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Richard-Devantoy S, Berlim MT, Garel N, Inja A, Turecki G. The impact of antidepressant treatment on the network structure of neurocognition and core emotional depressive symptoms among depressed individuals with a history of suicide attempt: An 8-week clinical study. J Affect Disord 2024; 361:425-433. [PMID: 38823590 DOI: 10.1016/j.jad.2024.05.111] [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: 01/15/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND A more in-depth understanding of the relationship between depressive symptoms, neurocognition and suicidal behavior could provide insights into the prognosis and treatment of major depressive disorder (MDD) and suicide. We conducted a network analysis among depressed patients examining associations between history of suicide attempt (HSA), core emotional major depression disorder, and key neurocognitive domains. METHOD Depressed patients (n = 120) aged 18-65 years were recruited from a larger randomized clinical trial conducted at the Douglas Institute in Montreal, Canada. They were randomly assigned to receive one of two antidepressant treatments (i.e., escitalopram or desvenlafaxine) for 8 weeks. Core emotional MDD and key neurocognitive domains were assessed pre-post treatment. RESULTS At baseline, an association between history of suicide attempt (HSA) and phonemic verbal fluency (PVF) suggested that HSA patients reported lower levels of the latter. After 8 weeks of antidepressant treatment, HSA became conditionally independent from PVF. Similar results were found for both the HAM-D and the QIDS-SR core emotional MDD/neurocognitive networks. CONCLUSION Network analysis revealed a pre-treatment relationship between a HSA and decreased phonemic VF among depressed patients, which was no longer present after 8 weeks of antidepressant treatment.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada.
| | - Marcelo T Berlim
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Nicolas Garel
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Ayla Inja
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Gustavo Turecki
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada.
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Bornheimer LA, Verdugo JL, Brdar NM, Im V, Jeffers N, Bushnell CB, Hoener K, Tasker M, DeWeese K, Florence T, Jester JM, King CA, Taylor SF, Himle JA. A cognitive-behavioral treatment for suicide prevention among adults with schizophrenia spectrum disorders in community mental health: Study protocol for a pilot feasibility and acceptability randomized clinical trial. Pilot Feasibility Stud 2024; 10:99. [PMID: 38997747 PMCID: PMC11241875 DOI: 10.1186/s40814-024-01523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Suicide is among the leading causes of death for adults with schizophrenia spectrum disorders (SSDs), and there is a paucity of evidence-based suicide prevention-focused interventions tailored for this vulnerable population. Cognitive-Behavioral Suicide Prevention for psychosis (CBSPp) is a promising intervention developed in the UK that required modifications for delivery in community mental health (CMH) settings in the United States of American. This pilot trial evaluates the feasibility, acceptability, and preliminary effectiveness of our modified CBSPp intervention in comparison to services as usual (SAU) within a CMH setting in a Midwestern state of the USA. METHODS This is a single-site randomized pilot trial with a planned enrollment of 60 adults meeting criteria for both SSD and SI/A. Eligible participants will be randomized 1:1 to either 10 sessions of CBSPp or SAU. Clinical and cognitive assessments will be conducted within a 4-waive design at baseline (prior to randomization and treatment) and approximately 1 month (mid-treatment), 3 months (post-treatment), and 5 months (follow-up) after baseline assessment. Qualitative interviews will also be conducted at post-treatment. The primary objective is to determine whether CBSPp is feasible and acceptable, involving examinations of recruitment rate, treatment engagement and adherence, retention and completion rates, and experiences in the CBSPp treatment and overall study. The secondary objective is to preliminarily evaluate whether modified CBSPp is associated with reductions in clinical (suicide ideation, suicide attempt, symptoms of psychosis, depression, and emergency/hospital service, hopelessness, defeat, and entrapment) and cognitive (information processing biases, appraisals, and schemas) outcomes in comparison to SAU from baseline to post-treatment assessment. DISCUSSION This randomized pilot trial will provide clinically relevant information about whether CBSPp can improve SI/A, depression, and psychosis among adults with SSDs. Testing this modified cognitive-behavioral suicide prevention-focused intervention has the potential for a large public health impact by increasing the intervention's utility and usability in CMH where many individuals with SSDs receive care, and ultimately working towards reductions in premature suicide death. TRIAL REGISTRATION ClinicalTrials.gov NCT#05345184. Registered on April 12, 2022.
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Affiliation(s)
- Lindsay A Bornheimer
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA.
| | | | - Nicholas M Brdar
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Vitalis Im
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Nakea Jeffers
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Katie Hoener
- Washtenaw County Community Mental Health, Ann Arbor, MI, USA
| | - Melisa Tasker
- Washtenaw County Community Mental Health, Ann Arbor, MI, USA
| | - Krista DeWeese
- Washtenaw County Community Mental Health, Ann Arbor, MI, USA
| | | | - Jennifer M Jester
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Cheryl A King
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Joseph A Himle
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
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Brüdern J, Spangenberg L, Stein M, Forkmann T, Schreiber D, Stengler K, Gold H, Glaesmer H. Implicit measures of suicide vulnerability: Investigating suicide-related information-processing biases and a deficit in behavioral impulse control in a high-risk sample and healthy controls. Behav Res Ther 2024; 180:104601. [PMID: 38943987 DOI: 10.1016/j.brat.2024.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE Relevant implicit markers of suicidal thoughts and behaviors (STBs) have only been studied in isolation with mixed evidence. This is the first study that investigated a suicide attentional bias, a death-identity bias and a deficit in behavioral impulsivity in a high-risk sample and healthy controls. METHOD We administered the Death Implicit Association Test, the Modified Suicide Stroop Task, and a Go/No-Go Task to inpatient suicide ideators (n = 42), suicide attempters (n = 40), and community controls (n = 61). RESULTS Suicide ideators and attempters showed a suicide attentional bias and a death-identity bias compared to healthy controls. Ideators and attempters did not differ in these implicit information-processing biases. Notably, only attempters were more behaviorally impulsive compared to controls; however, ideators and attempters did not significantly differ in behavioral impulsivity. Moreover, implicit scores were positively intercorrelated in the total sample. CONCLUSION In line with the Cognitive Model of Suicide, ideators and attempters display suicide-related information processing biases, which can be considered as implicit cognitive markers of suicide vulnerability. Furthermore, attempters have elevated levels of behavioral impulsiveness. These results are highly relevant in the context of crisis intervention strategies and warrant further research.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Maria Stein
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital Leipzig, Germany
| | - Helena Gold
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
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Rogers ML, Carosa CL, Haliczer LA, Hughes CD, Schofield CA, Armey MF. The Suicide Dot Probe Task: Psychometric properties and validity in relation to suicide-related outcomes. Suicide Life Threat Behav 2023; 53:1010-1024. [PMID: 37702551 DOI: 10.1111/sltb.12999] [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: 03/14/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Attentional biases to suicide-related stimuli have been linked to suicide-related outcomes. However, behavioral tasks that have been previously modified to capture suicide-specific attentional biases have demonstrated inconsistent reliability and validity. Adaptation of the Dot Probe Task, a computerized assessment that has been adapted to study a wide variety of biases, may be a promising candidate for assessing suicide-specific biases. METHODS In 280 recently discharged inpatients (51% male; Mage = 40.22 years), we evaluated the psychometric properties of a modified Suicide Dot Probe Task. Participants completed this task and assessments of suicidal thoughts and behaviors at baseline and 6-month follow-up. RESULTS The Suicide Dot Probe Task demonstrated poor-to-moderate internal consistency and poor test-retest reliability, and participant response times were slower to suicide-specific and dysphoric stimuli than positive stimuli. However, there were no differences based on the presence or characteristics of recent or lifetime suicidal ideation or attempts. Participants' suicide-specific biases were not predictive of suicidal ideation or attempts at follow-up. CONCLUSIONS The Suicide Dot Probe Task exhibited questionable reliability, and differences in attentional biases were not associated with suicidal ideation or attempts. This study contributes to a body of research demonstrating the questionable utility of several behavioral tasks to study suicide-specific attentional biases.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Catarina L Carosa
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Lauren A Haliczer
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher D Hughes
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Michael F Armey
- Butler Hospital, Providence, Rhode Island, USA
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
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5
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Quigley L, Dobson KS, Russell K, Sears CR. Negative affective priming: Reliability and associations with depression symptoms in three samples. Behav Res Methods 2023:10.3758/s13428-023-02248-5. [PMID: 37801214 DOI: 10.3758/s13428-023-02248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
The negative affective priming (NAP) task is a behavioral measure of inhibition of emotional stimuli. Previous studies using the NAP task have found that individuals with depression show reduced inhibition of negative stimuli, suggesting that inhibition biases may play a role in the etiology and maintenance of depression. However, the psychometric properties of the NAP task have not been evaluated or reported. In the present study, we report data on the association between NAP task performance and depression symptoms in three independent samples, and we evaluate the internal consistency and test-retest reliability of the NAP effect indices. The NAP effect for both negative and positive target words had poor internal consistency in all three samples, as well as poor 2-week (Study 2) and 6-month (Study 3) test-retest reliability. The internal consistency and test-retest reliability of response times (RT) for the individual trial types were moderate to high, as were the intercorrelations between trial types. This pattern of results indicates that overall RT is reliable but variance in RTs for the different trial types in the NAP task is indistinguishable from variance in overall RT. Depression symptom severity was not associated with the NAP effect for negative or positive target words in any of the samples, which could be due to the poor reliability of the NAP effect. Based on these findings, we do not recommend that researchers use the NAP task as a measure of individual differences in the inhibition of emotional stimuli.
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Affiliation(s)
- Leanne Quigley
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Keith S Dobson
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kristin Russell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Shin KE, Baroni A, Gerson RS, Bell KA, Pollak OH, Tezanos K, Spirito A, Cha CB. Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01507-y. [PMID: 36821015 DOI: 10.1007/s10578-023-01507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10-17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08-0.87, ORs = 0.96-3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge.
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Affiliation(s)
- Ki Eun Shin
- Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ruth S Gerson
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Kerri-Anne Bell
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine Tezanos
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA.
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7
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Rosario-Williams B, Akter S, Kaur S, Mirada R. Suicide-related construct accessibility and attention disengagement bias in suicide ideation. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:173-184. [PMID: 36808961 PMCID: PMC10042265 DOI: 10.1037/abn0000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Previous attempts to determine whether attention bias toward suicide-related stimuli is associated with risk for future suicide attempts have yielded mixed findings that have been difficult to replicate. Recent evidence suggests that methods used to assess attention bias toward suicide-specific stimuli have low reliability. The present study used a modified attention disengagement and construct accessibility task to examine suicide-specific disengagement biases, along with cognitive accessibility of suicide-related stimuli, among young adults with different histories of suicide ideation. Young adults (N = 125; 79% women), screened for moderate-to-high levels of anxiety or depressive symptoms completed an attention disengagement and lexical decision (cognitive accessibility) task, along with self-report measures of suicide ideation and clinical covariates. Findings using generalized linear mixed-effects modeling revealed that young adults with recent suicide ideation displayed a suicide-specific facilitated disengagement bias, compared to peers with lifetime ideation. In contrast, there was no evidence of a construct accessibility bias for suicide-specific stimuli, irrespective of suicide ideation history. These findings point to a suicide-specific disengagement bias that may depend on the recency of suicidal thoughts and suggests automatic processing of suicide-specific information. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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8
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Mandel AA, Revzina O, Jessani Z, Brown GK. Revised Attentional Fixation on Suicide Experiences Questionnaire and its relationship with suicidal ideation and behavior: A cross-sectional study. Suicide Life Threat Behav 2022; 52:1096-1109. [PMID: 35838112 DOI: 10.1111/sltb.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ) was developed to measure attentional fixation on suicide, a cognitive process characterized by a preoccupation with suicide as a solution. This study investigated a revised version (AFSEQ-R) and examined differences between those who made a recent suicide attempt and those with suicidal ideation (SI). METHOD Participants were 57 inpatients who attempted suicide within 14 days of study participation and 57 inpatients who presented with SI but no suicidal behavior within the past year. Analyses examined the internal reliability, multidimensionality, and construct validity of the AFSEQ-R, and whether attentional fixation moderated the correlation between SI and attempt status. RESULTS Exploratory factor analysis revealed a two-factor structure, and subscale and total scores demonstrated excellent internal consistency. Cognitive Stuckness (and total score) correlated with SI, anxiety, impulsivity, and specific problem-solving deficits, while Cognitive Dysfunction correlated with anxiety and acted as a moderator of the correlation between Stuckness and SI. AFSEQ-R scores did not moderate the relationship between SI and attempt status. CONCLUSION AFSEQ-R is a psychometrically sound and valid measure of attentional fixation. Attentional fixation on suicide is correlated with SI, and prospective studies are needed to uncover its directional effect on suicidal crises.
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Affiliation(s)
- Abby Adler Mandel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Olga Revzina
- Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Zohaib Jessani
- Department of Psychology, The Catholic University of America, Washington, District of Columbia, USA
| | - Gregory K Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Moscardini EH, Tucker RP. Psychometric Properties of an Online Administered Version of the Suicide Stroop Task. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Kline EA, Ortin-Peralta A, Polanco-Roman L, Miranda R. Association Between Exposure to Suicidal Behaviors and Suicide Attempts Among Adolescents: The Moderating Role of Prior Psychiatric Disorders. Child Psychiatry Hum Dev 2022; 53:365-374. [PMID: 33569742 DOI: 10.1007/s10578-021-01129-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Theories suggest that adolescents exposed to suicide attempts and/or deaths are at higher risk of attempting suicide, themselves. However, research findings have been mixed, with most studies not accounting for psychiatric vulnerability. We examined past psychiatric diagnosis as a moderator of the association between lifetime exposure to suicide attempts and/or deaths and adolescents' suicide attempts. Adolescents (N = 518; 60% female; 45% White), ages 12-21, reported on prior suicide ideation and attempts, and mood, anxiety, and substance use disorders at baseline. Suicide attempts since baseline and exposure to suicidal behaviors were assessed 4-6 years later. Lifetime exposure to family suicide attempts and/or suicide deaths, but not to suicidal behaviors of peers/friends or others, was associated with a suicide attempt at follow-up among those with prior psychiatric disorders. Psychologically vulnerable adolescents may require additional support after exposure to suicidal behaviors of a family member to reduce their risk of attempting suicide.
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Affiliation(s)
- Emily A Kline
- Hunter College, City University of New York, New York, USA.,Montclair State University, Montclair, USA
| | - Ana Ortin-Peralta
- Hunter College, City University of New York, New York, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA
| | - Lillian Polanco-Roman
- Columbia University Medical Center, New York State Psychiatric Institute, New York, USA.,The New School for Social Research, New York, USA
| | - Regina Miranda
- Hunter College, City University of New York, New York, USA. .,The Graduate Center, City University of New York, New York, USA. .,Department of Psychology, Hunter College, City University of New York, 695 Park Ave., Room 611HN, New York, NY, 10065, USA.
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Abstract
PURPOSE OF REVIEW Suicide risk assessment is a challenge in clinical practice. Implicit measures may present with advantages with respect to explicit methods, and therefore may be useful for the assessment of suicide risk. We conducted a systematic review of 2 databases (PubMed and EMBASE) about implicit tests that measure suicide risk to explore their validity and reliability. RECENT FINDINGS Initial research revealed 321 articles. After the selection process, 31 articles were included in the review. The most death-related implicit cognition test used was the Death/Suicide Implicit association test (D/S IAT), followed by the Suicide Stroop Task. The Suicide Affect Misattribution Procedure (S-AMP) and the Death version of the Implicit Relational Assessment Procedure (D-IRAP) were also used. We found that the measures reviewed were generally valid for the assessment of past and future suicidal thoughts and behaviors, with statistically significant results regarding retrospective and prospective associations.
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12
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Brüdern J, Glaesmer H, Berger T, Spangenberg L. Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments. Front Psychiatry 2022; 13:899500. [PMID: 36518367 PMCID: PMC9742465 DOI: 10.3389/fpsyt.2022.899500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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Chesin MS, Keilp JG, Kline A, Stanley B, Myers C, Latorre M, St Hill LM, Miller RB, King AR, Boschulte DR, Rodriguez KM, Callahan M, Sedita M, Interian A. Attentional control may be modifiable with Mindfulness-Based Cognitive Therapy to Prevent Suicide. Behav Res Ther 2021; 147:103988. [PMID: 34700258 DOI: 10.1016/j.brat.2021.103988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To test whether Mindfulness-Based Cognitive Therapy to Prevent Suicide (MBCT-S) is associated with improvement in attentional control, an objective marker of suicide attempt. METHOD In the context of a randomized clinical trial targeting suicide risk in Veterans, computerized Stroop and emotion Stroop (E-Stroop) tasks were administered 3 times over 6-months follow-up to 135 high suicide risk Veterans. Seventy were randomized to receive MBCT-S in addition to enhanced treatment as usual (eTAU), and 65 were randomized to eTAU only. E-Stroop word types included positively- and negatively-valenced emotion, suicide, and combat-related words. Interference scores and mixed effects linear regression analyses were used. RESULTS Veterans receiving MBCT-S showed a more favorable trajectory of attentional control over time, as indicated by performance on two E-Stroop tasks. Combat-stress interference scores improved over time among Veterans in MBCT-S. Interference processing time for negative affective words deteriorated over time among Veterans receiving eTAU only. CONCLUSIONS MBCT-S may effectively target attentional control, and in particular reduce processing time during affective interference, in high suicide risk Veterans. Future studies to replicate these findings are warranted.
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Affiliation(s)
- Megan S Chesin
- Department of Psychology, William Paterson University, USA.
| | - John G Keilp
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, USA
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, USA
| | - Catherine Myers
- Veterans Affairs New Jersey Healthcare System, USA; Department of Pharmacology, Physiology, and Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, USA
| | | | | | | | | | | | | | | | - Megan Sedita
- Department of Psychology, William Paterson University, USA
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Niu L, Feng X, Jia Z, Yu Y, Zhou L. Psychometric Properties of the Suicide Stroop Task in a Chinese College Population. Front Psychol 2021; 12:586391. [PMID: 33716857 PMCID: PMC7952749 DOI: 10.3389/fpsyg.2021.586391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/27/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to test the psychometric properties of the suicide stroop task in a Chinese college population. Methods College students (n = 121) who were in the 1st–4th grade, fluent in Chinese, and without color blindness were recruited from a university in Guangzhou, China from September to December 2019. Participants were administered the suicide stroop task at baseline and 1-month follow-up. Results The suicide stroop task showed excellent internal reliability (Cronbach’s α ranged from 0.940 to 0.953). However, the suicide stroop task did not reveal suicide-related attentional biases among current suicide ideators and was not significantly associated with the severity of suicidal ideation, depression, hopelessness, nor anhedonia (all p values > 0.05), indicating a lack of concurrent validity for the task. Additionally, the two-time data of interference scores could not generate intraclass correlation coefficients (ICCs) due to a negative average covariance among data, which indicated poor test–retest consistency for the task. Conclusion The results of this study did not support the use of the suicide stroop task on the identification of suicidal risk among Chinese college students. It is crucial to assess the psychometric properties of behavioral measures rigorously as self-report measures before large applications in clinical and community settings.
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Affiliation(s)
- Lu Niu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xia Feng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhouxin Jia
- School of Economic and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu Yu
- Hospital Evaluation Office, Xiangya Hospital, Central South University, Changsha, China
| | - Liang Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Yin H, Guo J, Xin Q, Zheng S, Xue X, Li E, Liu T, Yan N, Keilp J, Mann JJ. Influence of the GABA Receptor Subunit Gene Polymorphism and Childhood Sexual Abuse on Processing Speed in Major Depression and Suicide Attempt. Front Psychiatry 2021; 12:712231. [PMID: 34733184 PMCID: PMC8558369 DOI: 10.3389/fpsyt.2021.712231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Suicide is moderately heritable and also more common in those who report childhood abuse. Previously, it was found that allele A of GABRG2 (GABA A receptor subunit gamma2) polymorphism rs211034 was protective in a suicide attempt (SA). Hence, it was proposed that rs211034 may interact with childhood trauma to influence cognitive deficits related to SA or depression risk. Genetic variants may predict the benefits of certain cognitive treatments. Methods: A total of 52 individuals who had attempted suicide, 59 individuals with major depressive disorder (MDD) or bipolar depression who had not previously attempted suicide, and 90 healthy volunteers were subjected to the modified Suicide Stroop task and were clinically assessed using the Childhood Trauma Questionnaire (CTQ) and Hamilton Depression Scale-24 items (HAMD-24). rs211034 was genotyped using Sanger sequencing. Results: After correcting for covariates, depressed participants displayed longer reaction times for all emotional conditions, including suicide-related words, compared with healthy controls. Depressed suicide attempters displayed longer reaction times for negative words than depressed non-attempters. Depressed non-attempters displayed higher interference scores for negative words compared with healthy controls. There was an interaction between rs211034 risk allele and the effects of reported childhood sexual abuse (CSA) on reaction time for all emotional words and suicide-related words. Carriers of the rs211034 risk allele A exhibited shorter reaction times, but the protective effects of this allele were eliminated in those exposed to reported CSA. Conclusion: Only limited results were found regarding effects of a past suicide attempt on response times to emotional and suicide-related words, but there was an overall effect of major depression on slower response time. Protective genetic effects of the rs211034 A allele on this slowing were eliminated in those with a history of sexual abuse during childhood. Further research is needed to better characterize the mechanisms underlying the effects of childhood trauma on these genetic effects.
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Affiliation(s)
- Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - Jia Guo
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Qianqian Xin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - Shuqiong Zheng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - Xiang Xue
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - Enze Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - Ting Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - Na Yan
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong, China
| | - John Keilp
- Department of Psychiatry, Columbia University, New York, NY, United States.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, United States
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY, United States.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, United States
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Interian A, Myers CE, Chesin MS, Kline A, Hill LS, King AR, Miller R, Latorre M, Gara MA, Stanley BH, Keilp JG. Towards the objective assessment of suicidal states: Some neurocognitive deficits may be temporally related to suicide attempt. Psychiatry Res 2020; 287:112624. [PMID: 31727438 PMCID: PMC7165019 DOI: 10.1016/j.psychres.2019.112624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
Neurocognitive detection of suicidal states has the potential to significantly advance objective risk assessment. This goal requires establishing that neurocognitive deficits fluctuate around the time of a suicide attempt. The current study therefore evaluated whether neurocognitive performance is temporally related to suicide attempt, in a sample at highrisk for suicide (n = 141). Evaluations consisted of a clinician-administered interview, self-report questionnaires, and neurocognitive tasks assessing response inhibition, attentional control, and memory recognition. Analyses examined whether neurocognitive scores significantly differed according to the following temporal suicide attempt categories: (a) past-week attempt; (b) past-year attempt (not in past week); and (c) no past-year attempt. Univariate results showed that response inhibition and memory recognition were significantly related to suicide attempt recency. Post-hoc pairwise tests showed that participants with a past-week suicide attempt showed greater impairments than those without a past-year attempt. Multivariate tests showed the same pattern of results, adjusting for age, suicide attempts prior to past year, mood disturbance, and suicidal ideation. These results show that neurocognitive assessment of response inhibition and memory recognition shows sensitivity to the recency of a suicide attempt. While future prospective studies are needed, results suggest that phasic neurocognitive deficits may serve as objective markers of short-term suicide risk.
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Affiliation(s)
- Alejandro Interian
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA; Department of Psychiatry, Robert Wood Johnson Medical School, The State University of New Jersey, Piscataway, NJ, USA.
| | - Catherine E Myers
- Research and Development Service, VA New Jersey Healthcare System, East Orange, NJ, USA; Department of Pharmacology, Physiology, and Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Megan S Chesin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, The State University of New Jersey, Piscataway, NJ, USA
| | - Lauren St Hill
- War Related Illness and Injury Study Center, VA New Jersey Healthcare System, East Orange, NJ, USA
| | - Arlene R King
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA
| | - Rachael Miller
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA
| | - Miriam Latorre
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA
| | - Michael A Gara
- Department of Psychiatry, Robert Wood Johnson Medical School, The State University of New Jersey, Piscataway, NJ, USA
| | - Barbara H Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - John G Keilp
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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Neurocognitive Processes Implicated in Adolescent Suicidal Thoughts and Behaviors: Applying an RDoC Framework for Conceptualizing Risk. Curr Behav Neurosci Rep 2019; 6:188-196. [PMID: 33312840 DOI: 10.1007/s40473-019-00194-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Identifying risk factors for STBs during adolescence is essential for suicide prevention. In this review, we employ the Research Domain Criteria (RDoC) framework to synthesize studies on key neurocognitive processes-cognitive control, reward responsiveness/valuation, and negative urgency-relevant to adolescent STBs. Recent Findings Within subdomains of Cognitive Control, studies of inhibition/suppression and updating/maintenance were mixed, while response selection (i.e., decision-making) deficits were consistently associated with suicide attempts. Fewer studies, by comparison, have probed the Positive Valence Systems. Relative to healthy controls, adolescents with prior STBs may show a blunted neural response to rewards and value rewards less, but findings require replication. Finally, negative urgency, which may span subdomains within both Cognitive Control and the Positive Valence Systems, was associated with recent suicide attempts in the only study to directly test this association. Summary Few studies have examined neurocognitive functioning in relation to adolescent STBs, despite the relevance of this research to detecting suicide risk. We recommend that future studies incorporate developmental contexts relevant to both neurocognitive processes and STBs.Broadly, cognitive control is associated with activation of the prefrontal cortex (PFC) and its interaction with other brain areas (e.g., reward and motor regions) [32]. Functional magnetic resonance imaging (fMRI) studies using emotional stimuli have provided evidence of abnormalities in neural regions supporting cognitive control among youth with STBs. [33] computed neural activation corresponding to viewing angry faces (relative to a fixation cross) in a sample of depressed youth. They found that, relative to non-attempters, attempters had: (a) increased activation in the right anterior gyrus and dorsolateral PFC and (b) reduced functional connectivity between the anterior cingulate gyrus and bilateral insulae. Relatedly, youth with bipolar disorder and a history of suicide attempts showed reduced functional connectivity between the amygdala and the left ventral PFC while viewing emotional (happy, fearful) and neutral faces compared to patient non-attempters [34]. The findings indicate that attempters may have problems regulating and appropriately deploying attention, as well as planning and executing behavioral responses, in emotional contexts.
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