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Yang J. Childhood maltreatment, peer victimization, borderline personality feature, suicidal risk in adolescents: Direct and indirect associations among developmental trajectories. J Adolesc 2024; 96:1278-1292. [PMID: 38734993 DOI: 10.1002/jad.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Childhood maltreatment, peer victimization, and borderline personality traits have all been shown to be linked to suicidal risk. However, there remains a need to illuminate the possible direct and indirect pathways among them from a developmental perspective that could serve as intervention targets. This study thus aimed to investigate the direct and indirect relationships among developmental trajectories of childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk in adolescents. METHODS A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82) in junior middle schools completed self-report measures on three-time points across 1 year. Latent growth curve modeling was used to evaluate the direct and indirect relationships among the developmental trajectories of the aforementioned study variables. RESULTS The developmental trajectories of childhood maltreatment, peer victimization, and borderline personality feature were positively and directly related to the developmental trajectory of suicidal risk; and the developmental trajectories of childhood maltreatment, peer victimization were indirectly related to the developmental trajectory of suicidal risk through the mediating effect of the developmental trajectory of borderline personality feature. CONCLUSIONS The findings elucidated the direct and indirect longitudinal relationships among childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk, highlighting that interventions should target childhood maltreatment, peer victimization, and borderline personality feature to decrease suicidal risk in adolescents with a developmental perspective.
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Affiliation(s)
- Jiaping Yang
- Department of Psychology, Guangzhou University, Guangzhou, China
- Guangzhou Liwan District Institute for Educational Development Research, Guangzhou, China
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Benton TD, Beers L, Carlson G, Kee Ng WY. The Declaration of the National Emergency in Child and Adolescent Mental Health: It Takes a Village. Child Adolesc Psychiatr Clin N Am 2024; 33:277-291. [PMID: 38823803 DOI: 10.1016/j.chc.2024.03.001] [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] [Indexed: 06/03/2024]
Abstract
Recognition of the high prevalence of children's mental health conditions and challenges to accessing needed care faced by children and their families have been long-standing concerns, emerging well before the onset of the COVID-19 pandemic. Global data examining the prevalence of at least one mental health and/or substance-use disorder for 2516 million people aged 5 to 24 years in 2019 found that at least 293 million people were affected by at least one mental health disorder and 31 million affected by a substance-use disorder.
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Affiliation(s)
- Tami D Benton
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, The Hub for Clinical collaboration, 12th floor, Philadelphia, PA 19104, USA.
| | - Lee Beers
- The Child Health Advocacy Institute, Childrens National Hospital, Washington, DC 20010, USA; Children's National Medical Center Child Health Advocacy Institute, 111 Michigan Avenue, NW, Washington, DC 20010, USA
| | - Gaye Carlson
- Professor of Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook, Stony Brook, NY 11794-8790, USA
| | - Warren Yiu Kee Ng
- Outpatient Behavioral Health, Psychiatry, CUMC/New York-Presbyterian, Morgan Stanley Childrens Hospital, 3959 Broadway, New York, NY 10032, USA
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Wilner JG, Ronzio B, Gillen C, Aguirre B. Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder. J Pers Disord 2024; 38:157-170. [PMID: 38592908 DOI: 10.1521/pedi.2024.38.2.157] [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] [Indexed: 04/11/2024]
Abstract
Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.
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Affiliation(s)
- Julianne G Wilner
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blake Ronzio
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Carly Gillen
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blaise Aguirre
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
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Belli GM, Law C, Obisie-Orlu IC, Eisen JL, Rasmussen SA, Boisseau CL. Course and clinical correlates of obsessive-compulsive disorder with or without comorbid personality disorder. J Affect Disord 2024; 348:218-223. [PMID: 38145841 PMCID: PMC10939496 DOI: 10.1016/j.jad.2023.12.041] [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: 08/21/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Personality disorders (PDs) are often comorbid with obsessive-compulsive disorder (OCD) which may influence symptom presentation and course. This investigation sought to examine the impact of comorbid PDs on clinical presentation and symptom chronicity in a large, prospective longitudinal OCD study. METHODS Participants (n = 263) were treatment-seeking adults with a primary diagnosis of OCD separated into two groups: individuals with and without a co-occurring PD. We conducted two-tailed t-tests to compare symptom severity, functioning, and quality of life between the OCD + PD group (n = 117) and the OCD w/o PD group (n = 146). Chronicity analyses were conducted to compare the amount of time in-episode for OCD and major depressive disorder (MDD) between the two groups. RESULTS The OCD + PD group reported greater OCD and depression severity, lower levels of psychosocial functioning and worse quality of life than the OCD w/o PD group. The OCD + PD group exhibited greater OCD and MDD symptom chronicity; over 5 years the OCD + PD group spent 16.2 % weeks longer at full criteria for OCD and three times as many weeks in episode for MDD than the OCD w/o PD group. LIMITATIONS Focusing on PDs as a group limited our ability to make observations about specific PDs. Further, the participants in our sample were predominantly White and all were treatment seeking which limits the generalizability of our findings. CONCLUSIONS Our results suggest that those with OCD and comorbid PDs present with greater overall impairment and may require additional considerations during treatment conceptualization and planning.
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Affiliation(s)
- Gina M Belli
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Immanuela C Obisie-Orlu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Bete T, Birhanu A, Negash A, Yadeta E, Lemi M, Balcha T, Sertsu A, Birhanu B, Nigussie S, Gemechu K, Meseret F, Mohammed H, Alemu A, Dechasa DB, Asmerom H, Arkew M, Shewangizaw A, Mohamed A, Ahemed F, Wodaje D, Dessie Y, Debella A, Getachew T, Nigussie K, Eyeberu A. Suicidal ideation, attempt and associated factor among secondary school students in Harari regional state, Eastern Ethiopia. A multi-center cross-sectional study. Front Psychiatry 2023; 14:1069910. [PMID: 37215668 PMCID: PMC10196371 DOI: 10.3389/fpsyt.2023.1069910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/27/2023] [Indexed: 05/24/2023] Open
Abstract
Background Suicide is a major public health issue across the globe. It is the second leading cause of death in adolescents. Even though the rate of suicide has increased, no study has been conducted to investigate the determinants of suicide in the study area. Therefore, this study aimed to assess the magnitude of suicidal ideation, suicide attempts, and its associated factors among secondary school students in the Harari regional state of Eastern Ethiopia. Methods An institutional-based cross-sectional study was conducted among randomly selected 1,666 secondary school students. A structured-self-administered questionnaire was used for data collection. The WHO Composite International Diagnostic Interview (CIDI) was used to assess suicidal ideation and suicide attempts. The Depression Anxiety and Stress Scale (DASS) was also used to assess depression, anxiety, and stress. Data were entered into EpiData version 3.1 and exported to Stata version 14.0 for the analysis. A logistic regression analysis was performed to determine the association between the outcome and independent variables and the statistical significance was declared at a p-value of < 0.05. Result The overall magnitude of suicidal ideation and attempts was 13.82% at 95% confidence interval (CI): 12.16-15.66 and 7.61% at 95% CI: 6.37-9.07, respectively. Suicidal ideations and suicide attempts were significantly associated with undergoing depressive symptoms (adjusted odds ratio [AOR]: 1.54; 95% CI: 1.08-2.19 and AOR: 2.37; 95% CI: 1.46-3.86, respectively), experiencing anxiety symptoms (AOR: 1.80; 95% CI: 1.25-2.59 and AOR: 1.89; 95% CI: 2.14-10.65, respectively), being exposed to sexual violence (AOR: 3.36; 95% CI: 1.65-6.84), and having a family history of suicidal attempts (AOR: 2.12; 95% CI: 1.21-3.69 and AOR: 4.74; 95% CI: 2.14-10.65, respectively), whereas living in a rural residence (AOR: 1.65 95%, CI: 1.08-2.55) was significantly associated only with suicide attempts. Conclusion and recommendations Nearly one in six secondary school students had both suicidal ideation and attempted to take their own life. Suicide is one of the psychiatric emergencies that need immediate action. Therefore, the concerned body from either a governmental or a non-governmental organization should work in setting strategies to minimize sexual violence as well as depressive and anxiety symptoms.
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Affiliation(s)
- Tilahun Bete
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Elias Yadeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Magarsa Lemi
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tegenu Balcha
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bekelu Birhanu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shambel Nigussie
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fentahun Meseret
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hanan Mohammed
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Deribe Bekele Dechasa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abayneh Shewangizaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Debre Birhan University, Debre Berhan, Ethiopia
| | - Ahmed Mohamed
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fila Ahemed
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawud Wodaje
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Raffagnato A, Iannattone S, Fasolato R, Parolin E, Ravaglia B, Biscalchin G, Traverso A, Zanato S, Miscioscia M, Gatta M. A Pre-Adolescent and Adolescent Clinical Sample Study about Suicidal Ideation, Suicide Attempt, and Self-Harming. Eur J Investig Health Psychol Educ 2022; 12:1441-1462. [PMID: 36286085 PMCID: PMC9600697 DOI: 10.3390/ejihpe12100100] [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: 06/29/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
Suicide is the second cause of death among adolescents, and nonsuicidal self-injury (NSSI) is one of the main risk factors for suicidal behavior. However, the possible variables specifically associated with suicidal ideation and suicide attempt, as well as the psychopathological characteristics linked to the concomitant presence of suicidal ideation/attempt and NSSI are still under-investigated in youth. The current study aimed to address these issues in a sample of 174 young Italian inpatients (Mage = 14.3 years ± 1.93, 78.2% girls). Sociodemographic and clinical variables were assessed through psycho-diagnostic interviews and ad hoc questionnaires. A binomial logistic regression was performed to identify the predictors of suicidal ideation and suicide attempt. Then, Kruskal-Wallis tests were run to analyze the psychopathological differences between patients with suicidal ideation and suicide attempt considering the coexistence of NSSI. The results highlighted that previous access to child mental health services and general psychopathological problems significantly predicted suicidal ideation, while previous hospitalizations, borderline personality functioning, and affective disorders significantly predicted suicide attempt. In general, inpatients with also NSSI reported higher levels of internalizing, somatic and total problems, impulsiveness, alexithymia, and emotional dysregulation. The clinical implications of our findings in terms of primary and secondary preventive programs are discussed.
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Affiliation(s)
- Alessia Raffagnato
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Sara Iannattone
- Department of General Psychology, University of Padua, 35131 Padua, Italy
- Correspondence: ; Tel.: +39-049-827-6918
| | - Rachele Fasolato
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Elisa Parolin
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Benedetta Ravaglia
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Gaia Biscalchin
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Annalisa Traverso
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Silvia Zanato
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Marina Miscioscia
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy
| | - Michela Gatta
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
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7
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Cerdá M, Hamilton AD, Tracy M, Branas C, Fink D, Keyes KM. Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? An agent-based simulation. Inj Epidemiol 2022; 9:17. [PMID: 35681243 PMCID: PMC9185952 DOI: 10.1186/s40621-022-00381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. We used an agent-based model to simulate the change in firearm violence after disqualifying people from owning a firearm given prior alcohol- and drug-related misdemeanors.
Methods We created a population of 800,000 agents reflecting a 15% sample of the adult New York City population. Results Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1.0% [95% CI 0.4–1.6%] and suicide by 3.0% [95% CI 1.9–4.0%]. Disqualification based on a drug-related misdemeanor conviction reduced homicide by 1.6% [95% CI 1.1–2.2%] and suicide by 4.6% [95% CI 3.4–5.8%]. Reductions were generally 2 to 8 times larger for agents meeting the disqualification criteria. Conclusions Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Enactment of substance use-related firearms denial criteria needs to be balanced against concerns about introducing new sources of disenfranchisement among already vulnerable populations.
Supplementary Information The online version contains supplementary material available at 10.1186/s40621-022-00381-x.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA. .,Department of Population Health, Grossman School of Medicine, NYU Langone Health, 180 Madison Avenue, Room 416, New York, NY, 10016, USA.
| | - Ava D Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Massaal-van der Ree LY, Eikelenboom M, Hoogendoorn AW, Thomaes K, van Marle HJF. Cluster B versus Cluster C Personality Disorders: A Comparison of Comorbidity, Suicidality, Traumatization and Global Functioning. Behav Sci (Basel) 2022; 12:bs12040105. [PMID: 35447677 PMCID: PMC9031793 DOI: 10.3390/bs12040105] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 12/10/2022] Open
Abstract
A general clinical assumption states that cluster B personality disorders (PDs) represent a more severe form of PD than cluster C PDs. Consequently, most PD research is centered on cluster B PDs (especially borderline PD). Yet, prevalence ratings of cluster C PDs exceed those of cluster B PDs. In this explorative, cross-sectional study, we compared cluster B and C PD patients (N = 94) on a wide range of clinically-relevant severity measures, including comorbidity, suicidality, (childhood) traumatization and global functioning. Results showed that, although cluster B PD patients suffered more often from substance use disorders and lifetime suicide attempts, no difference could be established between groups for all other severity measures, including trauma variables. In our study, we additionally included a group of combined cluster B and C PDs, who were largely similar to both other groups. Although our study is insufficiently powered to claim a significant non-difference, these findings emphasize that high rates of comorbidity, suicidality, childhood traumatization and functional impairment apply to both cluster B and C patients. As such, our findings encourage more research into cluster C PDs, ultimately leading to more evidence-based treatments for this prevalent patient group. In addition, the high level of traumatization across groups calls for a routine trauma screening, especially since PD treatment may benefit from concurrent trauma treatment.
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Affiliation(s)
| | - Merijn Eikelenboom
- GGZ in Geest Mental Health Care, 1081 HJ Amsterdam, The Netherlands; (L.Y.M.-v.d.R.); (M.E.); (A.W.H.)
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Amsterdam Public Health, Mental Health Program, 1007 MB Amsterdam, The Netherlands
| | - Adriaan W. Hoogendoorn
- GGZ in Geest Mental Health Care, 1081 HJ Amsterdam, The Netherlands; (L.Y.M.-v.d.R.); (M.E.); (A.W.H.)
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Amsterdam Public Health, Mental Health Program, 1007 MB Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Sinai Centrum, Arkin Institute for Mental Health, 1033 NN Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, 1007 MB Amsterdam, The Netherlands
| | - Hein J. F. van Marle
- GGZ in Geest Mental Health Care, 1081 HJ Amsterdam, The Netherlands; (L.Y.M.-v.d.R.); (M.E.); (A.W.H.)
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands;
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep Program, 1007 MB Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-7885000
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9
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Boot K, Wiebenga JXM, Eikelenboom M, van Oppen P, Thomaes K, van Marle HJF, Heering HD. Associations between personality traits and suicidal ideation and suicide attempts in patients with personality disorders. Compr Psychiatry 2022; 112:152284. [PMID: 34763292 DOI: 10.1016/j.comppsych.2021.152284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION People with personality disorders (PDs) have an elevated suicide risk. However, correlates of suicidal ideation (SI) and suicide attempts (SA) remain largely unknown in this population. A growing body of literature highlights the contribution of the Big Five personality traits in suicide-outcomes. Therefore, the present study investigates the association between the Big Five personality traits and SI and SA in people with PDs while applying the ideation-to-action framework. METHOD Data were obtained from 105 treatment-seeking individuals diagnosed with PDs participating in the Trauma tO Personality Spectrum Study (TOPSS). Multinomial logistic regression analyses were used to analyze the association between the NEO Five-Factor Inventory and the three category suicide-outcome: non-suicidal, SI, and SA. RESULTS After controlling for age, gender, a comorbid depressive disorder, the severity of borderline manifestations, and other personality traits from the Big Five taxonomy, significantly lower levels of extraversion were observed in participants with SI compared to non-suicidal participants (OR = 0.27, 95% CI 0.10-0.72) but not in SA participants. In contrast, higher levels of extraversion were associated with SA when compared to SI (OR = 3.52, 95% CI 1.33-9.32). Other Big Five traits were not independently associated with suicide-outcomes. CONCLUSIONS Of the Big Five traits, the introversion-extraversion dimension most clearly distinguishes individuals with SI from non-suicidal individuals, as well as those with a SA in the past from those with SI only. Prospective studies are required to investigate if this personality trait can predict the progression from being non-suicidal to having SI and from having SI to performing an attempt.
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Affiliation(s)
- Katja Boot
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands.
| | - Jasper X M Wiebenga
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan, 1117 Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, location VUmc, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Merijn Eikelenboom
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan, 1117 Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, location VUmc, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan, 1117 Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, location VUmc, De Boelelaan, 1117 Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam UMC, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam UMC, location VUmc, De Boelelaan, 1117 Amsterdam, the Netherlands; Sinai Centrum / Arkin Institute for Mental Health, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands.
| | - Hein J F van Marle
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, location VUmc, De Boelelaan, 1117 Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam UMC, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Henriette D Heering
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan, 1117 Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, location VUmc, De Boelelaan, 1117 Amsterdam, the Netherlands.
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10
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Lawson KM, Kellerman JK, Kleiman EM, Bleidorn W, Hopwood CJ, Robins RW. The role of temperament in the onset of suicidal ideation and behaviors across adolescence: Findings from a 10-year longitudinal study of Mexican-origin youth. J Pers Soc Psychol 2022; 122:171-186. [PMID: 33539152 PMCID: PMC8333186 DOI: 10.1037/pspp0000382] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Suicide among young people is an increasingly prevalent and devastating public health crisis around the world. To reduce the rate of suicide, it is important to identify factors that can help us better predict suicidal ideation and behaviors. Adolescent temperament (effortful control, negative emotionality, positive emotionality) may be a source of risk and resilience for the onset of suicidal ideation, plans, and attempts. The present study uses longitudinal data from a large, community sample of Mexican-origin youth (N = 674), assessed annually from age 12 to 21, to examine how temperament is associated with the onset of suicidal ideation and behaviors during adolescence and young adulthood. Results indicate that higher levels of effortful control (activation control, inhibitory control, attention) are associated with decreased probability of experiencing the onset of suicidal ideation, plans, and attempts, whereas higher levels of negative emotionality (particularly aggression, frustration, and depressed mood) are associated with increased probability of experiencing the onset of suicidal ideation and behaviors. Positive emotionality (surgency, affiliation) was not associated with the onset of suicidal ideation and behaviors. Supplemental analyses showed conceptually similar findings for the Big Five, with Conscientiousness associated with decreased risk, Neuroticism associated with increased risk, and the other three dimensions showing largely null results. The findings did not vary significantly for boys and girls or for youth born in the U.S. versus Mexico. Overall, these findings suggest that adolescent temperament serves as both a protective factor (via effortful control/Conscientiousness) and a risk factor (via negative emotionality/Neuroticism) for suicidal ideation and behaviors in Mexican-origin youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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11
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Finch EF, Choi-Kain LW, Iliakis EA, Eisen JL, Pinto A. Good Psychiatric Management for Obsessive–Compulsive Personality Disorder. Curr Behav Neurosci Rep 2021. [DOI: 10.1007/s40473-021-00239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Gregory R, Sperry SD, Williamson D, Kuch-Cecconi R, Spink GL. High Prevalence of Borderline Personality Disorder Among Psychiatric Inpatients Admitted for Suicidality. J Pers Disord 2021; 35:776-787. [PMID: 33661019 DOI: 10.1521/pedi_2021_35_508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borderline personality disorder (BPD) is associated with high risk of suicidality and high rates of health care utilization; however, the prevalence and characteristics of BPD among inpatients admitted for suicidality are unknown. In the present study of 72 adult psychiatric inpatients admitted for suicide risk, BPD was highly prevalent (n = 31; 43.1%), but 68% were misdiagnosed by admitting providers. Compared to patients without BPD, those with BPD were significantly younger, were prescribed more psychiatric medications, were more depressed, and had greater suicide ideation. Patients with BPD were also three times as likely to be readmitted to a psychiatric hospital at 30, 90, and 180 days postdischarge for an average of almost 9 days of inpatient care per patient for the first 180 days. In this sample, BPD was highly prevalent, underdiagnosed, and associated with frequent readmissions, findings that highlight the importance of improved recognition and access to specialized treatments.
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Affiliation(s)
- Robert Gregory
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York
| | - Susan D Sperry
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel Williamson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York
| | | | - Garry L Spink
- College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, New York
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Quesada-Franco M, Pintor-Pérez L, Daigre C, Baca-García E, Ramos-Quiroga JA, Braquehais MD. Medically Serious Suicide Attempts in Personality Disorders. J Clin Med 2021; 10:4186. [PMID: 34575302 PMCID: PMC8469317 DOI: 10.3390/jcm10184186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviors very close to suicides. Personality disorders (PD) are highly prevalent among them, together with affective and substance use disorders. However, few studies have specifically analyzed the role of PD in MSSA. These suicide attempts (SA) are usually followed by longer hospitalization periods and may result in severe physical and psychological consequences. The aim of this study is to compare the profile of MSSA patients with and without PD. MSSA were defined according to Beautrais 'criteria, but had to remain hospitalized ≥48 h. Overall, 168 patients from two public hospitals in Barcelona were evaluated during a three-year period. Mean hospital stay was 23.68 (standard deviation (SD) = 41.14) days. Patients with PD (n = 69) were more likely to be younger, female, make the first and the most serious SA at a younger age, reported recent stressful life-events and more frequently had previous suicide attempts compared to those without PD. However, no differences were found with regards to comorbid diagnoses, current clinical status, features of the attempt, or their impulsivity and hopelessness scores. Therefore, focusing on the subjective, qualitative experiences related to MSSA among PD patients may increase understanding of the reasons contributing to these attempts in order to improve prevention strategies in the future.
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Affiliation(s)
- Marta Quesada-Franco
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.D.); (J.A.R.-Q.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Luis Pintor-Pérez
- Department of Psychiatry, Hospital Clinic, Instituto de Investigaciones Biomédicas Augusto Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.D.); (J.A.R.-Q.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain;
| | - Enrique Baca-García
- Department of Psychiatry, Madrid Autonomous University, 28017 Madrid, Spain;
- CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, 28040 Madrid, Spain
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, 30900 Nîmes, France
- Psychology Department, Universidad Católica de Maule, Talca 3605, Chile
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, 28020 Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.D.); (J.A.R.-Q.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain;
- Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - María Dolores Braquehais
- Biomedical Network Research Centre on Mental Health (CIBERSAM), 08035 Barcelona, Spain;
- Psychiatry, Mental Health and Addictions Research Group, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Integral Care Program for Sick Health Professionals, Galatea Clinic, 08017 Barcelona, Spain
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14
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Mirkovic B, Delvenne V, Robin M, Pham-Scottez A, Corcos M, Speranza M. Borderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation. BMC Psychiatry 2021; 21:393. [PMID: 34372810 PMCID: PMC8351432 DOI: 10.1186/s12888-021-03377-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.
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Affiliation(s)
- Bojan Mirkovic
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, "DevPsy", 94807, Villejuif, France. .,Pôle de psychiatrie de l'enfant et de l'adolescent, Nouvel Hôpital de Navarre, Université de Normandie, Nouvel Hôpital de Navarre, route de Conches, 27000, Évreux, France.
| | - Véronique Delvenne
- grid.412209.c0000 0004 0578 1002Service de Pédopsychiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Marion Robin
- grid.418120.e0000 0001 0626 5681Département de Psychiatrie de l’Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France
| | - Alexandra Pham-Scottez
- grid.414435.30000 0001 2200 9055GHT Paris Psychiatrie et Neurosciences, Centre Hospitalier Sainte Anne, Paris, France
| | - Maurice Corcos
- grid.418120.e0000 0001 0626 5681Département de Psychiatrie de l’Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France
| | - Mario Speranza
- grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, “DevPsy”, 94807 Villejuif, France ,grid.418080.50000 0001 2177 7052Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Centre Hospitalier de Versailles, Versailles, France
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15
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Kimbrel NA, Beckham JC, Calhoun PS, DeBeer BB, Keane TM, Lee DJ, Marx BP, Meyer EC, Morissette SB, Elbogen EB. Development and validation of the Durham Risk Score for estimating suicide attempt risk: A prospective cohort analysis. PLoS Med 2021; 18:e1003713. [PMID: 34351894 PMCID: PMC8341885 DOI: 10.1371/journal.pmed.1003713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Worldwide, nearly 800,000 individuals die by suicide each year; however, longitudinal prediction of suicide attempts remains a major challenge within the field of psychiatry. The objective of the present research was to develop and evaluate an evidence-based suicide attempt risk checklist [i.e., the Durham Risk Score (DRS)] to aid clinicians in the identification of individuals at risk for attempting suicide in the future. METHODS AND FINDINGS Three prospective cohort studies, including a population-based study from the United States [i.e., the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study] as well as 2 smaller US veteran cohorts [i.e., the Assessing and Reducing Post-Deployment Violence Risk (REHAB) and the Veterans After-Discharge Longitudinal Registry (VALOR) studies], were used to develop and validate the DRS. From a total sample size of 35,654 participants, 17,630 participants were selected to develop the checklist, whereas the remaining participants (N = 18,024) were used to validate it. The main outcome measure was future suicide attempts (i.e., actual suicide attempts that occurred after the baseline assessment during the 1- to 3-year follow-up period). Measure development began with a review of the extant literature to identify potential variables that had substantial empirical support as longitudinal predictors of suicide attempts and deaths. Next, receiver operating characteristic (ROC) curve analysis was utilized to identify variables from the literature review that uniquely contributed to the longitudinal prediction of suicide attempts in the development cohorts. We observed that the DRS was a robust prospective predictor of future suicide attempts in both the combined development (area under the curve [AUC] = 0.91) and validation (AUC = 0.92) cohorts. A concentration of risk analysis found that across all 35,654 participants, 82% of prospective suicide attempts occurred among individuals in the top 15% of DRS scores, whereas 27% occurred in the top 1%. The DRS also performed well among important subgroups, including women (AUC = 0.91), men (AUC = 0.93), Black (AUC = 0.92), White (AUC = 0.93), Hispanic (AUC = 0.89), veterans (AUC = 0.91), lower-income individuals (AUC = 0.90), younger adults (AUC = 0.88), and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals (AUC = 0.88). The primary limitation of the present study was its its reliance on secondary data analyses to develop and validate the risk score. CONCLUSIONS In this study, we observed that the DRS was a strong predictor of future suicide attempts in both the combined development (AUC = 0.91) and validation (AUC = 0.92) cohorts. It also demonstrated good utility in many important subgroups, including women, men, Black, White, Hispanic, veterans, lower-income individuals, younger adults, and LGBTQ individuals. We further observed that 82% of prospective suicide attempts occurred among individuals in the top 15% of DRS scores, whereas 27% occurred in the top 1%. Taken together, these findings suggest that the DRS represents a significant advancement in suicide risk prediction over traditional clinical assessment approaches. While more work is needed to independently validate the DRS in prospective studies and to identify the optimal methods to assess the constructs used to calculate the score, our findings suggest that the DRS is a promising new tool that has the potential to significantly enhance clinicians' ability to identify individuals at risk for attempting suicide in the future.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, United States of America
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jean C. Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Patrick S. Calhoun
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, United States of America
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Bryann B. DeBeer
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, Denver, Colorado, United States of America
| | - Terence M. Keane
- National Center for PTSD, Boston, Massachusetts, United States of America
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Daniel J. Lee
- National Center for PTSD, Boston, Massachusetts, United States of America
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Brian P. Marx
- National Center for PTSD, Boston, Massachusetts, United States of America
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Eric C. Meyer
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sandra B. Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Eric B. Elbogen
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
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16
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Abstract
IMPORTANCE Rates of suicide are increasing. Although borderline personality disorder (BPD) and other psychiatric disorders are associated with suicide, there is a dearth of epidemiological research on associations between BPD and suicide attempts (SAs). Delineating the SA risk associated with BPD and its specific criteria in a nationally representative sample of individuals could inform recognition and intervention efforts for SAs. OBJECTIVE To examine the association of a BPD diagnosis and specific BPD criteria with SAs in US adults. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a psychiatric epidemiological survey of noninstitutionalized US adults aged 18 or older conducted from April 2012 to June 2013. Eligible adults were randomly selected from households within census-defined counties or groups of counties. Data were analyzed from December 2020 to January 2021. MAIN OUTCOMES AND MEASURES Prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) psychiatric and personality disorders, BPD and its specific criteria, SAs, and adverse childhood experiences (ACEs), as assessed by structured diagnostic or clinical interviews; prevalence is expressed as weighted means. Multivariable-adjusted logistic regression was used to compare the risk of lifetime and past-year SAs by BPD diagnosis and by each specific BPD criterion. Analyses were adjusted for demographic and clinical factors, including psychiatric comorbidity, age at BPD onset, and ACEs. RESULTS Of 36 309 respondents, 20 442 (56.3%) were women and 52.9% were non-Hispanic White; the mean (SD) age was 45.6 (17.5) years. The prevalence (SE) of lifetime and past-year SAs among participants with a lifetime diagnosis of BPD based on original NESARC-III diagnostic codes was 22.7% (0.8%) (adjusted odds ratio [AOR], 8.40; 95% CI, 7.53-9.37) and 2.1% (0.2%) (AOR, 11.77; 95% CI, 7.86-17.62), respectively. With use of diagnostic codes requiring 5 BPD criteria to meet social-occupational dysfunction, prevalence (SE) of lifetime and past-year SAs was 30.4% (1.1%) (AOR, 9.15; 95% CI, 7.99-10.47) and 3.2% (0.4%) (AOR, 11.42; 95% CI, 7.71-16.91), respectively. After excluding the BPD criterion of self-injurious behavior (to eliminate criterion overlap), the prevalence (SE) of lifetime and past-year SAs was 28.1% (1.1%) (AOR, 7.61; 95% CI, 6.67-8.69) and 3.0% (0.4%) (AOR, 9.83; 95% CI, 6.63-14.55), respectively. In analyses adjusting for sociodemographic variables, psychiatric disorders, age at BPD onset, and ACEs, BPD diagnosis and specific BPD criteria of self-injurious behaviors and chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (BPD diagnosis: AOR, 2.10; 95% CI, 1.79-2.45; self-injurious behaviors: AOR, 24.28; 95 CI, 16.83-32.03; feelings of emptiness: AOR, 1.58; 95% CI, 1.16-2.14) and past-year SAs (BPD diagnosis: AOR, 11.42; 95% CI, 7.71-16.91; self-injurious behaviors: AOR, 19.32; 95% CI, 5.22-71.58; feelings of emptiness: AOR, 1.99; 95% CI, 1.08-3.66). In analysis with BPD criteria simultaneously entered (excluding self-injurious behavior), chronic feelings of emptiness were significantly associated with increased odds of lifetime SAs (AOR, 1.66; 95% CI, 1.23-2.24) and past-year SAs (AOR, 2.45; 95% CI, 1.18-5.08). CONCLUSIONS AND RELEVANCE In a national sample of adults, after adjusting for demographic and clinical variables, a BPD diagnosis and the specific BPD criteria of self-injurious behaviors and chronic emptiness were significantly associated with increased SA risk. Although BPD is a complex heterogeneous diagnosis, the results of this study suggest that the criteria of self-injurious behaviors and chronic feelings of emptiness should be routinely considered in suicide risk assessment.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer
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17
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Yen S, Peters JR, Nishar S, Grilo CM, Sanislow CA, Shea MT, Zanarini MC, McGlashan TH, Morey LC, Skodol AE. Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up. JAMA Psychiatry 2021; 78:187-194. [PMID: 33206138 PMCID: PMC7675214 DOI: 10.1001/jamapsychiatry.2020.3598] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. OBJECTIVE To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. DESIGN, SETTING, AND PARTICIPANTS The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. MAIN OUTCOMES AND MEASURES Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. RESULTS Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. CONCLUSIONS AND RELEVANCE In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.
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Affiliation(s)
- Shirley Yen
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, Massachusetts,Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Shivani Nishar
- Alpert Medical School, Brown University, Providence, Rhode Island
| | | | | | - M. Tracie Shea
- Alpert Medical School, Brown University, Providence, Rhode Island,Providence Veterans Affairs Medical Center, Providence, Rhode Island
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18
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Aouidad A, Cohen D, Mirkovic B, Pellerin H, Garny de La Rivière S, Consoli A, Gérardin P, Guilé JM. Borderline personality disorder and prior suicide attempts define a severity gradient among hospitalized adolescent suicide attempters. BMC Psychiatry 2020; 20:525. [PMID: 33148207 PMCID: PMC7643473 DOI: 10.1186/s12888-020-02930-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) and history of prior suicide attempt (SA) have been shown to be high predictors for subsequent suicide. However, no previous study has examined how both factors interact to modify clinical and suicide severity among adolescents. METHODS This study presents a comprehensive assessment of 302 adolescents (265 girls, mean age = 14.7 years) hospitalized after a SA. To test clinical interactions between BPD and history of prior SA, the sample was divided into single attempters without BPD (non-BPD-SA, N = 80), single attempters with BPD (BPD-SA, N = 127) and multiple attempters with BPD (BPD-MA, N = 95). RESULTS Univariate analyses revealed a severity gradient among the 3 groups with an additive effect of BPD on the clinical and suicide severity already conferred by a history of SA. This gradient encompassed categorical (anxiety and conduct disorders and non-suicidal-self-injury [NSSI]) and dimensional comorbidities (substance use and depression severity) and suicide characteristics (age at first SA). According to regression analyses, the BPD-MA group that was associated with the most severe clinical presentation also showed specific features: the first SA at a younger age and a higher prevalence of non-suicidal self-injury (NSSI) and anxiety disorders. The BPD-MA group was not associated with higher impulsivity or frequency of negative life events. CONCLUSIONS Based on these findings and to improve youth suicide prevention, future studies should systematically consider BPD and the efficacy of reinforcing early interventions for anxiety disorders and NSSI.
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Affiliation(s)
| | - David Cohen
- grid.462015.40000 0004 0617 9849Institut des Systemes Intelligents et de Robotique, Paris, France
| | - Bojan Mirkovic
- grid.417615.00000 0001 2296 5231Hopital Charles Nicolle, Rouen, France
| | - Hugues Pellerin
- grid.411439.a0000 0001 2150 9058Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Angèle Consoli
- grid.411439.a0000 0001 2150 9058Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Jean-Marc Guilé
- grid.134996.00000 0004 0593 702XCentre Hospitalier Universitaire Amiens-Picardie, Amiens, France
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19
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Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). METHODS A literature search was conducted for original articles examining the general and psychiatric populations. RESULTS There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. CONCLUSION The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.
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Forcano L, Fernández-Aranda F, Álvarez-Moya E, Bulik C, Granero R, Gratacòs M, Jiménez-Murcia S, Krug I, Mercader JM, Riesco N, Saus E, Santamaría JJ, Estivill X. Suicide attempts in bulimia nervosa: Personality and psychopathological correlates. Eur Psychiatry 2020; 24:91-7. [DOI: 10.1016/j.eurpsy.2008.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/06/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022] Open
Abstract
AbstractBackgroundLittle evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.MethodFive hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.ResultsLifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).ConclusionOur results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.
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Meaning in life moderates hopelessness, suicide ideation, and borderline psychopathology in participants with eating disorders: A longitudinal study. Clin Psychol Psychother 2020; 27:146-158. [DOI: 10.1002/cpp.2414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/09/2023]
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Söderholm JJ, Socada JL, Rosenström T, Ekelund J, Isometsä ET. Borderline Personality Disorder With Depression Confers Significant Risk of Suicidal Behavior in Mood Disorder Patients-A Comparative Study. Front Psychiatry 2020; 11:290. [PMID: 32362847 PMCID: PMC7181053 DOI: 10.3389/fpsyt.2020.00290] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/24/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE We investigated risk factors for suicidal ideation and behavior among currently depressed patients with major depressive disorder (MDD), major depressive episode (MDE) in bipolar disorder (BD), or MDE with comorbid borderline personality disorder (MDE/BPD). We compared current and lifetime prevalence of suicidal ideation and behavior, and investigated dimensional measures of BPD or mixed affective features of the MDE as indicators of risk. METHODS Based on screening of 1,655 referrals, we recruited 124 psychiatric secondary care outpatients with MDE and stratified them into three subcohorts (MDD, BD, and MDE/BPD) using the Structured Clinical Interview for DSM-IV I and II. We examined suicidal ideation and behavior with the Columbia Suicide Severity Rating Scale (CSSRS). In addition, we quantified the severity of BPD symptoms and BD mixed features both categorically/diagnostically and dimensionally (using instruments such as the Borderline Personality Disorder Severity Index) in two time frames. RESULTS There were highly significant differences between the lifetime prevalences of suicide attempts between the subcohorts, with attempts reported by 16% of the MDD, 30% of the BD, and 60% of the BPD subcohort. Remarkably, the lifetime prevalence of suicide attempts in patients with comorbid BD and BPD exceeded 90%. The severity of BPD features was independently associated with risk of suicide attempts both lifetime and during the current MDE. It also associated in a dose-dependent manner with recent severity of ideation in both BPD and non-BPD patients. In multinominal logistic regression models, hopelessness was the most consistent independent risk factor for severe suicidal ideation in both time frames, whereas younger age and more severe BPD features were most consistently associated with suicide attempts. CONCLUSIONS Among patients with major depressive episodes, diagnosis of bipolar disorder, or presence of comorbid borderline personality features both imply remarkably high risk of suicide attempts. Risk factors for suicidal ideation and suicidal acts overlap, but may not be identical. The estimated severity of borderline personality features seems to associate with history of suicidal behavior and current severity of suicidal ideation in dose-dependent fashion among all mood disorder patients. Therefore, reliable assessment of borderline features may advance the evaluation of suicide risk.
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Affiliation(s)
- John J Söderholm
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - J Lumikukka Socada
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jesper Ekelund
- Department of Psyhiatry, University of Turku and Turku University Central Hospital, Turku, Finland
| | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Guzmán EM, Cha CB, Ribeiro JD, Franklin JC. Suicide risk around the world: a meta-analysis of longitudinal studies. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1459-1470. [PMID: 31485691 DOI: 10.1007/s00127-019-01759-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/20/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred. METHODS We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma. RESULTS Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors. CONCLUSIONS Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.
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Affiliation(s)
- E M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA
| | - C B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA.
| | - J D Ribeiro
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
| | - J C Franklin
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
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Evren C, Karabulut V, Alniak I, Evren B, Carkci OH, Yilmaz Cengel H, Ozkara Menekseoglu P, Cetin T, Bozkurt M, Umut G. Emotion dysregulation and internalizing symptoms affect relationships between ADHD symptoms and borderline personality features among male patients with substance use disorders. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1595271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahap Karabulut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Izgi Alniak
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
| | - Ozlem Helin Carkci
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Hanife Yilmaz Cengel
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Pelin Ozkara Menekseoglu
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Turan Cetin
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Muge Bozkurt
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
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Abstract
Prospective predictors of suicide attempts were assessed in 118 subjects with borderline personality disorder (BPD) after 10 or more years of follow-up. Mean (SD) time to follow-up was 14.4 (4.7) years. Subjects were predominately female (78.8%), Caucasian (81.4%), and of lower socioeconomic status. Initial recruitment was evenly balanced between inpatient, outpatient, and non-patient (community) sources. In the 10-year interval, 55 subjects (46.6%) attempted suicide. Compared to baseline, suicidal ideation, number of attempts, and non-suicidal self-injury diminished markedly. Core symptoms of BPD, substance abuse, and alcohol use disorders decreased significantly; however, major depressive disorder (MDD) remained constant at 50%. Forty-four percent of subjects had poor psychosocial, vocational, and economic outcomes. Psychosocial outcome was independent of suicide history and any treatment. Increased risk was associated with interval hospitalization prior to any attempt (illness severity), as well as poor social, vocational, and psychosocial functioning at baseline.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurel Chiappetta
- Statistics Department, University of Pittsburgh, Pittsburgh, Pennsylvania
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26
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Sher L, Rutter SB, New AS, Siever LJ, Hazlett EA. Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder. Acta Psychiatr Scand 2019; 139:145-153. [PMID: 30353921 DOI: 10.1111/acps.12981] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined gender differences and similarities in aggression, impulsivity, suicidal behaviour, and psychiatric comorbidity in men and women with borderline personality disorder (BPD) compared with healthy controls. METHOD A community sample of 511 participants (healthy controls: 81 men and 82 women; BPD patients: 145 men and 203 women) were rigorously characterized using structured diagnostic interviews and symptom severity assessments. RESULTS In comparison with women with BPD, men were less educated, had higher total Barratt Impulsivity Scale (BIS), BIS-motoric impulsiveness and BIS-non-planning impulsiveness subscale, total Buss-Perry Aggression Questionnaire (BPAQ), and BPAQ-physical aggression subscale scores. Men with BPD were more likely to have comorbid narcissistic, antisocial, paranoid, and schizotypal personality disorders, alcohol and substance use disorders but less likely to have dependent and obsessive-compulsive personality disorders compared to women with BPD. There was a trend toward higher maximum lethality of suicide attempts in men suicide attempters compared with women suicide attempters but no difference between men and women with regard to the proportion of suicide attempters or the number of suicide attempts. CONCLUSION Men with BPD are more impaired and may be at higher risk of dying by suicide compared to women with BPD.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S B Rutter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A S New
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L J Siever
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E A Hazlett
- James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
BACKGROUND A strong association has been shown to exist between schizophrenia and suicide; however, research examining suicidality in the prodromal phase of psychotic disorders is limited. This study aimed to meet this need by examining potential risk factors for lifetime suicide attempts in a population of individuals with attenuated psychosis syndrome (APS), as defined in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders as a condition for further study. METHODS A retrospective chart review was conducted to identify individuals with APS during a 5-year period across a large medical university's inpatient and outpatient settings. Sociodemographic and clinical factors were examined in relation to suicide attempts to identify risk factors for suicide attempts. χ analyses were used to analyze dichotomous variables, and t test analyses were used to compare means of continuous predictors among those with versus without suicide attempts. Final analyses consisted of fitting multivariate logistic regression models to control for sociodemographic factors. RESULTS In total, 26.3% of the APS population had at least 1 lifetime suicide attempt. Six covariates were found to be statistically significant predictors of suicide attempts: Axis II disorders (P=0.006); history of trauma as a whole (P=0.022); the subcategory of sexual trauma (P=0.005); tobacco use (P=0.039); family history of nonpsychotic Axis I disorders (P=0.042); and number of hospitalizations (P=0.001). CONCLUSIONS Suicidality is a prominent feature of APS, and a number of risk factors increase the likelihood of suicide attempts in this population.
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28
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Bhatt M, Perera S, Zielinski L, Eisen RB, Yeung S, El-Sheikh W, DeJesus J, Rangarajan S, Sholer H, Iordan E, Mackie P, Islam S, Dehghan M, Thabane L, Samaan Z. Profile of suicide attempts and risk factors among psychiatric patients: A case-control study. PLoS One 2018; 13:e0192998. [PMID: 29470514 PMCID: PMC5823369 DOI: 10.1371/journal.pone.0192998] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Suicidal behaviour remains challenging for clinicians to predict, with few established risk factors and warning signs among psychiatric patients. AIM We aimed to describe characteristics and identify risk factors for suicide attempts among patients with psychiatric disorders. METHODS Multivariable logistic regression analysis, adjusted for clinically important confounders, was employed to determine risk factors for suicide attempts within a psychiatric patient population. RESULTS The case (n = 146) and control groups (n = 104) did not differ significantly with regards to sociodemographic characteristics. The majority of the participants who had attempted suicide did so with high intent to die, and expected to die without medical intervention. The primary method of attempt was pharmaceutical overdose among the case participants (73.3%). Results showed impulsivity (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.03-1.30) and borderline personality symptoms (OR = 1.07, 95% CI = 1.01-1.13) were significantly associated with attempted suicide. CONCLUSIONS Our findings indicate that known sociodemographic risk factors for suicide may not apply within psychiatric populations. Prevention strategies for suicidal behaviour in psychiatric patients may be effective, including limited access to means for suicide attempts (i.e. excess pharmaceutical drugs) and target screening for high-risk personality and impulsivity traits.
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Affiliation(s)
- Meha Bhatt
- Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Ontario, Canada
| | - Stefan Perera
- Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Ontario, Canada
| | - Laura Zielinski
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca B. Eisen
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Yeung
- Bachelor of Health Sciences Program, McMaster University, Hamilton, Ontario, Canada
| | - Wala El-Sheikh
- Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Jane DeJesus
- Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Heather Sholer
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Pam Mackie
- Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, Ontario, Canada
- System-Linked Research Unit on Health and Social Service Utilization, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addiction Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
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29
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Ammerman BA, Olino TM, Coccaro EF, McCloskey MS. Predicting Nonsuicidal Self-Injury in Borderline Personality Disorder Using Ecological Momentary Assessment. J Pers Disord 2017; 31:844-855. [PMID: 28072044 DOI: 10.1521/pedi_2017_31_278] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is a highly comorbid disorder, and these comorbidities increase the impairment associated with BPD. For example, depression, which occurs in the majority of individuals with BPD, increases the likelihood of an individual with BPD to engage in nonsuicidal self-injury (NSSI). Little research, however, has investigated potential mechanisms of NSSI engagement in this population. The current study aimed to fill this gap by examining momentary experiences, levels of distress tolerance, and NSSI among 51 individuals meeting current diagnostic criteria for BPD and a comorbid depressive disorder. Using data from an ecological momentary assessment across 7 days, it was found that daily urges to hurt oneself and impulsive urges, but not daily negative affect or aggressive urges, predicted NSSI occurrence. Furthermore, low levels of distress tolerance was a stronger predictor of NSSI behavior than daily experiences. These findings have important implications with regard to state versus trait dispositions in NSSI engagement among those with BPD and depression.
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30
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Soloff PH, Chiappetta L. Suicidal Behavior and Psychosocial Outcome in Borderline Personality Disorder at 8-Year Follow-Up. J Pers Disord 2017; 31:774-789. [PMID: 28263092 PMCID: PMC6544464 DOI: 10.1521/pedi_2017_31_280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We sought predictors of both suicidal behavior and psychosocial outcome in subjects with BPD followed for 8 years and asked if there was a relationship between these outcomes. One hundred twenty-three BPD subjects, recruited from inpatient (35.8%), outpatient (30.9%) and community (33.3%) sources, were assessed annually for known risk factors for suicidal behavior. Interval attempts were reported by 25 subjects (20.2%). Increased risk of suicide attempt was associated with negative affectivity, aggression, inpatient recruitment, hospitalizations, minority race, and frequent changes in employment. Decreased risk was associated with increased education. Poor psychosocial outcome was predicted by impulsivity, negative affectivity, and antisocial traits at baseline, and by comorbid MDD at 8-year follow-up. There was no significant relationship between poor psychosocial outcome at 8-year follow-up and risk of suicidal behavior. Predictors of suicidality include modifiable risk factors. Rehabilitation models are needed to address educational and vocational deficits associated with suicidality, especially among minorities.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laurel Chiappetta
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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31
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Turner BJ, Jin HM, Anestis MD, Dixon-Gordon KL, Gratz KL. Personality pathology and intentional self-harm: cross-cutting insights from categorical and dimensional models. Curr Opin Psychol 2017; 21:55-59. [PMID: 29017093 DOI: 10.1016/j.copsyc.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 02/07/2023]
Abstract
This paper reviews current literature on the links between personality pathology and intentional self-harm, including nonsuicidal self-injury (NSSI) and suicidal behaviors. Specifically, this review highlights recent advances stemming from longitudinal, epidemiological, and health registry studies, as well as emerging research on pathological personality traits and intentional self-harm, and integrates current knowledge across dimensional and categorical frameworks to provide recommendations for clinical practice and future research. This review provides strong evidence that personality disorders marked by intense and unstable negative affect, detachment/low extraversion, aggression/hostility, and specific facets of impulsivity may be considered risk factors for suicidal behaviors. Further, there is some evidence of a stronger relation between maladaptive personality traits and suicidal versus non-suicidal intentional self-harm.
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Affiliation(s)
- Brianna J Turner
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
| | - Hyejin M Jin
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606, USA.
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32
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Sher L, Grunebaum MF, Burke AK, Chaudhury S, Mann JJ, Oquendo MA. Depressed Multiple-SuicideAttempters – A High-Risk Phenotype. CRISIS 2017; 38:367-375. [DOI: 10.1027/0227-5910/a000475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract. Background: There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. Aim: This study aimed to examine psychopathology in multiple-suicide attempters. Method: We compared the demographic and clinical features of three groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). Results: We found that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Importantly, multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt compared with attempters. Limitations: The cross-sectional design of the study. Conclusion: Our data suggest that multiple-suicide attempters require careful evaluation as their behavior can have serious medical consequences.
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Affiliation(s)
- Leo Sher
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael F. Grunebaum
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ainsley K. Burke
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sadia Chaudhury
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J. John Mann
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Maria A. Oquendo
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Berman ME, Fanning JR, Guillot CR, Marsic A, Bullock J, Nadorff MR, McCloskey MS. Effect of alcohol dose on deliberate self-harm in men and women. J Consult Clin Psychol 2017; 85:854-861. [PMID: 28581318 DOI: 10.1037/ccp0000222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Nonexperimental survey and field research support the notion that alcohol use may be associated with deliberate self-harm (DSH) across the spectrum of lethality, from nonsuicidal self-injury (NSSI) through suicide. Nonexperimental studies, however, provide limited information about potential causal relationships between alcohol consumption and DSH. Two previous experiments showed that a relatively high-dose of alcohol increases the likelihood of engaging in DSH in men, with DSH defined by the self-administration of a "painful" shock (the self-aggression paradigm [SAP]; Berman & Walley, 2003; McCloskey & Berman, 2003). In this study, we examined whether (a) lower doses of alcohol also elicit DSH, (b) this effect occurs for women as well as men, and (c) individual differences in past nonsuicidal self-injury (NSSI) moderate alcohol's effects on DSH. METHOD Nonalcohol dependent men and women (N = 210) were assigned either to .00%, .05%, .075%, or .100% blood alcohol concentration (BAC) drink conditions and completed a self-rating scale of NSSI (the Deliberate Self-Harm Inventory [DSHI]; Gratz, 2001). As in previous SAP studies, DSH was operationalized by shock setting behavior during a competitive reaction time (RT) game. RESULTS Overall, a greater proportion of participants in the .075% and .100% (but not .050%) alcohol conditions self-selected a "painful" shock to administer compared to participants in the placebo condition. NSSI predicted self-administration of painful shocks, but did not moderate the alcohol effect. CONCLUSIONS Results provide experimental evidence to support the notion that interventions for self-harm should include processes to monitor and limit alcohol intake. (PsycINFO Database Record
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Affiliation(s)
| | - Jennifer R Fanning
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | | | - Angelika Marsic
- Department of Psychology, University of Southern Mississippi
| | - Joshua Bullock
- Department of Psychology, University of Southern Mississippi
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Bolat N, Kadak T, Eliacik K, Sargin E, Incekas S, Gunes H. Maternal and paternal personality profiles of adolescent suicide attempters. Psychiatry Res 2017; 248:77-82. [PMID: 28024181 DOI: 10.1016/j.psychres.2016.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/08/2016] [Accepted: 12/13/2016] [Indexed: 12/20/2022]
Abstract
Personality features have been correlated with suicidal behaviors in recent decades. Given its neurobiological background, Cloninger's model of personality, the Temperament and Character Inventory (TCI), may help to identify the maternal and paternal personality dimensions associated with adolescent suicide attempts. The present study is the first that specifically compares the temperament and character profiles of both mothers and fathers of the adolescent suicide attempters with a control group, by considering the influence of demographic and clinical factors. The study group comprised 117 parents of 71 adolescent suicide attempters and 119 parents of 71 age- and gender-matched adolescents without a suicide attempt included as a control group. The TCI and Brief Symptom Inventory (BSI) were applied to the parents in both groups. Logistic regression analysis, which was performed to adjust confounding factors, demonstrated significantly higher scores for harm avoidance among the mothers and lower scores of self-directedness among the fathers of the adolescent suicide attempters. New psychotherapeutic modalities considering the high-risk parental personality traits would be beneficial to support parent-adolescent relationships and may have a preventative effect on adolescent suicide.
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Affiliation(s)
- Nurullah Bolat
- Department of Child and Adolescent Psychiatry, Tepecik Teaching and Research Hospital, Izmir, Turkey.
| | - Tayyib Kadak
- Department of Child and Adolescent Psychiatry, Istanbul University Cerrahpasa Medical Faculty, İstanbul, Turkey
| | - Kayi Eliacik
- Department of Pediatrics, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Enis Sargin
- Department of Child and Adolescent Psychiatry, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Secil Incekas
- Department of Child and Adolescent Psychiatry, Dortcelik Children Hospital, Bursa, Turkey
| | - Hatice Gunes
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Sher L, Fisher AM, Kelliher CH, Penner JD, Goodman M, Koenigsberg HW, New AS, Siever LJ, Hazlett EA. Clinical features and psychiatric comorbidities of borderline personality disorder patients with versus without a history of suicide attempt. Psychiatry Res 2016; 246:261-266. [PMID: 27728869 DOI: 10.1016/j.psychres.2016.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/31/2016] [Accepted: 10/02/2016] [Indexed: 11/18/2022]
Abstract
Patients with borderline personality disorder (BPD) are at high risk for suicidal behavior. However, many BPD patients do not engage in suicidal behavior. In this study, we compared clinical features of BPD patients with or without a history of suicide attempts and healthy volunteers. Compared with healthy volunteers, both BPD groups had higher Affective Lability Scale (ALS), ALS - Depression-Anxiety Subscale, Barratt Impulsivity Scale (BIS), and Lifetime History of Aggression (LHA) scores and were more likely to have a history of temper tantrums. BPD suicide attempters had higher ALS, ALS - Depression-Anxiety Subscale and LHA scores and were more likely to have a history of non-suicidal self-injury or temper tantrums compared to BPD non-attempters. Also, BPD suicide attempters were more likely to have a history of comorbid major depressive disorder and less likely to have comorbid narcissistic personality disorder (NPD) in comparison to BPD non-attempters. About 50% of study participants in each BPD group had a history of comorbid substance use disorder (SUD). Our study indicates that BPD patients with a history of suicide attempt are more aggressive, affectively dysregulated and less narcissistic than BPD suicide non-attempters.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States.
| | - Amanda M Fisher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Caitlin H Kelliher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Justin D Penner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Harold W Koenigsberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States
| | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Larry J Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
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A Within-Person Analysis of the Association between Borderline Personality Disorder and Alcohol Use in Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:1157-1167. [PMID: 27812907 DOI: 10.1007/s10802-016-0225-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Many studies examining the association between borderline personality disorder (BPD) and alcohol use during adolescence have focused on between-individual differences (rank order stability), comparing whether adolescents with elevated rates of alcohol use have higher BPD symptoms than those with lower rates of alcohol use. As such, the extent to which an individual's alcohol use is associated with concurrent and future BPD symptoms has been relatively unstudied. The current study assessed year-to-year fluctuations in alcohol use and BPD symptoms in a large urban sample of girls from age 14 to age 17 (N = 2450). The primary aim was to examine whether increases in alcohol use were associated with increases in adolescent girls' BPD symptoms in the same year and in the following year. Results of fixed-effects (within-individual) models revealed that even while controlling for the time-varying impact of symptoms of both internalizing and externalizing disorders, prior and concurrent other substance use, and all time invariant, pre-existing differences between individuals, higher past-year alcohol use was associated with higher levels of BPD symptoms. Furthermore, this association did not vary by age, or by sociodemographic factors, including child race and socioeconomic status of the family. The results of this study indicate heightened risk for the exacerbation of BPD symptoms following increases in alcohol use frequency and highlight the potential utility of interventions targeting drinking behavior for preventing escalations in BPD symptoms.
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Tong Y, Phillips MR, Conner KR. DSM-IV Axis II personality disorders and suicide and attempted suicide in China. Br J Psychiatry 2016; 209:319-326. [PMID: 26585099 PMCID: PMC6173803 DOI: 10.1192/bjp.bp.114.151076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are meagre data on Axis II personality disorders and suicidal behaviour in China. AIMS To describe the prevalence of Axis II personality disorders in suicides and suicide attempts in China and to estimate risk for these outcomes associated with personality disorders. METHOD People who died by suicide (n = 151), people who attempted suicide (n = 118) and living community controls (n = 140) were randomly sampled from four Chinese counties and studied using the Structured Clinical Interviews for DSM-IV-TR Axis I Disorders (SCID-I) and Axis II Personality Disorders (SCID-II). We also determined the prevalence of subthreshold versions of ten DSM-IV personality disorders. RESULTS Axis II personality disorders were present in 7% of the suicide group, 6% of the suicide attempt group and 1% of the control group. Threshold and subthreshold personality disorders had adjusted odds ratios (point estimates) in the range of 2.7-8.0 for suicide and for suicide attempts. CONCLUSIONS Axis II personality disorders may confer increased risk for suicidal behaviour in China, but their low prevalence in the community and among people with suicidal behaviour suggests that other personality constructs such as select dimensional traits may be a more fruitful avenue for understanding and preventing suicide in China.
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Affiliation(s)
- Yongsheng Tong
- Yongsheng Tong, MD, PhD, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Michael R. Phillips, MD, MA, MPH, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China; Kenneth R. Conner, PsyD, MPH, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Kenneth R. Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NewYork and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Conway CC, Hammen C, Brennan PA. Optimizing Prediction of Psychosocial and Clinical Outcomes With a Transdiagnostic Model of Personality Disorder. J Pers Disord 2016; 30:545-66. [PMID: 26168327 PMCID: PMC5520625 DOI: 10.1521/pedi_2015_29_218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transdiagnostic models hold promise for transforming research and treatment practices for personality disorders (PDs), but widespread acceptance and implementation of such approaches will require persuasive evidence of construct validity and clinical utility. Toward that end, the authors examined the criterion-related validity of a transdiagnostic PD model in relation to psychosocial and clinical outcomes in a high-risk community sample of 700 young adults. Participants and their mothers completed semistructured interviews to assess young adults' PD symptomatology, psychosocial functioning, suicidality, and mental health treatment use. Bifactor modeling revealed an overarching dimension of PD severity-capturing symptoms across all PD categories-that strongly predicted all functional and clinical outcomes in multivariate analyses. Effect sizes for lower-order, specific PD processes were comparatively modest for functional outcomes; however, they provided clinically significant information about suicide risk and treatment use. The authors discuss implications of a transdiagnostic perspective for research on PD etiology, classification, and treatment.
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Affiliation(s)
| | - Constance Hammen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA
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Mallick F, McCullumsmith CB. Ketamine for Treatment of Suicidal Ideation and Reduction of Risk for Suicidal Behavior. Curr Psychiatry Rep 2016; 18:61. [PMID: 27194043 DOI: 10.1007/s11920-016-0680-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ketamine, an NMDA receptor antagonist with efficacy as a rapid anti-depressant, has early evidence for action to reduce suicidal ideation. This review will explore several important questions that arise from these studies. First, how do we measure reductions in suicidal ideation that occur over minutes to hours? Second, are the reductions in suicidal ideation after ketamine treatment solely a result of its rapid anti-depressant effect? Third, is ketamine only effective in reducing suicidal ideation in patients with mood disorders? Fourth, could ketamine's action lead us to a greater understanding of the neurobiology of suicidal processes? Last, do the reductions in depression and suicidal ideation after ketamine treatment translate into decreased risk for suicidal behavior? Our review concludes that ketamine treatment can be seen as a double-edged sword, clinically to help provide treatment for acutely suicidal patients and experimentally to explore the neurobiological nature of suicidal ideation and suicidal behavior.
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Affiliation(s)
- Faryal Mallick
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Cheryl B McCullumsmith
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA.
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McGinty EE, Choksy S, Wintemute GJ. The Relationship Between Controlled Substances and Violence. Epidemiol Rev 2016; 38:5-31. [DOI: 10.1093/epirev/mxv008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/12/2022] Open
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May AM, Klonsky ED. What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12136] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexis M. May
- Department of Psychology; University of British Columbia; Vancouver BC Canada
| | - E. David Klonsky
- Department of Psychology; University of British Columbia; Vancouver BC Canada
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Jylhä P, Rosenström T, Mantere O, Suominen K, Melartin T, Vuorilehto M, Holma M, Riihimäki K, Oquendo MA, Keltikangas-Järvinen L, Isometsä ET. Personality disorders and suicide attempts in unipolar and bipolar mood disorders. J Affect Disord 2016; 190:632-639. [PMID: 26590510 DOI: 10.1016/j.jad.2015.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/07/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. METHODS Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. RESULTS Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. LIMITATIONS Findings generalizable only to patients with mood disorders. CONCLUSIONS Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
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Affiliation(s)
- Pekka Jylhä
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Tom Rosenström
- IBS, Unit of Personality, Work and Health Psychology,University of Helsinki, Helsinki, Finland
| | - Outi Mantere
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Kirsi Suominen
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; City of Helsinki, Social Services and Healthcare, Department of Mental Health and Substance Abuse, Helsinki, Finland
| | - Tarja Melartin
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Maria Vuorilehto
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Mikael Holma
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Riihimäki
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; Healthcare and Social Services, City of Järvenpää, Järvenpää, Finland
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Erkki T Isometsä
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
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Otsuka K, Nakamura H, Kudo K, Endo J, Sanjo K, Fukumoto K, Hoshi K, Yagi J, Sakai A. The characteristics of the suicide attempter according to the onset time of the suicidal ideation. Ann Gen Psychiatry 2015; 14:48. [PMID: 26719756 PMCID: PMC4696195 DOI: 10.1186/s12991-015-0087-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the timing of development of suicidal ideation and factors associated therewith in suicide attempters who required psychiatric emergency treatment. METHODS Of a total of 2818 suicide attempters in Japan who presented to the primary or secondary emergency department of Iwate Medical University Hospital (hereinafter, referred to as our hospital) or Iwate Prefecture Advanced Emergency and Critical Care Center (hereinafter, referred to as the emergency center), an affiliated institution to our hospital, during the 12-year period from April 1, 2002-March 31, 2014, 2274 patients for whom the timing of development of suicidal ideation was identified were included in the study. The study subjects were classified into three groups according to the timing of development of suicide ideation: the "same-day" group, those who developed suicidal ideation and attempted suicide on the same day; the "short-term" group, those who developed suicidal ideation 2-7 days before attempting suicide; and the "long-term" group, those who developed suicidal ideation more than 7 days before attempting suicide. Factors associated with the development of suicidal ideation in each group were analyzed by a multiple logistic regression analysis with background factors, the diagnosis according to the ICD and the situations before and after the suicide attempt as explanatory variables. RESULTS The same-day group was characterized by a high female ratio, high global functioning, low stress level, non-depressed status and a lack of seeking consultation. In contrast, the long-term group was characterized by low global functioning and a high stress level, suggesting that these patients exhibit consultation behavior, but have not received psychiatric services. In the short-term group, only male gender was identified as a significant factor. DISCUSSION For those patients who developed suicidal ideation and attempted suicide on the same day, treatment strategies focusing on the acquisition of coping skills and stress management are recommended. For those with suicidal ideation lasting for more than a week or recurrent ideation, early detection and subsequent early treatment of such ideation are essential. In intermediate cases, treatment strategies that make the full use of mental health management in the workplace and gate-keeping are likely to be effective.
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Affiliation(s)
- Kotaro Otsuka
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
- />Department of Neuropsychiatry, Iwate Medical University, Morioka, Japan
| | - Hikaru Nakamura
- />Department of Neuropsychiatry, Iwate Medical University, Morioka, Japan
| | - Kaoru Kudo
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
| | - Jin Endo
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
| | - Katsumi Sanjo
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
| | - Kentaro Fukumoto
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
| | - Katsuhito Hoshi
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
| | - Junko Yagi
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
| | - Akio Sakai
- />Department of Disaster and Community Psychiatry, Iwate Medical University, Morioka, Japan
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Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clin Psychol Rev 2015; 43:30-46. [PMID: 26688478 DOI: 10.1016/j.cpr.2015.11.008] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 02/08/2023]
Abstract
Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.
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Affiliation(s)
- Kate H Bentley
- Center for Anxiety and Related Disorders, Boston University, USA.
| | | | - Jessica D Ribeiro
- Department of Psychology, Harvard University, USA; Military Suicide Research Consortium, USA
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Mellesdal L, Gjestad R, Johnsen E, Jørgensen HA, Oedegaard KJ, Kroken RA, Mehlum L. Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm. J Trauma Stress 2015; 28:556-62. [PMID: 26581019 DOI: 10.1002/jts.22053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important predictor of the number of self-harm admissions to general hospitals(B = 1.52, p < .01). Dysregulation predicted self-harm directly (B = 0.28, p < .05), and also through PTSD [corrected]. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients.
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Affiliation(s)
- Liv Mellesdal
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Clinical Institute 1, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Hugo A Jørgensen
- Clinical Institute 1, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Clinical Institute 1, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Capability for suicide interacts with states of heightened arousal to predict death by suicide beyond the effects of depression and hopelessness. J Affect Disord 2015; 188:53-9. [PMID: 26342889 PMCID: PMC4770567 DOI: 10.1016/j.jad.2015.07.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/24/2015] [Accepted: 07/29/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND States of heightened arousal (e.g., agitation, sleep disturbance) have been repeatedly linked to suicidal thoughts and behaviors, including attempts and death. Studies have further indicated that these states may be particularly pernicious among individuals who evidence high suicidal capability. The objective of this study was to examine the interactive effects of heightened arousal and the capability for suicide in the prospective prediction of death by suicide. We examine this relation beyond the effects of robust predictors of suicide, namely depression and hopelessness. METHODS Participants were drawn from a larger study of undergraduates who completed baseline assessments during their freshman year and were then followed to time of death. The sample in this study only included individuals who had died by suicide (n=96) or other causes (n=542). Proxy measures to assess predictor variables were constructed using items from the MMPI, which was administered at baseline. An independent sample of clinical outpatients (n=was used to evaluate the construct validity of the proxy measures). RESULTS Results were in line with expectation: heightened arousal interacted with capability for suicide to prospectively predict death by suicide, such that, as severity of heightened arousal symptoms increased, the likelihood of death by suicide increased among individuals high but not low on capability for suicide. LIMITATIONS Limitations include the use of proxy measures, the extended length of follow-up, and the homogeneity of the sample (i.e., primarily White males). CONCLUSION These findings add to an emerging literature that supports the moderating influence of capability for suicide on the relationship between states of heightened arousal on the likelihood of death by suicide.
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Webber TA, Kiselica AM, Arango A, Rojas E, Neale MC, Bornovalova MA. Unidirectionality Between Borderline Personality Disorder Traits and Psychopathology in a Residential Addictions Sample: A Short-Term Longitudinal Study. J Pers Disord 2015; 29:755-70. [PMID: 25562538 PMCID: PMC4836848 DOI: 10.1521/pedi_2014_28_172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is a barrier to treatment, yet the relationship between BPD features and other psychopathology symptoms in residential addictions treatment samples is understudied. Using a sample of adults enrolled in a residential drug treatment facility measured at baseline and 2-3 month follow-up, the authors examined the prospective relationship between BPD features and five indices of psychopathology: depression, anxiety, interpersonal sensitivity, hostility, and psychoticism, as well as psychopathology global severity. There was no effect of time on any of the forms of psychopathology, but females reported higher levels of BPD features, anxiety symptoms, and interpersonal sensitivity than males. A series of latent change score models indicated that BPD features predicted increases in all psychopathology scales at follow-up, while the reverse was not true. These results suggest that targeting BPD features in residents of drug treatment facilities may reduce the emergence of new psychopathology in the short term.
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Affiliation(s)
- Troy A. Webber
- Department of Psychology, University of South Florida, Tampa, FL
| | | | - Alejandra Arango
- Department of Psychology, University of South Florida, Tampa, FL
| | - Elizabeth Rojas
- Department of Psychology, University of South Florida, Tampa, FL
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Marina A. Bornovalova
- Department of Psychology, University of South Florida, Tampa, FL
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL
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Hayashi N, Igarashi M, Imai A, Yoshizawa Y, Asamura K, Ishikawa Y, Tokunaga T, Ishimoto K, Tatebayashi Y, Kumagai N, Ishii H, Okazaki Y. Pathways from life-historical events and borderline personality disorder to symptomatic disorders among suicidal psychiatric patients: A study of structural equation modeling. Psychiatry Clin Neurosci 2015; 69:563-71. [PMID: 25645160 DOI: 10.1111/pcn.12280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/07/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
AIMS Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated. METHODS The subjects were 155 patients consecutively admitted with SB to a psychiatric center in Tokyo. Structured interviews, including the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, were conducted to determine characteristics of the SB-related factors. To illustrate their interrelation, this study applied the technique of structural equation modeling. The latent constructs of life-historical events, borderline personality disorder (BPD) features and three symptomatic disorders (depression, anxiety disorders and substance dependence) were aligned in the chronological order of their manifestation, and connected one another within the model. Indicator variables of life-historical events were maltreatment in the developmental period and early onset of problematic behaviors. Indicators of BPD features and symptomatic disorders included the scales composed of the items in the SCID-I and II. RESULTS The constructed model with favorable goodness-of-fit indices confirmed that BPD features had a mediating role in which they were influenced by life-historical events, and exerted an influence on the symptomatic disorders. Outside the BPD-mediating paths, the model suggested three clinically interpretable links between life-historical events and symptomatic disorders. CONCLUSIONS The model of this study demonstrated the pathways from life-historical events and BPD to symptomatic disorders, and indicated a generating process of psychiatric comorbidity among suicidal patients. The wide-range view this study portrayed has important clinical implications, and deserves further substantiation by future studies.
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Affiliation(s)
- Naoki Hayashi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Miyabi Igarashi
- Tokyo Metropolitan Chubu Comprehensive Center for Mental Health and Welfare, Tokyo, Japan
| | - Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yuka Yoshizawa
- Osaka Prefectural Tondabayashi Health Center, Osaka, Japan
| | | | | | - Taro Tokunaga
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kayo Ishimoto
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Naoki Kumagai
- Tokyo Government Bureau of Social Welfare and Public Health, Tokyo, Japan
| | - Hidetoki Ishii
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Yuji Okazaki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Michinoo Hospital, Nagasaki, Japan
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50
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Okado Y, Bierman KL. Differential risk for late adolescent conduct problems and mood dysregulation among children with early externalizing behavior problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:735-47. [PMID: 25183553 PMCID: PMC4999081 DOI: 10.1007/s10802-014-9931-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To investigate the differential emergence of antisocial behaviors and mood dysregulation among children with externalizing problems, the present study prospectively followed 317 high-risk children with early externalizing problems from school entry (ages 5-7) to late adolescence (ages 17-19). Latent class analysis conducted on their conduct and mood symptoms in late adolescence revealed three distinct patterns of symptoms, characterized by: 1) criminal offenses, conduct disorder symptoms, and elevated anger ("conduct problems"), 2) elevated anger, dysphoric mood, and suicidal ideation ("mood dysregulation"), and 3) low levels of severe conduct and mood symptoms. A diathesis-stress model predicting the first two outcomes was tested. Elevated overt aggression at school entry uniquely predicted conduct problems in late adolescence, whereas elevated emotion dysregulation at school entry uniquely predicted mood dysregulation in late adolescence. Experiences of low parental warmth and peer rejection in middle childhood moderated the link between early emotion dysregulation and later mood dysregulation but did not moderate the link between early overt aggression and later conduct problems. Thus, among children with early externalizing behavior problems, increased risk for later antisocial behavior or mood dysfunction may be identifiable in early childhood based on levels of overt aggression and emotion dysregulation. For children with early emotion dysregulation, however, increased risk for mood dysregulation characterized by anger, dysphoric mood, and suicidality--possibly indicative of disruptive mood dysregulation disorder--emerges only in the presence of low parental warmth and/or peer rejection during middle childhood.
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Affiliation(s)
- Yuko Okado
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 740, Memphis, TN, 38105, USA,
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