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Saputra R, Nuraida, Suhardita K, Oktasari M, Folastri S. Correspondence to Blum et al. The role of interpersonal stressors and connectedness in acute suicide risk and the suicide crisis syndrome during the COVID-19 pandemic. J Affect Disord 2024; 362:404-405. [PMID: 39009314 DOI: 10.1016/j.jad.2024.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/11/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Rikas Saputra
- Universitas Islam Negeri Raden Fatah Palembang, South Sumatra, Indonesia.
| | - Nuraida
- Universitas Islam Negeri Raden Fatah Palembang, South Sumatra, Indonesia
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Kirshenbaum JS, Pagliaccio D, Bitran A, Xu E, Auerbach RP. Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review. Transl Psychiatry 2024; 14:266. [PMID: 38937430 PMCID: PMC11211511 DOI: 10.1038/s41398-024-02914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.
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Affiliation(s)
- Jaclyn S Kirshenbaum
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Alma Bitran
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Elisa Xu
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
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López R, Turnamian MR, Liu RT. Prospective Relations between Life Stress, Emotional Clarity, and Suicidal Ideation in an Adolescent Clinical Sample. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-14. [PMID: 38690948 DOI: 10.1080/15374416.2024.2344735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample. METHODS The sample consisted of 180 youths (Mage = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest. RESULTS At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R2 = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress. CONCLUSIONS Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth's understanding of their emotional experiences may reduce subsequent suicidal ideation.
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Affiliation(s)
- Roberto López
- Department of Psychiatry and Biobehavioral Sciences, University of California
| | - Margarid R Turnamian
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Richard T Liu
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard
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Chen D, Zhou X, Wu H, Ying J, Shen Y, Zhu Q, You J. The impacts of latent profiles and transitions of stresses on adolescent mental health: A person-centred analysis. Stress Health 2024; 40:e3261. [PMID: 37199056 DOI: 10.1002/smi.3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
Research has demonstrated robust links between adolescent stress and serious psychological problems. The current study aimed to identify latent stress profiles of 1510 adolescents (59.7% females; Mage = 16.77 years, SD = 0.86) based on five stresses (parental stresses, family environment stresses, academic stresses, teacher stresses, and peer stresses) at three time points (T1/2/3). Moreover, this study would investigate the transition patterns of these profiles over time and examine the associations between the profiles and adverse psychological symptoms (e.g., anxiety, depression, nonsuicidal self-injury [NSSI], and suicidal ideation). Three latent stress profiles were identified, including High-stress profile, Medium-stress profile, and Low-stress profile. The three profiles were significantly different on the levels of T1/2/3 anxiety, depression, NSSI, and suicidal ideation. The profile memberships remained relatively stable across three time points. Notably, the present study found gender differences, with boys were more likely to be in the High-stress profile and to transition from the Medium- to the High-stress profile, compared to girls. Furthermore, left-behind adolescents were more likely to be in the High-stress profile than non-left-behind adolescents. The findings highlight the importance of adopting 'this-approach-fits-this-profile' interventions for adolescents. Parents and teachers are advised to adopt different strategies for girls and boys.
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Affiliation(s)
- Danrui Chen
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Xinglin Zhou
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Huijiao Wu
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Jiefeng Ying
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Yunhong Shen
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Qixin Zhu
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Jianing You
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, South China Normal University, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
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Leonardi J, Gazzillo F, Gorman B, Bush M. Assessing Burdening Guilt and Its Correlates. Psychodyn Psychiatry 2023; 51:479-499. [PMID: 38047672 DOI: 10.1521/pdps.2023.51.4.479] [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] [Indexed: 12/05/2023]
Abstract
Burdening guilt refers to the belief that one's emotions, needs, and ways of being are a burden to others, and is one type of interpersonal guilt proposed by the control-mastery theory (CMT). The aim of this article is to validate two new measures of burdening guilt. In the two studies conducted, we examined the psychometric properties of these scales and the relationship between burdening guilt and self-perceived burden (burdensomeness), self-esteem, shame, anxiety, depression, mental health, attachment insecurity, adverse childhood experiences, social desirability, empathy, and suicidal ideation. In Study 1, we presented a newly developed Burdening Guilt Rating Scale (BGRS) and its correlation with measures of the abovementioned dimensions. In Study 2 we verified, through confirmatory factor analysis and correlation techniques, the possibility of expanding the Interpersonal Guilt Rating Scale-15 with a shorter, 5-item burdening guilt scale derived from the BGRS, and showed that this shorter scale correlates similarly to the longer one. Findings allowed us to validate these new scales providing empirical measures of burdening guilt-a theoretical concept with important clinical implications.
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Affiliation(s)
- Jessica Leonardi
- Department of Dynamic and Clinical Psychology and Health Studies, "Sapienza" University of Rome
| | - Francesco Gazzillo
- Department of Dynamic and Clinical Psychology and Health Studies, "Sapienza" University of Rome
| | - Bernard Gorman
- Derner School of Psychology, Adelphi University, Garden City, NY
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Buitron V, Mayorga NA, Brooks JR, Nizio P, Schmidt B, Zvolensky MJ. Self-reported COVID-19 symptoms and perceived likelihood of suicide attempt among Latinx individuals who experience acculturative stress. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 14:100632. [PMID: 38098764 PMCID: PMC10720670 DOI: 10.1016/j.jadr.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
The impact of COVID-19 has led to a substantial economic and psychosocial burden on the Latinx population. However, few studies have evaluated how COVID-19 symptoms may exacerbate suicide risk indicators among Latinx persons, or the particular social determinants of health facilitating such detrimental effects. The present study examined the association between self-reported COVID-19 symptoms and suicide likelihood (i.e., self-reported perceived likelihood that one will attempt suicide in the future) among Latinx individuals within a timeframe involving high COVID-19 contagion before the onset of vaccine dissemination. Further, the possible moderating role of acculturative stress in the association between COVID-19 symptoms and suicide likelihood was examined. The sample included 200 Latinx participants (67.5% male, Mage = 34.67 years, SD = 9.15) who completed self-report measures on COVID-19 symptoms, suicide likelihood, acculturative stress, depressive symptoms, trauma symptoms, somatic symptoms, and general COVID-19 emotional impact. Findings indicated that self-reported COVID-19 symptoms were positively associated with suicide likelihood. Further, the association between COVID-19 symptoms and suicide likelihood was moderated by acculturative stress, such that the association was only statistically significant at mean or higher levels of acculturative stress but was not significant among participants with lower acculturative stress. The moderation effect was statistically significant after controlling for sociodemographic factors, depressive symptoms, trauma symptoms, somatic symptoms, and the general emotional impact of the COVID-19 pandemic. The current findings indicate that, among Latinx individuals, acculturative stress is a key social determinant of health for marked psychological distress in the context of the COVID-19 pandemic.
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Affiliation(s)
- Victor Buitron
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | | | - Jasmin R. Brooks
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Pamella Nizio
- Department of Psychology, University of Houston, Houston, TX, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Brad Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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MacNeil S, Renaud J, Gouin JP. Respiratory sinus arrhythmia, negative social interactions, and fluctuations in unmet interpersonal needs: A daily diary study. Suicide Life Threat Behav 2023; 53:597-612. [PMID: 37208985 DOI: 10.1111/sltb.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/04/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION This study examined daily fluctuations in the unmet interpersonal needs of thwarted belongingness and perceived burdensomeness in response to daily negative social interactions, as well as the moderating role of respiratory sinus arrhythmia (RSA) across adolescents at lower and higher risk for suicidal ideation. METHODS Fifty five adolescents with major depressive disorder (MDD, i.e., higher-risk group) and without MDD (i.e., lower-risk group) completed measures of resting RSA, and daily measures of negative social interactions, perceived burdensomeness, and loneliness, as a proxy for thwarted belongingness, for 10 consecutive days. Within-person analyses examined the association between daily negative social interactions and unmet interpersonal needs, and the moderating roles of RSA and higher-risk group status. Between-person analyses also examined the association between RSA and unmet interpersonal needs across groups. RESULTS At the within-person level, participants reported more unmet interpersonal needs on days when they reported more negative social interactions. At the between-person level, higher RSA was associated with decreased loneliness in both groups, and decreased burdensomeness among the higher-risk group. CONCLUSIONS Negative social interactions are associated with daily unmet interpersonal needs. Higher RSA may serve as a protective factor mitigating risk for unmet interpersonal needs, particularly burdensomeness, among adolescents at higher risk for suicidal ideation.
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Affiliation(s)
- Sasha MacNeil
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Johanne Renaud
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Maultsby K, López R, Wolff J, Spirito A, Esposito-Smythers C. Longitudinal Relations Between Parenting Practices and Adolescent Suicidal Ideation in a High-Risk Clinical Sample: A Moderated Mediation Model. Res Child Adolesc Psychopathol 2023; 51:613-623. [PMID: 36652026 DOI: 10.1007/s10802-022-01018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
Parenting behaviors are associated with adolescent suicidal ideation (SI), but few studies have examined this relation longitudinally or investigated underlying mechanisms. We investigated a moderated mediation model to evaluate perceived burdensomeness as a mediator in the longitudinal relation between parenting behavior (warmth and verbal hostility) and adolescent SI. We hypothesized that this association would be particularly strong among adolescents with greater functional impairment. The sample included 147 adolescents (Mage = 14.9, Age Range = 12-18 years, 76.2% female) and a primary caregiver (Mage = 43.5, Age Range = 27-60 years, 81.4% female) enrolled in a clinical trial. Caregivers completed measures of warmth and verbal hostility (PCPR) and adolescents completed measures of functional impairment (CDI-2), perceived burdensomeness (INQ), and SI (SIQ-JR) at baseline, 12 and 18 months. Two moderated mediation path analyses, one for each parenting behavior, were conducted. Age, sex, treatment condition, baseline and 12-month SI, baseline perceived burdensomeness, and the alternate baseline parenting behavior were included as covariates. Neither model yielded a significant direct effect between baseline parental verbal hostility or warmth and 18-month SI. However, lower warmth and higher verbal hostility were positively associated with 18-month SI indirectly through greater 12-month perceived burdensomeness among youth with relatively higher levels of functional impairment. Perceptions of burdensomeness are a mechanism by which low parental warmth and high parental verbal hostility contribute to SI, but only among youth with greater functional impairment. Interventions to address youth perceptions of burdensomeness may be beneficial, particularly for the most highly impaired youth.
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Affiliation(s)
| | - Roberto López
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Ashworth E, Jarman I, McCabe P, McCarthy M, Provazza S, Crosbie V, Quigg Z, Saini P. Suicidal Crisis among Children and Young People: Associations with Adverse Childhood Experiences and Socio-Demographic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1251. [PMID: 36674021 PMCID: PMC9858613 DOI: 10.3390/ijerph20021251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Suicide is a major public health issue and a leading cause of death among children and young people (CYP) worldwide. There is strong evidence linking adverse childhood experiences (ACEs) to an increased risk of suicidal behaviours in adults, but there is limited understanding regarding ACEs and suicidal crises in CYP. This study aims to examine the ACEs associated with CYP presenting at Emergency Departments for suicidal crises, and specifically the factors associated with repeat attendances. This is a case series study of CYP (aged 8-16) experiencing suicidal crisis who presented in a paediatric Emergency Department in England between March 2019 and March 2021 (n = 240). The dataset was subjected to conditional independence graphical analysis. Results revealed a significant association between suicidal crisis and several ACEs. Specifically, evidence of clusters of ACE variables suggests two distinct groups of CYP associated with experiencing a suicidal crisis: those experiencing "household risk" and those experiencing "parental risk". Female sex, history of self-harm, mental health difficulties, and previous input from mental health services were also associated with repeat hospital attendances. Findings have implications for early identification of and intervention with children who may be at a heightened risk for ACEs and associated suicidal crises.
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Affiliation(s)
- Emma Ashworth
- Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Ian Jarman
- Faculty of Engineering and Technology, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Philippa McCabe
- Faculty of Engineering and Technology, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Molly McCarthy
- Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Serena Provazza
- Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Vivienne Crosbie
- Alder Hey Children’s NHS Foundation Trust, Liverpool L14 5AB, UK
| | - Zara Quigg
- Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Pooja Saini
- Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
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Buitron V, Hill RM, Cabrera V, Pettit JW. Development and initial validation of a parent report measure of youth belongingness and burdensomeness. Suicide Life Threat Behav 2022; 52:857-865. [PMID: 35403736 DOI: 10.1111/sltb.12869] [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: 11/02/2021] [Revised: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Interpersonal Theory of Suicide (ITS) implicates thwarted belongingness and perceived burdensomeness as casually related to suicide desire. The self-report Interpersonal Needs Questionnaire (INQ) is the most commonly used measure to assess belongingness and burdensomeness, including in youth. No parent-report version of the INQ exists. The current study adapted the ten-item version of the INQ (INQ-10) for parent report of youth belongingness and burdensomeness, thereby moving ITS research in youth to a multi-informant measurement approach, and examined its factor structure and convergent and concurrent validity. METHODS Participants were 168 clinic-referred youths ages 9-17 years (58.9% female; Mage = 11.91) and their parents. RESULTS Findings supported a two-factor structure of the parent INQ. In support of convergent and concurrent validity, parent-reported belongingness and burdensomeness were significantly associated with youth-reported belongingness and burdensomeness, suicide ideation, anxiety symptoms, depressive symptoms, and impairment. CONCLUSIONS The current study provides initial support the INQ-parent version as a valid measure to complement youth self-reports of belongingness and burdensomeness.
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Affiliation(s)
- Victor Buitron
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Ryan M Hill
- University of Texas at San Antonio, San Antonio, Texas, USA
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Buitron V, Hill RM, Bose D, Vaclavik D, Rey Y, Pettit JW. Brief modular approach to target perceived burdensomeness in clinic-referred youth. Suicide Life Threat Behav 2022; 52:752-762. [PMID: 35384039 PMCID: PMC9731507 DOI: 10.1111/sltb.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Existing CBT protocols for internalizing disorders target thoughts and behaviors related to anxiety and/or depression, but do not explicitly target other identified risk factors for suicide ideation, including perceived burdensomeness toward others. The aims of the current study were to (1) develop a novel, brief module (the "Give program") targeting perceived burdensomeness toward others that can be embedded within existing CBT protocols for youth internalizing disorders, (2) evaluate the acceptability and feasibility of the module with an eye toward intervention refinement, and (3) examine reductions in perceived burdensomeness. METHODS Participants were 18 clinic-referred youths with anxiety or depressive disorders who endorsed burdensomeness. We used a quasi-experimental interrupted time-series design to evaluate changes in burdensomeness scores following the administration of the module. RESULTS The module was clinically feasible and well-accepted. Youth burdensomeness scores increased in the first half of the CBT protocol and decreased immediately following the administration of the Give program module. Burdensomeness scores were significantly associated with suicide ideation. CONCLUSION The current study is the first to develop and evaluate a module targeting burdensomeness in at-risk youth in an outpatient setting, demonstrating that burdensomeness can be efficiently and effectively targeted within existing evidence-based treatment protocols for internalizing disorders in youth.
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Affiliation(s)
| | - Ryan M. Hill
- University of Texas at San Antonio, San Antonio, Texas, USA
| | - Deepika Bose
- Florida International University, Miami, Florida, USA
| | | | - Yasmin Rey
- Florida International University, Miami, Florida, USA
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12
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Benjet C, Mortier P, Kiekens G, Ebert DD, Auerbach RP, Kessler RC, Cuijpers P, Green JG, Nock MK, Demyttenaere K, Albor Y, Bruffaerts R. A risk algorithm that predicts alcohol use disorders among college students. Eur Child Adolesc Psychiatry 2022; 31:1-11. [PMID: 33723648 PMCID: PMC9336831 DOI: 10.1007/s00787-020-01712-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12-2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08-2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31-8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions.
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Affiliation(s)
- C Benjet
- Department of Epidemiology and Psychosocial Research, National Institute of Psychiatry Instituto Nacional de Psiquiatría Ramón de La Fuente Muñiz, Calzada México-Xochimilco 101, San Lornenzo Huipulco, CDMX, 14370, Mexico City, Mexico.
| | - P Mortier
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - G Kiekens
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
- School of Psychology, Curtin University, Perth, Australia
| | - D D Ebert
- Clinical Psychology and Psychotherapy, Department of Psychology, Friedrich-Alexander-UniversityErlangen-Nürnberg, Erlangen, Germany
| | - R P Auerbach
- Department of Psychiatry, Columbia University, New York, USA
| | - R C Kessler
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J G Green
- Wheelock College of Education and Human Development, Boston University, Boston, MA, USA
| | - M K Nock
- Department of Psychology, Harvard University, Cambridge, MA, 0000-0001-6508-1145, USA
| | - K Demyttenaere
- Universitair Psychiatrisch Centrum, Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - Y Albor
- National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City and Universidad Cuauhtémoc Plantel Aguascalientes, Aguascalientes, Mexico
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum, Public Health Psychiatry, KU Leuven, Leuven, Belgium
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13
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Kassing F, Dodd CG, Palmer LE, Hill RM. Comfort Expressing Emotions and Suicide Ideation: Evidence of Indirect Effects Via Perceived Burdensomeness and Thwarted Belongingness. Arch Suicide Res 2022; 26:886-895. [PMID: 33126840 DOI: 10.1080/13811118.2020.1841053] [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: 10/23/2022]
Abstract
OBJECTIVE Emotion regulation strategies and related constructs have been implicated both as risk and protective factors in a range of mental health outcomes among young adults. To expand upon this previous research, we examined comfort expressing four discrete emotions (i.e., love, happiness, sadness, and anger) as factors that protect against suicide ideation in young adults, within the context of the interpersonal theory of suicide. METHOD The sample consisted of 449 college students (73.1% female, 70.6% Hispanic, Mage = 20.5 years) taking part in a larger study of mood and well-being. Students were recruited from a psychology participant pool and completed self-report measures at a single time point for course credit. Comfort expressing emotions and suicide ideation were assessed using the Measure of Verbally Expressed Emotion (MoVEE) and Adult Suicidal Ideation Questionnaire (ASIQ), respectively. Perceived burdensomeness and thwarted belongingness were assessed using the Interpersonal Needs Questionnaire (INQ). RESULTS Preliminary analyses revealed negative associations between comfort expressing all four emotions and suicide ideation (rs = -.13 to -.26). Results from structural equation modeling supported indirect effects from comfort expressing happiness and sadness to suicide ideation, via perceived burdensomeness and thwarted belongingness. An indirect effect was also identified from comfort expressing love to suicide ideation, via thwarted belongingness. CONCLUSIONS Results suggest that comfort expressing emotions (particularly sadness and happiness) is a protective factor against suicide ideation for young adults. These findings suggest that suicide-prevention efforts may wish to focus on increasing comfort expressing emotions to trusted support networks as potential intervention targets.HIGHLIGHTSComfort expressing emotions is negatively associated with suicide ideation.Comfort expressing emotions is associated with belongingness and burdensomeness.Comfort expressing emotions may be a potential target for suicide prevention.
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14
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Relations between parental response to children's negative emotions and suicidal ideation in chinese adolescents: Internalizing problems, emotion regulation, and perceived relationship quality with parents as mediators. J Affect Disord 2022; 301:205-216. [PMID: 35033594 DOI: 10.1016/j.jad.2022.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Abstract
Past work points to the crucial role of parents' responses to children's negative emotions (PRCNE) in adolescents' socioemotional adjustment. The presence of suicidal ideation (SI) is an important sign of significant distress and suicide risk. However, research on the relations between PRCNE and adolescents' SI is lacking. This research aimed to investigate whether parental reactions to children's negative emotions (PRCNE) was related to adolescents' SI and, if so, through which processes. This research utilized data from a sample of Chinese adolescent families (N = 4,574; Parents: 35.81% males, M = 44.07 years old; Adolescents: 55.40% males, M = 16.28 years old), with parents giving their reports on PRCNE and adolescents self-evaluating their psychosocial development (i.e., internalizing problems, emotion regulation, perceived relationship quality with parents) and SI. We examined the relations between six types of PRCNE and adolescents' SI, and analyzed the mediating roles of adolescents' internalizing problems, emotion regulation (i.e., cognitive reappraisal and expressive suppression), and perceived relationship quality with parents. The results showed that emotion-focused response, problem-focused response, and expression encouragement negatively predicted, while punitive response and distress response positively predicted adolescents' SI. However, no statistically significant association emerged between minimization and adolescents' SI. Moreover, adolescents' internalizing problems, usage of expressive suppression, and perceived relationship quality with parents could mediate the relations between PRCNE and adolescents' SI. Contrary to our hypothesis, the results did not support an indirect effect of PRCNE on adolescents' SI through adolescents' cognitive reappraisal. The present research illuminates adolescents' SI by emphasizing the roles of PRCNE. The findings also highlight the importance of paying attention to adolescents' internalizing problems, expressive suppression, and perceived relationship quality with parents in relation to PRCNE in interventions aimed at reducing adolescents' SI.
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15
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Dizon JIWT, Mendoza NB. Low Perceived Social Rank Increases the Impact of Mental Health Symptoms on Suicidal Ideation: Evidence among Young Adults from the Philippines. Arch Suicide Res 2022; 27:522-539. [PMID: 34989659 DOI: 10.1080/13811118.2021.2022050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Studies on social factors that could influence the mental health-suicidal ideation link remain scarce, especially in non-Western contexts. This study examined the relationship between mental health symptoms (i.e., depression, anxiety, and stress) and suicidal ideation and whether one's perceived social rank moderates such a relationship. Data from 631 students from two universities in the Philippines collected between October to December 2018 was analyzed. Bivariate correlations show that greater symptoms of depression, anxiety, and stress are associated with increased suicidal ideation. Hierarchical linear regression models supported the direct relationship between mental health symptoms and suicidal ideation and demonstrated that perceived social rank significantly moderated such a relationship. Johnson-Neyman plots and simple slopes analyses further illustrate how mental health symptoms and perceived social rank interact to impact suicidal ideation. The results show that as one's perceived social rank lowers, the strength of the positive association between depression, anxiety, and stress symptoms to suicidal ideation strengthens. The results held while controlling for age, gender, college year level, and family income. The findings are discussed using the social rank theory and the Integrated Motivational-Volitional (IMV) model of suicide to view suicidal ideation from both an individual and a social perspective. We expound on the role of low perceived social rank on suicidal ideation among young adults.HIGHLIGHTSHigher depression, anxiety, and stress symptoms are associated with higher suicidal ideation.Perceived social rank moderates the link between mental health symptoms and suicidal ideation.One's perception of being inferior to others can exacerbate suicidal ideation.
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16
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Quintana-Orts C, Rey L, Neto F. Beyond Cyberbullying: Investigating When and How Cybervictimization Predicts Suicidal Ideation. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:935-957. [PMID: 32345110 DOI: 10.1177/0886260520913640] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cybervictimization is a public health concern in adolescence. Victims of cyberbullying may present with important short- and long-term sequelae. Specifically, past research has demonstrated positive associations between being cybervictimized and risk of suicide among adolescents. Nonetheless, the underlying mechanisms that may mediate or moderate this relationship remain unclear. The present research examined perceived stress as a mediator and forgiveness as a moderator to explore the relationship between cybervictimization and suicidal ideation. Specifically, vengeance, avoidance, and benevolence motivations, as a means of measuring forgiveness experienced, were analyzed as moderators in the relations between cybervictimization and suicidal ideation. The sample included 1,821 adolescents (954 girls) who ranged in age from 12 to 17 years from nine centers. Adolescents' self-reported perceived stress levels, cybervictimization, and forgiveness were collected. A mediation and a moderated mediation analyses were used to explore the aim of the present study. Results suggest that, after controlling for sex and age, perceived stress partially mediates the association between cybervictimization and suicidal ideation. Furthermore, the mediation effects of perceived stress were independently moderated by vengeance and avoidance. Thus, revenge and avoidance might intensify the adverse impact of perceived stress on suicidal ideation. These results highlight how and when cybervictimization is related to suicidal ideation. We discuss the results in relation to previous research and consider their practical implications. These findings suggest that adolescents' perceived stress, together with vengeance and avoidance motivations, may be key targets for prevention and intervention programs dealing with cybervictimization. This highlights the need to implement treatment and prevention programs focused on decreasing such motivations.
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17
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Wong JCM, Chang CL, Shen L, Nyein N, Loh ASW, Yap NH, Kroneman LM, Feng L, Tan CH. Temperament, parenting, mental disorders, life stressors and help-seeking behavior of Asian adolescent suicide attempters: A case control study. Front Psychiatry 2022; 13:999089. [PMID: 36245865 PMCID: PMC9557074 DOI: 10.3389/fpsyt.2022.999089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The need to elucidate risk factors for adolescent suicide is urgent, as suicide consistently ranks among the top causes of death globally. Understanding suicide risk factors could inform more effective interventions. Previous studies have identified certain risk factors associated with suicide, but there is a paucity of research among adolescent and multi-ethnic Asian populations. MATERIALS AND METHODS This case-control study sampled 13-to-19-year-old Asian adolescents who had attempted suicide (N = 60) and controls (N = 58) matched by age, ethnicity and gender at group-level (73.7% female). Life stressors, temperament, parenting style, mental health conditions and help-seeking behavior were examined. RESULTS All domains of life stress apart from emerging adult responsibility were higher among cases than controls, especially home life, peer pressure and romantic relationships. Suicide attempters tended to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleep-wake cycle. Additionally, they perceived their parents to be significantly more aggressive, neglecting, rejecting and cold, while parents' perceptions of their own parenting were only significantly different in the domain of parental neglect. Cases were more likely to exhibit disorders of disruptive behavior, eating, mood, anxiety, symptoms of schizophrenia and experience of disturbing events. Significant differences were also found for 10 out of 12 Axis II disorders, particularly borderline, depressive, and avoidant personality disorder traits. No significant case-control differences were found regarding overall rates of help-seeking. CONCLUSION Findings from this study may help in suicide prevention efforts through more tailored interventions.
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Affiliation(s)
- John Chee Meng Wong
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Christel Lynne Chang
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nyein Nyein
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Adrian Seng Wei Loh
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie Huijing Yap
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leoniek Mirjam Kroneman
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Chay Hoon Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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18
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Byeon H. Prediction of adolescent suicidal ideation after the COVID-19 pandemic: A nationwide survey of a representative sample of Korea. Front Pediatr 2022; 10:951439. [PMID: 35958177 PMCID: PMC9357914 DOI: 10.3389/fped.2022.951439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/06/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study developed a model to predict groups vulnerable to suicidal ideation after the declaration of the COVID-19 pandemic based on nomogram techniques targeting 54,948 adolescents who participated in a national survey in South Korea. METHODS This study developed a model to predict suicidal ideation by using logistic regression analysis. The model aimed to understand the relationship between predictors associated with the suicidal ideation of South Korean adolescents by using the top seven variables with the highest feature importance confirmed in XGBoost (extreme gradient boosting). The regression model was developed using a nomogram so that medical workers could easily interpret the probability of suicidal ideation and identify groups vulnerable to suicidal ideation. RESULTS This epidemiological study predicted that eighth graders who experienced depression in the past 12 months, had a lot of subjective stress, frequently felt lonely in the last 12 months, experienced much-worsened household economic status during the COVID-19 pandemic, and had poor academic performance were vulnerable to suicidal ideation. The results of 10-fold cross-validation revealed that the area under the curve (AUC) of the adolescent suicidal ideation prediction nomogram was 0.86, general accuracy was 0.89, precision was 0.87, recall was 0.89, and the F1-score was 0.88. CONCLUSION It is required to recognize the seriousness of adolescent suicide and mental health after the onset of the COVID-19 pandemic and prepare a customized support system that considers the characteristics of persons at risk of suicide at the school or community level.
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Affiliation(s)
- Haewon Byeon
- Department of Digital Anti-Aging Healthcare (BK21), Graduate School, Inje University, Gimhae, South Korea.,Department of Medical Big Data, College of AI Convergence, Inje University, Gimhae, South Korea
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19
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Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME. Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention. Curr Diab Rep 2021; 21:51. [PMID: 34902071 PMCID: PMC8666467 DOI: 10.1007/s11892-021-01427-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population. RECENT FINDINGS Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths' access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care. Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A S Gallagher
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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20
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Eckhardt CI, Oesterle DW, Maloney MA. The instigating effects of isolation on substance-related intimate partner violence: A review. Curr Opin Psychol 2021; 44:18-23. [PMID: 34536712 DOI: 10.1016/j.copsyc.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
In this article, we examine the empirical and theoretical support for the idea that experiences of isolation can intensify substance use, even among those in committed close relationships, and can increase the likelihood of negative conflict behaviors, including intimate partner violence (IPV). Cross-sectional, longitudinal, and laboratory-based research suggest that individuals and couples who report experiences of social exclusion and have fewer social supports experience more mental health problems, more negative emotional experiences, and higher levels of stress. These negative outcomes spur coping efforts to reduce these distressing states, which often involve pain-relieving substances such as alcohol. We describe how dynamic models of relationship conflict and IPV can integrate alcohol and substance use patterns among both individuals and couples to understand and predict contexts leading to conflict escalation and IPV perpetration.
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21
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Abbott CH, Zisk A, Herres J, Diamond GS, Krauthamer Ewing S, Kobak R. Exploring the relations between interpersonal risk and adolescent suicidality during treatment. J Consult Clin Psychol 2021; 89:528-536. [PMID: 34264700 DOI: 10.1037/ccp0000656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite considerable evidence that supports perceived burdensomeness (PB) and thwarted belongingness (TB) as risk factors for suicidal ideation (SI), far less is known about the direction of effects between these constructs in treatments for suicidal adolescents. The present study examined bidirectional relations between PB, TB, and adolescents' suicidal ideation (SI) during a 16-week randomized clinical trial. METHOD 129 depressed and suicidal adolescents completed PB, TB, and SI measures at three time points: baseline (T1), mid-treatment (T2), and treatment completion (T3). Random-intercept cross-lagged panel models (RI-CLPM) examined within-subject direction of effects between interpersonal variables (PB & TB) and suicidal ideation (SI) in the first and second halves of treatment. RESULTS Within-subjects, autoregressive paths indicated significant carryover in PB and SI. In the first half of treatment, a significant cross-lagged path indicated that T1 PB predicted change in T2 SI, and in the last half of treatment change in T2 SI predicted change in T3 PB. There were no significant auto-regressive or cross-lagged effects for TB. CONCLUSIONS In the first half of treatment, baseline PB predicted fewer reductions in SI suggesting that PB initially moderated adolescents' response to treatment. However, in the last half of treatment, initial reductions in SI predicted subsequent reductions in PB suggesting that adolescents' initial response to treatment decreased their perceptions of burdening others. The clinical and treatment implications of these bidirectional findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Roger Kobak
- Department of Psychological and Brain Sciences
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22
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Park CHK, Lee JW, Moon J, Jeon DW, Lee SY, Shim SH, Kim SG, Lee J, Paik JW, Cho SJ, Kim MH, You S, Jeon HJ, Rhee SJ, Kim MJ, Kim J, Ahn YM. Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women. J Korean Med Sci 2021; 36:e72. [PMID: 33724739 PMCID: PMC7961867 DOI: 10.3346/jkms.2021.36.e72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. METHODS Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. RESULTS Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. CONCLUSION Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.
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Affiliation(s)
| | - Jae Won Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Jungjoon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jeewon Lee
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea
| | - Min Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, Cheongju, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.
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Hill RM, Mellick W, Alvis L, Dodd CG, Do C, Buitron V, Sharp C, Pettit JW, Kaplow JB. Performance of the interpersonal needs questionnaire in adolescent clinical samples: Confirmatory factor analyses and evaluation of measurement invariance. Suicide Life Threat Behav 2020; 50:1214-1222. [PMID: 33078464 DOI: 10.1111/sltb.12714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 06/02/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study evaluated the factor structure, internal consistency reliability, construct and criterion validity, and measurement invariance of the Interpersonal Needs Questionnaire (INQ) among adolescents. METHOD Participants (N = 539) included three distinct samples of youth drawn from two outpatient psychology clinics and an inpatient psychiatric unit. The combined sample was 63.3% female and had a mean age of 14.95 years (SD = 1.31 years). All participants completed the INQ as well as measures of depressive symptoms and suicide ideation. RESULTS Confirmatory factor analyses indicated that the removal of three items from the thwarted belongingness subscale of the INQ was needed to achieve acceptable model fit. The resulting combined 12-item scale demonstrated good factor structure, internal consistency reliability, construct validity, and criterion validity. The modified 12-item INQ also demonstrated scalar invariance across subgroups defined by sex, race, and age. CONCLUSIONS Findings support the use of this reduced 12-item version of the INQ among adolescents. Youth may have difficulty accurately responding to changes in item valence; thus, future research with youth should consider using a 12-item version of the INQ that avoids valence changes within subscales.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - William Mellick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Alvis
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Cody G Dodd
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Calvin Do
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Victor Buitron
- Department of Psychology and Center for Children and Families, Florida International University, Miami, Florida, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Jeremy W Pettit
- Department of Psychology and Center for Children and Families, Florida International University, Miami, Florida, USA
| | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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24
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Le TM, Wang W, Zhornitsky S, Dhingra I, Chen Y, Zhang S, Li CSR. The Neural Processes Interlinking Social Isolation, Social Support, and Problem Alcohol Use. Int J Neuropsychopharmacol 2020; 24:333-343. [PMID: 33211853 PMCID: PMC8059487 DOI: 10.1093/ijnp/pyaa086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/19/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Subjective feeling of social isolation, as can be measured by perceived burdensomeness (PB), is a major risk factor for alcohol misuse. Heightened PB is associated with elevated stress response and diminished cognitive control, both of which contribute to problem drinking. Here, we sought to identify the neural substrates underlying the relationship between PB and alcohol misuse. METHODS We employed resting-state functional magnetic resonance imaging data collected from 61 problem drinkers to characterize the functional connectivity of the hypothalamus and ventral striatum (VS) in relation to PB. We specifically examined whether the connectivities of the hypothalamus and VS were differentially influenced by PB to produce contrasting effects on alcohol use. Finally, we evaluated how individual differences in social support modulate the inter-relationships of social isolation, neural connectivity, and the severity of problem drinking. RESULTS Whole-brain multiple regressions show a positive relationship between PB and hypothalamic connectivity with the hippocampus and an inverse pattern for VS connectivity with the middle frontal gyrus. Difference in strength between the 2 connectivities predicted the severity of problem drinking, suggesting an imbalance involving elevated hypothalamic and diminished prefrontal cortical modulation in socially isolated problem drinkers. A path analysis further revealed that the lack of social support was associated with a bias toward low prefrontal connectivity, which in turn increased PB and facilitated problem drinking. CONCLUSIONS Altered hypothalamus and VS connectivity may underlie problem drinking induced by social isolation. The current findings also highlight the important role of social support as a potential protective factor against alcohol misuse.
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Affiliation(s)
- Thang M Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA,Correspondence: Thang M. Le, PhD, Connecticut Mental Health Center, S105, 34 Park Street, New Haven, CT 06519-1109, USA ()
| | - Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isha Dhingra
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yu Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chiang-Shan R Li
- Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut, USA,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, Connecticut, USA
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Perceived burdensomeness and neural responses to ostracism in the Cyberball task. J Psychiatr Res 2020; 130:1-8. [PMID: 32763557 PMCID: PMC7554229 DOI: 10.1016/j.jpsychires.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/22/2020] [Indexed: 12/23/2022]
Abstract
Previous studies have identified the brain correlates of social pain processing during ostracism. However, the affective response to ostracism may vary according to individual differences in interpersonal needs and subsequent social actions. Despite this relationship, how the neural processes underlying ostracism may be modulated by interpersonal needs to regulate prosocial behaviors remains unknown. Here, in an fMRI study of 64 adults performing the Cyberball task, we quantified ball catching and tossing response time (RT) as a behavioral measure of participants' willingness to seek and reciprocate social interactions. Neural activations to social exclusion were identified and characterized in relation to individual differences in behavioral performance and perceived burdensomeness (PB), a measure of interpersonal needs. The results showed that social exclusion elicited activity in the anterior insula, middle frontal gyrus, postcentral gyrus, and dorsomedial prefrontal cortex, replicating previous studies on ostracism. Importantly, those with higher PB also exhibited greater brain activations to exclusion as well as reduced prosocial behaviors, as reflected by slower ball catching and tossing RT in the Cyberball task. Taken together, these findings suggest that emotional distress in ostracism may increase with PB, resulting in stronger neural responses to social pain and behavioral avoidance of social interactions.
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Buitron V, Vaclavik D, Hill RM, Bose D, Pettit JW. Low Parental Warmth and High Youth Impairment: A Recipe for Perceived Burdensomeness? Behav Ther 2020; 51:789-799. [PMID: 32800306 DOI: 10.1016/j.beth.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
Theory and research document the role of perceived burdensomeness in the development of suicide ideation, including in youth. There is a critical need to identify and evaluate variables that foster perceived burdensomeness in youth, with an eye toward advancing etiological models and informing prevention approaches for at-risk youth who are not yet actively suicidal. The current study examined and replicated a conceptual model wherein the association between low parental warmth and burdensomeness is moderated by youth impairment. Participants were 75 and 150 clinic referred youths in Study 1 and Study 2, respectively, with anxiety-related difficulties. Youth impairment significantly moderated the association between low parental warmth and youth perceived burdensomeness such that the association was negative and statistically significant at high levels of impairment, but not at low levels of impairment. The moderation effect was statistically significant in both studies while controlling for anxiety and depressive symptoms. These findings provide insight into variables that are associated with a sense of burdensomeness toward others in youth, and identify potential targets for preventing or intervening to reduce perceived burdensomeness in clinic-referred youth.
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Affiliation(s)
| | | | - Ryan M Hill
- Baylor College of Medicine and Texas Children's Hospital
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Cáceda R, James GA, Stowe ZN, Delgado PL, Kordsmeier N, Kilts CD. The neural correlates of low social integration as a risk factor for suicide. Eur Arch Psychiatry Clin Neurosci 2020; 270:619-631. [PMID: 30903270 PMCID: PMC6756996 DOI: 10.1007/s00406-019-00990-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022]
Abstract
Low social integration is commonly described in acutely suicidal individuals. Neural mechanisms underlying low social integration are poorly understood in depressed and suicidal patients. We sought to characterize the neural response to low social integration in acutely suicidal patients. Adult depressed patients within 3 days of a suicide attempt (n = 10), depressed patients with suicidal ideation (n = 9), non-suicidal depressed patients (n = 15), and healthy controls (N = 18) were administered the Cyberball Game while undergoing functional magnetic resonance imaging. We used complementary functional connectivity and region of interest data analysis approaches. There were no group differences in functional connectivity within neural network involving the pain matrix, nor in insula neural activity or the insula during either social inclusion. Superior anterior insula activity exhibited an inverted U-shaped curve across the suicide risk spectrum during social inclusion. Superior insula activity during social inclusion correlated with depression severity and psychological pain. Dorsal anterior cingulate cortex activity during social exclusion correlated with physical pain severity. Neural responses in the anterior insula significantly correlated with depression severity and with psychological pain during social inclusion, whereas dACC activity significantly correlated with physical pain during social exclusion. Recent suicidal behavior seems associated with a distinct neural response to social exclusion independently of presence of depression or suicidal thoughts.
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Affiliation(s)
- Ricardo Cáceda
- Department of Psychiatry, Stony Brook University, HSC T-10-040D, Stony Brook, NY, 11794, USA.
| | - G Andrew James
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, Madison, WI, USA
| | - Pedro L Delgado
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nolan Kordsmeier
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clint D Kilts
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Oosterhoff B, Hill RM, Slonaker NJ. Longitudinal associations between civic engagement and interpersonal needs during the 2018 US midterm elections. APPLIED DEVELOPMENTAL SCIENCE 2020. [DOI: 10.1080/10888691.2020.1787169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Ryan M. Hill
- Baylor College of Medicine/Texas Children’s Hospital
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29
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Hunt QA, Weiler LM, McGuire J, Mendenhall T, Kobak R, Diamond GS. Testing Basic Assumptions of the Interpersonal Needs Questionnaire-15 in a Sample of Clinically Depressed and Suicidal Youth. Suicide Life Threat Behav 2020; 50:372-386. [PMID: 31600010 DOI: 10.1111/sltb.12594] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicide is a leading cause of death in adolescence. The mechanisms of adolescent suicidality, however, are not fully understood. Although the Interpersonal-Psychological Theory of Suicide, as assessed by the Interpersonal Needs Questionnaire-15 (INQ), may be a promising framework, systematic study of its utility during adolescence is lacking. METHOD To this end, we utilized factor analyses and hierarchical regression analyses to test the factor structure, correlates, and predictive validity of the INQ in a sample of clinically depressed and suicidal adolescents (N = 120, aged 12-18). The sample was mostly female (81.9%), ethnically diverse (68.2% non-White) and with nearly a third identifying as a sexual minority (31.8%). RESULTS Contrary to studies including adult samples in which a two-factor solution is identified, results within this sample indicated three factors: perceived burdensomeness, thwarted belongingness, and perceived isolation. Perceived burdensomeness and the interaction between perceived burdensomeness and perceived isolation predicted suicide ideation above and beyond depression, but thwarted belongingness and perceived isolation did not. CONCLUSION Perceived burdensomeness appears to play a role in adolescent suicidality and may be a point of intervention, yet the notable deviation from previous findings and the relative weakness of two of the factors warrant further study.
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Affiliation(s)
- Quintin A Hunt
- Couple and Family Therapy Program, University of Minnesota, St. Paul, MN, USA.,Marriage and Family Therapy Program, Brigham Young University, Provo, UT, USA
| | - Lindsey M Weiler
- Couple and Family Therapy Program, University of Minnesota, St. Paul, MN, USA
| | - Jenifer McGuire
- Family Social Science Program, University of Minnesota, St. Paul, MN, USA
| | - Tai Mendenhall
- Couple and Family Therapy Program, University of Minnesota, St. Paul, MN, USA
| | - Roger Kobak
- Department of Psychology, University of Delaware, Newark, DE, USA
| | - Guy S Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
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30
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Hill RM, Katusic M. Examining suicide risk in individuals with autism spectrum disorder via the interpersonal theory of suicide: clinical insights and recommendations. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1741360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ryan M. Hill
- Department of Pediatrics, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, USA
| | - Maja Katusic
- Department of Pediatrics, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, USA
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31
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Horváth LO, Győri D, Komáromy D, Mészáros G, Szentiványi D, Balázs J. Nonsuicidal Self-Injury and Suicide: The Role of Life Events in Clinical and Non-Clinical Populations of Adolescents. Front Psychiatry 2020; 11:370. [PMID: 32435210 PMCID: PMC7218062 DOI: 10.3389/fpsyt.2020.00370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is highly prevalent in clinical and non-clinical populations of adolescents. Several studies have supported both the distinction and the strong association between NSSI and suicidal behavior. Although there is a great deal of data on the role of life events in both suicidal behavior and NSSI, few studies have assessed the role of life events in the NSSI-suicidal behavior relationship. Our aims were to explore the relationship between NSSI and suicidal behavior, and the possible moderating role of stressful life events in a clinical and non-clinical adolescent population. METHOD A clinical (n = 202) and a nonclinical (n = 161) population of adolescents, aged 13-18 years were assessed. The Mini International Neuropsychiatric Interview Kid, Deliberate Self-Harm Inventory and the Life Events List were used. Group differences related to suicidal behavior, NSSI, and life events were tested with Wilcoxon tests. Two- and three-way interactions were tested with negative binomial regression models including zero-inflation parameter. RESULTS The prevalence of suicidal behavior (W = 7,306, p < .001), NSSI (W = 9,652, p < .001) and life events (W = 10,410 p < .001) were significantly higher in the clinical than in the non-clinical group. Between number of life events and NSSI, a moderate effect size (.38, 95%CI [.28,.46]) was found. The main effect of NSSI (χ2 (1) = 109.65, p < .001) and group membership (χ2 (1) = 39.13, p < .001) predicted suicidal behavior; the main effect of quantity of life events did not explain suicidal behavior. The interaction between NSSI and number of life events (χ2 (1) = 10.49, p < .01) was associated with suicidal behavior. Among interpersonal, non-interpersonal events and adverse childhood circumstances, only interpersonal events were associated with both suicidal behavior (χ2 (1) = 6.08, p < .05) and had a moderating effect (χ2 (1) = 8.59, p < .01) on the NSSI-suicidal behavior relationship. Patterns of the effects of life events on the NSSI-suicidal behavior relationship did not differ in the two groups. CONCLUSION Our results confirm the importance of prevention and intervention of NSSI, considering its high prevalence and frequent co-occurrence with suicidal behavior in both clinical and non-clinical adolescent populations. Moreover, to support NSSI and suicide prevention, we would like to highlight the importance of stressful life events, especially those associated with interpersonal conflicts, require special attention.
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Affiliation(s)
- Lili Olga Horváth
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dóra Győri
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Komáromy
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Faculty of Social and Behavioral Sciences, Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Gergely Mészáros
- Mental Health Sciences, School of PhD Studies, Semmelweis University, Budapest, Hungary.,Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Budapest, Hungary
| | - Dóra Szentiványi
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Pedagogical Assistance Services, Budapest, Hungary
| | - Judit Balázs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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32
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Black J, Bond MA, Hawkins R, Black E. Test of a clinical model of poor physical health and suicide: The role of depression, psychosocial stress, interpersonal conflict, and panic. J Affect Disord 2019; 257:404-411. [PMID: 31306991 DOI: 10.1016/j.jad.2019.05.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/08/2019] [Accepted: 05/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study employed a structural equation model to examine the relationships between poor physical health, suicide, depression, psychosocial stress, interpersonal conflict, and panic. METHODS The sample consisted of a large, archived set of mental health treatment-seeking adults who completed a behavioral outcome questionnaire prior to beginning treatment. RESULTS Results supported the extant literature indicating that poor physical health, depression, psychosocial stress, interpersonal conflict, and panic impose increased risk for suicidal ideation, with depression demonstrating the highest risk for increased suicidal ideation. The results also supported the hypotheses that depression, psychosocial stress, interpersonal conflict, and panic would mediate the association between poor physical health and suicidal ideation. Although no a priori hypotheses were made regarding relationships among the 15 physical illnesses examined, results indicated that HIV/AIDS had the strongest correlation with depression and the weakest correlation with interpersonal conflict. LIMITATIONS Firstly, the study sample was primarily Caucasian, limiting its generalizability. Secondly, causal inferences should be interpreted with caution, due to the quasi-experimental design. Thirdly, these data were self-reported, which create response biases since suicidal ideation is stigmatized. CONCLUSIONS These findings highlight the importance of considering interpersonal factors as potential mediators in the relationship between poor physical health, mental illness, and suicide. Clinically, the impact of an active major depressive episode on an individual who is struggling with a serious physical illness may be strongly predictive of suicidal ideation.
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Affiliation(s)
- Janie Black
- Department of Educational Psychology, The University of Texas at Austin, United States (BOND).
| | - Mark A Bond
- Department of Educational Psychology, The University of Texas at Austin, United States (BOND)
| | - Raymond Hawkins
- Department of Psychology, the University of Texas at Austin, United States
| | - Elizabeth Black
- Elizabeth A. Black: MSN Candidate, School of Nursing, University of Texas at Austin, United States
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33
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Mitchell SM, Cukrowicz KC, Roush JF, Brown SL, Alquist JL, Bolaños AD, Morgan. RD, Poindexter EK. Thwarted Interpersonal Needs and Suicide Ideation Distress Among Psychiatric Inpatients: The Moderating Role of Criminal Associates. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:2138-2156. [PMID: 30957603 PMCID: PMC6679915 DOI: 10.1177/0306624x19842027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Psychiatric inpatients are at elevated risk of suicide, and approximately half are criminal justice-involved. Their involvement with criminal associates may be linked to increased suicide ideation distress; however, this has not been examined. This study tested main effects of, and interactions between, thwarted belongingness (TB) or perceived burdensomeness (PB), time spent with associates, and associates' criminal involvement predicting suicide ideation distress. In our study, psychiatric inpatients (n = 139) completed assessments cross-sectionally. Results indicated that TB, PB, and associates' criminal involvement were significantly related to greater suicide ideation distress. A significant three-way interaction indicated participants who endorsed high TB, spent more time with associates, and had associates high in criminal involvement had the greatest probability of "Extreme" suicide ideation distress. These findings suggest that spending time with criminal associates may increase suicide ideation distress more than not having social interactions. Implications and limitations of this study are discussed.
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Affiliation(s)
- Sean M. Mitchell
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Box Psych, Rochester, NY 14642
| | - Kelly C. Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | - Jared F. Roush
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | - Sarah L. Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | - Jessica L. Alquist
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | - Angelea D. Bolaños
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | - Robert D. Morgan.
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX
| | - Erin K. Poindexter
- Rocky Mountain Regional Veterans Affairs Medical Center, Denver, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Kaniušonytė G, Truskauskaitė-Kunevičienė I, Žukauskienė R, Crocetti E. Knowing Who You Are for Not Feeling Lonely? A Longitudinal Study on Identity and Loneliness. Child Dev 2019; 90:1579-1588. [PMID: 31347159 DOI: 10.1111/cdev.13294] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In adolescence, both identity concerns and feelings of loneliness are of utmost importance to the experiences of young people. Yet, a theoretically grounded hypothesis that identity and loneliness are developmentally related has never been tested. Thus, the aim of this study was to disentangle the longitudinal associations between identity processes in educational and interpersonal domains and loneliness in adolescence. The sample consisted of 632 Lithuanian adolescents (53.2% girls; Mage = 14.32; SDage = 1.09) participating in a four-wave study with 6-month intervals between assessments. Cross-lagged analyses revealed reciprocal associations between identity processes and loneliness in the educational domain and unidirectional effects of adolescents' reconsideration of commitment on loneliness in the interpersonal domain.
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35
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Roley-Roberts ME, Hill RM, Layne CM, Goldenthal H, Kaplow JB. Cause of Caregiver Death and Surviving Caregiver Coping Style Predict Thwarted Belongingness in Bereaved Youth. Arch Suicide Res 2019; 23:455-470. [PMID: 29791306 DOI: 10.1080/13811118.2018.1470949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Both bereavement and thwarted belongingness serve as risk markers for youth suicide-related behaviors. This study examined candidate predictors of thwarted belongingness among bereaved youth, including caregiver cause of death and surviving caregiver coping style. A group of 43 caregiver-bereaved families (58 children aged 7-13-years-old) participated in a longitudinal study investigating associations between hypothesized bereavement-related contextual factors and youth thwarted belongingness. Cause of caregiver deaths included anticipated deaths preceded by illness (37%; n = 16), sudden natural deaths (25.6%; n = 11), accidental deaths (20.9%; n = 9), death by suicide (9.3%; n = 4), and death from drug overdose (7.0%; n = 3). Children's thwarted belongingness was significantly higher among youth bereaved by suicide compared to youth bereaved by sudden natural death, accident, and anticipated death by illness. Surviving caregivers' use of behavioral disengagement and positive reinterpretation and growth as coping strategies at Time 1 predicted lower thwarted belongingness in children at Time 2. Implications for risk screening and assessment of suicide risk among bereaved youth are discussed.
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Affiliation(s)
- Michelle E Roley-Roberts
- a Department of Psychiatry , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Ryan M Hill
- b Department of Pediatrics , Baylor College of Medicine/Texas Children's Hospital , Houston , TX , USA
| | - Christopher M Layne
- c Department of Psychiatry and Biobehavioral Sciences , UCLA/Duke University National Center for Child Traumatic Stress, University of California , Los Angeles , CA , USA
| | - Hayley Goldenthal
- d Department of Psychiatry , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Julie B Kaplow
- b Department of Pediatrics , Baylor College of Medicine/Texas Children's Hospital , Houston , TX , USA
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36
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HILL RYANM, PENNER FRANCESCA, VANWOERDEN SALOME, MELLICK WILLIAM, KAZIMI IRAM, SHARP CARLA. Interpersonal Trust and Suicide Ideation Among Adolescent Psychiatric Inpatients: An Indirect Effect via Perceived Burdensomeness. Suicide Life Threat Behav 2019; 49:240-252. [PMID: 29370447 PMCID: PMC8935391 DOI: 10.1111/sltb.12433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/03/2017] [Indexed: 11/27/2022]
Abstract
The identification of theoretically and empirically supported correlates of suicide ideation is important to improve treatment approaches to suicide. This study sought to examine the association between interpersonal trust (theoretically conceptualized as a distal risk marker) and suicide ideation in adolescence. Specifically, it was hypothesized that interpersonal trust would be negatively associated with suicide ideation via perceived burdensomeness and thwarted belongingness (conceptualized as more proximal risk markers). Data were drawn from a cross-sectional sample of 387 adolescent inpatients between the ages of 12 and 17 years (M = 14.72, SD = 1.49). The sample was 63.6% female, 37.5% Hispanic, 26.9% African American/Black, and 25.8% Caucasian. Adolescents completed a series of self-report measures to assess thwarted belongingness, perceived burdensomeness, interpersonal trust, depressive symptoms, and suicide ideation. A structural equation model was fit to the data, and results demonstrated a significant indirect path from interpersonal trust to suicide ideation via perceived burdensomeness, but not thwarted belongingness. Results suggest that interpersonal trust may be a distal risk marker for suicide ideation and that interventions to increase interpersonal trust may help prevent the development of thwarted belongingness, perceived burdensomeness, and suicide ideation.
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Affiliation(s)
- RYAN M. HILL
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - FRANCESCA PENNER
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - SALOME VANWOERDEN
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - WILLIAM MELLICK
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - IRAM KAZIMI
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - CARLA SHARP
- Department of Psychology, University of Houston, Houston, Texas, USA
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37
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Hill RM, Kaplow JB, Oosterhoff B, Layne CM. Understanding grief reactions, thwarted belongingness, and suicide ideation in bereaved adolescents: Toward a unifying theory. J Clin Psychol 2019; 75:780-793. [DOI: 10.1002/jclp.22731] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan M. Hill
- Section of Psychology, Department of Pediatrics; Baylor College of Medicine and Texas Children's Hospital; Houston Texas
| | - Julie B. Kaplow
- Section of Psychology, Department of Pediatrics; Baylor College of Medicine and Texas Children's Hospital; Houston Texas
| | | | - Christopher M. Layne
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences; University of California; Los Angeles California
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The Role of Interpersonal Problems and Family Environment in the Association Between Impulsivity and Suicidal Ideation: A Moderate Mediation Model. J Nerv Ment Dis 2019; 207:22-28. [PMID: 30575704 DOI: 10.1097/nmd.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impulsivity, interpersonal problems, and family environment are important factors in the development of suicidal ideation, but the pathway of these factors on suicidal ideation is not clear. This study constructed a moderated mediation model to examine whether interpersonal problems mediated the relationship between impulsivity and suicidal ideation and whether this mediating process was moderated by family environment. For this purpose, 902 college students from Tianjin Normal University located in the north of China were recruited to participate in this study with Barratt Impulsiveness Scale, Adolescent Self-Rating Life Events Check List, Family Environment Scale, and Beck Scale for Suicidal Ideation. Impulsivity could significantly predict suicidal ideation, and the relationship between impulsivity and suicidal ideation was significantly mediated by interpersonal problems; furthermore, the mediating effect and the directing effect were significantly moderated by family environment. These findings contribute to our understanding of a comprehensive interpretation of both environmental and individual factors' impacts on suicidal ideation.
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39
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Mitchell SM, Brown SL, Roush JF, Bolaños AD, Morgan RD, Cukrowicz KC. Do criminal associates impact psychiatric inpatients' social support and interpersonal needs? DEATH STUDIES 2018; 43:535-541. [PMID: 30285601 DOI: 10.1080/07481187.2018.1493003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
Suicide risk is elevated among psychiatric inpatients; however, research has not examined moderators of the associations between perceived social support and thwarted belongingness (TB) and perceived burdensomeness (PB), such as involvement with criminal associates. Adult psychiatric inpatients (N = 142) completed assessments. Perceived social support was negatively associated with TB and PB; however, associates' criminal involvement did not moderate these associations. A significant interaction indicated a stronger negative association between perceived social support and TB when participants spent more time with associates. Therefore, time spent with associates, regardless of criminal involvement, may be a relevant interpersonal suicide risk factor.
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Affiliation(s)
- Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Jared F Roush
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Angelea D Bolaños
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Robert D Morgan
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
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40
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Choo CC, Burton AA. Smartphone Apps for Mindfulness Interventions for Suicidality in Asian Youths: Literature Review. JMIR Mhealth Uhealth 2018; 6:e139. [PMID: 29880468 PMCID: PMC6013712 DOI: 10.2196/mhealth.8304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/13/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The advent of mobile technology has ushered in an era in which smartphone apps can be used as interventions for suicidality. OBJECTIVE We aimed to review recent research that is relevant to smartphone apps that can be used for mindfulness interventions for suicidality in Asian youths. METHODS The inclusion criteria for this review were: papers published in peer-reviewed journals from 2007 to 2017 with usage of search terms (namely "smartphone application" and "mindfulness") and screened by an experienced Asian clinician to be of clinical utility for mindfulness interventions for suicidality with Asian youths. RESULTS The initial search of databases yielded 375 results. Fourteen full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. CONCLUSIONS This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone apps that can be used for mindfulness interventions for suicidality with Asian youths.
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Affiliation(s)
| | - André Ad Burton
- School of Psychology, Curtin University, Western Australia, Australia
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41
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Siegel DM, Burke TA, Hamilton JL, Piccirillo ML, Scharff A, Alloy LB. Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress. ANXIETY STRESS AND COPING 2018; 31:526-538. [PMID: 29855206 DOI: 10.1080/10615806.2018.1482723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together. DESIGN The current study extended prior research by examining the role of social anxiety in the occurrence of negative and positive interpersonal events and evaluated whether interpersonal distress moderated these associations. METHODS Undergraduate students (N = 243; M = 20.46 years; 83% female) completed self-report measures of social anxiety, perceived burdensomeness, and thwarted belongingness, as well as a self-report measure and clinician-rated interview assessing negative and positive interpersonal events that occurred over the past six weeks. RESULTS Higher levels of social anxiety were associated only with a higher occurrence of negative interpersonal dependent events, after controlling for depressive symptoms. This relationship was stronger among individuals who also reported higher levels of perceived burdensomeness, but not thwarted belongingness. CONCLUSIONS It may be important to more strongly consider interpersonal stress generation in models of social anxiety.
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Affiliation(s)
- David M Siegel
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | - Taylor A Burke
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | - Jessica L Hamilton
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | | | - Adela Scharff
- a Department of Psychology , Temple University , Philadelphia , PA , USA
| | - Lauren B Alloy
- a Department of Psychology , Temple University , Philadelphia , PA , USA
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42
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Choo CC, Ho RC, Burton AAD. Thematic Analysis of Medical Notes Offers Preliminary Insight into Precipitants for Asian Suicide Attempters: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040809. [PMID: 29677141 PMCID: PMC5923851 DOI: 10.3390/ijerph15040809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022]
Abstract
One important dynamic risk factor for suicide assessment includes suicide precipitant. This exploratory study used a qualitative paradigm to look into the themes surrounding precipitants for suicide attempts in Singapore. Medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore over a three year period were subjected to analysis. A total of 666 cases were examined (69.2% females; 63.8% Chinese, 15% Malays, 15.8% Indians), ages ranged from 10 years old to 85 years old (Mean = 29.7, Standard Deviation = 16.1). The thematic analysis process that was applied to the textual data elicited key concepts labelled as Relationship issues, Financial strain, Socio-legal-academic—environmental stress, and Physical and mental illness and pain. Interpreted with other recent local research on suicide attempters in Singapore, the findings have implications for informing suicide interventions.
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Affiliation(s)
- Carol C Choo
- College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119007, Singapore.
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43
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Choo CC, Chew PKH, Ho RC. Suicide Precipitants Differ Across the Lifespan but Are Not Significant in Predicting Medically Severe Attempts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040691. [PMID: 29621197 PMCID: PMC5923733 DOI: 10.3390/ijerph15040691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/16/2022]
Abstract
An important risk factor for suicide assessment is the suicide precipitant. This study explores suicide attempt precipitants across the lifespan. Three years of medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. These cases were divided into three age groups: Adolescence, Early Adulthood, and Middle Adulthood. A total of 540 cases were examined (70.9% females; 63.7% Chinese, 13.7% Malays, 15.9% Indians), whose ages ranged from 12 to 62. There were eight cases above the age of 65 years which were excluded from the analysis. Significant differences were found in precipitants for suicide attempts across the lifespan. Middle adults had relatively fewer relationship problems, and adolescents had comparatively fewer financial and medical problems. The models to predict medically severe attempts across the age groups using suicide precipitants were not significant. The findings were discussed in regards to implications in suicide assessment and primary prevention in Singapore, as well as limitations and recommendations for future research.
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Affiliation(s)
- Carol C Choo
- College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore.
| | - Peter K H Chew
- College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119007, Singapore.
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44
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Hartley CM, Pettit JW, Castellanos D. Reactive Aggression and Suicide-Related Behaviors in Children and Adolescents: A Review and Preliminary Meta-Analysis. Suicide Life Threat Behav 2018; 48:38-51. [PMID: 28044358 PMCID: PMC7894982 DOI: 10.1111/sltb.12325] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Abstract
The empirical literature on the association between reactive aggression and suicide-related behaviors in children and adolescents was reviewed. A narrative review of seven studies that met inclusion/exclusion criteria is followed by a preliminary meta-analysis to provide insight into the strength of the association between reactive aggression and suicide-related behaviors. Each of the seven studies reported a statistically significant association between reactive aggression and suicide-related behaviors, including suicide, nonfatal suicide attempt, and suicide ideation. Results from the meta-analysis indicated a consistent, medium-sized association (k = 7; N = 4,693; rbar = .25). The narrative review and results of the preliminary meta-analysis support the promise of pursuing future research on reactive aggression and suicide-related behaviors in children and adolescents. A theoretical model is proposed to guide the development of future research.
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Affiliation(s)
- Chelsey M. Hartley
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Jeremy W. Pettit
- Departments of Psychology and Psychiatry and Behavioral Health, Florida International University, Miami, FL, USA
| | - Daniel Castellanos
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, FL, USA
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45
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Chu C, Buchman-Schmitt JM, Stanley IH, Hom MA, Tucker RP, Hagan CR, Rogers ML, Podlogar MC, Chiurliza B, Ringer-Moberg FB, Michaels MS, Patros C, Joiner TE. The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychol Bull 2017; 143:1313-1345. [PMID: 29072480 PMCID: PMC5730496 DOI: 10.1037/bul0000123] [Citation(s) in RCA: 561] [Impact Index Per Article: 80.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, Tallahassee, FL
- McLean Hospital, Belmont, MA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA
| | | | - Ian H. Stanley
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Raymond P. Tucker
- Louisiana State University, Department of Psychology, Baton Rouge, LA
| | | | - Megan L. Rogers
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | - Bruno Chiurliza
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | | | - Connor Patros
- Temple University, Department of Psychology, Philadelphia, PA
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL
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46
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Carbajal JM, Gamboa JL, Moore J, Smith F, Ann Eads L, Clothier JL, Cáceda R. Response to unfairness across the suicide risk spectrum. Psychiatry Res 2017; 258:365-373. [PMID: 28888697 DOI: 10.1016/j.psychres.2017.08.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022]
Abstract
Suicidal behavior is frequently triggered by social crises, such as familial, romantic, social or work-related conflict. A variety of cognitive and social functioning impairments has been associated with suicidal thoughts and acts. One of the precipitating and perpetuating factors of social conflict is the desire for retribution after a perceived offense, even at one's own detriment. We utilized the Ultimatum Game-a behavioral economic task which examines the behavioral response to perceived unfairness-in order to characterize the response to unfairness across the acute suicide risk spectrum. We examined five groups of adult individuals of both genders (n = 204): High- and Low-Lethality recent Suicide Attempters, Suicidal Ideators, Non-Suicidal Depressed Patients; and Healthy Controls. We also measured demographic and clinical variables. Even though all depressed groups showed similar rejection rates in the Ultimatum Game, there was a higher likelihood of rejecting offers in the low stakes condition in all acutely suicidal groups compared with healthy controls. Stake size, offer, education, and gender of the proposer were significantly associated with rejection rates. Acutely suicidal patients may be more vulnerable to adverse interpersonal interactions. Further characterization of social behavior may provide targets for secondary and tertiary prevention for high-risk individuals.
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Affiliation(s)
| | - Jorge L Gamboa
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jordan Moore
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Favrin Smith
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lou Ann Eads
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey L Clothier
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ricardo Cáceda
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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47
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Buitron V, Hill RM, Pettit JW. Mindfulness Moderates the Association Between Perceived Burdensomeness and Suicide Ideation in Adults With Elevated Depressive Symptoms. Suicide Life Threat Behav 2017; 47:580-588. [PMID: 27883204 DOI: 10.1111/sltb.12314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
A conceptual model in which the associations between perceived burdensomeness and suicide ideation, and between thwarted belongingness and suicide ideation, are moderated by mindfulness was examined. Participants were 218 undergraduates (mean age = 20.81) with moderate-to-severe depressive symptoms. Mindfulness significantly moderated the association between perceived burdensomeness and suicide ideation; participants with thoughts of burdensomeness experienced lower levels of suicide ideation if they were high, as opposed to low, in mindfulness. Mindfulness did not significantly moderate the association between thwarted belongingness and suicide ideation. Implications for intervention and elaboration of the interpersonal psychological theory of suicide are discussed.
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Affiliation(s)
- Victor Buitron
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Ryan M Hill
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Jeremy W Pettit
- Department of Psychology, Florida International University, Miami, FL, USA
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48
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Hill RM, Del Busto CT, Buitron V, Pettit JW. Depressive Symptoms and Perceived Burdensomeness Mediate the Association between Anxiety and Suicidal Ideation in Adolescents. Arch Suicide Res 2017; 22:555-568. [PMID: 29393837 DOI: 10.1080/13811118.2018.1427163] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A relationship between anxiety disorders and suicide-related behaviors has been demonstrated in adolescents, with a paucity of research examining mediators of this association. The present study hypothesized that anxiety would be associated with suicidal ideation via a serial mediation pathway through depressive symptoms and perceived burdensomeness and/or thwarted belongingness. A sample of 80 adolescents (68.8% female, 65.8% Hispanic), 13-19 years of age (mean = 16.93, SD = 1.66), completed 3 interviews as part of a randomized controlled trial. Results indicated a significant serial mediation from anxiety to suicidal ideation via depressive symptoms and perceived burdensomeness, but not thwarted belongingness. Clinicians and mental health service providers working with adolescents experiencing elevated anxiety should regularly assess for perceived burdensomeness and suicidal ideation.
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49
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Fatigue Moderates the Relationship Between Perceived Stress and Suicidal Ideation: Evidence From Two High-Resolution Studies. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:116-130. [PMID: 28715280 DOI: 10.1080/15374416.2017.1342543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Theoretical models of self-harm suggest that high perceived stress and high fatigue (which might affect the ability to cope with stress) may interact to predict the short-term occurrence of suicidal ideation and nonsuicidal self-injury (NSSI). We tested 3 approaches to examining this interaction, each of which provided a different understanding of the specific nature of these associations: comparing each individual's daily stress/fatigue to the entire sample's overall average (i.e., grand-mean centering), comparing each individual's daily perceived stress/fatigue to his or her overall average (i.e., group- or participant-mean centering), and comparing each individual's average perceived stress/fatigue to the sample's overall average (i.e., centering participant means on overall grand mean). In 2 studies, adolescents (n = 30; 574 daily reports, M age = 17.3 years, range = 12-19; 87.6% female) and young adults (n = 60; 698 daily reports; M age = 23.25 years, range = 18-35; 85% female) completed daily measures of perceived stress, fatigue, suicidal ideation, and NSSI. In both samples, the interaction between high daily perceived stress and high daily fatigue predicted greater odds of daily suicidal ideation (but not NSSI). Only the model comparing each individual's daily stress/fatigue to the entire sample's overall average was consistently significant across the two studies. Participants were most likely to experience suicidal ideation on days when both perceived stress and fatigue were elevated relative to the average level experienced across people and time points. Studies should build upon these findings with more in-depth examination of the temporal nature of stability and change in these factors as they relate to sustained suicidal ideation.
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50
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Mortier P, Kiekens G, Auerbach RP, Cuijpers P, Demyttenaere K, Green JG, Kessler RC, Nock MK, Zaslavsky AM, Bruffaerts R. A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College. J Clin Psychiatry 2017; 78:e828-e836. [PMID: 28640991 PMCID: PMC5664942 DOI: 10.4088/jcp.17m11485] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/09/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The primary aims of this study are to (a) identify patterns of suicidal thoughts and behaviors (STB) during college among students with lifetime pre-matriculation STB and (b) develop a risk-screening algorithm for persistence of pre-matriculation STB during college. METHODS Data come from the Leuven College Surveys, a series of prospective cohort studies of all incoming KU Leuven University freshmen. In the academic year 2012-2013, 4,889 incoming freshmen (73.2% response rate) provided baseline data on sociodemographic variables, childhood-adolescent traumatic experiences, 12-month stressful experiences, 12-month mental disorders, 12-month STB, and severity markers of pre-matriculation STB. A total of 2,566 students (69.3% conditional response rate) participated in 12- and 24-month follow-up surveys during the first 2 college years. RESULTS Thirteen percent (weighted n = 535) of incoming freshmen reported lifetime pre-matriculation STB. Of those, 28.0% reported 12-month STB in 1 follow-up assessment, and another 27.7%, in both follow-up assessments. High persistence of STB (ie, 12-month STB in 2 follow-up assessments) was most strongly associated with severity markers of pre-matriculation STB, with odds ratios in the 2.4-10.3 range and population attributable risk proportions between 9.2% and 50.8%. When the aim was for less than 50% of false-positive cases (positive predictive value = 54.4%), a multivariate predictive risk algorithm (cross-validated area under the curve = 0.79) situated 59.9% of highly persistent cases among the 30% respondents with highest baseline predicted risk. CONCLUSIONS An individualized web-based screening approach is a promising strategy to identify students at the time of university entrance who may be at high risk for STB persistence during their academic career.
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Affiliation(s)
- Philippe Mortier
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Herestraat 49, Leuven, Belgium.
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Glenn Kiekens
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Randy P Auerbach
- Department of Psychiatry, Harvard Medical School, Boston; and Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Koen Demyttenaere
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Jennifer G Green
- School of Education, Boston University, Boston, Massachusetts, USA
| | - Ronald C Kessler
- Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, Massachusetts, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Alan M Zaslavsky
- Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, Massachusetts, USA
| | - Ronny Bruffaerts
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
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