, or resulting in minor tissue damage) and both overall suicide attempts and two indicators of suicide attempt severity (attempts requiring medical attention and nonambivalent attempts) in 203 substance-dependent patients in residential treatment. METHOD Participants were administered questionnaires and semistructured interviews assessing the variables of interest. RESULTS Cutting was the only NSSI method to demonstrate significant relations with overall suicide attempts, nonambivalent suicide attempts, and suicide attempts requiring medical attention. Results remained when considering relevant covariates. CONCLUSION Results highlight an important link between NSSI methods involving cutting and suicide attempts among patients with substance use disorders. Findings also highlight the importance of more fine-grained characterizations of NSSI subgroups.
Collapse
Affiliation(s)
| | - Matthew T. Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA,Address correspondence to: Matthew T. Tull, Ph.D., Department of Psychology, Mail Stop 948, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio 43606; Telephone: 419-530-4392; Fax: 419-530-8479;
| | | | | | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| |
Collapse
|
50
|
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.
Collapse
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
| |
Collapse
|