Neurocognitive functioning predicts suicidal behaviour in young people with affective disorders

Family Functioning, Maternal Depression, and Adolescent Cognitive Flexibility and Its Associations with Adolescent Depression: A Cross-Sectional Study

BACKGROUND

This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents' cognitive flexibility, are examined. The research incorporates the perspectives of both adolescents and mothers.

METHODS

The sample includes 63 mother-teenager dyads in the clinical group and 43 in the control group. Instruments encompass the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Children's Depression Inventory (CDI-2), Beck Depression Inventory (BDI-II), The Brixton Spatial Anticipation Test, and structured interviews.

RESULTS

Families of adolescents with MDD exhibit lower flexibility, cohesion, communication, and overall satisfaction. Depressed adolescents display reduced cognitive flexibility. Discrepancies were observed between adolescents' and mothers' perspectives as associated with adolescents' MDD. Teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility.

CONCLUSIONS

This study emphasizes a holistic strategy in addressing adolescent depression, including family-based assessment and therapy. Screening for maternal depressive symptoms is identified as valuable. Cognitive flexibility also needs to be addressed during therapy for depression in adolescence.

The role of problem-solving skills in the prevention of suicidal behaviors: A systematic review and meta-analysis

BACKGROUND

This meta-analysis was conducted to assess the association between problem-solving skills and suicidal behaviors and elucidate the potential role of problem-solving skills in influencing the occurrence of suicidal behaviors.

METHODS

PubMed, Web of Science, and Scopus were searched until August 16, 2023. Studies addressing the associations between problem-solving skills and suicidal behaviors were included. The I2 statistics were used to examine between-study heterogeneity. The Begg and Egger tests were used to determine the possibility of publication bias. Using a random-effects model, the overall effect size was presented as an odds ratio (OR) or standard mean difference (SMD) with 95% confidence intervals (CIs).

RESULTS

Of 8040 identified studies, 29 (including 974,542 participants) were eligible. Based on observational studies, problem-solving skills were found to be inversely related to suicidal ideation (OR = 0.64; 95% CI: 0.50, 0.82); suicide attempts (OR = 0.75; 95% CI: 0.63, 0.89), and suicide death (OR = 0.02; 95% CI: 0.01, 0.03). The overall score of problem-solving skills was higher in those who did not attempt suicide than those who did (SMD = 0.84; 95% CI: 54, 1.13). Based on randomized clinical trials, problem-solving therapy was found to reduce the risk of suicide (OR = 0.51; 95% CI: 0.29, 0.87). Furthermore, the overall risk of suicide was lower among those who received problem-solving therapy than those who did not (SMD = -0.02; 95% CI: -0.29, 0.25).

CONCLUSIONS

This meta-analysis revealed an inverse association between problem-solving skills and suicidal behaviors. However, further research is needed to better understand the complex relationship between problem-solving skills and suicidal behaviors.

Baseline cognitive function predicts full remission of suicidal symptoms among patients with treatment-resistant depression and strong suicidal ideation after low-dose ketamine infusion

BACKGROUND

Whether pretreatment working memory and response inhibition function are associated with the rapid and sustained antisuicidal effect of low-dose ketamine among patients with treatment-resistant depression (TRD) and strong suicidal ideation is unclear.

METHODS

We enrolled 65 patients with TRD, comprising 33 who received a single infusion of 0.5 mg/kg ketamine and 32 who received a placebo infusion. The participants performed working memory and go/no-go tasks prior to infusion. We assessed suicidal symptoms at baseline and on postinfusion Days 2, 3, 5, and 7.

RESULTS

The full remission of suicidal symptoms persisted for 3 days after a single ketamine infusion and the ketamine-related antisuicidal effect persisted for 1 week. Lower cognitive impairment at baseline (indicated by a higher rate of correct responses on a working memory task) was associated with the rapid and sustained antisuicidal effect of low-dose ketamine in patients with TRD and strong suicidal ideation.

DISCUSSION

Patients with TRD and strong suicidal ideation but low cognitive impairment may benefit the most from the antisuicidal effect of low-dose ketamine.

Psychosocial and neurocognitive correlates of suicidal thoughts and behaviours amongst siblings of persons with and without neurodevelopmental conditions

OBJECTIVE

Siblings of individuals with neurodevelopmental conditions (NDCs) have greater incidence of neuropsychiatric diagnoses and neurocognitive difficulties compared to siblings of persons without NDCs. Despite suicidality being labelled a global health crisis (WHO, 2014) and NDC siblings experiencing risk factors implicated in suicidality, no previous studies examined suicidality amongst adolescent and young adult siblings of persons with NDCs. Our study aimed to bridge this gap.

METHOD

The present study used Bayesian analyses and risk classification models to examine individual and environmental risk factors associated with suicidal thoughts and behaviours amongst siblings of persons with and without NDCs (n = 267; 132 NDC, 135 control group, mean age 20.61, range 14-27, 76.40% female, 76.78% White Caucasian), as measured using self-report survey data and remote self-administered cognitive tests.

RESULTS

NDC siblings had higher rates of current nonsuicidal self-injury (NSSI; 18.94% versus 14.07%, δ = -0.32), suicidal ideation (25.76% versus 8.89%, δ = -0.40) and history of suicide attempts (18.18% versus 4.44%, δ = -0.43) compared to controls. Classification models using boosting and random forest demonstrated adequate performance: positive predictive value 0.86-0.91, negative predictive value 0.81-0.90, false negative rates 0.11-0.24. Cognitive inflexibility, alexithymia, inattention, bullying, depression, NSSI, and eating or psychotic disorder history had the highest relative importance in predicting lifetime suicidality. Poorer executive functioning (measured by the Wisconsin Card Sorting Task, Sustained Attention to Response Task, Stop Signal Task, and N-Back 2-back task) was strongly correlated with suicidality.

CONCLUSIONS

Screening for proximal and modifiable risk factors is critical to inform suicidal behaviour intervention and prevention programs for at-risk siblings.

Trajectory Analysis of Suicidal Ideation in Spanish College Students Using Ecological Momentary Assessment

Introduction

Suicide is a preventable death in young people. It is well known that suicide behavior is a multicausal phenomenon. However, suicidal ideation (SI) commonly underlies suicide, and Ecological Momentary Assessment (EMA) can help us to better characterize it and its risk and protective factors in the short term. We aimed, first, to investigate the estimated prevalence and trajectories of SI in a community sample of Spanish college students using an EMA methodology and, second, explore the associations between risk and protective factors and SI categorized as moderate or low.

Materials and Methods

A total of 737 participants followed the EMA during a period of 6 months. We estimated the prevalence and trajectories of SI and the associations between depressive symptoms, positive and negative affect, thwarted belongingness, perceived burdensomeness, cognitive reappraisal, emotional suppression, and purpose in life with the MEmind smartphone App. SI was assessed 14 times during this period.

Results

Twenty-eight participants referred to SI at least once in longitudinal assessments. We found a lack of curvature and, thus, a relatively stable trajectory of SI. Two groups of latent dimensions were observed related to risk and protective factors of SI. One latent dimension of the risk factors (higher levels of thwarted belongingness, perceived burdensomeness, depressive symptoms, negative affect, and emotional suppression) best represented the group with moderate levels of SI, and a second latent dimension of protective variables (positive affect, cognitive reappraisal, and purpose in life) best represented the group with lower levels of SI.

Discussion

These findings may indicate that students with a sense of having a life worth living, in addition to having the ability to reevaluate their negative beliefs, are less likely to experience high levels of SI. Therefore, purpose in life would be a protective factor against the presence of SI.

Premature mortality in early-intervention mental health services: a data linkage study protocol to examine mortality and morbidity outcomes in a cohort of help-seeking young people

INTRODUCTION

Understanding the risk of premature death from suicide, accident and injury and other physical health conditions in people seeking healthcare for mental disorders is essential for delivering targeted clinical interventions and secondary prevention strategies. It is not clear whether morbidity and mortality outcomes in hospital-based adult cohorts are applicable to young people presenting to early-intervention services.

METHODS AND ANALYSIS

The current data linkage project will establish the Brain and Mind Patient Research Register-Mortality and Morbidity (BPRR-M&M) database. The existing Brain and Mind Research Institute Patient Research Register (BPRR) is a cohort of 6743 young people who have accessed primary care-based early-intervention services; subsets of the BPRR contain rich longitudinal clinical, neurobiological, social and functional data. The BPRR will be linked with the routinely collected health data from emergency department (ED), hospital admission and mortality databases in New South Wales from January 2010 to November 2020. Mortality will be the primary outcome of interest, while hospital presentations will be a secondary outcome. The established BPRR-M&M database will be used to establish mortality rates and rates of ED presentations and hospital admissions. Survival analysis will determine how time to death or hospital presentation varies by identified social, demographic and clinical variables. Bayesian modelling will be used to identify predictors of these morbidity and mortality outcomes.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the human research ethics committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.

Violent suicide attempt history in elderly patients with bipolar disorder: The role of sex, abdominal obesity, and verbal memory: Results from the FACE-BD cohort (FondaMental Advanced center of Expertise for Bipolar Disorders)

BACKGROUND

Bipolar disorder (BD) is a chronic, lifelong condition, associated with increased risk of obesity, cognitive impairment, and suicidal behaviors. Abdominal obesity and a higher risk of violent suicide attempt (SA) seem to be shared correlates with older age, BD, and male sex until middle age when menopause-related female body changes occur. This study aimed at assessing the role of abdominal obesity and cognition in the violent SA burden of individuals with BD.

METHODS

From the well-defined nationwide cohort FACE-BD (FondaMental Advanced center of Expertise for Bipolar Disorders), we extracted data on 619 euthymic BD patients that were 50 years or older at inclusion. Cross-sectional clinical, cognitive, and metabolic assessments were performed. SA history was based on self-report.

RESULTS

Violent SA, in contrast to non-violent and no SA, was associated with higher waist circumference, abdominal obesity and poorer California Verbal Learning Test short-delay free recall (CVLT-SDFR) (ANOVA, p < .001, p = .014, and p = .006). Waist circumference and abdominal obesity were associated with violent SA history independently of sex, BD type and anxiety disorder (Exp(B) 1.02, CI 1.00-1.05, p = .018; Exp(B) 2.16, CI 1.00-4.64, p = .009, accordingly). In an exploratory model, waist circumference and CVLT-SDFR performance mediated the association between male sex and violent SA.

LIMITATIONS

Cross-sectional design and retrospective reporting.

CONCLUSIONS

Violent SA history was associated with abdominal obesity and poorer verbal memory in older age BD patients. These factors were interlinked and might mediate the association between male sex and violent SA.

Cognition in Recent Suicide Attempts: Altered Executive Function

Background: Neuropsychological alterations can lead to inaccurate perception, interpretation, and response to environmental information, which could be a risk factor for suicide. Methods: Ninety-six subjects were recruited from the Psychiatry Department of the Araba University Hospital-Santiago, including 20 patients with a recent attempt and diagnosis of major depressive disorder (MDD) according to DSM-V, 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients, and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on the following cognitive domains: working memory, processing speed, decision-making, executive function, and attention. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons, ANOVA and Bonferroni post-hoc tests were performed with a p < 0.05 significance level. Results: The patient groups did not differ regarding severity of depression and stressful events in the last 6 months. In comparison to healthy controls, depressed patients with lifetime suicide attempts had more general trauma (p = 0.003), emotional abuse (p = 0.003), emotional negligence (p = 0.006), and physical negligence (p = 0.009), and depressed patients with recent suicide attempts had experienced more child sexual abuse (p = 0.038). Regarding neuropsychological assessment, all patient groups performed significantly worse than did healthy controls in processing speed, decision-making, and attention. Comparisons between patient groups indicated that recent suicide attempters had poorer performance on executive function in comparison to both depressed lifetime attempters and depressed non-attempters (B = 0.296, p = 0.019, and B = 0.301, p = 0.028, respectively). Besides, women with recent attempts had slightly better scores on executive function than males. Regarding the rest of the cognitive domains, there were no significant differences between groups. Conclusion: Executive function performance is altered in recent suicide attempts. As impaired executive function can be risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.