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Kuehn KS, Piccirillo ML, Kuczynski AM, King KM, Depp CA, Foster KT. Person-specific dynamics between negative emotions and suicidal thoughts. Compr Psychiatry 2024; 133:152495. [PMID: 38728844 DOI: 10.1016/j.comppsych.2024.152495] [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: 01/12/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Recent technology has enabled researchers to collect ecological momentary assessments (EMA) to examine within-person correlates of suicidal thoughts. Prior studies examined generalized temporal dynamics of emotions and suicidal thinking over brief periods, but it is not yet known how variable these processes are across people. METHOD We use data EMA data delivered over two weeks with youth/young adults (N = 60) who reported past year self-injurious thoughts/behaviors. We used group iterative multiple model estimation (GIMME) to model group- and person-specific associations of negative emotions (i.e., fear, sadness, shame, guilt, and anger) and suicidal thoughts. RESULTS 29 participants (48.33%) reported at least one instance of a suicidal thought and were included in GIMME models. In group level models, we consistently observed autoregressive effects for suicidal thoughts (e.g., earlier thoughts predicting later thoughts), although the magnitude and direction of this link varied from person-to-person. Among emotions, sadness was most frequently associated with contemporaneous suicidal thoughts, but this was evident for less than half of the sample, while other emotional correlates of suicidal thoughts broadly differed across people. No emotion variable was linked to future suicidal thoughts in >14% of the sample, CONCLUSIONS: Emotion-based correlates of suicidal thoughts are heterogeneous across people. Better understanding of the individual-level pathways maintaining suicidal thoughts/behaviors may lead to more effective, personalized interventions.
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Affiliation(s)
- Kevin S Kuehn
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America.
| | - Marilyn L Piccirillo
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America
| | - Adam M Kuczynski
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Ave E, Seattle, WA, 98102, United States of America
| | - Kevin M King
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, 3120 Biomedical Sciences Way, La Jolla, CA, 92093, Untied States of America
| | - Katherine T Foster
- Department of Psychology, University of Washington, 3921 Stevens Way NE, Seattle, WA, 98195, United States of America; Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, United States of America
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Coppersmith DDL, Kleiman EM, Millner AJ, Wang SB, Arizmendi C, Bentley KH, DeMarco D, Fortgang RG, Zuromski KL, Maimone JS, Haim A, Onnela JP, Bird SA, Smoller JW, Mair P, Nock MK. Heterogeneity in suicide risk: Evidence from personalized dynamic models. Behav Res Ther 2024; 180:104574. [PMID: 38838615 DOI: 10.1016/j.brat.2024.104574] [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: 08/24/2022] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
Most theories of suicide propose within-person changes in psychological states cause suicidal thoughts/behaviors; however, most studies use between-person analyses. Thus, there are little empirical data exploring current theories in the way they are hypothesized to occur. We used a form of statistical modeling called group iterative multiple model estimation (GIMME) to explore one theory of suicide: The Interpersonal Theory of Suicide (IPTS). GIMME estimates personalized statistical models for each individual and associations shared across individuals. Data were from a real-time monitoring study of individuals with a history of suicidal thoughts/behavior (adult sample: participants = 111, observations = 25,242; adolescent sample: participants = 145, observations = 26,182). Across both samples, none of theorized IPTS effects (i.e., contemporaneous effect from hopeless to suicidal thinking) were shared at the group level. There was significant heterogeneity in the personalized models, suggesting there are different pathways through which different people come to experience suicidal thoughts/behaviors. These findings highlight the complexity of suicide risk and the need for more personalized approaches to assessment and prediction.
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Affiliation(s)
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, Department of Psychology, USA
| | - Alexander J Millner
- Harvard University, Department of Psychology, USA; Franciscan Children's, Mental Health Research, USA
| | | | - Cara Arizmendi
- Duke University School of Medicine, Department of Population Health Sciences, USA
| | - Kate H Bentley
- Harvard University, Department of Psychology, USA; Massachusetts General Hospital, Department of Psychiatry, USA
| | | | - Rebecca G Fortgang
- Harvard University, Department of Psychology, USA; Massachusetts General Hospital, Department of Psychiatry, USA
| | | | | | - Adam Haim
- National Institute of Mental Health, USA
| | - Jukka-Pekka Onnela
- Harvard T. H. Chan School of Public Health, Department of Biostatistics, USA
| | - Suzanne A Bird
- Massachusetts General Hospital, Department of Psychiatry, USA
| | | | - Patrick Mair
- Harvard University, Department of Psychology, USA
| | - Matthew K Nock
- Harvard University, Department of Psychology, USA; Franciscan Children's, Mental Health Research, USA; Massachusetts General Hospital, Department of Psychiatry, USA
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Coppersmith DD, Ryan O, Fortgang RG, Millner AJ, Kleiman EM, Nock MK. Mapping the timescale of suicidal thinking. Proc Natl Acad Sci U S A 2023; 120:e2215434120. [PMID: 37071683 PMCID: PMC10151607 DOI: 10.1073/pnas.2215434120] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/10/2023] [Indexed: 04/19/2023] Open
Abstract
This study aims to identify the timescale of suicidal thinking, leveraging real-time monitoring data and a number of different analytic approaches. Participants were 105 adults with past week suicidal thoughts who completed a 42-d real-time monitoring study (total number of observations = 20,255). Participants completed two forms of real-time assessments: traditional real-time assessments (spaced hours apart each day) and high-frequency assessments (spaced 10 min apart over 1 h). We found that suicidal thinking changes rapidly. Both descriptive statistics and Markov-switching models indicated that elevated states of suicidal thinking lasted on average 1 to 3 h. Individuals exhibited heterogeneity in how often and for how long they reported elevated suicidal thinking, and our analyses suggest that different aspects of suicidal thinking operated on different timescales. Continuous-time autoregressive models suggest that current suicidal intent is predictive of future intent levels for 2 to 3 h, while current suicidal desire is predictive of future suicidal desire levels for 20 h. Multiple models found that elevated suicidal intent has on average shorter duration than elevated suicidal desire. Finally, inferences about the within-person dynamics of suicidal thinking on the basis of statistical modeling were shown to depend on the frequency at which data was sampled. For example, traditional real-time assessments estimated the duration of severe suicidal states of suicidal desire as 9.5 h, whereas the high-frequency assessments shifted the estimated duration to 1.4 h.
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Affiliation(s)
| | - Oisín Ryan
- Department of Methodology and Statistics, Utrecht University, 3508 TCUtrecht, The Netherlands
| | | | - Alexander J. Millner
- Department of Psychology, Harvard University, Cambridge, MA02138
- Mental Health Research, Franciscan Children’s, Brighton, MA02135
| | - Evan M. Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ08854
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA02138
- Mental Health Research, Franciscan Children’s, Brighton, MA02135
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA02114
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Coppersmith DDL, Wang SB, Kleiman EM, Maimone JS, Fedor S, Bentley KH, Millner AJ, Fortgang RG, Picard RW, Beck S, Huffman JC, Nock MK. Real-time digital monitoring of a suicide attempt by a hospital patient. Gen Hosp Psychiatry 2023; 80:35-39. [PMID: 36566615 PMCID: PMC9884520 DOI: 10.1016/j.genhosppsych.2022.12.005] [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: 07/28/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Suicide is among the most devastating problems facing clinicians, who currently have limited tools to predict and prevent suicidal behavior. Here we report on real-time, continuous smartphone and sensor data collected before, during, and after a suicide attempt made by a patient during a psychiatric inpatient hospitalization. We observed elevated and persistent sympathetic nervous system arousal and suicidal thinking leading up to the suicide attempt. This case provides the highest resolution data to date on the psychological, psychophysiological, and behavioral markers of imminent suicidal behavior and highlights new directions for prediction and prevention efforts.
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Affiliation(s)
| | - Shirley B Wang
- Harvard University, Department of Psychology, United States of America
| | - Evan M Kleiman
- Rutgers University, Department of Psychology, United States of America
| | - Joseph S Maimone
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Szymon Fedor
- Massachusetts Institute of Technology, Media Lab, United States of America
| | - Kate H Bentley
- Harvard University, Department of Psychology, United States of America; Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Alexander J Millner
- Harvard University, Department of Psychology, United States of America; Franciscan Children's Hospital, Mental Health Research, United States of America
| | - Rebecca G Fortgang
- Harvard University, Department of Psychology, United States of America; Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Rosalind W Picard
- Massachusetts Institute of Technology, Media Lab, United States of America
| | - Stuart Beck
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Jeff C Huffman
- Massachusetts General Hospital, Department of Psychiatry, United States of America
| | - Matthew K Nock
- Harvard University, Department of Psychology, United States of America; Massachusetts General Hospital, Department of Psychiatry, United States of America; Franciscan Children's Hospital, Mental Health Research, United States of America
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