1
|
Zerach G, Levinstein Y, Levi-Belz Y. Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans - The mediating roles of depression and loneliness. J Affect Disord 2024; 350:689-697. [PMID: 38224741 DOI: 10.1016/j.jad.2024.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect. METHODS Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires. RESULTS Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness. LIMITATIONS We used self-report measures to assess PMIEs and SI, which may suffer from various biases. CONCLUSIONS Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.
Collapse
Affiliation(s)
- Gadi Zerach
- Dept. of Psychology, Ariel University, Ariel, Israel.
| | - Yoav Levinstein
- Dept. of Health and Well-being, Medical Corps, IDF, School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| |
Collapse
|
2
|
Peterson A, Chen J, Bozzay M, Bender A, Chu C. Suicide risk profiles among service members and veterans exposed to suicide. J Clin Psychol 2024; 80:65-85. [PMID: 37659101 DOI: 10.1002/jclp.23592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES Rates of suicide exposure are high among service members and Veterans and are especially concerning given the link between suicide exposure and subsequent suicide risk. However, to date, it is unclear which individuals who are exposed to suicide are subsequently at high risk for suicide. Latent profile analysis (LPA) can provide information on unique risk profiles and subgroups of service members and Veterans who have higher suicide risk after suicide exposure, which has not yet been empirically studied. The purpose of this study was to utilize LPA to identify subgroups of service members and Veterans who are at the highest risk for suicidal thoughts and behaviors following suicide exposure. METHODS We analyzed data using LPA from 2570 service members and Veterans (82.1% male, 69.5% White, and 12.1% Latino/a/x) who completed the Military Suicide Research Consortium's Common Data Elements, a battery of self-report suicide-related measures. Psychopathology, substance use, mental health service utilization, interpersonal theory of suicide, and suicide exposure variables were used to validate classes. RESULTS Three latent classes emerged from analyses, one low-risk class and two-high risk classes with differing profile compositions (one primarily differentiated by anxiety symptoms and one differentiated by substance use). CONCLUSION Class-specific recommendations for suicide prevention efforts will be discussed.
Collapse
Affiliation(s)
- Amanda Peterson
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Jason Chen
- Portland VA Health Care System, Portland, Oregon, USA
| | - Melanie Bozzay
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Ansley Bender
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Carol Chu
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
Liu L, Han Y, Lian Y, Wu X, Qiao Z, Wang W. Perceived discrimination and suicidal ideation among impoverished and nonimpoverished college students: Different mechanisms via social support, depressive symptoms, and nonsuicidal self-injury. Suicide Life Threat Behav 2023; 53:910-921. [PMID: 37594174 DOI: 10.1111/sltb.12992] [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: 05/24/2022] [Revised: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Being discriminated against is a potential interpersonal factor leading to suicidal ideation. Compared to nonimpoverished students, impoverished students have disadvantages in different aspects, leading to high risks of negative psychological states. However, few studies have contrasted the mechanism of discrimination in suicidal ideation between impoverished and nonimpoverished college students. The present study aimed to contrast the mediating effects of social support, depressive symptoms, and nonsuicidal self-injury (NSSI) between perceived discrimination and suicidal ideation among impoverished and nonimpoverished college students. METHOD The convenience cluster sampling method was used. A total of 1897 Chinese college students (1084 female; Mage = 19.93, SD = 1.44) participated in the two-wave survey with a six-month interval. RESULTS Perceived discrimination significantly predicted suicidal ideation. Social support, depressive symptoms, and NSSI acted as mediators. However, the structural weights were significantly different between impoverished and nonimpoverished students. Specifically, the role of social support was more significant among impoverished students, while the role of depressive symptoms was more significant among nonimpoverished students. CONCLUSIONS Discrimination is a risk factor leading to suicidal ideation for college students. To intervene in suicidal ideation caused by discrimination, school and social workers should pay extra attention to reduce stress and increase social support for impoverished students.
Collapse
Affiliation(s)
- Luming Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yuchen Han
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yangyu Lian
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
- School of Applied Psychology, Beijing Normal University at Zhuhai, Guangdong, China
| | - Zhihong Qiao
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
- School of Applied Psychology, Beijing Normal University at Zhuhai, Guangdong, China
| |
Collapse
|
4
|
Stanley IH, Marx BP, Fina BA, Young-McCaughan S, Tyler HC, Sloan DM, Blankenship AE, Dondanville KA, Walker JL, Boffa JW, Bryan CJ, Brown LA, Straud CL, Mintz J, Abdallah CG, Back SE, Blount TH, DeBeer BB, Flanagan J, Foa EB, Fox PT, Fredman SJ, Krystal J, McDevitt-Murphy ME, McGeary DD, Pruiksma KE, Resick PA, Roache JD, Shiroma P, Taylor DJ, Wachen JS, Kaplan AM, López-Roca AL, Nicholson KL, Schobitz RP, Schrader CC, Sharrieff AFM, Yarvis JS, Litz BT, Keane TM, Peterson AL. Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans. Assessment 2023; 30:2332-2346. [PMID: 36644835 DOI: 10.1177/10731911221143979] [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] [Indexed: 01/17/2023]
Abstract
We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.
Collapse
Affiliation(s)
- Ian H Stanley
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- University of Colorado, School of Medicine, Aurora, USA
| | - Brian P Marx
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, USA
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Hannah C Tyler
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Denise M Sloan
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | | | | | - James L Walker
- University of Texas Health Science Center at San Antonio, USA
| | - Joseph W Boffa
- Southeast Louisiana Veterans Health Care System, New Orleans, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Chadi G Abdallah
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sudie E Back
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Bryann B DeBeer
- University of Colorado, School of Medicine, Aurora, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Julianne Flanagan
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, USA
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John Krystal
- VA Connecticut Healthcare System, West Haven, USA
- Yale University, New Haven, CT, USA
| | | | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John D Roache
- University of Texas Health Science Center at San Antonio, USA
| | - Paulo Shiroma
- Minneapolis VA Medical Center, MN, USA
- University of Minnesota, Minneapolis, USA
| | | | | | | | | | - Karin L Nicholson
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | | | - Allah-Fard M Sharrieff
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- U.S. Department of Homeland Security, Miami, FL, USA
| | - Jeffrey S Yarvis
- Tulane University School of Medicine, New Orleans, LA, USA
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Brett T Litz
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- Boston University, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| |
Collapse
|
5
|
Vélez-Grau C, Magan IM, Gwadz M. The Burden of Not Belonging: A Qualitative Study of the Applicability of the Interpersonal Theory of Suicide Constructs of Belongingness and Burdensomeness to Ethnocultural Minoritized Youth. Behav Ther 2023; 54:777-793. [PMID: 37597957 DOI: 10.1016/j.beth.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 01/11/2023] [Accepted: 02/14/2023] [Indexed: 08/21/2023]
Abstract
Guided by the Interpersonal Theory of Suicide (IPTS), this study aims to understand the applicability of the constructs of belongingness and burdensomeness and their relevance to suicide risk and mental health among ethnocultural minoritized youth. A qualitative exploratory study was conducted using five focus groups with 29 self-identified Latinx and Black adolescents aged 13-17 years to explore the meaning they ascribed to belongingness and burdensomeness. Views of social media related to these constructs were also explored. Template analysis was used to analyze the data. Themes highlighted dimensions such as caring, self-worth, and liability, congruent with the IPTS dimensions of belongingness and burdensomeness. Notably, new themes emerged reflecting the distinctive experiences of these populations, such as the importance of being true to themselves, the burden of not belonging to families, and cultural aspects of liability, highlighting dimensions not found in the existing IPTS theoretical constructs. Consideration of the diverse experiences of ethnocultural minoritized youth can strengthen theoretical constructs, clinical practice, and aid in developing intervention strategies to increase protective factors and decrease risk factors for suicide behaviors relevant to such youth.
Collapse
Affiliation(s)
| | | | - Marya Gwadz
- New York University Silver School of Social Work; Center for Drug Use and HIV Research NYU Global Public Health
| |
Collapse
|
6
|
Halverson TF, Dillon KH, Weber DM, Dennis PA, Beckham JC, Calhoun PS, Kimbrel NA. Interpersonal stress and nonsuicidal self-injury disorder in veterans: An ecological momentary assessment study. Suicide Life Threat Behav 2023; 53:546-556. [PMID: 37052380 PMCID: PMC10523856 DOI: 10.1111/sltb.12963] [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: 08/10/2022] [Revised: 02/24/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
INTRO Nonsuicidal self-injury (NSSI) is associated with marked functional impairment and is a robust predictor of suicide attempts. Prevalence rates of NSSI, and self-directed violence more broadly, are elevated among military veterans. Despite the inclusion of interpersonal difficulty in the diagnostic criteria for NSSI disorder, the relationship between interpersonal risk factors and NSSI is not well-characterized, especially among veterans. This ecological momentary assessment (EMA) study investigated the hypothesis that interpersonal stressors and associated distress would precede and predict NSSI urge and engagement-but not vice versa-via cross-lagged multilevel modeling. METHOD Forty veterans with NSSI disorder completed a 28-day EMA protocol with three daily prompts assessing NSSI urges, NSSI engagement, the occurrence of interpersonal stressors, and associated subjective interpersonal distress. RESULTS Interpersonal stressors preceded and predicted subsequent NSSI urges, but not NSSI engagement, whereas subjective interpersonal distress preceded and predicted both NSSI urges and NSSI engagement. CONCLUSION Results identified interpersonal stressors as a risk factor for NSSI urges, and interpersonal distress as a risk factor for both NSSI urges and NSSI engagement. Findings highlight the importance of temporally assessing interpersonal factors related to NSSI and suggest that interpersonal distress may be a modifiable risk factor for NSSI.
Collapse
Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Kirsten H Dillon
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Danielle M Weber
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul A Dennis
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| |
Collapse
|
7
|
Lieberman A, Gai AR, Rogers ML, Jobes DA, David Rudd M, Chalker SA, Brenner JT, Joiner TE. Targeting Perceived Burdensomeness to Reduce Suicide Risk. Behav Ther 2023; 54:696-707. [PMID: 37330258 DOI: 10.1016/j.beth.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022]
Abstract
Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one's death is worth more than one's life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches-including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals-explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07-.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts.
Collapse
|
8
|
Gatta M, Raffagnato A, Angelico C, Benini E, Medda E, Fasolato R, Miscioscia M. Externalising Behaviours, Impulsivity, Alexithymia, and Emotional Dysregulation in Adolescents' Suicidality. CLINICAL NEUROPSYCHIATRY 2023; 20:17-28. [PMID: 36936619 PMCID: PMC10016105 DOI: 10.36131/cnfioritieditore20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objective suicide represents the second leading cause of death among adolescents (WHO, 2021). A deeper understanding of the characteristics that lead to it is crucial to increase the ability of clinicians in evaluating, treating, and preventing it. The objective of this study is to analyze the differences in impulsivity, externalizing behaviors, emotion dysregulation, and alexithymia between two groups of adolescents, the first presenting suicidal ideation (SI), the second presenting at least one suicide attempt (SA), in an ideation-to-action framework. Method we conducted a retrospective study with 190 adolescents (M= 14.5, SD age = 1.63; SI: n = 97, SA: n = 93). All were hospitalized in the Complex Operative Child Neuropsychiatry Hospital Unit (UOC-NPI) of the Hospital-University of Padua. Data were collected using the Youth Self-Report (YSR 11-18), Barratt's Impulsiveness Scale (BIS-11) and the Toronto Alexithymia Scale (TAS-20) questionnaires. Results the SA group obtained higher clinical scores in the YSR "rule-breaking behavior" and "conduct problems" scales, and in total TAS-20. Conclusions the role of externalizing problems and alexithymia could open new frontiers in the understanding of suicide. These new data could be useful for the implementation of early screening protocols and for directing clinical interventions, promoting greater emotion regulation and anger management skills among patients.
Collapse
Affiliation(s)
- Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Elena Benini
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Erica Medda
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Rachele Fasolato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padua, Italy
| |
Collapse
|
9
|
Moseley RL, Gregory NJ, Smith P, Allison C, Cassidy S, Baron-Cohen S. Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample. Mol Autism 2022; 13:45. [PMID: 36371252 PMCID: PMC9655904 DOI: 10.1186/s13229-022-00522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one's fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults. METHODS Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI. RESULTS While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability. LIMITATIONS Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community. CONCLUSIONS Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.
Collapse
Affiliation(s)
- Rachel L. Moseley
- grid.17236.310000 0001 0728 4630Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - Nicola J. Gregory
- grid.17236.310000 0001 0728 4630Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - Paula Smith
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sarah Cassidy
- grid.4563.40000 0004 1936 8868School of Psychology, University of Nottingham, Nottingham, UK
| | - Simon Baron-Cohen
- grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Van Wyk JA. Is Violence, Violence no Matter Where it Strikes? Adjudicated Boys, Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20816-NP20846. [PMID: 34841947 DOI: 10.1177/08862605211055080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study explores treating violence against others as a precursor to self-directed violence. It tests the utility of including violence against others in the measure of acquired capability to test assumptions from the interpersonal theory of violence. Four theoretical hypotheses are assessed that are consistent with the theory: (1) thwarted belongingness (parental abandonment and rejection) and perceived burdensomeness (exposure to parental interpersonal violence and child abuse) independently increase the likelihood of suicidal ideation; (2) the interaction of thwarted belongingness and perceived burdensomeness increases the likelihood of suicidal ideation controlling for other pertinent variables; (3) the three-way interaction of thwarted belongingness, perceived burdensomeness, and acquired capability (violence against others and prior suicidal attempts) increases the likelihood of suicidal attempts controlling for other pertinent variables; and (4) self-harm responds to the theoretical variables and similarly, to attempts. Subjects are court-adjudicated males (ages 13-18) who were residents for up to 1 year at the Ocean Tides School and rehabilitation center from 1975-2019. The data span 44 years and include 2195 youth. Depression, drug/alcohol use, race, ethnicity, socioeconomic status, and interaction terms between SES and race and SES and ethnicity are also examined. Backward conditional logistic regression analyses find mixed support for the hypotheses, but strong support for including violence against others in the concept of acquired capability. Support is also found for conceptualizing child abuse and exposure to parental interpersonal violence as perceived burdensomeness in tests of this theory as well as measures of depression. Major implications for programming in the treatment and rehabilitation of delinquent boys include conceptualizing and approaching violence against others as a precursor to suicidal attempts and other self-directed harm.
Collapse
|
11
|
Bayliss LT, Christensen S, Lamont-Mills A, du Plessis C. Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One 2022; 17:e0276070. [PMID: 36301944 PMCID: PMC9612581 DOI: 10.1371/journal.pone.0276070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide capability is theorised to facilitate the movement from suicidal ideation to suicide attempt. Three types of contributors are posited to comprise suicide capability: acquired, dispositional, and practical. Despite suicide capability being critical in the movement from ideation-to-attempt, there has been no systematic synthesis of empirical evidence relating to suicide capability that would enable further development and refinement of the concept. This study sought to address this synthesis gap. A scoping review was conducted on suicide capability studies published January 2005 to January 2022. Eleven electronic databases and grey literature sources were searched returning 5,212 potential studies. After exclusion criteria application, 90 studies were included for final analysis. Results synthesis followed a textual narrative approach allocating studies based on contributors of suicide capability. Most studies focused on investigating only one factor within contributors. Painful and provocative events appear to contribute to acquired capability more so than fearlessness about death. Whilst emerging evidence for dispositional and practical contributors is promising, the small number of studies prevents further conclusions from being drawn. An unexpected additional cognitive contributor was identified. The focus of a single factor from most studies and the limited number of studies on contributors other than acquired capability limits the theoretical development and practical application of suicide capability knowledge. Given that suicide is a complex and multifaceted behaviour, future research that incorporates a combination of contributors is more likely to advance our understandings of suicide capability.
Collapse
|
12
|
Halverson TF, Mann AJD, Zelkowitz RL, Patel TA, Evans MK, Aho N, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury in veterans: Prevalence, clinical characteristics, and gender differences from a national cohort. Psychiatry Res 2022; 315:114708. [PMID: 35868073 PMCID: PMC9378466 DOI: 10.1016/j.psychres.2022.114708] [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: 04/20/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicidal thoughts and behaviors; however, while there are typically only small differences observed in the prevalence of NSSI between men and women, this condition has been largely overlooked and underestimated among men. Assessing NSSI methods more common in men may address misidentification as well as allow for more precise NSSI prevalence estimates. Survey data from a national sample of Gulf War I-Era veterans (N = 1063) was used to estimate the prevalence of NSSI and compare prevalence of NSSI methods between men and women veterans. Demographic and clinical correlates of NSSI engagement were also examined. The national lifetime prevalence rate of NSSI among Gulf War I-Era veterans was 22.40%, whereas the past year prevalence rate was 8.10%. In both men and women, wall/object punching was the most common NSSI method endorsed across the lifetime. Men had slightly higher overall NSSI prevalence rates compared with women. This study highlights the need to systematically assess NSSI, particularly among veterans, to better identify, and consequently treat, NSSI in men. This is the first available prevalence estimate of NSSI to include the assessment of wall/object punching in a national sample of adult veterans.
Collapse
Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston School of Medicine, Boston, MA, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mariah K Evans
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Natalie Aho
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| |
Collapse
|
13
|
Stanley IH, Marx BP, Nichter B, Pietrzak RH. Non-response to questions about suicide ideation and attempts among veterans: Results from the National Health and Resilience in Veterans Study. Suicide Life Threat Behav 2022; 52:763-772. [PMID: 35362636 DOI: 10.1111/sltb.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/28/2021] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Veterans who decline to provide information on their history of self-injurious thoughts and behaviors (SITBs) may be at elevated suicide risk. We examined associations between non-response to a question assessing lifetime SITBs and proxy variables of suicide risk. METHODS In this population-based cross-sectional study of 4069 US veterans, responses to the Suicidal Behaviors Questionnaire-Revised were examined to group veterans into one of three categories: (1) denied lifetime SITBs, (2) reported lifetime SITBs, or (3) declined to respond. RESULTS Overall, 69.5% of veterans denied a SITB history, 29.5% reported a SITB history, and 1.0% declined to provide information regarding SITBs. In adjusted analyses, veterans who declined to provide information on SITBs were significantly more likely than veterans who explicitly denied lifetime SITBs to screen positive for posttraumatic stress disorder; report lifetime non-suicidal self-injury; and report elevated levels of total trauma burden, externalizing behaviors, loneliness, received social support, and provided social support. Across these constructs, veterans who declined to provide SITB information were statistically indistinguishable from veterans who explicitly reported lifetime SITBs. CONCLUSIONS Veterans who decline to provide information about suicidal thoughts and behaviors may represent a covert group at elevated risk for suicide.
Collapse
Affiliation(s)
- Ian H Stanley
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brandon Nichter
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
14
|
Joseph JS, Smith-MacDonald L, Filice MC, Smith MS. Reculturation: A new perspective on military-civilian transition stress. MILITARY PSYCHOLOGY 2022; 35:193-203. [PMID: 37133548 DOI: 10.1080/08995605.2022.2094175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Various forms of assistance are offered to help US Veterans achieve success in their post-military lives in recognition of their service. Despite the many successes, a significant number of Veterans continue to remain at risk for negative mental health outcomes, including suicidality and low levels of life satisfaction. These findings may be due to challenges arising from cultural identity dissonance. Problematic strategies used by Veterans to reduce this dissonance can result in a lack of belongingness, a key component in Joiner's Interpersonal Theory of Suicide. The authors suggest that research on the immigrant experience of acculturation may provide a new perspective to better understand issues of identity and sense of belonging in Veterans. Given that most Veterans return to the culture in which they grew up, the authors offer the term "reculturation." The authors propose clinical psychology focus on exploring the reculturation process of Veterans to support program engagement and suicide prevention.
Collapse
Affiliation(s)
- Jeremy S. Joseph
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meg C. Filice
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - Matthew S. Smith
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| |
Collapse
|
15
|
Schanz CG, Equit M, Schäfer SK, Michael T. Self-directed passive-aggressive behaviour as an essential component of depression: findings from two cross-sectional observational studies. BMC Psychiatry 2022; 22:200. [PMID: 35303807 PMCID: PMC8933131 DOI: 10.1186/s12888-022-03850-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The self-control model of depression suggests depressive symptoms to derive from distorted self-monitoring, dysfunctional self-evaluation and reduced self-reward as well as increased self-punishment. Building on this model a relationship between self-directed passive-aggressive behaviour, that is, harmful inactivity, and depression has been assumed. This association has been supported by a recent study in an inpatient sample. However, it remains unclear if patients with depressive disorders report more self-directed passive-aggressive behaviour than patients without depressive disorders and if self-directed passive aggression mediates the associations between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. METHODS Study 1 compared self-directed passive-aggressive behaviour levels between 220 psychotherapy outpatients with (n = 140; 67.9% female; Mage = 40.0) and without (n = 80; 65.0% female; Mage = 36.2) depressive disorders. Diagnoses were made based on the Structured Clinical Interview for DSM-IV. Study 2 examined self-directed passive-aggressive behaviour as a mediator of the relationship between distorted self-monitoring and dysfunctional self-evaluation and self-reported depressive symptoms in 200 undergraduate Psychology students. RESULTS Compared to outpatients without depressive disorders, outpatients with depressive disorder reported significantly more self-directed passive aggression (d = 0.51). Furthermore, Study 2 verified self-directed passive-aggressive behaviour as a partial mediator of the relationship between dysfunctional attitudes (abcs = .22, 95%-CI: .14, .31), attributional style (abcs = .20, 95%-CI: .13, .27), ruminative response style (abcs = .15, 95%-CI: .09, .21) and depressive symptoms. CONCLUSION Self-directed passive-aggressive behaviour partially mediates the association between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. Future longitudinal studies need to examine a potential causal relationship that would form a base to include interventions targeting self-directed passive-aggressive behaviour in prevention and treatment of depression. TRIAL REGISTRATION Both studies were preregistered at the German Clinical Trials Register ( DRKS00014005 and DRKS00019020 ).
Collapse
Affiliation(s)
- C. G. Schanz
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - M. Equit
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - S. K. Schäfer
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - T. Michael
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| |
Collapse
|
16
|
Martin CE, Pukay-Martin ND, Blain RC, Dutton-Cox C, Chard KM. Suicidal Ideation in a Veterans Affairs Residential Posttraumatic Stress Disorder Treatment Setting: The Roles of Thwarted Belongingness and Perceived Burdensomeness. J Trauma Stress 2021; 34:1188-1198. [PMID: 32598548 DOI: 10.1002/jts.22540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 11/08/2022]
Abstract
Suicide is a significant public health concern, and, specifically, the veteran population has exhibited a 22% higher risk of death by suicide than the general population (Department of Veterans Affairs, 2017). The interpersonal psychological theory of suicide (IPTS; Joiner, 2005) appears to be the most widely researched theory to examine factors associated with suicidal ideation. The IPTS applies to veteran suicidal ideation in that veterans may feel they are burdensome to others or that they do not belong following their transition from active duty. The current study sought to (a) identify the prevalence and correlates of the IPTS constructs perceived burdensomeness and thwarted belongingness; (b) examine the main and interactive effects of these constructs on suicidal ideation; and (c) examine their indirect effects in the associations between posttraumatic stress disorder (PTSD) symptomatology, depressive symptomatology, and substance use with suicidal ideation in a sample of veterans in PTSD residential treatment (N = 125). Regression results demonstrated that perceived burdensomeness was significantly associated with suicidal ideation, β = .50, p < .001; however, thwarted belongingness and the interaction of the two were not. In the models of indirect effects, perceived burdensomeness emerged as the only significant indirect effect in the association between PTSD symptomatology and suicidal ideation, β = .01 (SE = .00), 95% CI [.0050, .0149], as well as between depressive symptomatology and suicidal ideation, β = .02 (SE = .01), 95% CI [.0109, .0311]. Study limitations and future directions are also discussed.
Collapse
Affiliation(s)
- Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Rachel C Blain
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
17
|
Kearns JC, Brown SL, Cero I, Gorman KR, Nock MK, Keane TM, Marx BP. Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans. J Affect Disord 2021; 294:430-440. [PMID: 34320450 PMCID: PMC10910846 DOI: 10.1016/j.jad.2021.07.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among military veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA). METHOD Cross-sectional data were collected from two samples examining suicide risk among veterans receiving inpatient psychiatric care (n = 157) and community-residing veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs. RESULTS SITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient veterans. The time lag between SITBs was not significantly different between groups. Inpatient veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups. LIMITATIONS Limitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI). CONCLUSIONS Veterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.
Collapse
Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA; VA Boston Healthcare System, Boston, MA, USA
| | - Sarah L Brown
- VA Boston Healthcare System, Boston, MA, USA; Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Ian Cero
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kaitlyn R Gorman
- VA Boston Healthcare System, Boston, MA, USA; University of Massachusetts - Boston, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, USA; National Center for PTSD, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, USA; National Center for PTSD, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
18
|
Sels L, Homan S, Ries A, Santhanam P, Scheerer H, Colla M, Vetter S, Seifritz E, Galatzer-Levy I, Kowatsch T, Scholz U, Kleim B. SIMON: A Digital Protocol to Monitor and Predict Suicidal Ideation. Front Psychiatry 2021; 12:554811. [PMID: 34276427 PMCID: PMC8280352 DOI: 10.3389/fpsyt.2021.554811] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Each year, more than 800,000 persons die by suicide, making it a leading cause of death worldwide. Recent innovations in information and communication technology may offer new opportunities in suicide prevention in individuals, hereby potentially reducing this number. In our project, we design digital indices based on both self-reports and passive mobile sensing and test their ability to predict suicidal ideation, a major predictor for suicide, and psychiatric hospital readmission in high-risk individuals: psychiatric patients after discharge who were admitted in the context of suicidal ideation or a suicidal attempt, or expressed suicidal ideations during their intake. Specifically, two smartphone applications -one for self-reports (SIMON-SELF) and one for passive mobile sensing (SIMON-SENSE)- are installed on participants' smartphones. SIMON-SELF uses a text-based chatbot, called Simon, to guide participants along the study protocol and to ask participants questions about suicidal ideation and relevant other psychological variables five times a day. These self-report data are collected for four consecutive weeks after study participants are discharged from the hospital. SIMON-SENSE collects behavioral variables -such as physical activity, location, and social connectedness- parallel to the first application. We aim to include 100 patients over 12 months to test whether (1) implementation of the digital protocol in such a high-risk population is feasible, and (2) if suicidal ideation and psychiatric hospital readmission can be predicted using a combination of psychological indices and passive sensor information. To this end, a predictive algorithm for suicidal ideation and psychiatric hospital readmission using various learning algorithms (e.g., random forest and support vector machines) and multilevel models will be constructed. Data collected on the basis of psychological theory and digital phenotyping may, in the future and based on our results, help reach vulnerable individuals early and provide links to just-in-time and cost-effective interventions or establish prompt mental health service contact. The current effort may thus lead to saving lives and significantly reduce economic impact by decreasing inpatient treatment and days lost to inability.
Collapse
Affiliation(s)
- Laura Sels
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Experimental Clinical and Health Psychology, Faculty Psychology and Educational Sciences, Ghent University, East Flanders, Belgium
| | - Stephanie Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Anja Ries
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Hanne Scheerer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Isaac Galatzer-Levy
- Psychiatry, New York University School of Medicine, New York, NY, United States
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, Swiss Federal Institute of Technology, Zurich, Switzerland
- Department of Management, Technology, and Economics at ETH Zurich, Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Galatzer-Levy I, Abbas A, Ries A, Homan S, Sels L, Koesmahargyo V, Yadav V, Colla M, Scheerer H, Vetter S, Seifritz E, Scholz U, Kleim B. Validation of Visual and Auditory Digital Markers of Suicidality in Acutely Suicidal Psychiatric Inpatients: Proof-of-Concept Study. J Med Internet Res 2021; 23:e25199. [PMID: 34081022 PMCID: PMC8212625 DOI: 10.2196/25199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/15/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple symptoms of suicide risk have been assessed based on visual and auditory information, including flattened affect, reduced movement, and slowed speech. Objective quantification of such symptomatology from novel data sources can increase the sensitivity, scalability, and timeliness of suicide risk assessment. OBJECTIVE We aimed to examine measurements extracted from video interviews using open-source deep learning algorithms to quantify facial, vocal, and movement behaviors in relation to suicide risk severity in recently admitted patients following a suicide attempt. METHODS We utilized video to quantify facial, vocal, and movement markers associated with mood, emotion, and motor functioning from a structured clinical conversation in 20 patients admitted to a psychiatric hospital following a suicide risk attempt. Measures were calculated using open-source deep learning algorithms for processing facial expressivity, head movement, and vocal characteristics. Derived digital measures of flattened affect, reduced movement, and slowed speech were compared to suicide risk with the Beck Scale for Suicide Ideation controlling for age and sex, using multiple linear regression. RESULTS Suicide severity was associated with multiple visual and auditory markers, including speech prevalence (β=-0.68, P=.02, r2=0.40), overall expressivity (β=-0.46, P=.10, r2=0.27), and head movement measured as head pitch variability (β=-1.24, P=.006, r2=0.48) and head yaw variability (β=-0.54, P=.06, r2=0.32). CONCLUSIONS Digital measurements of facial affect, movement, and speech prevalence demonstrated strong effect sizes and linear associations with the severity of suicidal ideation.
Collapse
Affiliation(s)
- Isaac Galatzer-Levy
- Research and Development, AiCure, New York, NY, United States
- Psychiatry, New York University School of Medicine, New York, NY, United States
| | - Anzar Abbas
- Research and Development, AiCure, New York, NY, United States
| | - Anja Ries
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Homan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Sels
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | | | - Vijay Yadav
- Research and Development, AiCure, New York, NY, United States
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Hanne Scheerer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
Jankowski MS, Erdley CA, Schwartz-Mette RA. Social-cognitive risk for suicide and new relationship formation: False perception, self-fulfilling prophecy, or both? Suicide Life Threat Behav 2021; 51:416-428. [PMID: 32918770 DOI: 10.1111/sltb.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the impact of social-cognitive constructs associated with increased suicide risk (i.e., perceived burdensomeness and thwarted belongingness) on relationship formation during real-time interactions of older adolescents with strangers in a dyadic context. METHOD Two hundred and seventy-four older adolescents (61.9% female, M age = 18.96 years) were paired with same-gender strangers and completed a laboratory-based interaction task. Both target participants and their partners answered questions about their interaction at three time points during the 45-min session. Structural equation modeling was used to test hypothesized models. RESULTS Perceived burdensomeness and thwarted belongingness predicted interpersonal consequences during the interaction. In the first model, thwarted belongingness led targets to inaccurately perceive their partners' assessments of the interaction. This misperception negatively impacted the participants' own desires for friendship. In the second model, thwarted belongingness predicted decreases in targets' desire to continue the conversation, whereas perceived burdensomeness predicted higher levels of desire to continue the conversation. For females, thwarted belongingness in particular was related to new relationship formation in these models. Overall, those who desired to continue talking were more likely to like their partner at the end of the conversation. CONCLUSIONS Results add to our understanding of how perceived burdensomeness and thwarted belongingness contribute to increased social alienation, which could serve to increase suicide risk.
Collapse
|
21
|
Forkmann T, Glaesmer H, Paashaus L, Rath D, Schönfelder A, Juckel G, Gauggel S, Beginn-Göbel U, Teismann T. Testing the Four Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality. Behav Ther 2021; 52:626-638. [PMID: 33990238 DOI: 10.1016/j.beth.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18-81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility-at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.
Collapse
Affiliation(s)
| | | | | | - Dajana Rath
- University of Duisburg-Essen; Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH, Aachen
| | | | - Georg Juckel
- LWL-University Hospital, Ruhr-Universität Bochum
| | - Siegfried Gauggel
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH, Aachen
| | | | | |
Collapse
|
22
|
Chu C, Zuromski KL, Bernecker SL, Gutierrez PM, Joiner TE, Liu H, Naifeh JA, Stein MB, Ursano RJ, Nock MK. A test of the interpersonal theory of suicide in a large, representative, retrospective and prospective study: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Behav Res Ther 2020; 132:103688. [PMID: 32731055 PMCID: PMC10351027 DOI: 10.1016/j.brat.2020.103688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
The interpersonal theory of suicide hypothesizes that perceived burdensomeness, thwarted belongingness, and hopelessness lead to active suicidal thoughts and individuals with active suicidal thoughts and elevated capability for suicide are most likely to attempt suicide. We retrospectively and prospectively tested this theory in a large sample of 7677 U.S. Army soldiers followed post-deployment for up to nine months. The interaction of perceived burdensomeness and hopelessness (OR = 2.59) was significantly associated with lifetime suicidal thoughts; however, the interactions of thwarted belongingness and perceived burdensomeness and of thwarted belongingness and hopelessness were not. Consistent with the theory, capability for suicide prospectively predicted suicide attempts during and following deployment (OR = 1.22); however, among soldiers reporting lifetime suicidal thoughts, capability did not predict attempts, only perceived burdensomeness did (OR = 1.36). Results supported some, but not all, theory hypotheses, suggesting that additional constructs may be needed to better identify the psychological factors that lead soldiers to attempt suicide.
Collapse
Affiliation(s)
- Carol Chu
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; University of Colorado School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| |
Collapse
|
23
|
Lear MK, Penzenik ME, Forster JE, Starosta A, Brenner LA, Nazem S. Characteristics of nonsuicidal self-injury among veterans. J Clin Psychol 2020; 77:286-297. [PMID: 32662073 DOI: 10.1002/jclp.23027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study aimed to (a) assess basic nonsuicidal self-injury (NSSI) characteristics using a validated clinical interview among a sample of veterans not recruited for specific diagnostic or environmental criteria and (b) examine the relation between NSSI and medical severity of prior suicide attempts (SAs) among veterans. DESIGN We conducted secondary data analyses among a combined sample of veterans (N = 165) from two parent studies conducted at a large VA Medical Center that implemented identical recruitment protocols. No psychiatric criteria were utilized for inclusion or exclusion purposes. RESULTS Approximately 16% of participants reported NSSI history and almost 21% reported SA history. NSSI history was associated with probability of prior SA but not the medical severity of prior SA. CONCLUSIONS NSSI is a prevalent concern among veterans and is associated with probability of SA. It remains unclear whether prior NSSI is associated with more medically serious SA in this population.
Collapse
Affiliation(s)
- Mary K Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, Oregon, USA
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
24
|
Kramer EB, Gaeddert LA, Jackson CL, Harnke B, Nazem S. Use of the acquired capability for suicide scale (ACSS) among United States military and Veteran samples: A systematic review. J Affect Disord 2020; 267:229-242. [PMID: 32217223 DOI: 10.1016/j.jad.2020.01.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/26/2019] [Accepted: 01/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military personnel and Veterans are at increased risk for suicide. Theoretical and conceptual arguments have suggested that elevated levels of acquired capability (AC) could be an explanatory factor accounting for this increased risk. However, empirical research utilizing the Acquired Capability for Suicide Scale (ACSS) in military populations has yielded mixed findings. METHODS To better ascertain what factors are associated with AC, and whether methodological limitations may be contributing to mixed findings, a systematic review was conducted. RESULTS A total of 31 articles utilized the ACSS to examine factors associated with AC, including combat history, in United States (U.S.) military personnel and Veterans. Nearly all studies (96.8%) were rated high risk of bias. Use of the ACSS varied, with seven different iterations utilized. Nearly all studies examined correlations between the ACSS and sample characteristics, mental health and clinical factors, Interpersonal Theory of Suicide constructs, and/or suicide-specific variables. Results of higher-level analyses, dominated by cross-sectional designs, often contradicted correlational findings, with inconsistent findings across studies. LIMITATIONS Included studies were non-representative of all U.S. military and Veteran populations and may only generalize to these populations. CONCLUSIONS Due to the high risk of bias, inconsistent use of the ACSS, lack of sample heterogeneity, and variability in factors examined, interpretation of current ACSS empirical data is cautioned. Suggestions for future research, contextualized by these limitations, are discussed.
Collapse
Affiliation(s)
- Emily B Kramer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Laurel A Gaeddert
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Christine L Jackson
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E. Montview Blvd., MS A003, Aurora, CO 80045, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA; Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, 13001 E. 17th Place, Room C2000C, Aurora, CO 80045, USA.
| |
Collapse
|
25
|
Aboussouan A, Snow A, Cerel J, Tucker RP. Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans. J Affect Disord 2019; 259:186-194. [PMID: 31446379 DOI: 10.1016/j.jad.2019.08.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/10/2019] [Accepted: 08/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. METHOD Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. RESULTS Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. LIMITATIONS The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. CONCLUSION NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.
Collapse
Affiliation(s)
- Alix Aboussouan
- Louisiana State University, 216 Audubon, Baton Rouge, LA 70803, United States.
| | | | | | - Raymond P Tucker
- Louisiana State University, 216 Audubon, Baton Rouge, LA 70803, United States
| |
Collapse
|
26
|
Blow AJ, Farero A, Ganoczy D, Walters H, Valenstein M. Intimate Relationships Buffer Suicidality in National Guard Service Members: A Longitudinal Study. Suicide Life Threat Behav 2019; 49:1523-1540. [PMID: 30507054 DOI: 10.1111/sltb.12537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Members of the U.S. military are at a high suicide risk. While studies have examined predictors of suicide in the U.S. military, more studies are needed which examine protective factors for suicide. Informed by the interpersonal theory of suicide, this study examined the strength of the intimate relationship and its role as a buffer of suicidality in National Guard service members. METHOD A total of 712 National Guard residing in a Midwestern state, who had all recently returned home from a deployment, took part in this study and completed surveys at 6 and 12 months postdeployment. They were assessed on suicide risk, mental health (depression, post-traumatic stress disorder, anxiety), and relationship satisfaction. RESULTS Lower relationship satisfaction and more depressive symptoms at the 6-month assessment were significantly related to greater suicide risk at 12 months. Each interaction between couple satisfaction and three mental health variables (PTSD, depression, and anxiety) at the 6-month assessment was significantly associated with suicide risk at 12 months. CONCLUSIONS The strength of the intimate relationship serves as a buffer for suicide in National Guard service members who have PTSD, anxiety, or depression. Interventions that strengthen these intimate relationships could reduce suicide in service members.
Collapse
Affiliation(s)
- Adrian J Blow
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Adam Farero
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Dara Ganoczy
- Veterans Health Administration, Ann Arbor, MI, USA
| | | | - Marcia Valenstein
- Department of Psychiatry University of Michigan and VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI, USA
| |
Collapse
|
27
|
Yalch MM, Burkman KM. Applying contemporary interpersonal theory to the study of trauma. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2019. [DOI: 10.1016/j.ejtd.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
28
|
Molaie AM, Chiu CY, Habib Z, Galynker I, Briggs J, Rosenfield PJ, Calati R, Yaseen ZS. Emotional Pain Mediates the Link Between Preoccupied Attachment and Non-suicidal Self-Injury in High Suicide Risk Psychiatric Inpatients. Front Psychol 2019; 10:289. [PMID: 30846949 PMCID: PMC6393353 DOI: 10.3389/fpsyg.2019.00289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Non-suicidal self-injury (NSSI) is a risk factor for suicide attempts (SA). Both attachment disturbances and cognitive and emotional problems (e.g., emotional pain) have been associated with SA history. This study sought to determine differential contributions of attachment styles and cognitive and emotional states associated with SA to lifetime NSSI occurrence among adults hospitalized for suicide risk. Sampling and Methods: Adult psychiatric inpatients (n = 200) were assessed for attachment style, cognitive and emotional states, and lifetime NSSI within 72 h of hospitalization. Binary logistic regression and mediation analyses were performed. Results: Preoccupied attachment and emotional pain at admission were independently associated with lifetime NSSI. Emotional pain partially mediated the relationship between preoccupied attachment and lifetime NSSI. Limitations: The cross-sectional nature of the study and the use of a dichotomous (yes/no) measure of NSSI, not specifically designed for its assessment. Conclusions: Preoccupied attachment and emotional pain are associated with NSSI and may be useful targets for assessing risk of NSSI.
Collapse
Affiliation(s)
- Ali M Molaie
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Chih-Yun Chiu
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Zara Habib
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Jessica Briggs
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Paul J Rosenfield
- Department of Psychiatry, Mount Sinai St. Luke's and Mount Sinai West, New York, NY, United States
| | - Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| | - Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
| |
Collapse
|
29
|
Stanley IH, Boffa JW, Rogers ML, Hom MA, Albanese BJ, Chu C, Capron DW, Schmidt NB, Joiner TE. Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. J Consult Clin Psychol 2018; 86:946-960. [PMID: 30335426 PMCID: PMC6469498 DOI: 10.1037/ccp0000342] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Suicide is a global public health concern. To inform the prevention and treatment of suicidality, it is crucial to identify transdiagnostic vulnerability factors for suicide and suicide-related conditions. One candidate factor is anxiety sensitivity (AS)-the fear of anxiety-related sensations-which has been implicated in the pathogenesis of a host of mental health outcomes, including suicidal thoughts and behaviors. Importantly, AS is distinct from trait anxiety and negative affectivity, highlighting its potential incremental utility in the understanding of psychopathology. Despite a burgeoning body of literature demonstrating that AS is linked to suicidal thoughts and behaviors, this research has yet to be synthesized. METHOD This meta-analysis includes 33 articles representing 34 nonredundant samples (N = 14,002) that examined at least one relationship between AS global or subfactor (i.e., cognitive, physical, social) scores and suicidal ideation and/or suicide risk. RESULTS Findings revealed small-to-moderate and moderate associations between global AS and suicidal ideation (r = .24, 95% confidence interval (CI): [.21, .26], p < .001) and suicide risk (r = .35, 95% CI [.31, .38], p < .001), respectively. All AS subfactors evinced significant associations with suicidal ideation (rs = .13-.24) and suicide risk (rs = .22-.32). CONCLUSIONS AS is related to suicidal ideation and global suicide risk. Research is needed to disentangle AS from other indices of distress in the prediction of suicidal thoughts and behaviors. Theoretical and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi
| | | | | |
Collapse
|
30
|
Mbroh H, Zullo L, Westers N, Stone L, King J, Kennard B, Emslie G, Stewart S. Double trouble: Nonsuicidal self-injury and its relationship to suicidal ideation and number of past suicide attempts in clinical adolescents. J Affect Disord 2018; 238:579-585. [PMID: 29945076 DOI: 10.1016/j.jad.2018.05.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/22/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Death by suicide is one of the leading causes of mortality among adolescents, and nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicide attempts (SAs). The underlying bases for this relationship are unknown. We derived two hypotheses from the Interpersonal Psychological Theory of Suicide (IPTS): unmet interpersonal needs would explain NSSI's association with suicidal ideation (SI) and increased capability for suicide would explain NSSI's relationship with SA. METHODS Adolescents hospitalized on a psychiatric inpatient unit (N = 289) provided measures of current SI, number of past SAs, unmet interpersonal needs (perceived burdensomeness and thwarted belongingness), capability for suicide (fearlessness about death [FAD] and pain tolerance), depressive symptoms, and number of NSSI methods utilized. RESULTS Depressive symptoms, but not unmet interpersonal needs, explained NSSI's association with SI. FAD and SI, but not depressive symptoms or pain tolerance, accounted for NSSI's relationship with SA. FAD was associated with SA, but it did not fully account for NSSI's relationship with SA. LIMITATIONS This study utilized a cross-sectional design and retrospective, self-report measures. CONCLUSIONS Our study provides partial support for the role of the IPTS variables in NSSI's relationship with SA in adolescents. The finding that depressive symptoms and not unmet interpersonal needs explained NSSI's relationship with SI contradicts the IPTS. However, in those with SI, FAD was linearly associated with SA, which is consistent with the IPTS. Future studies are needed to clarify the persistent basis for NSSI's relationship with SA beyond FAD and SI.
Collapse
Affiliation(s)
- Hayden Mbroh
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Lucas Zullo
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Nicholas Westers
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Laura Stone
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Jessica King
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Betsy Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Graham Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
| | - Sunita Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Department of Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States.
| |
Collapse
|