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Fang L, Tong Y, Li M, Wang C, Li Y, Yuan M, Zhang X, Wang G, Wang J, Su P. Anxiety in adolescents and subsequent risk of suicidal behavior: A systematic review and meta-analysis. J Affect Disord 2024; 358:97-104. [PMID: 38703913 DOI: 10.1016/j.jad.2024.05.005] [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: 03/19/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Suicide is a major public health concern, and anxiety is a prevalent developmental challenge in adolescents closely linked to suicidal behavior. This study aimed to assess the association between anxiety in adolescents and subsequent risk of suicidal behavior through a meta-analysis, offering crucial insights for suicide prevention. METHODS Six bibliographic databases were comprehensively searched to clarify the association between adolescents anxiety and subsequent risk of suicidal behavior. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios and the corresponding 95 % confidence intervals. Subgroup analysis, sensitivity analysis and publication bias analysis were conducted with Stata version 15.1. RESULTS The findings revealed a significant association between anxiety in adolescents and subsequent suicidal behavior (OR = 2.33, 95 % CI [2.00, 2.71]). Subgroup analyses indicated differences in mean effect size estimates based on clinical diagnoses and self-reported measures used to assess anxiety. The correlation strength between adolescent anxiety and subsequent suicidal behavior increased with a longer follow-up period. Furthermore, adolescents anxiety was associated with increased risk of subsequent suicidal ideation (OR = 1.97, 95 % CI [1.72, 2.25]) and attempts (OR = 3.56, 95 % CI [2.49, 5.07]). Finally, boys (OR = 2.41, 95 % CI [1.67, 3.47]) with anxiety had a greater risk of subsequent suicidal behavior than girls (OR = 2.02, 95 % CI [1.47, 2.78]). CONCLUSION This study revealed that adolescents anxiety increases the risk of suicidal behavior, including suicidal ideation and attempts. Consequently, there is a critical need for timely interventions tailored to adolescents with anxiety to prevent future instances of suicide.
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Affiliation(s)
- Lulu Fang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Yingying Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Min Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Cong Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Mengyuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Gengfu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
| | - Jun Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
| | - Puyu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
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Seibel L, Harris KM, López R, Wolff J, Spirito A, Esposito-Smythers C. Perceived burdensomeness and thwarted belongingness as mediators of the relation between anxiety and suicidal ideation among adolescents. Suicide Life Threat Behav 2024. [PMID: 38778704 DOI: 10.1111/sltb.13094] [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] [Received: 12/20/2023] [Revised: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Anxiety and suicidal ideation have been shown to be positively related in adolescents. However, less is known about the strength of this association across different types of anxiety or the mechanisms through which this relation exists. Joiner's interpersonal theory of suicide suggests that thwarted belongingness (TB) and perceived burdensomeness (PB) lead to suicidal ideation; these constructs may explain a pathway through which anxiety and suicidal ideation are related. It was hypothesized that TB would mediate the relation between social anxiety disorder (SAD) symptoms and suicidal ideation, and PB would mediate the relation between generalized anxiety disorder (GAD) symptoms and suicidal ideation. METHODS These longitudinal mediation models were assessed using data collected from 147 depressed adolescents, who were recently hospitalized for suicidal ideation or behavior, enrolled in a randomized controlled trial (RCT). RESULTS Consistent with study hypotheses, PB mediated the relation between GAD symptoms and suicidal ideation severity. However, TB did not mediate the relation between SAD symptoms and suicidal ideation severity. CONCLUSION These results suggest that screening for and addressing PB among youth with GAD may help reduce risk for suicidal behavior.
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Affiliation(s)
- Lauren Seibel
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Katherine M Harris
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Roberto López
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Jennifer Wolff
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anthony Spirito
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Brott KH, Veilleux JC. Examining state self-criticism and self-efficacy as factors underlying hopelessness and suicidal ideation. Suicide Life Threat Behav 2024; 54:207-220. [PMID: 38112324 DOI: 10.1111/sltb.13034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/22/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION When people feel hopeless, they are more likely to think about suicide. Prior work has shown that both hopelessness and suicidal ideation fluctuate over time; however, there are likely other contextual factors underlying increased hopelessness and suicidal ideation in moments of time. METHOD In two studies using retrospective recall of a real event (Study 1, n = 268) and an experimental imaginal vignette design (Study 2, n = 356), we examined self-criticism and self-efficacy for self-regulation as crucial factors underlying hopelessness in people vulnerable to suicidal ideation. RESULTS In both studies, greater state self-criticism and lower state self-efficacy were associated with greater hopelessness. In Study 2, we also measured suicidal ideation, and found that higher self-criticism and lower self-efficacy for self-regulation scores were associated with greater suicidal ideation, even when controlling for negative affect. Evidence of an interaction between self-criticism and self-efficacy was found with scores in Study 2 but not in Study 1; specifically, lower self-efficacy was associated with greater ideation when self-criticism was high but not when self-criticism was low. CONCLUSION Overall, results support self-criticism and self-efficacy as important contextual factors underlying hopelessness and suicidal ideation and attending to the potential interactive effect between self-criticism and self-efficacy.
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Ye C, Pu D, Zhang J, Jia M, Zhang Y, Du S, Wang J, Xiong X. Unlocking the link between temporomandibular disorders and suicide ideation in pre-orthodontic patients: A moderated mediation model of depression and anxiety. J Affect Disord 2024; 349:486-493. [PMID: 38199395 DOI: 10.1016/j.jad.2024.01.079] [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: 09/14/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are a series of musculoskeletal diseases with high prevalence. A few studies have reported the correlation between TMD and suicide ideation (SI). However, the underlying mechanism of the relationship lacks in-depth exploration. METHODS A cross-sectional study was conducted among 954 pre-orthodontic patients. TMD assessment was based on the quintessential five TMD symptoms (5Ts) questionnaire. Anxiety, depression and pain catastrophizing was evaluated by Seven-item Generalized Anxiety Disorder Scale (GAD-7), Nine-item Patient Health Questionnaire (PHQ-9), and Pain Catastrophizing Scale (PCS), respectively. Correlational and moderated mediated analysis was preformed to demonstrate the relationship between TMD and SI. RESULTS In pre-orthodontic patients, 31.87 % reported having TMD symptoms and 6.50 % declared SI during the past two weeks. The SI prevalence was 10.53 % in participants with TMD and 4.62 % in those without TMD. Intra-articular TMD, rather than pain-related TMD were especially related with SI. Individuals with TMD had higher risk to SI (rs = 0.112, adjusted OR = 2.213, p < 0.001). The effect of TMD on SI was fully mediated through depression (β = 0.445, 95 % CI = [0.326, 0.563]). Anxiety exerted a negative moderating effect on the depression-SI relation (β = -0.033, 95 % CI = [-0.047, -0.019]). LIMITATIONS This study was a single-centered and cross-sectional survey. The data collection relied on self-reporting methods. CONCLUSIONS A positive link between TMD and SI was disclosed. The effect of TMD on SI was fully mediated through depression with anxiety as a negative moderator.
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Affiliation(s)
- Chengxinyue Ye
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Dan Pu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jie Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mao Jia
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yuyao Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Shufang Du
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jun Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Xiong
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Darteh EKM, Ninnoni JPK, Okyere J, Darteh F, John-Langba J, Dickson KS. Perceived discrimination, anxiety and mood disorders among university students during the COVID-19 era: evidence from a cross-sectional survey in a Ghanaian public university. Front Psychol 2024; 14:1274585. [PMID: 38282850 PMCID: PMC10811061 DOI: 10.3389/fpsyg.2023.1274585] [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: 08/09/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Before 2020 and the advent of the COVID-19 pandemic, mental disorders, including anxiety and mood disorders, were considered the leading causes of the global disease burden. There is evidence from multiple countries and social contexts that suggest the high risk of anxiety and mood disorders among students. Yet, there is a knowledge gap concerning understanding the association between the experience of discrimination and the risk of anxiety and mood disorders. We examined the association between the experience of discrimination and the risk of anxiety and mood disorders among university students. Methods This study is a cross-sectional survey among university students in Ghana. A quota sampling technique was used to recruit 1,601 students. Data were collected using structured questionnaires. All data were analyzed using Stata. Binary logistic regression model was used to examine the significant association between the outcome variable and the explanatory variables. Results The prevalence of anxiety disorder among the respondents was 67 per cent. Students who had experienced discrimination or had any member of their family experienced discrimination had higher odds (OR = 4.59, Cl = 2.64, 7.96) of anxiety and mood disorder compared to those who had not experienced any form of discrimination. Respondents aged 20-24 years had higher odds (OR = 1.47, Cl = 1.16, 1.85) of anxiety and mood disorder than those aged 15-19. Students with a high perceived risk of contracting COVID-19 had a higher odd (OR = 1.52, CI = 1.10, 2.10) compared to those with a low perceived risk. Conclusion The findings underscore a need for university authorities to lay out clear initiatives that will reinforce and meet the mental health needs of university students during and after periods of crisis, such as returning from COVID-19 lockdown. There must be a conscious effort to advocate and raise students' awareness of anxiety disorders. Also, it is imperative to create support groups within the university set up to address the mental health needs of all students. Younger students should be the primary focus of these interventions.
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Affiliation(s)
- Eugene K. M. Darteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Research and Advocacy, Challenging Heights, Winneba, Ghana
| | - Florie Darteh
- Institute of Education, University of Cape Coast, Cape Coast, Ghana
| | - Johannes John-Langba
- School of Applied Human Sciences, University of Kwazulu-Natal, Durban, South Africa
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Xi W, Banerjee S, Zima BT, Alexopoulos GS, Olfson M, Xiao Y, Pathak J. Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth. JAACAP OPEN 2023; 1:206-217. [PMID: 37946932 PMCID: PMC10635419 DOI: 10.1016/j.jaacop.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Objective Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth. Method This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011-2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event. Results At each follow-up time period, rates of SI and SA varied by the US geographic division (p < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%-10.26% for SI; 0.70%-2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46). Conclusion To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.
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Affiliation(s)
- Wenna Xi
- Weill Cornell Medicine, New York
| | | | - Bonnie T Zima
- Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | | | - Mark Olfson
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
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Moller CI, Badcock PB, Hetrick SE, Rice S, Berk M, Witt K, Chanen AM, Dean OM, Gao C, Cotton SM, Davey CG. Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety. Aust N Z J Psychiatry 2023; 57:1150-1162. [PMID: 36629043 DOI: 10.1177/00048674221144262] [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] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Depression and suicidal ideation are closely intertwined. Yet, among young people with depression, the specific factors that contribute to changes in suicidal ideation over time are uncertain. Factors other than depressive symptom severity, such as comorbid psychopathology and personality traits, might be important contributors. Our aim was to identify contributors to fluctuations in suicidal ideation severity over a 12-week period in young people with major depressive disorder receiving cognitive behavioural therapy. METHODS Data were drawn from two 12-week randomised, placebo-controlled treatment trials. Participants (N = 283) were 15-25 years old, with moderate to severe major depressive disorder. The primary outcome measure was the Suicidal Ideation Questionnaire, administered at baseline and weeks 4, 8 and 12. A series of linear mixed models was conducted to examine the relationship between Suicidal Ideation Questionnaire score and demographic characteristics, comorbid psychopathology, personality traits and alcohol use. RESULTS Depression and anxiety symptom severity, and trait anxiety, independently predicted higher suicidal ideation, after adjusting for the effects of time, demographics, affective instability, non-suicidal self-injury and alcohol use. CONCLUSIONS Both state and trait anxiety are important longitudinal correlates of suicidal ideation in depressed young people receiving cognitive behavioural therapy, independent of depression severity. Reducing acute psychological distress, through reducing depression and anxiety symptom severity, is important, but interventions aimed at treating trait anxiety could also potentially be an effective intervention approach for suicidal ideation in young people with depression.
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Affiliation(s)
- Carl I Moller
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul B Badcock
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah E Hetrick
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Katrina Witt
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M Chanen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Olivia M Dean
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Caroline Gao
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sue M Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
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Wang YF, You GY, Han T, Liu Y, Li J, Ji X, Xie XM. Network analysis of comorbid depression, suicidality and biomarkers on HPA axis among mood disorder patients to psychiatric emergency services. Transl Psychiatry 2023; 13:203. [PMID: 37316541 DOI: 10.1038/s41398-023-02503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
Rapid assessment and intervention of suicide risk are common and challenging in psychiatric emergency departments (PED). It is unclear whether distinct pathophysiological processes exist among depressive patients with suicidality. This study examined the network structures of biomarkers on Hypothalamic-Pituitary-Adrenal (HPA) axis, such as Adrenocorticotropic hormone (ACTH) and Corticosterone (Cort), as well as suicidality and depressive symptoms in mood disorder patients in PED. Mood disorder patients in PED were assessed with the measurements of suicidality and depressive symptoms, respectively. A network analysis was performed to identify central symptoms and bridge symptoms of this network and their links to ACTH and Cort. Network stability was examined using the case-dropping procedure. The Network Comparison Test (NCT) was conducted to evaluate whether network characteristics differed by gender. A total of 1815 mood disorder patients were recruited. The prevalence of SI was 31.2% (95% CI: 28.15-34.21%), SP was 30.4% (95% CI: 27.39-33.41%), SA was 30.62% (95% CI: 27.61-33.64%) among psychiatric outpatients. The mean score of HAMD-24 was 13.87 ± 8.02. Network analysis revealed that 'Somatic anxiety' had the highest expected centrality, followed by 'Hopelessness' and 'Suicide attempt'. 'Corticosterone' and 'Retardation' may be the main bridge symptoms between depressive symptoms and the suicidality community. The network model showed a high degree of stability. Gender did not significantly influence the network structure. The central symptoms and key bridge symptoms identified could be potential targets for interventions of the HPA axis, which is designed for regular screening of a range of suicidal activity. In the light of this, timely treatment should be provided for psychiatric emergency care.
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Affiliation(s)
- Yi-Fan Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Guang-Yun You
- Department of Psychiatry, The People's Hospital of Juxian County, Juxian, 276500, China
| | - Tian Han
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Juan Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiao Ji
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Xiao-Meng Xie
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Brief Behavioral Therapy for Anxiety and Depression in Pediatric Primary Care: Breadth of Intervention Impact. J Am Acad Child Adolesc Psychiatry 2023; 62:230-243. [PMID: 36030033 DOI: 10.1016/j.jaac.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/01/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report on broad-based outcomes of the Brief Behavioral Therapy (BBT) trial for pediatric anxiety and depression. Secondary data analyses expand on previous reports by assessing diagnostic remission and independent functioning, impact on targeted psychopathology, and spillover effects on non-targeted outcomes. METHOD Youth (N = 185; 8-16.9 years; 58% female; 78% White; 21% Hispanic) with anxiety and/or depression were eligible for this multi-site trial. Enrolled youth were randomly assigned to receive 8 to 12 sessions of BBT in primary care or assisted referral to outpatient care (ARC). Assessments were conducted 16 and 32 weeks post randomization. RESULTS BBT was superior to ARC on remission of all targeted diagnoses (week 16: 56.8% vs 28.2%, p < .001; week 32: 62.5% vs 38.9%, p = .004), clinician-rated independent functioning (week 16: 75.0% vs 45.7%, p < .001; week 32: 81.2% vs 55.7%, p < .001), and on measures of anxiety, depression, suicide items, total comorbid behavioral and emotional problems, and hyperactivity (d = 0.21-0.49). Moderation analyses revealed superior outcomes for Hispanic youth in BBT vs ARC for diagnostic remission, anxiety, emotional problems, and parent-child conflict. Youth depression at baseline moderated effects on peer problems and parent-child conflict, with effects favoring BBT. Significant main and moderated effects of BBT on change in non-targeted outcomes were largely mediated by change in anxiety (24.2%-49.3% of total effects mediated). CONCLUSION BBT has positive effects on youth, mediated by the strong impact of the intervention on anxiety. Analyses continue to support positive outcomes for Hispanic youth, suggesting that BBT is a broadly effective transdiagnostic treatment option for diverse populations. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; https://clinicaltrials.gov; NCT01147614.
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Li J, Zhang Y, Siu Man Chan B, Tan SN, Lu J, Luo X, Shen Y, Zhang XY. Associations between anxiety, depression, and risk of suicidal behaviors in Chinese medical college students. Front Psychiatry 2022; 13:1012298. [PMID: 36532186 PMCID: PMC9757065 DOI: 10.3389/fpsyt.2022.1012298] [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] [Received: 08/05/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background Previous studies have established a strong association between depression and suicidal behaviors, yet the relationship between anxiety and suicidal behaviors remains unclear. This study examines whether anxiety and depression are independent risk factors for suicidal behaviors in medical college students, and further, whether anxiety may increase the greater risk of suicidal behaviors (SB) in participants with depression. Methods This cross-sectional study was conducted among 4,882 medical students. Demographic information, anxiety, and depression data were collected using online questionnaires or through a widely used social media app named WeChat. Results Anxiety and depression were independent risk factors for suicidal behaviors, and levels of risk correlated positively with the severity of both anxiety and depressive symptoms. A dose-response relationship was identified between the severity of anxiety and the risk of SB, as well as the severity of depression and SB. Furthermore, anxiety increased the risk of suicidal behaviors in participants with depression, with a dose-response relationship between the severity of anxiety symptoms and the risk of SB. Conclusion The findings highlight the importance of screening for anxiety and depressive symptoms in medical college students, as well as reducing anxiety in addition to depressive symptoms in treatment. This study provides valuable data as a reference for clinicians for suicide risk assessments.
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Affiliation(s)
- Jia Li
- Department of Applied Psychology, College of Preschool Education, Changsha Normal University, Changsha, Hunan, China
| | - Yaru Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Bella Siu Man Chan
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Sun Nee Tan
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine (Neuroscience), The University of British Columbia, Vancouver, BC, Canada
| | - Jianping Lu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Mental Health School, Shenzhen Mental Health Center, Shenzhen University, Shenzhen, China
| | - Xuerong Luo
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanmei Shen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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11
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Colmenero-Navarrete L, García-Sancho E, Salguero JM. Relationship Between Emotion Regulation and Suicide Ideation and Attempt in Adults and Adolescents: A Systematic Review. Arch Suicide Res 2022; 26:1702-1735. [PMID: 34821201 DOI: 10.1080/13811118.2021.1999872] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Suicide is one of the main causes of death in adults and adolescents, so research focused on identifying risk factors for suicidal behavior is needed. In recent years, emotion regulation, mainly the presence of difficulties regulating one's own negative emotions, has been associated with negative mental health outcomes. OBJECTIVE The purpose of this study was to systematically review the available evidence on the association between emotion regulation and suicide (ideation and attempt) in both adults and adolescents. METHOD A systematic search of scientific articles published in English and Spanish was carried out through the databases PsycINFO, MEDLINE, Scopus, and the Cochrane Library. RESULTS We identified 76 eligible studies, of which 70 reported that people with difficulties in emotion regulation reported higher levels of suicide ideation and more suicide attempts. The results were consistent in adolescents and adults, in clinical and general population samples, and when studies assessed both emotion regulation processes and strategies. However, few studies were longitudinal and most of them were with women. CONCLUSIONS We discuss the theoretical implications of the results, suggesting that actual psychological models might benefit from considering individual differences in ER in understanding why people engage in suicide behavior. Clinical implications are also discussed.HIGHLIGHTSDifficulties regulating one's emotions is associated with suicide behavior (SI and SA).Consistent results at all the ages and in the clinical and general population.Individual differences in ER could help researchers to understand suicide.
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12
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Hutchison M, Russell BS, Starkweather AR, Gans KM. Outcomes From an Online Pilot Mindfulness Based Intervention with Adolescents: A Comparison by Categories of Risk. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:438-450. [PMID: 36193193 PMCID: PMC9520099 DOI: 10.1007/s10826-022-02448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Comorbid psychiatric presentations, defined as those who present with more than one mental and/or behavioral health diagnosis at the same time, during adolescence are on the rise. Mindfulness-based interventions can alleviate psychological symptoms and improve emotion regulation in youth. Mindfulness is a multifaceted phenomenon, with five underlying facets (Observing, Describing, Acting with Awareness, Non-Judgment and Non-Reactivity of Inner Experience). Little evidence has documented which facets produce pronounced psychiatric symptom reduction for adolescents. This pilot study examined the efficacy of an online mindfulness-based intervention delivered to adolescents undergoing mental health treatment during COVID-19 to reduce psychiatric outcomes. Fifty-six adolescents (m = 14.5 years, 66.1% female) categorized as moderate-risk (treatment histories of outpatient therapy only) or high-risk (treatment histories with intensive service participation) participated in the 8-session mindfulness-based intervention. Significant reductions in psychiatric symptoms and increases in adaptive coping strategies were observed at post-test, particularly for those at moderate-risk. Multivariate stepwise regression found significant associations between mindfulness facet use and anxiety, depression, and somatic symptoms (R 2 ranging from 42.5 to 52.8%). Results indicate preliminary efficacy for an online mindfulness-based intervention for adolescents, particularly those at moderate-risk, due to the introduction of new coping skills, given their history of less intense treatment. Further investigation is warranted to understand which mindfulness facet intervention components produce the most prominent outcomes.
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Affiliation(s)
- Morica Hutchison
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269 USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14620 USA
| | - Beth S. Russell
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269 USA
| | | | - Kim M. Gans
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269 USA
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13
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Hutchison M, Russell BS, Gans KM, Starkweather AR. Online administration of a pilot mindfulness-based intervention for adolescents: Feasibility, treatment perception and satisfaction. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 35382039 PMCID: PMC8972985 DOI: 10.1007/s12144-022-03025-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
Adolescents may be more vulnerable to COVID-19-related impacts and require long-term mental health care. Services that bolster emotion regulation, such as mindfulness-based interventions (MBIs) promote positive impacts on psychosocial outcomes and have high acceptability. No studies have assessed feasibility, treatment perceptions and satisfaction of online MBIs with adolescents. 56 moderate- and high-risk adolescent (m = 14.5 years, 66.1% female, 26.8% LatinX) participants tested the feasibility, treatment perceptions and satisfaction of an 8-session online MBI focused on observing non-judgmentally, attending to positivity, and self-soothing. The study achieved acceptable feasibility with high attendance (m = 5.75) and retention rates (87.5%). The moderate- vs. high-risk group reported significantly higher ratings of treatment perceptions (t = 2.03, p < .05, d = 0.60). Significant associations were found between increased pre-test depression and anxiety symptomology and reduced intervention utility (rs = -0.34 and -0.32, ps < .05). This study demonstrated feasibility, treatment perceptions and satisfaction of an online MBI for adolescents presenting with two risk levels. Higher-risk adolescents may need a higher-touch intervention than moderate-risk, who may be more likely to find online MBIs acceptable. The impact of adjunctive MBIs for adolescents on treatment attendance and mental health outcomes over longer periods is necessary to understand patterns in effective adolescent treatment options. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-03025-x.
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Affiliation(s)
- Morica Hutchison
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269-1058 USA
- Department of Psychiatry, University of Rochester Medical Center, 14620, Rochester, NY USA
| | - Beth S. Russell
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269-1058 USA
- Department of Psychiatry, University of Rochester Medical Center, 14620, Rochester, NY USA
| | - Kim M. Gans
- Human Development and Family Sciences, University of Connecticut, Storrs, CT 06269-1058 USA
- Department of Psychiatry, University of Rochester Medical Center, 14620, Rochester, NY USA
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Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors. Child Psychiatry Hum Dev 2022; 53:223-236. [PMID: 33462740 DOI: 10.1007/s10578-020-01114-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/28/2022]
Abstract
Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.
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15
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Badarch J, Chuluunbaatar B, Batbaatar S, Paulik E. Suicide Attempts among School-Attending Adolescents in Mongolia: Associated Factors and Gender Differences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052991. [PMID: 35270685 PMCID: PMC8910274 DOI: 10.3390/ijerph19052991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
Attempting suicide is an important risk factor that can lead to suicide death. The aim of the current study was to examine the prevalence of suicide attempts and to identify the gender-specific predictors of suicide among adolescents in Mongolia. We analyzed data from the 2019 Mongolian Global School-Based Health Survey (GSHS) conducted nationwide among 13–18-year-old students. Univariable and multivariable analyses were performed to assess the correlates of suicide attempts. Overall, 32.1% of the adolescents reported to have had suicide attempts. Multivariable analysis showed a significant association in the total sample of suicide attempts with lack of close friends, anxiety, injury and violence, smoking and alcohol drinking, and sexual intercourse. Male suicide attempters were less likely to have close friends and more likely to have injuries, been physically attacked, been bullied, smoke, drink alcohol, and have had sexual intercourse. Within the female subgroup, anxiety, injury and violence, smoking and alcohol drinking significantly increased the odds of reporting suicide attempts. Increase of the student’s age by one year decreased the odds ratio of suicide attempts. Nearly one in three students had had a suicide attempt. Several factors, including mental distress, violence, and risky behaviors were found to be associated with suicide attempts. These can aid in designing intervention strategies for preventing suicidal behaviors among adolescents.
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Affiliation(s)
- Javzan Badarch
- Department of Public Health, Albert Szent-Györgyi Medical School, University of Szeged, 6720 Szeged, Hungary;
- Correspondence:
| | - Bayar Chuluunbaatar
- Medicine and Medical Devices Regulatory Agency, Ulaanbaatar 14210, Mongolia;
| | - Suvd Batbaatar
- Department of Environmental Health, National Center for Public Health, Ulaanbaatar 13381, Mongolia;
| | - Edit Paulik
- Department of Public Health, Albert Szent-Györgyi Medical School, University of Szeged, 6720 Szeged, Hungary;
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16
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Xiao H, Li X, Zhou Z, Liu H, Hu C, Liu T, Chen D, You L. Negative coping style mediates the relationship between negative mental and suicide risk among migrant workers in China. Sci Rep 2022; 12:305. [PMID: 35013401 PMCID: PMC8748836 DOI: 10.1038/s41598-021-03888-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
Suicide is increasingly recognized as a major public health concern among migrant workers in China. Despite negative mental and negative coping styles being core themes found in suicide notes, there is scarce research addressing the theoretical framework of underlying mechanisms between these variables. The study was designed to examine the relationships of negative mental, negative coping styles, and suicide risk among migrant workers. It hypothesized that negative mental would exert a positive effect on suicide risk via increased negative coping. Using a cross-sectional design, the study was conducted using a sample of 3095 migrant workers from Shenzhen, China. Self-made Suicide Risk Scale (SRS), Short-form of the ULCA Loneliness Scale (USL-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7), Simplified Coping Style Questionnaire (SCSQ) were used to collect data. Structural equation modeling (SEM) was performed to quantitatively explore the path effects between negative mental, negative coping styles and suicide risk. Results showed that negative coping style had a positive association with suicide risk (β = 0.029, P < 0.001). Negative mental had both direct and indirect positive effects on suicide risk through negative coping styles (β = 0.109, β = 0.013, P < 0.001). Therefore, to prevent suicidal behaviors among migrant workers, targeted interventions focusing on improving their mental health and coping strategies are needed.
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Affiliation(s)
- Han Xiao
- Department of Public Health, Peking University Health Science Centre, Beijing, 100091, China
| | - Xiaoyi Li
- Department of Public Health, Peking University Health Science Centre, Beijing, 100091, China
| | - Zhijian Zhou
- Shenzhen Kangning Psychiatric Hospital, Shenzhen, 518020, Guangdong, China
| | - Huiming Liu
- Shenzhen Kangning Psychiatric Hospital, Shenzhen, 518020, Guangdong, China
| | - Chiyi Hu
- Shenzhen Kangning Psychiatric Hospital, Shenzhen, 518020, Guangdong, China
| | - Tiebang Liu
- Shenzhen Kangning Psychiatric Hospital, Shenzhen, 518020, Guangdong, China
| | - Dafang Chen
- Department of Public Health, Peking University Health Science Centre, Beijing, 100091, China.
| | - Liqing You
- Shenzhen Kangning Psychiatric Hospital, Shenzhen, 518020, Guangdong, China.
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17
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Berny LM, Tanner-Smith EE. Differential Predictors of Suicidal Ideation and Suicide Attempts: Internalizing Disorders and Substance Use in a Clinical Sample of Adolescents. J Dual Diagn 2022; 18:59-69. [PMID: 34982653 PMCID: PMC8960344 DOI: 10.1080/15504263.2021.2016343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. Methods: Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. Results: Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. Conclusions: Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.
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Affiliation(s)
- Lauren M Berny
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA
| | - Emily E Tanner-Smith
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA.,Prevention Science Institute, University of Oregon, Eugene, OR, USA
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18
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Murphy SE, Capitão LP, Giles SLC, Cowen PJ, Stringaris A, Harmer CJ. The knowns and unknowns of SSRI treatment in young people with depression and anxiety: efficacy, predictors, and mechanisms of action. Lancet Psychiatry 2021; 8:824-835. [PMID: 34419187 DOI: 10.1016/s2215-0366(21)00154-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023]
Abstract
The use of SSRIs for the treatment of depression and anxiety in young people is increasing. However, the effects of SSRIs in adolescence, a time when there are substantial changes in neural, cognitive, and social functioning, are not well understood. Here, we review evidence from clinical trials about the benefits and risks of SSRIs in young people and consider their mechanisms of action, as shown through human experimental work and animal models. We emphasise key outstanding questions about the effects of SSRIs in youth, identified through gaps in the literature and in consultation with young people with lived experience. It is crucial to characterise the mechanisms underpinning risks and benefits of SSRIs in this age group to progress the field, and to narrow the chasm between the widespread use of SSRIs in youth and the science on which this use is based.
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Affiliation(s)
- Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Liliana P Capitão
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sophie L C Giles
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Ahinkorah BO, Aboagye RG, Arthur-Holmes F, Hagan JE, Okyere J, Budu E, Dowou RK, Adu C, Seidu AA. A Multi-Country Analysis of Prevalence of Anxiety-Induced Sleep Disturbance and Its Associated Factors among In-School Adolescents in Sub-Saharan Africa Using the Global School-Based Health Survey. Healthcare (Basel) 2021; 9:healthcare9020234. [PMID: 33671775 PMCID: PMC7926929 DOI: 10.3390/healthcare9020234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Among the health problems affecting adolescents, anxiety disorders are considered among the health-compromising or debilitating outcomes that affect adolescents' mental health. We examined the prevalence and factors associated with anxiety-induced sleep disturbance among in-school adolescents in sub-Saharan Africa (SSA). (2) Methods: This study involved a cross-sectional analysis of data from the Global School-Based Health Survey (GSHS). We analyzed data on 25,454 in-school adolescents from eleven (11) countries in SSA with a dataset between 2010 and 2017. Two multivariable logistic regression models were built to determine the strength of the association between anxiety-induced sleep disturbance and the explanatory variables. The results of the regression analyses were presented using adjusted odds ratios (aOR) and their respective 95% confidence intervals (CIs). Statistical significance was set at p-value < 0.05. (3) Results: The overall prevalence of anxiety-induced sleep disturbance among in-school adolescents in SSA was 12.2%. The prevalence ranged from 5.1% in Tanzania to 20.5% in Benin. The odds of anxiety-induced sleep disturbance was higher among adolescents aged 15 and above [aOR = 1.26, 95% CI = 1.15, 1.39] compared to those aged 14 or younger. Additionally, the odds of anxiety-induced sleep disturbance was higher among adolescents who were bullied [aOR = 1.54, 95% CI = 1.42, 1.67], those that felt lonely [aOR = 3.85, 95% CI = 3.52, 4.22], those who had suicidal ideations [aOR = 1.70, 95% CI = 1.52, 1.90], those who had suicidal plan [aOR = 1.26, 95% CI = 1.13, 1.41], those who have had suicidal attempt [aOR = 1.21, 95% CI = 1.08, 1.35], those who used marijuana [aOR = 1.27, 95% CI = 1.06, 1.52], and those who were truant at school [aOR = 1.33, 95% CI = 1.22, 1.46]. However, male adolescents had lower odds of anxiety-induced sleep disturbance [aOR = 0.88, 95% CI = 0.81, 0.95], compared to their female counterparts. (4) Conclusions: We found a relatively high prevalence of anxiety-induced sleep disturbance among in-school adolescents in SSA. Higher age, being female, being bullied, loneliness, having suicidal ideations/plan/attempt, use of marijuana and truancy were risk factors for anxiety-induced sleep disturbance. The findings, therefore, highlight the urgency for policies (e.g., early school-based screening) and interventions (e.g., Rational Emotive Behavioral Education (REBE), Social Emotional Learning (SEL) that target in-school adolescents within the most at-risk populations of anxiety-induced sleep disturbance in SSA.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia;
| | - Richard Gyan Aboagye
- School of Public Health, University of Health and Allied Sciences, Ho PMB 31, Ghana; (R.G.A.); (R.K.D.)
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong, China;
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast PMB, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
- Correspondence:
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (J.O.); (E.B.); (A.-A.S.)
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (J.O.); (E.B.); (A.-A.S.)
| | - Robert Kokou Dowou
- School of Public Health, University of Health and Allied Sciences, Ho PMB 31, Ghana; (R.G.A.); (R.K.D.)
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi PMB AK, Ghana;
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (J.O.); (E.B.); (A.-A.S.)
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, QLD 4811, Australia
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Namuli JD, Nalugya JS, Bangirana P, Nakimuli-Mpungu E. Prevalence and Factors Associated With Suicidal Ideation Among Children and Adolescents Attending a Pediatric HIV Clinic in Uganda. FRONTIERS IN SOCIOLOGY 2021; 6:656739. [PMID: 34212027 PMCID: PMC8239397 DOI: 10.3389/fsoc.2021.656739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/25/2021] [Indexed: 05/15/2023]
Abstract
Background: Suicidal behavior and HIV/AIDS are vital public health challenges especially in low and middle-income countries. As suicide in adults is perturbing for those closest to them, this sentiment is much more intense and generalized in the case of a child or adolescent. Knowledge of factors associated with suicidal ideation in HIV infected children and adolescents may inform suicide prevention strategies needed to improve their quality of life. This study aimed to assess the prevalence and factors associated with suicidal ideation among HIV infected children and adolescents attending a pediatric HIV clinic in Uganda. Methods: Data from a sample of 271 children and adolescents aged 6-18 years living with HIV/AIDS attending a pediatric HIV clinic was analyzed. Child characteristics and clinical variables were assessed using a socio-demographic questionnaire and medical records respectively. Suicidal ideation and depression were assessed using the Child Depression Inventory. The types of behavioral problems and the parent-child relationship were assessed using Child Behavioral Check List (6-18 years) and the Parent Child Relationship Scale respectively. Child exposure to different stressful life events was assessed with a series of standardized questions. Logistic regression models were used to explore factors independently associated with suicidal ideation. Results: The prevalence of suicidal ideation was 17%. In the multivariate analysis; Child exposure to family or friend's death (prevalence rate ratio (PRR = 2.02; 95% CI, 1.01-4.03), p = 0.046), HIV wasting syndrome (PRR = 0.39; 95% CI, 0.21-0.75, p = 0.04), Depression (PRR = 1.08; 95% CI, 1.03-1.12, p = 0.001), Anxiety symptoms (PRR = 1.10; 95% CI, 1.01-1.20, p = 0.024) and Rule breaking behavior (PRR = 1.06; 95% CI, 0.99-1.13, p = 0.051) were independently associated with suicidal ideations. Conclusion: The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial. Children and adolescents with exposure to family or friend's death, those with higher depression scores, anxiety symptoms and rule breaking behavior are more likely to report suicidal ideation. Those with HIV wasting syndrome were less likely to report suicidal ideation. There is urgent need for HIV care providers to screen for suicide and link to mental health services.
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Affiliation(s)
- Justine Diana Namuli
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- *Correspondence: Justine Diana Namuli,
| | | | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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Makol BA, De Los Reyes A, Ostrander RS, Reynolds EK. Parent-Youth Divergence (and Convergence) in Reports of Youth Internalizing Problems in Psychiatric Inpatient Care. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1677-1689. [PMID: 30937814 DOI: 10.1007/s10802-019-00540-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
When compared to one another, multiple informants' reports of adolescent internalizing problems often reveal low convergence. This creates challenges in the delivery of clinical services, particularly for severe outcomes linked to internalizing problems, namely suicidal thoughts and behaviors. Clinicians would benefit from methods that facilitate interpretation of multi-informant reports, particularly in inpatient settings typified by high-cost care and high-stakes decision-making. 765 adolescent inpatients (70.3% female; Mage = 14.7) and their parents completed measures of adolescent internalizing problems. We obtained baseline clinical and treatment characteristics from electronic medical records. Latent class analysis revealed four reporting patterns: Parent-Adolescent Low (LL; 49.0%), Parent Low-Adolescent High (PL-AH; 11.5%), Parent High-Adolescent Low (PH-AL; 21.8%), Parent-Adolescent High (HH; 17.6%). Relative to the LL class, adolescents in the PH-AL and PL-AH classes were more likely to be admitted with suicidality. In terms of treatment characteristics and relative to the LL class, HH and PH-AL adolescents were more likely to receive standing antipsychotics, PH-AL adolescents were more likely to be in seclusion, and HH adolescents had longer hospital stays. At discharge and relative to the LL class, HH, PH-AL, and PL-AH adolescents were more likely to receive an anxiety disorder diagnosis. Further, HH, PH-AL, and PL-AH adolescents were more likely to receive partial hospitalization or care in another restrictive environment after inpatient treatment, relative to the LL class. This naturalistic study informs clinical decision-making by aiding our understanding of how multi-informant reports facilitate interpretations of adolescents' clinical presentations as well as predictions about treatment characteristics.
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Affiliation(s)
- Bridget A Makol
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123K, College Park, MD, 20742, USA.
| | - Andres De Los Reyes
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123K, College Park, MD, 20742, USA
| | - Rick S Ostrander
- Department of Psychiatry and Behavioral Science, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center (Level 12), Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Science, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center (Level 12), Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
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22
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Barzilay R, White LK, Moore TM, Calkins ME, Taylor JH, Patrick A, Huque ZM, Young JF, Ruparel K, Pine DS, Gur RC, Gur RE. Association of anxiety phenotypes with risk of depression and suicidal ideation in community youth. Depress Anxiety 2020; 37:851-861. [PMID: 32500960 PMCID: PMC7484017 DOI: 10.1002/da.23060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/02/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety symptoms are common in adolescence and are often considered developmentally benign. Yet for some, anxiety presents with serious comorbid nonanxiety psychopathology. Early identification of such "malignant" anxiety presentations is a major challenge. We aimed to characterize anxiety symptoms suggestive of risk for depression and suicidal ideation (SI) in community youths. METHODS Cross-sectional associations were evaluated in community youths (n = 7,054, mean age: 15.8) who were assessed for anxiety, depression, and SI. We employed factor and latent class analyses to identify anxiety clusters and subtypes. Longitudinal risk of anxiety was evaluated in a subset of 330 youths with longitudinal data on depression and SI (with baseline mean age of 12.3 years and follow-up mean age of 16.98 years). OUTCOMES Almost all (92%) adolescents reported anxiety symptoms. Data-driven approaches revealed anxiety factors and subtypes that were differentially associated with depression and SI. Cross-sectional analyses revealed that panic and generalized anxiety symptoms show the most robust associations with depression and SI. Longitudinal, multivariate analyses revealed that panic symptoms during early adolescence, not generalized anxiety symptoms, predict depression and SI for later adolescent years, particularly in males. INTERPRETATION Anxiety is common in youths, with certain symptom clusters/subtypes predicting risk for depression and SI. Panic symptoms in early adolescence, even below disorder threshold, predict high risk for late adolescent depression and SI.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Lauren K. White
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP
| | - Tyler M. Moore
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Monica E. Calkins
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Jerome H. Taylor
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Ariana Patrick
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP
| | - Zeeshan M. Huque
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Jami F. Young
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Kosha Ruparel
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Daniel S. Pine
- Section of Developmental Affective Neuroscience, National Institute of Mental Health
| | - Ruben C. Gur
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Raquel E. Gur
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
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23
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Prevalence and psychiatric correlates of suicidal ideation in UK university students. J Affect Disord 2020; 272:191-197. [PMID: 32379615 DOI: 10.1016/j.jad.2020.03.185] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Evidence highlights increased susceptibility to thoughts and behaviors related to suicide (i.e. suicidal ideation) in the student population, often in co-occurrence with mental health difficulties. Typically, studies focus on specific symptoms, with few providing comprehensive examination of risk factors. In this study we examined the prevalence of suicidal ideation among UK university students and assessed the association with multiple psychiatric risk factors. METHODS A total of N = 1273 students completed online measures of suicidal ideation, anxiety, depression, insomnia, mania, psychosis, and perceived stress. RESULTS 37.3% students were classified as high-risk for suicidal behaviour. Moreover, 42.2% of students contemplated suicide at least once within the past twelve months, and 25.1% reported telling someone about these thoughts at least once. Logistic regression analysis showed that suicidal ideation was significantly associated with symptoms of depression, mania, psychosis, and stress. LIMITATIONS The cross-sectional nature of ours study does not allow us to infer causality in the observed associations. CONCLUSIONS Our results indicate the prevalence of suicidal ideation in a large sample of university students in the UK, and highlight associated mental health risk factors associated with it. Our findings have implications for mental health practitioners working with University students.
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24
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Creswell C, Waite P, Hudson J. Practitioner Review: Anxiety disorders in children and young people - assessment and treatment. J Child Psychol Psychiatry 2020; 61:628-643. [PMID: 31960440 DOI: 10.1111/jcpp.13186] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
Abstract
Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Polly Waite
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Jennie Hudson
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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25
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Díez-Gómez A, Pérez-Albéniz A, Sebastián-Enesco C, Fonseca-Pedrero E. Suicidal Behavior in Adolescents: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082820. [PMID: 32325865 PMCID: PMC7216010 DOI: 10.3390/ijerph17082820] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 01/30/2023]
Abstract
The main goal of the present study was to identify and validate latent classes of suicidal behavior in a representative sample of adolescents. The sample comprised a total of 1506 students, including 667 males (44.3%), selected through a sample stratified by clusters. The mean age was 16.15 years (SD = 1.36). The instruments used evaluated suicidal behavior, positive and negative affect, emotional and behavioral problems, prosocial behavior, and subjective well-being. Using the Paykel Suicide Scale, the latent class analysis identified four homogeneous subgroups: “low risk”, “suicidal act”, “suicidal ideation”, and “high risk for suicide”. These subgroups presented a differential pattern in terms of their social-emotional adjustment. The subgroups with the highest theoretical risk showed lower scores on subjective well-being and positive affect as well as higher scores on emotional and behavioral problems and negative affect compared to the non-risk subgroups. This study contributes to an understanding of the typologies of suicidal behavior among adolescents and the relationship with psychopathological adjustment. Ultimately, these findings may promote the development or improvement of early detection and prevention strategies in the suicidal behavior field in order to reduce the socio-economic burdens associated with suicide in young populations.
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Affiliation(s)
- Adriana Díez-Gómez
- Department of Educational Sciences, University of La Rioja, 26004 Logroño, Spain; (A.D.-G.); (E.F.-P.)
- Programa Riojano de Investigación en Salud Mental (PRISMA), 26004 Logroño, Spain;
| | - Alicia Pérez-Albéniz
- Department of Educational Sciences, University of La Rioja, 26004 Logroño, Spain; (A.D.-G.); (E.F.-P.)
- Programa Riojano de Investigación en Salud Mental (PRISMA), 26004 Logroño, Spain;
- Correspondence:
| | - Carla Sebastián-Enesco
- Programa Riojano de Investigación en Salud Mental (PRISMA), 26004 Logroño, Spain;
- Department of Research and Psychology in Education, University Complutense of Madrid, 28223 Madrid, Spain
| | - Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, 26004 Logroño, Spain; (A.D.-G.); (E.F.-P.)
- Programa Riojano de Investigación en Salud Mental (PRISMA), 26004 Logroño, Spain;
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 33006 Oviedo, Spain
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26
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Levy T, Kronenberg S, Crosbie J, Schachar RJ. Attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidality in children: The mediating role of depression, irritability and anxiety symptoms. J Affect Disord 2020; 265:200-206. [PMID: 32090742 DOI: 10.1016/j.jad.2020.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/22/2019] [Accepted: 01/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with increased suicidality risk. Yet, potential mechanisms transmitting the effect of ADHD to suicidality remain unclear. We investigated whether depression, irritability and anxiety symptoms mediate between ADHD symptoms and suicidality. METHODS ADHD, depression, irritability and anxiety symptoms as well as suicidality (composited of suicidal ideation, attempts or self-harm) were measured in an outpatient clinic for ADHD (N = 1,516, 6-17 years old, 61.1% diagnosed with ADHD) using parent and teacher questionnaires. Multiple mediator models adjusted for age, sex and psychosocial adversities were constructed separately for parent- and teacher-report. RESULTS Parents reported higher rates of suicidality than did teachers (12.1% and 3.8%, p < .001). Suicidality was associated with parent (OR = 1.10, 95%CI: 1.07-1.14) and teacher (OR = 1.08, 95%CI: 1.03-1.15) reported ADHD symptoms. The association between ADHD symptoms and suicidality was mediated by both parent- and teacher-reported depression (39.1% and 45.3% of total effect, respectively) and irritability symptoms (36.8% and 38.4% of total effect, respectively). Anxiety symptoms mediated between ADHD and suicidality for parent- but not teacher-report (19.0% of total effect). No direct effect of ADHD symptoms was found once depression, irritability and anxiety were controlled. LIMITATIONS The cross-sectional design limits the ability to determine causal order between mediators and outcome. CONCLUSIONS Our results confirmed the association between ADHD symptoms and suicidality. However, this association was indirect and fully mediated by symptoms of depression, irritability and anxiety. Assessing these symptoms may enable an estimate of suicidality and help managing suicidal risk in ADHD.
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Affiliation(s)
- Tomer Levy
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sefi Kronenberg
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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27
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Majidi S, O'Donnell HK, Stanek K, Youngkin E, Gomer T, Driscoll KA. Suicide Risk Assessment in Youth and Young Adults With Type 1 Diabetes. Diabetes Care 2020; 43:343-348. [PMID: 31822488 PMCID: PMC6971783 DOI: 10.2337/dc19-0831] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe sociodemographic and clinical characteristics of youth and young adults with type 1 diabetes who endorsed suicidal ideations as part of routine depression screening and the results of their suicide risk assessments. RESEARCH DESIGN AND METHODS The Patient Health Questionnaire-9 was used to assess depressive symptoms and suicide/death ideation in 550 youth and young adults with type 1 diabetes ages 10-24 years. Only individuals who endorsed suicidal/death ideations (n = 49) completed a standardized suicide risk assessment protocol and safety planning. RESULTS Nine percent of individuals endorsed suicidal/death ideation and of those, 83.4% reported clinically elevated depressive symptoms; 16% made a previous suicide attempt. No youth (n = 39) or young adults (n = 11) disclosed current plans or preparations for suicide, but five who expressed suicidal ideation acknowledged the lethality of insulin for an attempt. Three previously used insulin to attempt suicide. The overwhelming majority of individuals were classified as being low risk for future suicide attempt/completion. None were hospitalized as a part of the suicide risk assessment, and no suicide completions have occurred. CONCLUSIONS The findings of this study provide initial insight into the behaviors and cognitions of youth and young adults with type 1 diabetes who experience suicidal and death ideations. Comprehensive suicide risk assessment and safety planning are feasible during routine type 1 diabetes clinic appointments.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Holly K O'Donnell
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kelly Stanek
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Erin Youngkin
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tara Gomer
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kimberly A Driscoll
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO .,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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28
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Ab Ghaffar SF, Mohd Sidik S, Ibrahim N, Awang H, Gyanchand Rampal LR. Effect of a School-Based Anxiety Prevention Program among Primary School Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244913. [PMID: 31817328 PMCID: PMC6950005 DOI: 10.3390/ijerph16244913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Anxiety is one of the most common mental health disorders in childhood, and children with anxiety have an increased risk of psychiatric disorders during adulthood. This study aimed to evaluate the effectiveness of a school-based anxiety prevention program for reducing anxiety among primary school students relative to a school-as-usual control group. Secondary to this, the current study aimed to examine the effect of a school-based prevention program on worry coping skills and self-esteem. A two-group parallel cluster randomized controlled trial of a single-blinded study was conducted to evaluate the effectiveness of the program, with schools as the unit of allocation and individual participants as the unit of analysis. The intervention program was conducted between May 2016 and December 2017. The primary outcome was anxiety, whereas the secondary outcomes were worry coping skills and self-esteem measured at three months post-intervention. Data were analyzed by using a generalized linear mixed model, accounting for the clustering effect. Subgroup analyses were performed for children with anxiety. A total of 461 students participated in this study. At baseline, there was no significant difference between groups for anxiety score, worry coping skills score, and self-esteem score (p > 0.05). The intervention was effective in reducing anxiety for the whole sample (p = 0.001) and the anxiety subgroup (p = 0.001). However, it was not effective in improving worry coping skills and self-esteem. These findings suggest that the program could be effective for reducing symptoms of anxiety when delivered in schools and provide some support for delivering this type of program in primary school settings.
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Affiliation(s)
- Siti Fatimah Ab Ghaffar
- Faculty of Hospitality, Tourism and Wellness, City Campus, Pengkalan Chepa, Locked Bag 36, Kota Bharu 16100, Kelantan, Malaysia;
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43300, Malaysia;
| | - Sherina Mohd Sidik
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
- Cancer Resource & Education Center, Faculty of Medicine and Health Sciences Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia
- Correspondence: ; Tel.: +60-3-8947-1011
| | - Normala Ibrahim
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
| | - Hamidin Awang
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
| | - Lekhraj Rampal Gyanchand Rampal
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43300, Malaysia;
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Characteristics of Child Psychiatric Outpatients at Highest Risk for Suicidal Thoughts and Behaviors. Child Psychiatry Hum Dev 2019; 50:505-519. [PMID: 30656508 DOI: 10.1007/s10578-018-0858-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
On average, compared to non-referred youth, child psychiatric outpatients show elevated rates of suicidal thoughts and behaviors (STBs), which are predictors of completed suicide. Determining the psychopathology features that associate with highest risk for STBs among youth outpatients may yield opportunities for targeted prevention/intervention. Yet, outpatient studies are limited and have not systematically examined comorbidity and dimensional psychopathology. In 758 youth, aged 6-18, consecutively referred for neuropsychiatric evaluation, we examined the extent to which diagnostic groups, comorbid subgroups and dimensional symptoms associated with STBs. After controlling for comorbidity, mood, anxiety and conduct disorders associated with elevated STB risk. Regarding dimensions, symptoms of depression, aggression and psychosis all contributed to higher STB risk. Although ADHD (as a diagnosis or dimension) did not associate with elevated STB risk independently, ADHD that was comorbid with other conditions did. Suicide prevention/intervention efforts should be investigated in youth outpatients with the highest risk for STBs.
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30
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Crawford EA, Burke TA, Siegel D, Jager-Hyman S, Alloy LB, Kendall PC. Somatic Symptoms of Anxiety and Suicide Ideation Among Treatment-Seeking Youth With Anxiety Disorders. Suicide Life Threat Behav 2019; 49:811-825. [PMID: 29900567 DOI: 10.1111/sltb.12479] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The severity of anxiety, in general, has been associated with suicide ideation (SI) among youth, but research has yet to examine the specific anxiety symptoms that may contribute to SI among youth. This study examined the severity of specific anxiety symptom clusters (i.e., tense/restless, somatic/autonomic symptoms, humiliation/rejection, performing in public, separation anxiety, perfectionism, and anxious coping) and SI in youth who met diagnostic criteria for an anxiety disorder. METHOD Participants (N = 87) were treatment-seeking children and adolescents ages 6-17 (M = 11.1 years, SD = 3.06; 52.9% male) diagnosed with a principal anxiety disorder. Youth and their parents completed measures of youth anxiety symptom severity, depression, and SI. RESULTS Hierarchical linear regressions revealed that when anxiety symptom clusters were entered simultaneously, only youth self-reported (and not parent-reported) somatic/autonomic symptoms of anxiety significantly predicted SI, after controlling for depression and sex. Importantly, the relationship between somatic/autonomic symptoms of anxiety and SI was stronger than that between depression and SI. CONCLUSIONS These results suggest that assessing somatic symptoms of anxiety is especially important when quantifying suicide risk among anxiety-disordered youth.
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Affiliation(s)
| | | | - David Siegel
- Psychology, Temple University, Philadelphia, PA, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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31
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Identifying and Managing Developmental and Behavioral Health Concerns within Primary Care: A Push for Change. J Pediatr 2019; 206:9-12. [PMID: 30448271 DOI: 10.1016/j.jpeds.2018.10.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022]
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32
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Jung S, Lee D, Park S, Hong HJ. Subtypes of suicidal ideation in Korean adolescents: A multilevel latent profile analysis. Aust N Z J Psychiatry 2019; 53:158-167. [PMID: 29544350 DOI: 10.1177/0004867418763530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors. METHOD Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted. RESULTS Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables. CONCLUSION The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies.
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Affiliation(s)
- Song Jung
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dayoung Lee
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea.,2 Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Seongjun Park
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hyun Ju Hong
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea.,2 Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
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Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Impulse control difficulties while distressed: A facet of emotion dysregulation links to Non-Suicidal Self-Injury among psychiatric inpatients at military treatment facilities. Psychiatry Res 2018; 269:419-424. [PMID: 30195229 DOI: 10.1016/j.psychres.2018.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 01/22/2023]
Abstract
Links between emotion dysregulation, suicide ideation, and suicidal versus non-suicidal self-injury (NSSI) are poorly understood within military samples. United States service members and beneficiaries (N = 186), psychiatrically hospitalized following a suicidal crisis, completed the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and reported lifetime suicide ideation, attempts, and NSSI. We expected that emotion dysregulation would positively associate with worst lifetime suicide ideation, multiple suicide attempt status, and lifetime NSSI. Suicide ideation severity and multiple suicide attempts did not associate with DERS components. Notably, difficulties with impulse control (feeling out of control while distressed) was positively associated with NSSI history. Theoretical models that clearly describe the role of emotion dysregulation in suicidal thoughts, its progression to suicidal actions, and NSSI are needed to advance clinical care for this highly vulnerable group. Longitudinal and micro-longitudinal study designs require further investigation.
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Affiliation(s)
- Margaret M Baer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Joy C Browne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Helena O Hassen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, MD, USA
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda 20814-4799, MD, USA.
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Albano AM, Comer JS, Compton SN, Piacentini J, Kendall PC, Birmaher B, Walkup JT, Ginsburg GS, Rynn MA, McCracken J, Keeton C, Sakolsky DJ, Sherrill JT. Secondary Outcomes From the Child/Adolescent Anxiety Multimodal Study: Implications for Clinical Practice. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2017; 3:30-41. [PMID: 30906874 PMCID: PMC6425733 DOI: 10.1080/23794925.2017.1399485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Controlled evaluations comparing medication, cognitive-behavioral therapy (CBT), and their combination in the treatment of youth anxiety have predominantly focused on global ratings by independent evaluators. Such ratings are resource-intensive, may be of limited generalizability, and do not directly inform our understanding of treatment responses from the perspective of treated families. We examined outcomes from the perspective of treated youth and parents in the Child/Adolescent Anxiety Multimodal Study (CAMS). METHODS Participants (N=488; ages 7-17 years) who had a primary diagnosis of separation, social, and/or generalized anxiety disorder were randomly assigned to a treatment condition in the CAMS trial. Linear mixed-effects and ANCOVA models examined parent- and youth-reported anxiety symptoms, impact of anxiety, broader internalizing and externalizing psychopathology, depressive symptoms, and family burden throughout the 12-week acute treatment phase and 6-month follow-up. RESULTS At week 12, combination treatment showed superiority over placebo, sertraline, and CBT with regard to parent-reported youth anxiety symptoms, and sertraline and CBT as monotherapies showed superiority over placebo with regard to parent-reported youth anxiety. Combination therapy and sertraline also showed week 12 superiority over placebo with regard to parent-reported internalizing psychopathology, and superiority over placebo and CBT with regard to parent-reported impact of anxiety, family burden, and youth depressive symptoms. By week 36, parent reports of many youth outcomes were comparable across active conditions. Youth measures tracked parent measures on many outcomes. CONCLUSIONS Findings were drawn on brief, readily available questionnaires that in conjunction with clinician measures can inform patient-centered care and collaborative decision-making.Trial Registry Name: Child and Adolescent Anxiety Disorders (CAMS)Registry identification number: NCT00052078Registry URL: https://www.clinicaltrials.gov/ct2/show/NCT00052078.
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Affiliation(s)
- Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, NY
| | - Jonathan S Comer
- Departments of Psychology and Psychiatry, Center for Children and Families, Florida International University, Miami, FL
| | - Scott N Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT
| | - Moira A Rynn
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Courtney Keeton
- Department of Psychiatry, Johns Hopkins Medical Institutions
| | - Dara J Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joel T Sherrill
- Division of Services and Interventions Research, National Institute of Mental Health, Bethesda, MD
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Wei C, Swan AJ, Makover HB, Kendall PC. A Multi-Informant Examination of Maternal Symptoms and Autonomy Granting in Youth Anxiety. Child Psychiatry Hum Dev 2017; 48:1001-1009. [PMID: 28389842 DOI: 10.1007/s10578-017-0722-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence suggests the important role of (a) parenting behaviors and (b) parental psychopathology in the development and maintenance of youth anxiety. Using a multi-informant approach, the current study examined the association of maternal autonomy granting and maternal symptoms (i.e., anxiety and depression) with youth anxiety among mothers and 88 youth (ages of 6-17) diagnosed with a principal anxiety disorder. Results from the generalized estimating equations (GEE) analyses indicated that mothers reported higher youth anxiety symptoms compared to youth self-reports. Youth-perceived maternal autonomy granting was inversely associated with youth anxiety, and maternal self-reported anxiety and depressive symptoms significantly moderated this relationship: As mothers reported higher anxiety and depressive symptoms, the inverse association between parental autonomy granting and youth anxiety weakened. The interaction between parenting behavior and parental psychopathology significantly influenced youth anxiety symptoms, which presents important clinical implications to integrate into parenting work in the treatment of youth anxiety disorders.
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Affiliation(s)
- Chiaying Wei
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Anna J Swan
- Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA, 19087, USA
| | - Heather B Makover
- Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA, 19087, USA
| | - Philip C Kendall
- Department of Psychology, Weiss Hall, Temple University, 1701 North 13th Street, Philadelphia, PA, 19087, USA.
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James KM, Woody ML, Feurer C, Kudinova AY, Gibb BE. Disrupted physiological reactivity among children with a history of suicidal ideation: Moderation by parental expressed emotion-criticism. Biol Psychol 2017; 130:22-29. [PMID: 29030216 DOI: 10.1016/j.biopsycho.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this study was to examine physiological reactivity during parent-child interactions in children with and without a history of suicidal ideation (SI), a group known to be at increased risk for suicidal thoughts and behaviors in the future. We also examined the potential moderating role of parental expressed emotion-criticism (EE-Crit) to determine whether the presence of parental criticism may help to identify a subgroup of children with a history of SI most at risk for physiological dysregulation. METHOD Participants were 396 children (age 7-11; 54% male, 71.7% Caucasian) and their biological parent. Children's levels of high frequency heart rate variability (HF-HRV) were assessed during a resting baseline period followed by a positive and negative discussion with their parent. Additionally, parents completed the Five-Minute Speech Sample to determine levels of EE-Crit toward their child, and children completed an interview assessing their history of SI. RESULTS Consistent with our hypothesis, we found that exposure to parental criticism moderated the relation between a child's history of SI and their HF-HRV reactivity to the discussions. Specifically, while most children exhibited the typical pattern of HF-HRV suppression from baseline to both interactions, the highest risk children (i.e., children with a history of SI who also had highly critical parents) did not display any change in HF-HRV across the tasks, suggesting a failure to engage a typical psychophysiological response during emotional contexts. CONCLUSIONS These results suggest a specific physiological mechanism that may place these children at risk for suicidal thoughts and behaviors in the future.
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Affiliation(s)
- Kiera M James
- Center for Affective Science, Binghamton University (SUNY), USA.
| | - Mary L Woody
- Center for Affective Science, Binghamton University (SUNY), USA
| | - Cope Feurer
- Center for Affective Science, Binghamton University (SUNY), USA
| | | | - Brandon E Gibb
- Center for Affective Science, Binghamton University (SUNY), USA
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Prevalence and Clinical Differences of Suicidal Thoughts and Behaviors in a Community Sample of Youth Receiving Cognitive-Behavioral Therapy for Anxiety. Child Psychiatry Hum Dev 2017; 48:705-713. [PMID: 27832342 PMCID: PMC5425323 DOI: 10.1007/s10578-016-0696-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined the incidence of suicidal thoughts and behaviors in youth with anxiety before initiating cognitive behavioral therapy, as well as the emergence of suicidal thoughts and behaviors during treatment. Overall, 30% of youth experienced suicidal thoughts and behaviors. Prior to treatment, 24% reported suicidal thoughts and behaviors, and 13.1% endorsed suicidal thoughts and behaviors during treatment. More than half who endorsed suicidal thoughts and behaviors during treatment were newly identified cases not detected prior to treatment. Disagreement among parent- and child-report measures of suicidality was found at baseline. Youth who experienced suicidal thoughts and behaviors had higher levels of loneliness, depressive symptoms, overt peer victimization, functional impairment, and externalizing symptoms. Findings suggest that the assessment of suicidality at a single time-point and from one informant is not sufficient to identify at-risk youth. Ongoing assessment of suicidal risk during treatment is important in this population.
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Rapp AM, Lau A, Chavira DA. Differential associations between Social Anxiety Disorder, family cohesion, and suicidality across racial/ethnic groups: Findings from the National Comorbidity Survey-Adolescent (NCS-A). J Anxiety Disord 2017; 48:13-21. [PMID: 27697370 DOI: 10.1016/j.janxdis.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 10/21/2022]
Abstract
The proposed research seeks to introduce a novel model relating Social Anxiety Disorder (SAD) and suicide outcomes (i.e., passive suicidal ideation, active suicidal ideation, and suicide attempts) in diverse adolescents. This model posits that family cohesion is one pathway by which suicide risk is increased for socially anxious youth, and predicts that the relationships between these variables may be of different strength in Latino and White subgroups and across gender. Data from a sample of Latino (n=1922) and non-Hispanic White (hereafter referred to as White throughout) (n=5648) male and female adolescents who participated in the National Comorbidity Survey-Adolescent were used for this study. Analyses were conducted using generalized structural equation modeling. Results showed that the mediation model held for White females. Further examination of direct pathways highlighted SAD as a risk factor unique to Latinos for active suicidal ideation and suicide attempt, over and above comorbid depression and other relevant contextual factors. Additionally, family cohesion showed a strong association with suicide outcomes across groups, with some inconsistent findings for White males. Overall, it appears that the mechanism by which SAD increases risk for suicidality is different across groups, indicating further need to identify relevant mediators, especially for racial/ethnic minority youth.
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Affiliation(s)
- Amy M Rapp
- Department of Psychology, University of California Los Angeles, United States.
| | - Anna Lau
- Department of Psychology, University of California Los Angeles, United States
| | - Denise A Chavira
- Department of Psychology, University of California Los Angeles, United States
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Kuramoto-Crawford SJ, Ali MM, Wilcox HC. Parent-Child Connectedness and Long-Term Risk for Suicidal Ideation in a Nationally Representative Sample of US Adolescents. CRISIS 2016; 38:309-318. [PMID: 27869507 DOI: 10.1027/0227-5910/a000439] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have addressed on the role of parent-child connectedness (PCC) on adolescents' risk for suicidal ideation from a longitudinal, developmental perspective. AIM This study examined PCC during adolescence and risk of suicidal ideation into adulthood among a nationally representative sample of American adolescents. METHOD The study includes 13,234 adolescents aged 11-18 from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who were surveyed during adolescence (1994-1995) and then again in early adulthood (2008-2009). Multinomial logistic regression estimated the association between PCC during adolescence and having ideation during the adolescence period only, in adulthood only, and in both adolescence and adulthood as compared with those without suicidal ideation. RESULTS After adjusting for depressive symptoms and other parent and adolescent characteristics, adolescents in two-parent households who reported higher PCC during adolescence had lower relative risk of having ideation during adolescence alone and in both adolescence and adulthood. In mother-only households, higher mother connectedness was also associated with decreased risk of having adolescent ideation. CONCLUSION PCC is an important modifiable target for the prevention of suicidal ideation from adolescence into adulthood.
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Affiliation(s)
- S Janet Kuramoto-Crawford
- 1 Substance Abuse & Mental Health Services Administration, enter for Behavioral Health Statistics and Quality, Division of Evaluation, Analysis and Quality, Analysis and Services Research Branch, Rockville, MD, USA
| | - Mir M Ali
- 1 Substance Abuse & Mental Health Services Administration, enter for Behavioral Health Statistics and Quality, Division of Evaluation, Analysis and Quality, Analysis and Services Research Branch, Rockville, MD, USA
| | - Holly C Wilcox
- 2 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
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Johnco C, McGuire JF, McBride NM, Murphy TK, Lewin AB, Storch EA. Suicidal ideation in youth with tic disorders. J Affect Disord 2016; 200:204-11. [PMID: 27136419 PMCID: PMC4887311 DOI: 10.1016/j.jad.2016.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/16/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examined the incidence and clinical correlates of suicidal ideation (SI) in youth with tic disorders (TD). The independent contribution of tics, anxiety, depressive and externalizing symptoms on SI severity in youth with TD was assessed. METHOD Participants were 75 treatment-seeking youth with a TD (N=75) aged 6-18. Participants completed diagnostic assessments, clinician-ratings, self- and parent-report measures of emotional functioning and the presence and/or severity of suicidal ideation. RESULTS Based on youth-report, 61% of youth endorsed at least some symptoms of SI, and 8% endorsed symptoms that exceeded the clinically significant cut-off. Parents reported SI in 11% of cases, with generally poor agreement between parent- and youth-report. Suicidal ideation correlated with higher anxiety, depressive and externalizing symptoms, affective lability, and with poorer distress tolerance and overall functioning. Anxiety, depressive and externalizing symptoms showed an independent relationship with SI. Tic severity was not associated with SI. Rather, higher tic severity was associated with an increase in anxiety symptoms, which in turn, was associated with greater SI severity. LIMITATIONS Cross-sectional data limits causal conclusions. Diagnosis was based on unstructured assessments by expert clinicians, including consensus diagnosis, rather than structured clinical interviews. CONCLUSIONS Around 8-11% of youth with TD experienced SI. Tic severity did not have any direct influence on SI, however the presence of comorbid anxiety and depressive symptoms significantly increases this risk. Results suggest that it is psychiatric comorbidity, rather than tics themselves, that predispose youth with tic disorders to increased risk of suicidality.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida, USA; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; All Children's Hospital - Johns Hopkins Medicine, St Petersburg, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; Department of Psychology, University of South Florida, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; All Children's Hospital - Johns Hopkins Medicine, St Petersburg, FL, USA; Department of Psychology, University of South Florida, USA; Department of Health Policy and Management, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
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Kupriyanova IE, Dashieva BA, Karaush IS. [Mental disorders and new opportunities to identify suicide risk in children and adolescents with disabiliting diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:30-34. [PMID: 26356512 DOI: 10.17116/jnevro20151157130-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To study mental health of children and adolescents with disabiliting diseases and comorbid mental disorders and to develop an instrument for assessment suicide risk. MATERIAL AND METHODS The structure of mental disorders in 800 students of correctional schools with disabilities, who have disabiliting diseases (somatoneurological, musculoskeletal, sensory impairment, intellectual disorders), was studied. RESULTS AND CONCLUSION The prevalence of mental disorders was 83.5%. The highest prevalence was observed for developmental disorders, mental retardation and disorders due to damage or brain dysfunction. High levels of anxiety were found in 33%. There were difficulties in the diagnosis of emotional disorders and signs of suicidal behavior in adolescents with disabiliting diseases and comorbid disorders of psychological development. To detect the signs of suicidal behavior, authors have developed a clinical questionnaire for assessment of suicide risk in people of this category. The results of the screening are presented.
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Wolk CB, Kendall PC, Beidas RS. Cognitive-behavioral therapy for child anxiety confers long-term protection from suicidality. J Am Acad Child Adolesc Psychiatry 2015; 54:175-9. [PMID: 25721182 PMCID: PMC4344955 DOI: 10.1016/j.jaac.2014.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/28/2014] [Accepted: 12/15/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Evidence for an independent relationship between anxiety and suicidality has been mixed. Few studies have examined this relationship in youth seeking treatment for anxiety. The present study examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts at a follow-up interval of 7 to 19 years. We hypothesized that successful treatment for an anxiety disorder in childhood would be protective against later suicidality. METHOD The present study was a 7- to 19-year (mean = 16.24 years; SD = 3.56 years) follow-up study. Adults (N = 66) completed cognitive-behavioral treatment (CBT) for anxiety as children. Information regarding suicidality at follow-up was obtained via the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory-II (BDI-II). RESULTS Results indicate that participants who responded favorably to CBT during childhood were less likely to endorse lifetime, past-month, and past-2-week suicidal ideation than treatment nonresponders. This was consistent across self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, although the infrequent occurrence of both limited the ability to detect findings. CONCLUSION Results suggest more chronic and enduring patterns of suicidal ideation among individuals with anxiety in childhood that is not successfully treated. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits and underscores the importance of the identification and evidence-based treatment of youth anxiety.
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Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Philip C Kendall
- Child and Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Wolitzky-Taylor K, Guillot CR, Pang RD, Kirkpatrick MG, Zvolensky MJ, Buckner JD, Leventhal AM. Examination of anxiety sensitivity and distress tolerance as transdiagnostic mechanisms linking multiple anxiety pathologies to alcohol use problems in adolescents. Alcohol Clin Exp Res 2015; 39:532-9. [PMID: 25706521 DOI: 10.1111/acer.12638] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple forms of anxiety psychopathology are associated with alcohol use problems in adolescents. Yet, the mechanisms underlying this association are unclear. Anxiety sensitivity (AS) and distress tolerance (DT) represent 2 distinct, conceptually relevant transdiagnostic constructs implicated in multiple manifestations of anxiety that may also underlie alcohol use problems and thereby explain why people with anxiety are more likely to have alcohol problems. METHODS The current cross-sectional study examined whether AS and DT accounted for (i.e., statistically mediated) the relationship between manifest indicators of the 3 common anxiety phenotypes (generalized anxiety, social anxiety, and panic disorders) and alcohol problems in a sample of 534 high school students (14 to 15 years old). RESULTS Multiple manifestations of anxiety were associated with greater alcohol use problems. AS statistically mediated multiple anxiety-alcohol associations, but DT did not. CONCLUSIONS These findings provide preliminary evidence suggesting AS may be an important transdiagnostic target for alcohol prevention programs for those in early adolescence that experience elevated anxiety symptoms.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Psychiatry and Behavioral Sciences , University of Southern California, Los Angeles, California
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Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull 2015; 141:176-212. [PMID: 25365764 PMCID: PMC4293352 DOI: 10.1037/bul0000003] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.
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Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
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Cummings CM, Caporino NE, Kendall PC. Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychol Bull 2014; 140:816-45. [PMID: 24219155 PMCID: PMC4006306 DOI: 10.1037/a0034733] [Citation(s) in RCA: 510] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.
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