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Kraiss J, Glaesmer H, Forkmann T, Spangenberg L, Hallensleben N, Schreiber D, Höller I. Beyond one-size-fits-all suicide prediction: Studying idiographic associations of risk factors for suicide in a psychiatric sample using ecological momentary assessment. J Psychiatr Res 2024; 178:130-138. [PMID: 39141992 DOI: 10.1016/j.jpsychires.2024.07.050] [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: 12/12/2023] [Revised: 06/28/2024] [Accepted: 07/31/2024] [Indexed: 08/16/2024]
Abstract
The Interpersonal Psychological Theory of Suicide (IPTS) states that thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness are risk factors for suicidal ideation. This ecological momentary assessment (EMA) study aimed to (1) demonstrate that there is substantial between-person variability in the association between IPTS predictors and suicidal ideation, (2) identify clusters of patients for which the predictors differently predict suicidal ideation, and (3) examine whether identified clusters are characterized by specific patient characteristics. EMA data were collected ten times per day for six days in 74 psychiatric inpatients and was analyzed with dynamic structural equation modelling. Idiographic associations were obtained and clustered using k-means clustering. We found substantial between-person variability in associations between IPTS predictors and suicidal ideation. Four distinct clusters were identified and different risk factors were relevant for different clusters. In the largest cluster (n = 36), none of the IPTS predictors predicted suicidal ideation. Clusters in which associations between IPTS variables and suicidal ideation were stronger showed higher suicidal ideation, depression, and lower positive affect. These findings suggest that a one-size-fits-all model may not adequately reflect idiosyncratic processes leading to suicidal ideation. A promising avenue might be to use idiographic approaches to personalize prediction and interventions.
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Affiliation(s)
- Jannis Kraiss
- Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands.
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Inken Höller
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
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Shou Y, Gulliver A, Farrer LM, Dawel A, Burns R, Calear AL, Cherbuin N, Batterham PJ. Psychological mechanisms of the development of suicidal ideation: Longitudinal cohort study. Suicide Life Threat Behav 2024; 54:593-605. [PMID: 38436505 DOI: 10.1111/sltb.13060] [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: 10/31/2023] [Revised: 01/16/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION This study aimed to investigate the mechanisms of the development of suicidal ideation and its moderating and protective factors. Drawing on the Interpersonal-psychological theory of suicide, we proposed that disruptions to belongingness, in conjunction with tolerance of health risk, may influence the development of suicidal ideation above and beyond psychosocial changes such as disruptions to finances and work. METHODS The study involved a longitudinal investigation of an Australian representative sample reporting suicidal ideation fortnightly for 12 weeks between March and June 2020. RESULTS The results indicated that participants who reported higher levels of belongingness, mastery, and intolerance of health risk were less likely to experience suicidal ideation and had lower severity of suicidal ideation. Mastery significantly strengthened the negative link between belongingness and the incidence of suicidal ideation, while agreeableness significantly strengthened the negative link between belongingness and the severity of suicidal ideation over time. CONCLUSION The findings suggest that supporting effective social connectedness during times of isolation and promoting self-efficacy, mastery, and regulation of risk tolerance, may be crucial for suicide prevention and therapeutic intervention.
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Affiliation(s)
- Yiyun Shou
- School of Medicine and Psychology, The Australian National University, Canberra, Australia
- Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Amelia Gulliver
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Amy Dawel
- School of Medicine and Psychology, The Australian National University, Canberra, Australia
| | - Richard Burns
- Department of Health, Economics, Wellbeing, and Society, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Department of Health, Economics, Wellbeing, and Society, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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López R, Turnamian MR, Liu RT. Prospective Relations between Life Stress, Emotional Clarity, and Suicidal Ideation in an Adolescent Clinical Sample. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-14. [PMID: 38690948 DOI: 10.1080/15374416.2024.2344735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample. METHODS The sample consisted of 180 youths (Mage = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest. RESULTS At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R2 = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress. CONCLUSIONS Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth's understanding of their emotional experiences may reduce subsequent suicidal ideation.
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Affiliation(s)
- Roberto López
- Department of Psychiatry and Biobehavioral Sciences, University of California
| | - Margarid R Turnamian
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Richard T Liu
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard
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Li J, Luo X, Liu H. Dynamic bidirectional relation between state mindfulness and suicidal ideation among female college students: The moderating effect of trait mindfulness. DEATH STUDIES 2024:1-12. [PMID: 38502577 DOI: 10.1080/07481187.2024.2329180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Research has indicated that mindfulness is a protective factor against suicidal ideation. However, the dynamic reciprocal relation between them has been understudied. In this study, 110 female college students with suicidal ideation completed a measure of trait mindfulness and a 28-day diary of suicidal ideation and three-dimensional state mindfulness, including acting with awareness, present-moment attention, and nonjudgmental acceptance. Dynamic structural equation modeling was used to examine the dynamic and bidirectional effects between dimensions of state mindfulness and suicidal ideation and the moderating effect of trait mindfulness. Results showed that suicidal ideation predicted lower levels of present-moment attention the next day. More importantly, there was a dynamic and bidirectional relation between nonjudgmental acceptance and suicidal ideation for people with trait mindfulness higher than the average level (i.e., M + 0.15SD). Our findings suggested that studies and interventions on suicide should pay more attention to specific dimensions of state mindfulness and trait mindfulness.
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Affiliation(s)
- Jingxian Li
- College of Education for the Future, Beijing Normal University, Zhuhai, China
- Beijing Key Laboratory of Applied Experimental Psychology Faculty of Psychology, Beijing Normal University, Beijing, China
- Department of Mental Health Education and Consultation Center, Lingnan Normal University, Zhanjiang, China
| | - Xiaohui Luo
- Beijing Key Laboratory of Applied Experimental Psychology Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Hongyun Liu
- Beijing Key Laboratory of Applied Experimental Psychology Faculty of Psychology, Beijing Normal University, Beijing, China
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Wallace GT, Brick LA, Provost EM, Peters JR, Miller IW, Schatten HT. Daily Levels and Dynamic Metrics of Affective-Cognitive Constructs Associate With Suicidal Thoughts and Behaviours in Adults After Psychiatric Hospitalization. Clin Psychol Psychother 2024; 31:e2982. [PMID: 38659356 DOI: 10.1002/cpp.2982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/03/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
The period after psychiatric hospitalization is an extraordinarily high-risk period for suicidal thoughts and behaviours (STBs). Affective-cognitive constructs (ACCs) are salient risk factors for STBs, and intensive longitudinal metrics of these constructs may improve personalized risk detection and intervention. However, limited research has examined how within-person daily levels and between-person dynamic metrics of ACCs relate to STBs after hospital discharge. Adult psychiatric inpatients (N = 95) completed a 65-day ecological momentary assessment protocol after discharge as part of a 6-month follow-up period. Using dynamic structural equation models, we examined both within-person daily levels and between-person dynamic metrics (intensity, variability and inertia) of positive and negative affect, rumination, distress intolerance and emotion dysregulation as risk factors for STBs. Within-person lower daily levels of positive affect and higher daily levels of negative affect, rumination, distress intolerance and emotion dysregulation were risk factors for next-day suicidal ideation (SI). Same-day within-person higher rumination and negative affect were also risk factors for same-day SI. At the between-person level, higher overall positive affect was protective against active SI and suicidal behaviour over the 6-month follow-up, while greater variability of rumination and distress intolerance increased risk for active SI, suicidal behaviour and suicide attempt. The present study provides the most comprehensive examination to date of intensive longitudinal metrics of ACCs as risk factors for STBs. Results support the continued use of intensive longitudinal methods to improve STB risk detection. Interventions focusing on rumination and distress intolerance may specifically help to prevent suicidal crises during critical transitions in care.
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Affiliation(s)
- Gemma T Wallace
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Emily Mower Provost
- Computer Science and Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ivan W Miller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Psychosocial Research Program, Butler Hospital, Providence, Rhode Island, USA
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Psychosocial Research Program, Butler Hospital, Providence, Rhode Island, USA
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López R, Esposito-Smythers C, Defayette AB, Harris KM, Seibel LF, Whitmyre ED. Facets of social problem-solving as moderators of the real-time relation between social rejection and negative affect in an at-risk sample. Behav Res Ther 2023; 169:104398. [PMID: 37708724 DOI: 10.1016/j.brat.2023.104398] [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: 05/07/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
Social rejection predicts negative affect, and theoretical work suggests that problem-solving deficits strengthen this relation in real-time. Nevertheless, few studies have explicitly tested this relation, particularly in samples at risk for suicide. This may be particularly important as social rejection and negative affect are significant predictors of suicide. The aim of the current study was to examine whether cognitive (i.e., perceiving problems as threats) and behavioral (i.e., avoidance) facets of problem-solving deficits moderated the real-time relation between social rejection and negative affect. The sample consisted of 49 young adults with past-month suicidal ideation. Demographic information, social problem-solving deficits, as well as depressive/anxiety symptoms and stress levels were assessed at baseline. Social rejection and negative affect were assessed using ecological momentary assessment over the following 28 days. Dynamic structural equation modeling was used to assess relations among study variables. After accounting for depressive/anxiety symptoms, stress levels, sex, and age, only avoidance of problems bolstered the real-time positive relation between social rejection severity and negative affect (b = 0.04, 95% credibility interval [0.003, 0.072]). Individuals with suicidal ideation who possess an avoidant problem-solving style may be particularly likely to experience heightened negative affect following social rejection and may benefit from instruction in problem-solving skills.
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Horwitz AG, Kentopp SD, Cleary J, Ross K, Wu Z, Sen S, Czyz EK. Using machine learning with intensive longitudinal data to predict depression and suicidal ideation among medical interns over time. Psychol Med 2023; 53:5778-5785. [PMID: 36177889 PMCID: PMC10060441 DOI: 10.1017/s0033291722003014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Use of intensive longitudinal methods (e.g. ecological momentary assessment, passive sensing) and machine learning (ML) models to predict risk for depression and suicide has increased in recent years. However, these studies often vary considerably in length, ML methods used, and sources of data. The present study examined predictive accuracy for depression and suicidal ideation (SI) as a function of time, comparing different combinations of ML methods and data sources. METHODS Participants were 2459 first-year training physicians (55.1% female; 52.5% White) who were provided with Fitbit wearable devices and assessed daily for mood. Linear [elastic net regression (ENR)] and non-linear (random forest) ML algorithms were used to predict depression and SI at the first-quarter follow-up assessment, using two sets of variables (daily mood features only, daily mood features + passive-sensing features). To assess accuracy over time, models were estimated iteratively for each of the first 92 days of internship, using data available up to that point in time. RESULTS ENRs using only the daily mood features generally had the best accuracy for predicting mental health outcomes, and predictive accuracy within 1 standard error of the full 92 day models was attained by weeks 7-8. Depression at 92 days could be predicted accurately (area under the curve >0.70) after only 14 days of data collection. CONCLUSIONS Simpler ML methods may outperform more complex methods until passive-sensing features become better specified. For intensive longitudinal studies, there may be limited predictive value in collecting data for more than 2 months.
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Affiliation(s)
- Adam G. Horwitz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Shane D. Kentopp
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Cleary
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Ross
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Zhenke Wu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ewa K. Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Abstract
BACKGROUND The exploration of inter- and intra-individual variability in suicidal ideation (SI) is vital to suicide research. However, this research relies on the identification and measurement of standardized SI characteristics. OBJECTIVE This review aimed to identify characteristics of SI examined in research, describe how these characteristics are measured, and assess how they are aligned with those included in the Columbia Suicide Severity Rating Scale (C-SSRS). METHODS Four databases were systematically searched, and relevant data was extracted. The C-SSRS provided a framework for comparing SI names, measures and operational definitions. RESULTS After comparing operational definitions of identified characteristics, five core domains emerged: (1) severity, (2) temporality, (3) variability, (4) controllability, and (5) deterrents/reasons for ideating. Except for variability, all SI characteristics in the literature were congruent with those measured in the C-SSRS. CONCLUSIONS This review highlighted conceptual and methodologic inconsistencies in the study of SI, specifically the nomenclature, measurement and definitions of SI characteristics. Standardized approaches to the study of SI characteristics are needed. These approaches will enhance accurate and reliable measurement of SI, allow for findings to be synthesized across studies and propel the exploration of inter and intra-individual SI variability leading to more individualized and effective SI treatment.
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Affiliation(s)
- Katherine W. Reeves
- Depression Center, University of California, San Francisco, CA 94312 USA
- Department of Community Health Systems, University of California, San Francisco, CA 94132 USA
| | - Genesis Vasconez
- Department of Community Health Systems, University of California, San Francisco, CA 94132 USA
| | - Sandra J. Weiss
- Depression Center, University of California, San Francisco, CA 94312 USA
- Department of Community Health Systems, University of California, San Francisco, CA 94132 USA
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Horwitz A, Czyz E, Al-Dajani N, Dempsey W, Zhao Z, Nahum-Shani I, Sen S. Utilizing daily mood diaries and wearable sensor data to predict depression and suicidal ideation among medical interns. J Affect Disord 2022; 313:1-7. [PMID: 35764227 PMCID: PMC10084890 DOI: 10.1016/j.jad.2022.06.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Intensive longitudinal methods (ILMs) for collecting self-report (e.g., daily diaries, ecological momentary assessment) and passive data from smartphones and wearable sensors provide promising avenues for improved prediction of depression and suicidal ideation (SI). However, few studies have utilized ILMs to predict outcomes for at-risk, non-clinical populations in real-world settings. METHODS Medical interns (N = 2881; 57 % female; 58 % White) were recruited from over 300 US residency programs. Interns completed a pre-internship assessment of depression, were given Fitbit wearable devices, and provided daily mood ratings (scale: 1-10) via mobile application during the study period. Three-step hierarchical logistic regressions were used to predict depression and SI at the end of the first quarter utilizing pre-internship predictors in step 1, Fitbit sleep/step features in step 2, and daily diary mood features in step 3. RESULTS Passively collected Fitbit features related to sleep and steps had negligible predictive validity for depression, and no incremental predictive validity for SI. However, mean-level and variability in mood scores derived from daily diaries were significant independent predictors of depression and SI, and significantly improved model accuracy. LIMITATIONS Work schedules for interns may result in sleep and activity patterns that differ from typical associations with depression or SI. The SI measure did not capture intent or severity. CONCLUSIONS Mobile self-reporting of daily mood improved the prediction of depression and SI during a meaningful at-risk period under naturalistic conditions. Additional research is needed to guide the development of adaptive interventions among vulnerable populations.
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Affiliation(s)
- Adam Horwitz
- Department of Psychiatry, University of Michigan, USA.
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan, USA
| | | | - Walter Dempsey
- Institute for Social Research, University of Michigan, USA
| | - Zhuo Zhao
- Molecular and Behavioral Neuroscience Institute, University of Michigan, USA
| | | | - Srijan Sen
- Department of Psychiatry, University of Michigan, USA; Molecular and Behavioral Neuroscience Institute, University of Michigan, USA
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Kuehn KS, Dora J, Harned MS, Foster KT, Song F, Smith MR, King KM. A meta-analysis on the affect regulation function of real-time self-injurious thoughts and behaviours. Nat Hum Behav 2022; 6:964-974. [PMID: 35484208 PMCID: PMC9329197 DOI: 10.1038/s41562-022-01340-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Prominent theories suggest that self-injurious thoughts and behaviours are negatively reinforced by decreased negative affect. The present meta-analysis quantifies effects from intensive longitudinal studies measuring negative affect and self-injurious thoughts and behaviours. We obtained data from 38 of the 79 studies (48%, 22 unique datasets) involving N = 1,644 participants (80% female, 75% white). Individual-participant data meta-analyses revealed changes in affect pre/post self-injurious thoughts and behaviours. In antecedent models, results supported increased negative affect before nonsuicidal self-injurious behaviour (k = 14, 95% CI 0.09 to 0.31) and suicidal thoughts (k = 14, 95% CI 0.03 to 0.19). For consequence models, negative affect was reduced following nonsuicidal self-injurious thoughts (k = 6, 95% CI -0.79 to -0.44), nonsuicidal self-injurious behaviours (k = 14, 95% CI -0.73 to -0.19) and suicidal thoughts (k = 13, 95% CI -0.79 to -0.23). Findings, which were not moderated by sampling strategies or sample composition, support the affect regulation function of self-injurious thoughts and behaviours.
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Affiliation(s)
- Kevin S Kuehn
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Jonas Dora
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Melanie S Harned
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Frank Song
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele R Smith
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, WA, USA
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Katzenmajer-Pump L, Komáromy D, Balázs J. The importance of recognizing worthlessness for suicide prevention in adolescents with Attention-deficit/hyperactivity disorder. Front Psychiatry 2022; 13:969164. [PMID: 36458127 PMCID: PMC9705741 DOI: 10.3389/fpsyt.2022.969164] [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: 06/14/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric diagnoses among children and adolescents. Depression and general anxiety disorder (GAD) are often co-occurring with ADHD among children and adolescents. Previous studies have found that ADHD, depression and GAD are all strongly correlated with suicidal thoughts and planning. AIM The current study aimed to further explore the association between ADHD, GAD and depressive symptoms as well as their association with suicidal thoughts and planning among adolescents. METHOD Adolescents with ADHD diagnosis were involved from child psychiatry outpatient clinics and adolescents without a psychiatric treatment or diagnosis were enrolled from high schools in Hungary. The Mini International Neuropsychiatric Interview for Children and Adolescents was used to evaluate psychiatric symptoms and disorders as well as suicidal thoughts and planning. Regularized psychological networks were used to investigate the associations. RESULTS Altogether 185 adolescents (58 females and 127 males; mean age 14.79 years, SD = 1.48), 89 with ADHD and 96 without ADHD were enrolled. Depression symptom worthlessness was directly related to suicidal thoughts and planning, CI95 of the logit B between worthlessness and suicidal thought (0.72, 1.66). Both ADHD and anxiety were indirectly related to suicidal thoughts and planning through depression: CI95 of the logit B between being disorganized and feeling worthless is (0.38, 3.02), and CI95 of the logit B between being distressed and feeling worthless is (0.57, 2.52). CONCLUSIONS This study draws the attention of clinicians to the importance of recognizing "worthlessness" for suicide prevention in adolescents with ADHD. Furthermore, the results support previous studies, whereby symptoms of depression and anxiety mediate the relationship between ADHD and suicidal thoughts and planning. These results highlight the importance of ADHD comorbidities with depression and GAD and their effect on suicidal thoughts and planning.
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Affiliation(s)
- Luca Katzenmajer-Pump
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Komáromy
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.,Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Judit Balázs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Oslo New University College, Oslo, Norway
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Coppersmith DDL, Dempsey W, Kleiman EM, Bentley KH, Murphy SA, Nock MK. Just-in-Time Adaptive Interventions for Suicide Prevention: Promise, Challenges, and Future Directions. Psychiatry 2022; 85:317-333. [PMID: 35848800 PMCID: PMC9643598 DOI: 10.1080/00332747.2022.2092828] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The suicide rate (currently 14 per 100,000) has barely changed in the United States over the past 100 years. There is a need for new ways of preventing suicide. Further, research has revealed that suicidal thoughts and behaviors and the factors that drive them are dynamic, heterogeneous, and interactive. Most existing interventions for suicidal thoughts and behaviors are infrequent, not accessible when most needed, and not systematically tailored to the person using their own data (e.g., from their own smartphone). Advances in technology offer an opportunity to develop new interventions that may better match the dynamic, heterogeneous, and interactive nature of suicidal thoughts and behaviors. Just-In-Time Adaptive Interventions (JITAIs), which use smartphones and wearables, are designed to provide the right type of support at the right time by adapting to changes in internal states and external contexts, offering a promising pathway toward more effective suicide prevention. In this review, we highlight the potential of JITAIs for suicide prevention, challenges ahead (e.g., measurement, ethics), and possible solutions to these challenges.
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