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Hunt RA, Levinson CA. Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors. Behav Ther 2021; 52:1137-1144. [PMID: 34452668 DOI: 10.1016/j.beth.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/19/2022]
Abstract
Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one's own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.
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Keefner TP, Stenvig T. Rethinking Suicide Risk With a New Generation of Suicide Theories. Res Theory Nurs Pract 2021; 34:389-408. [PMID: 33199410 DOI: 10.1891/rtnp-d-19-00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide is a global concern to nurses and other health-care providers. However, deaths by suicide are only part of the spectrum of suicide, as suicidal thinking and behaviors may precede a suicide attempt. Theoretical models are used infrequently in research to explain how the individual progresses from suicidal ideation to a suicide attempt. Thus, there is a critical need to advance the study of suicide with useful theoretical models to describe and explain processes whereby suicidal thoughts transition to attempts and to suicide. PURPOSE This article provides a conceptual discussion and scoping review comparing historical and contemporary ideation-to-action theories of suicide. METHOD Systematic reviews and meta-analyses from three databases (CINAHL, JSTOR, and PsychINFO) were reviewed to find literature describing suicide theories. RESULTS Historically, theory applications have limited capacity to differentiate between those individuals with suicidal ideations and those who attempt suicide. Newer theories, grounded in the ideation-to-action framework, propose distinct processes explaining what moves an individual from suicidal ideations toward suicidal behaviors. IMPLICATIONS FOR PRACTICE The ideation-to-action theories can guide health-care providers' assessment of at-risk individuals beyond merely asking about suicidal thinking. CONCLUSION The new generation of suicide theories suggest that suicidal ideations are only one component of risk. The common factor in ideation-to-action theories that distinguishes ideators from attempters is the acquired capability for suicide.
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Affiliation(s)
- Tamara P Keefner
- College of Nursing, South Dakota State University, Brookings, South Dakota
| | - Thomas Stenvig
- College of Nursing, South Dakota State University, Brookings, South Dakota
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Ganson KT, Rodgers RF, Murray SB, Nagata JM. Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students. J Eat Disord 2021; 9:88. [PMID: 34289904 PMCID: PMC8293526 DOI: 10.1186/s40337-021-00443-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020. METHODS Data from four academic survey years (2016-2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates. RESULTS Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy). CONCLUSIONS The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, San Francisco, CA, 94158, USA.
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Ortiz SN, Smith A. A longitudinal examination of the relationship between eating disorder symptoms and suicidal ideation. Int J Eat Disord 2020; 53:69-78. [PMID: 31479165 DOI: 10.1002/eat.23162] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cross-sectional research demonstrates significant correlations between eating disorders (EDs) and suicidal thoughts and behaviors. Although suicide ideation (SI) is a risk factor for suicidal behavior, longitudinal research investigating SI among EDs is limited. Thus, the aim of this study was to offer insight into the dynamic relationship between EDs and SI by investigating if these variables predicted one another at weekly time points. METHOD Autoregressive cross-lagged modeling was used to test bidirectional relationships between ED symptoms and suicidal ideation among an ED patient sample (n = 92). Participants completed a measure of suicidal ideation and the Eating Disorder Examination-Questionnaire (EDE-Q) weekly for 5 weeks. RESULTS SI and ED symptoms were correlated with each other at each time point. Unexpectedly, the majority of cross-lagged pathways were nonsignificant. However, SI at Week 4 predicted ED symptoms at Week 5, while controlling for Week 4 ED symptoms. This pattern of results was found when the shape concerns, weight concerns, and eating concerns subscales of the EDE-Q were entered into the model. Moreover, Week 2 shape concerns predicted Week 3 SI and Week 3 eating concerns predicted Week 4 SI. No significant cross-lagged pathways were found with the dietary restraint subscale. DISCUSSION Nonsignificant cross-lagged pathways may indicate that third variables better explain the relations between certain ED symptoms and SI over time. However, there were instances where ED symptoms and SI predicted one another. Given this, targeting suicidal thoughts in therapy may help to reduce eating pathology and vice versa.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - April Smith
- Department of Psychology, Miami University, Oxford, Ohio
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Trujillo A, Forrest LN, Claypool HM, Smith AR. Assessing Longitudinal Relationships among Thwarted Belongingness, Perceived Burdensomeness, and Eating Disorder Symptoms. Suicide Life Threat Behav 2019; 49:1609-1620. [PMID: 30730079 DOI: 10.1111/sltb.12541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Past work has documented a cross-sectional relationship between eating disorders (ED) and suicidality, but few studies have examined the directionality of this relationship. Informed by the interpersonal-psychological theory of suicide (IPTS), this study examines the bidirectional, longitudinal relationship between ED symptoms and two determinants of suicide ideation-thwarted belongingness (TB) and perceived burdensomeness (PB). METHOD Ninety-two treatment-seeking individuals with ED (94.5% White, 95.6% female) completed baseline (T1) measures of ED symptoms along with TB and PB. Of those, 75 (81.5%) completed a follow-up assessment eight weeks later (T2). RESULTS Separate linear regression models revealed that T1 ED symptoms did not predict T2 TB (b = .03, p = .42) or T2 PB (b = -.01, p = .68). Similarly, T1 TB did not predict T2 ED symptoms (b = .25, p = .37). T1 PB did significantly predict T2 ED symptoms (b = 0.52, p = .04). Further, among participants with AN/sub-AN, T1 TB and PB predicted T2 ED symptoms (p's ≤ .03). CONCLUSION Our results reveal the need for a nuanced understanding of the relationship between ED and suicidality. This study found that PB predicts greater ED symptoms and, among the AN/sub-AN sample, TB does as well.
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Velkoff EA, Smith AR. Examining Patterns of Change in the Acquired Capability for Suicide Among Eating Disorder Patients. Suicide Life Threat Behav 2019; 49:1032-1043. [PMID: 30125387 DOI: 10.1111/sltb.12505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/23/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Several models of suicidal behavior posit that, to transition from suicidal ideation to attempting suicide, individuals must have an acquired capability for suicide (ACS), comprised of fearlessness about death (FAD) and pain tolerance. ACS is hypothesized to increase monotonically through exposure to painful and provocative experiences. However, recent research suggests that ACS can decrease, bringing into question the hypothesis of monotonic increase. This study examined the nature of change in ACS over time within a sample of patients with eating disorder (ED). We predicted that there would be two classes of change in ACS: one high and increasing and one moderate and stable. METHOD One hundred female patients with ED reported on ACS at admission and weekly during treatment. RESULTS Growth mixture modeling to test models of FAD and pain tolerance identified that, for both factors, a one-class intercept-only model was the best-fitting model, suggesting that patients entered treatment with midlevel ACS and experienced no significant linear change over the course of treatment. CONCLUSIONS Acquired capability for suicide demonstrated stability in this study; results highlight the need for additional research examining ACS across different timescales and in varied populations.
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Ortiz S, Knauft K, Smith A, Kalia V. Expressive suppression mediates the relation between disordered eating and suicidal ideation. J Clin Psychol 2019; 75:1943-1958. [PMID: 31332800 DOI: 10.1002/jclp.22830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although disordered eating is robustly associated with suicidal thoughts, it is not well understood why these conditions relate to each other. Emotion dysregulation is a shared risk factor for disordered eating and suicidal thoughts. Individuals with dysregulated emotions struggle to select appropriate strategies to modulate emotions and the strategies they use might explain some of the shared variances. Thus, we examined whether emotion regulation strategies mediated the relationship between disordered eating and suicidal ideation. METHOD Adult participants (N = 230) completed questionnaires on current disordered eating symptoms, emotion regulation strategies, and current suicidal ideation. RESULTS Disordered eating symptoms positively associated with suicidal ideation. In addition, expressive suppression mediated the relation between disordered eating symptoms and current suicidal ideation. No relation was found for cognitive reappraisal. CONCLUSIONS The use of expressive suppression as an emotion regulation strategy may be related to increased suicidal ideation in individuals who express concerns about eating.
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Affiliation(s)
- Shelby Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | | | - April Smith
- Department of Psychology, Miami University, Oxford, Ohio
| | - Vrinda Kalia
- Department of Psychology, Miami University, Oxford, Ohio
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Goldstein A, Gvion Y. Socio-demographic and psychological risk factors for suicidal behavior among individuals with anorexia and bulimia nervosa: A systematic review. J Affect Disord 2019; 245:1149-1167. [PMID: 30699859 DOI: 10.1016/j.jad.2018.12.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/26/2018] [Accepted: 12/08/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Suicide is the second leading cause of death among individuals with anorexia nervosa (AN) and is also elevated in bulimia nervosa (BN). We carried out a systematic review in which we analyzed the relationship between AN and/or BN and suicidality (i.e. suicidal ideation or attempted and/or death by suicide) and the major risk factors for suicidal behavior among AN and BN patients by synthesizing the qualitative data from relevant studies. EVIDENCE ACQUISITION According to PRISMA guidelines, we conducted a systematic search of the literature on PsycNET, PubMed, Google Scholar, and ScienceDirect. Search terms were "eating disorders" "OR" "anorexia" "OR" "bulimia" combined with the Boolean "AND" operator with "suicide." EVIDENCE SYNTHESIS The initial search identified 8,590 records, of which 38 research reports met the predefined inclusion criteria and were analyzed. Eating disorders (EDs) were found to be associated with a marked increase in suicidal behaviors and ideation. ED type, impulsivity, and specific interpersonal features were associated with suicidal behavior. CONCLUSIONS Our findings highlight the importance of the combined role of socio-demographic and psychological factors to the co-occurrence of EDs and suicidal behavior. It is imperative that a thorough suicide assessment be conducted routinely for individuals with past and current EDs, and that clinicians be aware that this risk may be ongoing and occur throughout treatment, even after ED symptoms appear to be remitting. LIMITATIONS Study limitations include diagnostic definitions of and criteria for EDs, and the different terminology used by researchers to define suicide, including non-suicidal behaviors, which weakens the ability to draw conclusions regarding actual suicidal behaviors versus other self-harm behaviors.
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Affiliation(s)
- Amit Goldstein
- Department of Psychology, Bar Ilan University, Israel; The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Israel.
| | - Yari Gvion
- Department of Psychology, Bar Ilan University, Israel; Department of Psychology, The Academic College of Tel Aviv-Yaffo, Israel
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Haynos AF, Wall MM, Chen C, Wang SB, Loth K, Neumark-Sztainer D. Patterns of weight control behavior persisting beyond young adulthood: Results from a 15-year longitudinal study. Int J Eat Disord 2018; 51:1090-1097. [PMID: 30353938 PMCID: PMC6391054 DOI: 10.1002/eat.22963] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Dieting and unhealthy weight control behaviors have been associated with negative outcomes. Most research has examined the prevalence of these behaviors in adolescence and young adulthood. Less is known about whether they persist further into adulthood. We examined patterns of weight control behaviors beyond young adulthood using data from 1,455 males and females participating in Project EAT (Eating and Activity in Teens and Young Adults), a 15-year population-based, longitudinal study. METHOD Participants completed surveys assessing dieting, high-frequency dieting (i.e., 5+ times/year), unhealthy weight control (e.g., fasting), and extreme weight control (e.g., vomiting) at each 5-year assessment (Waves 1-4). Longitudinal logistic regression models tested trends in weight control behaviors across the waves. Likelihood of persisting or discontinuing each behavior from Wave 3 to Wave 4 was examined through cross tabulations. RESULTS Between Waves 3 and 4 in adulthood, dieting increased for both genders (Women: p < .001; Men: p = .004) and high-frequency dieting (p < .001) and unhealthy weight control behaviors (p = .011) increased for men. For both genders, dieting and unhealthy weight control patterns initiated in prior to young adulthood were more likely to persist than cease in adulthood (ps < .001). DISCUSSION Weight control behaviors continue to be prevalent in adulthood, and to especially increase among men. Research is needed to understand the consequences of weight control behaviors in different life stages; however, the results suggest that interventions to decrease unhealthy weight management practices may be needed well into adulthood.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Melanie M. Wall
- Department of Biostatistics, Columbia University, New York, New York
| | - Chen Chen
- Department of Biostatistics, Columbia University, New York, New York
| | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Katie Loth
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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10
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Brausch AM, Perkins NM. Nonsuicidal self-injury and disordered eating: Differences in acquired capability and suicide attempt severity. Psychiatry Res 2018; 266:72-78. [PMID: 29857291 DOI: 10.1016/j.psychres.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/13/2022]
Abstract
Nonsuicidal self-injury (NSSI) and eating disorders are both strongly related to suicide behaviors, and both can be conceptualized as painful and provocative events that associate with acquired capability for suicide. Individuals who self-injure report greater acquired capability than those who do not engage in these behaviors, but results are mixed in eating disorder samples. Given that NSSI and disordered eating (DE) commonly co-occur, it is important to examine how acquired capability for suicide and suicide attempt severity may differ between individuals who engage in either, both, or neither of these behaviors. It was expected that individuals with both NSSI and DE would report the greatest acquired capability, assessed by fearlessness about death and fear about suicide, and suicide attempt severity, compared to NSSI only, DE only, and controls. In a sample of 1179 undergraduates, results indicated no differences on fearlessness about death, but the NSSI + DE group reported the lowest scores on fear of suicide and greatest suicide attempt severity compared to the other groups. Differences between fearlessness about death and fear about suicide are discussed, as well as the possible additive effect of engaging in both direct (NSSI) and indirect (DE) self-harm on fear about suicide and suicide risk.
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Affiliation(s)
- Amy M Brausch
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd, Bowling Green, KY 42101, United States.
| | - Natalie M Perkins
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd, Bowling Green, KY 42101, United States
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11
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Duffy ME, Rogers ML, Joiner TE. Body trust as a moderator of the association between exercise dependence and suicidality. Compr Psychiatry 2018; 85:30-35. [PMID: 29957375 DOI: 10.1016/j.comppsych.2018.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Exercise dependence and interoceptive deficits, particularly low body trust, have been associated with suicidality. This study tested whether low body trust predicted current suicidal ideation and past suicide attempts in individuals exhibiting symptoms of exercise dependence. METHODS 540 individuals (55.6% female, mean age 36) recruited via MTurk completed online measures of exercise dependence, interoception, and history of suicidal ideation and attempts. RESULTS Exercise dependence symptoms and low body trust were associated with suicidal ideation. Body trust moderated the relationship between exercise dependence symptoms and suicidal ideation. Continuance in exercise despite adverse consequences and low body trust were associated with past suicide attempts. CONCLUSIONS Body trust was associated with suicidal ideation and suicide attempts in individuals with exercise dependence symptoms, and the associations strengthened as body trust decreased. The experience of not trusting one's own body may exacerbate suicide risk in at-risk individuals.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, United States of America.
| | - Megan L Rogers
- Department of Psychology, Florida State University, United States of America
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States of America
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12
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Smith AR, Zuromski KL, Dodd DR. Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Curr Opin Psychol 2018; 22:63-67. [DOI: 10.1016/j.copsyc.2017.08.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
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Chu C, Buchman-Schmitt JM, Stanley IH, Hom MA, Tucker RP, Hagan CR, Rogers ML, Podlogar MC, Chiurliza B, Ringer-Moberg FB, Michaels MS, Patros C, Joiner TE. The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychol Bull 2017; 143:1313-1345. [PMID: 29072480 PMCID: PMC5730496 DOI: 10.1037/bul0000123] [Citation(s) in RCA: 561] [Impact Index Per Article: 80.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, Tallahassee, FL
- McLean Hospital, Belmont, MA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA
| | | | - Ian H. Stanley
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Raymond P. Tucker
- Louisiana State University, Department of Psychology, Baton Rouge, LA
| | | | - Megan L. Rogers
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | - Bruno Chiurliza
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | | | - Connor Patros
- Temple University, Department of Psychology, Philadelphia, PA
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL
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Zuromski KL, Cero I, Witte TK, Zeng P. The Quadratic Relationship Between Body Mass Index and Suicide Ideation: A Nonlinear Analysis of Indirect Effects. Suicide Life Threat Behav 2017; 47:155-167. [PMID: 27291861 DOI: 10.1111/sltb.12270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022]
Abstract
A nonlinear indirect effects framework was used to investigate potential interpersonal indirect effects (i.e., perceived burden and thwarted belonging) accounting for the nonlinear relationship between body mass index (BMI) and suicide ideation. Using a sample of 338 undergraduates, results revealed a significant quadratic effect of BMI on suicide ideation via perceived burden only, which became significant as BMI fell below 18.00 kg/m2 and above 28.00 kg/m2 . Our results provide novel information relevant for suicide risk screening in the context of weight- and health-related interventions and provide justification for future longitudinal trials assessing suicide risk across the BMI spectrum.
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Affiliation(s)
| | - Ian Cero
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Tracy K Witte
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Peng Zeng
- Department of Mathematics and Statistics, Auburn University, Auburn, AL, USA
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15
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Davis MT, Daniel TA, Witte TK, Beyers RJ, Willis JZ, Wang Y, Denney TS, Katz JS, Salibi N, Deshpande G. Demonstration and validation of a new pressure-based MRI-safe pain tolerance device. J Neurosci Methods 2016; 271:160-8. [PMID: 27378028 DOI: 10.1016/j.jneumeth.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND One of the barriers to studying the behavioral and emotional effects of pain using functional Magnetic Resonance Imaging (fMRI) is the absence of a commercially available, MRI-compatible, pressure-based algometer to elicit pain. The present study sought to address this barrier through creation and validation of a novel MRI-safe apparatus capable of delivering incremental, measurable amounts of pressure inside a scanning bore. NEW METHOD We introduced an MR-safe device used to administer pressure-based pain. To test against a commercially available, MRI-incompatible algometer (AlgoMed), 199 participants reported their pain tolerance for both devices. A second experiment tested the validity of pressure-based pain in an MRI environment by comparing brain activation with established neural networks for pain. 10 participants performed an identical procedure to test for pain tolerance while being scanned in a 7T MRI scanner. RESULTS Results support the validity and reliability of our novel device. In Study 1, pain tolerance with this device was strongly correlated with pain tolerance as measured by a commercially available algometer (r=0.78). In Study 2, this device yielded BOLD activation within the insula (BA 13) and anterior cingulate gyrus (BA 24); as pressure increased, activation in these areas parametrically increased. COMPARISON WITH EXISTING METHOD These findings correspond to other studies using thermal, electrical, or mechanical pain applications. Behavioral and functional data demonstrate that this new device is a valid method of administering pressure-related pain in MRI environments. CONCLUSIONS Our novel MRI-safe device is a valid instrument to measure and administer pressure-based pain.
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Affiliation(s)
| | - Thomas A Daniel
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Tracy K Witte
- Department of Psychology, Auburn University, Auburn, AL, USA.
| | - Ronald J Beyers
- AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA
| | - J Zachary Willis
- AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA
| | - Yun Wang
- AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA
| | - Thomas S Denney
- Department of Psychology, Auburn University, Auburn, AL, USA; AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA; Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Jeffrey S Katz
- Department of Psychology, Auburn University, Auburn, AL, USA; AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA; Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Nouha Salibi
- AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA; MR R&D Siemens Healthcare, Malvern, PA, USA
| | - Gopikrishna Deshpande
- Department of Psychology, Auburn University, Auburn, AL, USA; AU MRI Research Center, Department of Electrical Engineering, Auburn University, Auburn, AL, USA; Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA.
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16
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Forrest LN, Bodell LP, Witte TK, Goodwin N, Bartlett ML, Siegfried N, Eddy KT, Thomas JJ, Franko DL, Smith AR. Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients. J Affect Disord 2016; 195:127-35. [PMID: 26895090 DOI: 10.1016/j.jad.2016.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/14/2016] [Accepted: 02/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. METHOD We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. RESULTS The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. LIMITATIONS The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. CONCLUSIONS Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.
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Affiliation(s)
- Lauren N Forrest
- Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States
| | - Lindsay P Bodell
- University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, United States
| | - Tracy K Witte
- Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, United States
| | - Natalie Goodwin
- Eating Recovery Center of Washington, 1231 116th Ave NE, Bellevue, WA 98004, United States
| | - Mary L Bartlett
- Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States
| | - Nicole Siegfried
- Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Bouvé College of Health Sciences and Department of Counseling and Applied Educational Psychology, Northeastern University, 123 Behrakis Health Sciences Center, Boston, MA 02115, United States
| | - April R Smith
- Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States.
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17
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Restrictive eating: Associated with suicide attempts, but not acquired capability in residential patients with eating disorders. Psychiatry Res 2016; 235:90-6. [PMID: 26710984 DOI: 10.1016/j.psychres.2015.11.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/20/2015] [Accepted: 11/22/2015] [Indexed: 11/21/2022]
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18
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Zuromski KL, Witte TK, Smith AR, Goodwin N, Bodell LP, Bartlett M, Siegfried N. Increased prevalence of vegetarianism among women with eating pathology. Eat Behav 2015; 19:24-7. [PMID: 26162593 DOI: 10.1016/j.eatbeh.2015.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Prior research has established a link between vegetarianism and disordered eating but has typically sampled vegetarians. This study examined prevalence of and variables related to vegetarianism in three samples with varying severity of eating pathology. METHOD Sample 1 consisted of female undergraduates who denied history of or current disordered eating (i.e., nonclinical; n=73), or engaged in disordered eating over past month (i.e., subclinical; n=136). Sample 2 included 69 female patients receiving residential treatment at an eating disorder center (i.e., clinical sample). Differences between groups were analyzed using Fisher's exact test. RESULTS The prevalence of lifetime vegetarianism was lowest in the nonclinical group (6.80%) and highest in the clinical group (34.80%), with the subclinical group falling in between (17.60%). According to Fisher's exact test, all pairwise comparisons between groups were statistically significant (p's<.05). Regarding current vegetarian status, the clinical group was more likely (11.10%) than both other groups to self-identify as current vegetarians. DISCUSSION Endorsement of vegetarianism was highest among females with severe eating pathology. Future research should use longitudinal data to examine the temporal relationship between these variables, or other underlying factors that may contribute to the co-occurrence of eating pathology and vegetarianism. Clinically, endorsement of vegetarianism may also be an important variable to consider in treatment disordered eating.
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Affiliation(s)
| | - Tracy K Witte
- Department of Psychology, Auburn University, Auburn, AL, USA.
| | - April R Smith
- Department of Psychology, Miami University, Oxford, OH, USA
| | | | - Lindsay P Bodell
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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