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Desjardins E, Gaber L, Larkin E, Benoit A, Boafo A, De Koninck J. The Dream Experience and Its Relationship with Morning Mood in Adolescents Hospitalized after a Suicide Attempt. Brain Sci 2024; 14:804. [PMID: 39199496 PMCID: PMC11353029 DOI: 10.3390/brainsci14080804] [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: 04/16/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 09/01/2024] Open
Abstract
Suicidality in adolescents has been associated with emotional distress, stressful life events, relationship issues, and nightmares to name a few. This study explored the actual dream content and the mood at pre-sleep, during a reported dream, and in the morning in 33 adolescents admitted to the hospital on account of a suicide attempt. In all aspects, hospitalized adolescents were compared to 33 matched adolescents who had followed the same protocol. In accordance with the Continuity and the Threat Simulation theories of dream formation, it was hypothesized that the waking-life experiences of suicidal adolescents would transpire in both dream mood and content as well as in the frequency of nightmares. Dreams were analyzed by independent judges using traditional dream content scales, including for the presence of negative and destructive themes and types of interpersonal relationships. As predicted, more suicidal adolescents experienced frequent nightmares, which was significant. A higher negative mood at pre-sleep, within dreams, and at post-sleep was also observed. Furthermore, their dreams contained a higher prevalence of destructive themes and failures, as well as self-directed and death-resulting aggressions. Regression analyses indicated that morning mood was most accurately predicted by positive and negative dream mood in the normative adolescents, whereas only negative dream mood appeared to predict subsequent waking affect in suicidal participants. Our results underline the valuable potential of implementing nightmare-reducing therapies in the presence of suicidal adolescents who suffer from frequent nightmares.
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Affiliation(s)
- Emma Desjardins
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; (E.D.); (L.G.); (E.L.); (A.B.)
| | - Lina Gaber
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; (E.D.); (L.G.); (E.L.); (A.B.)
| | - Emily Larkin
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; (E.D.); (L.G.); (E.L.); (A.B.)
| | - Antoine Benoit
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; (E.D.); (L.G.); (E.L.); (A.B.)
| | - Addo Boafo
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada;
| | - Joseph De Koninck
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; (E.D.); (L.G.); (E.L.); (A.B.)
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Godfrey DA, Kaufman EA, Crowell SE. Non-suicidal Self-injury History Moderates the Association Between Maternal Emotional Support and Adolescent Affect During Conflict. Child Psychiatry Hum Dev 2024; 55:415-425. [PMID: 36028639 DOI: 10.1007/s10578-022-01417-5] [Citation(s) in RCA: 1] [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: 08/17/2022] [Indexed: 11/24/2022]
Abstract
Onset of non-suicidal self-injury (NSSI) is most frequent during adolescence. Etiological models indicate that abnormal affective reactivity and regulation within interpersonal contexts is related to heightened NSSI risk. The current study examined the effects of maternal emotional support on adolescent sympathetic nervous system (SNS) activity and observed anger during a conflict discussion among 56 mother-daughter dyads consisting of healthy adolescents and adolescents with a history of self-injury. During the conflict discussion task, maternal emotional support and adolescent anger were coded from behavior, and cardiovascular pre-ejection period was used to index SNS responding. Results demonstrated that maternal emotional support was negatively associated with adolescent anger and SNS activity during the conflict. However, these associations were not significant among adolescents with heightened NSSI history. Maternal emotional support may serve as an interpersonal mechanism for adolescent physiological and behavioral regulation, yet may function differently among adolescents with more frequent NSSI.
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Affiliation(s)
- Donald A Godfrey
- Department of Psychology, University of Houston, 4505 Cullen Blvd, Houston, TX, 77204, USA
| | - Erin A Kaufman
- Department of Psychology, University of Western Ontario, 361 Windermere Road, London, ON, N6A 3K7, Canada.
| | - Sheila E Crowell
- Department of Psychology, University of Utah, 380 S. 1530 E. BEH S. 502, Salt Lake City, UT, 84112, USA
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Fernandes SN, Zuckerman E, Miranda R, Baroni A. When Night Falls Fast: Sleep and Suicidal Behavior Among Adolescents and Young Adults. Psychiatr Clin North Am 2024; 47:273-286. [PMID: 38302212 DOI: 10.1016/j.psc.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.
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Affiliation(s)
- Sara N Fernandes
- New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, Room 1600C, New York, NY 10032, USA
| | - Emily Zuckerman
- Department of Child and Adolescent Psychiatry, NYU Langone Health, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Regina Miranda
- Department of Psychology, Hunter College and The Graduate Center, City University of New York, 695 Park Avenue, Room 611HN, New York, NY 10065, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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Vai B, Calesella F, Lenti C, Fortaner-Uyà L, Caselani E, Fiore P, Breit S, Poletti S, Colombo C, Zanardi R, Benedetti F. Reduced corticolimbic habituation to negative stimuli characterizes bipolar depressed suicide attempters. Psychiatry Res Neuroimaging 2023; 331:111627. [PMID: 36924742 DOI: 10.1016/j.pscychresns.2023.111627] [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: 11/16/2022] [Revised: 02/10/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
Suicide attempts in Bipolar Disorder are characterized by high levels of lethality and impulsivity. Reduced rates of amygdala and cortico-limbic habituation can identify a fMRI phenotype of suicidality in the disorder related to internal over-arousing states. Hence, we investigated if reduced amygdala and whole-brain habituation may differentiate bipolar suicide attempters (SA, n = 17) from non-suicide attempters (nSA, n = 57), and healthy controls (HC, n = 32). Habituation was assessed during a fMRI task including facial expressions of anger and fear and a control condition. Associations with suicidality and current depressive symptomatology were assessed, including machine learning procedure to estimate the potentiality of habituation as biomarker for suicidality. SA showed lower habituation compared to HC and nSA in several cortico-limbic areas, including amygdalae, cingulate and parietal cortex, insula, hippocampus, para-hippocampus, cerebellar vermis, thalamus, and striatum, while nSA displayed intermediate rates between SA and HC. Lower habituation rates in the amygdalae were also associated with higher depressive and suicidal current symptomatology. Machine learning on whole-brain and amygdala habituation differentiated SA vs. nSA with 94% and 69% of accuracy, respectively. Reduced habituation in cortico-limbic system can identify a candidate biomarker for attempting suicide, helping in detecting at-risk bipolar patients, and in developing new therapeutic interventions.
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Affiliation(s)
- Benedetta Vai
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy.
| | - Federico Calesella
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Claudia Lenti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Lidia Fortaner-Uyà
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Elisa Caselani
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Paola Fiore
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sigrid Breit
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern Switzerland
| | - Sara Poletti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Cristina Colombo
- University Vita-Salute San Raffaele, Milano, Italy; Unit of Mood Disorders, IRCCS Ospedale San Raffaele Turro, Milano, Italy
| | - Raffaella Zanardi
- University Vita-Salute San Raffaele, Milano, Italy; Unit of Mood Disorders, IRCCS Ospedale San Raffaele Turro, Milano, Italy
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
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Abstract
Co-occurrence of nonsuicidal self-injury (NSSI) and suicide attempts (SA) might occur because they share common risk factors, or alternatively because one leads to the other. Using search terms salient to NSSI and SA, we screened 555 studies to identify 17 that presented temporal data about NSSI and SA. Much of the evidence indicates that NSSI predates SA, especially among females and individuals with depressive symptoms, or diagnosed with borderline personality disorder or mood disorders. However, in some studies, associated risk factors likely accounted for the effect. Greater NSSI frequency to a threshold increases risk for later SA. Findings suggest that the behaviors have common predisposing factors, but that there is also a potent gateway effect whereby NSSI precedes SA.
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Marraccini ME, Brick LA, O'Neill JC, Weyandt LL, Buchanan AL. Self-Injurious Thoughts and Behaviors Among College Students: A Latent Class Analysis. Arch Suicide Res 2021; 25:731-750. [PMID: 32233913 PMCID: PMC7529881 DOI: 10.1080/13811118.2020.1746942] [Citation(s) in RCA: 6] [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] [Indexed: 01/01/2023]
Abstract
This study explored emerging typologies of self-injurious thoughts and behaviors and how they relate to known psychological and cognitive correlates. Latent class analysis was employed to identify subgroups of college students (n = 626, mean age = 20, 73% female, and 83% White) based on history of self-injurious thoughts and behaviors. Differences among classes were tested to examine their associations with suicidal ideation, fearlessness of death, depression/hopelessness, thwarted belongingness, problems with alcohol or drugs, behavioral inhibition, and emotional control. Results of the latent class analysis supported a 3-class solution, with students classified as being likely to have (1) no history of any self-injurious thoughts and behaviors (78%); (2) a history of all self-injurious thoughts and behaviors (8%); or (3) a history of suicidal ideation, plan, and non-suicidal self-injurious thoughts and behaviors, but not suicide attempt (13%). Findings examining correlates of self-injurious thoughts and behaviors highlight the importance of fearlessness of death for distinguishing suicide attempters from non-attempters. Attention to mental health and suicide prevention initiatives should remain a critical priority across college campuses.
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Mirkovic B, Delvenne V, Robin M, Pham-Scottez A, Corcos M, Speranza M. Borderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation. BMC Psychiatry 2021; 21:393. [PMID: 34372810 PMCID: PMC8351432 DOI: 10.1186/s12888-021-03377-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.
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Affiliation(s)
- Bojan Mirkovic
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, "DevPsy", 94807, Villejuif, France. .,Pôle de psychiatrie de l'enfant et de l'adolescent, Nouvel Hôpital de Navarre, Université de Normandie, Nouvel Hôpital de Navarre, route de Conches, 27000, Évreux, France.
| | - Véronique Delvenne
- grid.412209.c0000 0004 0578 1002Service de Pédopsychiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Marion Robin
- grid.418120.e0000 0001 0626 5681Département de Psychiatrie de l’Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France
| | - Alexandra Pham-Scottez
- grid.414435.30000 0001 2200 9055GHT Paris Psychiatrie et Neurosciences, Centre Hospitalier Sainte Anne, Paris, France
| | - Maurice Corcos
- grid.418120.e0000 0001 0626 5681Département de Psychiatrie de l’Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France
| | - Mario Speranza
- grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, “DevPsy”, 94807 Villejuif, France ,grid.418080.50000 0001 2177 7052Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Centre Hospitalier de Versailles, Versailles, France
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8
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Benton TD, Muhrer E, Jones JD, Lewis J. Dysregulation and Suicide in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:389-399. [PMID: 33743946 DOI: 10.1016/j.chc.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Suicide rates continue to rise among children and adolescents; suicide is the second leading cause of death in the United States. Although research studies have identified factors associated with suicide risks for youths, none distinguishes those who have suicidal ideation from those who most likely will make an attempt or die by suicide. Most studies focus on psychiatric diagnoses associated with suicide risks. Recent studies suggest that cross-cutting symptom profiles may be a stronger predictor of risks for suicide than diagnosis. This article provides an overview of emotional dysregulation as it relates to suicidal ideation, intent, and behaviors for 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 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Eli Muhrer
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Roy B, Dwivedi Y. Modeling endophenotypes of suicidal behavior in animals. Neurosci Biobehav Rev 2021; 128:819-827. [PMID: 33421543 DOI: 10.1016/j.neubiorev.2020.12.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 12/26/2022]
Abstract
Suicide is a major public health concern. One of the common contributors to the increased risk for suicide is the genetic constitution of individuals, which determines certain endophenotypic traits used as quantifiable measure of neurobiological functions. Therefore, a logical deconstruction of the originating endophenotypes associated with suicidal risk could provide a better understanding of this complex disorder. In this regard, non-human animals can be a useful resource to test endophenotypes of suicidal behavior and the neurobiology underlying these endophenotypes. In this review, we have focused on the neurobiological abnormalities, primarily genetic and epigenetic abnormalities, associated with suicidal behavior and the scope of their modeling in animals. This can substantially advance the current understanding of suicidal behavior manifested with certain trait-based endophenotypes and may provide an opportunity to test novel hypotheses as well as aid in the development of treatment opportunities and risk assessment.
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Affiliation(s)
- Bhaskar Roy
- Department of Psychiatry and Behavioral Neurobiology, 1720 7(th) Avenue South, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, 1720 7(th) Avenue South, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
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10
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Abstract
Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.
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11
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Grattan RE, Tryon VL, Carter CS, Niendam TA. Suicide behavior is associated with childhood emotion dysregulation but not trait impulsivity in first episode psychosis. Psychiatry Res 2020; 294:113517. [PMID: 33113453 PMCID: PMC7719600 DOI: 10.1016/j.psychres.2020.113517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022]
Abstract
Historically, research on suicide behavior has not included those experiencing first episode psychosis (FEP), hindering prevention efforts for this population. Emotion dysregulation and impulsivity represent two mechanisms that contribute to suicide, but these have not been examined in FEP. We hypothesize that the combination of trait impulsivity and childhood emotion dysregulation are associated with suicide behavior (SB) and ideation (SI) in those experiencing FEP. Participants were recruited from an Early Psychosis Program (N=80, ages 12-32, 65% male). Clinician ratings of symptoms and history of SI and SB were obtained at baseline. Participants also completed self-report measures of childhood emotion dysregulation and trait impulsivity. Regression analyses examined whether childhood emotion dysregulation and trait impulsivity individually or in combination were associated with SI and SB, and the severity of SI and SB. Childhood emotion dysregulation was significantly associated with a history of SB and its severity, but not SI. Attention impulsivity was associated with the severity of SI. However, other impulsivity types, and interactions were not associated with a history of SI or SB. This suggests childhood emotion dysregulation is a potential target for prevention of SB in FEP, while trait impulsivity may be less important in this effort.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA, USA
| | - Valerie L Tryon
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA, USA
| | - Cameron S Carter
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA, USA
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA, USA.
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12
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May AM, Czyz EK, West BT. Differentiating Adolescent Suicide Attempters and Ideators: A Classification Tree Analysis of Risk Behaviors. J Adolesc Health 2020; 67:837-850. [PMID: 32576482 PMCID: PMC7959206 DOI: 10.1016/j.jadohealth.2020.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Although many youth consider suicide, only a subset act on suicidal thoughts and attempt suicide. The objective of this study was to identify patterns of risk factors that differentiate adolescents who experienced suicidal thoughts from those who attempted suicide. METHODS This study analyzed data from the 2013, 2015, and 2017 National Youth Risk Behavior Surveys. Classification tree analysis was used to identify combinations of health risk behaviors and demographic factors that improved the identification of past-year suicide attempts among adolescents with past-year suicide ideation or planning (overall n = 7,493). RESULTS Forty percent of the past-year ideators attempted suicide in the same period. The best-performing tree included three variables and defined four subgroups. Youth characterized by heroin use and past-year physical fights were at a strikingly high risk of being attempters (78%). Youth who had experienced rape were also likely to be attempters (58%), whereas those who had endorsed none of these three variables were relatively less likely to be attempters (29%). Overall, the tree's classification accuracy was modest (area under the curve = .65). CONCLUSIONS This study advances previous research by identifying notable constellations of risk behaviors that accounted for adolescents' transition from suicidal ideation to behavior. However, even with many health risk behavior variables, a large sample, and a multidimensional analytic approach, the overall classification of suicide attempters among ideators was limited. Implications for future research are discussed.
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Affiliation(s)
- Alexis M May
- Department of Psychology, Wesleyan University, Middletown, Connecticut.
| | - Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Brady T West
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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13
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Kim JH, Choi JY. Influence of childhood trauma and post-traumatic stress symptoms on impulsivity: focusing on differences according to the dimensions of impulsivity. Eur J Psychotraumatol 2020; 11:1796276. [PMID: 33029332 PMCID: PMC7473132 DOI: 10.1080/20008198.2020.1796276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Impulsivity, a trait and multidimensional construct, is associated with a wide range of impulsive behaviours. Although it is well documented that childhood trauma (CT) affects impulsivity, few studies examine whether its effects depend on particular dimensions of impulsivity and the role post-traumatic stress symptoms play in the relationship between childhood trauma and different dimensions of impulsivity. OBJECTIVE This research aims to explore the relationships between CT, PTSD, and impulsivity in a heterogeneous clinical sample. We also sought to examine whether the influence of CT on impulsivity differs across the dimensions of impulsivity. METHOD We investigated the relationships between CT, symptoms of post-traumatic stress disorder (PTSD), and five dimensions of impulsivity using a sample of 162 non-psychotic psychiatric patients without neurocognitive diagnoses. Participants completed the Childhood Trauma Questionnaire (CTQ), Impact of Event Scale - Revised (IES), and the UPPS-P Impulsive Behaviour Scale (UPPS-P). RESULTS The results of structural equation modelling showed that CT is associated with PTSD symptoms, in addition to four of the five dimensions of impulsivity in the UPPS-P:positive urgency, negative urgency, lack of premeditation, and lack of perseverance. The indirect effect of CT through PTSD symptoms was significant only for the two types of urgency. CONCLUSIONS The results of this study suggest that interventions that aim to alleviate impulsive behaviour derived from high urgency should pay particular attention to the presence of CT and PTSD symptoms.
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Affiliation(s)
- Ji Hye Kim
- Department of Psychiatry, Sanggye Paik Hospital, Inje University, Seoul, South Korea
| | - Ji Young Choi
- Department of Child Studies, Inha University, Incheon, South Korea
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14
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Dugré JR, Dumais A, Dellazizzo L, Potvin S. Developmental joint trajectories of anxiety-depressive trait and trait-aggression: implications for co-occurrence of internalizing and externalizing problems. Psychol Med 2020; 50:1338-1347. [PMID: 31172895 DOI: 10.1017/s0033291719001272] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In youth, anxiety-depressive traits (ADT) and trait-aggression (TA) are important risk factors of exhibiting maladaptive behaviors in adulthood (i.e. violence and substance use). However, the developmental co-occurrence of these traits in youth remains unknown. We thus sought to investigate the developmental trajectories of ADT and TA within a data-driven approach. The aim was two-fold: (i) to examine the developmental trajectories of ADT and TA in youth from ages 10 to 16, and (ii) to investigate both childhood predictors and problematic outcomes of the identified joint trajectories. METHOD The sample comprised 1354 children provided from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) Consortium. Group-based trajectory modeling was first employed to identify individual trajectory models of ADT and TA independently (from ages 10 to 16). Then, joint trajectory models were built on the found trajectories. Last, logistic regressions were used to evaluate the childhood characteristics and negative outcomes of the joint trajectory groups. RESULTS Our results showed five trajectory groups with varying levels of ADT and TA. A significant co-occurrence between ADT and TA was found in three of the trajectory groups. Notably, higher levels of childhood psychopathology and more severe/frequent childhood abuse were found in the groups with moderate to high ADT and high TA. The groups with higher ADT and high TA were also more likely to exhibit violence and substance use. CONCLUSIONS This study exposes the importance of assessing ADT and TA simultaneously and early in childhood to prevent and manage the risk of problematic behaviors in adolescence.
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Affiliation(s)
- Jules R Dugré
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Alexandre Dumais
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
- Institut National de Psychiatrie Légal Philippe-Pinel, Montreal, Canada
| | - Laura Dellazizzo
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
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15
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Kovacs M, George CJ. Maladaptive mood repair predicts suicidal behaviors among young adults with depression histories. J Affect Disord 2020; 265:558-566. [PMID: 31787418 PMCID: PMC7042083 DOI: 10.1016/j.jad.2019.11.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND As the rates of suicidal behaviors continue to rise, research is needed that can facilitate prevention. The present study therefore examined whether a modifiable process, dysfunctional regulation of sadness (maladaptive mood repair), predicts a range of suicidal behaviors and if its impact is affected by risk and protective factors. METHODS Young adults with histories of childhood-onset mood disorder (COMD) (n = 173) or no histories of major psychiatric illness (controls, n = 96) were followed for approximately 3 years. Self-rated questionnaires and psychiatric evaluations were administered at study entry (T1) and across the follow-up (T2) and clinicians assessed the DSM-range of non-fatal suicidal behaviors. We hypothesized that the impact of depression on suicidal behaviors was mediated by dysfunctional regulation of sadness. RESULTS At T1, 90% of the COMD group had histories of various suicidal behaviors; 63% had past suicide attempts. During follow-up, 40% exhibited suicidal behaviors; 7% reported suicide attempts. Controlling for prior suicidal behaviors, T1 maladaptive mood repair predicted suicidal behavior during the follow-up and differentiated recurrent thoughts of death from other forms of suicidality. Protective and risk factors lost their predictive power in the presence of maladaptive mood repair. LIMITATIONS Few control cases exhibited suicidal behavior during the follow-up and the high inter-correlations among several key variables constrained the models that could be fitted. CONCLUSIONS Programs to prevent suicidal behavior among high-risk individuals should include maladaptive mood repair as an intervention target. Further research is needed on whether recurrent thoughts of death constitute a valid index of suicidality.
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Affiliation(s)
- Maria Kovacs
- Department of Psychiatry, University of Pittsburgh, School of MedicineWPIC, 3811 O'Hara Street, Pittsburgh PA 15213, United States.
| | - Charles J George
- University of Pittsburgh Medical Center, Pittsburgh PA, United States
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16
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Kearns JC, Coppersmith DDL, Santee AC, Insel C, Pigeon WR, Glenn CR. Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment. Gen Hosp Psychiatry 2020; 63:141-151. [PMID: 30301558 DOI: 10.1016/j.genhosppsych.2018.09.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sleep problems are transdiagnostic symptoms that confer significant risk for suicidal thoughts and behaviors (STBs) in adults. However, less is known about the sleep-STB association in adolescence-a developmental period when rates of STBs increase drastically, and sleep problems may be particularly pernicious. This article provides a systematic review of research on the sleep-STB association in youth, an overview of changes in sleep regulation during adolescence that may make sleep problems particularly detrimental for youth, and a discussion of the clinical implications of the sleep-STB association for hospitalized youth. METHOD The systematic review included all longitudinal studies in which sleep problems were examined as prospective predictors of STBs in adolescents (aged 10-24 years). The search was conducted on December 1, 2017 using PsychINFO, PubMed, and Web of Science databases. RESULTS Ten studies qualified for inclusion in this review. Of these, seven studies found at least one type of sleep problem significantly predicted a STB outcome. CONCLUSIONS Although findings are mixed, growing research suggests that sleep problems may be a unique risk factor for STBs in youth. Sleep problems may be particularly important intervention target because they are easily assessed across healthcare settings and are amenable to treatment.
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Affiliation(s)
- Jaclyn C Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | | | - Angela C Santee
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Catherine Insel
- Department of Psychology, Harvard University, Cambridge, MA, USA; Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - Wilfred R Pigeon
- VISN 2 Center for Excellence at Canandaigua VA Medical Center, Canandaigua, NY, USA; Sleep and Neurophysiology Research Lab, Department of Psychiatry, University of Rochester Medical Center Rochester, NY, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Catherine R Glenn
- Department of Psychology, University of Rochester, Rochester, NY, USA.
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17
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Raudales AM, Short NA, Schmidt NB. Emotion Dysregulation as a Prospective Predictor of Suicidal Ideation in an at-Risk Mixed Clinical Sample. Arch Suicide Res 2020; 24:S310-S322. [PMID: 30955483 DOI: 10.1080/13811118.2019.1598526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current study tested whether emotion dysregulation predicts suicidal ideation over the course of 6 months. Community members (N = 298) with elevated suicide risk completed a clinical interview and self-report questionnaires at baseline and month-6 follow-up appointments. Elevated general emotion dysregulation but not subscales significantly predicted increases in suicidal ideation at month-6 follow-up after accounting for initial suicidal ideation, treatment condition, and negative affectivity. Furthermore, general emotion dysregulation as well as lack of awareness and lack of clarity subscales were significantly associated with prior suicide attempts at baseline after accounting for negative affectivity. Findings support the establishment of emotion dysregulation as a risk factor for suicidal ideation and provide evidence for a role in suicide attempts. Findings call for the development of interventions targeting emotion dysregulation in effectively predicting and preventing suicidality.
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18
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Hemming L, Bhatti P, Shaw J, Haddock G, Pratt D. Words Don't Come Easy: How Male Prisoners' Difficulties Identifying and Discussing Feelings Relate to Suicide and Violence. Front Psychiatry 2020; 11:581390. [PMID: 33362602 PMCID: PMC7758448 DOI: 10.3389/fpsyt.2020.581390] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
Suicide and violence are prevalent within male prisons in the UK. It has been suggested that alexithymia may be associated with both suicide and violence. Alexithymia can be defined as an inability to identify or discuss emotions. The present study aimed to qualitatively explore male prisoners' experiences of alexithymia and how these experiences may relate to suicide and violence. Fifteen male prisoners were recruited from two prisons in the North West of England. All participants had experienced suicidal and/or violent thoughts and/or behaviors in the past 3 months, and all screened positive on an established measure of alexithymia. Participants took part in a qualitative interview during which they were also given the opportunity to provide drawings of their emotions. Data were transcribed and analyzed using thematic analysis, with a collaborative approach taken between researchers and an individual with lived experience of residing in prison. The results indicated that male prisoners tended not to talk about their emotions with others, due to external pressures of residing in prison in addition to internal difficulties with recognizing and articulating emotions. Not discussing emotions with others was associated with a build-up of emotions which could result in either an emotional overload or an absence of emotions. Both experiences were perceived to be associated with hurting self or others, however, participants also identified a "safety valve" where it was acknowledged that using more adaptive approaches to releasing emotions could prevent harm to self and others. These findings suggest three main clinical implications; (1) a cultural shift in male prisons is needed which encourages open communication of emotions (2) individualized support is needed for those identified as experiencing a difficulty in recognizing and articulating emotions and (3) prison staff should encourage alternative ways of releasing emotions such as by using harm minimization or distraction techniques.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Peer Bhatti
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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19
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Fitzpatrick S, Zeifman R, Krantz L, McMain S, Kuo JR. Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder. Arch Suicide Res 2020; 24:102-123. [PMID: 30856367 DOI: 10.1080/13811118.2019.1586605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to examine which specific emotion processes influence self-inflicted injury: basal respiratory sinus arrhythmia, baseline negative emotional intensity, emotional reactivity, or emotion regulation deficits. Self-injuring individuals with borderline personality disorder (N = 22) reported their lifetime self-injury frequency. Basal respiratory sinus arrhythmia and baseline skin conductance responses measurements were collected. Participants then either reacted as they usually would (i.e., emotional reactivity), or utilized mindfulness- or distraction-based strategies (i.e., emotion regulation), in response to negative images while self-reported negative emotion and skin conductance were monitored. Higher basal respiratory sinus arrhythmia and baseline emotional intensity predicted higher lifetime self-injury frequency. Chronic, resting emotion processes may be more important targets for reducing self-injury compared to labile, acute emotion processes.
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20
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Hoyos C, Mancini V, Furlong Y, Medford N, Critchley H, Chen W. The role of dissociation and abuse among adolescents who self-harm. Aust N Z J Psychiatry 2019; 53:989-999. [PMID: 31146573 DOI: 10.1177/0004867419851869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Retrospective recall of dissociative symptoms has been found to mediate the association between childhood abuse and deliberate self-harm (DSH) in later life. To disentangle the effect of recall bias, we tested whether dissociation symptoms ascertained during an acute DSH presentation mediates this link. METHOD All participants with DSH were recruited during emergency presentation. Seventy-one individuals aged 11-17 years with overdose (OD) and/or self-injury (SI) participated in semi-structured interviews and psychiatric assessment to measure abuse and dissociation. An age- and gender-matched comparison group of 42 non-psychiatric patients admitted to the same service were also assessed. RESULTS The DSH groups reported significantly higher levels of abuse and dissociation compared to comparison group. Dissociation significantly mediated the association between abuse and DSH. Of the four dissociation subtypes, 'depersonalisation' was the primary mediator. Adolescents with chronic patterns of DSH and the 'OD + SI' self-harm type reported more severe dissociation. CONCLUSION Exposure to abuse significantly increased the risk of DSH in adolescence. This association was mediated by dissociation. Our findings suggest a possible dose-response relationship between dissociation with DSH chronicity and the 'OD + SI' self-harm type, implicating the importance of evaluating dissociation and depersonalisation symptoms as well as abuse exposure in DSH management.
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Affiliation(s)
- Carlos Hoyos
- Child and Adolescent Psychiatry, Solent NHS Trust, Southampton, UK
| | - Vincent Mancini
- Complex Attention and Hyperactivity Disorders Service (CAHDS), Department of Health, Perth, WA, Australia.,Discipline of Psychological Science, The Australian College of Applied Psychology, Sydney, NSW, Australia
| | - Yulia Furlong
- Paediatric Consultation Liaison Service, Perth Children's Hospital, Department of Health, Perth, WA, Australia
| | - Nick Medford
- Lishman Neuropsychiatry Unit, Maudsley & Bethlem Royal Hospitals, London, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Hugo Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - Wai Chen
- Complex Attention and Hyperactivity Disorders Service (CAHDS), Department of Health, Perth, WA, Australia.,Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia
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21
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Streeb N, Shoji K, Benight CC. The Capability for Suicide in Firefighters. Suicide Life Threat Behav 2019; 49:980-995. [PMID: 30079535 DOI: 10.1111/sltb.12500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Suicide among firefighters is a critical mental health concern that remains under studied. The interpersonal-psychological theory of suicidal behavior (IPTS) states that, to engage in lethal suicidal behaviors, an individual must possess thwarted belongingness, perceived burdensomeness, and fearlessness about death (IPTS factors). Social cognitive theory may assist IPTS in explaining suicidal behavior. METHOD Participants for the study were 216 volunteers and career firefighters. The sample was almost exclusively male, non-Hispanic or Latino, and Caucasian with a mean age of 40.6. We examined the mediating effect of firefighter coping self-efficacy (FFCSE) and coping self-efficacy for trauma (CSE-T) in the relationship between critical incidents and the IPTS factors. Moderated mediation analyses were performed with separate conditional effects of each social support subscale on the indirect effect of each self-efficacy perception in the relationship between critical incidents and the IPTS factors. RESULTS Mediation analysis indicated that FFCSE did not mediate the relationships; however, CSE-T did mediate the relationships between critical incidents and the IPTS factors. These significant indirect effects of CSE-T were moderated by social support from significant other. CONCLUSIONS CSE-T within the context of significant other support is important to consider in understanding firefighter mental health.
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Affiliation(s)
- Nicole Streeb
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kotaro Shoji
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
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22
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Hemming L, Taylor P, Haddock G, Shaw J, Pratt D. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord 2019; 254:34-48. [PMID: 31103905 PMCID: PMC6599888 DOI: 10.1016/j.jad.2019.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alexithymia reflects a difficulty with identifying and expressing emotions. This experience has been proposed as having an association with suicide ideation and behaviour. This review aimed to synthesise the evidence to establish the bivariate and multivariate relationships between alexithymia, and its subcomponents, with suicide ideation and behaviour. METHODS Search terms related to alexithymia and suicide ideation and behaviour were searched across nine prominent databases in May 2018. Studies were eligible for inclusion if they reported original empirical quantitative findings from adult samples, used a validated measure of alexithymia, and any measure of suicide ideation or behaviour. RESULTS Thirty-four studies were eligible for inclusion in this review. The review found a large effect size for the relationship between alexithymia and suicide ideation (r = 0.54, 95% CI= 0.40-0.65) and a small effect size for the relationship between alexithymia and suicide behaviour (r = 0.25, 95% CI = 0.16-0.34). LIMITATIONS A high level of heterogeneity was found in the meta-analysis meaning that results should be interpreted with caution. CONCLUSION A positive association was found between alexithymia and suicide ideation and, to a lesser extent, behaviour across a range of clinical and general population samples. This review has potentially important clinical implications, and promotes the need for suicide prevention to focus on emotion regulation skills.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Peter Taylor
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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23
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Brausch AM, Woods SE. Emotion Regulation Deficits and Nonsuicidal Self-Injury Prospectively Predict Suicide Ideation in Adolescents. Suicide Life Threat Behav 2019; 49:868-880. [PMID: 29900570 PMCID: PMC6294703 DOI: 10.1111/sltb.12478] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between emotion regulation deficits and nonsuicidal self-injury (NSSI) is well established. Many studies have documented the strong relationship between NSSI and suicidal thoughts and behaviors. The relationship between emotion regulation deficits and suicide is less understood, but recent studies indicate a moderate association. This study aimed to examine the relationship between emotion regulation deficits, NSSI behavior, and suicide ideation in an unselected community sample of adolescents. It was expected that NSSI history would moderate the relationship between emotion regulation and future suicide ideation. METHODS Data were collected from 367 unselected, community adolescents (mean age = 13). Self-report questionnaires assessed NSSI behavior, emotion regulation deficits, and suicide ideation at two time points, 6 months apart. RESULTS After controlling for suicide ideation at baseline, emotion regulation deficits (experiential avoidance and interoceptive deficits) significantly predicted suicide ideation severity at follow-up, and interactions with NSSI engagement showed support for moderation. CONCLUSIONS Results of this study provide insight into the mechanisms of these relationships and have significant clinical implications for the identification of adolescents at risk for suicide behaviors.
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Affiliation(s)
- Amy M. Brausch
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd., Bowling Green, KY, 42101
| | - Sherry E. Woods
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd., Bowling Green, KY, 42101,Department of Psychological and Brain Sciences, University of Massachusetts Amherst, 441 Tobin Hall, Amherst, MA, 01003
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24
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Yang X, Daches S, George CJ, Kiss E, Kapornai K, Baji I, Kovacs M. Autonomic correlates of lifetime suicidal thoughts and behaviors among adolescents with a history of depression. Psychophysiology 2019; 56:e13378. [PMID: 31002191 DOI: 10.1111/psyp.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 12/23/2022]
Abstract
Suicidal thoughts and behaviors (STBs) have been associated with emotion dysregulation and atypical responses to affective and stressful stimuli. To investigate the psychophysiology involved, we measured changes in respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP; indexing parasympathetic and sympathetic functioning, respectively) in response to stressful- and sadness-eliciting laboratory probes. Our sample included adolescents with a history of depression and STBs (n = 177), adolescents with a history of depression but no history of STBs (n = 47), and healthy controls (n = 175). The outcome of interest was the most severe form of clinician-rated STBs across the subject's lifetime. In partial support of our hypotheses, during the stressful task, adolescents with a history of depression and STBs did not evidence the RSA decrease that was exhibited by controls and displayed greater PEP shortening compared to ever-depressed adolescents with no lifetime STBs. No group differences were found in either RSA or PEP reactivity to the sadness-eliciting stimulus. As expected, severity of STBs was positively correlated with the extent of PEP shortening during the stressful task. The results suggest that adolescents with a history of depression and STBs experience blunted parasympathetic responses to stress along with compensatory efforts. Our findings contribute to a better understanding of STBs among youths and underscore that future studies should examine physiological risk factors for these psychopathological outcomes.
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Affiliation(s)
- Xiao Yang
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shimrit Daches
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Charles J George
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Enikő Kiss
- Department of Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Krisztina Kapornai
- Department of Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Ildikó Baji
- Department of Child and Adolescent Psychiatry, University of Szeged, Szeged, Hungary
| | - Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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25
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Marraccini ME, Brick LA, Weyandt LL, Francis A, Clarkin C, Fang Y. Effects of self-injurious thoughts and behaviors and sexual risk-taking behaviors through emotional control. J Affect Disord 2019; 249:183-191. [PMID: 30772746 DOI: 10.1016/j.jad.2019.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/02/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND College students are at increased risk for self-injurious thoughts and behaviors (SITB) and sexual risk behaviors (SRB). Although students with a history of SITB appear to be more prone to SRB, the mechanisms linking these risk behaviors remain largely unexplored. Previous research points to emotional control (EC), defined as one's awareness and adaptability of emotions, as a potential mechanism explaining the relationship between SITB and SRB.1 METHODS: Data included 722 college students attending two different universities in the northeast and southeast regions of the United States. Multiple group structural equation models were fit to estimate the direct and indirect effects of history of SITB (suicidal ideation, attempt, and nonsuicidal self-injury) and EC on SRB jointly across men and women. RESULTS Findings supported indirect relationships between SITB and SRB through dysregulated EC, with type of SITB and patterns of SRB differing between men and women. For women, history of suicidal ideation and nonsuicidal self-injury were indirectly related to increased SRB through dysregulated EC. For men, history of suicidal ideation showed an indirect relationship on SRB through EC. LIMITATIONS Although this study employed random sampling, limitations include a cross-sectional design, which does not allow for causal inference, and reliance on self-report assessment data. CONCLUSIONS College students with a history of SITB who experience dysregulated EC may be more likely to engage in risky sexual behavior. Clinicians working with college students should concomitantly consider suicide and self-injury with SRB and consider interventions to improve EC.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, 105H Peabody Hall, CB# 3500, 100 E. Cameron Ave., Chapel Hill, NC 27599, USA.
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Campus Box G-BH, 700 Butler Drive, Providence, RI 02906-7724, USA.
| | - Lisa L Weyandt
- Department of Psychology, Interdisciplinary Neuroscience Program, Chafee Social Science Center, URI, 142 Flagg Rd, Kingston, RI 02881, USA.
| | - Alyssa Francis
- Department of Psychology, Chafee Social Science Center, URI, 142 Flagg Rd, Kingston, RI 02881, USA.
| | - Christine Clarkin
- Graduate School, Interdisciplinary Neuroscience Program, Quinn Hall, 55 Lower College Road, University of Rhode Island, Kingston, RI 02881, USA.
| | - Yumeng Fang
- School of Education, University of North Carolina at Chapel Hill, 105H Peabody Hall, CB# 3500, 100 E. Cameron Ave., Chapel Hill, NC 27599, USA.
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26
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Relationships Between Components of Emotional Intelligence and Suicidal Behavior in Alcohol-dependent Patients. J Addict Med 2019; 12:24-30. [PMID: 28901998 DOI: 10.1097/adm.0000000000000358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The importance of investigating various emotional skills in assessment of suicide risk in alcohol-dependent (AD) individuals has recently become the focus of increasing interest. The objective of this study was to explore the relationships between self-reported components of emotional intelligence and lifetime prevalence of suicide attempts in a clinical sample of AD subjects. METHODS A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland, was recruited. Baseline information about demographics, psychopathological symptoms, personality, and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence Test was utilized for assessment of emotional processing. Lifetime history of suicide attempts was obtained from the MINI International Neuropsychiatric Interview. RESULTS After accounting for affect-related suicide risk factors (severity of depression, anxiety, neuroticism), and also other significant predictors (eg, age, sex, history of childhood abuse), mood regulation/optimism deficits remained a significant correlate of lifetime suicide attempts in AD patients. In the mediation models, mood regulation appeared to fully mediate the relationship between history of suicide attempts and depression, and also neuroticism. CONCLUSIONS The results of this study support the evidence that poor mood regulation might be related to the risk for suicidal behavior in AD individuals. These findings point towards the significance of addressing the issue of emotion-related skills in the therapy of those AD subjects who are at risk for suicide.
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Peters JR, Mereish EH, Solomon JB, Spirito AS, Yen S. Suicide Ideation in Adolescents Following Inpatient Hospitalization: Examination of Intensity and Lability Over 6 Months. Suicide Life Threat Behav 2019; 49:572-585. [PMID: 29577366 PMCID: PMC6157009 DOI: 10.1111/sltb.12448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/12/2018] [Indexed: 11/27/2022]
Abstract
Understanding suicide ideation (SI) in adolescents, especially during the high-risk time following hospitalization for a suicidal event, is a crucial component of improving risk assessment. Most studies rely on single assessments of SI, despite the potential for SI to vary considerably over time. This study examined how indices of SI intensity (mean values) and lability (mean squared successive difference values) over a 6-month period predict suicide attempts (SAs) and self-harm, as well as how they relate to psychosocial risk factors and affective functioning, in a sample of 103 adolescents hospitalized for a SA or significant SI. Across the sample, SI intensity, but not lability, was associated with SAs and nonsuicidal self-injury at 6-month follow-up. SI intensity performed similarly to single time point SI assessments, and its relations were not moderated by SI lability. SI intensity was also associated with borderline personality disorder criteria and a history of sexual abuse. In contrast, SI lability was associated with greater negative affect intensity and lability. These findings suggest that intensity of SI may confer more risk posthospitalization, and provide support for using these statistical methods to capture two distinct parameters of SI.
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Affiliation(s)
- Jessica R. Peters
- Alpert Medical School of Brown University,Rhode Island Hospital,Corresponding Author: Alpert Medical School of Brown University, Box G-BH, Providence, RI 02906,
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28
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Knorr AC, Ammerman BA, Hamilton AJ, McCloskey MS. Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury. Psychiatry Res 2019; 273:514-522. [PMID: 30708203 DOI: 10.1016/j.psychres.2019.01.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 12/01/2022]
Abstract
Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.
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Affiliation(s)
- Anne C Knorr
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Brooke A Ammerman
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Alexander J Hamilton
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
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Preliminary examination of gray and white matter structure and longitudinal structural changes in frontal systems associated with future suicide attempts in adolescents and young adults with mood disorders. J Affect Disord 2019; 245:1139-1148. [PMID: 30699858 PMCID: PMC6487887 DOI: 10.1016/j.jad.2018.11.097] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mood disorders are major risk factors for suicidal behavior. While cross-sectional studies implicate frontal systems, data to aid prediction of suicide-related behavior in mood disorders are limited. Longitudinal research on neuroanatomical mechanisms underlying suicide risk may assist in developing targeted interventions. Therefore, we conducted a preliminary study investigating baseline gray and white matter structure and longitudinal structural changes associated with future suicide attempts. METHODS High-resolution structural magnetic resonance imaging, diffusion tensor imaging, and suicide-related behavioral assessment data for 46 adolescents and young adults with mood disorders [baseline agemean = 18 years; 61% female] were collected at baseline and at follow-up (intervalmean = 3 years). Differences in baseline and longitudinal changes in gray matter volume and white matter fractional anisotropy in frontal systems that distinguished the participants who made future attempts from those who did not were investigated. RESULTS Seventeen (37%) of participants attempted suicide within the follow-up period. Future attempters (those attempting suicide between their baseline and follow-up assessment), compared to those who did not, showed lower baseline ventral and rostral prefrontal gray matter volume and dorsomedial frontal, anterior limb of the internal capsule, and dorsal cingulum fractional anisotropy, as well as greater decreases over time in ventral and dorsal frontal fractional anisotropy (p < 0.005, uncorrected). LIMITATIONS Sample size was modest. CONCLUSIONS Results suggest abnormalities of gray and white matter in frontal systems and differences in developmental changes of frontal white matter may increase risk of suicide-related behavior in youths with mood disorders. Findings provide potential new leads for early intervention and prevention strategies.
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Aiken CS, Wagner BM, Benjamin Hinnant J. Observed Interactions in Families of Adolescent Suicide Attempters. Suicide Life Threat Behav 2019; 49:104-119. [PMID: 29194697 DOI: 10.1111/sltb.12423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
Family interactions of 71 adolescents hospitalized following a suicide attempt were compared with those of 29 psychiatric controls, using observational methods and a 2-year prospective, longitudinal design. Parent-adolescent dyadic interactions were coded for emotional validation and invalidation, and problem-solving constructiveness. There were no between-group differences for parents. However, adolescents who had attempted suicide displayed more emotional invalidation than controls. Within the suicide attempt group, maternal constructive problem solving predicted greater declines in youth suicide ideation, and a similar trend was observed for fathers. Adolescents who displayed more unconstructive problem solving with fathers were more likely to reattempt suicide during the follow up.
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Affiliation(s)
- Christine S Aiken
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Barry M Wagner
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - J Benjamin Hinnant
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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Ramsey J, Martin EC, Purcell OM, Lee KM, MacLean AG. Self-injurious behaviours in rhesus macaques: Potential glial mechanisms. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:1008-1017. [PMID: 30450801 PMCID: PMC6385863 DOI: 10.1111/jir.12558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2018] [Accepted: 09/28/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) can be classified as intentional, direct injuring of body tissue usually without suicidal intent. In its non-suicidal form it is commonly seen as a clinical sign of borderline personality disorder, autism, PTSD, depression, and anxiety affecting a wide range of ages and conditions. In rhesus macaques SIB is most commonly manifested through hair plucking, self-biting, self-hitting, and head banging. SIB in the form of self-biting is observed in approximately 5-15% of individually housed monkeys. Recently, glial cells are becoming recognised as key players in regulating behaviours. METHOD The goal of this study was to determine the role of glial activation, including astrocytes, in macaques that had displayed SIB. To this end, we performed immunohistochemistry and next generation sequence of brain tissues from rhesus macaques with SIB. RESULTS Our studies showed increased vimentin, but not nestin, expression on astrocytes of macaques displaying SIB. Initial RNA Seq analyses indicate activation of pathways involved in tissue remodelling, neuroinflammation and cAMP signalling. CONCLUSIONS Glia are most probably activated in primates with self-injury, and are therefore potential novel targets for therapeutics.
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Affiliation(s)
- Joseph Ramsey
- Tulane Program in Neuroscience, Tulane University, New Orleans, LA 70112
| | - Elizabeth C. Martin
- Center for Stem Cell Research and Regenerative Medicine, School of Medicine, Tulane University, New Orleans, LA 70112
| | - Olivia M. Purcell
- Tulane Program in Neuroscience, Tulane University, New Orleans, LA 70112
| | - Kim M. Lee
- Tulane National Primate Research Center, Covington, LA 70433
- Tulane Program in Biomedical Science, Tulane Medical School, New Orleans, LA 70112
| | - Andrew G. MacLean
- Tulane Program in Neuroscience, Tulane University, New Orleans, LA 70112
- Tulane National Primate Research Center, Covington, LA 70433
- Tulane Program in Biomedical Science, Tulane Medical School, New Orleans, LA 70112
- Department of Microbiology & Immunology, Tulane Medical School, New Orleans, LA 70112
- Tulane Center for Aging, Tulane University New Orleans, LA 70112
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Morley KC, Sitharthan G, Haber PS, Tucker P, Sitharthan T. Characteristics of Suicide Attempters and Ideators in a Clinical Sample of Substance Users. Subst Use Misuse 2018; 53:1811-1818. [PMID: 29419353 DOI: 10.1080/10826084.2018.1435075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is little research to distinguish those who attempt suicide and those who only consider suicide, and the role that substance use plays in this progression. We aim to describe clinical correlates of suicide attempters versus ideators in substance users. We examined characteristics of substance users (N = 185) that had either a suicide attempt within the last 6 months (n = 94) or were suicide ideators (n = 91). Suicide attempters displayed significant different clinical profiles to that of non-attemptors. Relative to ideators, attempters had greater scores on impulsivity, the brief psychiatric scale and more likely to be female and a recent psychostimulant user. Logistic regression revealed that male gender was associated with a decreased odds of a previous suicide attempt (OR = 0.37, p < 0.05) and greater impulsivity scores were associated with increased odds of an attempt (OR = 1.15, p < 0.05), although entering interaction terms diminished the role of impulsivity and revealed a significant interaction of alcohol use x depression. While impulsivity was a significant predictor of suicide attempt relative to depression or alcohol use alone, this reduced when considering interactions between psychological characteristics and substance use, whereby the effect of alcohol use on the likelihood of a recent suicide attempt varied at different levels of depression.
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Affiliation(s)
- Kirsten C Morley
- a NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine , The University of Sydney , New South Wales , Australia
| | - Gomathi Sitharthan
- b Health Sciences , The University of Sydney , New South Wales , Australia
| | - Paul S Haber
- a NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine , The University of Sydney , New South Wales , Australia.,c Drug Health Services, Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia
| | - Peter Tucker
- d Department of Psychiatry, Sydney Medical School , The University of Sydney , New South Wales , Australia
| | - Thiagarajan Sitharthan
- d Department of Psychiatry, Sydney Medical School , The University of Sydney , New South Wales , Australia
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Bryan CJ, Wood DS, May A, Peterson AL, Wertenberger E, Rudd MD. Mechanisms of Action Contributing to Reductions in Suicide Attempts Following Brief Cognitive Behavioral Therapy for Military Personnel: A Test of the Interpersonal-Psychological Theory of Suicide. Arch Suicide Res 2018; 22:241-253. [PMID: 28422576 DOI: 10.1080/13811118.2017.1319313] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Brief cognitive behavioral therapy (BCBT) is associated with significant reductions in suicide attempts among military personnel. However, the underlying mechanisms of action contributing to reductions in suicide attempts in effective psychological treatments remain largely unknown. The present study conducted a secondary analysis of a randomized controlled trial of BCBT versus treatment as usual (TAU) to examine the mechanisms of action hypothesized by the interpersonal-psychological theory of suicide (IPT): perceived burdensomeness, thwarted belongingness, and fearlessness about death. In a sample of 152 active duty U.S. Army personnel with recent suicide ideation or attempts, there were significantly fewer suicide attempts in BCBT, but there were no differences between treatment groups from baseline to 6 months postbaseline on any of the 3 IPT constructs or their interactions. Tests of the moderated mediation failed to support an indirect effect for the IPT model, regardless of which IPT variables were specified as mediators or moderators. Results suggest that the IPT's hypothesized mechanisms of action do not account for reductions in suicide attempts in BCBT. Implications for clinical practice and research are discussed.
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Evaluating the Effectiveness of a Dialectical Behaviour Therapy (DBT) Informed Programme in a Community Perinatal Team. Behav Cogn Psychother 2018; 46:541-553. [DOI: 10.1017/s1352465817000790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background:Adapted DBT programmes have been well documented but little has been published on such programmes in the perinatal period.Aim:To assess the effectiveness of a stand-alone DBT skills group for perinatal women with emotion dysregulation.Method:A stand-alone DBT-informed skills training group was offered to 21 women with emotional dysregulation under the care of a perinatal community mental health team; 14 completed the programme. Staff received support via a consultation group. Modules included mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness adapted to the specific demands of parenting infants. Outcome measures were collected at three time points: assessment, start of the group and at the end.Results:Statistical analysis showed significant reduction in CORE scores over the intervention period (t(13) = 5.32,p< .001; Cohen'sd= 0.83), with similar effects on the Mental Health Confidence Scale (t(13) = ‒8.03,p< .001, Cohen'sd= 0.83) and Living with Emotions Scale (t(13) = ‒9.42,p< .001, Cohen'sd= 0.93). There were no significant changes on these three measures from assessment to start of the group.Conclusions:In this uncontrolled study, the intervention period was associated with reduced distress, increased confidence and ability to regulate emotion. Recommendations for continuing this model of service delivery are made. Further research is needed.
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Evaluation of attempted older adults suicides admitted to a University Hospital Emergency Department: Izmir study. Asian J Psychiatr 2017; 30:196-199. [PMID: 29121560 DOI: 10.1016/j.ajp.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/06/2017] [Accepted: 10/13/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Advanced age is one of the risk factors for attempting suicide. Suicide attempts are one of the reasons for elderly patients to admit emergency services. The aim of this study was to investigate the relationship between suicidal behavior and sociodemographic factors and concurrent somatic diseases. METHODS The medical records of patients aged 60 years and over who presented to the emergency department of our university hospital for attempted suicide between the dates of January 1, 2007 and December 31, 2015 were screened retrospectively. Individuals recorded as cases of suicide on the forensic case report form were identified, the data recorded at our hospital were obtained, and telephone interviews were conducted to acquire any missing data. RESULTS A total of 63 patients with a mean age of 65.88 years were included in the study. A large proportion of the suicide attempts occurred in the years 2014 and 2015. Overall, 23.8% of the patients had a previous history of suicide attempt. Overdose was the method in 74.6% of the suicide attempts, and 70.2% were impulsive; 63.5% of the patients had a history of psychiatric disease. The most common psychopathology was major depressive disorder. CONCLUSION We found that suicide attempts were more common among older adults with a history of depression, that approximately one in four had previously attempted suicide, and that the majority of individuals attempting suicide chose to use their own medication.
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Chesin MS, Galfavy H, Sonmez CC, Wong A, Oquendo MA, Mann JJ, Stanley B. Nonsuicidal Self-Injury Is Predictive of Suicide Attempts Among Individuals with Mood Disorders. Suicide Life Threat Behav 2017; 47:567-579. [PMID: 28211201 PMCID: PMC5724372 DOI: 10.1111/sltb.12331] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/06/2016] [Indexed: 11/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) prior to age 18 was evaluated as a risk factor for adulthood suicide attempt (SA). Archival data from 222 mood-disordered participants were analyzed using multivariate Cox proportional hazards analysis. Participants with a youth SA were excluded. The hazards of SA among adult participants with a history of youth NSSI were twice than those of mood-disordered participants without youth NSSI (hazard ratio = 2.00, 95% confidence interval = 1.16-3.44, p = .01). Moreover, participants who had both youth and adult NSSI attempted suicide significantly earlier than participants who began NSSI as an adult. Youth NSSI is associated with persistent, elevated SA risk in adulthood.
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Affiliation(s)
- Megan S Chesin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Hanga Galfavy
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | | | - Amanda Wong
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Maria A Oquendo
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Barbara Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
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Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res 2017; 21:455-469. [PMID: 27602917 DOI: 10.1080/13811118.2016.1222318] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.
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Johnston JAY, Wang F, Liu J, Blond BN, Wallace A, Liu J, Spencer L, Cox Lippard ET, Purves KL, Landeros-Weisenberger A, Hermes E, Pittman B, Zhang S, King R, Martin A, Oquendo MA, Blumberg HP. Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder. Am J Psychiatry 2017; 174:667-675. [PMID: 28135845 PMCID: PMC5939580 DOI: 10.1176/appi.ajp.2016.15050652] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems. METHOD The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors. RESULTS Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality. CONCLUSIONS Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.
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Affiliation(s)
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Benjamin N. Blond
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Amanda Wallace
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Jiacheng Liu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | | | - Kirstin L. Purves
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Division of Psychology and Language Sciences, University College London, London, UK
| | - Angeli Landeros-Weisenberger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Eric Hermes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Sheng Zhang
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US
| | - Robert King
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Andrés Martin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Maria A. Oquendo
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, US,Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Giromini L, Ales F, de Campora G, Zennaro A, Pignolo C. Developing Age and Gender Adjusted Normative Reference Values for the Difficulties in Emotion Regulation Scale (DERS). JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9611-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Bernert RA, Hom MA, Iwata NG, Joiner TE. Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk. J Clin Psychiatry 2017; 78:e678-e687. [PMID: 28682534 PMCID: PMC6613567 DOI: 10.4088/jcp.16m11193] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/05/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Young adults attempt suicide at disproportionately high rates relative to other groups and demonstrate high rates of sleep disturbance. No study has yet prospectively evaluated disturbed sleep as an acute indicator of risk using an objective index of sleep. We investigated objective and subjective parameters of disturbed sleep as a warning sign of suicidal ideation among young adults over an acute period. METHODS A longitudinal study across a 21-day observation period and 3 time points. Fifty of 4,847 participants (aged 18-23 years) were prescreened from a university undergraduate research pool (February 2007-June 2008) on the basis of suicide attempt history and recent suicidal ideation. Actigraphic and subjective sleep parameters were evaluated as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation), with adjustment for baseline symptoms. Hierarchical regression analyses were employed to predict residual change scores. RESULTS Ninety-six percent of participants (n = 48) endorsed a suicide attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78% (n = 39) and 36% (n = 18) endorsed clinically significant insomnia and nightmares, respectively. When results were controlled for baseline suicidal and depressive symptoms, actigraphic and subjective sleep parameters predicted suicidal ideation residual change scores at 7- and 21-day follow-ups (P < .001). Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation (P < .05). In a test of competing risk factors, sleep variability outperformed depressive symptoms in the longitudinal prediction of suicidal ideation across time points (P < .05). CONCLUSIONS Objectively and subjectively measured sleep disturbances predicted acute suicidal ideation increases in this population, independent of depressed mood. Self-reported insomnia and nightmares and actigraphically assessed sleep variability emerged as acute warning signs of suicidal ideation. These findings highlight the potential utility of sleep as a proposed biomarker of suicide risk and a therapeutic target.
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Affiliation(s)
- Rebecca A. Bernert
- Stanford University School of Medicine, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Naomi G. Iwata
- Stanford University School of Medicine, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL, United States
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McKinney JM, Hirsch JK, Britton PC. PTSD symptoms and suicide risk in veterans: Serial indirect effects via depression and anger. J Affect Disord 2017; 214:100-107. [PMID: 28288403 DOI: 10.1016/j.jad.2017.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/22/2017] [Accepted: 03/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suicide rates are higher in veterans compared to the general population, perhaps due to trauma exposure. Previous literature highlights depressive symptoms and anger as contributors to suicide risk. PTSD symptoms may indirectly affect suicide risk by increasing the severity of such cognitive-emotional factors. METHOD A sample of community dwelling veterans (N=545) completed online surveys, including the PTSD Checklist-Military Version, Suicidal Behaviors Questionnaire-Revised, Multidimensional Health Profile-Psychosocial Functioning, and Differential Emotions Scale -IV. Bivariate and serial mediation analyses were conducted to test for direct and indirect effects of PTSD symptoms on suicide risk. RESULTS In bivariate analyses, PTSD symptoms, depression, anger, and internal hostility were positively related to suicide risk. In serial mediation analyses, there was a significant total effect of PTSD symptoms on suicide risk in both models. PTSD symptoms were also indirectly related to suicidal behavior via depression and internal hostility, and via internal hostility alone. Anger was not a significant mediator. LIMITATION Our cross-sectional sample was predominantly White and male; prospective studies with diverse veterans are needed. DISCUSSION Our findings may have implications for veteran suicide prevention. The effects of PTSD and depression on anger, particularly internal hostility, are related to suicide risk, suggesting a potential mechanism of action for the PTSD-suicide linkage. A multi-faceted therapeutic approach, targeting depression and internal hostility, via cognitive-behavioral techniques such as behavioral activation and cognitive restructuring, may reduce suicide risk in veterans who have experienced trauma.
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Affiliation(s)
- Jessica M McKinney
- Department of Psychology, East Tennessee State University, United States
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, United States.
| | - Peter C Britton
- Center of Excellence, Canandaigua Veterans Administration Medical Center, United States
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Brake CA, Rojas SM, Badour CL, Dutton CE, Feldner MT. Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk. J Anxiety Disord 2017; 47:1-9. [PMID: 28126678 DOI: 10.1016/j.janxdis.2017.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/17/2016] [Accepted: 01/05/2017] [Indexed: 01/04/2023]
Abstract
Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with one's behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.
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Affiliation(s)
- C Alex Brake
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA.
| | - Sasha M Rojas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Christal L Badour
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA
| | - Courtney E Dutton
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Matthew T Feldner
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, 72701, USA; Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74136, USA
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Rogers ML, Joiner TE. Borderline Personality Disorder Diagnostic Criteria as Risk Factors for Suicidal Behavior Through the Lens of the Interpersonal Theory of Suicide. Arch Suicide Res 2016; 20:591-604. [PMID: 26953502 DOI: 10.1080/13811118.2016.1158681] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk.
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44
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Preti A. Suicide among Animals: Clues from Folklore That May Prevent Suicidal Behaviour in Human Beings. Psychol Rep 2016; 97:547-58. [PMID: 16342583 DOI: 10.2466/pr0.97.2.547-558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Knowing the most likely reasons for suicide might increase the chances to identify the early signs of suicide. Folkloric tales on suicide among animals are a possible source of such information, since people probably explain animal suicide using the same reasons they would apply to their kin. Modern naturalistic studies have found little evidence of self-harming conduct among nonhuman species. Nevertheless, mythological accounts often report suicidal behaviour among animals. Claudius Aelian's De natura animalium, a classic in its genre, written in the 2nd century AD, reports 21 cases of suicide among animals. In Aelian's tales, the severing of social ties emerges as an important motive for suicide, together with incest and rage caused by adultery. Paying attention to the mechanisms leading to suicide described in ancient mythology may help us understand unusual and uncommon motives for suicide and the reasons people feel suicidal.
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Abstract
Naturalists have not identified suicide in nonhuman species in field situations, despite intensive study of thousands of animal species. In this review, evidence on suicidal behavior among animals is analyzed to discover analogies with human suicidal behavior. Literature was retrieved by exploring Medline/PubMed and PsychINFO databases (1967–2007) and through manual literature searches. Keyword terms were “suicide or suicidal behavior” and “animal or animal behavior.” Few empirical investigations have been carried out on this topic. Nevertheless, sparse evidence supports some resemblance between the self-endangering behavior observed in the animal kingdom, particularly in animals held in captivity or put under pressure by environmental challenges, and suicidal behavior among humans. Animal models have contributed to the study of both normal and pathological human behaviors: discovering some correlates of suicide among animals could be a valid contribution to the field.
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Affiliation(s)
- Antonio Preti
- Department of Psychology, University of Cagliari, Genneruxi Medical Center, Cagliari
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46
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Abstract
This study examined how previously suicidal adolescents and emerging adults perceived their emotional experiences while being suicidal. Forty-one females and 9 males previously suicidal between the ages of 15 and 24 were interviewed. Qualitative data were analyzed using a grounded theory approach. Three major themes were identified in participants’ perceptions of their emotional experiences: (a) overwhelming despair, (b) shame and self-loathing, and (c) alienation and personal isolation. These emotional states were viewed within the multidimensional process of responding to emotions. Participants’ inability to deal with intense negative emotions appeared to be related to their suicidal state.
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47
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Leung CLK, Kwok SYCL, Ling CCY. An Integrated Model of Suicidal Ideation in Transcultural Populations of Chinese Adolescents. Community Ment Health J 2016; 52:574-81. [PMID: 26308835 DOI: 10.1007/s10597-015-9920-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/10/2015] [Indexed: 11/30/2022]
Abstract
This study tested the model of suicidal ideation, incorporating family and personal factors to predict suicidal ideation with hopelessness as a mediating factor in the Hong Kong sample, to a sample in Shanghai. Using MGSEM, the study aims to investigate the personal correlates and the family correlates of suicidal ideation in Hong Kong and Shanghai adolescents. We integrated the family ecological and diathesis-stress-hopelessness models of suicidal ideation in connecting the correlates. A cross-sectional design was used. The full model achieved metric invariance and partial path-loading invariance. Family functioning and social problem solving negatively predicted hopelessness or suicidal ideation in both the Hong Kong and Shanghai adolescents. The results supported an integrative approach in facilitating parent-adolescent communication and strengthening family functioning, and reducing the use of negative social problem-solving styles in adolescent suicide prevention.
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Affiliation(s)
- Cyrus L K Leung
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Sylvia Y C L Kwok
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon, Hong Kong.
| | - Chloe C Y Ling
- School of Social Sciences, Caritas Institution of Higher Education, New Territories, Hong Kong
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48
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Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology. J Affect Disord 2016; 197:231-8. [PMID: 26995466 DOI: 10.1016/j.jad.2016.03.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/09/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Adolescent risk-taking and self-harm behaviors are associated with affect dysregulation and impulsivity, both core features of borderline personality disorder (BPD). We hypothesized that the developmental courses of these behaviors i) tend to cluster rather than appear individually, and ii) might indicate adolescent BPD pathology. Therefore, we explored the developmental trajectories of self-injurious behavior (SIB), suicidal behavior (SB) and substance misuse (SM) in a community sample of adolescents; and we investigated the trajectories' overlap and its associations with BPD traits. METHOD 513 adolescents, aged 15-17 years, were followed for two years as part of the Saving and Empowering Young Lives in Europe study and its subsequent follow-up. Distinct developmental trajectories were explored using general growth mixture modeling. RESULTS Three distinct classes were identified within each of the harmful behaviors SIB, SB and SM. Both the high-risk SIB trajectory and the high-risk SB trajectory demonstrated elevated initial degree of engagement, followed by a gradual decrease. The SM high-risk trajectory had a medium initial degree of engagement, which increased over time. There was a high degree of overlap (80-90%) among the high-risk trajectories for the three behaviors (SIB, SB and SM), and this overlap was significantly associated with elevated levels of BPD pathology. LIMITATIONS The data collection was based on participants' self-report. CONCLUSION The findings indicate a similar pattern of reduction over time between SIB and SB for the high-risk trajectories, whereas the high-risk trajectories for SM show a pattern of increase over time. The observed symptom shift is associated with borderline personality pathology in adolescents. Therefore these behaviors might represent early indicators of risk supporting potential early detection.
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Bodzy ME, Barreto SJ, Swenson LP, Liguori G, Costea G. Self-Reported Psychopathology, Trauma Symptoms, and Emotion Coping Among Child Suicide Attempters and Ideators: An Exploratory Study of Young Children. Arch Suicide Res 2016; 20:160-75. [PMID: 25751265 DOI: 10.1080/13811118.2015.1004469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined self-reported psychopathology, trauma symptoms, and emotion coping in 7 to 12 year old children with suicidal ideation and attempts. This study compared 70 psychiatric inpatient children with current suicidal ideation to 59 psychiatric inpatient children with recent suicide attempts on measures of depression, anxiety, anger, emotional intelligence, and family/contextual factors. Results revealed greater self-reported anger as well as psychological distress associated with traumatic experiences (dissociation, anger, depression), among children who attempted suicide, in addition to increased reports of special education utilization, when compared to ideators only. These relationships were not affected by age or gender. Overall, the findings suggest self-reports of younger children who attempt suicide share similarities with older children and adolescent attempters, when compared with ideators who do not attempt. Implications for assessment and treatment are discussed.
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50
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Cha CB, Augenstein TM, Frost KH, Gallagher K, D'Angelo EJ, Nock MK. Using Implicit and Explicit Measures to Predict Nonsuicidal Self-Injury Among Adolescent Inpatients. J Am Acad Child Adolesc Psychiatry 2016; 55:62-8. [PMID: 26703911 DOI: 10.1016/j.jaac.2015.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the use of implicit and explicit measures to predict adolescent nonsuicidal self-injury (NSSI) before, during, and after inpatient hospitalization. METHOD Participants were 123 adolescent psychiatric inpatients who completed measures at hospital admission and discharge. The implicit measure (Self-Injury Implicit Association Test [SI-IAT]) and one of the explicit measures pertained to the NSSI method of cutting. Patients were interviewed at multiple time points at which they reported whether they had engaged in NSSI before their hospital stay, during their hospital stay, and within 3 months after discharge. RESULTS At baseline, SI-IAT scores differentiated past-year self-injurers and noninjurers (t121 = 4.02, p < .001, d = 0.73). These SI-IAT effects were stronger among patients who engaged in cutting (versus noncutting NSSI methods). Controlling for NSSI history and prospective risk factors, SI-IAT scores predicted patients' subsequent cutting behavior during their hospital stay (odds ratio (OR) = 8.19, CI = 1.56-42.98, p < .05). Patients' explicit self-report uniquely predicted hospital-based and postdischarge cutting, even after controlling for SI-IAT scores (ORs = 1.82-2.34, CIs = 1.25-3.87, p values <.01). Exploratory analyses revealed that in specific cases in which patients explicitly reported low likelihood of NSSI, SI-IAT scores still predicted hospital-based cutting. CONCLUSION The SI-IAT is an implicit measure that is outcome-specific, a short-term predictor above and beyond NSSI history, and potentially helpful in cases in which patients at risk for NSSI explicitly report that they would not do so in the future. Ultimately, both implicit and explicit measures can help to predict future incidents of cutting among adolescent inpatients.
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Affiliation(s)
| | | | | | | | | | - Matthew K Nock
- Harvard University, Cambridge, MA, Boston Children's Hospital, and the Center on the Developing Child at Harvard University
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