Early Life Trauma, Suicide Ideation, and Suicide Attempts: The Role of Rumination and Impulsivity

Repetitive negative thinking and suicidal ideation in internalizing psychopathologies: A replication study

Suicidal ideation (SI), a risk factor for suicide, is prevalent in internalizing psychopathologies, including depression and anxiety. Rumination and worry are well-studied repetitive negative thinking (RNT) constructs implicated in internalizing psychopathologies. These constructs have shared and distinct characteristics. However, the relationship between rumination and worry and their associations with SI are not fully understood in clinical samples. The present study used correlational and regression analysis to evaluate these relationships as a secondary data analysis in treatment-seeking participants with internalizing psychopathologies in two independent samples (Study 1:n = 143; Study 2:n = 133). Results showed about half of the participants endorsed SI (Study 1:n = 79; Study 2:n = 71). Correlations revealed a significant, positive relationship between rumination and worry. Regression results with SI as the dependent variable showed rumination significantly positively corresponded with SI in both studies. Post-hoc partial correlations controlling for symptom severity (depression, anxiety), worry, and age showed the rumination-SI relationship was maintained in both studies. Findings for worry and SI were inconsistent between studies. Findings indicate rumination, but not worry, could be a stable, unique contributor to SI in internalizing psychopathologies. It may be useful to incorporate RNT into suicide risk assessment for individuals with internalizing conditions.

A multi-level examination of impulsivity and links to suicide ideation among Native American youth

BACKGROUND

Despite preliminary evidence that links impulsivity to suicide risk among Native American youth, impulsivity has not been directly studied in relation to suicide ideation (SI) or behaviors in this population. We examined indexes of rapid-response impulsivity (RRI) across multiple levels of analysis (self-report, behavioral, neurobiological) and associations with SI among Native American youth ages 9-10 in the Adolescent Brain Cognitive Development Study.

METHODS

Data from the sample (n = 284) included self-report (UPPS-P), behavioral (Stop Signal Task), and neurobiological (right inferior frontal gyrus activation) indicators of RRI. RRI indicators were modeled using variable-centered (i.e., traditional multivariable regression) and person-centered (i.e., clustering analyses) approaches in measuring their association with SI.

RESULTS

Logistic regression analysis demonstrated that higher negative urgency was associated with higher odds of SI (Adjusted Odds Ratio = 1.23, p = 0.015). Latent profile analysis clustered youth into five profiles based on within-individual variation in RRI indicators. Youth with an elevated self-reported negative and positive urgency profile had higher odds of reporting SI than "normative" youth (Adjusted Odds Ratio = 2.38, p = 0.019).

LIMITATIONS

Limitations of this study include the modest sample size particularly regarding SI (14.1 %), potential bias in estimates of lifetime SI, and generalizability to youth from specific Native American communities.

CONCLUSIONS

Negative urgency may increase risk for SI among Native American youth in late childhood. Clinical implications, including the potential for person-centered RRI profiles to act as candidate markers of suicide risk and resilience in adolescence and inform safety assessments and planning, are discussed.

Associations of rumination with suicidal ideation and suicide attempts amongst individuals with major depressive disorder: A 12-month longitudinal study in China

BACKGROUND

This study aimed to explore the longitudinal associations of rumination with suicidal ideation and suicide attempts in individuals with major depressive disorder (MDD).

METHODS

Participants were derived from the Depression Cohort in China study (DCC). Those who completed at least one follow-up visit during the 12 months were included in the analysis. Dimensions of rumination including brooding and reflection were each measured using five items of the Ruminative Responses Scale. Suicidal ideation was assessed using the Beck Scale for Suicide Ideation. Suicide attempts were also assessed and all were analyzed with generalized estimating equations.

RESULTS

Our final sample included 532 participants aged 18 to 59 years (mean [SD], 26.91 [6.94] years) consisting of 148 (27.8%) males and 384 (72.2%) females. After adjusting for temporal trend and potential confounders, individuals with higher levels of reflection were more likely to report suicidal ideation (AOR =1.11, 95% CI:1.01-1.22). However, no statistically significant association was found between brooding and suicidal ideation (AOR =1.06, 95% CI:0.96-1.17). Conversely, individuals with higher levels of brooding were more likely to report suicide attempts (AOR =1.13, 95% CI:1.02-1.24), while no statistically significant association was observed between reflection and suicide attempts (AOR =0.91, 95% CI:0.82-1.01).

CONCLUSION

Rumination reflects a disturbance in cognitive emotional processing and manifests in different dimensions. Our findings suggest that high levels of reflection and brooding may be associated with a higher likelihood of having suicidal ideation and suicide attempts, respectively. However, it should be interpreted with caution, given that effect sizes are small.

The role of SKA2 on affective disorder, post-traumatic stress disorder and suicide behavior: systematic review and in silico analysis

Genes involved in the hypothalamic-pituitary-adrenal axis may be a robust biomarker of psychiatric disorders. Genetic polymorphisms of the SKA2 gene are associated with several behavioral disorders. In this study, we embarked on a systematic search of all possible reports of genetic association with SKA2 and affective disorder, post-traumatic stress disorder, and suicide behavior; the functional consequences of nsSNPs were explored through computational tools with an in silico analysis. Eight eligible articles were included. Our study identified that SKA2 did not show association with risk of Major Depression Disorder. Epigenetic variation at SKA2 mediates vulnerability to Post-Traumatic Stress Disorder. Studies provide strong preliminary evidence that alterations at the SKA2 gene covary with types of suicide behavior, including suicidal ideation, attempts, and completions. Results from in silico analysis predicted that I22S, I22G, I78T, A15L, D18R, R25L, N42I, Y21S, K14I, K14L, and L60R were the most structurally and functionally significant nsSNPs in SKA2. Amino acid conservation analysis revealed that the amino acids were highly conserved and some dissimilarities of mutant type amino acids from wild-type amino acids such as charge, size, and hydrophobicity were observed. In the future, SKA2 gene have the potential to be evaluated as prognostic biomarkers for diagnosis and research.

Attitudes, Emotions, and Emotion Regulation as Underlying and In-The-Moment Predictors of Men's Intentions to Perpetrate Sexual Assault: An Application of the I3 Model

Sexual assault is a significant problem among young men, and several underlying and in-the-moment factors are associated with this behavior. However, research has not examined how underlying factors may influence men's in-the-moment use of emotion regulation (ER) strategies, emotional experience during sexual situations, or intentions to perpetrate sexual assault. 187 young, single men from the United States who had sex with a woman in the past year completed questionnaires, projected themselves into hypothetical sexual scenarios, and indicated how they would behave when their partner withdrew consent during these scenarios. Participants were grouped into profiles of ER strategy use, which was used as part of a model predicting sexual assault perpetration. Specifically, men with greater hostility toward women were especially likely to use a "low acting with awareness, low resignation" profile, which was associated with greater anger, impulsivity, and intentions to perpetrate. This could be attributed to the increased cognitive load, increased rumination on their partner's refusal, or increased drive to obtain sex associated with this profile. Future research should replicate these results in a more diverse sample, and examine the efficacy of interventions redirecting participants away from a "low acting with awareness, low resignation" profile on sexual assault prevention.

Imagine before you leap: Episodic future thinking combined with transcranial direct current stimulation training for impulsive choice in repetitive negative thinking

Background

Immediate reward preference in repetitive negative thinking (RNT) has a high clinical correlation with a variety of maladaptive behaviors, whereas episodic future thinking (EFT) may be conducive to dealing with non-adaptive thinking and decision-making.

Objectives

This study aimed to evaluate the efficacy of EFT training combined with transcranial direct current stimulation (tDCS) stimulation over the ventromedial PFC (vmPFC) in inhibiting impulsive choice of RNT individuals.

Method

Study 1 explored the effects of EFT on immediate reward preference of participants with high and low RNT (N = 48). Study 2 conducted a randomized controlled trial (RCT) to examine the treatment effect of the EFT-neural training on impulsive choice of high RNT individuals (N = 103).

Results

In study 1, individuals with high RNT were more likely to choose smaller and sooner (SS) rewards, however, there were no significant differences between the high-RNT group and the low-RNT group under the positive EFT condition. In study 2, a significant decrease was shown in the proportion of choosing SS rewards under the 8-week EFT-neural training, and the effect was maintained at 1 month follow-up.

Conclusion

RNT is a vulnerability factor for short-sighted behaviors, and EFT-neural training could be suitable for reducing RNT and improving immediate reward preference.

Multidimensional Impulsivity and Suicidal Behaviour: A Partial Test of the Integrated Motivational-Volitional (IMV) Model of Suicide

OBJECTIVE

Suicide remains a public health problem within the United Kingdom (UK) and globally. Impulsivity is a key risk factor within the Integrated Motivational-Volitional Model (IMV) of Suicide warranting further study. The current study applied a multi-dimensional impulsivity framework (UPPS-P) to differentiate suicidality subgroups within an IMV framework (i.e., no suicidal behavior, suicidal ideation only, and suicide attempt). Impulsivity subscales were evaluated as moderators of the suicidal ideation-future suicide attempt link.

METHOD

Adults living in the UK (N = 1027) completed an online survey addressing demographics, impulsivity, psychological distress, and lifetime suicidal behavior. We used analysis of variance (ANOVA) and linear regression with simple slopes analyses to investigate study objectives.

RESULTS

Data analyses revealed that: (1) four impulsivity subtypes (negative urgency, positive urgency, lack of premeditation, sensation-seeking) differentially distinguished suicidal behavior groups; (b) negative urgency, positive urgency, and lack of premeditation were meaningfully associated with suicide outcomes, and (c) negative urgency served as a moderator of the suicidal ideation-future attempt link.

CONCLUSIONS

Urgency, regardless of positive or negative valence, is important for understanding differences in lifetime suicidal behavior. Sensation-seeking may play a protective role for direct suicidal behavior. Negative urgency may be the most prominent aspect of impulsivity when considered as an IMV moderator. Findings are contextualized with respect to impulsivity and IMV frameworks. Clinical implications involve accounting for negative urgency in suicide risk assessment and intervention.

Risk Factors for Suicide in Men

Suicide and the risk factors associated with it have been researched with increasing interest over the last 5 decades with respect to socioeconomic status, age, geographic location, and ethnic background. There has been less focus related to the risk factors specific to gender and how to incorporate clinical screening and interventions to reduce the mortality of suicide in males. With men accounting for a disproportionate number of deaths from suicide in the United States and worldwide, how gender could impact suicidal behavior and ideations remains a topic understudied and with great potential for significant improvement in clinical recognition and treatment.

Role of rumination and hope on negative life events and suicidal ideation under the background of normalization of pandemic prevention and control: A moderated mediation model

Introduction

The study aimed to investigate the impact and mechanism of negative life events on college students' suicidal ideation during the COVID-19 pandemic and the buffering effect of hope under the background of normalization of pandemic.

Methods

A total of 5211 participants took part in this study. Self-reported negative life events, rumination, hope and suicide ideation were measured using a range of questions and scales. Our research demonstrated that the incidence of suicidal ideation among college freshmen in the past week was higher during the COVID-19 pandemic than that before the pandemic. In this study, conditional process model 15 was used to verify the hypothetical model of rumination as a potential mediator and hope as a moderator.

Results

The hypothesized moderated mediation model was verified significant (β = -0.047, 95% CI = [-0.061, -0.035]), and hope was found to moderate the direct effect of negative life events on suicidal ideation (β = -0.039, t = -2.937, 95% CI = [-0.065, -0.013]) as well as the indirect effect of through the mediator rumination (β = -0.134, t = -10.850, 95% CI = [-0.158, -0.110]).

Discussion

We found that rumination partially mediated the effect of negative life events on suicidal ideation, and hope buffered the direct and indirect effect of negative life events on suicidal ideation. The implications of the findings for clinical interventions are discussed, including the importance of hope arousal as a protective factor and rumination as a cognitive mechanism for emotion regulation under the background of normalization of pandemic.

The UPPS Model of Impulsivity and Suicide: A Systematic Literature Review

INTRODUCTION

Suicide is a leading cause of death worldwide. Although inconsistent, impulsivity has been identified as a risk factor for suicidal thoughts and behaviors, and these inconsistent findings can largely be attributed to varying operationalizations of impulsivity. As such, the UPPS model of impulsivity provides a clear definition of impulsivity and its associated features that may provide utility in clarifying unreliable findings between impulsivity and suicide. This review aimed to summarize relevant information pertaining to the UPPS model of impulsivity and suicide.

METHODS

This systematic review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were gathered from PsycINFO, PsycArticles, Scopus, and PubMed.

RESULTS

Twenty-eight articles were reviewed and analyzed. Most articles reviewed reported on indirect (i.e., through mediators and moderators) associations between the UPPS dimensions and suicidal behaviors. Additionally, results noted limited between-group differences in UPPS facets among individuals with a history of suicide attempts and those without a history of suicide attempts, those with a history of suicide attempts and individuals with suicide ideation, and those with suicide ideation and those without suicide ideation, with the exception of lack of premeditation.

DISCUSSION

The results of this review indicate support for the UPPS model of impulsivity as a theoretical starting point when examining the relation between impulsivity and suicide. Further, findings are helpful for clinicians and case conceptualization. Particularly, suicide risk assessment and treatment would be impacted based on impulsivity traits and suicide history.

Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review

BACKGROUND

It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood.

METHODS

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'.

RESULTS

A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression.

CONCLUSION

Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.