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Mitchell S, Marvin C, Mitaj D, Rogers ML. Identifying latent classes of suicidal ambivalence: Associations with suicide risk correlates and outcomes. Suicide Life Threat Behav 2024. [PMID: 38994902 DOI: 10.1111/sltb.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/30/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Research has largely conceptualized suicidal ambivalence as the difference between one's wish to live and wish to die without fully considering other suicide ideation (SI) experiences included on measures like the Beck Scale for Suicide Ideation (BSS). We utilized BSS items to identify SI latent classes and examined relevant correlates and outcomes. METHODS We collected self-report data from two samples of US adults who: (1) self-identified as LGBTQ+ (N = 349; cross-sectional) and (2) self-reported past-week SI (BSS score ≥ 11; N = 133; 3 timepoints). RESULTS Latent class analyses supported three-class (Sample 1) and four-class solutions (Sample 2), which included ambivalent classes. In Sample 1, sexual orientation, gender, depression, anxiety, SI, and suicide-specific rumination were concurrently associated with class membership. In Sample 2, depression, SI, suicide-specific rumination, and physical/psychological distance from suicide methods were concurrently associated with class membership. In Sample 2, at both follow-ups, suicide plans/preparations and Acute Suicidal Affective Disturbance symptom frequencies were provided by class membership, and suicidal intent significantly differed by class membership. CONCLUSIONS SI classes differed by sample and evidenced nuances in SI and suicidal ambivalence. Risk factors and suicide-related outcomes also differed by class membership. Implications and limitations are discussed.
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Affiliation(s)
- Sean Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Cole Marvin
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Dea Mitaj
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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Hensel LM, Forkmann T, Teismann T. Suicide-specific rumination as a predictor of suicide planning and intent. Behav Res Ther 2024; 180:104597. [PMID: 38905955 DOI: 10.1016/j.brat.2024.104597] [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: 01/23/2024] [Revised: 05/23/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Suicide-specific rumination (SSR), that is repetitive negative thinking about suicide, has been proposed as a risk factor for suicidal behavior. Yet, few studies have investigated associations between SSR and suicide intent and planning in a longitudinal study design. The purpose of the present study was to investigate the association between SSR, suicide intent, suicide planning and suicide attempts in a sample of adult outpatients undergoing psychotherapy. METHOD Data from N = 637 patients (58.4% female, 41.6% male; Mage = 35.81, SDage = 13.50, range: 18-79 years) who started therapy at an outpatient clinic were collected. A subsample of n = 335 patients (n = 335; 56,4% female, 43,6% male; Mage = 35.4, SDage = 13.1, range: 18-73 years) also took part in a post-treatment assessment after twelve therapy sessions. RESULTS SSR differentiated lifetime suicide attempters from suicide ideators. Furthermore, SSR was associated with lifetime suicide attempt status above age, sex, suicide ideation, depression, anxiety, and stress. Finally, SSR served as a prospective predictor of both suicide planning and suicide intent. CONCLUSION The results emphasize the key role of SSR in understanding the suicidal process.
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Affiliation(s)
- Lena Marie Hensel
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
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Schwerthöffer D, Förstl H. [Insomniac symptoms and suicidality-link and management]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:53-61. [PMID: 37171521 PMCID: PMC11143018 DOI: 10.1007/s40211-023-00466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND A link between insomniac symptoms and suicidality has long been suspected and deserves specific attention. OBJECTIVE We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose a targeted management. MATERIAL AND METHOD Clinical example and selective Medline-literature research for insomnia symptoms and suicidality. RESULTS Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with a combination of suicidality and symptoms of insomnia. CONCLUSION patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert a favorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.
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Affiliation(s)
- Dirk Schwerthöffer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - Hans Förstl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland
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Cheung JC, Sorgi-Wilson KM, Ciesinski NK, McCloskey MS. Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review. Suicide Life Threat Behav 2024; 54:528-555. [PMID: 38411021 DOI: 10.1111/sltb.13051] [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: 11/01/2022] [Revised: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity. METHODS The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined. RESULTS A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present. CONCLUSION Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.
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Affiliation(s)
- Joey C Cheung
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Nicole K Ciesinski
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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Azizy AH, Thontowi HB. Stigma, Support, and Ideation About Suicide in Indonesian Twitter: A Topic Modelling Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241253972. [PMID: 38739857 DOI: 10.1177/00302228241253972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Stigma surrounding suicide is a massive problem in Indonesia. Thus, it is important to study how conversations about suicide take place. We take a machine learning approach and study tweets with suicide keywords to understand how people converse about suicide or express suicide ideation. Tweets with suicide-related keywords were extracted from May to June 2023. 20,057 tweets were subject to topic modelling with an 11-topic solution. While most topics contain negative messages, no purely stigmatizing topics emerge, despite prior research suggesting overwhelming stigma. Various kinds of existential, emotional, and social tweets about suicide take place among Indonesian users, indicating that Indonesian Twitter users utilize the platform to express their thoughts and emotions. Notably, religious-spiritual keywords are highly prevalent, suggesting that in a highly religious society, there is a need for policy makers and awareness campaigns to frame their positive messaging within the society's religious context.
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Affiliation(s)
- Afrizal Hasbi Azizy
- Center for Indigenous and Cultural Psychology, Universitas Gadjah Mada, Sleman, Indonesia
| | - Haidar Buldan Thontowi
- Center for Indigenous and Cultural Psychology, Universitas Gadjah Mada, Sleman, Indonesia
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Rogers ML, Law KC, Lawrence OC, Mandel AA. Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens. Behav Res Ther 2024; 177:104524. [PMID: 38583292 DOI: 10.1016/j.brat.2024.104524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Abstract
According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Keyne C Law
- Department of Psychology, Seattle Pacific University, Seattle, WA, USA
| | | | - Abby A Mandel
- Department of Psychology, Catholic University of America, Washington, DC, USA
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Krupnik V, Danilova N. To be or not to be: The active inference of suicide. Neurosci Biobehav Rev 2024; 157:105531. [PMID: 38176631 DOI: 10.1016/j.neubiorev.2023.105531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
Suicide presents an apparent paradox as a behavior whose motivation is not obvious since its outcome is non-existence and cannot be experienced. To address this paradox, we propose to frame suicide in the integrated theory of stress and active inference. We present an active inference-based cognitive model of suicide as a type of stress response hanging in cognitive balance between predicting self-preservation and self-destruction. In it, self-efficacy emerges as a meta-cognitive regulator that can bias the model toward either survival or suicide. The model suggests conditions under which cognitive homeostasis can override physiological homeostasis in motivating self-destruction. We also present a model proto-suicidal behavior, programmed cell death (apoptosis), in active inference terms to illustrate how an active inference model of self-destruction can be embodied in molecular mechanisms and to offer a hypothesis on another puzzle of suicide: why only humans among brain-endowed animals are known to practice it.
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Affiliation(s)
- Valery Krupnik
- Department of Mental Health, Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA.
| | - Nadia Danilova
- Department of Cell Biology, UCLA (retired), Los Angeles, CA, USA
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8
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Rogers ML, Carosa CL, Haliczer LA, Hughes CD, Schofield CA, Armey MF. The Suicide Dot Probe Task: Psychometric properties and validity in relation to suicide-related outcomes. Suicide Life Threat Behav 2023; 53:1010-1024. [PMID: 37702551 DOI: 10.1111/sltb.12999] [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: 03/14/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Attentional biases to suicide-related stimuli have been linked to suicide-related outcomes. However, behavioral tasks that have been previously modified to capture suicide-specific attentional biases have demonstrated inconsistent reliability and validity. Adaptation of the Dot Probe Task, a computerized assessment that has been adapted to study a wide variety of biases, may be a promising candidate for assessing suicide-specific biases. METHODS In 280 recently discharged inpatients (51% male; Mage = 40.22 years), we evaluated the psychometric properties of a modified Suicide Dot Probe Task. Participants completed this task and assessments of suicidal thoughts and behaviors at baseline and 6-month follow-up. RESULTS The Suicide Dot Probe Task demonstrated poor-to-moderate internal consistency and poor test-retest reliability, and participant response times were slower to suicide-specific and dysphoric stimuli than positive stimuli. However, there were no differences based on the presence or characteristics of recent or lifetime suicidal ideation or attempts. Participants' suicide-specific biases were not predictive of suicidal ideation or attempts at follow-up. CONCLUSIONS The Suicide Dot Probe Task exhibited questionable reliability, and differences in attentional biases were not associated with suicidal ideation or attempts. This study contributes to a body of research demonstrating the questionable utility of several behavioral tasks to study suicide-specific attentional biases.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Catarina L Carosa
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Lauren A Haliczer
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher D Hughes
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Michael F Armey
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
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9
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Herzog S, Galfalvy H, Keilp JG, Mann JJ, Sublette ME, Burke A, Oquendo MA, Stanley BH. Relationship of stress-reactive cortisol to suicidal intent of prior attempts in major depression. Psychiatry Res 2023; 327:115315. [PMID: 37542793 PMCID: PMC10530442 DOI: 10.1016/j.psychres.2023.115315] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 08/07/2023]
Abstract
Higher intent suicide attempts carry elevated risk of future suicidal behavior. Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis is both linked to nonfatal suicidal behavior and suicide deaths in major depressive disorder. Few studies, however, have identified biological markers of a high-intent suicidal subgroup. We examined HPA axis output and reactivity to the Trier Social Stress Test (TSST) via salivary cortisol in depressed individuals (N=68) with a suicide attempt (SA) history. A median split of higher and lower suicidal intent scores was used to define groups. Individuals with high intent SA had attenuated total cortisol output (AUCg), F(1,60)=10.04, SE=5.095, p=.003, and lower HPA-axis stress responsivity to the TSST (AUCi), F(1,60)=4.50, SE=4.604, p=.039, compared with the low intent SA group. The high intent group also reported more pronounced negative affect than the low intent group (F[1,61]=6.413, SE=10.55, p=.014) both at baseline (meandiff=22.32, p=.038) and in response to the stressor task (meandiff=37.62, p=.003). Vulnerability to suicidal behavior in high-intent individuals may be related to the combined profile of impaired physiological responses to stress and greater negative affectivity. This clinical and biologic subgroup may benefit from targeted suicide prevention interventions.
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Affiliation(s)
- Sarah Herzog
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - John G Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ainsley Burke
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara H Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Wong SMY, Ip CH, Hui CLM, Suen YN, Wong CSM, Chang WC, Chan SKW, Lee EHM, Lui SSY, Chan KT, Wong MTH, Chen EYH. Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors. Psychol Med 2023; 53:4603-4613. [PMID: 35650661 PMCID: PMC10388322 DOI: 10.1017/s0033291722001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential. METHODS Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use. RESULTS The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt. CONCLUSIONS Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.
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Affiliation(s)
- Stephanie M. Y. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Charlie H. Ip
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy L. M. Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y. N. Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Corine S. M. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W. C. Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Sherry K. W. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin H. M. Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Simon S. Y. Lui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K. T. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael T. H. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Y. H. Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Forkmann T, Knorr A, Gerdes C, Vüst B, Hamacher D, Teismann T. Metacognitions about suicidal thoughts. J Psychiatr Res 2023; 161:199-205. [PMID: 36933446 DOI: 10.1016/j.jpsychires.2023.03.018] [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: 09/20/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs. METHODS Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; Mage = 24.9, SDage = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; Mage = 33.2, SDage = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively. RESULTS Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions. CONCLUSION Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.
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Affiliation(s)
- Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany.
| | - Anna Knorr
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Christiane Gerdes
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Björn Vüst
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Dennis Hamacher
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
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Sahlan RN, Grunewald W, Smith AR. Validations of the Farsi versions of the depressive symptom inventory suicidality subscale (F-DSI-SS) and suicide rumination scale (F-SRS) among Iranian college students. Suicide Life Threat Behav 2023; 53:16-28. [PMID: 36029097 DOI: 10.1111/sltb.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Suicidal thoughts are relatively common among college students in Iran. However, measures frequently used to assess suicidality or specific aspects of suicidal ideation in the United States have yet to be validated in Iran. Thus, the present study validated Farsi versions of the Depressive Symptom Inventory Suicidality Subscale (F-DSI-SS) and Suicide Rumination Scale (F-SRS) among Iranian college students. METHODS College students (N = 1043; 88.1% women) completed the F-DSI-SS. Forty-six percent (n = 481) of participants reported the presence of suicidal thoughts and were eligible to fill out the F-SRS. Analyses focused on validating the factor structure, construct, and convergent validity of the F-DSI-SS and F-SRS among college students, as well as testing measurement invariance by gender of the F-DSI-SS. RESULTS Confirmatory factor analysis (CFA) indicated that the F-DSI-SS and F-SRS had good fit to the data and each displayed a one-factor structure. Furthermore, the F-DSI-SS showed strong measurement invariance across genders. Internal consistency of the F-DSI-SS and F-SRS was good. Lastly, the F-DSI-SS and F-SRS's items and their total scores were intercorrelated and demonstrated good convergent validity. CONCLUSION Findings suggest that the F-DSI-SS and F-SRS will enable researchers to examine suicidal thoughts and suicide-specific rumination in Iran.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - William Grunewald
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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Mandel AA, Revzina O, Jessani Z, Brown GK. Revised Attentional Fixation on Suicide Experiences Questionnaire and its relationship with suicidal ideation and behavior: A cross-sectional study. Suicide Life Threat Behav 2022; 52:1096-1109. [PMID: 35838112 DOI: 10.1111/sltb.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ) was developed to measure attentional fixation on suicide, a cognitive process characterized by a preoccupation with suicide as a solution. This study investigated a revised version (AFSEQ-R) and examined differences between those who made a recent suicide attempt and those with suicidal ideation (SI). METHOD Participants were 57 inpatients who attempted suicide within 14 days of study participation and 57 inpatients who presented with SI but no suicidal behavior within the past year. Analyses examined the internal reliability, multidimensionality, and construct validity of the AFSEQ-R, and whether attentional fixation moderated the correlation between SI and attempt status. RESULTS Exploratory factor analysis revealed a two-factor structure, and subscale and total scores demonstrated excellent internal consistency. Cognitive Stuckness (and total score) correlated with SI, anxiety, impulsivity, and specific problem-solving deficits, while Cognitive Dysfunction correlated with anxiety and acted as a moderator of the correlation between Stuckness and SI. AFSEQ-R scores did not moderate the relationship between SI and attempt status. CONCLUSION AFSEQ-R is a psychometrically sound and valid measure of attentional fixation. Attentional fixation on suicide is correlated with SI, and prospective studies are needed to uncover its directional effect on suicidal crises.
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Affiliation(s)
- Abby Adler Mandel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Olga Revzina
- Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Zohaib Jessani
- Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wolf J, Padberg F, Nenov-Matt T, Amann BL, Barton BB, Tang J, Glessner G, Brakemeier EL, Jobst A, Musil R, Reinhard MA. Suicidal behaviors are associated with loneliness and decrease during inpatient CBASP treatment for persistent depressive disorder. J Psychiatr Res 2022; 154:139-144. [PMID: 35939998 DOI: 10.1016/j.jpsychires.2022.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
Suicidal ideation and behavior (SIB) are common in persistent depressive disorder (PDD) and may be related to interpersonal dysfunction. While SIB has been extensively analyzed in other high-risk disorders (e.g., borderline personality disorder, BPD), data on interpersonal risk factors and effects of specific psychotherapy on SIB in PDD are limited. This study aimed at investigating loneliness versus social network size as interpersonal risk factors for SIB in PDD and assess effects of cognitive behavioral analysis system of psychotherapy (CBASP) on this domain. In a prospective naturalistic study, 64 PDD patients were assessed, who underwent a 10-weeks inpatient CBASP program. Our clinical comparison group consisted of 34 BPD patients, who underwent a 10-weeks inpatient dialectical behavioral therapy (DBT) program. SIB was measured with the Columbia-Suicide Severity Rating Scale (C-SSRS), loneliness and social network size with the UCLA Loneliness Scale (UCLA) and the Social Network Index (SNI). Twenty-six PDD patients (40.6% of the PDD sample) showed current SIB at baseline in comparison with 26 BPD patients (76.5% of the BPD sample). While in suicidal PDD patients, SIB was associated with perceived social isolation (UCLA), but not with reduced social network size (SNI), this association was not observed in suicidal BPD patients. In PDD, SIB significantly decreased during CBASP. In conclusion, SIB appears to be associated with interpersonal factors related to loneliness in PDD, but not in BPD. CBASP showed first positive evidence in reducing SIB in PDD, but our pilot data need replication studies.
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Affiliation(s)
- Johannes Wolf
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
| | - Frank Padberg
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Tabea Nenov-Matt
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Benedikt L Amann
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany; Parc de Salut Mar, Research Unit Centre Forum, IMIM, Univ. Pompeu Fabra, CIBERSAM, Barcelona, Spain
| | - Barbara B Barton
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Jeni Tang
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Gloria Glessner
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany
| | - Andrea Jobst
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Richard Musil
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Matthias A Reinhard
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
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Johnson SL, Robison M, Anvar S, Swerdlow BA, Timpano KR. Emotion-related impulsivity and rumination: Unique and conjoint effects on suicidal ideation, suicide attempts, and nonsuicidal self-injury across two samples. Suicide Life Threat Behav 2022; 52:642-654. [PMID: 35257404 PMCID: PMC9378431 DOI: 10.1111/sltb.12849] [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: 09/06/2021] [Revised: 11/19/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related impulsivity, though, are highly correlated, we consider their unique vs. conjoint influence on suicidal ideation and self-harm. METHOD Across two samples of adults (N's = 171 and 191), we examined how rumination and emotion-related impulsivity relate to suicidal ideation, suicide attempts, and NSSI. We assess the more general process of repetitive negative thinking and the more specific process of suicide-related rumination. Participants completed the Three-Factor Impulsivity Index and the self-report Columbia-Suicide Severity Rating Scale. Those in sample 1 completed the Perseverative Thinking Questionnaire and the Deliberate Self-Harm Inventory, and those in Sample 2 completed the Suicide Rumination Scale. RESULTS Emotion-related impulsivity and both forms of rumination showed robust bivariate correlations with suicidal ideation, suicide attempts, and NSSI. Neither rumination or impulsivity related to suicide attempts controlling for ideation or to NSSI. In multivariable analyses, emotion-related impulsivity but not general rumination was tied to suicidal ideation. In contrast, suicide-related rumination was more directly tied to suicidal ideation than was impulsivity. CONCLUSIONS Findings provide support for a more nuanced approach to the forms of impulsivity and rumination related to suicidal ideation.
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Affiliation(s)
- Sheri L. Johnson
- Department of Psychology, University of California Berkeley, Berkeley, California, USA
| | - Morgan Robison
- Department of Psychology, University of California Berkeley, Berkeley, California, USA
| | - Sarah Anvar
- Department of Psychology, University of California Berkeley, Berkeley, California, USA
| | - Benjamin A. Swerdlow
- Department of Psychology, University of California Berkeley, Berkeley, California, USA
| | - Kiara R. Timpano
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Boffa JW, Tock JL, Morabito DM, Schmidt NB. Measuring Psychological Inflexibility of Suicidal Thoughts: The Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI). COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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The relevance of the interpersonal theory of suicide for predicting past-year and lifetime suicidality in autistic adults. Mol Autism 2022; 13:14. [PMID: 35313974 PMCID: PMC8935684 DOI: 10.1186/s13229-022-00495-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/10/2022] [Indexed: 12/19/2022] Open
Abstract
Background While there are known risk factors for suicidality in autistic adults, these are often unconnected from theoretical frameworks that might explain why risk is elevated and guide clinical interventions. The present study investigated the relevance of constructs from the Interpersonal Theory of Suicide (ITS), including perceived burdensomeness, thwarted belongingness and acquired capability for suicide, and explored mechanisms through which certain risk factors (relationship status, age at diagnosis) might elevate suicide risk. Methods Autistic adults (n = 314) completed an online study including measures of depression, anxiety and constructs from the ITS. Linear and multinomial regression analysis disentangled contributions of ITS variables from effects of depression and anxiety for past-year suicide ideation, past-year and lifetime suicide attempts. Mediation analyses examined associations between risk factors and these suicide outcomes via mechanisms proposed by the ITS. Results Past-year suicide ideation was associated with burdensomeness, mental rehearsal of suicide plans (a facet of acquired capability), and depression. Greater feelings of burdensomeness, and reduced fear of death, marked out participants who had attempted suicide in comparison to those who had experienced suicide ideation in the past year. Relationship status was indirectly associated with past-year suicide ideation via the mediators of depression and burdensomeness, and was associated with past-year attempts via its effect on ideation. Age at diagnosis was unrelated to any variables. Limitations Cross-sectional research is insensitive to causality and temporal dynamics, which is likely why interaction hypotheses from the ITS were unsupported. Normative measures may be invalid in autistic samples. There was no control group. The autistic sample was unrepresentative of the whole population, particularly autistic people with intellectual disabilities, ethnic/racial minorities, and gender minorities. Conclusions Perceived burdensomeness and acquired capability appear potentially important to suicide in autistic people, and may mediate the effects of some risk factors. Future research should explore the temporal dynamics of suicide trajectories in longitudinal, prospective designs. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-022-00495-5.
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Höller I, Teismann T, Forkmann T. Perseverative Thinking about Suicide Questionnaire (PTSQ): Validation of a new measure to assess suicide-specific rumination. Compr Psychiatry 2022; 112:152287. [PMID: 34781079 DOI: 10.1016/j.comppsych.2021.152287] [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: 08/14/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Suicide-specific rumination has been shown to be associated with lifetime suicide attempts as well as suicide intent and might be an important risk factor for the transition from suicidal ideation to suicidal behavior. Based on this background, the wording of the items of an often-used self-report measure assessing core characteristics of rumination was adapted to assess specifically suicide-specific rumination. METHODS The entire study sample comprised N = 1689 participants from the German healthcare sector. A total of 721 participants with a history of suicidal ideation (68% female; Mage = 30.63, SDage = 8.41, range: 18-81 years) who had completed five measures assessing suicide-specific rumination, suicidal ideation, depression, hopelessness, and resilience were included for the present examination. Factorial validity (Exploratory [EFA] to determine the appropriate number of factors and confirmatory factor analyses [CFA] after randomly splitting of the sample to validate the EFA solution), construct validity, and reliability were evaluated. RESULTS The EFA revealed a one-factor solution consisting of four items, which could be confirmed within a CFA (RMSR = 0.006; RMSEA = 0.039; CFI = 0.999; TLI = 0.998). Internal consistency was excellent with Cronbachs α = 0.93. Construct validity was given with moderate to high positive correlations with suicidal ideation (0.76), depression (0.55), and hopelessness (0.38) and negative correlation with resilience (-0.31). Participants with recent suicidal ideation and/or lifetime suicide attempt reported significantly more suicide-specific rumination than those with only lifetime suicidal ideation. CONCLUSION A new 4-item measure for suicide-specific rumination was developed and could be shown to be a reliable and valid instrument in a large German sample. Results emphasize the potential importance of suicide-specific rumination for the understanding of trajectories of suicidal ideation and suicide risk assessments.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
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