1
|
Brancati GE, De Rosa U, Acierno D, Caruso V, De Dominicis F, Petrucci A, Moriconi M, Elefante C, Gemignani S, Medda P, Schiavi E, Perugi G. Development of a self-report screening instrument for emotional dysregulation: the Reactivity, Intensity, Polarity and Stability questionnaire, screening version (RIPoSt-SV). J Affect Disord 2024; 355:406-414. [PMID: 38570039 DOI: 10.1016/j.jad.2024.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Emotional dysregulation (ED) refers to the inability to manage emotional experiences or expressions hindering goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples exists. We aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40). METHODS 150 adult outpatients with non-psychotic conditions were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Clinically significant ED (CSED) was defined based on the previously suggested approach for ADHD. Differences between patients with and without CSED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30. RESULTS 75 subjects met criteria for CSED (50 %). CSED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected CSED, with accuracy, sensitivity, specificity, positive and negative predictive values of 80 % or higher in both the training and testing sets. LIMITATIONS Tertiary-level; no consensus on criteria; sample size. CONCLUSION The screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.
Collapse
Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Ugo De Rosa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Donatella Acierno
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Valerio Caruso
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Francesco De Dominicis
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy; Mental Health Centre, Local Health Unit 2, Spoleto, Italy
| | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy; Mental Health Centre, Local Health Unit 2, Terni, Italy
| | - Martina Moriconi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Camilla Elefante
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Samuele Gemignani
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Elisa Schiavi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Psychiatry Unit 2, Pisa, Italy.
| |
Collapse
|
2
|
Rogante E, Cifrodelli M, Sarubbi S, Costanza A, Erbuto D, Berardelli I, Pompili M. The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature. Healthcare (Basel) 2024; 12:169. [PMID: 38255058 PMCID: PMC10815449 DOI: 10.3390/healthcare12020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (E.R.); (S.S.)
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Psychiatry Unit, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy;
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (E.R.); (S.S.)
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1205 Geneva, Switzerland;
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.E.); (I.B.)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.E.); (I.B.)
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.E.); (I.B.)
| |
Collapse
|
3
|
Durpoix A, Lachaux E, Weiner L, Weibel S. Transdiagnostic skills training group of dialectical behavior therapy: a long-term naturalistic study. Borderline Personal Disord Emot Dysregul 2023; 10:37. [PMID: 38124187 PMCID: PMC10734074 DOI: 10.1186/s40479-023-00243-y] [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: 04/21/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Dialectical Behavior Therapy (DBT) has assembled a large body of evidence for the treatment of emotional dysregulation in borderline personality disorder (BPD), but also in other disorders characterized by emotional dysregulation (e.g., bipolar disorder (BD) and ADHD). Standalone skills learning groups address the problem of limited resources in several clinical settings. Furthermore, transdiagnostic skills groups facilitate the recruitment and decrease the scattering of resources in psychiatric settings. However, few studies have focused on the pertinence of transdiagnostic standalone skills groups in naturalistic settings as well as their long-term outcomes. The goal of this study is to assess the impact of participation in a transdiagnostic DBT skills group one year after its completion. METHOD Transdiagnostic DBT skills training groups were provided for BPD, BD and ADHD patients in a University Psychiatric Department (Strasbourg, France), between 2019 and 2020. They consisted of 16 group sessions of 2.5 h and 3 individual sessions. At 1-year follow-up, ad-hoc questionnaires were proposed to all participants to assess the perceived impacts, the changes in symptomatology, and the maintenance of skills learned. RESULT 22 of the 31 participants were interviewed at the one-year post-group session (64% BPD, 41% ADHD and 27% BD). 73% participants estimated that group impact was important or very important, 64% stated using the skills learned often or very often, mainly emotion regulation skills. An improvement in emotional instability, substance use, impulsivity and suicidal thoughts was reported by respectively 100%, 91%, 86% and 85% of participants. Quality of life improved according to 90% participants. All patients reported an improvement in suicidality during the post-group year, especially in suicide attempts. Psychotropic medication decreased in 59% of participants. DISCUSSION Our one-year naturalistic study suggests that transdiagnostic DBT skills training groups are promising for the treatment of emotional dysregulation in people with BPD, BD and/or ADHD. The observational design and the lack of control group are the main limitations. Randomized controlled studies are required to confirm the long-term efficacy of transdiagnostic skills learning groups in naturalistic settings.
Collapse
Affiliation(s)
- Amaury Durpoix
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France.
- Faculty of Medicine, Strasbourg University, Strasbourg, 67000, France.
| | - Enzo Lachaux
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Faculty of Psychology, Strasbourg University, Strasbourg, 67000, France
| | - Luisa Weiner
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Faculty of Psychology, Strasbourg University, Strasbourg, 67000, France
- Laboratoire de Psychologie des Cognitions, Strasbourg University, Strasbourg, 67000, France
| | - Sébastien Weibel
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Inserm u1114, Strasbourg, 67000, France
- Faculty of Medicine, Strasbourg University, Strasbourg, 67000, France
| |
Collapse
|
4
|
Nan J, Salina N, Chong ST, Jiang HJ. Trajectory of suicidal ideation among medical students during the COVID-19 pandemic: the role of childhood trauma. BMC Psychiatry 2023; 23:90. [PMID: 36747156 PMCID: PMC9900550 DOI: 10.1186/s12888-023-04582-6] [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: 09/30/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aim of this study was to understand the longitudinal trajectory of suicidal ideation (SI) among Chinese medical students and the role of childhood trauma (CT). METHODS Using a whole-group sampling method, we assessed SI in 2192 (male = 834, female = 1358) medical students on three occasions over a period of one year. The Suicidal Ideation Self-Assessment Scale (SISAS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess SI and CT. The growth mixture modeling (GMM) was used to classify the developmental trajectory of SI. RESULTS A greater number of medical students were experiencing suicidal ideation during the COVID-19 pandemic. The trajectory of SI among medical students was divided into two groups: a low risk, slowly rising group and a high risk, continuous group. The low risk, slowly rising group had a significant time effect (B = 1.57, p < 0.001) and showed a slowly increasing trend. Emotional neglect (EN), physical neglect (PN), emotional abuse (EA) and physical abuse (PA) all had significant positive predictive effects for the high risk, continuous group (B = 0.18-0.65, P < 0.01). CONCLUSION The trajectory of SI among medical students can be divided into a low risk, slowly rising group and a high risk, continuous group; the more EN, PN, EA and PA experienced during childhood, the more likely medical students are to develop a high risk, continuous state of SI.
Collapse
Affiliation(s)
- Jiang Nan
- grid.412113.40000 0004 1937 1557Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia ,grid.443397.e0000 0004 0368 7493Hainan Medical University, Haikou, 571199 China
| | - Nen Salina
- grid.412113.40000 0004 1937 1557Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia ,grid.412113.40000 0004 1937 1557Counselling Program, Postgraduate Secretariat, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia
| | - Sheau Tsuey Chong
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600, Bangi, Malaysia. .,Counselling Program, Postgraduate Secretariat, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600, Bangi, Malaysia.
| | - Hong-juan Jiang
- grid.443397.e0000 0004 0368 7493Hainan Medical University, Haikou, 571199 China ,grid.443397.e0000 0004 0368 7493The First Affiliated Hospital of Hainan Medical University, Haikou, 571199 China
| |
Collapse
|
5
|
Graph theory analysis of whole brain functional connectivity to assess disturbances associated with suicide attempts in bipolar disorder. Transl Psychiatry 2022; 12:7. [PMID: 35013103 PMCID: PMC8748935 DOI: 10.1038/s41398-021-01767-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/25/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
Brain targets to lower the high risk of suicide in Bipolar Disorder (BD) are needed. Neuroimaging studies employing analyses dependent on regional assumptions could miss hubs of dysfunction critical to the pathophysiology of suicide behaviors and their prevention. This study applied intrinsic connectivity distribution (ICD), a whole brain graph-theoretical approach, to identify hubs of functional connectivity (FC) disturbances associated with suicide attempts in BD. ICD, from functional magnetic resonance imaging data acquired while performing a task involving implicit emotion regulation processes important in BD and suicide behaviors, was compared across 40 adults with BD with prior suicide attempts (SAs), 49 with BD with no prior attempts (NSAs) and 51 healthy volunteers (HVs). Areas of significant group differences were used as seeds to identify regional FC differences and explore associations with suicide risk-related measures. ICD was significantly lower in SAs than in NSAs and HVs in bilateral ventromedial prefrontal cortex (vmPFC) and right anterior insula (RaIns). Seed connectivity revealed altered FC from vmPFC to bilateral anteromedial orbitofrontal cortex, left ventrolateral PFC (vlPFC) and cerebellum, and from RaIns to right vlPFC and temporopolar cortices. VmPFC and RaIns ICD were negatively associated with suicidal ideation severity, and vmPFC ICD with hopelessness and attempt lethality severity. The findings suggest that SAs with BD have vmPFC and RaIns hubs of dysfunction associated with altered FC to other ventral frontal, temporopolar and cerebellar cortices, and with suicidal ideation, hopelessness, and attempt lethality. These hubs may be targets for novel therapeutics to reduce suicide risk in BD.
Collapse
|