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Robinson K, Cornes JP, Karl JA, Wilson MS, Grimshaw GM. Emotion dysregulation in nonsuicidal self-injury: Dissociations between global self-reports and real-time responses to emotional challenge. J Affect Disord 2024; 362:835-842. [PMID: 39032715 DOI: 10.1016/j.jad.2024.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Prominent theories of nonsuicidal self-injury (NSSI) propose that the behaviour is characterised by amplified emotional responses. However, little is known about how people who self-injure respond during emotional challenge. METHODS We measured subjective and physiological responding (heart rate, heart rate variability, and electrodermal responding) among young adults with past-year NSSI (n = 51) and those with no lifetime NSSI (n = 50) during a resting baseline, a stress induction, and a post-stress resting phase. Participants reported the extent to which they spontaneously used cognitive reappraisal and expressive suppression during the post-stress phase. Two weeks later, a subset of the sample (n = 42) reported how they remembered feeling during the laboratory session. RESULTS Although the NSSI group reported considerably greater emotion dysregulation than Controls, both groups showed similar subjective and psychological reactivity to, and recovery from, emotional challenge. Both groups used reappraisal and suppression regulation strategies following acute stress to a similar extent, and later came to remember the emotional challenge in a similar manner. LIMITATIONS Within the NSSI group, past-year self-injury tended to be infrequent and sporadic. Only 43.6% of the sample participated in the follow-up survey assessing memory of emotional challenge. CONCLUSIONS Findings demonstrate that the role of emotion in NSSI is more complex than prominent theories can account for, raising substantial questions regarding the nature of emotion in NSSI. A more comprehensive understanding of the role of emotion in NSSI is needed to inform intervention strategies to better support people who self-injure.
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Affiliation(s)
- Kealagh Robinson
- School of Psychology, Massey University, New Zealand; School of Psychology, Victoria University of Wellington, New Zealand.
| | - Joe P Cornes
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Johannes A Karl
- Psychology and Disruptive Technologies, Dublin City University, Ireland
| | - Marc S Wilson
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Gina M Grimshaw
- School of Psychology, Victoria University of Wellington, New Zealand
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Goreis A, Pfeffer B, Hajek Gross C, Klinger D, Oehlke SM, Zesch H, Claes L, Plener PL, Kothgassner OD. Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents. JAMA Netw Open 2024; 7:e2422892. [PMID: 39023890 PMCID: PMC11258595 DOI: 10.1001/jamanetworkopen.2024.22892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/19/2024] [Indexed: 07/20/2024] Open
Abstract
Importance Nonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI. Objective To use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI. Design, Setting, and Participants From June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024. Exposure Exposure to NSSI-related stimuli. Main Outcomes and Measures During both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed. Results A total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI-but not those without a history of NSSI-showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P < .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P < .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P < .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P < .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P < .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group. Conclusions and Relevance In this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers. Trial Registration German Clinical Trials Register identifier: DRKS00025905.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Bettina Pfeffer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Sofia M. Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Heidi Zesch
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Laurence Claes
- Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
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Kirshenbaum JS, Pagliaccio D, Bitran A, Xu E, Auerbach RP. Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review. Transl Psychiatry 2024; 14:266. [PMID: 38937430 PMCID: PMC11211511 DOI: 10.1038/s41398-024-02914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.
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Affiliation(s)
- Jaclyn S Kirshenbaum
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Alma Bitran
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Elisa Xu
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
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Sigrist C, Jakob H, Beeretz CJ, Schmidt SJ, Kaess M, Koenig J. Diurnal variation of cardiac autonomic activity in adolescent non-suicidal self-injury. Eur Arch Psychiatry Clin Neurosci 2024; 274:609-628. [PMID: 36871247 PMCID: PMC10995014 DOI: 10.1007/s00406-023-01574-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
Heart rate (HR) and vagally mediated heart rate variability (HRV) are two distinct biomarkers of cardiac autonomic activity. Decreased cardiac vagal activity (or decreased HRV) in particular has been linked with impairments in the functional flexibility of the central autonomic network (CAN), resulting in impaired stress and emotion regulatory capacities. Decreased HRV is widely used as trait marker of psychopathology. Repetitive engagement in non-suicidal self-injury (NSSI) in adolescence correlates with both deficits in stress and emotion regulation, as well as decreased HRV. Existing research has, however, focused on short-term recordings of HR and HRV under resting and phasic conditions. In this study, we examined whether diurnal variation of cardiac autonomic activity, indexed by cosinor parameters of HR and HRV derived from 48 h of ambulatory ECG recording under natural conditions over a weekend, are altered in female adolescents with NSSI disorder compared to controls (HC; N = 30 per study group). Several important confounds, including physical activity, were controlled for. Female adolescents with NSSI show higher rhythm-adjusted 24 h mean levels and greater respective amplitude of HR, as well as lower rhythm-adjusted 24 h mean levels and smaller respective amplitude of HRV. Peak levels in both HR and HRV in the NSSI group were reached approximately 1 h later compared to HC. Severity of exposure to early life maltreatment might be linked with altered amplitudes of 24 h HR and HRV. Diurnal rhythms of cardiac autonomic activity might hold promise as objective indicators of disordered stress and emotion regulation in developmental psychopathology, and as such should be investigated in future studies with rigorous assessment and control of potential confounds.
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Affiliation(s)
- Christine Sigrist
- Faculty of Medicine, Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, University Hospital Cologne, Cologne, Germany.
| | - Hannah Jakob
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Christoph J Beeretz
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- Faculty of Medicine, Clinic and Policlinic for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, University Hospital Cologne, Cologne, Germany
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Thomson ND, Kjærvik SL, Blondell VJ, Hazlett LE. The Interplay between Fear Reactivity and Callous-Unemotional Traits Predicting Reactive and Proactive Aggression. CHILDREN (BASEL, SWITZERLAND) 2024; 11:379. [PMID: 38671596 PMCID: PMC11049142 DOI: 10.3390/children11040379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
Research has indicated that youths with CU traits are fearless, and this fearlessness plays a bidirectional role in both the development of CU traits and engagement in aggressive behavior. However, research specifically testing the role of fear in the association between CU traits and aggression is scarce. The goal of the current study was to test if fear reactivity, both conscious (self-report) and automatic (skin conductance reactivity; SCR), moderated the association between CU traits and aggression subtypes (reactive and proactive aggression). Participants included 161 adolescents (Mage = 15 years) diagnosed with conduct disorder. CU traits were assessed using the self-report Inventory of Callous-Unemotional Traits. Conscious and automatic fear reactivity were measured during a virtual reality rollercoaster using the Self-Assessment Manikin and skin conductance reactivity (SCR), respectively. Hierarchical regressions found that high fear reactivity on SCR moderated the link between CU traits and reactive aggression, while feeling more excited during fear induction moderated the link between CU traits and proactive aggression. Overall, a possible explanation of our divergent findings between conscious and automatic fear may be the difference between the instinctual biological response to threat versus the cognitive and emotional appraisal and experience of threat. Implications for intervention strategies targeting emotional recognition and regulation in reducing aggression in CD populations are discussed.
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Affiliation(s)
- Nicholas D. Thomson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Department of Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.L.K.); (V.J.B.); (L.E.H.)
| | - Sophie L. Kjærvik
- Department of Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.L.K.); (V.J.B.); (L.E.H.)
| | - Victoria J. Blondell
- Department of Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.L.K.); (V.J.B.); (L.E.H.)
| | - Laura E. Hazlett
- Department of Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.L.K.); (V.J.B.); (L.E.H.)
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6
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Chen FR, French K. PEP reward reactivity moderates the effects of RSA reactivity on antisocial behavior and substance use. Psychophysiology 2024; 61:e14445. [PMID: 37728176 DOI: 10.1111/psyp.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Integrating Polyvagal Theory and Reinforcement Sensitivity Theory (RST), we examined pre-ejection period (PEP) reward reactivity, which was suggested to index trait impulsivity, as a moderator between respiratory sinus arrhythmia (RSA) reactivity and antisocial behavior (ASB), and substance use in an urban male, adult sample. To understand the inconsistent findings between RSA reactivity and externalizing problems, we proposed to study both negatively and positively valenced tasks for RSA reactivity and to include PEP reward reactivity as a moderator for the RSA-behavior link. Data were collected from an urban sample of 131 male adults (active offenders, demographic controls, and college students). ICG (impedance cardiography) and ECG (electrocardiogram) were recorded, computing PEP (sympathetic nervous system activity marker) and RSA (parasympathetic nervous system activity marker), while participants completed the modified Trier Social Stress Test and a simple reward task. Reactivity was calculated by subtracting the baseline from the task activity. Consistent with prior studies, more RSA withdrawal to stress and less PEP shortening to reward predicted the most ASB and substance use. Less RSA withdrawal to reward and more PEP shortening to reward predicted the most ASB and substance use. We incorporated autonomic space, RST, and Polyvagal Theory to discuss our findings, and specifically highlight how clarifying what each reactivity captures based on the task demand (e.g., presence of social threat, need for vagal-mediated social affiliative behavior) can illuminate our understanding of the result patterns.
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Affiliation(s)
- Frances R Chen
- Department of Criminal Justice and Criminology, Georgia State University, Atlanta, Georgia, USA
| | - Katherine French
- Department of Criminal Justice and Criminology, Georgia State University, Atlanta, Georgia, USA
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Ortiz A, Park Y, MacLean S, Husain MI, Sanches M, Ravindran A, Mulsant BH. A History of Suicide Attempt Is Associated with Increased Sympathetic Activation in Bipolar Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:126-137. [PMID: 37583363 PMCID: PMC10789230 DOI: 10.1177/07067437231194334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Suicide risk in bipolar disorder (BD) is estimated to be up to 20 times higher than in the general population. While there is a large body of evidence suggesting that increased sympathetic activation is associated with disease and death, there is a paucity of research on the role of autonomic nervous system (ANS) dysfunction in patients with BD who have attempted suicide. METHODS Fifty-three participants with BD used a wearable device to assess the association between history of suicide attempt, current suicidal ideation, and ANS dysfunction, including measures of heart rate variability (HRV) and respiratory rate. Data were analyzed in a series of unadjusted and adjusted bivariate models of association controlling for relevant variables. RESULTS A history of suicide attempts was significantly associated with an increase in respiratory rate (p < 0.01). These results remained significant after adjusting for age, BMI, and current mood state. There was no association between current suicidal ideation and heart rate or respiratory rate. In the frequency domain, HRV parameters suggest reduced parasympathetic (i.e., vagal) activity in participants with a history of suicide attempts and in those with current suicidality, suggesting changes in sympathicovagal balance in BD. CONCLUSIONS Our results suggest that changes in the ANS in patients with BD and a history of suicide attempt are not restricted to pure vagally mediated HRV parameters, but rather signal a general ANS dysregulation. This ANS imbalance may be contributing to illness burden and cardiovascular disease. Further research on the relationship between ANS and suicidality in BD is needed.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yunkyung Park
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephane MacLean
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, Ontario, Canada
| | - M. Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Mürner-Lavanchy I, Koenig J, Reichl C, Josi J, Cavelti M, Kaess M. The quest for a biological phenotype of adolescent non-suicidal self-injury: a machine-learning approach. Transl Psychiatry 2024; 14:56. [PMID: 38267430 PMCID: PMC10810046 DOI: 10.1038/s41398-024-02776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
Non-suicidal self-injury (NSSI) is a transdiagnostic psychiatric symptom with high prevalence and relevance in child and adolescent psychiatry. Therefore, it is of great interest to identify a biological phenotype associated with NSSI. The aim of the present study was to cross-sectionally investigate patterns of biological markers underlying NSSI and associated psychopathology in a sample of female patients and healthy controls. Comprehensive clinical data, saliva and blood samples, heart rate variability and pain sensitivity, were collected in n = 149 patients with NSSI and n = 40 healthy participants. Using machine-based learning, we tested the extent to which oxytocin, dehydroepiandrosterone (DHEA), beta-endorphin, free triiodothyronine (fT3), leukocytes, heart rate variability and pain sensitivity were able to classify participants regarding their clinical outcomes in NSSI, depression and borderline personality disorder symptomatology. We evaluated the predictive performance of several models (linear and logistic regression, elastic net regression, random forests, gradient boosted trees) using repeated cross-validation. With NSSI as an outcome variable, both logistic regression and machine learning models showed moderate predictive performance (Area under the Receiver Operating Characteristic Curve between 0.67 and 0.69). Predictors with the highest predictive power were low oxytocin (OR = 0.55; p = 0.002), low pain sensitivity (OR = 1.15; p = 0.021), and high leukocytes (OR = 1.67; p = 0.015). For the psychopathological outcome variables, i.e., depression and borderline personality disorder symptomatology, models including the biological variables performed not better than the null model. A combination of hormonal and inflammatory markers, as well as pain sensitivity, were able to discriminate between participants with and without NSSI disorder. Based on this dataset, however, complex machine learning models were not able to detect non-linear patterns of associations between the biological markers. These findings need replication and future research will reveal the extent to which the respective biomarkers are useful for longitudinal prediction of clinical outcomes or treatment response.
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Affiliation(s)
- Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Johannes Josi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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9
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James KM, Balderrama-Durbin C, Israel E, Feurer C, Gibb BE. Self- and co-regulation of physiological activity during mother-daughter interactions: The role of adolescent non-suicidal self-injury. J Child Psychol Psychiatry 2024; 65:91-99. [PMID: 37469027 PMCID: PMC10796835 DOI: 10.1111/jcpp.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant public health concern that is thought to increase risk for future self-injurious behaviors, including suicide attempts. Notably, NSSI is especially prevalent among adolescents, which underscores a critical need to identify modifiable risk factors that could be targeted to reduce future risk. The current study examined self- and co-regulation of physiological responses during mother-daughter interactions in adolescent girls with and without a history of NSSI. METHODS Participants were 60 girls aged 13-17 with (n = 27) and without (n = 33) a history of NSSI and their mothers. Adolescents and their mothers completed positive and negative interaction tasks during which physiological reactivity was assessed via respiratory sinus arrhythmia (RSA). RESULTS Using Actor-Partner Interdependence Modeling (APIM), we found that adolescents with an NSSI history demonstrated a higher RSA setpoint than adolescents without this history during the negative, but not positive, interaction task. In addition, there were differences in co-regulation during the negatively valenced interaction, such that mothers of daughters with NSSI were more reactive to fluctuations in their daughters' RSA than mothers of daughters without an NSSI history. CONCLUSIONS These findings highlight intra- and interpersonal aspects of physiological dysregulation associated with NSSI that could provide promising targets of intervention to reduce future risk in adolescent girls.
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Affiliation(s)
| | | | - Elana Israel
- Binghamton University (SUNY), Department of Psychology
| | - Cope Feurer
- University of Illinois Chicago, Department of Psychiatry
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10
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Goreis A, Prillinger K, Bedus C, Lipp R, Mayer A, Nater UM, Koenig J, Plener PL, Kothgassner OD. Physiological stress reactivity and self-harm: A meta-analysis. Psychoneuroendocrinology 2023; 158:106406. [PMID: 37783020 DOI: 10.1016/j.psyneuen.2023.106406] [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: 05/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent. BACKGROUND We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis. RESULTS Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08). CONCLUSIONS Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carolin Bedus
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ronja Lipp
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anna Mayer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Urs M Nater
- Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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11
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Bellato A, Admani MA, Deak C, Farhat LC, Fontana Antunes de Oliveira MC, Vasconcelos R, Malanchini M, Shephard E, Michelini G. Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12148. [PMID: 37720589 PMCID: PMC10501700 DOI: 10.1002/jcv2.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/15/2023] [Indexed: 09/19/2023] Open
Abstract
Background Self-injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking. Methods Following a pre-registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0-25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle-Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models. Results Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta-analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (g = -0.328, p < 0.001), which was driven by lower heart rate variability in individuals with SITBs (g = -0.375, p = 0.025). Overall results for electrodermal activity were not significant (g = 0.026, p = 0.857), but subgroup analyses showed increased activity in studies of individuals who engaged specifically in non-suicidal self-harm (g = 0.249, p = 0.014) but decreased activity in the remaining studies (g = -0.567, p = 0.004). Conclusions Our systematic review and meta-analysis found evidence of reduced parasympathetic regulation as well as more tentative evidence of altered electrodermal activity in children and young people displaying SITBs. Future longitudinal studies should test the clinical utility of these markers for detecting and monitoring suicide risk.
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Affiliation(s)
- Alessio Bellato
- School of PsychologyUniversity of NottinghamSemenyihMalaysia
| | - Muskaan Aleeza Admani
- Department of Biological and Experimental PsychologySchool of Biological and Behavioural SciencesQueen Mary University of LondonLondonUK
| | - Camila Deak
- Department of PsychiatryFaculdade de MedicinaUniversidade de São PauloSao PauloBrazil
| | - Luis Carlos Farhat
- Department of PsychiatryFaculdade de MedicinaUniversidade de São PauloSao PauloBrazil
| | | | - Rebeca Vasconcelos
- Department of PsychologyHealth Sciences CenterUniversidade de FortalezaSao PauloBrazil
| | - Margherita Malanchini
- Department of Biological and Experimental PsychologySchool of Biological and Behavioural SciencesQueen Mary University of LondonLondonUK
| | - Elizabeth Shephard
- Department of PsychiatryFaculdade de MedicinaUniversidade de São PauloSao PauloBrazil
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN)King's College LondonLondonUK
| | - Giorgia Michelini
- Department of Biological and Experimental PsychologySchool of Biological and Behavioural SciencesQueen Mary University of LondonLondonUK
- Semel Institute for Neuroscience and Human BehaviorUniversity of California Los AngelesLos AngelesCaliforniaUSA
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12
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Nelson BW, Pollak OH, Clayton MG, Telzer EH, Prinstein MJ. An RDoC-based approach to adolescent self-injurious thoughts and behaviors: The interactive role of social affiliation and cardiac arousal. Dev Psychopathol 2023:1-11. [PMID: 36882930 DOI: 10.1017/s0954579423000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Recent theoretical models have posited that increases in self-injurious thoughts and behaviors (SITBs) during adolescence may be linked to failures in biological stress regulation in contexts of social stress. However, there is a lack of data examining this hypothesis during the transition to adolescence, a sensitive period of development characterized by changes across socioaffective and psychophysiological domains. Building on principles from developmental psychopathology and the RDoC framework, the present study used a longitudinal design in a sample of 147 adolescents to test whether interactions among experiences of social (i.e., parent and peer) conflict and cardiac arousal (i.e., resting heart rate) predicted adolescents' engagement in SITBs (i.e., nonsuicidal self-injury, NSSI; and suicidal ideation; SI) across 1-year follow-up. Prospective analyses revealed that adolescents experiencing a combination of greater peer, but not family, conflict and higher cardiac arousal at baseline showed significant longitudinal increases in NSSI. In contrast, social conflict did not interact with cardiac arousal to predict future SI. Findings indicate that greater peer-related interpersonal stress in adolescents may increase risk for future NSSI among youth with physiological vulnerabilities (i.e., higher resting heart rate) that may be markers of maladaptive stress responses. Future research should examine these processes at finer timescales to elucidate whether these factors are proximal predictors of within-day SITBs.
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Affiliation(s)
- Benjamin W Nelson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olivia H Pollak
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew G Clayton
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eva H Telzer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Aitchison G, Essex R. Self-harm in immigration detention: political, not (just) medical. JOURNAL OF MEDICAL ETHICS 2022:medethics-2022-108366. [PMID: 36581458 DOI: 10.1136/jme-2022-108366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Self-harm within immigration detention centres has been a widely documented phenomenon, occurring at far higher rates than the wider community. Evidence suggests that factors such as the conditions of detention and uncertainty about refugee status are among the most prominent precipitators of self-harm. While important in explaining self-harm, this is not the entire story. In this paper, we argue for a more overtly political interpretation of detainee self-harm as resistance and assess the ethical implications of this view, drawing on interviews with detainees from Australia's offshore system. Self-harm by detainees is not only a medical 'condition' arising in response to oppression but a form of political action to lessen or contest it. We first establish how self-harm could be conceptualised as resistance. We then discuss its political purpose, noting it serves at least three functions: intrinsic, instrumental and disruptive or coercive. Viewing detainee self-harm as political resistance is a supplement to (rather than a substitute for) a medical approach. However, conceptualising self-harm this way has several advantages, namely, moving away from the idea that such behaviour is 'maladaptive', recognising detainees as political agents, combatting government claims of 'manipulation' and 'blackmail' and clarifying the duties of healthcare workers who work in detention.
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Affiliation(s)
- Guy Aitchison
- International Relations, Politics and History, Loughborough University, Loughborough, Leicestershire, UK
| | - Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, UK
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14
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Sparrow-Downes VM, Trincao-Batra S, Cloutier P, Helleman AR, Salamatmanesh M, Gardner W, Baksh A, Kapur R, Sheridan N, Suntharalingam S, Currie L, Carrie LD, Hamilton A, Pajer K. Peripheral and neural correlates of self-harm in children and adolescents: a scoping review. BMC Psychiatry 2022; 22:318. [PMID: 35509053 PMCID: PMC9066835 DOI: 10.1186/s12888-022-03724-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group. METHODS PubMed and Embase databases were searched from January 1980-May 2020, seeking English language peer-reviewed studies about peripheral and neural correlates of self-harm, defined as completed suicide, suicide attempts, suicidal ideation, or non-suicidal self-injury (NSSI) in subjects, birth to 19 years of age. Studies were excluded if only investigating self-harm in persons with intellectual or developmental disability syndromes. A blinded multi-stage assessment process by pairs of co-authors selected final studies for review. Risk of bias estimates were done on final studies. RESULTS We screened 5537 unduplicated abstracts, leading to the identification of 79 eligible studies in 76 papers. Of these, 48 investigated peripheral correlates and 31 examined neural correlates. Suicidality was the focus in 2/3 of the studies, with NSSI and any type of self-harm (subjects recruited with suicidality, NSSI, or both) investigated in the remaining studies. All studies used observational designs (primarily case-control), most used convenience samples of adolescent patients which were predominately female and half of which were recruited based on a disorder. Over a quarter of the specific correlates were investigated with only one study. Inter-study agreement on findings from specific correlates with more than one study was often low. Estimates of Good for risk of bias were assigned to 37% of the studies and the majority were rated as Fair. CONCLUSIONS Research on peripheral and neural correlates of self-harm is not sufficiently mature to identify potential biomarkers. Conflicting findings were reported for many of the correlates studied. Methodological problems may have produced biased findings and results are mainly generalizable to patients and girls. We provide recommendations to improve future peripheral and neural correlate research in children and adolescents, ages 3-19 years, with self-harm.
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Affiliation(s)
- Victoria M. Sparrow-Downes
- grid.25055.370000 0000 9130 6822Department of Family Medicine Residency Program, Memorial University of Newfoundland, NL St. John’s, Canada
| | - Sara Trincao-Batra
- grid.25055.370000 0000 9130 6822Department of Pediatrics Residency Program, Memorial University of Newfoundland, NL St. John’s, Canada
| | - Paula Cloutier
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Amanda R. Helleman
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Mina Salamatmanesh
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - William Gardner
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, ON Ottawa, Canada
| | - Anton Baksh
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Rishi Kapur
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Nicole Sheridan
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Ottawa, ON Canada
| | - Sinthuja Suntharalingam
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, ON Ottawa, Canada
| | - Lisa Currie
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, ON Ottawa, Canada
| | - Liam D. Carrie
- Research Fellow, Harbourfront Health Group, Grand Falls, NB Canada
| | - Arthur Hamilton
- grid.34428.390000 0004 1936 893XPhD Program, Department of Cognitive Science, Carleton University, Ottawa, ON Canada
| | - Kathleen Pajer
- CHEO Research Institute, Ottawa, ON, Canada. .,Department of Psychiatry, University of Ottawa, ON, Ottawa, Canada.
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15
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Associations of three major physiological stress systems with suicidal ideation and suicide attempts in patients with a depressive and/or anxiety disorder. Brain Behav Immun 2022; 102:195-205. [PMID: 35202735 DOI: 10.1016/j.bbi.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND People with depressive and/or anxiety disorders are at increased risk of suicidal ideation and suicide attempts, but biological correlates signaling such risk remain unclear. Independent and cumulative dysregulations in physiological stress systems, in particular the hypothalamic-pituitaryadrenal axis (HPA-axis), immune-inflammatory system, and autonomous nervous system (ANS), may contribute to this risk. However, findings have either been heterogeneous or absent thus far. METHODS Associations between individual markers and cumulative indices of the HPA-axis (cortisol awakening response and evening cortisol), immune-inflammatory system (C-reactive protein, interleukin-6 (IL-6), and tumor necrosis factor-α), and the ANS (heart rate, respiratory sinus arrhythmia, and pre-ejection period) and the outcomes no suicide ideation with suicide attempt (SI-SA+), suicide ideation without suicide attempt (SI+SA-) and suicide ideation with suicide attempt (SI+SA+) were investigated in 1749 persons with depressive and/or anxiety disorders from the Netherlands Study of Depression and Anxiety (NESDA). RESULTS High levels of CRP and IL-6 were associated with SI-SA+ and SI+SA+ respectively when compared to non-suicidal patients after adjusting for confounders and multiple testing. Also, cumulative immune-inflammatory dysregulations were positively associated with SI+SA+, suggesting a dose-response effect. No significant associations were found between HPA-axis or ANS indicators and suicide-outcomes and between immune-inflammatory system markers or cumulative stress system dysregulations and SI+SA-. CONCLUSION Although stress system markers could not differentiate between SI+SA- and non-suicidal patients, findings indicate that dysregulations of individual and cumulative immune-inflammatory markers are associated with suicide attempts in depressive and/or anxiety patients. Thus, immune-inflammatory system dysregulation may be involved in the pathophysiology of suicidal behavior, supporting further examination of the effects of anti-inflammatory interventions on suicidality.
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16
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Johnson BN, McKernan LC, Bruehl S. A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury. Curr Pain Headache Rep 2022; 26:405-414. [PMID: 35380406 DOI: 10.1007/s11916-022-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Individuals with chronic pain are significantly more likely to have experienced overwhelming trauma early and often in key developmental years. There is increasing acknowledgment that childhood trauma disrupts how individuals process and cope with both physical and emotional pain. Emerging studies acknowledge elevated rates of non-suicidal self-injury (NSSI) in chronic pain populations. This review provides a theoretical framework to understand the relationship between NSSI behavior and pain experience in persons with chronic pain and childhood trauma histories. We discuss how NSSI may act to regulate neurobiological (e.g., endogenous opioid systems) and psychological (e.g., heightened negative affect and emotion dysregulation) systems affected by childhood trauma, leading to temporary pain relief and a cycle of negative reinforcement perpetuating NSSI. As these concepts are greatly understudied in pain populations, this review focuses on key areas relevant to chronic pain that may provide a testable, conceptual framework to support hypothesis generation, future empirical investigation, and intervention efforts. RECENT FINDINGS See Fig. 1. See Fig. 1.
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17
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Using Virtual Reality to Examine the Association Between Respiratory Sinus Arrhythmia and Adolescent Substance Use. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01308-1. [PMID: 35066713 DOI: 10.1007/s10578-021-01308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
Early substance use is associated with long-term negative health outcomes. Emotion regulation (ER) plays an important role in reducing risk, but detecting those vulnerable because of ER deficits is challenging. Respiratory sinus arrhythmia (RSA), a biomarker of ER, may be useful for early identification of substance use risk. To examine this, we enrolled 23 adolescents (Mage = 14.0; 56% minority) with and without a history of substance use and collected RSA during a neutral baseline, virtual reality challenge scene, and neutral recovery. ANOVAs indicated that adolescents who reported having used a substance were not different from non-using peers on baseline or challenge RSA but demonstrated lower RSA during recovery. This suggests that adolescents with a history of substance use exhibit slower return to baseline RSA after experiencing a challenging situation compared to non-using peers. RSA, an index of ER, may be useful in identifying adolescents at risk for early substance use.
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18
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Psychopathy, the Four Facet Model, and Fearlessness: Testing Sympathetic and Parasympathetic Nervous System Reactivity in a Late Adolescent Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-021-09948-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Bettis AH, Burke TA, Nesi J, Liu RT. Digital Technologies for Emotion-Regulation Assessment and Intervention: A Conceptual Review. Clin Psychol Sci 2022; 10:3-26. [PMID: 35174006 PMCID: PMC8846444 DOI: 10.1177/21677026211011982] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The ability to regulate emotions in response to stress is central to healthy development. While early research in emotion regulation predominantly employed static, self-report measurement, the past decade has seen a shift in focus toward understanding the dynamic nature of regulation processes. This is reflected in recent refinements in the definition of emotion regulation, which emphasize the importance of the ability to flexibly adapt regulation efforts across contexts. The latest proliferation of digital technologies employed in mental health research offers the opportunity to capture the state- and context-sensitive nature of emotion regulation. In this conceptual review, we examine the use of digital technologies (ecological momentary assessment; wearable and smartphone technology, physical activity, acoustic data, visual data, and geo-location; smart home technology; virtual reality; social media) in the assessment of emotion regulation and describe their application to interventions. We also discuss challenges and ethical considerations, and outline areas for future research.
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Affiliation(s)
| | | | | | - Richard T Liu
- Harvard Medical School
- Massachusetts General Hospital
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20
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Kaess M, Hooley JM, Klimes-Dougan B, Koenig J, Plener PL, Reichl C, Robinson K, Schmahl C, Sicorello M, Westlund Schreiner M, Cullen KR. Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review. Neurosci Biobehav Rev 2021; 130:228-239. [PMID: 34450182 PMCID: PMC8783544 DOI: 10.1016/j.neubiorev.2021.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/17/2021] [Accepted: 08/21/2021] [Indexed: 11/04/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.
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Affiliation(s)
- Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kealagh Robinson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN, USA
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21
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Examining the Neurobiology of Non-Suicidal Self-Injury in Children and Adolescents: The Role of Reward Responsivity. J Clin Med 2021; 10:jcm10163561. [PMID: 34441857 PMCID: PMC8396887 DOI: 10.3390/jcm10163561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Although prior work has shown heightened response to negative outcomes and reduced response to positive outcomes in youth with a history of non-suicidal self-injury (NSSI), little is known about the neural processes underlying these responses. Thus, this study examined associations between NSSI engagement and functional activation in specific regions of interest (ROIs) and whole-brain connectivity between striatal, frontal, and limbic region seeds during monetary and social reward tasks. To test for specificity of the influence of NSSI, analyses were conducted with and without depressive symptoms as a covariate. We found that NSSI was associated with decreased activation following monetary gains in all ROIs, even after controlling for depressive symptoms. Exploratory connectivity analyses found that NSSI was associated with differential connectivity between regions including the DS, vmPFC, insula, and parietal operculum cortex when controlling for depressive symptoms. Disrupted connectivity between these regions could suggest altered inhibitory control of emotions and pain processing in individuals with NSSI. Findings suggest dysfunctional reward processes in youth with NSSI, even very early in the course of the behavior.
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22
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Dixon-Gordon KL, Marsh NP, Balda KE, McQuade JD. Parent Emotion Socialization and Child Emotional Vulnerability as Predictors of Borderline Personality Features. Res Child Adolesc Psychopathol 2021; 48:135-147. [PMID: 31388862 DOI: 10.1007/s10802-019-00579-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although parent emotion socialization and child temperament are theorized to interact in the prediction of borderline personality disorder (BPD) features, few studies have directly examined these relationships. The present study examined whether parental emotion socialization interacted with behavioral ratings and physiological indicators of emotional vulnerability in the prediction of BPD features among preadolescent children. Participants were 125 children (10-12 years; 55% female) and their parents recruited from the community. Parents and children reported on children's BPD features and parents completed a measure of supportive and non-supportive emotion socialization. Children's emotional vulnerability was assessed based on parent-rated negativity/lability and emotion regulation skills and children's respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity to a social stressor. Several significant interactions of parent supportive reactions, non-supportive reactions, and child emotional reactivity emerged. Children were lowest in BPD features when parents were high in supportive reactions and/or low in non-supportive reactions and the child was low in emotional vulnerability (e.g., low negativity/lability, good emotion regulation skills, or low SCL reactivity to stress). These findings suggest that specific emotion socialization factors in interaction with children's emotional reactivity may predict risk for BPD features in preadolescence. Future research is needed to replicate these findings and examine whether this interaction prospectively predicts trajectories of BPD features.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Nicholas P Marsh
- Department of Psychology, Amherst College, Campus Box 2236, Amherst, MA, 01002, USA
| | - Kayla E Balda
- Department of Psychology, Amherst College, Campus Box 2236, Amherst, MA, 01002, USA
| | - Julia D McQuade
- Department of Psychology, Amherst College, Campus Box 2236, Amherst, MA, 01002, USA.
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23
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McQuade JD, Dixon-Gordon KL, Breaux R, Babinski DE. Interactive Effects of Parent Emotion Socialization and Child Physiological Reactivity in Predicting Adolescent Borderline Personality Disorder Features. Res Child Adolesc Psychopathol 2021; 50:89-100. [PMID: 33404951 DOI: 10.1007/s10802-020-00717-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
Theories suggest that a transaction between child biological vulnerability and parent emotion socialization underlies the development of borderline personality disorder (BPD) features. Yet, few studies have examined the interaction between these factors prospectively in at-risk samples. Consequently, this study tested whether parental reactions to children's negative emotions moderated the effect of the child's physiological reactivity to stress in predicting adolescent BPD features in a sample of youth with and without clinical elevations in attention deficit/hyperactivity disorder (ADHD). Participants were 61 children (52% female) and parents (90% mothers). When children were 9-13 years old, their physiological reactivity to a social stressor was assessed based on respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity; parents also reported on their supportive and non-supportive reactions to their child's negative emotions. Children were followed-up four to five years later at ages 14-18 years old and their BPD features were assessed based on parent and adolescent report. Significant interactions between children's SCL reactivity and parental reactions to children's negative emotions were found in predicting adolescent BPD features. Children with low SCL reactivity to social stress and parents high in supportive/low in non-supportive reactions were lowest in adolescent BPD features. However, greater SCL reactivity predicted greater adolescent BPD features specifically when the parent was high in support or low in non-support. Childhood ADHD symptoms also significantly predicted greater adolescent BPD features. Findings suggest that children with different patterns of SCL reactivity may respond differently to parental reactions to their emotions.
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Affiliation(s)
- Julia D McQuade
- Department of Psychology, Amherst College, Campus Box 2236, Amherst, MA, 01002, USA.
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rosanna Breaux
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
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Vlisides-Henry RD, Gao M, Thomas L, Kaliush PR, Conradt E, Crowell SE. Digital Phenotyping of Emotion Dysregulation Across Lifespan Transitions to Better Understand Psychopathology Risk. Front Psychiatry 2021; 12:618442. [PMID: 34108893 PMCID: PMC8183608 DOI: 10.3389/fpsyt.2021.618442] [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: 10/16/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Ethical and consensual digital phenotyping through smartphone activity (i. e., passive behavior monitoring) permits measurement of temporal risk trajectories unlike ever before. This data collection modality may be particularly well-suited for capturing emotion dysregulation, a transdiagnostic risk factor for psychopathology, across lifespan transitions. Adolescence, emerging adulthood, and perinatal transitions are particularly sensitive developmental periods, often marked by increased distress. These participant groups are typically assessed with laboratory-based methods that can be costly and burdensome. Passive monitoring presents a relatively cost-effective and unobtrusive way to gather rich and objective information about emotion dysregulation and risk behaviors. We first discuss key theoretically-driven concepts pertaining to emotion dysregulation and passive monitoring. We then identify variables that can be measured passively and hold promise for better understanding emotion dysregulation. For example, two strong markers of emotion dysregulation are sleep disturbance and problematic use of Internet/social media (i.e., use that prompts negative emotions/outcomes). Variables related to mobility are also potentially useful markers, though these variables should be tailored to fit unique features of each developmental stage. Finally, we offer our perspective on candidate digital variables that may prove useful for each developmental transition. Smartphone-based passive monitoring is a rigorous method that can elucidate psychopathology risk across human development. Nonetheless, its use requires researchers to weigh unique ethical considerations, examine relevant theory, and consider developmentally-specific lifespan features that may affect implementation.
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Affiliation(s)
| | - Mengyu Gao
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Leah Thomas
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Parisa R Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, United States.,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, United States.,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.,Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
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25
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Frasch MG, Shen C, Wu HT, Mueller A, Neuhaus E, Bernier RA, Kamara D, Beauchaine TP. Brief Report: Can a Composite Heart Rate Variability Biomarker Shed New Insights About Autism Spectrum Disorder in School-Aged Children? J Autism Dev Disord 2021; 51:346-356. [PMID: 32449059 DOI: 10.1007/s10803-020-04467-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several studies show altered heart rate variability (HRV) in autism spectrum disorder (ASD), but findings are neither universal nor specific to ASD. We apply a set of linear and nonlinear HRV measures-including phase rectified signal averaging-to segments of resting ECG data collected from school-age children with ASD, age-matched typically developing controls, and children with other psychiatric conditions characterized by altered HRV (conduct disorder, depression). We use machine learning to identify time, frequency, and geometric signal-analytical domains that are specific to ASD (receiver operating curve area = 0.89). This is the first study to differentiate children with ASD from other disorders characterized by altered HRV. Despite a small cohort and lack of external validation, results warrant larger prospective studies.
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Affiliation(s)
- Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | - Chao Shen
- Department of Mathematics, Duke University, Durham, NC, USA
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, USA
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Alexander Mueller
- Innere Medizin 1, Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Emily Neuhaus
- Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, WA, USA.
- Seattle Children's Autism Center, Seattle, WA, USA.
| | - Raphael A Bernier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Dana Kamara
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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26
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Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry 2021; 12:628252. [PMID: 34759846 PMCID: PMC8573252 DOI: 10.3389/fpsyt.2021.628252] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, Regional Psychiatric Hospital, Mauer, Austria
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27
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Salisbury MR, Stienwandt S, Giuliano R, Penner-Goeke L, Fisher PA, Roos LE. Stress system reactivity moderates the association between cumulative risk and children's externalizing symptoms. Int J Psychophysiol 2020; 158:248-258. [DOI: 10.1016/j.ijpsycho.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022]
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28
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Scott BG, Fike EA, McCullen JR. Depressive symptoms among stress-exposed youth: Relations with tonic and phasic indices of autonomic functioning. Dev Psychobiol 2020; 63:1029-1042. [PMID: 33200408 DOI: 10.1002/dev.22056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022]
Abstract
Theoretical models of adolescent depression postulate that one possible individual vulnerability factor for the development of depressive symptoms is autonomic dysregulation. However, there is limited and mixed support for these models among ethnically diverse and higher risk stress-exposed youth. Therefore, this study investigated the relations between both tonic and phasic indices of parasympathetic autonomic functioning (i.e., resting high-frequency heart rate variability [HF-HRV] and root mean square of successive differences [RMSSD]; HF-HRV and RMSSD reactivity to a mental arithmetic stressor) and depressive symptoms among 80 severely stress-exposed youth (51% female; 11-17 years of age) from diverse backgrounds (61.3% ethnic minority; caregiver-reported median family income = $20,000-$49,999 per year). Results demonstrated that lower resting HF-HRV and RMSSD, but not HF-HRV and RMSSD reactivity, was associated with greater youth depressive symptoms. Our findings suggest that lower resting parasympathetic autonomic functioning may be a potential vulnerability factor of depressive symptoms among stress-exposed youth, instead of specific emotional responses to stressors. These findings will need to be replicated in larger samples of stress-exposed youth and youth at higher risk for or exhibiting clinical levels of depressive symptoms to better elucidate relations with autonomic functioning and depressive symptoms among adolescents.
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29
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Lejderman B, Parisotto A, Spanemberg L. Trends in suicidal behavior at a general hospital emergency department in southern Brazil. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:311-317. [PMID: 33263710 PMCID: PMC7879089 DOI: 10.1590/2237-6089-2019-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of and factors associated with suicidal behavior in patients seen at the emergency department (ED) of a general hospital in southern Brazil. METHOD Descriptive, observational, cross-sectional study. The records of all patients who had an emergency psychiatric consultation at the ED conducted by the emergency psychiatric consultation service at Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul in 2016 and 2017 were analyzed and stratified by sex and by age groups (15-29 years, 30-49 years, 50-69 years, and 70 years and older). Suicidal behavior was characterized by factors such as thoughts of death, suicidal thoughts, and suicidal risk. Suicidal behavior was compared by sex and between age groups with chi-square tests. Multivariate analysis of suicidal behavior and gender, age, and specific diagnoses were compared with Poisson regression. RESULTS A total of 1,172 records from January 2016 to December 2017 were examined. There were more ED visits by females (63.1%) than males. Younger patients (15-29 years) had a higher severe risk of suicide than elderly (≥ 70 years) patients (54.1 vs. 19%; p < 0.01). Indicators of suicide behavior stratified by sex and by age group revealed marked differences between age groups for all variables among female patients. Overall, age group patterns for males were very similar in terms of suicidal behavior variables. CONCLUSIONS A high prevalence of suicidal behavior was observed in this sample, particularly among young adults and especially associated with female gender and diagnoses of depression and personality disorders.
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Affiliation(s)
- Betina Lejderman
- Núcleo de Formação em Neurociências, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Aline Parisotto
- Núcleo de Formação em Neurociências, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Lucas Spanemberg
- Núcleo de Formação em Neurociências, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.,Unidade de Internação Psiquiátrica, Hospital São Lucas, PUCRS, Porto Alegre, RS, Brazil
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30
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Lin B, Kidwell MC, Kerig PK, Crowell SE, Fortuna AJ. Profiles of autonomic stress responsivity in a sample of justice-involved youth: Associations with childhood trauma exposure and emotional and behavioral functioning. Dev Psychobiol 2020; 63:206-225. [PMID: 32181498 DOI: 10.1002/dev.21968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/05/2020] [Accepted: 02/13/2020] [Indexed: 02/02/2023]
Abstract
A limited number of studies have begun to investigate how the coordinated actions of distinct physiological systems may be related to the development of psychopathology. However, the form taken by these patterns of coordination as well as their antecedents and developmental implications remain to be clarified. The Adaptive Calibration Model (ACM) proposes four prototypical patterns of physiological stress responsivity and corresponding behavioral patterns, which are further tied to varying levels of childhood adversity. The current study is among the first to investigate whether patterns of sympathetic and parasympathetic stress responsivity predicted by the ACM generalize to a sample of justice-involved youth with disproportionately high rates of childhood trauma exposure. Psychophysiological and self-report data were collected from 822 justice-involved youth (182 girls) ages 12-19 years. Latent profile analyses yielded five profiles of physiological responsivity that largely corresponded to the patterns proposed by the ACM. Further, these profiles demonstrated predicted associations with self-reported emotionality and adjustment. Trauma exposure was associated with a lower likelihood of membership in one of the profiles showing blunted physiological responsivity. Our discussion highlights ways in which insights from the ACM may inform understanding about linkages between physiology and adjustment.
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Affiliation(s)
- Betty Lin
- University at Albany, State University of New York, Albany, NY, USA
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31
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Pain perception, distress tolerance and self-compassion in Turkish young adults with and without a history of non-suicidal self-injury. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00634-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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32
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Davis EL, Brooker RJ, Kahle S. Considering context in the developmental psychobiology of self‐regulation. Dev Psychobiol 2020; 62:423-435. [DOI: 10.1002/dev.21945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Elizabeth L. Davis
- Department of Psychology University of California, Riverside Riverside CA USA
| | | | - Sarah Kahle
- University of California, Davis Davis CA USA
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33
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Fitzpatrick S, Zeifman R, Krantz L, McMain S, Kuo JR. Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder. Arch Suicide Res 2020; 24:102-123. [PMID: 30856367 DOI: 10.1080/13811118.2019.1586605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.
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34
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Beauchaine TP, Sauder CL, Derbidge CM, Uyeji LL. Self-injuring adolescent girls exhibit insular cortex volumetric abnormalities that are similar to those seen in adults with borderline personality disorder. Dev Psychopathol 2019; 31:1203-1212. [PMID: 30394252 PMCID: PMC6500772 DOI: 10.1017/s0954579418000822] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Self-inflicted injury (SII) in adolescence is a serious public health concern that portends prospective vulnerability to internalizing and externalizing psychopathology, borderline personality development, suicide attempts, and suicide. To date, however, our understanding of neurobiological vulnerabilities to SII is limited. Behaviorally, affect dysregulation is common among those who self-injure. This suggests ineffective cortical modulation of emotion, as observed among adults with borderline personality disorder. In borderline samples, structural and functional abnormalities are observed in several frontal regions that subserve emotion regulation (e.g., anterior cingulate, insula, dorsolateral prefrontal cortex). However, no volumetric analyses of cortical brain regions have been conducted among self-injuring adolescents. We used voxel-based morphometry to compare cortical gray matter volumes between self-injuring adolescent girls, ages 13-19 years (n = 20), and controls (n = 20). Whole-brain analyses revealed reduced gray matter volumes among self-injurers in the insular cortex bilaterally, and in the right inferior frontal gyrus, an adjacent neural structure also implicated in emotion and self-regulation. Insular and inferior frontal gyrus gray matter volumes correlated inversely with self-reported emotion dysregulation, over-and-above effects of psychopathology. Findings are consistent with an emotion dysregulation construal of SII, and indicate structural abnormalities in some but not all cortical brain regions implicated in borderline personality disorder among adults.
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Affiliation(s)
| | - Colin L Sauder
- Department of Psychiatry,University of Texas San Antonio,San Antonio, TX,USA
| | - Christina M Derbidge
- Department of Physical Medicine and Rehabilitation,University of Utah,Salt Lake City, UT,USA
| | - Lauren L Uyeji
- Department of Psychology,Temple University,Philadelphia, PA,USA
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35
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Westlund Schreiner M, Klimes-Dougan B, Parenteau A, Hill D, Cullen KR. A Framework for Identifying Neurobiologically Based Intervention Targets for NSSI. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00188-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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36
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Beauchaine TP, Hinshaw SP, Bridge JA. Nonsuicidal Self-Injury and Suicidal Behaviors in Girls: The Case for Targeted Prevention in Preadolescence. Clin Psychol Sci 2019; 7:643-667. [PMID: 31485384 PMCID: PMC6726409 DOI: 10.1177/2167702618818474] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Non-suicidal self-injury (NSSI) affects 15-20% of adolescents-disproportionately girls-and is a strong predictor of eventual suicide attempts and suicide. Many girls now initiate NSSI before age 10. These early-starters exhibit greater frequency of NSSI, use more diverse methods, and are hospitalized more often, yet there are no empirically supported prevention programs for preadolescents. Obstacles to prevention include ascertaining who is sufficiently vulnerable and specifying mechanistic intervention targets. Recent research indicates that (1) preadolescent girls with ADHD who are also maltreated are at alarming risk for NSSI and suicide attempts by adolescence, and (2) the conjoint effects of these vulnerabilities are sufficiently potent for targeted prevention. Research also indicates that existing interventions are effective in altering child- and family-level mechanisms of NSSI. These interventions alter neurobiological markers of vulnerability, which can be used as proximal efficacy signals of prevention response, without waiting for NSSI and suicide attempts to emerge.
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Affiliation(s)
| | - Stephen P Hinshaw
- Departments of Psychology and Psychiatry, The University of California, Berkeley; University of California, San Francisco
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
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37
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Yang X, Daches S, George CJ, Kiss E, Kapornai K, Baji I, Kovacs M. Autonomic correlates of lifetime suicidal thoughts and behaviors among adolescents with a history of depression. Psychophysiology 2019; 56:e13378. [PMID: 31002191 DOI: 10.1111/psyp.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 12/23/2022]
Abstract
Suicidal thoughts and behaviors (STBs) have been associated with emotion dysregulation and atypical responses to affective and stressful stimuli. To investigate the psychophysiology involved, we measured changes in respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP; indexing parasympathetic and sympathetic functioning, respectively) in response to stressful- and sadness-eliciting laboratory probes. Our sample included adolescents with a history of depression and STBs (n = 177), adolescents with a history of depression but no history of STBs (n = 47), and healthy controls (n = 175). The outcome of interest was the most severe form of clinician-rated STBs across the subject's lifetime. In partial support of our hypotheses, during the stressful task, adolescents with a history of depression and STBs did not evidence the RSA decrease that was exhibited by controls and displayed greater PEP shortening compared to ever-depressed adolescents with no lifetime STBs. No group differences were found in either RSA or PEP reactivity to the sadness-eliciting stimulus. As expected, severity of STBs was positively correlated with the extent of PEP shortening during the stressful task. The results suggest that adolescents with a history of depression and STBs experience blunted parasympathetic responses to stress along with compensatory efforts. Our findings contribute to a better understanding of STBs among youths and underscore that future studies should examine physiological risk factors for these psychopathological outcomes.
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Affiliation(s)
- Xiao Yang
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shimrit Daches
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Charles J George
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Enikő Kiss
- Department of Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Krisztina Kapornai
- Department of Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Ildikó Baji
- Department of Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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38
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Abstract
Suicide is the second leading cause of death worldwide for adolescents. Despite decades of research on correlates and risk factors for adolescent suicide, we know little about why suicidal ideation and behavior frequently emerge in adolescence and how to predict, and ultimately prevent, suicidal behavior among youths. In this review, we first discuss knowledge regarding correlates, risk factors, and theories of suicide. We then review why adolescence is a period of unique vulnerability, given changing biology and social network reorganization. Next, we present a conceptual model through which to interpret emerging findings in adolescent suicide research. We suggest that a promising area for future research is to examine adolescent suicide as a failure of biological responses to acute stress in the proximal moments of a suicidal crisis. After reviewing initial evidence for this conceptualization, we review future directions for studies on adolescent suicide.
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Affiliation(s)
- Adam Bryant Miller
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA; ,
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA; ,
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39
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Cui L, Zhang X, Houltberg BJ, Criss MM, Morris AS. RSA reactivity in response to viewing bullying film and adolescent social adjustment. Dev Psychobiol 2019; 61:592-604. [DOI: 10.1002/dev.21835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/07/2018] [Accepted: 12/23/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Lixian Cui
- NYU‐ECNU Institute for Social Development at NYU Shanghai New York University Shanghai Shanghai China
| | - Xutong Zhang
- Department of Human Development and Family Studies Pennsylvania State University University Park Pennsylvania
| | - Benjamin J. Houltberg
- Performance Science Institute University of Southern California Los Angeles California
| | - Michael M. Criss
- Department of Human Development and Family Science Oklahoma State University Oklahoma
| | - Amanda S. Morris
- Department of Human Development and Family Science Oklahoma State University Oklahoma
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40
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Beauchaine TP, Bell Z, Knapton E, McDonough-Caplan H, Shader T, Zisner A. Respiratory sinus arrhythmia reactivity across empirically based structural dimensions of psychopathology: A meta-analysis. Psychophysiology 2019; 56:e13329. [PMID: 30672603 DOI: 10.1111/psyp.13329] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022]
Abstract
Low resting respiratory sinus arrhythmia (RSA) is observed in many mental health conditions, including anxiety disorders, mood disorders, schizophrenia spectrum disorders, disruptive behavior disorders, and nonsuicidal self-injury, among others. Findings for RSA reactivity are more mixed. We evaluate associations between RSA reactivity and empirically derived structural categories of psychopathology-including internalizing, externalizing, and thought problems-among physically healthy adults. We searched multiple electronic databases for studies of RSA among participants who were assessed either dimensionally using well-validated measures or diagnostically using structured interviews. Strict inclusion criteria were used to screen 3,605 published reports, which yielded 37 studies including 2,347 participants and 76 effect sizes. We performed a meta-analysis, with meta-analytic regressions of potential moderators, including psychopathology subtypes. The sample-wide meta-analytic association between RSA reactivity and psychopathology was quite small, but heterogeneity was considerable. Moderation analyses revealed significant RSA reactivity (withdrawal) specifically in externalizing samples. Additional moderators included (a) stimulus conditions used to elicit RSA reactivity (only negative emotion inductions were effective), (b) sex (women showed greater RSA reactivity than men), and (c) adherence to established methodological guidelines (e.g., higher electrocardiographic sampling rates yielded greater RSA reactivity). These findings indicate that associations between RSA reactivity and psychopathology are complex and suggest that future studies should include more standardized RSA assessments to increase external validity and decrease measurement error.
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Affiliation(s)
| | - Ziv Bell
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Erin Knapton
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | | | - Tiffany Shader
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Aimee Zisner
- Department of Psychology, The Ohio State University, Columbus, Ohio
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41
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Price CJ, Crowell SE, Pike KC, Cheng SC, Puzia M, Thompson EA. Psychological and Autonomic Correlates of Emotion Dysregulation among Women in Substance Use Disorder Treatment. Subst Use Misuse 2019; 54:110-119. [PMID: 30273086 PMCID: PMC6379107 DOI: 10.1080/10826084.2018.1508297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Emotion regulation is increasingly recognized as important for the prevention and treatment of substance use disorder (SUD). However, there is an identified lack of physiological indexes of emotion dysregulation in SUD treatment studies, critically needed to better understand the link between emotion regulation capacity (measured physiologically) and self-report health outcomes among individuals in SUD treatment. OBJECTIVE To examine the association between respiratory sinus arrhythmia (RSA) and self-report health outcomes among women in SUD treatment. METHODS This is a cross-sectional study based on baseline data from 217 women enrolled in a randomized control trial to study a mind-body intervention as an adjunct to SUD treatment. All participants were enrolled in community-based outpatient treatment. Participants were administered questionnaires to examine sample characteristics, mental health symptoms, and interoceptive awareness and mindfulness skills. RSA data was gathered as an index of emotion dysregulation. Descriptive statistics, bivariate correlations, and regression were used in the analyses. RESULTS Findings highlight the extensive trauma histories, low SES, and the high symptoms of distress in this sample. RSA was only significantly correlated with interoceptive awareness after controlling for age and BMI. Measures of symptomatic distress and mindfulness were not correlated with RSA. Conclusions/Importance: Results provide the first evidence of RSA as an index of interoceptive awareness in this population. The inclusion of biomarkers such as RSA in SUD clinical studies may help identify individuals that are in need of targeted treatments that include interoceptive awareness training focused on improving emotion regulation.
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Affiliation(s)
- Cynthia J Price
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Sheila E Crowell
- b Department of Psychology , University of Utah , Salt Lake City , Utah, USA
| | - Kenneth C Pike
- c Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sunny Chieh Cheng
- d Nursing and Healthcare Leadership , University of Washington , Tacoma , Washington, USA
| | - Megan Puzia
- b Department of Psychology , University of Utah , Salt Lake City , Utah, USA
| | - Elaine Adams Thompson
- c Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
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Miller AB, Eisenlohr-Moul TA. Biological responses to acute stress and suicide: A review and opportunities for methodological innovation. Curr Behav Neurosci Rep 2019; 6:141-150. [PMID: 33224711 DOI: 10.1007/s40473-019-00185-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose of Review While rates of other medical illnesses have declined over the past several decades, rates of suicide have increased, particularly among adolescents. Prior research on biological underpinnings of suicide risk has remained limited. In this review, we describe a recent model conceptualizing suicide as a failure of biological responses to acute stress. According to this model, youth who fail to mount an adaptive stress response following exposure to a stressor are at acute risk for suicide. Recent Findings Although much more research is needed, early evidence suggests that abnormal biological responses to acute stress, such as altered autonomic nervous system activity and altered hypothalamic-pituitary-adrenal axis function, may underlie risk for suicide, particularly during the transition to adolescence. Summary Overall, initial evidence supports a link between biological responses to acute stress and suicide risk. However, future work that incorporates makers of other biological and environmental systems will sharpen our understanding of who is at suicide risk and when this risk is highest.
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Fox AR, Hammond LE, Mezulis AH. Respiratory sinus arrhythmia and adaptive emotion regulation as predictors of nonsuicidal self-injury in young adults. Int J Psychophysiol 2018; 133:1-11. [DOI: 10.1016/j.ijpsycho.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 08/23/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022]
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Price CJ, Thompson EA, Crowell SE, Pike K, Cheng SC, Parent S, Hooven C. Immediate effects of interoceptive awareness training through Mindful Awareness in Body-oriented Therapy (MABT) for women in substance use disorder treatment. Subst Abus 2018; 40:102-115. [PMID: 29949455 DOI: 10.1080/08897077.2018.1488335] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Sensory information gained through interoceptive awareness may play an important role in affective behavior and successful inhibition of drug use. This study examined the immediate pre-post effects of the mind-body intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's substance use disorder (SUD) treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Methods: Women in intensive outpatient treatment (IOP) for chemical dependency (N = 217) at 3 community clinics in the Pacific Northwest of the United States were recruited and randomly assigned to one of 3 study conditions: MABT + treatment as usual (TAU), women's health education (WHE) +TAU (active control condition), and TAU only. At baseline and 3 months post-intervention, assessments were made of interoceptive awareness skills and mindfulness, emotion regulation (self-report and psychophysiological measures), symptomatic distress (depression and trauma-related symptoms), and substance use (days abstinent) and craving. Changes in outcomes across time were assessed using multilevel mixed-effects linear regression. Results: Findings based on an intent-to-treat approach demonstrated significant improvements in interoceptive awareness and mindfulness skills, emotion dysregulation (self-report and psychophysiology), and days abstinent for women who received MABT compared with the other study groups. Additional analyses based on participants who completed the major components of MABT (at least 75% of the intervention sessions) revealed these same improvements as well as reductions in depressive symptoms and substance craving. Conclusions: Findings that interoceptive training is associated with health outcomes for women in SUD treatment are consistent with emerging neurocognitive models that link interoception to emotion regulation and to related health outcomes, providing knowledge critical to supporting and improving SUD treatment.
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Affiliation(s)
- Cynthia J Price
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Elaine A Thompson
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sheila E Crowell
- c Department of Psychology , University of Utah , Salt Lake City , Utah , USA
| | - Kenneth Pike
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sunny C Cheng
- d Nursing and Healthcare Leadership Program , University of Washington , Tacoma , Washington , USA
| | - Sara Parent
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Carole Hooven
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
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Wass SV. How orchids concentrate? The relationship between physiological stress reactivity and cognitive performance during infancy and early childhood. Neurosci Biobehav Rev 2018; 90:34-49. [DOI: 10.1016/j.neubiorev.2018.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 12/19/2022]
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Kaufman EA, Crowell SE, Coleman J, Puzia ME, Gray DD, Strayer DL. Electroencephalographic and cardiovascular markers of vulnerability within families of suicidal adolescents: A pilot study. Biol Psychol 2018; 136:46-56. [PMID: 29782969 DOI: 10.1016/j.biopsycho.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/28/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
Abstract
Suicide, self-injury, and predisposing vulnerabilities aggregate in families. Those at greatest risk often show deficits in two biologically-mediated domains: behavioral control and emotion regulation. This pilot study explored electroencephalographic and cardiovascular indices of self-regulation among typical and suicidal adolescents (n = 30/group) and biological family members (mothers, fathers, and siblings). We measured event-related potentials during a flanker task designed to evoke impulsive responding and respiratory sinus arrhythmia (RSA) at rest and during social rejection. Multilevel models indicate control families' RSA was unaffected by social rejection (slope = 0.136, p = .097, d = 0.09), whereas clinical families demonstrated RSA withdrawal (slope = -0.191, p = .036, d = -0.13). Clinical families displayed weaker positive voltage (Pe) deflections following behavioral errors relative to controls (coefficient = -2.723, p = .017, d = -0.45), indicating risk for compromised cognitive control. Thus, families with suicidal adolescents showed autonomic and central nervous system differences in biological markers associated with suicide risk.
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Affiliation(s)
- Erin A Kaufman
- Department of Psychology, University of Utah, United States.
| | - Sheila E Crowell
- Department of Psychology, University of Utah, United States; Department of Psychiatry, University of Utah, United States
| | - James Coleman
- Department of Psychology, University of Utah, United States
| | - Megan E Puzia
- Department of Psychology, University of Utah, United States
| | - Douglas D Gray
- Department of Psychiatry, University of Utah, United States; University Neuropsychiatric Institute, University of Utah, United States; Department of Pediatrics, University of Utah, United States
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Sarchiapone M, Gramaglia C, Iosue M, Carli V, Mandelli L, Serretti A, Marangon D, Zeppegno P. The association between electrodermal activity (EDA), depression and suicidal behaviour: A systematic review and narrative synthesis. BMC Psychiatry 2018; 18:22. [PMID: 29370787 PMCID: PMC5785904 DOI: 10.1186/s12888-017-1551-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Electrodermal activity (EDA) and other peripheral autonomic electrical parameters have been used as indicators of emotional states, including depressive states and suicidal state. We aimed to review EDA research systematically, focusing on EDA's usefulness as a biomarker for depression and suicidal behaviour. METHODS We searched MEDLINE, Scopus, Cochrane Library, and Web of Science databases, following PRISMA guidelines. The initial screening of articles was based on titles and abstracts; then the full text was reviewed. A preliminary synthesis of findings was developed using tables, thematic analysis and quality ratings. RESULTS 1287 articles were screened and 77 relevant studies were identified and included in the systematic review. The studies were fairly consistent in maintaining that hypoactive electrodermal response is an established feature of patients affected by depression. There is also preliminary evidence that monitoring EDA may help to differentiate the phases of mood disorders. A few studies provided evidence that EDA can be used to differentiate acutely suicidal subjects from depressed patients who are not severely suicidal. Although EDA has been shown to be a valid, sensitive marker of suicidal ideation, suicide attempts and violent suicidal behaviour, it also seems to be influenced to some extent by antidepressant treatment. CONCLUSIONS Most of the studies summarised in this review are quite outdated and employed a variety of designs and methods to evaluate EDA. This limits the generalisability of the results and makes it difficult to draw clear conclusions about the role of EDA in real-world settings. Electrodermal hypoactivity seems to be a reliable feature of depression and a valid marker of suicidal risk. Nevertheless, the potential utility of EDA in diagnosis, prevention, and treatment planning for depression and suicidal behaviour, should be thoroughly studied.
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Affiliation(s)
- Marco Sarchiapone
- Department of Health Sciences, University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy.
- National Institute for Health, Migration and Poverty, Via di S. Gallicano 25/a, 00153, Rome, Italy.
| | - Carla Gramaglia
- Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Miriam Iosue
- Department of Health Sciences, University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, -171 77, Stockholm, SE, Sweden
| | - Laura Mandelli
- Department of Biomedical and Neuromotor Sciences, Institute of Psychiatry, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, Institute of Psychiatry, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Debora Marangon
- Institute of Psychiatry, Maggiore della Carità Hospital of Novara, C.so Mazzini 18, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
- Institute of Psychiatry, Maggiore della Carità Hospital of Novara, C.so Mazzini 18, 28100, Novara, Italy
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Tonhajzerova I, Mestanik M, Mestanikova A, Jurko A. Respiratory sinus arrhythmia as a non-invasive index of 'brain-heart' interaction in stress. Indian J Med Res 2018; 144:815-822. [PMID: 28474618 PMCID: PMC5433274 DOI: 10.4103/ijmr.ijmr_1447_14] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Respiratory sinus arrhythmia (RSA) is accepted as a peripheral marker of cardiac-linked parasympathetic regulation. According to polyvagal theory, the RSA is also considered as the index of emotion regulation. The neurovisceral integration model posits that parasympathetic modulation of the heart marked by RSA is related to complex nervous regulation associated with emotional and cognitive processing. From this perspective, high resting RSA amplitude associated with a greater withdrawal during stressors and subsequent recovery could represent a flexible and adaptive physiological response system to a challenge. Conversely, low resting RSA accompanied by an inadequate reactivity to stress might reflect maladaptive regulatory mechanisms. The RSA reactivity is different with various types of stressors: while the RSA decreases to cognitive tasks indicating a vagal withdrawal, the RSA magnitude increases to emotional challenge indicating an effective cognitive processing of emotional stimuli. The RSA reactivity to stress could have important implications for several mental disorders, e.g. depressive or anxiety disorder. It seems that the study of the RSA, as a non-invasive index of ‘brain-heart’ communication, could provide important information on the pathway linked to mental and physical health.
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Affiliation(s)
- Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin (JFM CU); Biomedical Center Martin JFM CU, Comenius University in Bratislava, Martin, Slovak Republic
| | - Michal Mestanik
- Biomedical Center Martin JFM CU, Comenius University in Bratislava, Martin, Slovak Republic
| | - Andrea Mestanikova
- Department of Physiology, Jessenius Faculty of Medicine in Martin (JFM CU); Biomedical Center Martin JFM CU, Comenius University in Bratislava, Martin, Slovak Republic
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Aldrich JT, Wielgus MD, Mezulis AH. Low physiological arousal and high impulsivity as predictors of self-injurious thoughts and behaviors among adolescents. J Adolesc 2017; 62:55-60. [PMID: 29156227 DOI: 10.1016/j.adolescence.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 11/04/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022]
Abstract
Self-injurious thoughts and behaviors are used to escape or regulate aversive physiological states during stress. Low sympathetic nervous system arousal during stress has been shown to confer risk. This risk may be exacerbated by trait impulsivity; adolescents high in impulsivity are more likely to rashly use maladaptive regulation strategies. We examined this relationship longitudinally in a sample of adolescents ages 10 to 14 (55.4% female) from the United States. Consistent with our hypothesis, low arousal during stress and high trait impulsivity interacted to predict the use of self-injurious thoughts and behaviors over a six-month period. This study extends and clarifies previous research findings regarding the relationship between physiological arousal and self-injurious thoughts and behaviors.
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Affiliation(s)
- Jaclyn T Aldrich
- Department of Clinical Psychology, Seattle Pacific University, USA.
| | | | - Amy H Mezulis
- Department of Clinical Psychology, Seattle Pacific University, USA
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James KM, Woody ML, Feurer C, Kudinova AY, Gibb BE. Disrupted physiological reactivity among children with a history of suicidal ideation: Moderation by parental expressed emotion-criticism. Biol Psychol 2017; 130:22-29. [PMID: 29030216 DOI: 10.1016/j.biopsycho.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this study was to examine physiological reactivity during parent-child interactions in children with and without a history of suicidal ideation (SI), a group known to be at increased risk for suicidal thoughts and behaviors in the future. We also examined the potential moderating role of parental expressed emotion-criticism (EE-Crit) to determine whether the presence of parental criticism may help to identify a subgroup of children with a history of SI most at risk for physiological dysregulation. METHOD Participants were 396 children (age 7-11; 54% male, 71.7% Caucasian) and their biological parent. Children's levels of high frequency heart rate variability (HF-HRV) were assessed during a resting baseline period followed by a positive and negative discussion with their parent. Additionally, parents completed the Five-Minute Speech Sample to determine levels of EE-Crit toward their child, and children completed an interview assessing their history of SI. RESULTS Consistent with our hypothesis, we found that exposure to parental criticism moderated the relation between a child's history of SI and their HF-HRV reactivity to the discussions. Specifically, while most children exhibited the typical pattern of HF-HRV suppression from baseline to both interactions, the highest risk children (i.e., children with a history of SI who also had highly critical parents) did not display any change in HF-HRV across the tasks, suggesting a failure to engage a typical psychophysiological response during emotional contexts. CONCLUSIONS These results suggest a specific physiological mechanism that may place these children at risk for suicidal thoughts and behaviors in the future.
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Affiliation(s)
- Kiera M James
- Center for Affective Science, Binghamton University (SUNY), USA.
| | - Mary L Woody
- Center for Affective Science, Binghamton University (SUNY), USA
| | - Cope Feurer
- Center for Affective Science, Binghamton University (SUNY), USA
| | | | - Brandon E Gibb
- Center for Affective Science, Binghamton University (SUNY), USA
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