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Janssens JJ, Kiekens G, Jaeken M, Kirtley OJ. A systematic review of interpersonal processes and their measurement within experience sampling studies of self-injurious thoughts and behaviours. Clin Psychol Rev 2024; 113:102467. [PMID: 39084142 DOI: 10.1016/j.cpr.2024.102467] [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: 11/09/2023] [Revised: 05/27/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Abstract
Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.
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Affiliation(s)
- Julie J Janssens
- Center for Contextual Psychiatry, KU Leuven, Department of Neuroscience, Campus Gasthuisberg, Herestraat 49 (ON5b), 3000 Leuven, Belgium
| | - Glenn Kiekens
- Center for Contextual Psychiatry, KU Leuven, Department of Neuroscience, Campus Gasthuisberg, Herestraat 49 (ON5b), 3000 Leuven, Belgium; Research Unit of Clinical Psychology, KU Leuven, Leuven, Belgium; Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Marieke Jaeken
- Center for Contextual Psychiatry, KU Leuven, Department of Neuroscience, Campus Gasthuisberg, Herestraat 49 (ON5b), 3000 Leuven, Belgium
| | - Olivia J Kirtley
- Center for Contextual Psychiatry, KU Leuven, Department of Neuroscience, Campus Gasthuisberg, Herestraat 49 (ON5b), 3000 Leuven, Belgium; Leuven Child and Youth Institute, KU Leuven, Tiensestraat 102, 3000 Leuven, Belgium; Leuven Brain Institute, KU Leuven, Herestraat 49 (ON V), 3000 Leuven, Belgium.
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2
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Wang J, Han M, Xi Y, He X, Feng Y, Chen R. A longitudinal study of self-injurious thoughts and behaviors transitions and help-seeking intentions among young adults. Suicide Life Threat Behav 2024. [PMID: 38934487 DOI: 10.1111/sltb.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Engagement in self-injurious thoughts and behaviors (SITBs) is associated with low help-seeking intentions. Nevertheless, prior research has primarily relied on cross-sectional data, leaving uncertainties about the longitudinal dynamics between SITBs and help-seeking intentions. This study aims to investigate the longitudinal relationship between SITBs and help-seeking intentions for them. METHOD A one-year interval follow-up investigation was conducted among 1788 Chinese students (71.5% girls, Mage = 19.5). Changes in help-seeking intentions were initially analyzed among four SITBs transition groups. Subsequently, a cross-lagged model was employed to explore the possible bidirectional associations. RESULTS 232 participants (12.90%) experienced changes in SITBs, while 65 participants (3.60%) exhibited sustained SITBs between two measurement time points. Changes in help-seeking intentions varied across SITBs transition groups. Participants whose SITBs faded 1 year later showed a significant increase in help-seeking intentions, whereas those who experienced newly developed SITBs across two measurement time points demonstrated a significant decline. The cross-lagged analysis revealed that help-seeking intentions negatively predicted the subsequent risk of experiencing SITBs. CONCLUSIONS Greater help-seeking intentions predicted decreased SITBs 1 year later. Changes in help-seeking intentions serve as a valuable indicator for distinguishing between different types of SITBs transition. These findings underscore the importance of implementing prevention and intervention strategies targeted at enhancing help-seeking intentions to reduce SITBs.
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Affiliation(s)
- Juan Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Meng Han
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yingjun Xi
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiaoxiao He
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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3
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Miller AB, Jenness JL, Elton AL, Pelletier-Baldelli A, Patel K, Bonar A, Martin S, Dichter G, Giletta M, Slavich GM, Rudolph KD, Hastings P, Nock M, Prinstein MJ, Sheridan MA. Neural Markers of Emotion Reactivity and Regulation Before and After a Targeted Social Rejection: Differences Among Girls With and Without Suicidal Ideation and Behavior Histories. Biol Psychiatry 2024; 95:1100-1109. [PMID: 37918460 PMCID: PMC11063123 DOI: 10.1016/j.biopsych.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) are common among adolescent girls and increase risk for suicide death. Emotion regulation difficulties are linked with STBs, particularly in response to targeted social rejection. However, neural correlates of this link have not been investigated and may identify novel targets for interventions. Here, we examined neural correlates of emotion regulation before and after an experimentally delivered targeted social rejection in adolescent girls with STBs and girls without STBs (i.e., control participants). METHODS Girls (N = 138; age range, 9-15 years; mean [SD] age = 11.6 [1.79] years) completed a functional neuroimaging emotion regulation task. In the middle of the task, participants were socially rejected by an unfamiliar confederate whom the participants had elected to meet. Participants also completed a multimethod STB assessment. RESULTS Before rejection, girls with a history of STBs, compared with control participants, showed greater activation in the right superior frontal gyrus when passively viewing negative stimuli, and girls with suicidal behavior (SB) versus those without SB showed less activation in the right frontal pole during emotion regulation attempts. Following the rejection, girls with STBs, compared with control participants, showed greater activation in the right inferior frontal gyrus during emotion regulation. CONCLUSIONS Before social rejection, girls with SB versus without SB may not activate brain regions implicated in emotion regulation, suggesting a vulnerability to poor regulation at their baseline emotional state. After social rejection, girls with any history of STBs showed altered activation in a brain region strongly associated with inhibition and emotion regulation success, possibly reflecting increased effort at inhibiting emotional responses during regulation following stress exposure.
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Affiliation(s)
- Adam Bryant Miller
- Mental Health Risk and Resilience Research Program, RTI International, Research Triangle Park, North Carolina; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Jessica L Jenness
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Amanda L Elton
- Department of Psychiatry, University of Florida, Gainesville, Florida
| | | | - Kinjal Patel
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adrienne Bonar
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sophia Martin
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gabriel Dichter
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matteo Giletta
- Department of Developmental, Personality, and Social Psychology, Gent University, Gent, Belgium
| | - George M Slavich
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, California
| | - Karen D Rudolph
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Paul Hastings
- Department of Psychology, University of California Davis, Davis, California
| | - Matthew Nock
- Department of Psychology, Harvard University, Boston, Massachusetts
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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4
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Duarté-Vélez Y, Jimenez-Colon G, Jones RN, Spirito A. Socio-Cognitive Behavioral Therapy for Latinx Adolescent with Suicidal Behaviors: A Pilot Randomized Trial. Child Psychiatry Hum Dev 2024; 55:754-767. [PMID: 36183051 DOI: 10.1007/s10578-022-01439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/26/2022]
Abstract
Evidence-based treatment for Latinx/Hispanic (L/H) with suicidal behaviors (SB) is scarce. This study evaluated the acceptability and preliminary efficacy of a socio-cognitive-behavioral therapy protocol for SB (SCBT-SB) with L/H adolescents and the feasibility of conducting a randomized controlled trial (RCT) of SCBT-SB compared to treatment-as-usual (TAU). A pilot RCT was conducted with 46 L/H teens. The target outcomes included suicidal ideation (SI), suicide attempts (SAs), and depressive/internalizing symptoms. Results indicated that the SCBT-SB was acceptable and an RCT with diverse L/H families is feasible to implement. Within group analyses showed reductions over time for each group in SI and depressive/internalizing symptoms. Intent-to-treat between-group analyses showed a medium effect for the SCBT-SB at the twelve-month follow-up for depressive/internalizing symptoms and a large effect for SA. Although results must be interpreted cautiously given the small sample size, outcomes suggest that SCBT-SB may be a promising psychosocial treatment for depressive/internalizing symptoms, and SAs in L/H youth.
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Affiliation(s)
- Yovanska Duarté-Vélez
- Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital, 1011 Veterans Memorial Pkwy, East Providence, RI, 02915, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912, USA.
| | - Gisela Jimenez-Colon
- Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital, 1011 Veterans Memorial Pkwy, East Providence, RI, 02915, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912, USA
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5
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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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6
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Haw R, Marsden M, Hartley S, Turpin C, Taylor PJ. A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series. Clin Psychol Psychother 2024; 31:e2976. [PMID: 38757462 DOI: 10.1002/cpp.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y). METHODS A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure. RESULTS The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low. CONCLUSIONS The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.
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Affiliation(s)
- R Haw
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Specialist Perinatal Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - M Marsden
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Aquarius Ward, South West London and St. George's Mental Health NHS Trust, London, UK
| | - S Hartley
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Tameside and Glossop CAMHS, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - C Turpin
- Specialist Psychotherapy Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - P J Taylor
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Hare M, Conroy K, Georgiadis C, Shaw AM. Abbreviated Dialectical Behavior Therapy Virtual Skills Group for Caregivers of Adolescents: An Exploratory Study of Service User and Clinical Outcomes. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01681-7. [PMID: 38530589 DOI: 10.1007/s10578-024-01681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/28/2024]
Abstract
Prior work emphasizes involving caregivers in youth mental health services. To support youth with emotion dysregulation, dialectical behavior therapy for adolescents (DBT-A) includes a multi-family skills group, wherein adolescents and caregivers learn skills together. However, limited work has examined the impact of caregiver involvement within DBT-A. The current study examines outcomes of two caregiver-only DBT-A skills groups adapted for abbreviated telehealth delivery. We report on caregivers' (N = 11, 100% mothers, 55% Hispanic) service user outcomes (e.g. self-efficacy at skill usage, group cohesion, therapeutic alliance) and clinical outcomes (i.e. their own emotion functioning, criticism, responses to their adolescent's negative emotions). Results indicate caregiver-only groups were feasible and acceptable, and suggest preliminary efficacy, including improvements in caregiver emotion functioning, distress during interactions with their adolescents, and adolescent-reported criticism. Caregivers also reported reductions in unsupportive responses with their adolescents. Overall, while we caution interpretation due to a small sample size, findings support the preliminary feasibility and efficacy of modifying caregiver participation in DBT-A to be less time-consuming and administered via telehealth.
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Affiliation(s)
- Megan Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA
| | - Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA
| | - Christopher Georgiadis
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA
| | - Ashley M Shaw
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA.
- School of Social and Behavioral Sciences, University of New England, Biddeford, ME, 04005, USA.
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8
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Taussig HN, Fulginiti A, Racz SJ, Evans R, Cary Katz C. Long-term impact of the Fostering Healthy Futures for Preteens program on suicide-related thoughts and behaviors for youth in out-of-home care: A randomized controlled trial. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38436484 DOI: 10.1002/ajcp.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
Youth in out-of-home care are at high risk for suicide-related thoughts and behaviors (STB), yet there are no known efficacious interventions that reduce STB for this population. Fostering Healthy Futures for Preteens (FHF-P) is a 9-month community-based mentoring and skills training preventive intervention for children in out-of-home care. A randomized controlled trial enrolled 156 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 48.9% female, 54.1% Hispanic, 30.1% Black, and 27.1% American Indian. Follow-up interviews, conducted 7-12 years postintervention (85.2% retention rate), asked young adult participants, aged 18-22, to self-report lifetime STB as indexed by non-suicidal self-injury, suicidal thoughts, plans, and/or attempts. There was a nonsignificant reduction in the odds of STB for the intervention group at follow-up (OR = 0.74; CI, 0.32, 1.69). However, FHF-P significantly moderated the effect of baseline STB; control youth who reported baseline STB had 10 times the odds of young adult STB (OR = 10.44, CI, 2.28, 47.78), but there was no increase in the odds of adult-reported STB for intervention youth. Findings suggest that FHF-P buffers the impact of pre-existing STB on young adult STB for care-experienced youth. Further research is needed to identify mechanisms that may reduce STB in this population.
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Affiliation(s)
- Heather N Taussig
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
- Kempe Center, University of Colorado, Denver, Colorado, USA
| | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Sarah J Racz
- Department of Psychology, University of Maryland College Park, College Park, Maryland, USA
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Colleen Cary Katz
- Silberman School of Social Work, Hunter College, CUNY, New York, New York, USA
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Bettis AH, Burke TA, Scott SR, Bedock C, Ambriano C, Parrish J, Marsh D, Fox KR. Disclosures of self-injurious thoughts and behaviors to parents in the context of adolescent therapy: A qualitative investigation. J Clin Psychol 2024; 80:537-558. [PMID: 38111150 PMCID: PMC10922370 DOI: 10.1002/jclp.23633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023]
Abstract
Self-injurious thoughts and behaviors (SITBs), including suicidal thoughts, suicide attempts, and nonsuicidal self-injury, are highly prevalent among adolescents. Identifying adolescents at risk for SITBs relies on their disclosure, and these disclosures commonly occur in therapy context. Moreover, therapists often breach confidentiality to inform adolescents' parent or guardian when they disclose SITBs. Research has explored rates of and barriers to disclosure among adolescents, yet no studies have examined adolescents' experiences of disclosure in the therapy context. Further, no studies have examined adolescents' experiences when their parents are then informed. In this study, we examined qualitative responses from 1495 adolescents who had experienced a SITB disclosure in the therapy context. Qualitative questions included asking adolescents to describe how the SITB disclosure occurred, how their parents were informed, and their parents' reactions. Using open and axial coding, several themes emerged. Adolescents described therapist breaches of confidentiality as collaborative, noncollaborative, or unclear. Adolescents described their parents' affective responses, communication about SITBs, validating and invalidating responses, treatment-oriented responses, and ways that parents restricted their access to people, places, and activities. Findings have implications for the development of clinical guidelines when adolescents disclose SITBs in therapy and highlight areas for future research in adolescent SITB disclosure.
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Affiliation(s)
- Alexandra H Bettis
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Taylor A Burke
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha R Scott
- Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Cara Bedock
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Caroline Ambriano
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Jordan Parrish
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Destinee Marsh
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, Colorado, USA
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10
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Berk MS, Gallop R, Asarnow JR, Adrian MC, Hughes JL, McCauley E. Remission, Recovery, Relapse, and Recurrence Rates for Suicide Attempts and Nonsuicidal Self-Injury for Suicidal Youth Treated With Dialectical Behavior Therapy or Supportive Therapy. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00059-5. [PMID: 38325518 PMCID: PMC11298569 DOI: 10.1016/j.jaac.2024.01.012] [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: 04/28/2023] [Revised: 10/06/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To evaluate rates of remission, recovery, relapse, and recurrence in suicidal youth who participated in a clinical trial comparing Dialectical Behavior Therapy (DBT) and Individual and Group Supportive Therapy (IGST). METHOD Participants were 173 youth, aged 12 to 18 years, with repetitive self-harm (including at least 1 prior suicide attempt [SA]) and elevated suicidal ideation (SI). Participants received 6 months of DBT or IGST and were followed for 6 months post-treatment. The sample was 95% female, 56.4% White, and 27.49% Latina. Remission was defined as absence of SA or nonsuicidal self-injury (NSSI) across one 3-month interval; recovery was defined across 2 or more consecutive intervals. Relapse and recurrence were defined as SA or NSSI following remission or recovery. Cross-tabulation with χ2 was used for between-group contrasts. RESULTS Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA in DBT than for IGST. Across treatments and time points, SA had higher remission and recovery rates and lower relapse and recurrence rates than NSSI. There were no significant differences in NSSI remission between conditions; however, participants receiving DBT had significantly higher NSSI recovery rates than those receiving IGST for the 3- to 9-month, 3- to 12-month, and 6- to 12-month intervals. CONCLUSION Results showed higher percentages of SA remission and recovery for DBT as compared to IGST. NSSI was less likely to remit than SA. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. CLINICAL TRIAL REGISTRATION INFORMATION Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www. CLINICALTRIALS gov/; NCT01528020.
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Affiliation(s)
| | - Robert Gallop
- West Chester University of Pennsylvania, West Chester, Pennsylvania
| | | | | | - Jennifer L Hughes
- Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio; and UT Southwestern Medical Center, Dallas, Texas
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11
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Millon EM, Alqueza KL, Kamath RA, Marsh R, Pagliaccio D, Blumberg HP, Stewart JG, Auerbach RP. Non-suicidal Self-injurious Thoughts and Behaviors Among Adolescent Inpatients. Child Psychiatry Hum Dev 2024; 55:48-59. [PMID: 35727385 PMCID: PMC9782727 DOI: 10.1007/s10578-022-01380-1] [Citation(s) in RCA: 2] [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] [Accepted: 05/19/2022] [Indexed: 01/07/2023]
Abstract
Non-suicidal self-injury (NSSI) is a serious public health concern that typically onsets during early adolescence. Adolescents (N = 980, ages 12-19 years) admitted for acute, residential psychiatric treatment completed baseline clinical interviews assessing mental disorders and questionnaires measuring demographics, early life adversity, and symptom severity. Prevalence rates of NSSI for lifetime (thoughts: 78%; behaviors: 72%), past year (thoughts: 74%; behaviors: 65%), and past month (thoughts: 68%; behaviors: 51%) were high. Although effect sizes were modest, the presence of a lifetime depressive disorder, sexual abuse, and comorbidity (i.e., three or more current disorders) were significant correlates of experiencing NSSI thoughts and behaviors. Furthermore, lifetime depressive disorder, current anxiety disorder, and comorbidity were associated with a greater odds of persistent NSSI thoughts and/or behaviors. Longitudinal studies are needed to determine whether targeting these factors reduces the persistence of NSSI thoughts and behaviors.
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Affiliation(s)
- Emma M Millon
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Pardes 2407, New York, NY, 10032, USA
| | - Kira L Alqueza
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Pardes 2407, New York, NY, 10032, USA
| | - Rahil A Kamath
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Pardes 2407, New York, NY, 10032, USA
| | - Rachel Marsh
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Pardes 2407, New York, NY, 10032, USA
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Pardes 2407, New York, NY, 10032, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy G Stewart
- Department of Psychology and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Pardes 2407, New York, NY, 10032, USA.
- Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.
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12
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Rubenson MP, Gurtovenko K, Simmons SW, Thompson AD. Systematic Review: Patient Outcomes in Transdiagnostic Adolescent Partial Hospitalization Programs. J Am Acad Child Adolesc Psychiatry 2024; 63:136-153. [PMID: 37271333 DOI: 10.1016/j.jaac.2023.03.022] [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: 09/27/2022] [Revised: 03/02/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Partial hospitalization programs (PHPs) are designed to help stabilize patients with acute mental health problems and are considered more cost-effective than inpatient care for patients who do not require 24-hour monitoring. Many PHPs treat transdiagnostic adolescents to reduce suicidality, self-harm, and other high-risk behaviors; however, the effectiveness of such programs is unknown. We aimed to review the existing evidence for the effects of PHPs on adolescent mental health symptoms and functioning. METHOD We retrieved peer-reviewed evaluations of PHPs treating adolescents with a range of disorders that reported quantitative clinical outcomes. We followed PRISMA guidelines for systematic reviews and included studies published since 2000. RESULTS Fifteen studies of 10 PHPs in North America, Europe, Asia, and Australia met inclusion criteria, 5 of which used comparison groups. Most participants were White and female with depressive disorders. All studies found improvements in adolescents' functioning and mental health from admission to discharge; however, only 1 study tested PHP relative to other levels of care, and only 1 study included follow-up data. Dialectical behavior therapy (DBT) may be an effective theoretical orientation for PHP settings, but evidence is limited. CONCLUSION Evidence for effectiveness of PHPs relative to other models is limited. Currently available research suggests that many high-risk transdiagnostic adolescents tend to improve during PHP treatment; however, controlled studies with follow-up data are needed to determine whether partial hospitalization is effective and, if so, how effective, and whether treatment gains persist after discharge.
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Affiliation(s)
- Miriam P Rubenson
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington.
| | - Kyrill Gurtovenko
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Shannon W Simmons
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Alysha D Thompson
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
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13
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Babajani F, Salari N, Hosseinian-Far A, Abdoli N, Mosafer H, Heidarian P, Mohammadi M. Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis. Asian J Psychiatr 2024; 91:103878. [PMID: 38142521 DOI: 10.1016/j.ajp.2023.103878] [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: 09/15/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis. METHODS To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2). RESULTS In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively. CONCLUSION Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.
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Affiliation(s)
- Fateme Babajani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadis Mosafer
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pegah Heidarian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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14
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Tuda D, Stefancic A, Lam P, John D, Sadaghiyani S, Choo TH, Galfalvy H, Coronel B, Gil R, Lewis-Fernández R. Life is precious: A quasi-experimental study of a community-based program to prevent suicide among Latina adolescents in New York City. Suicide Life Threat Behav 2023. [PMID: 38050824 PMCID: PMC11150327 DOI: 10.1111/sltb.13027] [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: 02/21/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Rising rates of suicidal thoughts and behaviors (STBs) among U.S. Latina adolescents urgently need attention. Life is Precious (LIP) is a culturally responsive, community-based, afterschool-model program offering wellness-support services to supplement outpatient mental health treatment for Latina adolescents experiencing STB's. This 12-month quasi-experimental pilot study explored LIP's impact on clinical outcomes. METHODS Latina adolescents newly enrolled in LIP and receiving outpatient treatment (n = 31) and those newly starting outpatient treatment only (n = 12; Usual Care) were assessed for Suicidal Ideation (Suicidal Ideation Questionnaire; SIQ) and depressive symptoms (Patient Health Questionnaire-9). We estimated differences in mean scores using longitudinal linear mixed models and adjusted risk ratios (ARRs) of SIQ-25%, SIQ-50%, and PHQ-9-5-point improvements using exact logistic models. RESULTS The direction of the estimated impact of LIP was positive [differences (95% CIs): -15.5 (-34.16, 3.15) for SIQ; -1.16 (-4.39, 2.07) for PHQ-9], with small-to-moderate nonsignificant effect sizes (0.19-0.34). LIP participants saw two to three times higher prevalence than controls of SIQ-25%, SIQ-50%, and PHQ-9-5-point improvements; ARRs (95% CIs) were 1.91 (0.61, 3.45), 3.04 (0.43, 11.33), and 1.97 (0.44, 5.07), respectively. Suicidal behaviors also decreased in LIP. CONCLUSION The effects of LIP were in positive directions across clinical outcomes, warranting further research on its effectiveness in decreasing STBs.
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Affiliation(s)
- Daniela Tuda
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
- Center for Mental Health Services Research, Brown School, Washington University, St. Louis, Missouri, USA
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, New York, USA
| | - Ana Stefancic
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
| | - Peter Lam
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
| | - Dolly John
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
| | - Shima Sadaghiyani
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York City, New York, USA
| | | | - Rosa Gil
- Comunilife, Inc., New York City, New York, USA
| | - Roberto Lewis-Fernández
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York City, New York, USA
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15
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Rabinowitz JA, Kahn GD, Felton JW, Drabick DAG, Wilcox HC. Correlates of Informant Discrepancies in Self-Harm Among Youth Involved in Child Protective Services. CHILDREN AND YOUTH SERVICES REVIEW 2023; 155:107200. [PMID: 38053918 PMCID: PMC10695356 DOI: 10.1016/j.childyouth.2023.107200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Youth involved with child protective services (CPS) are at elevated risk for engaging in self-harm. Participation in interventions or treatments that may reduce youths' self-harm behaviors often depends on the accurate reporting of their self-injurious behaviors. However, informants often disagree on the presence or severity of self-harm engagement, making the identification of youth in need of treatment more challenging. The current study aims to characterize discrepancies between youth and caregiver reports of children's self-harm among a sample of youth with a history of CPS involvement, and to identify factors (e.g., demographics, youth and caregiver psychological impairments, aspects of the caregiving environment) associated with these discrepancies. Participants (N = 258) were drawn from a large, nationally representative sample of youth under the age of 18 (mean age = 13.8) and their caregivers who were investigated by CPS. Multinomial logistic regressions were used to examine correlates of discrepancies in caregiver and youth reports of youth self-harm. Results indicated that 10% of caregiver-child dyads agreed on children's engagement in self-harm. In 33% of cases, only the child reported self-harm and in 57% of cases, only the caregiver reported youth self-harm. Being a biological caregiver, child female sex, higher levels of internalizing symptoms; higher post-traumatic stress disorder (PTSD) symptoms; and greater caregiver alcohol use was associated with a lower likelihood of caregivers reporting self-harm only. Older child age; lower externalizing symptoms; higher PTSD symptoms, and greater levels of caregiver emotional security and structure were linked to lower odds of children reporting self-harm only. These results underscore important factors to consider when assessing self-harm among youth involved with CPS and have potential implications for practice guidelines in this population.
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Affiliation(s)
- Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Geoffrey D Kahn
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, US
| | - Julia W Felton
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, US
| | | | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
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16
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Diaz-Ramos RE, Noriega I, Trejo LA, Stroulia E, Cao B. Using Wearable Devices and Speech Data for Personalized Machine Learning in Early Detection of Mental Disorders: Protocol for a Participatory Research Study. JMIR Res Protoc 2023; 12:e48210. [PMID: 37955959 PMCID: PMC10682927 DOI: 10.2196/48210] [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: 04/15/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Early identification of mental disorder symptoms is crucial for timely treatment and reduction of recurring symptoms and disabilities. A tool to help individuals recognize warning signs is important. We posit that such a tool would have to rely on longitudinal analysis of patterns and trends in the individual's daily activities and mood, which can now be captured through data from wearable activity trackers, speech recordings from mobile devices, and the individual's own description of their mental state. In this paper, we describe such a tool developed by our team to detect early signs of depression, anxiety, and stress. OBJECTIVE This study aims to examine three questions about the effectiveness of machine learning models constructed based on multimodal data from wearables, speech, and self-reports: (1) How does speech about issues of personal context differ from speech while reading a neutral text, what type of speech data are more helpful in detecting mental health indicators, and how is the quality of the machine learning models influenced by multilanguage data? (2) Does accuracy improve with longitudinal data collection and how, and what are the most important features? and (3) How do personalized machine learning models compare against population-level models? METHODS We collect longitudinal data to aid machine learning in accurately identifying patterns of mental disorder symptoms. We developed an app that collects voice, physiological, and activity data. Physiological and activity data are provided by a variety of off-the-shelf fitness trackers, that record steps, active minutes, duration of sleeping stages (rapid eye movement, deep, and light sleep), calories consumed, distance walked, heart rate, and speed. We also collect voice recordings of users reading specific texts and answering open-ended questions chosen randomly from a set of questions without repetition. Finally, the app collects users' answers to the Depression, Anxiety, and Stress Scale. The collected data from wearable devices and voice recordings will be used to train machine learning models to predict the levels of anxiety, stress, and depression in participants. RESULTS The study is ongoing, and data collection will be completed by November 2023. We expect to recruit at least 50 participants attending 2 major universities (in Canada and Mexico) fluent in English or Spanish. The study will include participants aged between 18 and 35 years, with no communication disorders, acute neurological diseases, or history of brain damage. Data collection complied with ethical and privacy requirements. CONCLUSIONS The study aims to advance personalized machine learning for mental health; generate a data set to predict Depression, Anxiety, and Stress Scale results; and deploy a framework for early detection of depression, anxiety, and stress. Our long-term goal is to develop a noninvasive and objective method for collecting mental health data and promptly detecting mental disorder symptoms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48210.
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Affiliation(s)
- Ramon E Diaz-Ramos
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Isabella Noriega
- School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey, Mexico
| | - Luis A Trejo
- School of Engineering and Sciences, Tecnologico de Monterrey, Atizapan, Mexico
| | - Eleni Stroulia
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Connell AM, Seidman S, Ha T, Stormshak E, Westling E, Wilson M, Shaw D. Long-term Effects of the Family Check-Up on Suicidality in Childhood and Adolescence: Integrative Data Analysis of Three Randomized Trials. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1558-1568. [PMID: 35476247 PMCID: PMC9606146 DOI: 10.1007/s11121-022-01370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
This study employed integrative data analysis techniques to examine the long-term effects of the family check-up (FCU) on changes in youth suicide risk using three randomized prevention trials, including one trial initiated in early childhood and two initiated in early adolescence. Data were harmonized across studies using moderated nonlinear factor analysis, and intervention effects were tested using an autoregressive latent trajectory model examining changes in suicide risk across long-term follow-up. Across trials, significant long-term effects of the FCU on reductions in suicide risk were observed, although differences between intervention and control group trajectories declined over time. No moderation of intervention effects was observed by youth gender or race/ethnicity or across samples. While results offer further support for the benefits of the FCU for suicide risk reduction, they also suggest that such effects may wane over time, underscoring the need for continued development of the FCU to enhance longer-term durability of effects on suicide-related behaviors.
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Affiliation(s)
| | | | - Thao Ha
- Arizona State University, Tempe, USA
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18
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Rodrigues R, Mehesz EZ, Lingford-Hughes A, Di Simplicio M. Approach-avoidance biases to self-harm cues in young people with self-harm. J Affect Disord 2023; 340:435-441. [PMID: 37549813 DOI: 10.1016/j.jad.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/13/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The urge to self-harm can be likened to craving in addictive behaviours. However, it remains unclear whether cognitive mechanisms involved in craving, such as attentional biases to cues, also underpin the urge to self-harm. METHODS A Dot Probe Task was used to investigate attentional biases to self-harm cues in young people aged 16-25 with self-harm. Cues were shown for either 0.2 s or 2 s. Dot Probe Task performance in the Self-harm group (N = 50) was compared with age-matched Healthy Controls (N = 50) and age- and negative-affect (Depression Anxiety Stress Scale-21) matched controls with no self-harm (N = 50). RESULTS The Self-harm group showed significantly greater avoidance of self-harm cues than Healthy Controls at 2 s. The Negative Affect group showed significantly less difficulty disengaging from self-harm cues than the Self-harm group and Healthy Controls at 2 s. There were no between-group differences in attentional bias at 0.2 s. LIMITATIONS Study limitations that may affect attentional biases in the Self-harm group include not measuring indicators of recovery and recruiting only from the community potentially missing more severe self-harm presentations in clinical settings. CONCLUSIONS Avoidance of self-harm cues in young people with self-harm may reflect conflict around self-harm behaviour, consistent with ambivalence models of craving. An ability to disengage from self-harm cues may be a protective factor in young people with higher levels of negative affect who do not self-harm. Whether these attentional biases represent a quantifiable marker of treatment response or susceptibility to relapse in individuals with self-harm remains an area for future investigation.
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Affiliation(s)
- R Rodrigues
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
| | - E Z Mehesz
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - A Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - M Di Simplicio
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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Meza JI, Zullo L, Vargas SM, Ougrin D, Asarnow JR. Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with intervention benefits. J Child Psychol Psychiatry 2023; 64:1409-1421. [PMID: 36878853 DOI: 10.1111/jcpp.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self-harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. METHODS A systematic search of RCTs evaluating interventions targeting suicide/self-harm in youth (ages 12-18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty-seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self-harm behavior (n = 11 supported trials) and those without supported evidence (n = 7 unsupported trials). RESULTS Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship-building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self-harm monitoring and safety planning. CONCLUSIONS This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self-harm behaviors.
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Affiliation(s)
- Jocelyn I Meza
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lucas Zullo
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sylvanna M Vargas
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry and Global Mental Health, Queen Mary University of London, London, UK
| | - Joan R Asarnow
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
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Simes D, Shochet I, Murray K, Gill DJ. Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study. Psychother Res 2023:1-19. [PMID: 37748115 DOI: 10.1080/10503307.2023.2253360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.
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Affiliation(s)
- Di Simes
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- New South Wales Health, Australia
| | - Ian Shochet
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate Murray
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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21
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Evans SC, Shaughnessy S, Karlovich AR. Future Directions in Youth Irritability Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:716-734. [PMID: 37487108 DOI: 10.1080/15374416.2023.2209180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.
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22
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Arango A, Czyz EK, Magness CS, Hong V, Smith T, Kettley J, Ewell Foster C. Predictors of suicide coping self-efficacy among youth presenting to a psychiatric emergency department. Suicide Life Threat Behav 2023; 53:586-596. [PMID: 37157179 DOI: 10.1111/sltb.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Low levels of youth-reported self-efficacy to cope with suicidal urges have been shown to prospectively predict repeat emergency department (ED) visits and suicide attempts, yet little is known about how self-efficacy may change following receipt of crisis services or about factors that may strengthen self-efficacy. Protective factors (e.g., parent-reported youth competence, parent-family connectedness, and receipt of mental health services) were examined in relation to self-efficacy at the time of a psychiatric ED visit and 2 weeks later. METHODS Participants were 205 youth (ages 10-17), presenting to a psychiatric ED due to a suicide-related concern. Youth primarily identified as biological female (63%) and White (87%). Multivariate hierarchical linear regressions were used to examine candidate protective factors in relation to initial and follow-up suicide coping self-efficacy. RESULTS Self-efficacy significantly improved in the 2 weeks following the ED visit. Parent-family connectedness was positively related to suicide coping self-efficacy at the time of the ED visit. Parent-family connectedness and receipt of inpatient psychiatric care following the ED visit were associated with higher follow-up suicide coping self-efficacy. CONCLUSIONS During the adolescent developmental period when suicidal thoughts and behaviors notably increase, study findings highlight potential malleable intervention targets, including parent-family connectedness, that may strengthen suicide coping self-efficacy.
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Affiliation(s)
- Alejandra Arango
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Victor Hong
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Tayla Smith
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - John Kettley
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Lee CA, Gamino D, Lore M, Donelson C, Windsor LC. Use of research electronic data capture (REDCap) in a sequential multiple assignment randomized trial (SMART): a practical example of automating double randomization. BMC Med Res Methodol 2023; 23:162. [PMID: 37415099 PMCID: PMC10327314 DOI: 10.1186/s12874-023-01986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Adaptive interventions are often used in individualized health care to meet the unique needs of clients. Recently, more researchers have adopted the Sequential Multiple Assignment Randomized Trial (SMART), a type of research design, to build optimal adaptive interventions. SMART requires research participants to be randomized multiple times over time, depending upon their response to earlier interventions. Despite the increasing popularity of SMART designs, conducting a successful SMART study poses unique technological and logistical challenges (e.g., effectively concealing and masking allocation sequence to investigators, involved health care providers, and subjects) in addition to other challenges common to all study designs (e.g., study invitations, eligibility screening, consenting procedures, and data confidentiality protocols). Research Electronic Data Capture (REDCap) is a secure, browser-based web application widely used by researchers for data collection. REDCap offers unique features that support researchers' ability to conduct rigorous SMARTs. This manuscript provides an effective strategy for performing automatic double randomization for SMARTs using REDCap. METHODS Between January and March 2022, we conducted a SMART using a sample of adult (age 18 and older) New Jersey residents to optimize an adaptive intervention to increase COVID-19 testing uptake. In the current report, we discuss how we used REDCap for our SMART, which required double randomization. Further, we share our REDCap project XML file for future investigators to use when designing and conducting SMARTs. RESULTS We report on the randomization feature that REDCap offers and describe how the study team automated an additional randomization that was required for our SMART. An application programming interface was used to automate the double randomizations in conjunction with the randomization feature provided by REDCap. CONCLUSIONS REDCap offers powerful tools to facilitate the implementation of longitudinal data collection and SMARTs. Investigators can make use of this electronic data capturing system to reduce errors and bias in the implementation of their SMARTs by automating double randomization. TRIAL REGISTRATION The SMART study was prospectively registered at Clinicaltrials.gov; registration number: NCT04757298, date of registration: 17/02/2021.
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Affiliation(s)
- Carol A. Lee
- Addiction Center, University of Michigan, North Campus Research Complex Building 16, 2800 Plymouth Rd., Room 222W, Ann Arbor, MI 48109 USA
| | - Danilo Gamino
- North Jersey Community Research Initiative, 393 Central Ave, Newark, NJ 07103 USA
| | - Michelle Lore
- Interdisciplinary Health Sciences Institute, University of Illinois at Urbana Champaign, 405 N. Mathews Ave, Urbana, IL 61801 USA
| | - Curt Donelson
- Data and Technology Innovation Group, University of Illinois at Urbana Champaign, 901 West University Ave, Urbana, IL 61801 USA
| | - Liliane C. Windsor
- School of Social Work, University of Illinois at Urbana Champaign, 1010 W. Nevada St, Urbana, IL 61801 USA
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Bjureberg J, Ojala O, Hesser H, Häbel H, Sahlin H, Gratz KL, Tull MT, Claesdotter Knutsson E, Hedman-Lagerlöf E, Ljótsson B, Hellner C. Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2322069. [PMID: 37440232 PMCID: PMC10346121 DOI: 10.1001/jamanetworkopen.2023.22069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/21/2023] [Indexed: 07/14/2023] Open
Abstract
Importance Nonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking. Objective To test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects. Design, Setting, and Participants This 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021. Interventions Twelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only. Main Outcomes and Measures Primary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment. Results A total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment. Conclusions and Relevance In this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury. Trial Registration ClinicalTrials.gov Identifier: NCT03353961.
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Affiliation(s)
- Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Olivia Ojala
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hugo Hesser
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Henrike Häbel
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sahlin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio
- Lyra Health, Burlingame, California
| | - Matthew T. Tull
- Department of Psychology, University of Toledo, Toledo, Ohio
| | | | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Clara Hellner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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25
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Masland SR, Finch EF, Schnell SE. Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis. Int J Group Psychother 2023; 73:183-201. [PMID: 38446601 DOI: 10.1080/00207284.2023.2191683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.
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26
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Dobias ML, Chen S, Fox KR, Schleider JL. Brief Interventions for Self-injurious Thoughts and Behaviors in Young People: A Systematic Review. Clin Child Fam Psychol Rev 2023; 26:482-568. [PMID: 36715874 PMCID: PMC9885418 DOI: 10.1007/s10567-023-00424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/31/2023]
Abstract
Rates of self-injurious thoughts and behaviors (SITBs) increase sharply across adolescence and remain high in young adulthood. Across 50 years of research, existing interventions for SITBs remain ineffective and inaccessible for many young people in particular need of mental healthcare. Briefer intervention options may increase access to care. However, many traditional interventions for SITBs take 6 months or more to complete-making it difficult for providers to target SITBs under real-world time constraints. The present review (1) identifies and (2) summarizes evaluations of brief psychosocial interventions for SITBs in young people, ages 10-24 years. We conducted searches for randomized and quasi-experimental trials conducted in the past 50 years that evaluated effects of "brief interventions" (i.e., not exceeding 240 min, or four 60-min sessions in total length) on SITBs in young people. Twenty-six articles were identified for inclusion, yielding a total of 23 brief interventions. Across all trials, results are mixed; only six interventions reported any positive intervention effect on at least one SITB outcome, and only one intervention was identified as "probably efficacious" per standard criteria for evidence-based status. While brief interventions for SITBs exist, future research must determine if, how, and when these interventions should be disseminated.
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Affiliation(s)
- Mallory L Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Sharon Chen
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO, 80210, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
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27
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Marshall P, Sansom K, Jagfeld G, Jones S, Lobban F. Caring for a friend or family member who has experienced suicidal behaviour: A systematic review and qualitative synthesis. Psychol Psychother 2023; 96:426-447. [PMID: 36786386 PMCID: PMC10952656 DOI: 10.1111/papt.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/21/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Friends and family members can be important sources of support for people who are or have been suicidal. This review aimed to synthesise qualitative evidence regarding carers' perspectives of supporting someone who has experienced suicidal behaviour. METHODS Five electronic databases (Web of Science, CINAHL, PsychINFO, MEDLINE, and SocINDEX) were searched from inception to May 2022. Eligible qualitative studies were published in English and investigated the caring experiences of friends or family members of people who had experienced suicidal behaviour, defined as any form of suicidal ideation and/or attempts. Studies focused on non-suicidal self-injury or suicide bereavement were excluded. Data from 19 eligible studies were analysed using thematic synthesis. RESULTS Initial carer reactions to suicidal behaviour included profound anxiety and intensive monitoring for signs of increased suicide risk amongst those they supported. Carers also reported significant challenges with understanding how to provide effective interpersonal support following suicidal crises. Professional support was perceived to be most effective when provided in a timely, interpersonally sensitive and safety-focused manner. However, several studies detailed carers' difficulties accessing appropriate support and challenges managing their own distress. CONCLUSIONS Carers face significant challenges with knowing how to respond to suicidal behaviour, where to find appropriate help, and how to manage their own distress. Future research should seek to investigate the effectiveness of easily accessible methods of information provision and support tailored for carers of people who have experienced suicidal behaviour.
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Affiliation(s)
- Paul Marshall
- Division of Health Research, Spectrum Centre for Mental Health ResearchLancaster UniversityLancasterUK
| | - Keith Sansom
- Division of Health Research, Spectrum Centre for Mental Health ResearchLancaster UniversityLancasterUK
| | - Glorianna Jagfeld
- Division of Health Research, Spectrum Centre for Mental Health ResearchLancaster UniversityLancasterUK
| | - Steven Jones
- Division of Health Research, Spectrum Centre for Mental Health ResearchLancaster UniversityLancasterUK
| | - Fiona Lobban
- Division of Health Research, Spectrum Centre for Mental Health ResearchLancaster UniversityLancasterUK
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Scopetti M, Morena D, Padovano M, Manetti F, Di Fazio N, Delogu G, Ferracuti S, Frati P, Fineschi V. Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die. Healthcare (Basel) 2023; 11:healthcare11101470. [PMID: 37239756 DOI: 10.3390/healthcare11101470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The admission of people suffering from psychiatric and neurocognitive disorders to euthanasia and physician-assisted suicide (E/PAS) in some European and non-European countries represents a controversial issue. In some countries, the initial limitation of E/PAS to cases of severe physical illness with poor prognosis in the short term has been overcome, as it was considered discriminatory; thus, E/PAS has also been made available to subjects suffering from mental disorders. This decision has raised significant ethical questions regarding the capacity and freedom of self-determination; the family, social, and economic contexts; the social consideration of the sense of dignity and the pressure on the judgment of one's personal value; the contextual therapeutic possibilities; the identification of figures involved in the validation and application; as well as the epistemological definitions of the clinical conditions in question. To these issues must be added the situation of legislative vacuum peculiar to different countries and the widespread lack of effective evaluation and control systems. Nonetheless, pessimistic indicators on global health status, availability of care and assistance, aging demographics, and socioeconomic levels suggest that there may be further pressure toward the expansion of such requests. The present paper aims to trace an international overview with the aim of providing ethical support to the debate on the matter. Precisely, the goal is the delimitation of foundations for clinical practice in the complex field of psychiatry between the recognition of the irreversibility of the disease, assessment of the state of physical and mental suffering, as well as the possibility of adopting free and informed choices.
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Affiliation(s)
- Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
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29
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Adolescent non-suicidal self-injury during the COVID-19 pandemic: A prospective longitudinal study of biological predictors of maladaptive emotion regulation. Psychoneuroendocrinology 2023; 151:106056. [PMID: 36822129 PMCID: PMC9922437 DOI: 10.1016/j.psyneuen.2023.106056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) in adolescence is thought to stem from interactions between vulnerability in developing biological systems and experience of stressors. The current study assesses whether multiple levels of the stress system's response to threat could prospectively predict NSSI engagement during the COVID-19 pandemic, a shared, time-locked stressor. METHODS Participants were 64 female adolescents (ages 12-16) from community and clinical settings who were oversampled for NSSI histories. Prior to the onset of the COVID-19 pandemic, adolescents completed a protocol that measured hypothalamic-pituitary-adrenal axis response to a social stressor (via salivary cortisol), amygdala volume, amygdala emotion-evoked activation, and frontolimbic resting-state functional connectivity. During early months of the pandemic (Summer 2020), measures of NSSI behavior (Inventory of Statements About Self-Injury), emotion regulation difficulties (Difficulties in Emotion Regulation Scale), perceived stress (Perceived Stress Scale), and pandemic-related stressors (Epidemic Pandemic Impacts Inventory) were collected. Multinomial logistic regression was used to assess if pre-pandemic biomarkers predicted mid-pandemic NSSI engagement: persistence of NSSI (Persist; N = 21), cessation of NSSI (Desist; N = 26), and no history of NSSI (Never; N = 17). Linear regressions explored if pre-pandemic biomarkers predicted mid-pandemic difficulties in emotion regulation and perceived stress. RESULTS Higher pre-pandemic overall cortisol response to stress and amygdala emotion-evoked activation characterized adolescents who persisted in NSSI, compared to those who desisted. These findings remained significant when controlling for pandemic related stressors. Lower prepandemic cortisol reactivity predicted more difficulties in emotion regulation during the pandemic. This finding did not remain significant after controlling for pandemic related stressors. CONCLUSIONS Findings suggest that patterns in key biological threat response systems may confer vulnerability for risk outcomes including NSSI engagement in adolescent females in the context of a shared, novel, naturally-occurring stressor. The results point to the importance of multi-level, longitudinal approaches for understanding the interface between developing neurobiological systems and experiential stress in at-risk adolescents. Identified patterns give insight into potential risk assessment strategies based on an understanding of the multi-level threat response.
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Hughes JL, Horowitz LM, Ackerman JP, Adrian MC, Campo JV, Bridge JA. Suicide in young people: screening, risk assessment, and intervention. BMJ 2023; 381:e070630. [PMID: 37094838 DOI: 10.1136/bmj-2022-070630] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.
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Affiliation(s)
- Jennifer L Hughes
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institutes of Mental Health, NIH, Bethesda, MD, USA
| | - John P Ackerman
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly C Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center College of Medicine, Columbus, OH, USA
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31
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Waraan L, Siqveland J, Hanssen-Bauer K, Czjakowski NO, Axelsdóttir B, Mehlum L, Aalberg M. Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta-analysis. Clin Child Psychol Psychiatry 2023; 28:831-849. [PMID: 36053279 PMCID: PMC10018060 DOI: 10.1177/13591045221125005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation. METHOD We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation. RESULTS We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation. CONCLUSIONS Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.
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Affiliation(s)
- Luxsiya Waraan
- Division of Mental Health Services, 60483Akershus University Hospital, Lørenskog, Norway.,Department of Psychology, 6305University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Division of Mental Health Services, 60483Akershus University Hospital, Lørenskog, Norway.,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, 6305University of Oslo, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, 60483Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, 6305University of Oslo, Oslo, Norway
| | - Nikolai O Czjakowski
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,PROMENTA Research Center, Department of Psychology, 6305University of Oslo, Oslo, Norway
| | - Brynhildur Axelsdóttir
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, 6305University of Oslo, Oslo, Norway
| | - Marianne Aalberg
- Division of Mental Health Services, 60483Akershus University Hospital, Lørenskog, Norway
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Zhao YL, Liu ZH, Li YY, Liu DL, Yi JN. The lived experiences of parents providing care to young people who self-harm: A meta-aggregative synthesis of qualitative studies. Int J Ment Health Nurs 2023; 32:402-419. [PMID: 36408959 DOI: 10.1111/inm.13095] [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] [Accepted: 11/02/2022] [Indexed: 11/22/2022]
Abstract
Self-harm, which affects the whole family system, is an international public health concern. Empirical evidence supports the efficacy of interventions incorporating a family/parent training component for self-injurious thoughts and behaviours, and a quantitative synthesis of these empirical studies has been undertaken and updated. A qualitative synthesis of the experiences of parents whose child self-harms remains limited. This report aimed to systematically review qualitative research about the experiences, preferences, and expectations of parents whose children self-harmed. A comprehensive search was conducted across ten databases and four grey literature sources, along with the manual search of reference lists and relevant websites. Study screening, data extraction, and quality appraisal were all performed by two independent researchers. Twenty-four articles, two of which were mixed-methods studies, were included and analysed using a meta-aggregation approach. Five synthesized findings were identified: initial negative reactions to the discovery of their child's self-harm, the ongoing impact of self-harm on parents and the wider family, parents' various coping strategies, parents' negative experiences with mental health professionals expectations, and the lack of and need for psychoeducational resources. Our review finds that parents express keen interest in engaging with the treatment process, and our results support family-based therapy. However, with the overwhelming emotions most parents experience, clinicians should approach them with sensitivity, empathy and finesse. Psychoeducational self-help resources should also be made readily available to parents who are reluctant to seek help.
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Affiliation(s)
- Yan-Li Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhi-Hua Liu
- Psychotherapy Department, Zhengzhou Eighth People's Hospital, Zhengzhou, China
| | - Ying-Ying Li
- Hematology Department, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dong-Ling Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Jing-Na Yi
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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33
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Asarnow JR, Mehlum L. Practitioner Review: Treatment for Suicidal and Self-Harming Adolescents-Advances in Suicide Prevention Care. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:209-216. [PMID: 37201143 PMCID: PMC10172564 DOI: 10.1176/appi.focus.23021005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Suicide is a leading cause of death globally in youths, and suicidal behavior and self-harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue. Methods The article reviews scientific evidence related to steps in the care pathway for identifying and treating youths with elevated suicide/self-harm risk, specifically: (a) screening and risk assessment; (b) treatment; and (c) community-level suicide prevention strategies. Results Review of current evidence indicates that major advances have been achieved in knowledge regarding clinical and preventive practices for reducing suicide and self-harm risk in adolescents. The evidence supports the value of brief screeners for identifying youths with elevated suicide/self-harm risk and the efficacy of some treatments for suicidal and self-harm behavior. Dialectical behavior therapy currently meets Level 1 criteria (2 independent trials supporting efficacy) as the first well-established treatment for self-harm, and other approaches have shown efficacy in single randomized controlled trials. The effectiveness of some community-based suicide prevention strategies for reducing suicide mortality and suicide attempt rates has been demonstrated. Conclusions Current evidence can guide practitioners in delivering effective care for youth suicide/self-harm risk. Treatments and preventive interventions that address the psychosocial environment and enhance the ability of trusted adults to protect and support youths, while also addressing the psychological needs of youths appear to yield the greatest benefits. Although additional research is needed, our current challenge is to do our best to effectively utilize new knowledge to improve care and outcomes in our communities.Reprinted from J Child Psychol Psychiatry 2019; 60:1046-1054, with permission from John Wiley and Sons. Copyright © 2019.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA (Asarnow); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Mehlum)
| | - Lars Mehlum
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA (Asarnow); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Mehlum)
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Yeh YJ, Tsai W, Chen JH, Kimel S. Culture, Family Problems, Emotion Dysregulation and Nonsuicidal Self-injury: Differences among Taiwanese and Americans. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Meza JI, Godoy SM, Nguyen PT, Perris GE, Barnert ES, Bath EP. Risk profiles of suicide attempts among girls with histories of commercial sexual exploitation: A latent class analysis. CHILD ABUSE & NEGLECT 2023; 137:106036. [PMID: 36680963 PMCID: PMC10226678 DOI: 10.1016/j.chiabu.2023.106036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Girls impacted by commercial sexual exploitation (CSE) in the juvenile legal system are three times more likely to have suicide attempts than girls without histories of exploitation. Yet, research on risk profiles and correlates that contribute to elevated suicide risk among girls with CSE histories remains scant. OBJECTIVE We sought to examine suicide attempts profiles among CSE-impacted girls in the juvenile legal system. PARTICIPANTS AND SETTING We partnered with a specialty court for CSE-impacted youth in Los Angeles County. METHODS Data were collected from case files of the 360 girls participating in the court from 2012 to 2016. Latent class analysis was used to identify their profiles of risk indicators. RESULTS Four risk profiles for suicide attempts emerged: (1) Parental Incarceration (PI; 30 %), (2) Child Welfare Contact (CWC; 25 %), (3) Disruptive Behavior and Sleep Problems (DBS; 25 %), and (4) Pervasive Risk (PR; 22 %). Among youth in the PI group, 5 % had a suicide attempt; however, contrary to our hypothesis, no youth in the CWC group had a suicide attempt. Rates of suicide attempt were significantly higher among youth in the DBS group, as 14 % had a suicide attempt. As hypothesized, youth in the PR were associated with higher risk of suicide attempts, with 28 % reporting a prior suicide attempt. CONCLUSIONS Findings underscore the need for standardized suicide screenings and treatment referrals for girls with CSE histories and suggest an important opportunity for multidisciplinary collaboration with courts to improve suicide prevention strategies. The present study also supports the importance of examining risk across the socioecological context.
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Affiliation(s)
- Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 300 Medical Plaza Driveway, Room 3308, Los Angeles, CA 90095, United States.
| | - Sarah M Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro Street, Room 400-I, Chapel Hill, NC 27599, United States.
| | - Phuc T Nguyen
- Department of Psychology, UC Berkeley, Berkeley Way West Building, 2121 Berkeley Way, Berkeley, CA 94720, United States.
| | - Georgia E Perris
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, UCLA Semel Neuropsychiatric Institute, 760 Westwood Plaza, Room A8-232, Los Angeles, CA 90024, United States.
| | - Elizabeth S Barnert
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, UCLA Pediatrics BOX 951752, 12-467 MDCC, Los Angeles, CA 90095, United States.
| | - Eraka P Bath
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, UCLA Semel Neuropsychiatric Institute, 760 Westwood Plaza, Room A8-228, Los Angeles, CA 90024, United States.
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Lee CA, Gamino D, Lore M, Donelson C, Windsor LC. Use of research electronic data capture (REDCap) in a sequential multiple assignment randomized trial (SMART): A practical example of automating double randomization. RESEARCH SQUARE 2023:rs.3.rs-2573133. [PMID: 36865151 PMCID: PMC9980278 DOI: 10.21203/rs.3.rs-2573133/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background: Adaptive interventions are often used in individualized health care to meet the unique needs of clients. Recently, more researchers have adopted the Sequential Multiple Assignment Randomized Trial (SMART), a type of research design, to build optimal adaptive interventions. SMART requires research participants to be randomized multiple times over time, depending upon their response to earlier interventions. Despite the increasing popularity of SMART designs, conducting a successful SMART study poses unique technological and logistical challenges (e.g., effectively concealing and masking allocation sequence to investigators, involved health care providers, and subjects) in addition to other challenges common to all study designs (e.g., study invitations, eligibility screening, consenting procedures, and data confidentiality protocols). Research Electronic Data Capture (REDCap) is a secure, browser-based web application widely used by researchers for data collection. REDCap offers unique features that support researchers’ ability to conduct rigorous SMARTs. This manuscript provides an effective strategy for performing automatic double randomization for SMARTs using REDCap. Methods: Between January and March 2022, we conducted a SMART using a sample of adult (age 18 and older) New Jersey residents to optimize an adaptive intervention to increase COVID-19 testing uptake. In the current report, we discuss how we used REDCap for our SMART, which required double randomization. Further, we share our REDCap project XML file for future investigators to use when designing and conducting SMARTs. Results: We report on the randomization feature that REDCap offers and describe how the study team automated an additional randomization that was required for our SMART. An application programming interface was used to automate the double randomizations in conjunction with the randomization feature provided by REDCap. Conclusions: REDCap offers powerful tools to facilitate the implementation of longitudinal data collection and SMARTs. Investigators can make use of this electronic data capturing system to reduce errors and bias in the implementation of their SMARTs by automating double randomization. Trial registration: The SMART study was prospectively registered at Clinicaltrials.gov; registration number: NCT04757298, date of registration: 17/02/2021. Keywords: Research Electronic Data Capture (REDCap), randomized controlled trials (RCT), adaptive interventions, Sequential Multiple Assignment Randomized Trial (SMART), randomization, experimental design, reducing human errors, automation.
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Affiliation(s)
- Carol A Lee
- Addiction Center, University of Michigan, North Campus Research Complex Building 16, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA
| | - Danilo Gamino
- North Jersey Community Research Initiative, 393 Central Ave., Newark, NJ 07103
| | - Michelle Lore
- Interdisciplinary Health Sciences Institute, University of Illinois at Urbana Champaign, 901 West University Ave., Urbana, IL 61801
| | - Curt Donelson
- Data and Technology Innovation Group, University of Illinois at Urbana Champaign, 901 West University Ave., Urbana, IL 61801
| | - Liliane C Windsor
- School of Social Work, University of Illinois at Urbana Champaign, 1010 W. Nevada St., Urbana, IL 61801
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Ohlis A, Bjureberg J, Ojala O, Kerj E, Hallek C, Fruzzetti AE, Hellner C. Experiences of dialectical behaviour therapy for adolescents: A qualitative analysis. Psychol Psychother 2023; 96:410-425. [PMID: 36756991 DOI: 10.1111/papt.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To explore how former patients in dialectical behaviour therapy for adolescents (DBT-A) experience their treatment, and specifically if there were aspects of the treatment that they retrospectively identify as particularly meaningful, helpful or unhelpful. DESIGN From a larger sample of 75 former DBT-A patients 19 were selected for a qualitative semi-structured interview study. METHODS Young adults (N = 19; 18 females, one male), who as adolescents had been enrolled in DBT-A due to self-harming behaviours and features of borderline personality disorder, were interviewed up to 8 years (median 6.0; min 1.3; max 8.2) after end of treatment, at mean age 23 years (SD 2.5). Reflexive thematic analysis was implemented. RESULTS Six key themes were revealed; (1) The need to be seen, listened to and believed in, (2) the importance of teamwork between patient and therapist, (3) the value of group and structure, (4) therapy as lifesaving and life-changing, (5) the risks of feeling misplaced and (6) the risks of abrupt endings. CONCLUSION A trusting relationship with the therapist promoted commitment and motivation for treatment. This relationship was facilitated by the therapist showing explicit care and belief in the patient's own competence in changing their destructive behaviours. Meeting peers in group skill training offered a salient form of validation and was reported to be of particular value. The format of meeting peers and the importance of the dialectical therapeutic stance need to be studied further. Not all youth experienced DBT-A as suitable and the need for sufficient treatment dose was emphasized.
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Affiliation(s)
- Anna Ohlis
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stanford University, Stanford, California, USA
| | - Olivia Ojala
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Emme Kerj
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Camilla Hallek
- DBT-unit, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Hellner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Reas DL, Wisting L, Lindvall Dahlgren C. Co-occurrence of nonsuicidal self-injury and eating disorder pathology in adolescents. Int J Eat Disord 2023; 56:439-445. [PMID: 36524669 PMCID: PMC10107669 DOI: 10.1002/eat.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Little is known about the co-occurrence of nonsuicidal self-injurious (NSSI) behaviors and eating disorder (ED) pathology in community samples of adolescents. METHODS A total of 1558 Norwegian upper secondary school students (Grades 11, 12, and 13) completed the Deliberate Self-Harm Inventory and a measure of ED pathology. RESULTS Adolescents (53.1% F, 46.9% M) were a mean age of 17.1 years. A higher level of ED pathology was reported (12.1 vs. 5.3, p < .001) among adolescents who had a history of NSSI. Significantly higher levels of ED pathology were found among females who reported hitting themselves until bruised, head banging, severe scratching, and burning with a lighter, but not cutting, or the other forms of self-injury. Of adolescents with a history of NSSI, 60% of females and 15% of males scored above a cutoff for ED pathology. Of adolescents scoring above a cutoff for ED pathology, 42.5% of females and 37.1% of males had engaged in lifetime NSSI. DISCUSSION Adolescents-in particular, females- with a history of NSSI reported significantly greater ED pathology. Notably, a higher proportion of males with ED pathology reported lifetime self-injury than vice versa, underscoring the importance of carefully screening for the presence of self-harm among males with ED pathology. PUBLIC SIGNIFICANCE STATEMENT Over 1500 upper secondary school students with an average age of 17 years completed an online survey assessing current ED pathology and lifetime NSSI. Adolescents, particularly females, with a history of self-harm reported significantly more ED pathology. Findings also indicated the need to carefully screen for self-harm among males with ED pathology. Parents, schools, and health professionals should be aware that self-harm and ED pathology commonly co-occur and warrant assessment.
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Affiliation(s)
- Deborah Lynn Reas
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Line Wisting
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Oslo New University College, Oslo, Norway
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Maultsby K, López R, Wolff J, Spirito A, Esposito-Smythers C. Longitudinal Relations Between Parenting Practices and Adolescent Suicidal Ideation in a High-Risk Clinical Sample: A Moderated Mediation Model. Res Child Adolesc Psychopathol 2023; 51:613-623. [PMID: 36652026 DOI: 10.1007/s10802-022-01018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
Parenting behaviors are associated with adolescent suicidal ideation (SI), but few studies have examined this relation longitudinally or investigated underlying mechanisms. We investigated a moderated mediation model to evaluate perceived burdensomeness as a mediator in the longitudinal relation between parenting behavior (warmth and verbal hostility) and adolescent SI. We hypothesized that this association would be particularly strong among adolescents with greater functional impairment. The sample included 147 adolescents (Mage = 14.9, Age Range = 12-18 years, 76.2% female) and a primary caregiver (Mage = 43.5, Age Range = 27-60 years, 81.4% female) enrolled in a clinical trial. Caregivers completed measures of warmth and verbal hostility (PCPR) and adolescents completed measures of functional impairment (CDI-2), perceived burdensomeness (INQ), and SI (SIQ-JR) at baseline, 12 and 18 months. Two moderated mediation path analyses, one for each parenting behavior, were conducted. Age, sex, treatment condition, baseline and 12-month SI, baseline perceived burdensomeness, and the alternate baseline parenting behavior were included as covariates. Neither model yielded a significant direct effect between baseline parental verbal hostility or warmth and 18-month SI. However, lower warmth and higher verbal hostility were positively associated with 18-month SI indirectly through greater 12-month perceived burdensomeness among youth with relatively higher levels of functional impairment. Perceptions of burdensomeness are a mechanism by which low parental warmth and high parental verbal hostility contribute to SI, but only among youth with greater functional impairment. Interventions to address youth perceptions of burdensomeness may be beneficial, particularly for the most highly impaired youth.
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Affiliation(s)
| | - Roberto López
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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MacPherson HA, Kim KL, Seymour KE, Wolff J, Esposito-Smythers C, Spirito A, Dickstein DP. Cognitive Flexibility and Impulsivity Deficits in Suicidal Adolescents. Res Child Adolesc Psychopathol 2022; 50:1643-1656. [PMID: 35751716 PMCID: PMC10269680 DOI: 10.1007/s10802-022-00952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Although neurocognitive deficits have been documented in adolescents with suicidal ideation (SI) and suicide attempts (SA), it is unclear whether certain impairments differentiate these groups, potentially suggesting heightened risk for SA. Focus on specific facets of impulsivity and cognitive control may indicate distinctions between adolescents with SA vs. SI. The current study examined dimensions of impulsivity and cognitive control in 141 adolescents with SA (n = 41) vs. SI without SA (n = 49) vs. typically-developing controls (TDCs; n = 51). Adolescents completed cross-sectional neurocognitive tasks via the Cambridge Neuropsychological Testing Automated Battery, in addition to demographic and clinical measures. Analyses involved ANOVAs and ANCOVAs. Results indicated that adolescents with SA demonstrated less set shifting/cognitive flexibility (reduced ability to adapt to/disengage from stimuli) and greater impulsive decision making (reduced ability to collect/evaluate information before making decisions) compared to TDCs. In addition, both TDCs and adolescents with SA had greater response inhibition (increased ability to stop motor responses that have begun/become prepotent) than those with SI. Similar results were found when analyzing female adolescents separately. There were no significant differences for male adolescents, potentially due to the small subsample (n = 40). There were no significant findings for spatial planning/problem solving or visuospatial working memory. Findings suggest: 1) less set shifting/cognitive flexibility and greater impulsive decision making for adolescents with SA vs. TDCs; and 2) greater response inhibition for TDCs and adolescents with SA vs. SI. Such information may be useful for improving risk assessments (adding neurocognitive tasks) and targeted treatments (incorporating cognitive remediation) for this impaired population.
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Affiliation(s)
| | - Kerri L Kim
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Karen E Seymour
- National Institutes of Health, Center for Scientific Review, Rockville, MD, USA
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P Dickstein
- PediMIND Program, Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
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Abstract
Concerns have been raised about the impact of the COVID-19 pandemic on individuals with lived experience of nonsuicidal self-injury (NSSI). Yet, few efforts have explored this. Accordingly, using a mixed-methods approach, we sought to examine whether emerging adults who have self-injured experienced changes in NSSI urges and behavior during the pandemic and what may have accounted for these changes. To do so, university students with lived experience of NSSI completed online questions asking about NSSI and self-reported changes in urges and behavior since the onset of COVID-19. They then answered open-ended questions asking what contributed to these changes and how they have coped during this timeframe. Approximately 80% of participants reported no change or a decrease in NSSI urges and behavior. Participants discussed removal from stressors (e.g., social stress) that previously evoked NSSI, as well as having time for self-care and to develop resilience as accounting for this. Nevertheless, some participants reported challenges amid the pandemic (i.e., exacerbated stress, isolation); approximately one fifth of participants reported increases in NSSI urges and behavior. Our findings add to recent evidence that many individuals with prior mental health difficulties, including NSSI, can demonstrate resilience in the face of collective adversity. Research and clinician implications are discussed.
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Abstract
Reducing deaths by suicide in youth is an urgent public health goal and effective treatment approaches remain limited. This editorial reviews new research published in this issue of Child and Adolescent Mental health that may inform youth suicide prevention efforts, including an open trial of a new, family-focused group intervention for youth with suicidal ideation and findings showing that life problems associated with presentation to the emergency department for self-harm vary by age and gender. The need for multi-component treatments that have the flexibility to target a range of life problems/risk factors and to include families in treatment is discussed, along with the need to find a way to make such interventions scalable. Finally, this editorial addresses this issue's debate by discussing the role of mindfulness in dialectical behavior therapy for suicidal youth and the need to carefully monitor and further examine the effectiveness and safety of mindfulness with this patient population.
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Affiliation(s)
- Michele S Berk
- Stanford University Medical Center, Stanford University, Stanford, CA, USA
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43
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Bertelsen TB, Hoffart A, Rekdal SS, Zahl-Olsen R. Bayes factor benefits for clinical psychology: review of child and adolescent evidence base. F1000Res 2022; 11:171. [PMID: 37809055 PMCID: PMC10558984 DOI: 10.12688/f1000research.76842.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/11/2023] Open
Abstract
Background: Statistical methods are a cornerstone of research in clinical psychology and are used in clinical trials and reviews to determine the best available evidence. The most widespread statistical framework, frequentist statistics, is often misunderstood and misused. Even when properly applied, this framework can lead to erroneous conclusions and unnecessarily prolonged trials. The implications for clinical psychology are difficulties in interpreting best available evidence and unnecessarily costly and burdensome research. An alternative framework, Bayesian statistics, is proposed as a solution to several issues with current practice. Methods: Statistical tests of primary outcome measures were extracted from 272 studies, which were cited in 11 recent reviews in the Evidence-based updates series in the Journal of Clinical Child and Adolescent Psychology. The extracted tests were examined regarding relevant features and re-analyzed using Bayes Factors. Results: When statistical tests were significant, the majority (98%) of re-analyzed tests agreed with such claims. When statistical tests were nonsignificant almost half (43%) of re-analyzed tests disagreed with such claims. Equally important for clinical research, an average of 13% fewer participants per study would have been required if the studies had used Bayes Factors. Conclusions: Bayes Factors offer benefits for research in clinical psychology through intuitive interpretations, and less costly trials.
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Affiliation(s)
- Thomas B. Bertelsen
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Asle Hoffart
- Research institute of Modum Bad psychiatric hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sondre Sverd Rekdal
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Rune Zahl-Olsen
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
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Bertelsen TB, Hoffart A, Rekdal SS, Zahl-Olsen R. Bayes factor benefits for clinical psychology: review of child and adolescent evidence base. F1000Res 2022; 11:171. [PMID: 37809055 PMCID: PMC10558984 DOI: 10.12688/f1000research.76842.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 10/10/2023] Open
Abstract
Background: Statistical methods are a cornerstone of research in clinical psychology and are used in clinical trials and reviews to determine the best available evidence. The most widespread statistical framework, frequentist statistics, is often misunderstood and misused. Even when properly applied, this framework can lead to erroneous conclusions and unnecessarily prolonged trials. The implications for clinical psychology are difficulties in interpreting best available evidence and unnecessarily costly and burdensome research. An alternative framework, Bayesian statistics, is proposed as a solution to several issues with current practice. Methods: Statistical tests of primary outcome measures were extracted from 272 studies, which were cited in 11 recent reviews in the Evidence-based updates series in the Journal of Clinical Child and Adolescent Psychology. The extracted tests were examined regarding relevant features and re-analyzed using Bayes Factors. Results: When statistical tests were significant, the majority (98%) of re-analyzed tests agreed with such claims. When statistical tests were nonsignificant almost half (43%) of re-analyzed tests disagreed with such claims. Equally important for clinical research, an average of 13% fewer participants per study would have been required if the studies had used Bayes Factors. Conclusions: Bayes Factors offer benefits for research in clinical psychology through intuitive interpretations, and less costly trials.
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Affiliation(s)
- Thomas B. Bertelsen
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Asle Hoffart
- Research institute of Modum Bad psychiatric hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sondre Sverd Rekdal
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
| | - Rune Zahl-Olsen
- Department of Child and Adolescent Mental Health, Sørlandet sykehus, Kristiansand, Agder, 4615, Norway
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Berk MS, Gallop R, Asarnow JR, Adrian M, Avina C, Hughes JL, Korslund KE, McCauley E. Trajectories of Treatment Response and Nonresponse in Youth at High Risk for Suicide. J Am Acad Child Adolesc Psychiatry 2022; 61:1119-1130. [PMID: 35122952 PMCID: PMC9343478 DOI: 10.1016/j.jaac.2022.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/21/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine trajectories of treatment response in suicidal youth who participated in a randomized controlled trial comparing dialectical behavior therapy (DBT) and individual and group supportive therapy. METHOD Using latent class analysis across both treatment conditions, secondary analyses were conducted of data from a multisite randomized controlled trial comprising 173 youths ages 12-18 with repetitive self-harm (SH) (including ≥1 lifetime suicide attempts) and elevated suicidal ideation (SI). The sample was 95% female, 56.4% White, and 27.49% Latina. Participants received 6 months of DBT or individual and group supportive therapy and 6 months of follow-up. Primary outcomes were SH and SI. RESULTS Of the sample, 63% and 74% were members of latent classes that showed improvement in SI and SH, respectively; 13% were total nonresponders, with no improvement in SI or SH. SH nonresponse emerged at the midpoint of treatment (3 months), with nonresponders showing a sharp increase in SH over the remainder of treatment and follow-up. Youth receiving DBT were significantly more likely to be an SH responder vs nonresponder than youths in individual and group supportive therapy (ꭓ21 = 6.53, p = .01). An optimal threshold cut point using multivariate predictors of total nonresponse (White, externalizing symptoms, total SH, and SI) predicted total nonresponders to DBT with 100% accuracy. CONCLUSION This is the first study to identify trajectories of both SI and SH response to treatment in a sample of adolescents at risk of suicide. Results may inform personalized treatment approaches. CLINICAL TRIAL REGISTRATION INFORMATION Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www. CLINICALTRIALS gov/; NCT01528020.
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Affiliation(s)
| | - Robert Gallop
- West Chester University of Pennsylvania, West Chester
| | | | | | | | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, and UT Southwestern Medical Center
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Zhao Y, D Dela Rosa R, Zhang Q, Zhao W, Xu H, Wang R, Ma L. Lived experiences of parents providing care to young people who self-harm: a protocol for a meta-aggregative synthesis of qualitative studie. BMJ Open 2022; 12:e065489. [PMID: 36038177 PMCID: PMC9438063 DOI: 10.1136/bmjopen-2022-065489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The self-harm of young people can cause tremendous distress to their parents/carers and impair parents' ability to provide care. At the same time, parents play an essential role in supporting their child during the management and treatment of self-harm. The synthesis of evidence about parental experiences and needs can inform mental health practice and the development of interventions to provide better care to young people who self-harm and their parents. METHODS AND ANALYSIS A comprehensive search will be conducted across several information sources, including multiple electronic databases (eg, PubMed, Embase, CINAHL, PsycINFO, ProQuest, CNKI, Wanfang, VIP and SinoMed), grey literature, the websites of specific organisations and hand-searched reference lists of all the relevant studies. Qualitative studies published in English or Chinese and focusing on the lived experiences of parents whose child self-harms will be included. Two reviewers will independently screen all the retrieved articles according to the flow diagram proposed by PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two independent reviewers will then appraise the methodological quality of all the included articles using the JBI (Joanna Briggs Institute) critical appraisal checklist for qualitative research. The meta-aggregation approach will be used to synthesise the findings of the included qualitative studies, and the level of confidence in the synthesised findings will be assessed using the Confidence in the Qualitative synthesised finding approach. ETHICS AND DISSEMINATION No additional ethical clearance is required since this review is a secondary analysis of published primary studies. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021265525.
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Affiliation(s)
- Yanli Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | | | - Qiushi Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Xu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Rui Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ling Ma
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Meza JI, Piña-Watson B, Garcia A, Manzo G, Gonzalez IM. Caregiver-Youth intergeneration acculturation conflict moderates the relationship between depression severity and suicidality among female Mexican-Descent college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-11. [PMID: 35997695 PMCID: PMC9947194 DOI: 10.1080/07448481.2022.2109039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/21/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Suicide is the second leading cause of death among college-age students in the U.S., with disparities in suicide ideation and attempts among Latinas. The current study aims to examine if depression severity predicts suicide ideation and attempts and to examine if caregiver intergeneration acculturation conflict (IAC) moderates this link. PARTICIPANTS A sample of 246 Mexican-descent female college students. METHODS Self-reported measures for depression severity, male and female caregiver IAC, and suicide ideation and attempts in the previous 12-months were ascertained. RESULTS In our sample, 31.1% endorsed suicide ideation and 15.9% suicide attempts. Controlling for age, both male and female caregiver IAC moderated the relationship between depression severity and suicide ideation. A similar moderation pattern emerged for the suicide attempts outcome. CONCLUSIONS Understanding this exacerbating contextual factor can help inform prevention/intervention efforts targeting Mexican-descent college students who are experiencing depressive symptoms by focusing on decreasing IAC with both caregivers.Suicide is the second leading cause of death among emerging adults, defined as 18-29-year-olds,1 in the United States (U.S.) and is responsible for more deaths than any single major medical illness.2 Significant gender and ethnic/racial disparities have been well-documented and highlight that Latina emerging adults experience some of the highest rates of suicide ideation (SI) and suicide attempts (SA) and the greatest increases in SA over time, when compared to non-Latinx White, female emerging adults.3,4 In fact, recent research suggests that Latina college students report a 1.7% prevalence rate of suicide attempts compared to 1.2% among non-Latina White college students and data trends report a nearly double increase in the percent of suicide attempts from 2011 to 2015 (from 0.9% to 1.7%) for Latinas versus a minimal change (from 1.1% to 1.2%) among non-Latina White college students.4 Key research examining this disparity have cited that elevated depressive symptoms, which are also experienced at higher levels among Latinx groups in the U.S.,5 are strongly linked to SI and SA among Latinx college students and emerging adults.6,7 Developmentally, the highest risk period for the onset of SI and SA is during late adolescence or emerging adulthood8 and deaths due to suicide increase as adolescents move into emerging adulthood.2,9 Emerging adulthood is an even riskier developmental period for minoritized college students, like Latinx college students, because this period is marked by identity formation processes that are exacerbated by intercultural interactions on college campuses and cultural expectations at home.10 These data underscore the significance of detecting how unique contextual factors may interact with elevated depressive symptoms, and importantly, how these factors are associated with the increased suicide risk among Latinx college-age youth, as they represent a high-risk developmental and ethnic group.
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Affiliation(s)
- Jocelyn I. Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | | | - Aundrea Garcia
- Department of Psychological Sciences, Texas Tech University
| | - Gabriela Manzo
- Department of Psychological Sciences, Texas Tech University
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Harris LM, Huang X, Funsch KM, Fox KR, Ribeiro JD. Efficacy of interventions for suicide and self-injury in children and adolescents: a meta-analysis. Sci Rep 2022; 12:12313. [PMID: 35853962 PMCID: PMC9296501 DOI: 10.1038/s41598-022-16567-8] [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: 02/11/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Despite increased numbers of children and adolescents seeking and receiving mental health treatment, rates of self-injurious thoughts and behaviors (SITBs) in youth are rising. In the hopes of aiding ongoing efforts to alleviate the burden of SITBs in this vulnerable population, the present study summarizes current knowledge on the efficacy of SITB interventions in children and adolescents. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing treatment effects on SITBs in child and adolescent populations. A total of 112 articles comprising 558 effect sizes were included in analyses. Nearly all interventions produced nonsignificant reductions in SITBs. For binary SITB outcomes, a nonsignificant treatment effect was detected, with an RR of 1.06 (95% CIs [0.99, 1.14]). For continuous SITB outcomes, analyses also yielded a nonsignificant treatment effect (g = - 0.04 [- 0.12, 0.05]). These patterns were largely consistent across SITB outcomes, regardless of intervention type, treatment components, sample and study characteristics, and publication year. Our findings highlight opportunities for improving SITB intervention development and implementation in child and adolescent populations. The most efficacious interventions are likely to directly target the causes of SITBs; therefore, future research is needed to identify the causal processes underlying the onset and maintenance of SITBs in youth.
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Affiliation(s)
- Lauren M Harris
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA.
| | - Xieyining Huang
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
| | - Kensie M Funsch
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
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Meza JI, Patel K, Bath E. Black Youth Suicide Crisis: Prevalence Rates, Review of Risk and Protective Factors, and Current Evidence-Based Practices. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:197-203. [PMID: 37153125 PMCID: PMC10153500 DOI: 10.1176/appi.focus.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Suicide is the second leading cause of death among adolescents and young adults. Historically, Black youths have experienced lower rates of suicide; however, recent data point to significant racial disparities. In this article, the authors review current suicide rates, including alarming new data suggesting that suicide rates are two times higher among Black children ages 5-12 compared with White children in that age range. A clinically focused summary of socioecological risk and protective factors associated with suicide among Black youths, with particular attention on structural drivers and culturally relevant factors, is provided. Current evidence-based reviews suggest that dialectical behavior therapy is the only well-established treatment against self-harm and suicide among youths. However, it is unknown whether current established treatments work for Black youths, because Black youths are rarely included in randomized controlled trials. The authors conclude by reviewing emerging treatments developed and tested specifically for Black youths.
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Affiliation(s)
- Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Meza, Bath); Graduate School of Psychology, California Lutheran University, Thousand Oaks (Patel)
| | - Katie Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Meza, Bath); Graduate School of Psychology, California Lutheran University, Thousand Oaks (Patel)
| | - Eraka Bath
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Meza, Bath); Graduate School of Psychology, California Lutheran University, Thousand Oaks (Patel)
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Abstract
Suicide rates continue to increase among children and adolescents in the United States, with suicide remaining the second leading cause of death for youth aged 10 to 24 years of age. Most studies of suicide among children and adolescents have not focused on youth of color because of research suggesting that suicide was a health threat for white youth. Research showing shifting trends in suicide for minoritized youth of color has increased national focus, revealing disparities in recognition and treatment of suicidal behaviors for racially and culturally diverse youth.
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Affiliation(s)
- Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 400, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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