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Salles J, Stephan F, Molière F, Bennabi D, Haffen E, Bouvard A, Walter M, Allauze E, Llorca PM, Genty JB, Leboyer M, Holtzmann J, Nguon AS, D'Amato T, Rey R, Horn M, Vaiva G, Fond G, Richieri R, Hennion V, Etain B, El-Hage W, Camus V, Courtet P, Aouizerate B, Yrondi A. Indirect effect of impulsivity on suicide risk through self-esteem and depressive symptoms in a population with treatment-resistant depression: A FACE-DR study. J Affect Disord 2024; 347:306-313. [PMID: 37992775 DOI: 10.1016/j.jad.2023.11.063] [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: 05/25/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Suicide is a major health issue. Its prevalence is particularly high in subjects presenting major depression disorder (MDD), making this a key suicide-related risk factor. Suicide attempts in severe forms of MDD were assumed to be linked to impulsivity and loss of control. Nevertheless, we failed to find data specifically investigating the link between impulsivity and suicide risk in treatment-resistant depression (TRD). This study seeks to review this relationship. METHOD Patients were recruited for a prospective cohort. Suicide risk and impulsivity were assessed using the International Neuropsychiatric Interview and Barratt Impulsiveness Scale, Version 10, respectively, while the severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale, anxiety with the State-Trait Anxiety Inventory and childhood maltreatment using the Childhood Trauma Questionnaire. RESULTS 220 TRD patients were enrolled in the study. The impulsivity score was correlated with self-esteem, marital status, professional status and anxiety. There was no direct link to suicide risk. However, impulsivity was associated with self-esteem (coefficient: -0.24; p value 0.043) and depressive symptom severity (coefficient: 0.; p value 0.045). The suicide risk was significantly correlated with depressive symptom severity (coefficient = 0.38, p < 0.001) and self-esteem (coefficient = -0.34, p = 0.01). Considering these correlations, we postulated that the effect of impulsivity on suicide risk could be mediated by self-esteem in terms of depressive symptom severity and we finally found a relevant mediation model within impulsivity having an indirect effect on suicide risk by impacting self-esteem and depressive symptoms with anxiety also playing a significant role as a covariable. CONCLUSION We found that impulsivity could play an indirect role with the involvement of self-esteem and depressive symptoms and the contributing role of anxiety.
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Affiliation(s)
- Juliette Salles
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service des urgences psychiatriques, Infinity (Infinity, Department of Emergency Psychiatry), INSERM UMR1291, CNRS UMR5051, Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital), Toulouse, France
| | - Florian Stephan
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02 (University Hospital Department of General Psychiatry and Psycho-Social Rehabilitation 29G01 and 29G02), Centre Expert Depression Résistante FondaMental (Fondaental Expert Centre for Resistant Depression), EA 7479, CHRU de Brest (Brest Regional University Hospital), Hôpital de Bohars (Bohars Hospital), Brest, France
| | - Fanny Molière
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier (Montpellier University Hospital), INSERM U1061, Montpellier University, Montpellier, France
| | - Djamila Bennabi
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie (Department of Psychiatry), Centre Expert Dépression Résistante FondaMental (FondaMental Expert Centre for Resistant Depression), CIC-1431 INSERM, CHU de Besançon (Besançon University Hospital), EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Emmanuel Haffen
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie (Department of Psychiatry), Centre Expert Dépression Résistante FondaMental (FondaMental Expert Centre for Resistant Depression), CIC-1431 INSERM, CHU de Besançon (Besançon University Hospital), EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Alexandra Bouvard
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Pôle de Psychiatrie Générale et Universitaire (General and University Psychiatry Unit), Centre de référence régional des pathologies anxieuses et de la dépression (Regional Reference Centre for Anxiety and Depression-Related Disorders), Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Michel Walter
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02 (University Hospital Department of General Psychiatry and Psycho-Social Rehabilitation 29G01 and 29G02), Centre Expert Depression Résistante FondaMental (Fondaental Expert Centre for Resistant Depression), EA 7479, CHRU de Brest (Brest Regional University Hospital), Hôpital de Bohars (Bohars Hospital), Brest, France
| | - Etienne Allauze
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - Jean Baptiste Genty
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Unit), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Foundation for Scientific Cooperation), Créteil, France
| | - Marion Leboyer
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Unit), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Foundation for Scientific Cooperation), Créteil, France
| | - Jérôme Holtzmann
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie de l'adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHU de Grenoble-Alpes, Hôpital Nord, Grenoble, CS 10217, France
| | - Anne Sophie Nguon
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie de l'adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHU de Grenoble-Alpes, Hôpital Nord, Grenoble, CS 10217, France
| | - Thierry D'Amato
- Fondation FondaMental (FondaMental Foundation), Créteil, France; INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, Bron, France
| | - Romain Rey
- Fondation FondaMental (FondaMental Foundation), Créteil, France; INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, Bron, France
| | - Mathilde Horn
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Guillaume Vaiva
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France; Centre National de Ressources et Résilience pour les psychotraumatismes (National Psychological Trauma Resource and Resilience Centre) (Cn2r Lille Paris), Lille, France
| | - Guillaume Fond
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Faculté de Médecine (Faculty of Medicine), Marseille Univ, EA 3279, Service d'Épidémiologie et d'Économie de la Santé (Department of Epidemiology and Health Economics), Marseille, France
| | - Raphaelle Richieri
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Pôle Psychiatrie (Psychiatry Unit), Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Vincent Hennion
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Département de Psychiatrie et de Médecine Addictologique (Department of Psychiatry and Addiction Medicine), Lariboisière-Fernand Widal GHU APHP Nord Université Paris cité Paris, France
| | - Bruno Etain
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Département de Psychiatrie et de Médecine Addictologique (Department of Psychiatry and Addiction Medicine), Lariboisière-Fernand Widal GHU APHP Nord Université Paris cité Paris, France; Université Paris Cité, INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie (Therapeutic Optimisation in Neuropsychopharmacology), OTeN, F-75006 Paris, France
| | - Wissam El-Hage
- Fondation FondaMental (FondaMental Foundation), Créteil, France; U1253, iBrain, CIC1415, Inserm, Pôle psychiatrie-Addictologie, (Psychiatry-Addiction Unit) CHRU de Tours, Université de Tours, Tours, France
| | - Vincent Camus
- Fondation FondaMental (FondaMental Foundation), Créteil, France; U1253, iBrain, CIC1415, Inserm, Pôle psychiatrie-Addictologie, (Psychiatry-Addiction Unit) CHRU de Tours, Université de Tours, Tours, France
| | - Philippe Courtet
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier (Montpellier University Hospital), INSERM U1061, Montpellier University, Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Pôle de Psychiatrie Générale et Universitaire (General and University Psychiatry Unit), Centre de référence régional des pathologies anxieuses et de la dépression (Regional Reference Centre for Anxiety and Depression-Related Disorders), Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Antoine Yrondi
- Fondation FondaMental (FondaMental Foundation), Créteil, France; Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France.
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Sheehan AE, Bounoua N, Rose RE, Sadeh N, Javdani S. Profiles of Risk for Self-injurious Thoughts and Behaviors Among System-Impacted Girls of Color. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)00326-X. [PMID: 37442206 PMCID: PMC10748794 DOI: 10.1016/j.jaac.2023.06.010] [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: 05/17/2022] [Revised: 02/11/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Suicide is a leading cause of death among youth in custodial settings. Prior research investigating risk factors for suicide among system-impacted youth fail to incorporate an intersectional framework to contextualize suicide risk among system-impacted girls of color. METHOD Profiles of risk for self-injurious thoughts and behaviors (SITBs) were investigated in a sample of 240 racially and ethnically diverse system-impacted girls (mean [SD] age = 14.5 [1.7] years, Hispanic/Latinx 49.6%, Black 37.1%). Participants completed self-report measures evaluating traditional risk factors for suicide (mental health symptoms, trauma exposure) as well as assessments of minority stress (eg, daily discrimination) and recent engagement in SITBs at baseline and 3-month follow-up. RESULTS Latent profile analysis revealed 3 distinct profiles: low-risk, characterized by relatively low levels of suicide risk indicators (n = 102); high-risk internalizing, characterized by elevations in internalizing symptom indicators (n = 96); and high-risk comorbid, characterized by relatively high levels of suicide risk indicators (n = 42). Girls in the high-risk profiles reported more SITBs at baseline and 3-month follow-up than girls in the low-risk profile. CONCLUSION Results suggest that indicators of suicide risk can be used to classify system-impacted girls into profiles that differ concurrently and prospectively on SITBs. Findings could be used to inform more accurate risk and referral assessments for system-impacted girls of color, whose SITB-related challenges may be overlooked or framed as criminal. These findings highlight the continued need for assessments evaluating multiple indicators of risk for SITBs in the juvenile legal system. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
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Bach B, Bo S, Simonsen E. Maladaptive personality traits may link childhood trauma history to current internalizing symptoms. Scand J Psychol 2022; 63:468-475. [PMID: 35606936 PMCID: PMC9790355 DOI: 10.1111/sjop.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/08/2022] [Accepted: 04/22/2022] [Indexed: 12/30/2022]
Abstract
Research supports a strong relationship between childhood maltreatment and internalizing psychopathology (e.g., anxiety and depression), and features of personality are assumed to explain some of this relationship. In this study, we proposed a model in which maladaptive traits mediate the effect of childhood trauma history on internalizing symptoms in adult individuals. A mixed sample (N = 462) composed of 142 psychiatric patients and 320 community-dwelling individuals completed the Childhood Trauma Questionnaire (CTQ), the Personality Inventory for DSM-5 (PID-5), and the Symptom Checklist (SCL-27) for internalizing psychopathology. The effect of childhood traumas explained 34% of the variance in internalizing symptoms while controlling for the influence of age and gender. The traits accounted for 78% of this effect, which was predominantly exerted through the domains of Negative Affectivity, Detachment, and Psychoticism, and specifically through the facets of Depressivity, Suspiciousness, Anxiousness, Perceptual Dysregulation, and Distractibility. This finding provides preliminary support for the proposed model indicating that the aforementioned maladaptive trait domains potentially function as mediating links by which childhood traumas are translated into internalizing symptoms in adulthood. However, these findings must be interpreted with caution due to the cross-sectional and retrospective mono-method design of this study. Clinical implications are discussed in relation to transdiagnostic treatment and the potential value of specifying trait domain specifiers in ICD-11 and DSM-5 models of personality disorders.
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Affiliation(s)
- Bo Bach
- Psychiatric Research UnitCenter for Personality Disorder Research, Region ZealandSlagelseDenmark
| | - Sune Bo
- Department of Child and Adolescent PsychiatryRegion ZealandRoskildeDenmark
| | - Erik Simonsen
- Psychiatric Research UnitCenter for Personality Disorder Research, Region ZealandSlagelseDenmark,Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Effects of childhood adversity and cortisol levels on suicidal ideation and behaviour: Results from a general population study. Psychoneuroendocrinology 2022; 138:105664. [PMID: 35063686 DOI: 10.1016/j.psyneuen.2022.105664] [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: 09/27/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
Childhood trauma is known to increase the risk of suicidal ideation and behaviours, and has also been linked to hypothalamic pituitary adrenal (HPA) axis dysregulation measured in cortisol levels. Recent evidence has shown that adverse childhood experiences are associated with lower cortisol reactivity to stress and diminished cortisol levels upon awakening in individuals vulnerable to suicide. The present study aimed to investigate whether less traumatic long term difficulties during childhood produced a similar effect on suicidal ideation/behaviour and cortisol levels in a general population sample. Participants (N = 1094; mean age 53 years, 53.7% female) from a large cohort study completed retrospective measures of long-term difficulties during childhood and adolescent years and a measure of history of suicidal thoughts, plans and actions together with a measure of current psychological distress. 24-hour urinary free cortisol samples were collected over two days. The results showed that experiencing childhood long-term difficulties were associated with 21% higher odds of reporting suicidal thoughts or plans in adulthood. Early childhood and adolescent difficulties were equally important predictors of suicide thoughts and plans. However, childhood difficulties were not found to be associated with adult urinary free cortisol, nor were adulthood suicidal thoughts, plans and behaviour associated with adult urinary free cortisol levels. Future research should explore the extent to which childhood difficulties and stressors are related to other indicators of HPA axis functioning. The current findings have implications for clinicians and for the development of future suicide prevention interventions.
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Kim G, Shin J, Kim JW. The mediating role of internalizing and externalizing symptoms in the relationship between childhood trauma and suicidality among adolescents: a structural equation model. Child Adolesc Psychiatry Ment Health 2021; 15:79. [PMID: 34949214 PMCID: PMC8705103 DOI: 10.1186/s13034-021-00434-x] [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: 07/30/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the direct and indirect effects of childhood trauma, internalizing symptoms, and externalizing symptoms on suicidality among adolescents, thereby establishing a structural equation model. METHODS The present study uses a cross-sectional descriptive design. Among 147 adolescents aged 12-17, 93 outpatients diagnosed with major depressive disorder and 54 controls were included in the study. They completed the Early Trauma Inventory Self-Report (Short Form) and Columbia Suicidality Severity Rating Scale. Their parents completed the Child Behavior Checklist. Analyses were performed using Pearson's correlation and structural equation modelling. RESULTS Childhood trauma had both direct and indirect effects, via internalizing symptoms and externalizing symptoms, on suicidality. Internalizing symptoms had a direct effect on suicidality. Meanwhile, externalizing symptoms were not directly associated with suicidality, but indirectly associated via internalizing symptoms. CONCLUSIONS Findings provide in-depth understanding of the mediating role of internalizing symptoms and externalizing symptoms in the relationship between childhood trauma and suicidality, suggesting that the therapeutic interventions for both internalizing symptoms and externalizing symptoms may be important to prevent suicide in adolescents with childhood trauma.
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Affiliation(s)
- Gangsan Kim
- grid.412484.f0000 0001 0302 820XDepartment of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiyoon Shin
- grid.412484.f0000 0001 0302 820XDepartment of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea. .,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Donofry SD, Stillman CM, Hanson JL, Sheridan M, Sun S, Loucks EB, Erickson KI. Promoting brain health through physical activity among adults exposed to early life adversity: Potential mechanisms and theoretical framework. Neurosci Biobehav Rev 2021; 131:688-703. [PMID: 34624365 PMCID: PMC8642290 DOI: 10.1016/j.neubiorev.2021.09.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022]
Abstract
Adverse childhood experiences such as abuse, neglect, and poverty, profoundly alter neurobehavioral development in a manner that negatively impacts health across the lifespan. Adults who have been exposed to such adversities exhibit premature and more severe age-related declines in brain health. Unfortunately, it remains unclear whether the negative effects of early life adversity (ELA) on brain health can be remediated through intervention in adulthood. Physical activity may represent a low-cost behavioral approach to address the long-term consequences of ELA on brain health. However, there has been limited research examining the impact of physical activity on brain health among adults with a history of ELA. Accordingly, the purpose of this review is to (1) review the influence of ELA on brain health in adulthood and (2) highlight evidence for the role of neurotrophic factors, hypothalamic-adrenal-pituitary axis regulation, inflammatory processes, and epigenetic modifications in mediating the effects of both ELA and physical activity on brain health outcomes in adulthood. We then propose a theoretical framework to guide future research in this area.
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Affiliation(s)
- Shannon D Donofry
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; Psychiatric and Behavioral Health Institute, Allegheny Health Network Pittsburgh, PA, United States.
| | - Chelsea M Stillman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jamie L Hanson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, Pittsburgh, PA, United States
| | - Margaret Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Mindfulness Center, Brown University, Providence, RI, United States
| | - Eric B Loucks
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Mindfulness Center, Brown University, Providence, RI, United States; Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Murdoch University, College of Science, Health, Engineering, and Education, Perth, Western Australia, Australia; PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
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Characteristics and Circumstances Associated with Work-Related Suicides from the National Violent Death Reporting System, 2013-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189538. [PMID: 34574474 PMCID: PMC8465410 DOI: 10.3390/ijerph18189538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Workplaces are critical in suicide prevention because work-related factors can be associated with suicide, and because workplaces can be effective suicide prevention sites. Understanding the circumstances associated with work-related suicides can advance worksite prevention efforts. Data from the United States Centers for Disease Control and Prevention, National Violent Death Reporting System from 2013 to 2017 were used to examine characteristics and circumstances associated with work compared with non-work suicides. Work-related suicides included those indicated as work-related on the death certificate or in which the death investigation mentioned a work problem or work crisis. Of the 84,389 suicides, 12.1% had some relation to the decedent’s work. Males, those aged 21–54, and with at least a college education, were most likely to have work-related suicides. The circumstances most strongly associated with work-related suicide were financial problems (Odds Ratio (OR) = 4.7; 95% Confidence Interval (CI) = 4.5–5.0), prior depressed mood (OR = 2.4; 95% CI = 2.3–2.5), and eviction/loss of home (OR = 1.6; 95% CI = 1.4–1.7). Suicides among healthcare practitioners and management occupations had the highest odds of being work-related. Workplace wellness programs can consider incorporating services, such as financial planning and mental health services, as potentially up-stream approaches to prevent work-related suicide.
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Desai S, Tanguay-Sela M, Benrimoh D, Fratila R, Brown E, Perlman K, John A, DelPozo-Banos M, Low N, Israel S, Palladini L, Turecki G. Identification of Suicidal Ideation in the Canadian Community Health Survey-Mental Health Component Using Deep Learning. Front Artif Intell 2021; 4:561528. [PMID: 34250463 PMCID: PMC8264793 DOI: 10.3389/frai.2021.561528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Suicidal ideation (SI) is prevalent in the general population, and is a risk factor for suicide. Predicting which patients are likely to have SI remains challenging. Deep Learning (DL) may be a useful tool in this context, as it can be used to find patterns in complex, heterogeneous, and incomplete datasets. An automated screening system for SI could help prompt clinicians to be more attentive to patients at risk for suicide. Methods: Using the Canadian Community Health Survey-Mental Health Component, we trained a DL model based on 23,859 survey responses to classify patients with and without SI. Models were created to classify both lifetime SI and SI over the last 12 months. From 582 possible parameters we produced 96- and 21-feature versions of the models. Models were trained using an undersampling procedure that balanced the training set between SI and non-SI; validation was done on held-out data. Results: For lifetime SI, the 96 feature model had an Area under the receiver operating curve (AUC) of 0.79 and the 21 feature model had an AUC of 0.77. For SI in the last 12 months the 96 feature model had an AUC of 0.71 and the 21 feature model had an AUC of 0.68. In addition, sensitivity analyses demonstrated feature relationships in line with existing literature. Discussion: Although further study is required to ensure clinical relevance and sample generalizability, this study is an initial proof of concept for the use of DL to improve identification of SI. Sensitivity analyses can help improve the interpretability of DL models. This kind of model would help start conversations with patients which could lead to improved care and a reduction in suicidal behavior.
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Affiliation(s)
- Sneha Desai
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Aifred Health Inc., Montreal, QC, Canada
| | - Myriam Tanguay-Sela
- Aifred Health Inc., Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - David Benrimoh
- Aifred Health Inc., Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- *Correspondence: David Benrimoh,
| | | | - Eleanor Brown
- Aifred Health Inc., Montreal, QC, Canada
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Kelly Perlman
- Aifred Health Inc., Montreal, QC, Canada
- Douglas Mental Health University Institute, Montrea, QC, Canada
| | - Ann John
- Swansea University, Swansea, United Kingdom
| | | | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Lisa Palladini
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montrea, QC, Canada
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9
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Angelakis I, Austin JL, Gooding P. Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2012563. [PMID: 32756929 PMCID: PMC7407092 DOI: 10.1001/jamanetworkopen.2020.12563] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Importance Children and young people's reports of experiences of adverse childhood events have increased in recent years, and this trend has been associated with an elevated risk for suicide behaviors. However, a systematic review and meta-analysis is needed to confirm the significance of this association in young people. Objective To quantify the association between core types of childhood maltreatment, including sexual, physical, and emotional abuse and/or neglect and suicide behaviors in children and young adults. Data Sources Medline, PsychInfo, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health) databases were searched from January 1, 1980, until December 31, 2019. The reference lists of all the included studies were also checked. Study Selection Quantitative studies that focused on the association between core types of childhood abuse and/or neglect and suicide ideation, plans, and attempts. Data Extraction and Synthesis Data were extracted by 2 independent raters. Publication bias and risk of bias across studies were assessed. Meta-analyses using random-effect models were applied, and heterogeneity was quantified using the I2 statistic. Data were analyzed from January to May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Main Outcomes and Measures The association between core types of childhood maltreatment and suicide behaviors. Results Seventy-nine studies with 337 185 young individuals (mean [SD] age, 15.67 [2.11] years; 63.19% female) were included. The findings demonstrated that sexual abuse (odds ratio [OR], 3.41; 95% CI, 2.90-4.00), physical abuse (OR, 2.18; 95% CI, 1.75-2.71), emotional abuse (OR, 2.21; 95% CI, 1.37-3.57), emotional neglect (OR, 1.93; 95% CI, 1.36-2.74), physical neglect (OR, 1.79; 95% CI, 1.27-2.53), and combined abuse (OR, 3.38; 95% CI, 2.09-5.47) were significantly associated with higher rates of suicide attempts. Core types of childhood maltreatment were also associated with as much as 2.5-fold greater odds for suicide ideation, and sexual abuse with a 4.0-fold increase for suicide plans. Studies based on community samples (β [SE] = -1.68 [0.79]; P = .04) or with lower methodological quality (β [SE] = -2.86 [1.30]; P = .03) were associated more strongly with suicide attempts in those reporting experiences of sexual abuse, whereas young age was associated with both suicide attempts (β [SE] = -0.59 [0.27]; P = .03) and ideation (β [SE] = -0.41 [0.18]; P = .03). Conclusions and Relevance These findings suggest that policy actions should focus on raising public awareness and offering proactive suicide prevention therapies for children and young adults who have experienced abuse and/or neglect.
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Affiliation(s)
- Ioannis Angelakis
- School of Psychology, University of South Wales, Pontypridd, United Kingdom
| | - Jennifer L. Austin
- School of Psychology, University of South Wales, Pontypridd, United Kingdom
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
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10
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Duprey EB, Oshri A, Liu S. Developmental pathways from child maltreatment to adolescent suicide-related behaviors: The internalizing and externalizing comorbidity hypothesis. Dev Psychopathol 2020; 32:945-959. [PMID: 31407646 PMCID: PMC7306177 DOI: 10.1017/s0954579419000919] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Child maltreatment is a robust risk factor for suicidal ideation and behaviors during adolescence. Elevations in internalizing and externalizing symptomology have been identified as two distinct developmental pathways linking child maltreatment and adolescent risk for suicide. However, recent research suggests that the co-occurrence of internalizing and externalizing symptomology may form a distinct etiological pathway for adolescent risk behaviors. Using the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) sample (N = 1,314), the present study employed a person-centered approach to identify patterns of concurrent change in internalizing and externalizing psychopathology over five time points from early childhood to adolescence in relation to previous experiences of child maltreatment and subsequent suicidal ideation and behaviors. Results indicated four distinct bivariate externalizing and internalizing growth trajectories. Group membership in a heightened comorbid internalizing and externalizing symptom trajectory mediated the association between childhood abuse and adolescent suicidal ideation and suicidal behaviors. These findings suggest that the concurrent development of externalizing and internalizing symptoms in childhood and adolescence may constitute a unique developmental trajectory that confers risk for suicide-related outcomes.
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Affiliation(s)
- Erinn Bernstein Duprey
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Assaf Oshri
- The Youth Development Institute, Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
| | - Sihong Liu
- The Youth Development Institute, Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
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11
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Dir AL, Allebach CL, Hummer TA, Adams ZW, Aalsma MC, Finn PR, Nurnberger JI, Hulvershorn LA. Atypical Cortical Activation During Risky Decision Making in Disruptive Behavior Disordered Youths With Histories of Suicidal Ideation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:510-519. [PMID: 32007432 PMCID: PMC10568982 DOI: 10.1016/j.bpsc.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicidality is a leading cause of death among adolescents. In addition to other psychiatric conditions, youths with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs) are at heightened risk for suicide. Decision-making deficits are a hallmark symptom of ADHD and DBDs and are also implicated in suicidal behavior. We examined behavioral and neural differences in decision making among youths with ADHD and DBDs with (SI+) and without (SI-) histories of suicidal ideation. METHODS The Balloon Analog Risk Task, a risky decision-making task, was completed by 57 youths with ADHD and DBDs (38% SI+) during functional magnetic resonance imaging. Mean stop wager (mean wager at which youths bank money) was the primary measure of risk taking. We conducted whole-brain and region-of-interest analyses in the anterior cingulate cortex and orbitofrontal cortex (OFC) during choice (win vs. inflate) and outcome (inflate vs. explode) contrasts using parametric modulators accounting for probability of balloon explosion. RESULTS There were no differences between SI+ and SI- youths in Balloon Analog Risk Task performance. SI+ youths showed decreasing activation in the right medial frontal gyrus when choosing inflate as explosion probability increased compared with SI- youths. During explosions, SI- youths showed increasing activation in the left OFC as explosions became more likely. SI+ showed increasing left medial OFC activity in response to inflations as explosion probability increased. CONCLUSIONS SI+ youths may show heightened sensitivity to immediate reward and decreased sensitivity to potential loss as evidenced by medial frontal gyrus activity. OFC findings suggest that SI+ youths may be drawn to reward even when there is high probability of loss.
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Affiliation(s)
- Allyson L Dir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana; Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christian L Allebach
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tom A Hummer
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana; Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana.
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12
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Johnstone KM, Middleton T, Kemps E, Chen J. A pilot investigation of universal school‐based prevention programs for anxiety and depression symptomology in children: A randomized controlled trial. J Clin Psychol 2020; 76:1193-1216. [DOI: 10.1002/jclp.22926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tracey Middleton
- School of Psychology Flinders University Adelaide South Australia Australia
| | - Eva Kemps
- School of Psychology Flinders University Adelaide South Australia Australia
| | - Junwen Chen
- Research School of Psychology Australian National University Canberra Australian Capital Territory Australia
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13
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Abstract
Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual's risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity.
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14
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Goodday SM, Shuldiner J, Bondy S, Rhodes AE. Exposure to parental psychopathology and offspring's risk of suicide-related thoughts and behaviours: a systematic review. Epidemiol Psychiatr Sci 2019; 28:179-190. [PMID: 28748774 PMCID: PMC6998933 DOI: 10.1017/s2045796017000397] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/03/2017] [Indexed: 12/31/2022] Open
Abstract
AIMS The primary objective of this systematic review was to identify and synthesise analytic studies examining the association between exposure to parental psychopathology in childhood and the nature of subsequent suicide-related thoughts (SRT) and suicide-related behaviour (SRB) (severity of ideation, planned/unplanned attempts/lethality) and to describe the direction, and magnitude of associations. The secondary objective was to determine if the associations from the primary objective differ by the type(s) and timing of parental psychopathology, sex/gender of the parent and child and is mediated by child psychiatric symptoms and family functioning. METHODS A systematic review was conducted using guidelines from the PRISMA statement. MEDLINE, CINAHL, EMBASE, psycINFO, Web of Science and grey literature sources were searched by two reviewers to March, 2017. Studies were included if they examined any parental psychopathology (Diagnostic and Statistical Manual of Mental Disorders criteria or equivalent) or SRT or SRB and offspring SRT or SRB occurring from birth <25 years of age. RESULTS Out of 10 231 studies identified, 54 were included for review. Studies were clinically and methodologically heterogeneous with none at low risk of bias (ROB). Nine studies with moderate ROB indicated a significantly increased risk of offspring SRT, suicide attempts (SA) and suicide among those exposed to maternal SA and suicide in childhood or adolescence. In the remaining 45 studies with higher ROB this association persisted. Several studies (67%) did not confirm that the exposure occurred in the offspring's childhood or adolescence. Findings were suggestive of a mediating effect of offspring psychiatric symptoms, however, few studies examined mediation and effect modification of contextual variables. CONCLUSIONS Offspring exposed to maternal SA are at an increased risk of these same behaviours early in life. Prospective attention to the types and timing of maternal and paternal psychopathology and the intermediate pathways to offspring SRT and SRB onset is needed and could have implications for informing modifiable targets for early intervention and prevention.
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Affiliation(s)
- S. M. Goodday
- Department of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - J. Shuldiner
- Department of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - S. Bondy
- Department of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - A. E. Rhodes
- Department of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
- McMaster University, The Offord Centre for Child Studies, Hamilton, Ontario, Canada
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15
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Abdelraheem M, McAloon J, Shand F. Mediating and moderating variables in the prediction of self-harm in young people: A systematic review of prospective longitudinal studies. J Affect Disord 2019; 246:14-28. [PMID: 30572208 DOI: 10.1016/j.jad.2018.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Self-harm is widespread amongst young people. A growing body of research has explored factors that predict self-harm in young people, however, a systematic review of mediators and moderators of those factors has not yet been offered. This review aims to fill this gap by synthesising research about mediators and moderators of factors that prospectively predict self-harm in young people. METHOD A systematic review of research trials published up until 2018 was undertaken. Electronic databases Scopus (Elsevier), CINAHL, PsychINFO (EBSCO) and Medline were searched. Included studies utilised prospective longitudinal designs with participants aged 25 years or younger and self-harm outcome measures with published or reported psychometric properties. The aim of the review was to identify mediators and moderators of factors that predict self-harm in young people. RESULTS Of the 25 studies that met inclusion criteria, 22 reported at least one positive finding of a mediator or moderator. Specifically, 15 significant mediators and 20 significant moderators were identified in relation to a broad range of predictors of self-harm. Predictors were classified as adverse childhood experiences and parenting factors, psychological and psychiatric factors, social factors and intrapersonal factors. A number of potentially modifiable mediators and moderators were identified including interpersonal difficulties, impulsivity, self-esteem and self-compassion. Gender was the most commonly reported moderator. LIMITATIONS Included studies were assessed as limited by the heterogeneity of the mediators and moderators assessed, and by methodological factors including study durations, population characteristics, and the definition and assessment of self-harm. In addition, replication research was limited. Therefore it was difficult to integrate results and draw firm conclusions. CONCLUSIONS This review allowed us to explore diverse relationships between factors predictive of self-harm in young people and to identify a number of potentially modifiable mediators and moderators. Our findings have important implications for future research and treatment efforts as the identification of mediators and moderators is demonstrated to assist in identifying high risk individuals as well informing potential targets for treatment.
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Affiliation(s)
- Mona Abdelraheem
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Ultimo, NSW, Australia
| | - John McAloon
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Ultimo, NSW, Australia.
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
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16
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Exposure to maternal depressive symptoms in childhood and adolescent suicide-related thoughts and attempts: mediation by child psychiatric symptoms. Epidemiol Psychiatr Sci 2019; 29:e17. [PMID: 30714563 PMCID: PMC8061164 DOI: 10.1017/s2045796018000847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS The nature of the association between child psychiatric symptoms and adolescent suicide-related thoughts (SRT) and attempts (SA) remains unclear. Our objective was to assess whether child psychiatric symptoms from 6 to 10 years of age mediate the association between exposure to maternal depressive symptoms in childhood and offspring SRT and SA in adolescence. METHODS A population-based cohort study was constructed by linking all eight cycles from the National Longitudinal Survey of Children and Youth (NLSCY), a nationally representative Canadian panel survey conducted from 1994 to 2009. Self-reported maternal depressive symptoms were measured when offspring were between 0 and 5 years. Maternal-reported child psychiatric symptoms and psychiatric comorbid symptoms were measured from 6 to 10 years, and offspring self-reported SRT and SA were measured between 11 and 19 years. Indirect effects, the effect proportion mediated and their corresponding bootstrapped 95% confidence intervals (CI) were estimated. RESULTS Hyperactivity and inattention significantly mediated the association between maternal depressive symptoms in childhood and risk of both SRT and SA from 11 to 19 years, where approximately 60% (SRT 95% CI 23-94%; SA 95% CI 27-95%) of this association was explained by hyperactivity and inattention. Psychiatric comorbid symptoms also significantly mediated this relationship and accounted for 50% (95% CI 18-81%) of this association with SA. CONCLUSIONS Targeting hyperactivity and inattention, and co-occurring psychiatric symptoms in offspring of depressed mothers could reduce risk of SRT, eventual SA and halt progression towards suicide. However, further understanding of comorbid psychiatric symptoms in childhood that most strongly predict adolescent SA is needed.
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17
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Johnstone KM, Kemps E, Chen J. A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children. Clin Child Fam Psychol Rev 2018; 21:466-481. [DOI: 10.1007/s10567-018-0266-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Lutz PE, Mechawar N, Turecki G. Neuropathology of suicide: recent findings and future directions. Mol Psychiatry 2017; 22:1395-1412. [PMID: 28696430 DOI: 10.1038/mp.2017.141] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 05/21/2017] [Accepted: 05/26/2017] [Indexed: 12/11/2022]
Abstract
Suicide is a major public health concern and a leading cause of death in most societies. Suicidal behaviour is complex and heterogeneous, likely resulting from several causes. It associates with multiple factors, including psychopathology, personality traits, early-life adversity and stressful life events, among others. Over the past decades, studies in fields ranging from neuroanatomy, genetics and molecular psychiatry have led to a model whereby behavioural dysregulation, including suicidal behaviour (SB), develops as a function of biological adaptations in key brain systems. More recently, the unravelling of the unique epigenetic processes that occur in the brain has opened promising avenues in suicide research. The present review explores the various facets of the current knowledge on suicidality and discusses how the rapidly evolving field of neurobehavioural epigenetics may fuel our ability to understand, and potentially prevent, SB.
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Affiliation(s)
- P-E Lutz
- McGill Group for Suicide Studies, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - N Mechawar
- McGill Group for Suicide Studies, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - G Turecki
- McGill Group for Suicide Studies, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada
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19
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Non-violent and violent forms of childhood abuse in the prediction of suicide attempts: Direct or indirect effects through psychiatric disorders? J Affect Disord 2017; 215:15-22. [PMID: 28292658 DOI: 10.1016/j.jad.2017.03.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Childhood abuse is linked to suicide. Potential pathways include the increased risk for the development of psychiatric disorders and the contribution of abuse to suicide capability. The current study compared the effects of childhood non-violent and violent abuse in the prediction of suicide attempts, and examined the potential mediated effects of psychiatric disorders. METHODS Data from the National Comorbidity Surveys were obtained. At baseline, assessments of childhood non-violent abuse (e.g., parental verbal abuse) and violent abuse (e.g., parental physical abuse, relative rape) were obtained. We also assessed for other adverse childhood experiences, baseline suicidal behaviors, and psychiatric disorders. At the ten-year follow-up, we assessed for psychiatric disorders and suicide attempts that had occurred over time. RESULTS Both non-violent and violent abuse predicted attempts, though participants experiencing violent abuse had significantly higher rates. Bootstrapped mediation analyses determined that the influence of non-violent abuse on suicide attempts was indirect, and exerted its influence through the psychiatric disorders that occurred during the ten-year follow-up. LIMITATIONS The study relied on retrospective reports of childhood abuse. Further, we could not clearly determine the temporal order of the psychiatric disorders and suicide attempts occurring over follow-up. CONCLUSION Different mechanisms may underlie the pathway between violent and non-violent abuse and suicide attempts. Verbal abuse may lead to negative cognitive styles and psychiatric disorders associated with suicidality; violent abuse may contribute to the capacity for suicide. Interventions may need to be specifically tailored to meet the distinct needs of individuals who have experienced past childhood abuse.
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20
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Castellví P, Miranda-Mendizábal A, Parés-Badell O, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Roca M, Rodríguez-Marín J, Rodríguez-Jimenez T, Soto-Sanz V, Alonso J. Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies. Acta Psychiatr Scand 2017; 135:195-211. [PMID: 27995627 DOI: 10.1111/acps.12679] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults. METHOD We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775). RESULTS From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07). CONCLUSION Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.
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Affiliation(s)
- P Castellví
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - A Miranda-Mendizábal
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - O Parés-Badell
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - J Almenara
- Area of Preventive Medicine and Public Health, University of Cadiz, Cadiz, Spain
| | - I Alonso
- Morales Meseguer Hospital, Murcia, Spain
| | - M J Blasco
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - A Cebrià
- Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - A Gabilondo
- Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, Donostia-San Sebastián, Spain.,Mental Health and Psychiatric Care Research Unit, BioDonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - M Gili
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain.,Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - C Lagares
- Department of Statistics and Operative Research, University of Cádiz, Cádiz, Spain
| | - J A Piqueras
- Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain.,Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - J Rodríguez-Marín
- Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
| | - T Rodríguez-Jimenez
- Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
| | - V Soto-Sanz
- Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
| | - J Alonso
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
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21
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Abstract
INTRODUCTION Sleep and lifestyles interact to allow the appropriate development of cerebral structures, and prevention of mood disorders. But just a hand of articles identified a precise relationship between these two above, and the probability to develop a suicidal behaviour. OBJECTIVE The aim of this study is to explore how the suicidal behaviour is associated in simultaneous with sleep components, psychological stress, depression, anxiety, well-being, addiction, and global health of participants; and if it is also influenced by the sociodemographic profile of each subject. METHODS The present study was led by a questionnaire incorporating McNair test, and an incorporated score to evaluate suicide tendencies. The questionnaire also included socio-demographic items and other questions to exhibit a profile of suicide tendency for each individual. RESULTS Our results showed that the stress levels and well-being are comparable according to gender. Specifically the results showed that lack of sleep combined with a low score to McNair test strongly affects the suicidal tendency, while score of memory and attention decreased. CONCLUSIONS The suicidal behaviour is closely linked with sleep parameters which decreased accordingly, and the family's history of medication and suicidal behaviour.
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Affiliation(s)
- Faustin Armel Etindele Sosso
- Research Centre in Neuropsychology and Cognition, Quebec, Canada.,Department of Biological Sciences, University of Montreal, Quebec, Canada
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22
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Stansfeld SA, Clark C, Smuk M, Power C, Davidson T, Rodgers B. Childhood adversity and midlife suicidal ideation. Psychol Med 2017; 47:327-340. [PMID: 27762177 PMCID: PMC5216460 DOI: 10.1017/s0033291716002336] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/22/2016] [Accepted: 07/26/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood adversity predicts adolescent suicidal ideation but there are few studies examining whether the risk of childhood adversity extends to suicidal ideation in midlife. We hypothesized that childhood adversity predicts midlife suicidal ideation and this is partially mediated by adolescent internalizing disorders, externalizing disorders and adult exposure to life events and interpersonal difficulties. METHOD At 45 years, 9377 women and men from the UK 1958 British Birth Cohort Study participated in a clinical survey. Childhood adversity was prospectively assessed at the ages of 7, 11 and 16 years. Suicidal ideation at midlife was assessed by the depressive ideas subscale of the Revised Clinical Interview Schedule. Internalizing and externalizing disorders were measured by the Rutter scales at 16 years. Life events, periods of unemployment, partnership separations and alcohol dependence were measured through adulthood. RESULTS Illness in the household, paternal absence, institutional care, parental divorce and retrospective reports of parental physical and sexual abuse predicted suicidal ideation at 45 years. Three or more childhood adversities were associated with suicidal ideation at 45 years [odds ratio (OR) 4.31, 95% confidence interval (CI) 2.67-6.94]. Psychological distress at 16 years partially mediated the associations of physical abuse (OR 3.41, 95% CI 2.29-5.75), sexual abuse (OR 4.99, 95% CI 2.90-11.16) with suicidal ideation. Adult life events partially mediated the association of parental divorce (OR 6.34, 95% CI -7.16 to 36.75) and physical (OR 9.59, 95% CI 4.97-27.88) and sexual abuse (OR 6.59, 95% CI 2.40-38.36) with suicidal ideation at 45 years. CONCLUSIONS Adversity in childhood predicts suicidal ideation in midlife, partially mediated by adolescent internalizing and externalizing disorders, adult life events and interpersonal difficulties. Understanding the pathways from adversity to suicidal ideation can inform suicide prevention and the targeting of preventive interventions.
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Affiliation(s)
- S. A. Stansfeld
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - C. Clark
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - M. Smuk
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - C. Power
- Population, Policy and
Practice, University College London,
Institute of Child Health, 30 Guilford
Street, London WC1N 1EH, UK
| | - T. Davidson
- Centre for Gambling Research,
School of Sociology, Beryl Rawson Building,
The Australian National University,
Acton, ACT 2601, Australia
| | - B. Rodgers
- School of Demography, The
Australian National University, Acton, ACT
2601, Australia
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23
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Sosso FAE. Neurocognitive game between risk factors, sleep and suicidal behaviour. Sleep Sci 2016. [DOI: 10.1016/j.slsci.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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24
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Fuller-Thomson E, Baird SL, Dhrodia R, Brennenstuhl S. The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study. Child Care Health Dev 2016; 42:725-34. [PMID: 27280449 DOI: 10.1111/cch.12351] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 04/01/2016] [Accepted: 04/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender-specific and mediating effects. METHODS Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional, population-based survey comprised of respondents aged 18 or older who provided self-reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) (n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the relationship. RESULTS The odds of suicide attempts are significantly higher among those with a history of CPA (OR = 3.29; 99.9% CI 2.33-4.64), CSA (OR = 4.42; 99.9% CI 3.14-6.23) or PDV (OR = 2.52; 99.9% CI 1.69-3.76), when ACEs are mutually adjusted. There is little evidence that gender acts as a moderator; however, depression, anxiety, substance abuse and chronic pain appear to partially mediate the associations. Depression alone accounts for about a quarter of the associations with CSA and CPA. CONCLUSIONS Mental health factors and chronic pain appear only to partially mediate relationships between ACEs and lifetime suicide attempts. Future research should look at other pathways with the goal of developing multi-level interventions.
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Affiliation(s)
- E Fuller-Thomson
- Department of Family and Community Medicine, Factor-Inwentash Faculty of Social Work, and Institute for Life Course & Aging, University of Toronto, Toronto, Canada
| | - S L Baird
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - R Dhrodia
- Student Life, Outreach and Equity Advisor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - S Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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25
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Geoffroy MC, Turecki G. The developmental course of suicidal ideation in first-episode psychosis. Lancet Psychiatry 2016; 3:395-6. [PMID: 26948483 DOI: 10.1016/s2215-0366(15)00574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada.
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26
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Abstract
Suicide is a complex public health problem of global importance. Suicidal behaviour differs between sexes, age groups, geographic regions, and sociopolitical settings, and variably associates with different risk factors, suggesting aetiological heterogeneity. Although there is no effective algorithm to predict suicide in clinical practice, improved recognition and understanding of clinical, psychological, sociological, and biological factors might help the detection of high-risk individuals and assist in treatment selection. Psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders can often prevent suicidal behaviour; additionally, regular follow-up of people who attempt suicide by mental health services is key to prevent future suicidal behaviour.
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Affiliation(s)
- Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - David A Brent
- Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
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27
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Fiori LM, Turecki G. Investigating epigenetic consequences of early-life adversity: some methodological considerations. Eur J Psychotraumatol 2016; 7:31593. [PMID: 27837582 PMCID: PMC5106862 DOI: 10.3402/ejpt.v7.31593] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/22/2022] Open
Abstract
Stressful and traumatic events occurring during early childhood have been consistently associated with the development of psychiatric disorders later in life. This relationship may be mediated in part by epigenetic mechanisms, such as DNA methylation, which are influenced by the early-life environment. Epigenetic patterns can have lifelong effects on gene expression and on the functioning of biological processes relevant to stress reactivity and psychopathology. Optimization of epigenetic research activity necessitates a discussion surrounding the methodologies used for DNA methylation analysis, selection of tissue sources, and timing of psychological and biological assessments. Recent studies related to early-life adversity and methylation, including both candidate gene and epigenome-wide association studies, have drawn from the variety of available techniques to generate interesting data in the field. Further discussion is warranted to address the limitations inherent to this field of research, along with future directions for epigenetic studies of adversity-related psychopathology.
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Affiliation(s)
- Laura M Fiori
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada;
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28
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Abstract
Suicide ranks among the leading causes of death around the world and takes a heavy emotional and public health toll on most societies. Both distal and proximal factors contribute to suicidal behaviour. Distal factors - such as familial and genetic predisposition, as well as early-life adversity - increase the lifetime risk of suicide. They alter responses to stress and other processes through epigenetic modification of genes and associated changes in gene expression, and through the regulation of emotional and behavioural traits. Proximal factors are associated with the precipitation of a suicidal event and include alterations in key neurotransmitter systems, inflammatory changes and glial dysfunction in the brain. This Review explores the key molecular changes that are associated with suicidality and discusses some promising avenues for future research.
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29
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Turecki G. Epigenetics and suicidal behavior research pathways. Am J Prev Med 2014; 47:S144-51. [PMID: 25145732 PMCID: PMC5319855 DOI: 10.1016/j.amepre.2014.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 05/27/2014] [Accepted: 06/10/2014] [Indexed: 10/24/2022]
Abstract
Suicide and suicidal behaviors are complex, heterogeneous phenomena that are thought to result from the interactions among distal factors increasing predisposition and proximal factors acting as precipitants. Epigenetic factors are likely to act both distally and proximally. Aspirational Goal 1 aims to find clear targets for suicide and suicidal behavior intervention through greater understanding of the interplay among the biological, psychological, and social risk and protective factors associated with suicide. This paper discusses Aspirational Goal 1, focusing on the research pathway related to epigenetics, suicide, and suicidal behaviors. Current knowledge on epigenetic factors associated with suicide and suicidal behaviors is reviewed and avenues for future research are discussed. Epigenetic factors are a promising area of further investigation in the understanding of suicide and suicidal behaviors and may hold clues to identifying targets or avenues for intervention.
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Affiliation(s)
- Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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30
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Edwards AC, Latendresse SJ, Heron J, Cho SB, Hickman M, Lewis G, Dick DM, Kendler KS. Childhood internalizing symptoms are negatively associated with early adolescent alcohol use. Alcohol Clin Exp Res 2014; 38:1680-8. [PMID: 24848214 PMCID: PMC4047162 DOI: 10.1111/acer.12402] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 02/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between childhood internalizing problems and early adolescent alcohol use has been infrequently explored and remains unclear. METHODS We employed growth mixture modeling of internalizing symptoms for a large, population-based sample of U.K. children (the Avon Longitudinal Study of Parents and Children Cohort) to identify trajectories of childhood internalizing symptoms from age 4 through age 11.5. We then examined the relationship between membership in each trajectory and alcohol use in early adolescence (reported at age 13.8). RESULTS Overall, children experiencing elevated levels of internalizing symptoms were less likely to use alcohol in early adolescence. This finding held true across all internalizing trajectories; that is, those exhibiting increasing levels of internalizing symptoms over time, and those whose symptoms desisted over time, were both less likely to use alcohol than their peers who did not exhibit internalizing problems. CONCLUSIONS We conclude that childhood internalizing symptoms, unlike adolescent symptoms, are negatively associated with early adolescent alcohol experimentation. Additional studies are warranted to follow up on our preliminary evidence that symptoms of phobia and separation anxiety drive this effect.
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Affiliation(s)
- Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Dept. of Psychiatry, VCU
| | | | - Jon Heron
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Seung Bin Cho
- Virginia Institute for Psychiatric and Behavioral Genetics, Dept. of Psychiatry, VCU
| | - Matt Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Danielle M. Dick
- Virginia Institute for Psychiatric and Behavioral Genetics, Dept. of Psychiatry, VCU
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Dept. of Psychiatry, VCU
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31
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Runions KC. Reactive aggression and peer victimization from pre-kindergarten to first grade: accounting for hyperactivity and teacher-child conflict. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2014; 84:537-55. [PMID: 24796699 DOI: 10.1111/bjep.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 03/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of reactive aggression in the development of peer victimization remains unclear due in part to a failure to account for confounding problems of behavioural undercontrol (e.g., hyperactivity). As well, the school social context has rarely been examined to see whether these risks are mediated by relationships with teachers. AIMS This study tests the prospective relations between reactive aggression, hyperactivity, victimization, and teacher-child (T-C) relationship, to determine whether conflict mediates the relationships between externalizing problems and victimization. SAMPLE A sample of 1,114 Australian students were followed from pre-kindergarten through first grade. METHODS Cross-lagged path analyses were conducted, with comparison of gender-moderating models and autocorrelation models. Full-information maximum likelihood was deployed to account for missingness. RESULTS Best fitting models found that the relationship of early externalizing problems to later victimization was mediated by T-C conflict. No evidence of victimization increasing externalizing problems nor gender differences were observed. T-C conflict in kindergarten predicted subsequent increases in victimization, reactive aggression, and hyperactivity. CONCLUSIONS Understanding the processes whereby externalizing problems confer risk of victimization involves understanding the whole social context of classrooms, including relationships with teachers. Finer-grained research is needed to better understand how peer dynamics may be influenced by observation of T-C relationships. Pre-service teacher education needs to ensure a focus on the potential social impact of teacher's relationships with students.
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Affiliation(s)
- Kevin C Runions
- Educational Psychology & Leadership Studies, University of Victoria, British Columbia, Canada; Child Health Promotion Research Centre, Edith Cowan University, Perth, Western Australia, Australia
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32
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Lutz PE, Turecki G. DNA methylation and childhood maltreatment: from animal models to human studies. Neuroscience 2014; 264:142-56. [PMID: 23933308 PMCID: PMC5293537 DOI: 10.1016/j.neuroscience.2013.07.069] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 11/21/2022]
Abstract
Childhood maltreatment (CM) has estimated prevalence among Western societies between 10% and 15%. As CM associates with increased risk of several psychiatric disorders, early age of illness onset, increased comorbidity and negative clinical outcome, it imposes a major public health, social and economic impact. Although the clinical consequences of CM are well characterized, a major challenge remains to understand how negative early-life events can affect brain function over extended periods of time. We review here both animal and human studies indicating that the epigenetic mechanism of DNA methylation is a crucial mediator of early-life experiences, thereby maintaining life-long neurobiological sequelae of CM, and strongly determining psychopathological risk.
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Affiliation(s)
- P-E Lutz
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - G Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada.
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33
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Abstract
With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma.
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Affiliation(s)
- Claire Gregorowski
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University
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34
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Hickie IB, Hermens DF, Naismith SL, Guastella AJ, Glozier N, Scott J, Scott EM. Evaluating differential developmental trajectories to adolescent-onset mood and psychotic disorders. BMC Psychiatry 2013; 13:303. [PMID: 24215120 PMCID: PMC4226022 DOI: 10.1186/1471-244x-13-303] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is an open question as to whether differential developmental trajectories, potentially representing underlying pathophysiological processes, can form the basis of a more useful typology in young persons who present for mental health care. METHODS A cohort of 605 young people was recruited from youth mental health services that target the early phases of anxiety, mood or psychotic disorders. Participants were assigned to one of three clinical sub-types (anxious-depression; mania-fatigue; developmental-psychotic) according to putative developmental trajectories. RESULTS The distribution of subtypes was: 51% anxiety-depression, 25% mania-fatigue and 24% developmental-psychotic, with key differences in demographic, clinical, family history and neuropsychological characteristics. When analyses were limited to 286 cases with 'attenuated' or sub-threshold syndromes, the pattern of differences was similar. Multinomial logistic regression demonstrated that compared to the developmental-psychotic subtype, both the mania-fatigue and anxiety-depression subtypes were younger and more depressed at presentation, but less functionally impaired. Other discriminating variables between the developmental-psychotic and mania-fatigue sub-types were that the latter were significantly more likely to have a family history of bipolar disorder but have less likelihood of impaired verbal learning; whilst the anxious-depression group were more anxious, more likely to have a family history of depression, and had a higher premorbid IQ level. CONCLUSIONS This cross-sectional evaluation provides preliminary support for differing developmental trajectories in young persons presenting for mental health care. Prospective follow-up is needed to examine the predictive validity of this approach and its relationships to underlying pathophysiological mechanisms.
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Affiliation(s)
- Ian B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Sharon L Naismith
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Adam J Guastella
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Nick Glozier
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK,Centre for Affective Disorders, Institute of Psychiatry, London, UK,Academic Psychiatry, Wolfson Unit, Centre for Ageing & Vitality, Newcastle , UK
| | - Elizabeth M Scott
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia,School of Medicine, University of Notre Dame, Sydney, Australia
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35
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Kundakovic M, Lim S, Gudsnuk K, Champagne FA. Sex-specific and strain-dependent effects of early life adversity on behavioral and epigenetic outcomes. Front Psychiatry 2013; 4:78. [PMID: 23914177 PMCID: PMC3730082 DOI: 10.3389/fpsyt.2013.00078] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/17/2013] [Indexed: 12/18/2022] Open
Abstract
Early life adversity can have a significant long-term impact with implications for the emergence of psychopathology. Disruption to mother-infant interactions is a form of early life adversity that may, in particular, have profound programing effects on the developing brain. However, despite converging evidence from human and animal studies, the precise mechanistic pathways underlying adversity-associated neurobehavioral changes have yet to be elucidated. One approach to the study of mechanism is exploration of epigenetic changes associated with early life experience. In the current study, we examined the effects of postnatal maternal separation (MS) in mice and assessed the behavioral, brain gene expression, and epigenetic effects of this manipulation in offspring. Importantly, we included two different mouse strains (C57BL/6J and Balb/cJ) and both male and female offspring to determine strain- and/or sex-associated differential response to MS. We found both strain-specific and sex-dependent effects of MS in early adolescent offspring on measures of open-field exploration, sucrose preference, and social behavior. Analyses of cortical and hippocampal mRNA levels of the glucocorticoid receptor (Nr3c1) and brain-derived neurotrophic factor (Bdnf) genes revealed decreased hippocampal Bdnf expression in maternally separated C57BL/6J females and increased cortical Bdnf expression in maternally separated male and female Balb/cJ offspring. Analyses of Nr3c1and Bdnf (IV and IX) CpG methylation indicated increased hippocampal Nr3c1 methylation in maternally separated C57BL/6J males and increased hippocampal Bdnf IX methylation in male and female maternally separated Balb/c mice. Overall, though effect sizes were modest, these findings suggest a complex interaction between early life adversity, genetic background, and sex in the determination of neurobehavioral and epigenetic outcomes that may account for differential vulnerability to later-life disorder.
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