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Mitchell S, Marvin C, Mitaj D, Rogers ML. Identifying latent classes of suicidal ambivalence: Associations with suicide risk correlates and outcomes. Suicide Life Threat Behav 2024. [PMID: 38994902 DOI: 10.1111/sltb.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/30/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Research has largely conceptualized suicidal ambivalence as the difference between one's wish to live and wish to die without fully considering other suicide ideation (SI) experiences included on measures like the Beck Scale for Suicide Ideation (BSS). We utilized BSS items to identify SI latent classes and examined relevant correlates and outcomes. METHODS We collected self-report data from two samples of US adults who: (1) self-identified as LGBTQ+ (N = 349; cross-sectional) and (2) self-reported past-week SI (BSS score ≥ 11; N = 133; 3 timepoints). RESULTS Latent class analyses supported three-class (Sample 1) and four-class solutions (Sample 2), which included ambivalent classes. In Sample 1, sexual orientation, gender, depression, anxiety, SI, and suicide-specific rumination were concurrently associated with class membership. In Sample 2, depression, SI, suicide-specific rumination, and physical/psychological distance from suicide methods were concurrently associated with class membership. In Sample 2, at both follow-ups, suicide plans/preparations and Acute Suicidal Affective Disturbance symptom frequencies were provided by class membership, and suicidal intent significantly differed by class membership. CONCLUSIONS SI classes differed by sample and evidenced nuances in SI and suicidal ambivalence. Risk factors and suicide-related outcomes also differed by class membership. Implications and limitations are discussed.
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Affiliation(s)
- Sean Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Cole Marvin
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Dea Mitaj
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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Brailovskaia J, Teismann T, Margraf J. Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes. J Psychiatr Res 2024; 174:192-196. [PMID: 38642456 DOI: 10.1016/j.jpsychires.2024.04.030] [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: 07/05/2023] [Revised: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.
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Affiliation(s)
- Julia Brailovskaia
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany; DZPG (German Center for Mental Health), partner site Bochum/Marburg, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany; DZPG (German Center for Mental Health), partner site Bochum/Marburg, Germany
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Melzer L, Forkmann T, Teismann T. Suicide Crisis Syndrome: A systematic review. Suicide Life Threat Behav 2024; 54:556-574. [PMID: 38411273 DOI: 10.1111/sltb.13065] [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: 03/07/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The objective of this systematic review is to describe the scientific evidence for the Suicide Crisis Syndrome (SCS), a presuicidal cognitive and affective state consisting of five symptomatic dimensions: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The aim of this article is to summarize the emerging literature on the SCS and to assess the extent to which a uniform syndrome can be assumed. METHODS A systematic literature search was conducted in three different databases (PubMed, PsycInfo, and Google Scholar) using the search terms "Suicide Crisis Inventory," "Suicide Crisis Syndrome," "Narrative Crisis Model of Suicide," and "Suicide Trigger State." RESULTS In total, 37 articles from 2010 to 2022 were identified by search criteria. Twenty-one articles published between 2017 and 2022 were included in the systematic review. All but three studies were conducted in the United States and examined clinical samples of adult high-risk psychiatric in- and outpatients. Sample sizes ranged from N = 170 to 4846. The findings confirm the unidimensional structure of the proposed disorder and support the predictive validity for short-term suicidal behavior above and beyond suicidal ideation. CONCLUSION Despite the promising predictive validity of the SCS, a precise prediction of future suicidal behavior remains difficult.
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Affiliation(s)
- Laura Melzer
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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Bauer B, Norel R, Leow A, Rached ZA, Wen B, Cecchi G. Using Large Language Models to Understand Suicidality in a Social Media-Based Taxonomy of Mental Health Disorders: Linguistic Analysis of Reddit Posts. JMIR Ment Health 2024; 11:e57234. [PMID: 38771256 PMCID: PMC11112053 DOI: 10.2196/57234] [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: 02/08/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/22/2024] Open
Abstract
Background Rates of suicide have increased by over 35% since 1999. Despite concerted efforts, our ability to predict, explain, or treat suicide risk has not significantly improved over the past 50 years. Objective The aim of this study was to use large language models to understand natural language use during public web-based discussions (on Reddit) around topics related to suicidality. Methods We used large language model-based sentence embedding to extract the latent linguistic dimensions of user postings derived from several mental health-related subreddits, with a focus on suicidality. We then applied dimensionality reduction to these sentence embeddings, allowing them to be summarized and visualized in a lower-dimensional Euclidean space for further downstream analyses. We analyzed 2.9 million posts extracted from 30 subreddits, including r/SuicideWatch, between October 1 and December 31, 2022, and the same period in 2010. Results Our results showed that, in line with existing theories of suicide, posters in the suicidality community (r/SuicideWatch) predominantly wrote about feelings of disconnection, burdensomeness, hopeless, desperation, resignation, and trauma. Further, we identified distinct latent linguistic dimensions (well-being, seeking support, and severity of distress) among all mental health subreddits, and many of the resulting subreddit clusters were in line with a statistically driven diagnostic classification system-namely, the Hierarchical Taxonomy of Psychopathology (HiTOP)-by mapping onto the proposed superspectra. Conclusions Overall, our findings provide data-driven support for several language-based theories of suicide, as well as dimensional classification systems for mental health disorders. Ultimately, this novel combination of natural language processing techniques can assist researchers in gaining deeper insights about emotions and experiences shared on the web and may aid in the validation and refutation of different mental health theories.
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Affiliation(s)
- Brian Bauer
- Department of Psychology, University of Georgia, Athens, GA, United States
| | - Raquel Norel
- Digital Health, IBM Research, New York, NY, United States
| | - Alex Leow
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
- Department of Biomedical Engineering and Computer Science, University of Illinois Chicago, Chicago, IL, United States
| | | | - Bo Wen
- Digital Health, IBM Research, New York, NY, United States
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De Luca GP, Parghi N, El Hayek R, Bloch-Elkouby S, Peterkin D, Wolfe A, Rogers ML, Galynker I. Machine learning approach for the development of a crucial tool in suicide prevention: The Suicide Crisis Inventory-2 (SCI-2) Short Form. PLoS One 2024; 19:e0299048. [PMID: 38728274 PMCID: PMC11086905 DOI: 10.1371/journal.pone.0299048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/04/2024] [Indexed: 05/12/2024] Open
Abstract
The Suicide Crisis Syndrome (SCS) describes a suicidal mental state marked by entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal that has predictive capacity for near-term suicidal behavior. The Suicide Crisis Inventory-2 (SCI-2), a reliable clinical tool that assesses SCS, lacks a short form for use in clinical settings which we sought to address with statistical analysis. To address this need, a community sample of 10,357 participants responded to an anonymous survey after which predictive performance for suicidal ideation (SI) and SI with preparatory behavior (SI-P) was measured using logistic regression, random forest, and gradient boosting algorithms. Four-fold cross-validation was used to split the dataset in 1,000 iterations. We compared rankings to the SCI-Short Form to inform the short form of the SCI-2. Logistic regression performed best in every analysis. The SI results were used to build the SCI-2-Short Form (SCI-2-SF) utilizing the two top ranking items from each SCS criterion. SHAP analysis of the SCI-2 resulted in meaningful rankings of its items. The SCI-2-SF, derived from these rankings, will be tested for predictive validity and utility in future studies.
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Affiliation(s)
- Gabriele P. De Luca
- Department of Psychiatry, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Neelang Parghi
- Department of Biology, New York University, New York City, New York, United States of America
| | - Rawad El Hayek
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Devon Peterkin
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Amber Wolfe
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Megan L. Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, United States of America
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
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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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Rogers ML, Law KC, Lawrence OC, Mandel AA. Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens. Behav Res Ther 2024; 177:104524. [PMID: 38583292 DOI: 10.1016/j.brat.2024.104524] [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: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Abstract
According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Keyne C Law
- Department of Psychology, Seattle Pacific University, Seattle, WA, USA
| | | | - Abby A Mandel
- Department of Psychology, Catholic University of America, Washington, DC, USA
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Kotzalidis GD, Fiaschè F, Alcibiade A, Monti L, Di Segni F, Mazza M, Sani G. New pharmacotherapies to tackle the unmet needs in bipolar disorder: a focus on acute suicidality. Expert Opin Pharmacother 2024; 25:435-446. [PMID: 38517222 DOI: 10.1080/14656566.2024.2334425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/20/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Suicidal behavior is relatively frequent in patients with bipolar disorder (BD) and constitutes their most frequent cause of death. Suicide rates remain high in patients with BD despite adherence to guidelines recommending lithium as first line, and/or antidepressants, antipsychotics, psychotherapy, psychosocial interventions, and electroconvulsive therapy. Hence the need to identify more effective and rapid anti-suicide interventions. AREAS COVERED To tackle the unmet needs of pharmacotherapy, we investigated the PubMed database on 24-25 January 2024 using strategies like ('acute suicid*'[ti] OR 'suicide crisis syndrome' OR 'acute suicidal affective disturbance') AND (lithium[ti] OR clozapine[ti]), which obtained 3 results, and ('acute suicid*'[ti] OR 'suicide crisis syndrome' OR 'acute suicidal affective disturbance') AND (ketamine[ti] OR esketamine[ti] OR NMDA[ti] OR glutamat*[ti]), which yielded 14 results. We explored glutamatergic abnormalities in BD and suicide and found alterations in both. The noncompetitive NMDS antagonist ketamine and its S-enantiomer esketamine reportedly decrease acute suicidality. EXPERT OPINION Intranasal esketamine or subcutaneous ketamine, single-bolus or intravenous, and possibly other glutamate receptor modulators may improve suicidal behavior in patients with unipolar and bipolar depression. This may be achieved through prompt remodulation of glutamate activity. The correct use of glutamatergic modulators could reduce acute suicidality and mortality in patients with BD.
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Affiliation(s)
- Georgios D Kotzalidis
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Rome, Italy
| | - Alessandro Alcibiade
- Marina Militare Italiana (Italian Navy), Defense Ministry of Italy, Rome, Italy
- Psychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Laura Monti
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Di Segni
- Psychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
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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 PNS, Shreekantiah U, Bhandari SS, Ransing R, Ramasubramanian V, Praharaj SK. Factor structure, reliability, and validity of the revised Suicide Crisis Inventory in major depression: A multicentric Indian study. J Affect Disord 2024; 345:226-233. [PMID: 37898473 DOI: 10.1016/j.jad.2023.10.102] [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: 07/12/2023] [Revised: 10/07/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The revised Suicide Crisis Inventory (SCI)-2 is a self-report measure to assess the suicide crisis syndrome (SCS). We aimed to assess the factor structure, reliability, and validity of SCI-2 among adults with major depression. METHODS Using a cross-sectional design, between November 2021 and August 2022, the Hindi SCI-2, along with other self-report measures, was administered to Indian adult respondents clinically diagnosed with major depression across 24 centers in India. Confirmatory factor analysis was carried out to test the factor structure of SCI-2. Additionally, convergent, discriminant, and criterion validity were tested using bivariate or biserial correlations, as appropriate. RESULTS We obtained responses from 654 participants (Mean age = 36.9 ± 11.9 years, 50.2 % female). The SCI-2 fit both a one-factor (χ2[1769] = 14,150.74, p < .001, CFI = 0.98, RMSEA = 0.10), and five-factor solution (χ2[1759] = 13,130.83, p < .001,CFI = 0.98, RMSEA = 0.10) with the five-factor solution providing a significantly better fit. Internal consistencies of the SCI-2 total and subscale scores ranged from good to excellent. Most subscales significantly converged with each other and with other relevant measures although these associations were weak for thwarted belongingness and goal reengagement subscales. Small to moderate associations were noted in support of discriminant and criterion validity. LIMITATIONS We could not assess the predictive validity of SCI-2 for suicidal behaviors. CONCLUSION Consistent with prior data, the Hindi SCI-2 fit a five-factor solution and showed good psychometric properties. These findings support the use of SCI-2 to assess SCS among Indian adults with major depression.
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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, 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 689101, Kerala, 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 411001, 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 and Bai Yamunabai Laxmanrao (BYL) Nair Charitable Hospital, 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
| | - P N 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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10
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Teismann T, Brailovskaia J, Robison M, Joiner TE. Self-burdensomeness, other-burdensomeness, and suicidal ideation. Behav Res Ther 2023; 169:104388. [PMID: 37643552 DOI: 10.1016/j.brat.2023.104388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - Morgan Robison
- Department of Psychology, Florida State University, USA.
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11
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Mandel AA, Kleiman EM, Johnson S, Rogers ML, Jobes DA, Joiner T. A test of invariance of the construct of suicidal ideation across three diverse samples. J Affect Disord 2023; 329:124-130. [PMID: 36841297 DOI: 10.1016/j.jad.2023.02.055] [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: 10/02/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Suicide treatment research has placed major emphasis on preventing behavior, an observable phenomenon. Suicidal ideation (SI), however, is a distressing experience that annually impacts >15 million Americans; yet the construct validity of SI has not been well established, limiting empirical attention. METHOD We compared the coherence of three SI items (diminished wish to live, urge to die/controllability, suicide intent/expectations) and four related items across three adult samples (N = 314) that differed based on current SI severity and assessment time-scales (retrospective versus momentary). RESULTS A measurement model with scalar invariance had acceptable fit (CFI = 0.969, RMSEA = 0.076), indicating that the SI items consistently loaded onto one construct across samples. The structural model with metric invariance also had acceptable fit (CFI = 0.956, RMSEA = 0.063) and three of four related items (burdensome, hopelessness, and fatigue, but not agitation) were associated with SI across samples. LIMITATIONS Use of existing data limited the items considered. CONCLUSIONS Suicidal ideation is a coherent construct independent of the items used to assess it, the assessment's time-scale (retrospective versus momentary), or the severity of thoughts, and is worthy of greater empirical, clinical, and policy attention.
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Affiliation(s)
- Abby Adler Mandel
- Department of Psychology, The Catholic University of America, Washington, DC, USA.
| | - Evan M Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Sheri Johnson
- Department of Psychology, University of California - Berkeley, Berkeley, CA, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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12
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Rogers ML, Jeon ME, Zheng S, Richards JA, Joiner TE, Galynker I. Two sides of the same coin? Empirical examination of two proposed characterizations of acute suicidal crises: Suicide crisis syndrome and acute suicidal affective disturbance. J Psychiatr Res 2023; 162:123-131. [PMID: 37149921 DOI: 10.1016/j.jpsychires.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
Two proposed suicide-specific diagnoses, with accumulating research support, characterize the phenomenology of acute suicidal crises: Suicide Crisis Syndrome (SCS) and Acute Suicidal Affective Disturbance (ASAD). Despite conceptual overlap and some similar criteria, the two syndromes have never been compared empirically. The present study addressed this gap by examining SCS and ASAD utilizing a network analysis approach. A sample of 1568 community-based adults (87.6% cisgender women, 90.7% White, Mage = 25.60 years, SD = 6.59) in the United States completed an online battery of self-report measures. SCS and ASAD were first examined in individual network models, followed by a combined network to determine changes in network structure, as well as identify bridge symptoms that connected SCS and ASAD. The proposed criteria of SCS and ASAD formed sparse network structures that were largely unaffected by the influence of the other syndrome in a combined network. Social disconnection/withdrawal and manifestations of overarousal-particularly agitation, insomnia, and irritability-emerged as bridge symptoms that may connect SCS and ASAD. Our findings indicate the network structures of SCS and ASAD exhibit patterns of independence, alongside interdependence between overlapping symptom domains (i.e., social withdrawal, overarousal). Future work should examine SCS and ASAD prospectively to better understand their temporal dynamics and predictive utility in relation to imminent suicide risk.
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Affiliation(s)
| | - Min Eun Jeon
- Department of Psychology, Florida State University, USA
| | - Sifan Zheng
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
| | | | | | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
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13
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Confirmatory factor analysis of Acute Suicidal Affective Disturbance in a sample of treatment-seeking eating disorder patients. J Affect Disord 2023; 326:155-162. [PMID: 36724842 DOI: 10.1016/j.jad.2023.01.089] [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: 06/15/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We examined the factor structure of Acute Suicidal Affective Disturbance (ASAD) in individuals with eating disorders. ASAD is a proposed diagnosis with four symptoms: rapidly increasing suicidal intent, social or self-alienation, hopelessness regarding the previous symptoms, and overarousal. METHODS Patients with eating disorders (N = 378) completed self-report symptom questionnaires at admission to a partial hospitalization program for eating disorders. Using proxy measures, we conducted a confirmatory factor analysis (CFA) of the one-factor model of ASAD. RESULTS Initial model fit was poor. We iteratively revised the model to include theoretically-justified correlated residuals (i.e., those between items intended to measure the same ASAD symptom). After these modifications, model fit remained mediocre. We next conducted a multiple-group CFA to compare ASAD between individuals with the restricting subtype of anorexia nervosa (the "ANR" model, n = 145) and individuals with binge/purge disorders (i.e., bulimia nervosa and the binge-purge subtype of anorexia nervosa; the "BP" model, n = 234). The final model had mediocre fit with partial invariance between subgroups; the ASAD factor mean was higher in the BP model. We additionally tested a bifactor model, with similar findings. LIMITATIONS Our use of proxy measures of ASAD items may have resulted in imprecise measurement of ASAD symptoms, pointing to the importance of future research using validated measures of ASAD. CONCLUSIONS We found moderate support for ASAD in an eating disorder sample, with invariance between eating disorder phenotypes. Our findings suggest that the ASAD diagnosis may not fully generalize to eating disorder samples.
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14
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Jeon ME, Gomez MM, Stewart RA, Joiner TE. Acute suicidal affective disturbance and borderline personality disorder symptoms: Distinct yet correlated constructs. J Affect Disord 2023; 325:62-72. [PMID: 36586595 DOI: 10.1016/j.jad.2022.12.131] [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: 01/28/2022] [Revised: 09/08/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Acute Suicidal Affective Disturbance (ASAD) has been proposed to address the need for a suicide-specific diagnostic entity that better accounts for the psychological symptoms that may emerge during an acute suicidal crisis and that may precede imminent suicidal behaviors. However, additional research is needed to establish ASAD's delimitation from preexisting psychological disorders, especially disorders that include suicidal thoughts and behaviors in their diagnostic criteria such as borderline personality disorder (BPD). METHODS We estimated two Gaussian graphical models (GGMs), exploratory factor analysis (EFA) models, and confirmatory factor analysis models in a sample of psychiatric outpatients (N = 460) to examine the structure of ASAD and BPD symptoms. RESULTS Our estimated models showed while most ASAD and BPD symptoms largely shared associations with other symptoms belonging to their respective disorder construct, strong associations connected some ASAD symptoms with BPD symptoms, which, in a network model, emerged in the form of nonzero edges among those symptoms, and in EFA models, as factors that featured both ASAD and BPD symptoms as indicators. CONCLUSIONS Our findings suggest the network structure of the proposed criteria of ASAD features symptoms that are largely distinct to ASAD but do include symptoms that share meaningful correlations with BPD symptoms that suggest ASAD and BPD are correlated constructs.
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Affiliation(s)
- Min Eun Jeon
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Marielle M Gomez
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Rochelle A Stewart
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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15
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Kinkel-Ram SS, Grunewald W, Bodell LP, Smith AR. Unsound sleep, wound-up mind: a longitudinal examination of acute suicidal affective disturbance features among an eating disorder sample. Psychol Med 2023; 53:1518-1526. [PMID: 34348803 DOI: 10.1017/s003329172100310x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders. METHODS Women (N = 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment. RESULTS There was a significant interaction between within-person agitation and sleep quality on suicidal ideation [B(s.e.) = -0.02(0.01), p < 0.05], such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation. CONCLUSIONS This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.
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Affiliation(s)
| | | | - Lindsay P Bodell
- Department of Psychology, Western University, London, Ontario, Canada
| | - April R Smith
- Department of Psychology, Auburn University, Auburn, Alabama, USA
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16
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Mandel AA, Revzina O, Jessani Z, Brown GK. Revised Attentional Fixation on Suicide Experiences Questionnaire and its relationship with suicidal ideation and behavior: A cross-sectional study. Suicide Life Threat Behav 2022; 52:1096-1109. [PMID: 35838112 DOI: 10.1111/sltb.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ) was developed to measure attentional fixation on suicide, a cognitive process characterized by a preoccupation with suicide as a solution. This study investigated a revised version (AFSEQ-R) and examined differences between those who made a recent suicide attempt and those with suicidal ideation (SI). METHOD Participants were 57 inpatients who attempted suicide within 14 days of study participation and 57 inpatients who presented with SI but no suicidal behavior within the past year. Analyses examined the internal reliability, multidimensionality, and construct validity of the AFSEQ-R, and whether attentional fixation moderated the correlation between SI and attempt status. RESULTS Exploratory factor analysis revealed a two-factor structure, and subscale and total scores demonstrated excellent internal consistency. Cognitive Stuckness (and total score) correlated with SI, anxiety, impulsivity, and specific problem-solving deficits, while Cognitive Dysfunction correlated with anxiety and acted as a moderator of the correlation between Stuckness and SI. AFSEQ-R scores did not moderate the relationship between SI and attempt status. CONCLUSION AFSEQ-R is a psychometrically sound and valid measure of attentional fixation. Attentional fixation on suicide is correlated with SI, and prospective studies are needed to uncover its directional effect on suicidal crises.
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Affiliation(s)
- Abby Adler Mandel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Olga Revzina
- Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Zohaib Jessani
- Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Linthicum KP, Ribeiro JD. Suicide plan prevalence, recurrence, and longitudinal association with nonfatal suicide attempt. Suicide Life Threat Behav 2022; 52:1062-1073. [PMID: 35851502 DOI: 10.1111/sltb.12901] [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: 10/19/2021] [Revised: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Each year, millions of people develop suicide plans. These plans are assumed to indicate imminent suicide risk, yet this has rarely been tested. The present study seeks to address two questions: (1) how prevalent are specific thoughts of suicide plans among individuals with a history of suicidal thoughts and behaviors and (2) do suicide plans confer risk of future suicide attempts in the short term? METHODS Secondary data analysis was performed on a longitudinal dataset (N = 1021). Prevalence and frequencies of suicide planning features (i.e., method, time, place) at baseline and 3, 14, and 28 days post-baseline were calculated. Logistic regressions were conducted to assess whether suicide plans confer risk of suicide attempts across a 28-day follow-up period. RESULTS Suicide planning more commonly involved thoughts of method than place and/or time. High variability in suicide planning was evident and thoughts of suicide plans frequently recurred. Contrary to assumptions, suicide plans displayed weak associations with nonfatal suicide attempt across the 28-day follow-up period. CONCLUSIONS Suicide plans appear heterogeneous in nature. They do not appear to play a strong role in predicting nonfatal suicide attempts. Re-evaluation of the central role that suicide plans occupy within clinical risk assessments may be warranted.
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Affiliation(s)
- Kathryn P Linthicum
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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18
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Oh Y, Lee S, Rogers ML, You S. Assessment of acute and non-acute suicide crisis symptoms: Validation of the Korean version of the acute suicidal affective disturbance inventory. Front Psychol 2022; 13:1034130. [DOI: 10.3389/fpsyg.2022.1034130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide risk assessment is predominantly based on assessing current/recent suicidal ideation and past suicidal behavior. However, suicidal ideation and lifetime suicide attempt are poor predictors of imminent suicide risk or crisis. The acute suicidal affective disturbance inventory-lifetime (ASADI-L) was developed to assess symptoms of acute suicidal affective disturbance, which includes a drastic increase in suicidal intent, perceptions of social and/or self-alienation, hopelessness, and overarousal. However, the ASADI-L has not yet been validated in a Korean population. Also, the ASADI-L has only been validated for people who experience a drastic increase in suicidal intention over the course of hours or days (i.e., the acute suicidal intention group) and not validated for those who experience suicidal intention for a longer period (i.e., the non-acute suicidal intention group). Thus, the aims of this study were to (1) validate the ASADI-L in a sample of Korean community adults; and (2) compare clinical characteristics of the acute and non-acute suicidal intention groups. Among 1,675 community adults, data from 682 participants who reported a lifetime drastic increase in suicidal intent were analyzed. Results indicated that the ASADI-L has relevant reliability, validity, and a unidimensional factor structure. The acute suicidal intention group had higher ASAD symptoms as well as clinical symptoms than the non-acute group, but the two groups did not differ in history of suicide attempt. Overall, these findings suggest that the ASADI-L is a valid measure of acute and non-acute suicidal affective disturbance among Korean adults. Further investigation of the differences in acute and non-acute suicide risk is warranted.
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19
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Conner KR, Kearns JC, Denneson LM. Qualitative analysis of hospital patient narratives of warning signs on the day of their suicide attempt. Gen Hosp Psychiatry 2022; 79:146-151. [PMID: 36375343 PMCID: PMC9729416 DOI: 10.1016/j.genhosppsych.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Research on warning signs, defined as acute risk factors for suicide or suicide attempt, has been slow due to the difficulty of examining the hours and minutes preceding suicidal behavior. This study sought to identify new warning signs and to re-examine warning signs that have been proposed. METHOD Narrative stories of adult patients with substance use problems hospitalized following a suicide attempt were transcribed. The narrative segments describing the 24-h period prior to suicide attempt were examined with directed qualitative content analysis using codes based on prior literature and new codes developed inductively. RESULTS The sample (N = 35) was mean age = 40, 51% female, and 49% White non-Hispanic. Analysis of the transcripts of the 24-h periods (M word count = 637) yielded a broad range of cognitive (e.g., cognitive disturbance such as rumination), behavioral (e.g., alcohol use), emotional (e.g., dramatic mood changes), and social (e.g., social withdrawal) warning signs, along with a small number of cognitions and behaviors that appeared to mark a dangerous shift to acute preparation and intent for attempt, for example 'self-persuasion to attempt suicide.' CONCLUSION We posit that a broad range of cognitive, behavioral, emotional, and social warning signs increase acute risk for suicidal behavior by creating the conditions for a shift to acute preparation and intent, a highly potent category of warning signs.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Lauren M Denneson
- HSR&D Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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20
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Anvar S, Swerdlow BA, Jobes D, Timpano KR, Mandel AA, Kleiman E, Joiner T, Johnson SL. Emotion-related impulsivity and suicidal ideation: Towards a more specific model. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1219-1235. [PMID: 35912940 PMCID: PMC9560962 DOI: 10.1111/bjc.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Suicidal ideation is a pervasive and painful experience that varies considerably in its phenomenology. Here, we consider how one key risk variable might inform our understanding of variation in suicidal ideation: emotion-related impulsivity, the trait-like tendency towards unconstrained speech, behaviour, and cognition in the face of intense emotions. We hypothesized that emotion-related impulsivity would be tied to specific features, including severity, perceived lack of controllability, more rapidly fluctuating course, higher scores on a measure of acute suicidal affective disturbance, and more emotional and cognitive disturbance as antecedents. METHODS We recruited two samples of adults (Ns = 421, 221) through Amazon Mechanical Turk (MTurk), with oversampling of those with suicidal ideation. Both samples completed psychometrically sound self-report measures online to assess emotion- and non-emotion-related dimensions of impulsivity and characteristics of suicidal ideation. RESULTS One form of emotion-related impulsivity related to the severity, uncontrollability, dynamic course, and affective and cognitive precursors of ideation. CONCLUSIONS Despite limitations of the cross-sectional design and self-report measures, the current findings highlight the importance of specificity in considering key dimensions of impulsivity and suicidal ideation.
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Affiliation(s)
- Sarah Anvar
- University of California, Berkeley, California, USA
| | | | - David Jobes
- American University, Washington, District of Columbia, USA
| | | | | | - Evan Kleiman
- Rutgers University, New Brunswick, New Jersey, USA
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21
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Oakey-Frost DN, Moscardini EH, Russell K, Rasmussen S, Cramer RJ, Tucker RP. Defeat, Entrapment, and Hopelessness: Clarifying Interrelationships between Suicidogenic Constructs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10518. [PMID: 36078232 PMCID: PMC9517901 DOI: 10.3390/ijerph191710518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Psychological theories of suicide posit conceptually similar constructs related to the development of suicidal thinking. These constructs often evince high-magnitude interrelationships across studies. Within these theories, defeat, entrapment and hopelessness standout as conceptually and quantitatively similar. Theoretical improvements may be facilitated through clarifying the subscale and item-level similarities among these constructs. Factor analytic and phenomenological work has demonstrated equivocal evidence for a distinction between defeat and entrapment; hopelessness is not typically analyzed together with defeat and entrapment despite evidence of large-magnitude interrelationships. This study explored the interrelationships among the foregoing constructs within a sample of undergraduate students (N = 344) from two universities within the Southeastern United States. Participants, oversampled for lifetime history of suicidal ideation and attempts, completed an online cross-sectional survey assessing defeat, entrapment, hopelessness and SI. Exploratory factor and parallel analyses demonstrated support for a one factor solution when analyzed at subscale level of the three measures as well as when all items of the three measures were analyzed together. Ad hoc exploratory structural equation modeling (ESEM) bifactor results evinced support for the existence of a single, general factor at the item level. Item level communalities and bifactor fit indices suggest that hopelessness may be somewhat distinct from defeat and entrapment. Clinical and theoretical implications are discussed in the context of study limitations.
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Affiliation(s)
- D. Nicolas Oakey-Frost
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Emma H. Moscardini
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Kirsten Russell
- School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK
| | - Robert J. Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, USA
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
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22
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Exploring associations between the Modular Assessment of Risk for Imminent Suicide (MARIS) questionnaire and recent suicidal ideation and behavior among patients admitted at an acute psychiatric inpatient department. Nord J Psychiatry 2022; 77:266-275. [PMID: 37039324 DOI: 10.1080/08039488.2022.2100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE The aim of the present study was to investigate the psychometric validity of the Modular Assessment of Risk for Imminent Suicide (MARIS) questionnaire in relation to recent suicidal ideation and behavior among a sample of patients admitted to an acute psychiatric inpatient department in Norway. METHODS The MARIS was completed within the first 24 h after admission by 338 patients and their clinicians. Information on recent suicidal ideation and behavior was extracted from patients' medical charts. Two out of four MARIS modules, the Suicide Trigger Scale Short-Form (STS-SF; modified version), and the Therapist Response Questionnaire Short-Form (TRQ-SF) demonstrated good internal consistency. The relationships between the STS-SF, addressing symptoms of the suicide crisis syndrome, and the TRQ-SF, exploring therapist emotional responses, and recent suicidal ideation was investigated by logistic regression analysis. RESULTS In the logistic regression analysis including pre-selected diagnoses, age, and gender as covariates, both STS-SF and TRQ-SF showed significant associations with recent suicidal ideation (inclusive of suicidal behavior in 27% of the patients with suicidal ideation). CONCLUSION Both the STS-SF and the TRQ-SF showed concurrent and incremental validity with regard to suicidal ideation. This is the first study showing the cross-cultural validity of the MARIS and supports its clinical utility as a suicide risk assessment tool in inpatient settings. Additionally, this study adds to the literature supporting the value of assessing clinicians' emotional responses to high risk patients.
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23
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Oakey-Frost N, Cowan T, Moscardini EH, Pardue-Bourgeois S, de Beurs D, Cohen A, Bryan CJ, Tucker RP. Examining the Interrelationships Among Suicide Cognitions, Suicidal Ideation, and Theoretically Derived Protective Factors. Arch Suicide Res 2022:1-18. [PMID: 35818724 DOI: 10.1080/13811118.2022.2096521] [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] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Several protective factors for mitigating suicidal ideation (SI) such as positive affect, reasons for living, purpose in life, meaning in life, gratitude, grit, optimism, social support, and hope have been identified and received empirical support. However, few studies have examined the interrelationships of these protective factors and the identification of protective factors most closely linked to lower levels of SI may be useful for both theory-building initiatives and improvement of suicide-specific interventions. Network analysis offers an approach for testing the relation among these constructs, SI, and suicide risk factors. METHODS A sample N = 557 undergraduate students oversampled for lifetime SI completed a cross-sectional, online survey. The data was used to estimate an undirected, cross-sectional network of the aforementioned protective factors. RESULTS The resulting inferred network implicates strong negative influence of suicide cognitions, but not recent SI, and the strong positive influence of presence of meaning in life, trait hope, and low negative affect. CONCLUSIONS Implications for dimensionality of SI versus suicide cognitions, targeting presence of meaning in life, trait hope, and negative affect in treatment, and cross-cultural variations in reasons for living are discussed. The study is limited by the cross-sectional and convenience sampling methodology.HighlightsProtective factors may have less direct influence on suicidal ideationSuicide cognitions and the suicidal mode may be of phenomenological importancePresence of meaning and trait hope may be primary targets for suicide interventions.
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Capron DW, Bauer BW, Bryan CJ. When people die by suicide: Introducing unacceptable loss thresholds as a potential missing link between suicide readiness states and actively suicidal clinical states. Suicide Life Threat Behav 2022; 52:280-288. [PMID: 34854497 DOI: 10.1111/sltb.12820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Contemporary models of suicide have largely overlooked why a person at high risk for suicide attempts suicide at a specific time. We propose the construct of unacceptable loss thresholds (i.e., a person's tolerance limit for a negative life event, which if violated results in an increase in suicide risk), which addresses many paradoxes in the literature related to suicide triggers. The aim of this paper is to provide preliminary proof of concept and to stimulate replication and further empirical study. METHODS We recruited an online community sample of individuals with a suicide attempt history (n = 144). These individuals answered questions about the time leading up to their most recent suicide attempt. RESULTS The majority (70.8% yes; 18.1% cannot remember; 11.1% no) reported creating a threshold of unacceptable loss, and that relatively small events were enough to trigger feelings that life was not worth living (63.9% yes; 30.6% maybe; 5.6% no). Further, the majority (57.6% yes; 21.5% yes, but only if asked; 20.8% - no) reported they would be willing to tell their therapist/doctor about their thresholds of unacceptable loss. CONCLUSION The construct of unacceptable loss deserves further empirical inquiry. Individuals contemplating suicide set them and if the loss occurs, it may trigger suicidal action in suicide ready individuals. Thresholds could provide risk assessment and safety planning data currently being overlooked.
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Affiliation(s)
- Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Sharma P, Peck R, Sinicrope AR, Pavey T, Muehlenkamp JJ. Proximal Risk for Suicide: A Daily Diary Study Protocol (Preprint). JMIR Res Protoc 2022; 11:e37583. [PMID: 35819832 PMCID: PMC9328781 DOI: 10.2196/37583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background Suicide is a prevalent public health concern in the United States across all age groups. Research has emphasized the need to identify risk markers that prevent suicide along shorter timeframes, such as days to weeks. Furthermore, little has been done to explore the relative significance of factors that can predict short-term suicide risk or to evaluate how daily variability in these factors impacts suicidal ideation or behavior. This proposed project aims to identify risk factors that best predict near-time changes in suicidal ideation and examine potential interactions between these factors to predict transitions into suicidal thinking or behaviors. Objective The aim of this proposed study is threefold: (1) To identify which psychological risk factors are most strongly associated with proximal changes in suicide risk across days and weeks. (2) To evaluate theoretical assumptions of the Integrative-Motivational-Volitional Theory of Suicide. (3) To determine how disruptions in physiological arousal interact with theoretical mechanisms of risk to predict concurrent and short-term prospective increase in suicidal thoughts and behaviors. Methods A daily diary or ecological momentary assessment design will be utilized with 200 participants. Participants will complete 2 in-person visits separated by 3 weeks during which they will complete 3 brief daily assessments within their natural environments using the ilumivu research app on a smart device. Research will occur at the Mayo Clinic Health System (MCHS) Eau Claire site. Participants will be recruited through chart review and standard care delivery assessment. Results This manuscript outlines the protocol that will guide the conduct of the forthcoming study. Conclusions The proposed project aims to lead efforts using technological advances to capture microchanges in suicidal thinking/behavior over shorter timeframes and thereby guide future clinical assessment and management of suicidal patients. Results of this study will generate robust evidence to evaluate which risk factors predict proximal changes in suicidal ideation and behaviors. They will also provide the ability to examine potential interactions with multiple theoretically derived risk factors to predict proximal transitions into worsening suicidal thinking or behaviors. Such information will provide new targets for intervention that could ultimately reduce suicide-related morbidity and mortality. International Registered Report Identifier (IRRID) PRR1-10.2196/37583
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Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry and Psychology, Mayo Clinic Health Systems, Eau Claire, WI, United States
- Behavioral Health Reseach Program, Mayo Clinic, Rochester, MN, United States
| | - Robert Peck
- Department of Psychiatry and Psychology, Mayo Clinic Health Systems, Eau Claire, WI, United States
| | - Anthony R Sinicrope
- Behavioral Health Reseach Program, Mayo Clinic, Rochester, MN, United States
| | - Thomas Pavey
- Department of Psychiatry and Psychology, Mayo Clinic Health Systems, Eau Claire, WI, United States
| | - Jennifer J Muehlenkamp
- Department of Psychology, University of Wisconsin Eau Claire, Eau Claire, WI, United States
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Does Hopelessness Accurately Predict How Bad You Will Feel in the Future? Initial Evidence of Affective Forecasting Errors in Individuals with Elevated Suicide Risk. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10285-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bloch-Elkouby S, Barzilay S, Gorman BS, Lawrence OC, Rogers ML, Richards J, Cohen LJ, Johnson BN, Galynker I. The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. J Affect Disord 2021; 295:1280-1291. [PMID: 34706442 DOI: 10.1016/j.jad.2021.08.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/10/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory-2 (SCI-2). METHODS The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. RESULTS The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DISCUSSION The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients' readiness to disclose suicidal ideation.
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Affiliation(s)
- Sarah Bloch-Elkouby
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States.
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Bernard S Gorman
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Olivia C Lawrence
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Megan L Rogers
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Jenelle Richards
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Lisa J Cohen
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Benjamin N Johnson
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
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Chatterjee D, Rai R. Choosing Death Over Survival: A Need to Identify Evolutionary Mechanisms Underlying Human Suicide. Front Psychol 2021; 12:689022. [PMID: 34803791 PMCID: PMC8595259 DOI: 10.3389/fpsyg.2021.689022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
The act of killing self contradicts the central purpose of human evolution, that is, survival and propagation of one’s genetic material. Yet, it continues to be one of the leading causes of human death. A handful of theories in the realm of evolutionary psychology have attempted to explain human suicide. The current article analyses the major components of certain prominent viewpoints, namely, Inclusive fitness, Bargaining model, Pain-Brain model, Psychological aposematism, and few other perspectives. The article argues that relatively more weightage has been given to understanding ultimate (the “why”) rather than proximate (the “how”) functionality of suicidal acts. Evolutionary theorists have consistently pointed out that to comprehensively understand a trait or behavior, one needs to delineate not only how it supports survival but also the evolution of the mechanisms underlying the trait or behavior. Existing theories on suicide have primarily focused on its fitness benefits on surviving kin instead of providing evolutionary explanations of the more complex mechanisms leading up to such self-destructive motivations. Thus, the current paper attempts to highlight this gap in theorizing while suggesting probable proximate explanations of suicide which stresses the need to diffuse attention paid to fitness consequences of the act alone. We speculate that such explorations are needed in order to build a robust and comprehensive evolutionary theory of human suicide.
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Affiliation(s)
- Diya Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology, Kharagpur, India
| | - Rishabh Rai
- Department of Humanities and Social Sciences, Indian Institute of Technology, Kharagpur, India
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McMullen L, Parghi N, Rogers ML, Yao H, Bloch-Elkouby S, Galynker I. The role of suicide ideation in assessing near-term suicide risk: A machine learning approach. Psychiatry Res 2021; 304:114118. [PMID: 34403873 DOI: 10.1016/j.psychres.2021.114118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The majority of suicide attempters do not disclose suicide ideation (SI) prior to making an attempt. When reported, SI is nevertheless associated with increased risk of suicide. This paper implemented machine learning (ML) approaches to assess the degree to which current and lifetime SI affect the predictive validity of the Suicide Crisis Syndrome (SCS), an acute condition indicative of imminent risk, for near-term suicidal behaviors (SB ). METHODS In a sample of 591 high-risk inpatient participants, SCS and SI were respectively assessed using the Suicide Crisis Inventory (SCI) and the Columbia Suicide Severity Rating Scale (C-SSRS). Two ML predictive algorithms, Random Forest and XGBoost, were implemented and framed using optimism adjusted bootstrapping. Metrics collected included AUPRC, AUROC, classification accuracy, balanced accuracy, precision, recall, and brier score. AUROC metrics were compared by computing a z-score. RESULTS The combination of current SI and SCI showed slightly higher predictive validity for near-term SB as evidenced by AUROC metrics than the SCI alone, but the difference was not significant (p<0.05). Current SI scored the highest amongst a chi square distribution in regards to predictors of near-term SB. CONCLUSION The addition of SI to the SCS does not materially improve the model's predictive validity for near-term SB, suggesting that patient self-reported SI should not be a requirement for the diagnosis of SCS.
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Affiliation(s)
- Lauren McMullen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A.
| | - Neelang Parghi
- Courant Institute of Mathematical Sciences, New York University, New York City, NY U.S.A
| | - Megan L Rogers
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A
| | - Heng Yao
- College of Engineering, University of Florida, Gainesville, FL, U.S.A
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A
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Sels L, Homan S, Ries A, Santhanam P, Scheerer H, Colla M, Vetter S, Seifritz E, Galatzer-Levy I, Kowatsch T, Scholz U, Kleim B. SIMON: A Digital Protocol to Monitor and Predict Suicidal Ideation. Front Psychiatry 2021; 12:554811. [PMID: 34276427 PMCID: PMC8280352 DOI: 10.3389/fpsyt.2021.554811] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Each year, more than 800,000 persons die by suicide, making it a leading cause of death worldwide. Recent innovations in information and communication technology may offer new opportunities in suicide prevention in individuals, hereby potentially reducing this number. In our project, we design digital indices based on both self-reports and passive mobile sensing and test their ability to predict suicidal ideation, a major predictor for suicide, and psychiatric hospital readmission in high-risk individuals: psychiatric patients after discharge who were admitted in the context of suicidal ideation or a suicidal attempt, or expressed suicidal ideations during their intake. Specifically, two smartphone applications -one for self-reports (SIMON-SELF) and one for passive mobile sensing (SIMON-SENSE)- are installed on participants' smartphones. SIMON-SELF uses a text-based chatbot, called Simon, to guide participants along the study protocol and to ask participants questions about suicidal ideation and relevant other psychological variables five times a day. These self-report data are collected for four consecutive weeks after study participants are discharged from the hospital. SIMON-SENSE collects behavioral variables -such as physical activity, location, and social connectedness- parallel to the first application. We aim to include 100 patients over 12 months to test whether (1) implementation of the digital protocol in such a high-risk population is feasible, and (2) if suicidal ideation and psychiatric hospital readmission can be predicted using a combination of psychological indices and passive sensor information. To this end, a predictive algorithm for suicidal ideation and psychiatric hospital readmission using various learning algorithms (e.g., random forest and support vector machines) and multilevel models will be constructed. Data collected on the basis of psychological theory and digital phenotyping may, in the future and based on our results, help reach vulnerable individuals early and provide links to just-in-time and cost-effective interventions or establish prompt mental health service contact. The current effort may thus lead to saving lives and significantly reduce economic impact by decreasing inpatient treatment and days lost to inability.
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Affiliation(s)
- Laura Sels
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Experimental Clinical and Health Psychology, Faculty Psychology and Educational Sciences, Ghent University, East Flanders, Belgium
| | - Stephanie Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Anja Ries
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Hanne Scheerer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Isaac Galatzer-Levy
- Psychiatry, New York University School of Medicine, New York, NY, United States
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, Swiss Federal Institute of Technology, Zurich, Switzerland
- Department of Management, Technology, and Economics at ETH Zurich, Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
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Höller I, Forkmann T. Brief Self-Report Measure of Agitation: A Psychometric Investigation in a German Sample. J Pers Assess 2021; 104:110-121. [PMID: 33970724 DOI: 10.1080/00223891.2021.1912057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To perform repeated measurements in clinical practice without putting unnecessary strain on patients, short instruments are needed. The Brief Self-Report Measure of Agitation (BAM) is a short measure assessing agitation, which has been associated with suicidal ideation and behavior. However, its reliability and validity have not been examined in an independent sample. A non-clinical sample of N = 429 participants aged between 18-81 (M = 27.36, SD = 9.67; 82.3% female) was surveyed online. A confirmatory factor analysis was conducted and reliability was investigated. The validity of the BAM was examined by calculating correlations and an ANOVA for differences in BAM scores between subgroups. BAM items significantly loaded onto one factor (factor loadings: ≥ .62) and the measure was found to have good reliability (Cronbach's α = .83) and convergent/discriminant validity. Participants with recent suicidal ideation and those with recent suicidal ideation and lifetime suicide attempts had significantly higher BAM scores than participants without suicidal ideation/suicide attempt. Results indicate good validity and reliability for the measurement of agitation with the German version of the BAM in the present sample. Thereby, we introduce a brief instrument in German for repeated assessment of agitation in research and clinical practice.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrine-Westphalia, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Northrine-Westphalia, Germany
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Rogers ML, Gallyer AJ, Joiner TE. The relationship between suicide-specific rumination and suicidal intent above and beyond suicidal ideation and other suicide risk factors: A multilevel modeling approach. J Psychiatr Res 2021; 137:506-513. [PMID: 33812323 DOI: 10.1016/j.jpsychires.2021.03.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/17/2020] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Abstract
Suicide-specific rumination, characterized by perseveration on and difficulties disengaging from suicidal thoughts and ideas, has been linked to increased suicide risk; however, previous studies were limited by the use of a cross-sectional design and relatively lower risk samples. This study aimed to replicate and extend previous findings by examining the short-term longitudinal association between suicide-specific rumination and suicidal intent, controlling for numerous robust covariates, in a sample of community-based adults at high risk for suicide, who were recruited from suicide-related forums online. Ninety-one adults with significant suicidal ideation (Mage = 27.03, SD = 8.64; 53.8% female, 44.0% male, 1.1% non-binary, 1.1% transgender female) completed brief online self-report measures at six time-points, each three days apart. Multilevel modeling analyses indicated that suicide-specific rumination was associated with suicidal intent, above and beyond suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, insomnia, nightmares, and sociodemographic characteristics. Further, a lagged model demonstrated that suicide-specific rumination predicted subsequent time-point suicidal intent, controlling for current suicidal intent and all other covariates. Overall, these findings suggest that perseverating on one's suicidal thoughts may serve as a proximal factor that increases suicide risk. Future investigations should explore potential mechanisms of this association, as well as interventions that may reduce suicide-specific rumination.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Florida State University, USA.
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Voros V, Tenyi T, Nagy A, Fekete S, Osvath P. Crisis Concept Re-loaded?-The Recently Described Suicide-Specific Syndromes May Help to Better Understand Suicidal Behavior and Assess Imminent Suicide Risk More Effectively. Front Psychiatry 2021; 12:598923. [PMID: 33868041 PMCID: PMC8044894 DOI: 10.3389/fpsyt.2021.598923] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/22/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Despite of the decreasing suicide rates in many countries, suicide is still a major public health concern worldwide. Traditional suicide risk factors have limited clinical predictive value, as they provide little reliable information on the acute psychological processes leading to suicide. Aims: The aim of this analysis is to describe and compare the recently introduced two suicide-specific syndromes [Acute Suicidal Affective Disturbance (ASAD) and Suicidal Crisis Syndrome (SCS)] with the classic psychological features of pre-suicidal crisis and also to assess the clinical utility of the new suicide prediction scales in contrast to classical risk factors. Method: Conceptual analysis. Results: Suicide-specific syndromes are not novel in terms of symptomatology or dynamics of symptom onset, but in their use of well-defined diagnostic criteria. In addition to symptomatic classification, they also provide an opportunity to objectively measure the current pre-suicidal emotional and mental state by validated tools. Limitations: Future studies need to be completed to prove the reliability and predictive validity of suicide-specific diagnostic categories and the related suicide risk assessment tools. Conclusion: Clinical use of suicide-specific syndromes is suggested. This transdiagnostic approach not only enables a more accurate and objective assessment of imminent suicide risk, but also facilitates research in neuroscience, which represent a major step forward in managing and complex understanding of suicidal behavior.
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Affiliation(s)
- Viktor Voros
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Tenyi
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Agnes Nagy
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Sandor Fekete
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Osvath
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
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Bloch-Elkouby S, Gorman B, Lloveras L, Wilkerson T, Schuck A, Barzilay S, Calati R, Schnur D, Galynker I. How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide. J Affect Disord 2020; 277:914-926. [PMID: 33065834 DOI: 10.1016/j.jad.2020.08.088] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022]
Abstract
AIM The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. METHODS The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18-65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. RESULTS The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. DISCUSSION The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.
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Affiliation(s)
| | | | - Lauren Lloveras
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Timothy Wilkerson
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Allison Schuck
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - David Schnur
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Adelphi University, New York City, USA
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Claus C, Teismann T. Akut suizidal-affektive Störung: Ein systematisches Review. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000511922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Die Arbeitsgruppe um Thomas Joiner postuliert ein als <i>acute suicidal affective disturbance</i> (ASAD) bezeichnetes Syndrom, welches durch vier Symptomgruppen (Suizidabsicht, Entfremdung, Hoffnungslosigkeit, Übererregung) definiert sein soll. Ziel des vorliegenden Artikels ist, die Literatur zum ASAD-Syndrom zusammenfassend darzustellen und eine Einschätzung vorzunehmen, inwieweit tatsächlich von einem einheitlichen Syndrom ausgegangen werden kann. <b><i>Methoden:</i></b> Im Rahmen einer Literaturrecherche konnten neun Artikel identifiziert werden, die im Zeitraum von 2016 bis 2020 zum Thema publiziert wurden. <b><i>Ergebnisse und Schlussfolgerungen:</i></b> Die Befundlage unterstützt den einheitlichen Störungscharakter und die Abgrenzbarkeit der akut suizidal-affektiven Störung von anderen Störungsbildern. Die Aussagekraft der Befundlage ist dadurch eingeschränkt, dass bislang ausschließlich Querschnittsuntersuchungen durchgeführt wurden und keinerlei Befunde dazu vorliegen, ob ASAD tatsächlich suizidalem Verhalten vorausgeht.
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Liu RT, Steele SJ, Hamilton JL, Do QBP, Furbish K, Burke TA, Martinez AP, Gerlus N. Sleep and suicide: A systematic review and meta-analysis of longitudinal studies. Clin Psychol Rev 2020; 81:101895. [PMID: 32801085 PMCID: PMC7731893 DOI: 10.1016/j.cpr.2020.101895] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/06/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
The current review provides a quantitative synthesis of the empirical literature on sleep disturbance as a risk factor for suicidal thoughts and behaviors (STBs). A systematic search of PsycINFO, MEDLINE, and the references of prior reviews resulted in 41 eligible studies included in this meta-analysis. Sleep disturbance, including insomnia, prospectively predicted STBs, yielding small-to-medium to medium effect sizes for these associations. Complicating interpretation of these findings however, is that few studies of suicidal ideation and suicide attempts, as well as none of suicide deaths, assessed short-term risk (i.e., employed follow-up assessments of under a month). Such studies are needed to evaluate current conceptualizations of sleep dysregulation as being involved in acute risk for suicidal behavior. This want of short-term risk studies also suggests that current clinical recommendations to monitor sleep as a potential warning sign of suicide risk has a relatively modest empirical basis, being largely driven by cross-sectional or retrospective research. The current review ends with recommendations for generating future research on short-term risk and greater differentiation between acute and chronic aspects of sleep disturbance, and by providing a model of how sleep disturbance may confer risk for STBs through neuroinflammatory and stress processes and associated impairments in executive control.
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Affiliation(s)
- Richard T Liu
- Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Stephanie J Steele
- Department of Psychology, Williams College, Williamstown, MA, United States of America
| | - Jessica L Hamilton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Quyen B P Do
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Kayla Furbish
- Department of Psychology, Boston University, Boston, MA, United States of America
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Ashley P Martinez
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Nimesha Gerlus
- Duke University School of Medicine, Durham, NC, United States of America
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The association between nocturnal panic attacks and suicidal ideation, plans, and attempts. Psychiatry Res 2020; 291:113280. [PMID: 32763542 DOI: 10.1016/j.psychres.2020.113280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 01/15/2023]
Abstract
Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.
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Affiliation(s)
- Morton M Silverman
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alan L Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Barros J, Morales S, García A, Echávarri O, Fischman R, Szmulewicz M, Moya C, Núñez C, Tomicic A. Recognizing states of psychological vulnerability to suicidal behavior: a Bayesian network of artificial intelligence applied to a clinical sample. BMC Psychiatry 2020; 20:138. [PMID: 32228548 PMCID: PMC7106600 DOI: 10.1186/s12888-020-02535-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/06/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aimed to determine conditional dependence relationships of variables that contribute to psychological vulnerability associated with suicide risk. A Bayesian network (BN) was developed and applied to establish conditional dependence relationships among variables for each individual subject studied. These conditional dependencies represented the different states that patients could experience in relation to suicidal behavior (SB). The clinical sample included 650 mental health patients with mood and anxiety symptomatology. RESULTS Mainly indicated that variables within the Bayesian network are part of each patient's state of psychological vulnerability and have the potential to impact such states and that these variables coexist and are relatively stable over time. These results have enabled us to offer a tool to detect states of psychological vulnerability associated with suicide risk. CONCLUSION If we accept that suicidal behaviors (vulnerability, ideation, and suicidal attempts) exist in constant change and are unstable, we can investigate what individuals experience at specific moments to become better able to intervene in a timely manner to prevent such behaviors. Future testing of the tool developed in this study is needed, not only in specialized mental health environments but also in other environments with high rates of mental illness, such as primary healthcare facilities and educational institutions.
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Affiliation(s)
- Jorge Barros
- grid.7870.80000 0001 2157 0406Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, La Reconquista 498, Las Condes, Santiago, Chile
| | - Susana Morales
- Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, La Reconquista 498, Las Condes, Santiago, Chile. .,Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile.
| | - Arnol García
- Independent mathematical engineer, Santiago, Chile
| | - Orietta Echávarri
- grid.7870.80000 0001 2157 0406Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, La Reconquista 498, Las Condes, Santiago, Chile ,grid.488997.3Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile
| | - Ronit Fischman
- grid.488997.3Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile
| | - Marta Szmulewicz
- grid.7870.80000 0001 2157 0406Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, La Reconquista 498, Las Condes, Santiago, Chile ,grid.488997.3Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile
| | - Claudia Moya
- grid.488997.3Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile ,grid.442215.4School of Nursing, San Sebastian University, Santiago, Chile
| | - Catalina Núñez
- grid.7870.80000 0001 2157 0406Psychiatry Department, School of Medicine, Pontificia Universidad Católica de Chile, La Reconquista 498, Las Condes, Santiago, Chile
| | - Alemka Tomicic
- grid.488997.3Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile ,grid.412193.c0000 0001 2150 3115School of Psychology, Diego Portales University, Santiago, Chile
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Schatten HT, Gaudiano BA, Primack JM, Arias SA, Armey MF, Miller IW, Epstein-Lubow G, Weinstock LM. Monitoring, assessing, and responding to suicide risk in clinical research. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:64-69. [PMID: 31868389 DOI: 10.1037/abn0000489] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is essential that investigators in clinical research settings follow ethical guidelines for monitoring, assessing, and responding to suicide risk. Given the unique considerations associated with suicide risk assessment in a research context, resources informing the development of research-specific suicide risk management procedures are needed. With decades of collective experience across heterogeneous contexts, we discuss approaches to monitoring, assessing, and responding to suicide risk as a function of study sample (e.g., students, psychiatric inpatients), data collection methodologies (e.g., interview, self-report, or ecological momentary assessment), and study design (e.g., treatment research). Additional considerations include training and supervision of staff to identify suicide risk, coordination of others to respond to risk, and documentation of procedures. Finally, we attend to the impact of these procedures on the external validity of outcome data. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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Fulginiti A, Frey LM. Are the "Right" People Selected for First Disclosures About Suicidal Thoughts? Exploring What We Know About Advance Care Planning in the Context of Safety Planning. Community Ment Health J 2020; 56:174-185. [PMID: 31512079 DOI: 10.1007/s10597-019-00457-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/07/2019] [Indexed: 11/28/2022]
Abstract
Nominating primary confidants (i.e., safety plan nominees) is central to safety planning for suicide but there is a dearth of research about such confidants-a serious oversight given their high-leverage position to affect pathways into clinical care. Informed by advance care planning (ACP) work, this study examined differences between social network members who were and were not identified as primary confidants on attributes that could impact their effectiveness in a helping role. Using social network methodology, information was collected from 41 individuals with affective disorders about the 332 people and relationships in their networks. Logistic regression analysis revealed that being perceived as capable of managing stress and prioritizing the participant's best interests over one's own increased the odds of being a primary confidant. Clinicians working with suicidal individuals may benefit from integrating ACP principles-which recognize the thoughtful selection of nominees based on specific attributes-into their safety planning procedures.
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Affiliation(s)
- Anthony Fulginiti
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA.
| | - Laura M Frey
- Kent School of Social Work, University of Louisville, 136 Burhans Hall, Shelby Campus, Louisville, KY, 40292, USA
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Fehling KB, Selby EA. Suicide in DSM-5: Current Evidence for the Proposed Suicide Behavior Disorder and Other Possible Improvements. Front Psychiatry 2020; 11:499980. [PMID: 33613330 PMCID: PMC7891495 DOI: 10.3389/fpsyt.2020.499980] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Suicide continues to be one of the greatest challenges faced by mental health clinicians and researchers, an issue made worse by increasing trends in the global suicide rate. Suicide behavior disorder (SBD) was introduced in DSM-5 as a disorder for further consideration and potential acceptance into the diagnostic system. There are numerous positive developments that would arise from the addition of a suicide-related diagnosis. Utilizing the 2009 guidelines established by Kendler and colleagues, the present review examines the evidence for SBD's validity and discusses the diagnosis' potential clinical benefits and limitations. Altogether, growing evidence indicates that SBD has preliminary validity and benefit. SBD presents with several significant limitations, however, and possible alternative additions to future DSMs are highlighted.
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Affiliation(s)
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Buckner JD, Lewis EM, Tucker RP. Mental Health Problems and Suicide Risk: The Impact of Acute Suicidal Affective Disturbance. Arch Suicide Res 2020; 24:303-313. [PMID: 30734644 PMCID: PMC6687574 DOI: 10.1080/13811118.2019.1574688] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acute Suicidal Affective Disturbance (ASAD) is a suicide-specific, episodic clinical entity that is theorized to characterize acute suicide risk. Little work has examined the role of ASAD in mental health conditions linked to suicide risk. Thus, the current study examined whether depression, social anxiety, panic, and alcohol-related problems were related to suicide risk via ASAD history. A total of 527 undergraduates completed an online survey. Depression, social anxiety, and alcohol problem risk (but not panic) were robustly, significantly related to suicide risk, but only social anxiety and depression were robustly related to ASAD history. Depression and social anxiety symptoms were indirectly related to suicide risk via ASAD. ASAD may serve as a potential explanatory pathway through which some mental health conditions may lead to greater suicide risk.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Elizabeth M Lewis
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Bauer BW, Capron DW. How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 15:44-61. [PMID: 31697611 DOI: 10.1177/1745691619866463] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People regularly make decisions that are not aligned with their own self-interests. These irrational decisions often stem from humans having bounded rationality (e.g., limited computational power), which produces reliable cognitive biases that occur outside of people's awareness and influences the decisions people make. There are many important decisions leading up to a suicide attempt, and it is likely that these same biases exist within suicide-related decisions. This article presents an argument for the likely existence of cognitive biases within suicide-related decision making and how they may influence people to make irrational decisions. In addition, this article provides new evidence for using a behavioral economic intervention-nudges-as a potential way to combat rising suicide rates. We explore how nudges can help increase means safety, disseminate suicide prevention skills/materials, diminish well-known biases (e.g., confirmation bias), and uncover biases that may be occurring when making suicide-related decisions.
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Affiliation(s)
- Brian W Bauer
- Department of Psychology, University of Southern Mississippi
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi
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45
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Rogers ML, Joiner TE. Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality. CRISIS 2019; 40:413-421. [DOI: 10.1027/0227-5910/a000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables. Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.
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Affiliation(s)
- Megan L. Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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46
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Yaseen ZS, Hawes M, Barzilay S, Galynker I. Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide Life Threat Behav 2019; 49:1124-1135. [PMID: 30073686 DOI: 10.1111/sltb.12495] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Determining imminent risk of suicide continues to challenge psychiatrists. To this end, we test the clinical utility of a proposed set of diagnostic criteria for the suicide crisis syndrome (SCS) for prediction of imminent suicidal thoughts and behaviors prospectively. METHOD One hundred and seventy individuals hospitalized for suicidal thoughts and behaviors (STB) were evaluated within 72 hr of admission with measures assessing symptoms of the proposed SCS, history of STB, current ideation, and depression severity. Four-eight weeks following discharge, STB were reassessed. Associations between SCS and postdischarge attempts were examined using chi-square and logistic regression analyses. The receiver operator characteristic analysis was used to test the optimal number of symptoms required to meet proposed SCS criteria. RESULTS The syndrome was maximally informative about short-term risk of postdischarge suicide behavior when all criteria were met. The syndrome conferred a sevenfold increase in risk of postdischarge suicide attempt, and significantly improved prediction by standard risk factors, which was null to limited. CONCLUSIONS The SCS diagnostic criteria are supported and appear to describe a clinically meaningful syndrome in a high-risk population. Assessment of SCS may meaningfully improve clinical assessment of imminent suicide risk. Further study is needed to better understand the syndrome and its applicability in low-risk populations.
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Affiliation(s)
- Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Mariah Hawes
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Shira Barzilay
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
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47
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Rogers ML, Hom MA, Joiner TE. Differentiating acute suicidal affective disturbance (ASAD) from anxiety and depression Symptoms: A network analysis. J Affect Disord 2019; 250:333-340. [PMID: 30875677 DOI: 10.1016/j.jad.2019.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND A growing body of literature supports the potential existence of a new clinical entity, Acute suicidal affective disturbance (ASAD), which is characterized by rapid-onset, acute suicidality. This study aimed to evaluate whether current ASAD symptoms (i.e., suicidal intent, thwarted belongingness, perceived burdensomeness, disgust with others and oneself, agitation, irritability, insomnia, and nightmares) comprise a psychopathological network distinct from anxiety and depression symptoms. METHODS A sample of 167 psychiatric inpatients completed self-report measures of current ASAD, anxiety, and depression symptoms. RESULTS Network analyses revealed three distinct clusters of symptoms corresponding to ASAD, anxiety, and depression symptom self-report measure items. Namely, ASAD symptoms not only demonstrated strong associations with each other, but they also exhibited weak associations with symptoms of anxiety and depression. LIMITATIONS This study utilized a cross-sectional design and distinct self-report measures to assess all constructs, which may have led to methodological confounds that influenced the observed network structure. CONCLUSIONS Overall, our findings provide further evidence for ASAD as a syndrome with strongly interrelated symptoms. Furthermore, results indicate that ASAD may represent a construct distinct from anxiety and depression, underscoring its potential diagnostic value. Additional research is needed to replicate these findings across other high-risk populations, as well as to examine how ASAD symptoms may relate to other psychiatric symptoms.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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48
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Schuck A, Calati R, Barzilay S, Bloch-Elkouby S, Galynker I. Suicide Crisis Syndrome: A review of supporting evidence for a new suicide-specific diagnosis. BEHAVIORAL SCIENCES & THE LAW 2019; 37:223-239. [PMID: 30900347 DOI: 10.1002/bsl.2397] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self-reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence-based components-entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre-suicidal mental state, regardless of their self-reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.
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Affiliation(s)
- Allison Schuck
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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49
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Hom MA, Stanley IH, Chu C, Sanabria MM, Christensen K, Albury EA, Rogers ML, Joiner TE. A Longitudinal Study of Psychological Factors as Mediators of the Relationship Between Insomnia Symptoms and Suicidal Ideation Among Young Adults. J Clin Sleep Med 2019; 15:55-63. [PMID: 30621841 DOI: 10.5664/jcsm.7570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Prior cross-sectional studies indicate that psychological factors (eg, perceived burdensomeness, thwarted belongingness) may explain the relationship between insomnia and suicidal ideation. Longitudinal studies are needed, however, to examine how these variables may relate to one another over time. Using data collected at three time points, this study aimed to evaluate various psychological factors as mediators of the longitudinal relationship between insomnia symptoms and suicidal ideation. METHODS Young adults (n = 226) completed self-report measures of insomnia symptoms, suicidal ideation, and psychological factors (ie, disgust with self, others, and the world; perceived burdensomeness; thwarted belongingness; and loneliness) at baseline (T1), 1-month follow-up (T2), and 2-month follow-up (T3). Bias-corrected bootstrap mediation models were utilized to evaluate each T2 psychological factor as a mediator of the relationship between T1 insomnia symptoms and T3 suicidal ideation severity, controlling for the corresponding T1 psychological factor and T1 suicidal ideation severity. RESULTS Only T2 disgust with others and T2 disgust with the world significantly mediated the relationship between T1 insomnia symptoms and T3 suicidal ideation severity. When both mediators were included in the same model, only T2 disgust with the world emerged as a significant mediator. CONCLUSIONS Findings indicate that disgust with others, and particularly disgust with the world, may explain the longitudinal relationship between insomnia symptoms and suicidal ideation among young adults. These factors may serve as useful therapeutic targets in thwarting the trajectory from insomnia to suicidal ideation. Research is needed, however, to replicate these findings in higher risk samples.
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Affiliation(s)
| | | | - Carol Chu
- Harvard University, Cambridge, Massachusetts
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50
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Rogers ML, Chu C, Joiner T. The necessity, validity, and clinical utility of a new diagnostic entity: Acute suicidal affective disturbance. J Clin Psychol 2019; 75:999-1010. [PMID: 30632615 DOI: 10.1002/jclp.22743] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/31/2018] [Accepted: 12/04/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Here we argue for the necessity, validity, and clinical utility of a new diagnostic entity, acute suicidal affective disturbance (ASAD). METHOD We expand on the conceptual, clinical, and practical rationale for ASAD, propose its defining features, describe research results to date, and suggest avenues for future research. RESULTS There is accruing evidence for the existence of a previously unclassified, rapid-onset mood disturbance that geometrically escalates and regularly results in life-threatening behavior. CONCLUSIONS ASAD research may not only improve the field's understanding of suicidal behavior but also enhance clinical effectiveness and save lives.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Carol Chu
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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