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Menon V, Balasubramanian I, Rogers ML, Grover S, Lakdawala B, Ranjan R, Sarkhel S, Nebhinani N, Kallivayalil RA, Raghavan V, Mishra KK, Aneja J, Abhivant N, Deep R, Singh LK, De Sousa A, Nongpiur A, Subramanyam AA, Mohapatra D, Kar SK, Dhiman V, Kumar PS, Shreekantiah U, Bhandari SS, Ransing R, Ramasubramanian V, Praharaj SK. Psychometric properties and factor structure of the suicidal narrative inventory in major depression: A multicentric evaluation. Asian J Psychiatr 2024; 95:104002. [PMID: 38492443 DOI: 10.1016/j.ajp.2024.104002] [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: 01/28/2024] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Suicidal Narrative Inventory (SNI) is a 38-item self-report measure developed to assess elements of the suicidal narrative, a subacute, predominantly cognitive, presuicidal construct. Our objectives were to assess the factor structure, validity, and reliability of the SNI-38 among adults with major depressive disorder (MDD). METHODS Using a cross-sectional design, we administered the Hindi version of the SNI along with other self-report measures to adults with MDD, recruited from 24 tertiary care hospitals across India. Confirmatory factor analysis (CFA) was performed to assess the factor structure of SNI-38. Reliability (internal consistency) was assessed using Cronbach's alpha (α). Convergent, discriminant, and criterion validity of the SNI-38 were tested by comparing it against other appropriate measures. RESULTS We collected usable responses from 654 Hindi-speaking participants (Mean age = 36.9 ± 11.9 years, 50.2% female). The eight-factor solution of the SNI showed good model fit indices (χ2[637] = 3345.58, p <.001, CFI =.98, and RMSEA =.08). Internal consistencies for the SNI subscale scores were good to excellent, α ranging from .73 to.92. While most subscales significantly converged with other measures, associations were comparatively weaker and inconsistent for the 'thwarted belongingness' and 'goal reengagement' subscales. CONCLUSION Consistent with prior data, our study confirmed an eight-factor solution and demonstrated adequate psychometric properties for the Hindi version of the SNI-38 in our sample. These findings provide empirical support for the use of SNI to assess the suicidal narrative among Indian adults with MDD.
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Affiliation(s)
- Vikas Menon
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - Ilambaridhi Balasubramanian
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Megan L Rogers
- Dept of Psychology, Texas State University, TX 78666-4684, USA
| | - Sandeep Grover
- Dept of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India
| | - Bhavesh Lakdawala
- Dept of Psychiatry, Narendra Modi Medical College, Ahmedabad 380006, India
| | - Rajeev Ranjan
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Patna 801507, India
| | - Sujit Sarkhel
- Dept of Psychiatry, Institute of Psychiatry, Kolkata 700025, India
| | - Naresh Nebhinani
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, India
| | - Roy Abraham Kallivayalil
- Dept of Psychiatry, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala 689101, India
| | - Vijaya Raghavan
- Dept of Psychiatry, Schizophrenia Research Foundation (SCARF), Chennai 600101, India
| | - Kshirod Kumar Mishra
- Dept of Psychiatry, Mahatma Gandhi Institute of Medical Science (MGIMS), Sevagram, Maharashtra 442102, India
| | - Jitender Aneja
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhatinda, Punjab 151001, India
| | - Niteen Abhivant
- Dept of Psychiatry, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune 411011, India
| | - Raman Deep
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Delhi 110029, India
| | - Lokesh Kumar Singh
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh 492009, India
| | - Avinash De Sousa
- Dept of Psychiatry, Lokmanya Tilak Municipal Medical College (LTMMC), Mumbai 400022, India
| | - Arvind Nongpiur
- Dept of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya 793018, India
| | - Alka A Subramanyam
- Dept of Psychiatry, Topiwala National Medical College (TNMC) and Bai Yamunabai Laxman (BYL) Nair Medical College, Mumbai 400008, India
| | - Debadatta Mohapatra
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019, India
| | - Sujita Kumar Kar
- Dept of Psychiatry, King George's Medical University (KGMU), Lucknow, Uttar Pradesh 226003, India
| | - Vishal Dhiman
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203, India
| | - Pn Suresh Kumar
- Dept of Psychiatry, Iqraa International Hospital and Research Center, Calicut, Kerala 673009, India
| | - Umesh Shreekantiah
- Dept of Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, Jharkhand 834006, India
| | - Samrat Singh Bhandari
- Dept of Psychiatry, Sikkim Manipal Institute of Medical Sciences (SMIMS), Sikkim Manipal University, Tadong, Gangtok, Sikkim 737102, India
| | - Ramdas Ransing
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Guwahati, Assam 781101, India
| | | | - Samir Kumar Praharaj
- Dept of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Brausch AM, Muehlenkamp JJ, Fergerson AK, Laves EH, Whitfield MB, Clapham RB. Examining Nonsuicidal Self-Injury Features as Motivational Moderators in the Relationship Between Hopelessness and Suicide Ideation. Arch Suicide Res 2022; 26:1108-1121. [PMID: 33296294 PMCID: PMC8187477 DOI: 10.1080/13811118.2020.1853638] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Nonsuicidal self-injury (NSSI) is a robust predictor of suicide ideation and attempts, but it is not clear how and why this connection is so strong. Using the Integrated Motivational-Volitional Model of suicide as a framework, select features of NSSI were examined as motivational moderators between hopelessness and suicide ideation. METHOD Data were collected from 420 emerging adults (mean age = 18.9; 84% female, 92% white), all of whom had past-year NSSI. Participants completed self-report measures that assessed NSSI and suicide history, effectiveness of NSSI in achieving functions, and hopelessness; they also completed the self-injury Implicit Association Test (IAT). RESULTS Moderation analyses revealed that none of the interactions were significant. Additional analyses tested unconditional effects of all predictor variables and found hopelessness, self-rated future likelihood of engaging in NSSI, effectiveness of NSSI in achieving intrapersonal functions, and self-injury IAT scores were each significantly associated with suicide ideation. CONCLUSIONS These results reinforce the important role of hopelessness, perceived effectiveness of NSSI in achieving intrapersonal functions, acknowledgement of future NSSI, and self-identification with NSSI as potential indicators of increased suicide risk, while also emphasizing further study of other possible moderating factors.HIGHLIGHTSFeatures of NSSI did not moderate the hopelessness-suicide ideation relationship.Features of NSSI did associate with increased suicide ideation frequency.Future likelihood of, implicit association with, and intrapersonal effectiveness of NSSI were important.
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4
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Cohen LJ, Mokhtar R, Richards J, Hernandez M, Bloch-Elkouby S, Galynker I. The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk. Suicide Life Threat Behav 2022; 52:231-243. [PMID: 34766360 DOI: 10.1111/sltb.12816] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events can trigger a specific progression of cognitive-affective responses (the suicidal narrative and the suicide crisis syndrome), resulting in increased near-term risk of suicidal thoughts and behavior (STB). Identification of each step in this progression provides opportunities for more precise interventions. Concurrent validity was tested with 732 psychiatric patients and predictive validity with 524 participants, assessed one to two months later. Chronic risk factors were measured with the Childhood Trauma Questionnaire, Relationship Styles Questionnaire, and UPPS-P Impulsive Behavior Scale; acute risk factors with the Stressful Life Events Questionnaire, Suicide Narrative Inventory, and Suicide Crisis Inventory. The Columbia Suicide Severity Rating Scale was administered at the initial research assessment and follow-up. Indirect effects were significant for the full model and most pathways, in both concurrent and prospective analyses. In sum, this study provides empirical support for a novel, stepwise model of the progression from chronic to near-term suicidal risk.
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Affiliation(s)
- Lisa Janet Cohen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Mount Sinai Beth Israel, New York, New York, USA
| | - Radwa Mokhtar
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Jenelle Richards
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York, USA
| | - Michelle Hernandez
- Department of Psychology, The City College of New York, New York, New York, USA
| | | | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Mount Sinai Beth Israel, New York, New York, USA
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5
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Kirtley OJ, Lafit G, Vaessen T, Decoster J, Derom C, Gülöksüz S, De Hert M, Jacobs N, Menne-Lothmann C, Rutten BPF, Thiery E, van Os J, van Winkel R, Wichers M, Myin-Germeys I. The relationship between daily positive future thinking and past-week suicidal ideation in youth: An experience sampling study. Front Psychiatry 2022; 13:915007. [PMID: 36245862 PMCID: PMC9556869 DOI: 10.3389/fpsyt.2022.915007] [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: 04/07/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Reduced positive future thinking has been associated with suicidal ideation and behavior in adults, and appears to be exacerbated by negative affect. Yet, this has received little attention in youth. Prior research has also focused on longer-term future thinking, e.g., months and years, and relied on lab-based assessments. Using the experience sampling method (ESM), we investigated whether short-term future thinking in daily life was associated with suicidal ideation in youth and explored the role of affect in the future thinking-suicidal ideation relationship. A community sample of N = 722 adolescent twins and their non-twin siblings completed ESM as part of the TwinssCan study (n = 55 with, and n = 667 without, past-week suicidal ideation). Participants completed self-report questionnaires, including on past-week suicidal ideation as part of the SCL-90. Subsequently, daily future thinking was assessed each morning for six days with ESM. To investigate the relationship between daily positive future thinking and past-week suicidal ideation, we estimated a mixed-effects linear regression model with a random intercept for participant, including age and sex as covariates. The relationship between daily positive future thinking, past-week suicidal ideation, and average positive and negative affect from the previous day was investigated by estimating two separate mixed-effects linear regression models (one for negative affect, one for positive affect), with a random intercept for participant, and random slopes for average positive and negative affect. Our results showed that participants reporting higher past-week suicidal ideation also reported significantly less daily positive future thinking during the ESM period, and this association remained significant when controlling for previous-day average positive and negative affect. Higher average positive affect from the previous day was significantly associated with higher positive future thinking. Although average negative affect from the previous day was associated with lower positive future thinking, this association was not statistically significant. Our findings indicate that short-term future thinking relates to suicidal ideation among a non-clinical sample of adolescents. Future research should investigate the directionality of the future thinking-suicidal ideation relationship, in order to investigate whether impaired future thinking may be an early warning signal for escalating suicidal ideation in youth.
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Affiliation(s)
- Olivia J Kirtley
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | | | - Catherine Derom
- Department of Human Genetics, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Sinan Gülöksüz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Marc De Hert
- Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Nele Jacobs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands.,Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
| | - Claudia Menne-Lothmann
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health and Teaching Network, EURON, Maastricht University, Maastricht, Netherlands.,Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Ruud van Winkel
- University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, Katholieke Universiteit Leuven, Leuven, Belgium
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Brüdern J, Glaesmer H, Berger T, Spangenberg L. Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments. Front Psychiatry 2022; 13:899500. [PMID: 36518367 PMCID: PMC9742465 DOI: 10.3389/fpsyt.2022.899500] [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: 03/18/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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Utilising the Integrated Motivational Volitional (IMV) model to guide CBT practitioners in the use of their core skills to assess, formulate and reduce suicide risk factors. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Cognitive behavioural therapists based in primary care are not usually expected to provide therapy to acutely suicidal individuals or work directly on suicidal thoughts. However, all practitioners should be vigilant about suicide risk and potentially help to reduce vulnerabilities to future suicide risk as part of their routine work. Many of the risk factors and processes hypothesised to play a role in the development of suicidal thinking and behaviours are likely to be evident within the usual content of standard evidence-based protocols for depression or anxiety disorders. In this paper we are suggesting that even within the current primary care remit, (i) an increased awareness of suicide risk vulnerability factors and (ii) using knowledge of a psychological model of suicidal behaviour to inform clinical care are likely to be extremely helpful in structuring clinical formulation and informing interventions.
Key learning aims
(1)
To understand the IMV model and the factors associated with suicidal thoughts and suicidal behaviour.
(2)
To understand how core CBT skills and interventions can address these factors.
(3)
To support CBT practitioners in using their current CBT knowledge and skills in the service of reducing the risk of suicidal behaviour.
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Rogers ML, Cao E, Sinclair C, Galynker I. Associations between goal orientation and suicidal thoughts and behaviors at one-month follow-up: Indirect effects through ruminative flooding. Behav Res Ther 2021; 145:103945. [PMID: 34399271 DOI: 10.1016/j.brat.2021.103945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/24/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022]
Abstract
Previous research has identified both goal orientation and ruminative flooding as potential risk factors for suicidal thoughts and behaviors, as well as positive associations between goal orientation and rumination. The present study examined whether the association between goal orientation and suicidal thoughts and behaviors, assessed one month later, was accounted for by ruminative flooding. A sample of 924 psychiatric outpatients (Mage = 39.09 years, SD = 14.82, range = 18 to 84; 61.7% female; 37.0% White) completed self-report and interview measures at baseline and provided information about suicide-related outcomes at one-month follow-up. Goal orientation was positively associated with ruminative flooding, and both goal orientation and ruminative flooding were associated with suicidal thoughts and behaviors at one-month follow-up. Controlling for lifetime suicidal thoughts and behaviors, as well as patient age and sexual orientation, ruminative flooding accounted for the relationship between goal orientation and suicidal thoughts and behaviors at one-month follow-up. These findings were especially relevant for individuals with a history of multiple suicide attempts. Overall, this study provided evidence that difficulties with goal orientation may relate to suicidal thoughts and behaviors through intense ruminations perceived as a loss of cognitive control. Interventions that address ruminative thinking and cognitive flexibility may, in turn, assist in reducing emotion dysregulation and managing suicidality among those who struggle with goal orientation.
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Affiliation(s)
| | - Erjia Cao
- Icahn School of Medicine, Mount Sinai Beth Israel, USA; Department of Counseling and Clinical Psychology, Teachers College, Columbia University, USA
| | - Courtney Sinclair
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, USA
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, USA
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9
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Salem T, Winer ES, Jordan DG, Nadorff MR, Fanning JR, Bryant J, Berman ME, Veilleux JC. Anhedonia and the Relationship Between Other Depressive Symptoms and Aggressive Behavior. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:3257-3284. [PMID: 29768994 DOI: 10.1177/0886260518770646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Depression has been linked to multiple forms of aggressive behavior in college students; however, it is unclear which aspects of depression explain this connection. Anhedonia, defined as the loss of interest and/or pleasure in previously enjoyed activities, may provide unique information about relationships between depression and aggression. Using cross-sectional data from two independent samples of college students (N = 747 and N = 736 for Study 1 and Study 2, respectively), we examined whether anhedonia helped explain the relationship between broader depressive symptoms and different forms of aggressive and antisocial behavior. Anhedonia accounted for variance in both self-directed aggression and antisocial behavior independent of gender, hostility, anger, other depressive symptoms, and cognitive distortions (Study 2). In addition, there were significant indirect effects of depressive symptoms on self-directed aggression (Studies 1 and 2) and antisocial behavior (Study 2) via anhedonia. Hypotheses involving other-directed aggression received mixed support, with anhedonia atemporally associated with other-directed aggression independent of broader depressive symptoms in Study 1, but not in Study 2. The current findings suggest that anhedonia is an important individual difference that helps explain the relationship between depression and aggressive and antisocial acts and that anhedonia may be differentially associated with various types of aggressive and antisocial behavior.
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Affiliation(s)
- Taban Salem
- Mississippi State University, Mississippi State, USA
| | | | - D Gage Jordan
- Mississippi State University, Mississippi State, USA
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10
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Abstract
BACKGROUND Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm. OBJECTIVE This study aimed to understand Jordanian adolescents' perceptions, beliefs, and attitudes toward suicide. METHODS A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14-17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software. RESULTS Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents' suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family's reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems. DISCUSSION Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.
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11
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Snooks MP, McLaren S. Dispositional optimism and suicide among trans and gender diverse adults. DEATH STUDIES 2021; 46:1954-1962. [PMID: 33523778 DOI: 10.1080/07481187.2021.1876787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population.
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Affiliation(s)
- Matthew Paul Snooks
- School of Science, Psychology and Sport, Federation University, Ballarat, Australia
| | - Suzanne McLaren
- School of Science, Psychology and Sport, Federation University, Ballarat, Australia
- School of Psychology, Charles Sturt University, Port Macquarie, Australia
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12
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Kirtley OJ, Rodham K, Crane C. Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors. Lancet Psychiatry 2020; 7:282-290. [PMID: 31982031 DOI: 10.1016/s2215-0366(19)30288-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/29/2022]
Abstract
Individuals with chronic pain are at an elevated risk of suicide, yet psychosocial factors that might be involved in increasing or decreasing vulnerability for suicidal ideation and behaviour have received little attention. Extant literature on the topic of suicide in individuals with chronic pain incorporates only a few of the wide array of known vulnerability and protective factors. This Review focuses on transdiagnostic psychological processes, (ie, those of relevance for both chronic pain and suicide). We reviewed a selection of published literature on chronic pain and suicide, concentrating on previously unexplored and underexplored lines of research, including future orientation, mental imagery, and psychological flexibility. A greater degree of crosspollination between the fields of chronic pain and suicide research is required to progress our understanding of why some people with chronic pain become suicidal and others do not.
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Affiliation(s)
| | - Karen Rodham
- Staffordshire Centre for Psychological Research, Staffordshire University, Stoke-on-Trent, UK
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13
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Moselli M, Frattini C, Williams R, Ronningstam E. The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality. Front Psychiatry 2020; 11:598866. [PMID: 33519549 PMCID: PMC7838538 DOI: 10.3389/fpsyt.2020.598866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development. Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture. Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area. Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument.
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Affiliation(s)
- Marta Moselli
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Camilla Frattini
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, Rome, Italy
| | - Elsa Ronningstam
- Harvard Medical School, McLean Hospital, Belmont, MA, United States
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Streeb N, Shoji K, Benight CC. The Capability for Suicide in Firefighters. Suicide Life Threat Behav 2019; 49:980-995. [PMID: 30079535 DOI: 10.1111/sltb.12500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Suicide among firefighters is a critical mental health concern that remains under studied. The interpersonal-psychological theory of suicidal behavior (IPTS) states that, to engage in lethal suicidal behaviors, an individual must possess thwarted belongingness, perceived burdensomeness, and fearlessness about death (IPTS factors). Social cognitive theory may assist IPTS in explaining suicidal behavior. METHOD Participants for the study were 216 volunteers and career firefighters. The sample was almost exclusively male, non-Hispanic or Latino, and Caucasian with a mean age of 40.6. We examined the mediating effect of firefighter coping self-efficacy (FFCSE) and coping self-efficacy for trauma (CSE-T) in the relationship between critical incidents and the IPTS factors. Moderated mediation analyses were performed with separate conditional effects of each social support subscale on the indirect effect of each self-efficacy perception in the relationship between critical incidents and the IPTS factors. RESULTS Mediation analysis indicated that FFCSE did not mediate the relationships; however, CSE-T did mediate the relationships between critical incidents and the IPTS factors. These significant indirect effects of CSE-T were moderated by social support from significant other. CONCLUSIONS CSE-T within the context of significant other support is important to consider in understanding firefighter mental health.
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Affiliation(s)
- Nicole Streeb
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kotaro Shoji
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
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15
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Barlow MA, Wrosch C, McGrath JJ. Goal adjustment capacities and quality of life: A meta‐analytic review. J Pers 2019; 88:307-323. [DOI: 10.1111/jopy.12492] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 04/30/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Meaghan A. Barlow
- Department of Psychology Concordia University Montreal Quebec Canada
| | - Carsten Wrosch
- Department of Psychology Concordia University Montreal Quebec Canada
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16
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O'Connor RC, Lundy JM, Stewart C, Smillie S, McClelland H, Syrett S, Gavigan M, McConnachie A, Smith M, Smith DJ, Brown GK, Stanley B, Simpson SA. SAFETEL randomised controlled feasibility trial of a safety planning intervention with follow-up telephone contact to reduce suicidal behaviour: study protocol. BMJ Open 2019; 9:e025591. [PMID: 30782938 PMCID: PMC6377516 DOI: 10.1136/bmjopen-2018-025591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There are no evidence-based interventions that can be administered in hospital settings following a general hospital admission after a suicide attempt. AIM To determine whether a safety planning intervention (SPI) with follow-up telephone support (SAFETEL) is feasible and acceptable to patients admitted to UK hospitals following a suicide attempt. METHODS AND ANALYSIS Three-phase development and feasibility study with embedded process evaluation. Phase I comprises tailoring an SPI with telephone follow-up originally designed for veterans in the USA, for use in the UK. Phase II involves piloting the intervention with patients (n=30) who have been hospitalised following a suicide attempt. Phase III is a feasibility randomised controlled trial of 120 patients who have been hospitalised following a suicide attempt with a 6-month follow-up. Phase III participants will be recruited from across four National Health Service hospitals in Scotland and randomised to receive either the SPI with telephone follow-up and treatment as usual (n=80) or treatment as usual only (n=40). The primary outcomes are feasibility outcomes and include the acceptability of the intervention to participants and intervention staff, the feasibility of delivery in this setting, recruitment, retention and intervention adherence as well as the feasibility of collecting the self-harm re-admission to hospital outcome data. Statistical analyses will include description of recruitment rates, intervention adherence/use, response rates and estimates of the primary outcome event rates, and intervention effect size (Phase III). Thematic analyses will be conducted on interview and focus group data. ETHICS AND DISSEMINATION The East of Scotland Research Ethics Service (EoSRES) approved this study in March 2017 (GN17MH101 Ref: 17/ES/0036). The study results will be disseminated via peer-reviewed publication and conference presentations. A participant summary paper will also be disseminated to patients, service providers and policy makers alongside the main publication. TRIAL REGISTRATION NUMBER ISRCTN62181241.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenna-Marie Lundy
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Corinna Stewart
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susie Smillie
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Suzy Syrett
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcela Gavigan
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Michael Smith
- Mental Health Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gregory K Brown
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sharon Anne Simpson
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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17
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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18
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A brief psychological intervention to reduce repetition of self-harm in patients admitted to hospital following a suicide attempt: a randomised controlled trial. Lancet Psychiatry 2017; 4:451-460. [PMID: 28434871 PMCID: PMC5447136 DOI: 10.1016/s2215-0366(17)30129-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND We investigated whether a volitional helpsheet (VHS), a brief psychological intervention, could reduce repeat self-harm in the 6 months following a suicide attempt. METHODS We did a prospective, single-site, randomised controlled trial. Patients admitted to a hospital in Edinburgh, UK, after a suicide attempt were deemed eligible for the study if they were over the age of 16 years, had a self-reported history of self-harm, were fluent in English, were medically fit to interview, and were not participating in other research studies within the hospital. Eligible patients were randomly assigned (1:1), via web-based randomisation, to receive either VHS plus usual treatment (intervention group) or only treatment as usual (control group). Randomisation was stratified by sex and self-reported past self-harm history. The Information Services Division of the National Health Service (NHS-ISD) staff and those extracting data from medical notes were masked to the study group the participant was allocated to. Clinical staff working within the hospital were also masked to participants' randomisation status. There were three primary outcomes: the proportion of paticipants who re-presented to hospital with self-harm during the 6-month follow-up period; the number of times a participant re-presented to hospital with self-harm during the 6-month follow-up period; and cost-effectiveness of the VHS as measured by estimated incremental cost per self-harm event averted. Primary outcomes were analysed in all randomised patients. Follow-up data collection was extracted from the Information Services Division of the NHS and from patient medical records. The trial is registered with International Standard Randomised Controlled Trial Number Registry, number ISRCTN99488269. FINDINGS Between May 9, 2012, and Feb 24, 2014, we assessed 1308 people for eligibility. Of these, 259 patients were randomly assigned to the intervention group and 259 to the control group. We obtained complete follow-up data on 512 (99%) of 518 patients (five participants were lost to follow-up in the intervention group and one in the control group). 11 patients assigned to the intervention group did not complete the VHS in hospital. Overall, the intervention did not affect the number of people who re-presented with self-harm (67 [26%] of 254 patients in the intervention group vs 71 [28%] of 258 patients in the control group, odds ratio [OR] 0·90, 95% CI 0·58-1·39, p=0·63). The intervention had no effect on the number of re-presentations per patient (mean 0·67 [SD 2·55] re-presentations for the intervention group vs 0·85 [2·79] for the control group, incident rate ratio [IRR] 1·65, 95% CI 0·74-3·67, p=0·21). Mean total costs per person for NHS hospital services in the VHS intervention group over the 6 months were £513 versus £561 in the control group but this difference was not significant (95% CI-£353 to £257, p=0·76). Three patients died by suicide in the 6 months following their index suicide attempt (one in the intervention group and two in the control group). There were no reported unintended effects or adverse events in either group. INTERPRETATION For the primary outcomes, there were no significant differences between groups. Although the VHS had no overall effect, post-hoc analyses suggest VHS might be effective in reducing the number of self-harm repetitions following a suicide attempt in people who complete the helpsheet and who have been previously admitted to hospital with self-harm. This is the first study to investigate the usefulness of the VHS to reduce self-harm among those who have attempted suicide. These subgroup findings require replication. The potential use of the VHS in those who self-harm for different motives requires further exploration. FUNDING Chief Scientist Office (CZH/4/704).
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19
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Carver CS, Scheier MF. Self-Regulatory Functions Supporting Motivated Action. ADVANCES IN MOTIVATION SCIENCE 2017. [DOI: 10.1016/bs.adms.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Dickson JM, Moberly NJ, O’Dea C, Field M. Goal Fluency, Pessimism and Disengagement in Depression. PLoS One 2016; 11:e0166259. [PMID: 27902708 PMCID: PMC5130184 DOI: 10.1371/journal.pone.0166259] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/25/2016] [Indexed: 11/25/2022] Open
Abstract
Despite the development of prominent theoretical models of goal motivation and its importance in daily life, research has rarely examined goal dysregulation processes in clinical depression. Here we aimed to investigate problematic aspects of goal regulation in clinically depressed adults, relative to controls. Depressed participants (n = 42) were recruited from two Improving Access to Psychological Therapy clinics in north-west England. Control participants (n = 51) were recruited from the same region. Participants generated personal approach goals (e.g., improve my marathon time) and avoidance goals (e.g., avoid getting upset over little things) and completed self-report measures of goal attainment likelihood and depressive symptoms. Participants also completed a measure of ease of disengagement from unattainable goals and re-engagement with new goals. Compared to controls, depressed participants reported fewer approach goals (but not more avoidance goals), rated their approach goal (rewarding) outcomes as less likely to happen and avoidance goal (threatening) outcomes as more likely to happen. Depressed participants also reported greater ease of disengagement from unattainable goals and more difficulty re-engaging with new goals than controls. Our findings extend current knowledge of the psychopathology of depression from a goal regulation perspective, suggesting that pessimism around goal pursuit accompanies fewer approach goal pursuits and a general tendency to disengage when difficulties are encountered.
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Affiliation(s)
- Joanne M. Dickson
- Department of Psychology, Edith Cowan University, Joondalup, Australia
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Christian O’Dea
- Newhall Independent Hospital, Mental Health Care, Wrexham, United Kingdom
| | - Matt Field
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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21
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Tucker RP, O'Connor RC, Wingate LR. An Investigation of the Relationship Between Rumination Styles, Hope, and Suicide Ideation Through the Lens of the Integrated Motivational-Volitional Model of Suicidal Behavior. Arch Suicide Res 2016; 20:553-66. [PMID: 27309643 DOI: 10.1080/13811118.2016.1158682] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To investigate the roles specific ruminative styles (brooding and reflection) and hope play in the Integrated Motivational-Volitional (IMV) model of suicidal behavior. Participants were students from a large U.S. state university who were selectively sampled for the experience of recent suicide ideation. Results of a bootstrapped moderated mediation model indicated that defeat had a direct effect on suicide ideation but not an indirect effect on suicide ideation through entrapment. Brooding, but not reflection, strengthened the relationship between defeat and entrapment. Hope weakened the relationship between entrapment and suicide ideation. Implications for the assessment and treatment of suicide risk and future research directions are discussed.
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Dhingra K, Boduszek D, Klonsky ED. Empirically Derived Subgroups of Self-Injurious Thoughts and Behavior: Application of Latent Class Analysis. Suicide Life Threat Behav 2016; 46:486-99. [PMID: 26852368 DOI: 10.1111/sltb.12232] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
Latent class analysis was applied to the sample data to identify homogenous subtypes or classes of self-injurious thoughts and behavior (SITB) based on indicators indexing suicide ideation, suicide gesture, suicide attempt, thoughts of nonsuicidal self-injury (NSSI), and NSSI behavior. Analyses were based on a sample of 1,809 healthy adults. Associations between the emergent latent classes and demographic, psychological, and clinical characteristics were assessed. Two clinically relevant subtypes were identified, in addition to a class who reported few SITBs, and were labeled as follows: low SITBs (25.8%), NSSI and ideation (25%), and suicidal behavior (29.2%). Several unique differences between the latent classes and external measures emerged. For instance, those belonging to the NSSI and ideation class compared with the suicidal behavior class reported lower levels of entrapment, burdensomeness, fearlessness about death, exposure to the attempted suicide or self-injury of family members and close friends, and higher levels of goal disengagement and acute agitation. SITBs are best explained by three homogenous subgroups that display quantitative and qualitative differences. Profiling the behavioral and cognitive components of suicidal and nonsuicidal self-injury is potentially useful as a first step in developing tailored intervention and treatment programs.
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Affiliation(s)
| | - Daniel Boduszek
- Department of Psychology, University of Huddersfield, Huddersfield, UK
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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23
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Stanley IH, Hom MA, Rogers ML, Hagan CR, Joiner TE. Understanding suicide among older adults: a review of psychological and sociological theories of suicide. Aging Ment Health 2016; 20:113-22. [PMID: 25693646 DOI: 10.1080/13607863.2015.1012045] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions. METHOD In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults. RESULTS Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults. CONCLUSION To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory.
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Affiliation(s)
- Ian H Stanley
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Melanie A Hom
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Megan L Rogers
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Christopher R Hagan
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Thomas E Joiner
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
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Klibert J, LeLeux-LaBarge K, Tarantino N, Yancey T, Lamis DA. Procrastination and suicide proneness: A moderated-mediation model for cognitive schemas and gender. DEATH STUDIES 2016; 40:350-357. [PMID: 26766597 DOI: 10.1080/07481187.2016.1141262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined the direct and indirect paths between procrastination and suicide proneness while considering gender differences. Participants included 547 undergraduates from a southeastern university. Procrastination was positively related to suicide proneness for both genders, although this relation was stronger for women. Moderated-mediation analyses with bootstrapping highlighted insufficient self-control schemas as a mediator in the relation between procrastination and suicide proneness. However, indirect pathways did not vary by gender. Results represent an extension of the Procrastination-Health Model by highlighting the contribution of cognitive factors in explaining the relation between procrastination and suicide proneness.
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Affiliation(s)
- Jeffrey Klibert
- a Department of Psychology , Georgia Southern University , Statesboro , Georgia , USA
| | - Kayla LeLeux-LaBarge
- a Department of Psychology , Georgia Southern University , Statesboro , Georgia , USA
| | - Nicholas Tarantino
- b Department of Psychology , Georgia State University , Atlanta , Georgia , USA
| | - Thresa Yancey
- a Department of Psychology , Georgia Southern University , Statesboro , Georgia , USA
| | - Dorian A Lamis
- c Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , Georgia , USA
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Dhingra K, Boduszek D, O'Connor RC. A structural test of the Integrated Motivational-Volitional model of suicidal behaviour. Psychiatry Res 2016; 239:169-78. [PMID: 27137980 DOI: 10.1016/j.psychres.2016.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
Abstract
Suicidal behaviours are highly complex, multi-determined phenomena. Despite this, historically research has tended to focus on bivariate associations between atheoretical demographic and/or psychiatric factors and suicidal behaviour. The aim of this study was to empirically test the Integrated Motivational-Volitional model of suicidal behaviour using structural equation modelling. Healthy adults (N=1809) completed anonymous self-report surveys. The fit of the proposed model was good, and explained 79% of variance in defeat, 83% of variance in entrapment, 61% of variance in suicidal ideation, and 27% of variance in suicide attempts. All proposed paths were significant except for those between goal re-engagement and two factors of suicide resilience (Internal Protective and External Protective) and suicidal ideation; and impulsivity and discomfort intolerance and suicide attempts. These findings represent a preliminary step towards greater clarification of the mechanisms driving suicidal behaviour, and support the utility of basing future research on the Integrated Motivational-Volitional model of suicidal behaviour.
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Affiliation(s)
- Katie Dhingra
- Leeds Beckett University, Department of Criminology, Calverley Building (CL905), Leeds LS1 3HE, United Kingdom.
| | - Daniel Boduszek
- University of Huddersfield, Department of Psychology, Ramsden Building, Queensgate, Huddersfield HD1 3DH, United Kingdom; Psychology Department Katowice, SWPS University of Social Sciences and Humanities, Poland.
| | - Rory C O'Connor
- University of Glasgow, Institute of Health & Wellbeing, Academic Centre, Gartnavel Royal Hospital Glasgow, Glasgow G12 0XH, United Kingdom.
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Brüdern J, Berger T, Caspar F, Maillart AG, Michel K. The Role of Self-Organization in the Suicidal Process. Psychol Rep 2016; 118:668-85. [PMID: 27154385 DOI: 10.1177/0033294116633351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article describes the application of a dual-regulation model to a case example of a female suicide attempter. The model complements the traditional goal-and-feedback view with self-organizing processes, which may help to better understand the suicidal process. From this view, impulsive suicidal behavior can be interpreted as a dysfunctional pattern by which high-internal tension is reduced through self-organized processes. High tension might result from intrapersonal factors and adverse life conditions, by which self-regulation is depleted. Also concepts from social psychology (i.e., ego depletion, self-regulation failure) are consistent with this view and are discussed in context of a suicidal crisis. Identifying dysfunctional self-organization processes and acquiring strategies to strengthen self-regulation might, therefore, be important for suicide prevention.
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Tajikzadeh F, Sajadi SF, Mehrabizade Honarmand M, Davudi I. Suicidal Ideation in Female Students: Examining the Role of Perfectionism and Goal Adjustment. WOMEN’S HEALTH BULLETIN 2015. [DOI: 10.17795/whb-29177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dhingra K, Boduszek D, O'Connor RC. Differentiating suicide attempters from suicide ideators using the Integrated Motivational-Volitional model of suicidal behaviour. J Affect Disord 2015; 186:211-8. [PMID: 26247914 DOI: 10.1016/j.jad.2015.07.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suicidal behaviour is a significant public health concern, yet little is known about the factors that enable or impede behavioural enactment (engaging in a suicide attempt). AIMS Drawing on the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour (2011), this study examined the factors associated with having thoughts of suicide (ideation) versus those associated with suicide enaction (attempts). Within a multivariate context, it was predicted that the factors associated with ideation formation (motivational factors) would be distinct from those factors which governed behavioural enaction (volitional moderators). METHOD Healthy adults (N=1, 288) completed an anonymous self-report survey. Analyses compared three groups: suicide attempters (n=230), suicide ideators (n=583), and those without any suicide history (n=475). RESULTS Suicide attempters differed from suicide ideators on all volitional factors (fearlessness about death, impulsivity, and exposure to suicidal behaviour), with the exception of discomfort tolerance. Compared to ideators, attempters were more likely to have a family member and close friend who had self-injured or attempted suicide, and were more impulsive and fearless about death. Conversely, the two suicide groups did not differ on any of the variables (motivational factors) associated with the development of thoughts of death by suicide. LIMITATIONS This is a cross-sectional study based on self-report measures. CONCLUSIONS Further research efforts to distinguish between suicide ideators and suicide attempters is crucial to inform the development of intervention and treatment approaches.
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Mens MG, Scheier MF. The Benefits of Goal Adjustment Capacities for Well-Being Among Women With Breast Cancer: Potential Mechanisms of Action. J Pers 2015; 84:777-788. [PMID: 26270869 DOI: 10.1111/jopy.12217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Breast cancer can seriously disrupt a person's important life goals. As such, the ability to adjust one's goals may be critical for well-being. The present study investigated the relationships between disengagement/reengagement capacity and well-being among women with breast cancer, as well as several potential mechanisms (intrusive thoughts, life purpose, and physical activity) that could explain these relationships. The sample consisted of 230 women with early-stage (n = 172) or late-stage (n = 58) breast cancer, who were followed prospectively for 8 months. Well-being measures consisted of global mental health, perceived physical health, positive/negative affect, and sleep efficiency. Disengagement capacity did not predict any outcome variable. In contrast, reengagement capacity prospectively predicted changes in global mental health, positive affect, negative affect, sleep efficiency, life purpose, and physical activity. Life purpose mediated the prospective relationship between reengagement capacity and multiple aspects of well-being. The relationships between purpose and positive/negative affect were reciprocal over time. Results also suggested that physical activity is not a mediator, but is in fact a result of the effect of reengagement capacity on well-being. The results demonstrate that reengagement capacity is important for well-being among women with breast cancer.
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Are Suicide Attempters Wired Differently?: A Comparison With Nonsuicidal Depressed Individuals Using Plan Analysis. J Nerv Ment Dis 2015; 203:514-21. [PMID: 26057773 DOI: 10.1097/nmd.0000000000000321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Limited research exists on internal risk processes in suicide attempters and factors that distinguish them from nonsuicidal depressive individuals. In this qualitative study, we investigated Plans, motives, and underlying self-regulatory processes of the two groups and conducted a comparative analysis. We analyzed narrative interviews of 17 suicide attempters and intake interviews of 17 nonsuicidal depressive patients using Plan Analysis. Then, we developed a prototypical Plan structure for both groups. Suicidal behavior serves various Plans found only in suicide attempters. Plans of this group are especially related to social perfectionism and withdrawal to protect their self-esteem. Depressive patients use several interpersonal control and coping strategies, which might help prevent suicidal behavior. The prototypical Plan structure of suicide attempters may be a valuable tool for clinicians to detect critical Plans and motives in their interaction with patients, which are related to suicide risk.
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Galynker I, Yaseen ZS, Briggs J, Hayashi F. Attitudes of acceptability and lack of condemnation toward suicide may be predictive of post-discharge suicide attempts. BMC Psychiatry 2015; 15:87. [PMID: 25884153 PMCID: PMC4403982 DOI: 10.1186/s12888-015-0462-5] [Citation(s) in RCA: 15] [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: 11/26/2014] [Accepted: 03/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicide attempts (SA) after psychiatric hospitalization continue to be a major cause of morbidity. Implicit measures may enhance our ability to assess suicide risk. In this context, we describe the first use of the Suicide Opinion Questionnaire (SOQ) to identify post-discharge suicide attempters. METHODS Adult psychiatric inpatients admitted for suicidality (N = 91) were administered a battery of measures including the SOQ, and forty were reached and reassessed for SA at two months post-discharge. Exploratory factor analysis (EFA) on items associated with suicidality was performed to identify latent constructs. Linear discriminant analysis (LDA) was used to optimize factor combination for suicide identification. Results were compared with explicit measures of suicidality, and logistic regression was used to control for other risk factors. Finally, a simplified 9-item scale was derived from the results and its performance compared to that of the linear discriminant function. RESULTS Twenty items differed between patients with and without SA at intake or follow-up. EFA on these identified two factors: suicide attempters indicated greater acceptability and less moral condemnation of suicide. The LDA-derived discriminant function and 9-item scale was significantly sensitive and specific for post-discharge SA. CONCLUSIONS Attitudes of acceptability and lack of condemnation toward suicide may constitute an implicit measure of suicidality that could contribute to risk assessment in a high-risk population.
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Affiliation(s)
- Igor Galynker
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
| | - Zimri S Yaseen
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
| | - Jessica Briggs
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
| | - Fumitaka Hayashi
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
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O'Connor RC, Smyth R, Williams JMG. Intrapersonal positive future thinking predicts repeat suicide attempts in hospital-treated suicide attempters. J Consult Clin Psychol 2014; 83:169-76. [PMID: 25181026 PMCID: PMC4321534 DOI: 10.1037/a0037846] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Although there is clear evidence that low levels of positive future thinking (anticipation of positive experiences in the future) and hopelessness are associated with suicide risk, the relationship between the content of positive future thinking and suicidal behavior has yet to be investigated. This is the first study to determine whether the positive future thinking–suicide attempt relationship varies as a function of the content of the thoughts and whether positive future thinking predicts suicide attempts over time. Method: A total of 388 patients hospitalized following a suicide attempt completed a range of clinical and psychological measures (depression, hopelessness, suicidal ideation, suicidal intent and positive future thinking). Fifteen months later, a nationally linked database was used to determine who had been hospitalized again after a suicide attempt. Results: During follow-up, 25.6% of linked participants were readmitted to hospital following a suicide attempt. In univariate logistic regression analyses, previous suicide attempts, suicidal ideation, hopelessness, and depression—as well as low levels of achievement, low levels of financial positive future thoughts, and high levels of intrapersonal (thoughts about the individual and no one else) positive future thoughts predicted repeat suicide attempts. However, only previous suicide attempts, suicidal ideation, and high levels of intrapersonal positive future thinking were significant predictors in multivariate analyses. Discussion: Positive future thinking has predictive utility over time; however, the content of the thinking affects the direction and strength of the positive future thinking–suicidal behavior relationship. Future research is required to understand the mechanisms that link high levels of intrapersonal positive future thinking to suicide risk and how intrapersonal thinking should be targeted in treatment interventions. This study highlights the importance of positive future thinking as a predictor of future suicidal behavior. Clinicians ought to consider the content of positive future thinking, as not all types of positive future thinking are protective over time.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health & Wellbeing, University of Glasgow
| | - Roger Smyth
- Department of Psychological Medicine, Royal Infirmary of Edinburgh
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Abstract
The causes of suicidal behaviour are not fully understood; however, this behaviour clearly results from the complex interaction of many factors. Although many risk factors have been identified, they mostly do not account for why people try to end their lives. In this Review, we describe key recent developments in theoretical, clinical, and empirical psychological science about the emergence of suicidal thoughts and behaviours, and emphasise the central importance of psychological factors. Personality and individual differences, cognitive factors, social aspects, and negative life events are key contributors to suicidal behaviour. Most people struggling with suicidal thoughts and behaviours do not receive treatment. Some evidence suggests that different forms of cognitive and behavioural therapies can reduce the risk of suicide reattempt, but hardly any evidence about factors that protect against suicide is available. The development of innovative psychological and psychosocial treatments needs urgent attention.
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O'Connor RC, Rasmussen S, Hawton K. Adolescent self-harm: a school-based study in Northern Ireland. J Affect Disord 2014; 159:46-52. [PMID: 24679388 DOI: 10.1016/j.jad.2014.02.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. METHODS Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. RESULTS Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. LIMITATIONS This is a cross-sectional study. CONCLUSIONS The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Mental Health & Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom.
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Abstract
Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social, and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena.
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Affiliation(s)
- Shira Barzilay
- a Feinberg Child Study Center, Schneider Children's Medical Center of Israel , Petach Tikva , Israel
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Zhang J, Kong Y, Gao Q, Li Z. When aspiration fails: a study of its effect on mental disorder and suicide risk. J Affect Disord 2013; 151:243-7. [PMID: 23806585 PMCID: PMC3769498 DOI: 10.1016/j.jad.2013.05.092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/29/2013] [Accepted: 05/31/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Strain Theory of Suicide postulates that psychological strains usually precede suicide mental disorders including suicidal behavior. The four sources of strain are basically (1) differential value conflicts, (2) discrepancies between aspiration and reality, (3) relative deprivation, and (4) lack of coping skills. This paper focuses on the effect of perceived failed life aspiration on the individual's mental disorder and suicide risk. METHOD Data for this study were from a large psychological autopsy study conducted in rural China, where 392 suicides and 416 community living controls were consecutively recruited. Two informants (a family member and a close friend) were interviewed for each suicide and each control. Major depression was assessed with HAM-D and the diagnosis of mental disorder was made with SCID. RESULTS It was found that individuals having experienced failed aspiration were significantly more likely than those having not experienced a failed aspiration to be diagnosed with at least one disorder measured by the SCID and major depression measured by HAM-D, and to be a suicide victim, which is true of both suicides and controls. CONCLUSION This study supports the hypothesis that the discrepancies between an individual's aspiration and the reality is likely to lead to mental disorder including major depression and suicidal behavior. Lowering a patient's unrealistic aspiration can be part of the of psychological strains reduction strategies in cognitive therapies by clinicians' and mental health professionals.
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Affiliation(s)
- Jie Zhang
- Shandong University School of Public Health Center for Suicide Prevention Research, Jinan, China.
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Eddington KM. Perfectionism, Goal Adjustment, and Self-Regulation: A Short-term Follow-up Study of Distress and Coping. SELF AND IDENTITY 2013. [DOI: 10.1080/15298868.2013.781740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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