Suicide attempts and emotion regulation in psychiatric outpatients

The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

Heterogeneity of non-suicidal self-injury behavior in adolescents with depression: latent class analysis

BACKGROUND

Non-suicidal self-injury (NSSI) by adolescent patients with depression has become a serious public health problem. This cross-sectional study aims to identify subgroups of adolescents based on NSSI and explore the factors related to these subgroups.

METHODS

The study recruited 326 in- and out-patient adolescents (263 girls and 63 boys) aged 12 to 18 years (mean = 14.7, SD = 1.6) who had self-injured in the past year. Latent class indicators included 12 NSSI variables, as well as suicidal ideation. Logistic regression examined associations between identified classes and related factors.

RESULTS

In this study, two distinct subgroups were identified: a "high suicidal ideation NSSI group" (n = 129, 39.6%) and a "low suicidal ideation NSSI group" (n = 197, 60.4%). Depression (OR = 1.10; 95% CI, 1.05-1.16), female (OR = 2.01; 95% CI, 1.09-3.69), left-behind experience (OR = 2.08; 95% CI, 1.17-3.71), single-parent family (OR = 1.84; 95% CI, 1.11-3.04) and peer victimization (OR = 1.04; 95% CI, 1.02-1.05) increases the probability of belonging to the "high suicidal ideation NSSI group". A high level of perceived social support (OR = 0.99; 95% CI, 0.97-0.99) was a protective factor towards NSSI.

CONCLUSIONS

This study identifies two subgroups of NSSI and the factors associated with each subgroup. The early identification of high-risk groups for major NSSI in adolescents diagnosed with depression is possible due to the identification of correlating factors. Different treatment plans can be developed for different subtypes of NSSI to improve the effectiveness of prevention and intervention, promoting the healthy physical and mental development of adolescents with depression.

Relationship Between Emotion Regulation and Suicide Ideation and Attempt in Adults and Adolescents: A Systematic Review

INTRODUCTION

Suicide is one of the main causes of death in adults and adolescents, so research focused on identifying risk factors for suicidal behavior is needed. In recent years, emotion regulation, mainly the presence of difficulties regulating one's own negative emotions, has been associated with negative mental health outcomes.

OBJECTIVE

The purpose of this study was to systematically review the available evidence on the association between emotion regulation and suicide (ideation and attempt) in both adults and adolescents.

METHOD

A systematic search of scientific articles published in English and Spanish was carried out through the databases PsycINFO, MEDLINE, Scopus, and the Cochrane Library.

RESULTS

We identified 76 eligible studies, of which 70 reported that people with difficulties in emotion regulation reported higher levels of suicide ideation and more suicide attempts. The results were consistent in adolescents and adults, in clinical and general population samples, and when studies assessed both emotion regulation processes and strategies. However, few studies were longitudinal and most of them were with women.

CONCLUSIONS

We discuss the theoretical implications of the results, suggesting that actual psychological models might benefit from considering individual differences in ER in understanding why people engage in suicide behavior. Clinical implications are also discussed.HIGHLIGHTSDifficulties regulating one's emotions is associated with suicide behavior (SI and SA).Consistent results at all the ages and in the clinical and general population.Individual differences in ER could help researchers to understand suicide.

[Differences in non-suicidal self-injury behaviors between only-child and non-only-child adolescents with mood disorders: a cross-sectional study]

OBJECTIVES

To investigate the differences in non-suicidal self-injury (NSSI) behaviors between only-child and non-only-child adolescents with mood disorders.

METHODS

A three-stage sampling method was used to perform a cross-sectional survey of 529 adolescents, aged 12-18 years, who had mood disorders and NSSI behaviors. These adolescents were sampled from the outpatient service of 20 mental hospitals in 9 provinces of China from August to November 2020. A self-made questionnaire was used to collect general demographic data. The Functional Assessment of Self-Mutilation, Beck Scale for Suicide Ideation, Kessler Psychological Distress Scale, Stress Mindset Measure-General, Multidimensional Scale of Perceived Social Support, Multidimensional Students' Life Satisfaction Scales, and Rosenberg Self-Esteem Scale were used to collect the information on self-injury behaviors and psychological factors in these adolescents.

RESULTS

A total of 529 adolescents with mood disorders and NSSI behaviors were surveyed, among whom 375 were only-child adolescents and 154 were non-only-child adolescents. Compared with the non-only-child group, the only-child group had a significantly higher total score of Functional Assessment of Self-Mutilation (P<0.05) .The type and frequency of self-injury in the only-child group were significantly higher than those in the non-only-child group (P<0.05). Psychological analysis showed that compared with the non-only-child group, the only-child group had a significantly lower score of self-esteem (P<0.05) and significantly higher scores of psychological distress and depressive symptoms (P<0.05). The multiple linear regression analysis showed that the score of suicidal ideation was positively correlated with the frequency of NSSI behaviors in both only-child and non-only-child adolescents with mood disorders (P<0.05); in the only-child adolescents, the level of self-esteem was negatively correlated with the frequency of NSSI behaviors (P<0.05), and the score of stress perception was positively correlated with the frequency of NSSI behaviors (P<0.05); in the non-only-child adolescents, the score of anxious emotion was positively correlated with the frequency of NSSI behaviors (P<0.05).

CONCLUSIONS

Among the adolescents with mood disorders and NSSI behaviors, the only-child adolescents tend to have a higher frequency of self-injury and poorer mental health, and therefore, the only-child adolescents with mood disorders and NSSI behaviors need more attention.

Difficulties in emotion regulation: The role of repetitive negative thinking and metacognitive beliefs

BACKGROUND

Using the Self-Regulatory Executive Function model as a basis, this study explored whether, in both general population and clinical samples, metacognitive beliefs and repetitive negative thinking (i.e., rumination and worry) are associated with higher levels of emotion dysregulation.

METHODS

395 participants from the general population and 388 outpatients seeking psychological treatment were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, depression, personality disorders were assessed. ANOVA and Welch's tests, correlation and path analyses were run.

RESULTS

Repetitive negative thinking was found to play a mediating role in the relationship between metacognitive beliefs and emotion dysregulation in both general population and clinical samples. Moreover, metacognitive beliefs were found to be directly associated to emotion dysregulation.

LIMITATIONS

The cross-sectional design.

CONCLUSIONS

Emotion dysregulation appears to be associated with the tendency to engage in repetitive negative thinking and metacognitive beliefs. Repetitive negative thinking and metacognitive beliefs could be a suitable therapeutic target to reduce difficulties in emotion regulation.

Body Emotional Investment and Emotion Dysregulation in a Sample of Adolescents with Gender Dysphoria Seeking Sex Reassignment

Adolescents with gender dysphoria (GD) often have internalizing symptoms, but the relationship with affective bodily investment and emotion dysregulation is actually under-investigated. The aims of this study are: (1) the comparison of Self-Administrated Psychiatric Scales for Children and Adolescents’ (SAFA), Body Investment Scale’s (BIS), and Difficulties in Emotion Regulation Scale’s (DERS) scores between GD adolescents (n = 30) and cisgenders (n = 30), (2) finding correlations between body investment and emotion regulation in the GD sample, (3) evaluating the link between these dimensions and internalizing symptomatology of GD adolescents. In addition to the significant impairment in emotion regulation and a negative body investment in the GD sample, Spearman’s correlation analyses showed a relationship between worse body protection and impaired emotion regulation, and binary logistic regressions of these dimensions on each SAFA domain evidenced that they may have a role in the increased probability of pathological scores for depression. Our results focused on the role played by emotion regulation and emotional investment in the body in the exacerbating and maintenance of internalizing symptoms, in particular depression, and self-harming behaviors in GD adolescents.

Content Analysis of Warning Signs Identified as Part of Crisis Response Planning in a Community Sample of Gun Owners and Non-owners

Background

Assessing for and identifying those at imminent risk for suicide continues to present challenges, especially as many who die do not interact with specialty mental health treatment preceding suicide. Suicide-specific interventions in healthcare settings have been found to improve suicide-related outcomes, yet little is known about the confluence of behavioral, cognitive, emotional, and physiological indicators of emotional distress as they correspond to other key risk characteristics and high-risk groups like gun owners.

Aim

The purpose of this content analysis was to examine self-identified warning signs of distress between gun owners and non-owners through crisis response planning (CRP).

Methods

Participants completed a collaborative CRP. Warning signs were categorized as being either behavioral, cognitive, emotional, or physiological in nature. Bivariate logistic regression models were used to examine associations between firearm ownership and variables of interest. Participants were evenly split between men (n = 44) and women (n = 44) and were predominantly white (67.1%) with a mean age of 35.9 (SD = 13.6).

Results

Emotional warning signs of distress (68.2%) were reported slightly more often than behavioral (65.9%) followed by physiological (52.3%), and cognitive (46.6%). Firearm owners were significantly more likely to be male (OR = 2.5, 95%CI [1.07-6.0]). All participants were about a fourth as likely to report both a behavioral and physiological warning sign concurrently (OR = 0.26, 95% CI [0.09-0.67]).

Conclusion

Similarities and departures in warning signs of emotional distress may inform future research exploring both self-reported warning signs and related self-management strategies identified through suicide-specific interventions, particularly among high-risk groups such as gun owners.

From emotional intelligence to suicidality: a mediation analysis in patients with borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) is a serious mental illness with a high suicidality rate between 40 and 85%. However, little is known concerning psychosocial risk and protective factors associated with suicidal behaviors in this clinical group. The main focus of the present study was on examining the relationship of emotional intelligence (EI) with suicidal behaviors and its mediators (e.g., depression, self-esteem, addiction potential, and disorder severity) among patients with BPD.

METHODS

In this cross-sectional study, a total of 220 participants (including 110 patients with BPD and 110 healthy controls) in Zahedan, Iran, were examined using clinical interviewing and self-report measures of EI, suicidal behaviors, depression, self-esteem, addiction potential, and BPD symptom severity. The data were analyzed using SPSS v25.0 software at the significance level of p < 0.05.

RESULTS

Our preliminary analysis showed higher levels of EI, depression, and self-esteem in the BPD group in comparison to healthy controls (p < 0.001). Furthermore, our findings showed that higher levels of addiction potential, BPD symptom severity, and depression and lower levels of self-esteem and EI were likely to be related to suicidal behaviors of the BPD group. Our results also supported the overall hypothesis that addiction potential, depression, BPD symptom severity, and self-esteem had a mediating role in the impact of EI on suicidal behaviors in the BPD group.

CONCLUSIONS

According to these findings, we have come to believe that training EI possibly plays a directly and/or indirectly potential preventive and therapeutic role in suicidal behaviors among patients with BPD. However, further longitudinal studies must be carried out to clarify the cause and effect relationship between EI, depression, self-esteem, addiction potential, BPD symptom severity, and suicidal behaviors.

The psychological characteristics and risk factors of suicidal attempt among mood disorders adolescents accompany with non-suicidal self-injury: A multi-center study

BACKGROUND

Identifying the risk factors of suicide attempts(SA) in adolescents with mood disorders(MD) who engage in non-suicidal self-injury(NSSI) is of great significance for suicide prevention. The aim of the present study was to explore the psychological characteristics and risk factors of SA among MD adolescents engaged in NSSI.

METHODS

We recruited MD outpatients accompany with NSSI aged 12-18 years. SA, NSSI methods and function, suicidal ideation(SI), psychological distress(PD), self-esteem, stress mindset and perceived social support were assessed by valid scales. Classification and regression tree analysis (CART) was employed to explore the characteristics and risk factors of SA among MD adolescent with NSSI.

RESULTS

We included 658 participants in this study. Of 58.1% participants reported SA during the past 12 months. Compared with the adolescents without SA, the attempters used more different NSSI methods and reported more frequent NSSI. SA, SI, PD, self-esteem and amount of thinking time before engaging in self-injury were risk factors of SA among MD adolescents. Interactions between the four risk factors resulted in varying degrees of risk of SA. Compared to adolescents with the characteristics of low level of SI - little consideration before self-injury, adolescents who having multiple characteristics of the high level of SI -high level of PD - low self-esteem were associated with a 15.1-fold increased risk of SA(P < 0.001), and those with the characteristics of high SI - deliberated before engaging in self-injury were associated with a 28.1-fold increased risk of attempted suicide(P < 0.001).

CONCLUSIONS

Our findings identify multiple correlates for SA in MD adolescents accompany with NSSI, including SI, PD, self-esteem and deliberate time they thought before self-injury, which may contribute to the development of suicidal behaviors in an interactive manner.

Auditory evoked potentials and suicidal behaviors in patients with major depressive disorders

Loudness dependence of auditory evoked potentials (LDAEP) has been proposed as a biological marker of central serotonergic activity related to suicides. This study’s objective was to analyze the difference in LDAEP between depressed patients with suicide attempts (SA) and suicidal ideation (SI). It included 130 participants (45 depressed patients with SA, 49 depressed patients with SI, and 36 healthy controls) aged > 18 years who exhibited LDAEP during electroencephalography. Psychological characteristics and event-related potentials of the three groups were compared. There was no significant difference in LDAEP between major depressive disorder (MDD) patients with SA and SI (p = 0.59). MDD patients with SI, who attempted suicide had significantly lower LDAEP than healthy controls (p = 0.01 and p = 0.01, respectively). However, the significance disappeared when psychological characteristics were controlled. Our results suggest that LDAEP might not be possible biomarkers for suicidal behaviors in patients with MDD. Further studies to assess the biological basis of suicide and identify the underlying dimensions that mediate the relationship between the biological basis and suicidal behaviors will be needed.

Emotion dysregulation and suicidality in eating disorders

OBJECTIVE

Suicidality in eating disorders (EDs) is high, and identification of therapeutically targetable traits associated with past, current, and future suicidality is of considerable clinical importance. We examined overall and ED subtype-specific associations among suicidal ideation, suicide attempts, and general and specific aspects of emotion dysregulation in a large sample of individuals with ED, at presentation for treatment and 1-year follow-up.

METHOD

Using registry data from 2,406 patients, scores on the Difficulties in Emotion Dysregulation Scale (DERS) at initial registration were examined as predictors of recent suicidal ideation and self-report lifetime suicide attempts. Associations were examined in the full sample and in each ED subtype. In 406 patients, initial DERS scores were examined as predictors of suicidality at 1-year follow-up.

RESULTS

Overall DERS was associated with suicidal ideation and suicide attempts, even when adjusting for ED psychopathology and current depression. Perceived lack of emotion regulation strategies showed unique associations with suicidal ideation and suicide attempts, both in the full sample and in most ED subtypes. Initial DERS was also associated with follow-up suicidal ideation and suicide attempts, although this association did not remain when adjusting for past suicidality.

DISCUSSION

Results suggest that emotion dysregulation may be a potential mechanism contributing to suicidality in EDs, beyond the effects of ED psychopathology and current depression. Although the prevalence of suicidality differs across ED subtypes, emotion dysregulation may represent a risk trait for future suicidality that applies transdiagnostically. Results support addressing emotion dysregulation in treatment in order to reduce suicidality.

Negative emotion dysregulation is linked to the intensity of suicidal ideation in a mixed inpatient sample

BACKGROUND

Suicide has been associated with dysfunctional strategies for emotion regulation but, so far, research findings have been inconclusive.

METHODS

To investigate how difficulties in emotion regulation impact suicidal ideation (SI) and behavior, 111 psychiatric inpatients were enrolled. Affective instability (AI), emotional impulsivity (EI), and negative and positive emotionality (NE and PE) were measured by the RIPoSt-40 questionnaire; the first three subscales have been summed to form a total negative emotion dysregulation (NED) score.

RESULTS

In the sample, 55 subjects reported at least one-lifetime suicide attempt; 50 patients were diagnosed with mood-disorder (MD), 30 with the schizophrenia-spectrum disorder (SSD), and 15 with personality-disorder (PD). Diagnostic groups differed for NED scores (p=.008) but not for PE (p>0.05), with patients suffering from PD having higher scores (p=0.03). Compared to non-attempters, lifetime-suicide attempters were 6.5 times more likely to have a personality disorder (95% CI=1.34/31.83). Partial correlation analyses, controlling for the presence of suicide attempts, showed that lifetime SI-intensity score was significantly and positively associated with NED (r=.39, p<.001), AI (r=.40, p<.001), and NE (r=.42, p<.001). NED scores (p=.001) and the presence of lifetime suicide attempts (p<.001) were independently associated with lifetime SI-intensity scores.

LIMITATIONS

The lack of a non-clinical control group and the cross sectional nature of the study limits the generalizability of the results.

CONCLUSION

Our findings support the hypothesis that negative emotion dysregulation is independently associated with SI and behavior. Negative emotion dysregulation should be targeted in suicide prevention.

Psychometric Properties of the Chinese Version of the Functional Assessment of Self-Mutilation (FASM) in Chinese Clinical Adolescents

BACKGROUND

Functional Assessment of Self-Mutilation (FASM) is one of the most widely used tools assessing adolescent's non-suicidal self-injury. However, the Chinese version of FASM (C-FASM) is lacking. The present study aimed to adapt the FASM to the Chinese patients and examine its reliability and validity.

METHODS

The original English version of the FASM was translated into Chinese following Brislin's model of cross-culture translation, and then, pilot study and cognitive interview were carried out with 15 adolescent patients to assess the acceptability and comprehensibility of all items. The items were subsequently tested in a sample of 621 Chinese adolescent patients recruited by 20 psychiatric or general hospitals in nine provinces across China. We examined the distribution of responses for each item. Factor analysis, Cronbach's α and McDonald's Ω, intraclass coefficient, and Spearman's rank correlations were deployed to assess the dimensional structure, internal consistency reliability, test-retest reliability, and criterion validity.

RESULTS

The final adapted C-FASM included a 10-item method checklist and a 15-item function checklist of NSSI, and other characteristics of NSSI. C-FASM exhibited acceptable internal consistency (α = 0.81 and Ω = 0.80 for method checklist; α = 0.80 and Ω = 0.76 for function checklist) and test-retest reliability (method checklist: 0.79; function checklist: 0.87). Factor analysis for NSSI functions yielded a three-factor model with a good model fit. In addition, the instrument showed an expected correlation with the instrument of the Deliberate Self-Harm Behavior Inventory (r = 0.84, p < 0.001).

CONCLUSIONS

The C-FASM has good content, structural validity, and reliability. The instrument can be helpful to Chinese adolescents as a comprehensive measure of NSSI behaviors.

Is Emotion Dysregulation Associated With Suicidal Ideation in Post 9/11 Veterans?

Emotion dysregulation, a risk factor for suicide ideation and attempts, has not been studied in U.S. veterans of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND). Data were collected through standardized telephone interviews and computer-based surveys from 278 OEF/OIF/OND veterans (70.6% male, 29.4% female). Bivariate analyses indicated that emotion dysregulation was associated with suicidal ideation during the past-three-months (r = 0.30, p < 0.05) and lifetime suicide attempts (r = 0.21, p < 0.05). When PTSD and depression symptoms were added to a sequential logistic regression model, emotion dysregulation was no longer significantly associated with ideation or attempt. Emotion dysregulation was associated with suicidal ideation and attempt; however, current distress had greater associations. Dysregulation is one of several factors in veteran suicide risk.

Emotion Reactivity and Suicide Risk in Patients With Depression: The Mediating Role of Non-Suicidal Self-Injury and Moderating Role of Childhood Neglect

Background: The association between emotion reactivity (ER) and suicide risk has been confirmed in recent studies, especially in patients with depression. However, there is a lack of understanding of the underlying mechanism of the relation from ER to suicide risk among patients with depression. This study planned to examine a model of how ER, non-suicidal self-injury (NSSI), and childhood neglect (CN) interact to affect suicide risk in depressed patients. Methods: Four hundred and ninety-six patients (64.5% female, mean age = 30.40 years, SD = 12.56) who have accomplished self-rating instruments of ER, NSSI, CN, and suicide risk were included. Results: Findings showed that ER was positively connected with suicide risk, and NSSI partially mediated the above connection. Besides, CN moderated the mediation model, that is, the mediation effect was more pronounced in depressed patients with CN compared to depressed patients without CN. Conclusions: It was concluded that there is a relationship among ER, NSSI, CN, and suicide risk in patients with depression, and it strengthens our knowledge of the mechanism behind suicide risk. Our findings emphasize that the identification of NSSI and CN should be considered when assessing the suicide risk of patients with depression, as well as the intervention focus on emotion regulation and support for patients.

Emotion regulation difficulties are associated with nightmares and suicide attempts in an adult psychiatric inpatient sample

Although many studies have examined potential moderators of the relation between nightmares and suicide, few have examined emotion regulation, particularly utilizing severe populations such as psychiatric inpatients. The present study sought to investigate whether emotion regulation difficulties are associated with nightmares and suicide attempts in an inpatient sample. We included 2,683 psychiatric inpatients ranging from 18 to 81 years (M = 34.35, SD = 14.70). Nightmare frequency, emotion regulation difficulties, and their interaction predicted previous suicide attempts. Limitations include the homogeneity and cross-sectional nature of the sample. Suggestions for future study are discussed.

Emotion Dysregulation as a Prospective Predictor of Suicidal Ideation in an at-Risk Mixed Clinical Sample

The current study tested whether emotion dysregulation predicts suicidal ideation over the course of 6 months. Community members (N = 298) with elevated suicide risk completed a clinical interview and self-report questionnaires at baseline and month-6 follow-up appointments. Elevated general emotion dysregulation but not subscales significantly predicted increases in suicidal ideation at month-6 follow-up after accounting for initial suicidal ideation, treatment condition, and negative affectivity. Furthermore, general emotion dysregulation as well as lack of awareness and lack of clarity subscales were significantly associated with prior suicide attempts at baseline after accounting for negative affectivity. Findings support the establishment of emotion dysregulation as a risk factor for suicidal ideation and provide evidence for a role in suicide attempts. Findings call for the development of interventions targeting emotion dysregulation in effectively predicting and preventing suicidality.

Symptom network connectivity in adolescents with comorbid major depressive disorder and social phobia

PURPOSE

Major depressive disorder (MDD) and social phobia (SP) are both common and highly co-occurring psychiatric disorders. This study used symptom network analysis approach to examine comorbidity structure and the complex symptom dynamics which may play a role in the co-occurrence of MDD and SP.

METHOD

Data comes from the National Comorbidity Survey - Adolescent Supplement, a nationally representative survey of adolescents ages 13 to 18 years. This study examined data of adolescents with a lifetime diagnosis of MDD (n = 597), SP (n = 708), and adolescents with comorbid MDD and SP (n = 189). Networks were estimated by means of 26 symptoms from both disorders.

RESULTS

All MDD and SP symptoms were involved in the network of both pure disorders (MDD; SP) and comorbid condition (MDD + SP). Network structure was different between the pure disorders (p = 0.014), but not when comparing each of these disorders that have comorbid condition. Depressive symptoms of poor self-esteem and suicidal symptoms were central (i.e., showed a higher influence) in the symptom network for the pure disorders and for the comorbid condition. Other key symptoms in the comorbid condition network were two depressive symptoms: feelings of worthlessness and anhedonia. SP and MDD networks showed two common key SP symptoms: feeling uncomfortable when meeting new people and feeling uncomfortable talking to people do not know well.

CONCLUSION

The study of symptom dynamics will provide useful targets for preventing the development of comorbid disorders as well as new lines of intervention to deal with key symptoms of psychiatric disorders.

Difficulties in emotion regulation and suicide ideation and attempt in adolescent inpatients

This study aimed to examine the concurrent relation between six dimensions of emotion dysregulation, proposed by Gratz and Roemer (2004), and suicide ideation and attempt in a large sample of psychiatric adolescent inpatients. A sample of 547 adolescent inpatients completed measures on dimensions of emotion dysregulation, psychiatric diagnoses, and suicidal ideation and attempt. Binary logistic regression analyses revealed that limited access to emotion regulation strategies, difficulties in impulse control, and mood disorder diagnosis, were significantly associated with past year suicidal ideation, covarying for other emotion dysregulation subscales, anxiety and externalizing diagnoses, sex, and age. However, difficulties in impulse control was not significantly related to suicide ideation when analyses were conducted separately by sex. Binary logistic regressions also revealed that past year suicidal ideation uniquely and significantly associated with lifetime attempt, covarying for sociodemographics, psychiatric diagnoses, and all emotion dysregulation subscales; these results held when analyses were also conducted separately by sex. Results indicating an association between perceived limited emotion regulation strategies and suicide ideation are consistent with existing research and suicide-focused theory. This finding may have some tentative benefit to informing clinical assessment and treatment of suicidal thoughts. Other findings are discussed.

Suicidal ideation and history of suicide attempts in treatment-seeking patients with gambling disorder: The role of emotion dysregulation and high trait impulsivity

BACKGROUND AND AIMS

Gambling disorder (GD) presents high rates of suicidality. The combined influences of emotion dysregulation and trait impulsivity are crucially important (albeit understudied) for developing strategies to treat GD and prevent suicide attempts. The aim of this study is to investigate the association between trait impulsivity, emotion dysregulation, and the dispositional use of emotion regulation (ER) strategies with suicidal ideation and psychopathological symptom severity in GD.

METHODS

The sample composed of 249 patients with GD (166 with suicidal ideation) who underwent face-to-face clinical interviews and completed questionnaires to assess psychopathological symptoms, impulsive traits, and ER.

RESULTS

Patients with GD who presented suicidal ideation were older and had a later age of GD onset and higher GD severity. Analyses of variance showed higher comorbid symptoms, emotion dysregulation, and trait impulsivity in patients with suicidal ideation. Still, no significant differences were found in the use of ER strategies. SEM analysis revealed that a worse psychopathological state directly predicted suicidal ideation and that both emotion dysregulation and GD severity indirectly increased the risk of suicidal ideation through this state. High trait impulsivity predicted GD severity. Finally, a history of suicide attempts was directly predicted by suicidal ideation.

CONCLUSIONS

Patients with GD are at risk of presenting suicidal behaviors. The results of this study revealed the importance of comorbid psychopathology in the occurrence of suicidal ideation and the indirect effect of trait impulsivity and emotion dysregulation on suicidality. Thus, suicidal rates in GD could possibly be reduced by specifically targeting these domains during treatment.