Interaktive Gesundheitskompetenz, soziodemografische Faktoren und der Zeitraum bis zur Inanspruchnahme psychotherapeutischer oder medikamentöser Behandlung – gibt es Hinweise auf soziale Ungleichheiten in der Therapie der Sozialen Angststörung?

Predictors of suicidal ideation in social anxiety disorder - evidence for the validity of the Interpersonal Theory of Suicide

BACKGROUND

This study aims to identify covariates of suicidal ideation (SI) in a large sample of individuals diagnosed with social anxiety disorder (SAD).

METHODS

In a cross-sectional design, 305 individuals (38.4 ± 14.1 years, 59% female) with SAD were assessed by the Social Phobia Inventory, Beck Depression Inventory, Adverse Childhood Experience Questionnaire, State Trait Anger Expression Inventory, Beck Scale for Suicidal Ideation and the Interpersonal Needs Questionnaire.

RESULTS

SAD individuals with SI (n = 142, 46.6%) reported higher SAD and depression symptoms, more adverse childhood experiences (ACE), higher state anger (SA), perceived burdensomeness (PB) and higher thwarted belongingness (TB) compared to SAD individuals without SI (n = 163, 53.4%). In binary logistic regression, PB (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.06-1.15), TB (OR = 1.05, 95% CI = 1.02-1.07), SA (OR = 1.07, 95% CI = 1.01-1.13) and ACE (OR = 1.18, 95% CI = 1.03-1.35) emerged as significant covariates of acute SI (Nagelkerke's R² = 0.39). Receiver operating characteristic (ROC) curves showcased the following areas under the curve (AUC): PB (AUC = 0.78), TB (AUC = 0.76), SA (AUC = 0.62) and ACE (AUC = 0.62). Multinomial logistic regression (no SI = ref.) showcased similar results for passive and active SI (n = 42), with SA reaching significance only for active SI. The Youden index identified appropriate cut-off values for PB, TB, SA and ACEQ by maximizing sensitivity and specificity.

LIMITATIONS

Cross-sectional design and self-reporting measures limit generalization.

CONCLUSION

Our findings confirm the validity of the Interpersonal Theory of Suicide concerning SI in SAD. PB and TB with SA and ACE may support the valid assessment of SI in therapeutic settings.

[Psychotherapy with an Autonomous Artifical Intelligence - Ethical Benefits and Challenges]

OBJECTIVE

This paper provides an overview of a range of ethical aspects involved in the use of autonomous, virtual or embodied artificial intelligence (AI) in the care of people with mental health issues.

METHODOLOGY

The overview is based on a thematic literature review. It is guided by the principles of biomedical ethics together with the concept of epistemic (in)justice.

RESULTS

In addition to a risk-benefit analysis, (digital) health literacy, equity of access, issues of under- or misuse of care, and an adaptation of informed consent need to be considered.

CONCLUSION

The ethical assessment of autonomous AI in psychotherapy remains open; too many clinical, ethical, legal, and practical questions remain to be addressed. Quality criteria for AI application as well as guidelines for its clinical use need to be developed before wider clinical implementation.