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Schimpf MG, Gershengoren L, Moschenross D, Winston H, Simpson SA. Consultation-Liaison Case Conference: Assessment and Management of a Physician With Thoughts of Suicide. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00062-4. [PMID: 38844207 DOI: 10.1016/j.jaclp.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/19/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in consultation-liaison psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment, peer response programs for healthcare workers, and ethical and clinical considerations in treating colleagues. Consultation-liaison psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.
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Affiliation(s)
| | | | - Darcy Moschenross
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Helena Winston
- Department of Behavioral Health Services, Denver Health, Denver, CO
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health, Denver, CO; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO.
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2
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Levine J, Sher L. Future orientation and suicide. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01688-6. [PMID: 37658918 DOI: 10.1007/s00406-023-01688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Joshua Levine
- Veterans' Administration New York Harbor Healthcare System, 800 Poly Place, Brooklyn, NY, USA.
- Columbia University School of Social Work, New York, NY, USA.
| | - Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Liu J, Ran G, Zhang Q, Li Y, Zhang Q. The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis. J Affect Disord 2023; 328:245-254. [PMID: 36806662 DOI: 10.1016/j.jad.2023.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association. METHODS Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3. RESULTS We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects. LIMITATIONS Use of self-report measures and cross-sectional design. CONCLUSIONS These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.
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Affiliation(s)
- Juncai Liu
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China
| | - Guangming Ran
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China.
| | - Qi Zhang
- College of Preschool and Primary Education, China West Normal University, Nanchong 637002, China
| | - Yinglun Li
- Sichuan Jianmenguan High School, Guangyuan 628317, China
| | - Qiongzhi Zhang
- Department of Psychology, Institute of Education, China West Normal University, Nanchong 637002, China
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4
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Ai H, Duan L, Huang L, Luo Y, Aleman A, Xu P. Dissociated deficits of anticipated and experienced regret in at-risk suicidal individuals. Front Psychiatry 2023; 14:1121194. [PMID: 36970290 PMCID: PMC10034165 DOI: 10.3389/fpsyt.2023.1121194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundsDecision-making deficits have been reported as trans-diagnostic characteristics of vulnerability to suicidal behaviors, independent of co-existing psychiatric disorders. Individuals with suicidal behaviors often regret their decision to attempt suicide and may have impairments in future-oriented processing. However, it is not clear how people with suicidal dispositions use future-oriented cognition and past experience of regret to guide decision-making. Here, we examined the processes of regret anticipation and experience in subclinical youth with and without suicidal ideation during value-based decision-making.MethodsIn total, 80 young adults with suicidal ideation and 79 healthy controls completed a computational counterfactual thinking task and self-reported measures of suicidal behaviors, depression, anxiety, impulsivity, rumination, hopelessness, and childhood maltreatment.ResultsIndividuals with suicidal ideation showed a reduced ability to anticipate regret compared to healthy controls. Specifically, suicidal ideators’ experience of regret/relief was significantly different from that of healthy controls upon obtained outcomes, while their disappointment/pleasure experience was not significantly different from healthy controls.ConclusionThese findings suggest that young adults with suicidal ideation have difficulty predicting the consequences or the future value of their behavior. Individuals with suicidal ideation showed impairments in value comparison and flat affect to retrospective rewards, whereas individuals with high suicidality showed blunted affect to immediate rewards. Identifying the counterfactual decision-making characteristics of at-risk suicidal individuals may help to elucidate measurable markers of suicidal vulnerability and identify future intervention targets.
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Affiliation(s)
- Hui Ai
- Institute of Applied Psychology, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Lian Duan
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
- *Correspondence: Lian Duan, ; Pengfei Xu,
| | - Lin Huang
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
| | - Yuejia Luo
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
- Center for Emotion and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
| | - André Aleman
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
- Section Cognitive Neuroscience, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Pengfei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
- Center for Emotion and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
- *Correspondence: Lian Duan, ; Pengfei Xu,
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5
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Smith LM, Wells TT. Suicidal Ideation and Risky Behavior are Related through Impulsivity and Low Wish to Live. Arch Suicide Res 2022:1-15. [PMID: 35924824 DOI: 10.1080/13811118.2022.2106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Numerous studies have found support for the relationship between suicide and risky behavior. However, few studies have examined factors that may help explain the relationship between suicidal ideation (SI) and risky behavior. This preregistered study examined the relationship between SI and risky behavior and whether there is an indirect relationship through hopelessness, impulsivity, and low wish to live. These factors were selected due to their relationships with both SI and risky behavior. METHODS Participants recruited from Amazon Mechanical Turk completed measures of SI, risky behavior, hopelessness, impulsivity, and wish to live. Consistent with our preregistered methods, we analyzed data from 180 participants with valid data. Indirect effects were evaluated via bootstrapping with 5000 resamples of the a path x b path product. RESULTS Consistent with prior work, we found a significant positive association between SI and frequency of risky behavior (r = .49). We found significant indirect effects of SI on risky behavior through impulsivity and wish to live but not through hopelessness. CONCLUSION SI and risky behavior are associated with each other through impulsivity and wish to live. Though future longitudinal research is needed to determine causality, this has important implications for models of suicidal thoughts and behaviors and their relationship with risky behavior. The potential of future orientation to explain the results is discussed.
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Carpenter RK, Horton JC, Alloway TP. Time Perspective, Working Memory, and Depression in Non-Clinical Samples: Is There a Link? THE JOURNAL OF PSYCHOLOGY 2022; 156:414-434. [PMID: 35737895 DOI: 10.1080/00223980.2022.2078948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Non-clinical depression is a major issue on college campuses, with some surveys estimating that 30% of college students have experienced a major depressive episode. One theoretical framework of depression is Zimbardo and Boyd (1999) time perspective model, which posits that our perspectives on time impact different aspects of life including our emotions, judgments, and decision making. The current study seeks to determine the role of this time perspectives model and a range of cognitive constructs including hope, rumination, and working memory on their influence in depression. Currently enrolled college students and participants not currently enrolled in college completed the Center for Epidemiologic Studies Depression Scale, the Zimbardo Time Perspective Inventory, the Adult Hope Scale, the Rumination Reflection Questionnaire, and the Automated Working Memory Assessment. Linear regression analysis revealed that, for the college students, Rumination and Past Negative scores predicted depressive symptoms. For the non-college students, Rumination, Present Fatalism, Hope Agency and Verbal Working Memory scores predicted depressive symptoms. The current results reiterate the importance of rumination in depression symptomology and that current cognitive depression models and treatments may benefit from including time perspective measures. Further implications of the results are discussed.
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Heisel MJ, Flett GL. The Social Hopelessness Questionnaire (SHQ): Psychometric properties, distress, and suicide ideation in a heterogeneous sample of older adults. J Affect Disord 2022; 299:475-482. [PMID: 34774647 DOI: 10.1016/j.jad.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/29/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Older adults have high rates of suicide, necessitating attention to psychological factors that confer risk for suicide. Hopelessness is significantly associated with psychological despair and suicide risk factors; however, research has been limited by unidimensional treatment of the construct. The purpose of the present study was thus to investigate the psychometric properties of the Social Hopelessness Questionnaire (SHQ; Flett et al., 2021), a 20-item measure of hopelessness in the interpersonal domain, in a heterogeneous sample of older adults. METHODS Ninety adults 65 years of age or older were recruited from community, residential, or healthcare facilities in the context of a validation study of the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006). Participants voluntarily completed the SHQ, a demographics form, and concurrent measures of global hopelessness, depressive symptom severity, suicide ideation, and subjective well-being. RESULTS The SHQ demonstrated strong internal consistency, construct validity by way of significant positive associations with negative psychological factors and negative associations with positive factors, and differentiated older adults recruited from community and mental health settings. It also explained significant variability in depression, suicide ideation, and subjective well-being beyond that accounted for by an age-specific measure of global hopelessness. LIMITATIONS Findings were limited by a small clinical sub-sample, relatively few male participants, cross-sectional analysis, and focus on suicide ideation rather than suicide behavior. CONCLUSION These findings suggest that the SHQ is a reliable and valid measure of an interpersonal form of hopelessness for use with older adults across diverse settings.
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Affiliation(s)
- Marnin J Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London Health Sciences Centre-Victoria Hospital, 800 Commissioners Rd. E., Office #A2-515, London, Ontario N6A-5W9, Canada; Lawson Health Research Institute, Canada; Center for the Study and Prevention of Suicide, University of Rochester Medical Center, United States.
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Mossbridge J, Johnson K, Washburn P, Williams A, Sapiro M. Smartphone Time Machine: Tech-Supported Improvements in Time Perspective and Wellbeing Measures. Front Psychol 2021; 12:744209. [PMID: 34803826 PMCID: PMC8595919 DOI: 10.3389/fpsyg.2021.744209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022] Open
Abstract
Individuals with a balanced time perspective, which includes good thoughts about the past, awareness of present constraints and adaptive planning for a positive future, are more likely to report optimal wellbeing. However, people who have had traumas such as adverse childhood experiences (ACEs) are likely to have less balanced time perspectives and lower overall wellbeing when compared to those with fewer or no ACEs. Time perspective can be improved via time-travel narratives that support people in feeling connected to a wise and loving future version of themselves, an approach that has until now only been provided in counseling contexts. Our team used an iterative inclusive design process to shape a scalable time-travel narrative tool – a responsive and progressive web application called Time Machine. Among other functionalities, Time Machine allowed people to record and listen to messages as if they were from and to their past and future selves. Using pre-planned as well as post-hoc analyses, we analyzed quantitative and qualitative data from 96 paid design partners (participants) who were taken through a 26-day pilot study of the technology. Among other effects, the results revealed: (1) high engagement throughout the design process, (2) improvements in self-reported time perspective and overall wellbeing scores that were greater for those using Time Machine during an optional-use period, (3) twice as much improvement in overall wellbeing scores for design partners with high ACEs (16%) versus low ACEs (8%), and (4) feelings of unconditional love apparently mediating the relationship between scores on time perspective and overall wellbeing measures. We discuss the limitations of these results as well as implications for the future role of spiritually informed scalable time-travel narrative technologies in healthcare and wellness.
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Affiliation(s)
- Julia Mossbridge
- TILT: The Institute for Love and Time, Sebastopol, CA, United States.,University of San Diego, San Diego, CA, United States.,Institute of Noetic Sciences, Petaluma, CA, United States
| | - Khari Johnson
- TILT: The Institute for Love and Time, Sebastopol, CA, United States
| | - Polly Washburn
- TILT: The Institute for Love and Time, Sebastopol, CA, United States
| | - Amber Williams
- TILT: The Institute for Love and Time, Sebastopol, CA, United States
| | - Michael Sapiro
- TILT: The Institute for Love and Time, Sebastopol, CA, United States
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Resilience in adolescence: Prospective Self moderates the association of early life adversity with externalizing problems. J Adolesc 2020; 81:61-72. [PMID: 32361462 DOI: 10.1016/j.adolescence.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Early life adversity (ELA) can result in negative behavioral outcomes, including internalizing and externalizing problems. Evidence suggests that adolescence is a critical developmental period for processing ELA. Identity formation, which is crucial to this developmental period, may moderate the effect between ELA and these problems. One potential moderating variable associated with identity formation is the latent construct Prospective Self, comprised of future-oriented attitudes and behaviors. METHODS Participants are from the first wave of an ongoing longitudinal study designed to characterize behavioral and cognitive correlates of risk behavior trajectories. A community sample of 10th and 12th grade adolescents (N = 2017, 55% female) were recruited from nine public school districts across eight Southeastern Michigan counties in the United States. Data were collected in schools during school hours or after school via self-report, computer-administered surveys. Structural equation modeling was utilized to assess Prospective Self as a latent construct and to evaluate the relationship between ELA, internalizing and externalizing problems, and Prospective Self. RESULTS Preliminary findings indicated a satisfactory fit for the construct Prospective Self. The predicted negative associations between Prospective Self and internalizing and externalizing problems were found and evidence of moderation was observed for externalizing problems, such that the effects of ELA (i.e., childhood maltreatment) on externalizing problems were lower for individuals with higher levels of Prospective Self. CONCLUSIONS These results indicate that Prospective Self may play a role in supporting resilience against externalizing problems associated with ELA among adolescents.
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10
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Wadhwa S, Heisel MJ. Enhancing the Assessment of Resiliency to Suicide Ideation among Older Adults: The Development and Initial Validation of the Reasons for Living-Suicide Resiliency Scale (RFL-SR). Clin Gerontol 2020; 43:61-75. [PMID: 31635560 DOI: 10.1080/07317115.2019.1675840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: To derive a brief late-life suicide resiliency scale from the 69-item Reasons for Living Scale-Older Adult version (RFL-OA).Methods: We conducted a series of secondary analyses of RFL-OA data (N = 204) from a dataset combining: 1. A follow-up assessment of nursing home residents in the Geriatric Suicide Ideation Scale (GSIS) development study; 2. A trial of Interpersonal Psychotherapy (IPT) with suicidal older adults; 3. A longitudinal study of risk and resiliency to late-life suicide ideation. We specifically assessed the distributions of RFL-OA items and their associations with suicide ideation and behavior to create an RFL-Suicide Resiliency subscale (RFL-SR); we then tested the psychometric properties of this measure's items drawn from the larger RFL-OA.Results: Nine RFL-OA items were significantly associated with suicide ideation and history of suicide behavior and were not highly correlated with social desirability. Psychometric analyses supported the internal consistency, test-retest reliability, and construct validity of this scale.Conclusions: The items of the RFL-SR demonstrated strong psychometric properties with older adults in clinical and community settings.Clinical Implications: The RFL-SR may make a useful addition to suicide risk assessment in gerontological research and clinical practice.
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Affiliation(s)
- Sonia Wadhwa
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Marnin J Heisel
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York, USA
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Shahnaz A, Saffer BY, Klonsky ED. Examining Time Perspective Orientation in Suicide Ideation and Suicide Attempts. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2019. [DOI: 10.1521/jscp.2019.38.7.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Time perspective orientation (TPO) refers to the way an individual psychologically and behaviorally connects to temporal concepts of past, present, and future. Previous studies have hypothesized that certain types of time perspectives, such as a negative orientation towards the past, predict negative psychological functioning and outcomes, including suicide risk. The current study examines whether differences in TPOs are linked to suicidal thoughts or suicidal acts using two measures of time perspective. Methods: We recruited a large online U.S.-based sample comprised of three groups: participants with (a) a history of suicide attempts (attempters; n = 107), (b) a history of suicide ideation but no history of attempts (ideators; n = 164), and (c) no history of ideation or attempts (nonsuicidal; n = 194). Results: A Positive Past (d = 0.71) and Negative Past (d = 0.89) orientation yielded large differences between individuals with a history of suicide ideation and nonsuicidal participants, where Positive Past was elevated among nonsuicidal participants and Negative Past among ideators. These differences were not accounted for by depression or anxiety. However, TPO differences between individuals with a history of suicide ideation and individuals with a history of attempts ranged from negligible to small (d range = 0.03—0.33). Discussion: The findings suggest that time perspective may be robustly associated with the development of suicide ideation, but only minimally related to suicide attempts among ideators.
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12
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Mavandadi S, Ingram E, Klaus J, Oslin D. Social Ties and Suicidal Ideation Among Veterans Referred to a Primary Care-Mental Health Integration Program. Psychiatr Serv 2019; 70:824-832. [PMID: 31138058 DOI: 10.1176/appi.ps.201800451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined associations between three indices of social ties (perceived social support, frequency of negative social exchanges, and degree of social integration) and suicidal ideation among veterans referred by their primary care provider for a behavioral health assessment. METHODS The sample included 15,277 veterans who completed a mental health and substance use assessment on referral to a Primary Care-Mental Health Integration (PCMHI) program. Data on sociodemographic factors, mental health and substance use conditions (e.g., depression, anxiety, and substance use), perceived general health, the three indices of social ties, and suicidal ideation were extracted from clinical interviews. RESULTS The mean±SD age of the sample was 51.3±15.9, most (89%) were men, and about half (48%) were white. Most met criteria for at least one mental health or substance use condition on PCMHI assessment, and 39% reported either low- or high-severity suicidal ideation, as measured by the Paykel Suicide Scale. Logistic regression analyses indicated that after adjustment for sociodemographic factors, perceived health, and comorbid mental health and substance use conditions, each of the three social tie indices was uniquely associated with higher odds of reporting suicidal ideation, compared with no ideation. CONCLUSIONS Findings underscore the value of assessing multiple indices of social ties when examining suicidal ideation among high-risk veterans in primary care experiencing behavioral health issues. Incorporating an assessment of the quality of patients' social interactions and level of social integration into routine PCMHI practice has the potential to enhance screening and intervention efforts aimed at reducing suicidal ideation.
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Affiliation(s)
- Shahrzad Mavandadi
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia (Mavandadi, Ingram, Klaus, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Klaus, Oslin)
| | - Erin Ingram
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia (Mavandadi, Ingram, Klaus, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Klaus, Oslin)
| | - Johanna Klaus
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia (Mavandadi, Ingram, Klaus, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Klaus, Oslin)
| | - David Oslin
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia (Mavandadi, Ingram, Klaus, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Klaus, Oslin)
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Chang EC, Lucas AG, Chang OD, Angoff HD, Li M, Duong AH, Huang J, Perera MJ, Sirois FM, Hirsch JK. Relationship between Future Orientation and Pain Severity in Fibromyalgia Patients: Self-Compassion as a Coping Mechanism. SOCIAL WORK 2019; 64:253-258. [PMID: 31143955 DOI: 10.1093/sw/swz013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 11/13/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
The present study examined the relationship between future orientation and fibromyalgia-related pain severity in a sample of 287 adults with fibromyalgia. Specifically, authors examined dimensions of self-compassion (for example, self-kindness, isolation, mindfulness) as possible mechanisms through which future orientation might be associated with pain severity. Results of conducting a multiple mediator test with 10,000 bootstraps indicated that the significant negative association between future orientation and pain severity was mediated through one specific self-compassion dimension, namely, isolation. The article concludes with a discussion of the implications of the present findings for working with fibromyalgia patients, specifically the potential value of social workers working with fibromyalgia patients to build future orientation as a resilience factor to combat pain severity. Also discussed is the value of working with patients to develop a sustainable social support system that can disrupt experiences of social isolation and disconnectedness from others, and which appear to contribute to greater pain severity.
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Affiliation(s)
- Edward C Chang
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor
| | - Abigael G Lucas
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor
| | - Olivia D Chang
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor
| | - Harrison D Angoff
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor
| | - Mingqi Li
- Department of Psychology, DePaul University, Chicago
| | - Ashley H Duong
- Department of Psychology, University of Michigan, Ann Arbor
| | - Judy Huang
- Department of Psychology, University of Michigan, Ann Arbor
| | - Marisa J Perera
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Fuschia M Sirois
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City
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14
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Lucas AG, Chang EC, Morris LE, Angoff HD, Chang OD, Duong AH, Li M, Hirsch JK. Relationship between Hope and Quality of Life in Primary Care Patients: Vitality as a Mechanism. SOCIAL WORK 2019; 64:233-241. [PMID: 31190068 DOI: 10.1093/sw/swz014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/05/2018] [Accepted: 07/31/2018] [Indexed: 06/09/2023]
Abstract
The present study examined the role of vitality as a mediator of the association between dispositional hope and quality of life (QoL) (namely, physical health, psychological health, social relationships, and environment) in a sample of 101 adult primary care patients. Vitality was found to fully mediate the relationship between hope and physical health, social relationships, and environment. In addition, vitality was found to partially mediate the association between hope and psychological health. The present findings are consistent with a model in which vitality represents an important mechanism through which hope affects QoL in adults. Accordingly, these findings point to the importance of fostering both hope and vitality in efforts to promote positive QoL in adults.
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Affiliation(s)
| | - Edward C Chang
- Department of Psychology, University of Michigan, Ann Arbor
| | - Lily E Morris
- Department of Psychology, University of Michigan, Ann Arbor
| | | | - Olivia D Chang
- Department of Psychology, University of Michigan, Ann Arbor
| | - Ashley H Duong
- Department of Psychology, University of Michigan, Ann Arbor
| | | | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City
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Liu X, Liu X, Sun J, Yu NX, Sun B, Li Q, Zhu T. Proactive Suicide Prevention Online (PSPO): Machine Identification and Crisis Management for Chinese Social Media Users With Suicidal Thoughts and Behaviors. J Med Internet Res 2019; 21:e11705. [PMID: 31344675 PMCID: PMC6682269 DOI: 10.2196/11705] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/02/2018] [Accepted: 03/30/2019] [Indexed: 12/29/2022] Open
Abstract
Background Suicide is a great public health challenge. Two hundred million people attempt suicide in China annually. Existing suicide prevention programs require the help-seeking initiative of suicidal individuals, but many of them have a low motivation to seek the required help. We propose that a proactive and targeted suicide prevention strategy can prompt more people with suicidal thoughts and behaviors to seek help. Objective The goal of the research was to test the feasibility and acceptability of Proactive Suicide Prevention Online (PSPO), a new approach based on social media that combines proactive identification of suicide-prone individuals with specialized crisis management. Methods We first located a microblog group online. Their comments on a suicide note were analyzed by experts to provide a training set for the machine learning models for suicide identification. The best-performing model was used to automatically identify posts that suggested suicidal thoughts and behaviors. Next, a microblog direct message containing crisis management information, including measures that covered suicide-related issues, depression, help-seeking behavior and an acceptability test, was sent to users who had been identified by the model to be at risk of suicide. For those who replied to the message, trained counselors provided tailored crisis management. The Simplified Chinese Linguistic Inquiry and Word Count was also used to analyze the users’ psycholinguistic texts in 1-month time slots prior to and postconsultation. Results A total of 27,007 comments made in April 2017 were analyzed. Among these, 2786 (10.32%) were classified as indicative of suicidal thoughts and behaviors. The performance of the detection model was good, with high precision (.86), recall (.78), F-measure (.86), and accuracy (.88). Between July 3, 2017, and July 3, 2018, we sent out a total of 24,727 direct messages to 12,486 social media users, and 5542 (44.39%) responded. Over one-third of the users who were contacted completed the questionnaires included in the direct message. Of the valid responses, 89.73% (1259/1403) reported suicidal ideation, but more than half (725/1403, 51.67%) reported that they had not sought help. The 9-Item Patient Health Questionnaire (PHQ-9) mean score was 17.40 (SD 5.98). More than two-thirds of the participants (968/1403, 69.00%) thought the PSPO approach was acceptable. Moreover, 2321 users replied to the direct message. In a comparison of the frequency of word usage in their microblog posts 1-month before and after the consultation, we found that the frequency of death-oriented words significantly declined while the frequency of future-oriented words significantly increased. Conclusions The PSPO model is suitable for identifying populations that are at risk of suicide. When followed up with proactive crisis management, it may be a useful supplement to existing prevention programs because it has the potential to increase the accessibility of antisuicide information to people with suicidal thoughts and behaviors but a low motivation to seek help.
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Affiliation(s)
- Xingyun Liu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Xiaoqian Liu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiumo Sun
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Bingli Sun
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Qing Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Tingshao Zhu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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16
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Zheng L, Lippke S, Chen Y, Li D, Gan Y. Future orientation buffers depression in daily and specific stress. Psych J 2019; 8:342-352. [PMID: 30945435 DOI: 10.1002/pchj.283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/27/2019] [Accepted: 02/25/2019] [Indexed: 01/17/2023]
Abstract
Future orientation has been regarded as a protective factor that helps prevent problem behaviors, such as drug and alcohol use, smoking, and unprotected sex. Recently, many studies have focused on the relationship between a person's orientation towards the future and his or her depression symptoms; however, relatively few studies have explored the effect of future orientation on depressive responses to ordinary stress. The present study aimed to test whether future orientation could be a protective factor against depression in ordinary stress contexts. We conducted two studies to test this hypothesis and recruited 369 participants. Study 1 was a cross-sectional study that involved 217 employees from a food-processing company and examined the effect of future orientation in a daily stress context. Study 2 tested a hierarchical linear model in which 152 college students from an examination training institution in Beijing completed a five-wave assessment with 3-week intervals before taking the national entrance examination for postgraduate studies. The results showed that future orientation moderated the stress-depression relationship in the two samples. The present study provides evidence supporting the hypothesis that future orientation helps individuals cope with stress and protects people from depression, suggesting that future orientation plays a protective role in the stress-depression relationship.
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Affiliation(s)
- Lei Zheng
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Yidi Chen
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Danyang Li
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Yiqun Gan
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
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17
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Kachadourian LK, Tsai J, Harpaz-Rotem I, Southwick SM, Pietrzak RH. Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study. J Affect Disord 2019; 246:731-737. [PMID: 30616162 DOI: 10.1016/j.jad.2018.12.058] [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: 02/27/2018] [Revised: 11/28/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although several studies have identified risk factors for suicidal behaviors in general samples of Veterans, fewer studies have examined protective factors, particularly in high-risk samples. To address this gap, we examined protective correlates of suicidal ideation (SI) and suicide attempts (SA) in a sample of Veterans with histories of posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). METHOD Data were analyzed from a nationally representative sample of 3157 U.S. Veterans who completed the first wave of a web-based survey as part of the National Health and Resilience in Veterans Study (NHRVS). Of this sample, 577 Veterans met criteria for history of PTSD, MDD or both. RESULTS Multivariable logistic regression analyses were used to examine relationships between protective factors (curiosity, resilience, purpose in life, dispositional gratitude, optimism, and community integration) and suicidal behaviors (SI and SA). The prevalence of any SI during the previous two weeks was 29.4% and the prevalence of lifetime SA was 28.0%. After adjusting for relevant sociodemographic and military characteristics, greater purpose in life, curiosity, and optimism were negatively associated with SI. None of the protective correlates were associated with SA. LIMITATIONS Given the cross-sectional nature of this study, conclusions about causality cannot be made. The assessment of suicidality also was limited to three self-report items. CONCLUSION Results provide a characterization of protective factors for suicidality, and may help inform prevention and treatment approaches designed to mitigate suicide risk among high-risk military Veterans.
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Affiliation(s)
- Lorig K Kachadourian
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, Connecticut, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Jack Tsai
- United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ilan Harpaz-Rotem
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, Connecticut, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Steven M Southwick
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, Connecticut, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robert H Pietrzak
- United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, West Haven, Connecticut, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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18
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Chang OD, Batra MM, Premkumar V, Chang EC, Hirsch JK. Future orientation, depression, suicidality, and interpersonal needs in primary care outpatients. DEATH STUDIES 2018; 44:98-104. [PMID: 30541418 DOI: 10.1080/07481187.2018.1522389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Based on past research findings with college students, we tested whether perceived burdensomeness and thwarted belongingness represent important mediators of the association between future orientation and suicide risk (namely, depression and suicidality) in primary care patients. We conducted a multiple mediator test in a sample of 97 primary care patients. Our results indicated that perceived burdensomeness and thwarted belongingness accounted for the negative associations present between future orientation and measures of suicide risk. These findings provide evidence for perceived burdensomeness and thwarted belongingness as mechanisms accounting for the association between future orientation and suicide risk in primary care patients.
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Affiliation(s)
- Olivia D Chang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Madeleine M Batra
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Vidhya Premkumar
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward C Chang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
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Kwon HJ, Jeong JU, Choi M. Social Relationships and Suicidal Ideation Among the Elderly Who Live Alone in Republic of Korea: A Logistic Model. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018774177. [PMID: 29756503 PMCID: PMC5954569 DOI: 10.1177/0046958018774177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With population aging and change in family structure, the number of the elderly who live alone is rapidly increasing in Korea. The aim of this study was to explore the association between social relationships—especially newly formed formal social relationships (FSRs)—and suicidal ideation among Korean elderly who live alone. The elderly who live alone (N = 2509) from the 2014 Survey of Living Conditions and Welfare Needs of Older Koreans were analyzed using logistic regression. This study found that informal social relationships (ISRs) (eg, children, friends and neighbors) of the elderly who live alone had statistically significant association with suicidal ideation, whereas FSRs (eg, formal helper and social participation) did not have significant association with suicidal ideation. The findings of this study suggest that the Korean Government needs to strengthen public system for alleviating social isolation of the elderly living alone. Therefore, this study proposed 2 strategic approaches to maintain and strengthen ISRs and to develop different types of FSRs (eg, the measures to combine FSRs with ISRs, gatekeepers, etc).
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Chang EC, Chang OD, Yu EA, Wu K, Lucas AG, Lui PP, Rollock D, Chen X, Hirsch JK, Jeglic EL. How Future Orientation is Associated with Depressive Symptoms in Multiethnoracial Adults: Basic Psychological Needs as a Mediator. THE JOURNAL OF PSYCHOLOGY 2018; 153:89-101. [DOI: 10.1080/00223980.2018.1524356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Jordan JT, McNiel DE. Characteristics of a suicide attempt predict who makes another attempt after hospital discharge: A decision-tree investigation. Psychiatry Res 2018; 268:317-322. [PMID: 30096659 DOI: 10.1016/j.psychres.2018.07.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/06/2018] [Accepted: 07/29/2018] [Indexed: 12/18/2022]
Abstract
The year following discharge from psychiatric hospitalization is a high-risk period for suicidal behavior, particularly among patients initially hospitalized after a suicide attempt. Demographic and clinical correlates have been identified; however, characteristics of the initial attempt may provide insight into risk for subsequent attempts as well. This investigation examined whether individual or a combination of suicide attempt characteristics predicted future attempts. Two hundred and eighteen psychiatric inpatients from the MacArthur Violence Risk Assessment Study with a recent suicide attempt were administered items from the Suicide Intent Scale and followed one year after discharge. Sixty-nine (31.65%) made a subsequent attempt. Data were analyzed by a stepwise logistic regression, followed by an iterative receiver operator curve (IROC) analysis, a recursive partitioning classification tree. The cross-validated IROC, but not logistic regression, predicted subsequent suicide attempts. Furthermore, the IROC found that participants who made definite plans and underwent extensive preparation were at highest risk for subsequent attempts. These findings suggest that suicide attempt characteristics preceding psychiatric hospitalization can help identify patients at elevated risk for another attempt post-discharge.
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Affiliation(s)
- Joshua T Jordan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Dale E McNiel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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22
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Kelliher Rabon J, Webb JR, Chang EC, Hirsch JK. Forgiveness and suicidal behavior in primary care: Mediating role of future orientation. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2018. [DOI: 10.1080/19349637.2018.1469454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jessica Kelliher Rabon
- Department of Psychology, East Tennessee State University College of Arts and Sciences, Johnson City, Tennessee, USA
| | - Jon R. Webb
- Department of Psychology, East Tennessee State University College of Arts and Sciences, Johnson City, Tennessee, USA
| | - Edward C. Chang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Jameson K. Hirsch
- Department of Psychology, East Tennessee State University College of Arts and Sciences, Johnson City, Tennessee, USA
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23
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Chang EC, Wan L, Li P, Guo Y, He J, Gu Y, Wang Y, Li X, Zhang Z, Sun Y, Batterbee CNH, Chang OD, Lucas AG, Hirsch JK. Loneliness and Suicidal Risk in Young Adults: Does Believing in a Changeable Future Help Minimize Suicidal Risk Among the Lonely? THE JOURNAL OF PSYCHOLOGY 2017; 151:453-463. [PMID: 28486077 DOI: 10.1080/00223980.2017.1314928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study examined loneliness and future orientation as predictors of suicidal risk, namely, depressive symptoms and suicide ideation, in a sample of 228 college students (54 males and 174 females). Results of regression analyses indicated that loneliness was a significant predictor of both indices of suicidal risk. The inclusion of future orientation was found to significantly augment the prediction model of both depressive symptoms and suicide ideation, even after accounting for loneliness. Noteworthy, beyond loneliness and future orientation, the Loneliness × Future Orientation interaction term was found to further augment both prediction models of suicidal risk. Consistent with the notion that future orientation is an important buffer of suicidal risk, among lonely students, those with high future orientation, compared to low future orientation, were found to report significantly lower levels of depressive symptoms and suicide ideation. Some implications of the present findings for studying both risk and protective factors associated with suicidal risk in young adults are discussed.
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Affiliation(s)
| | | | | | | | - Jiaying He
- d University of International Business and Economics
| | - Yu Gu
- e The University of British Columbia
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24
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Chang EC, Chang OD, Martos T, Sallay V. Future orientation and suicide risk in Hungarian college students: Burdensomeness and belongingness as mediators. DEATH STUDIES 2017; 41:284-290. [PMID: 27937969 DOI: 10.1080/07481187.2016.1270371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We tested a model consistent with the notion that perceived burdensomeness and thwarted belongingness mediate the association between future orientation and suicide risk (viz., depressive symptoms and suicide ideation) in college students. The sample was comprised of 195 Hungarian college students. Results indicated that the negative associations found between future orientation and suicide risk outcomes were accounted for by both perceived burdensomeness and thwarted belongingness. The present findings highlight the importance of studying positive future cognitions in suicide risk and provide support for perceived burdensomeness and thwarted belongingness as potential proximal mechanisms associated with heighted suicide risk in adults.
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Affiliation(s)
- Edward C Chang
- a Department of Psychology , University of Michigan , Ann Arbor , Michigan , USA
| | - Olivia D Chang
- b Research in Action Academy™ , Ann Arbor , Michigan , USA
| | - Tamás Martos
- c Department of Personality, Clinical and Health Psychology , University of Szeged , Szeged , Hungary
| | - Viola Sallay
- c Department of Personality, Clinical and Health Psychology , University of Szeged , Szeged , Hungary
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25
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Walker KL, Hirsch JK, Chang EC, Jeglic EL. Non-Suicidal Self-Injury and Suicidal Behavior in a Diverse Sample: The Moderating Role of Social Problem-Solving Ability. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9755-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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26
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Heisel MJ, Neufeld E, Flett GL. Reasons for living, meaning in life, and suicide ideation: investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults. Aging Ment Health 2016; 20:195-207. [PMID: 26305088 DOI: 10.1080/13607863.2015.1078279] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the roles of reasons for living (RFL) and meaning in life (MIL) in potentially promoting mental health and well-being and protecting against suicide ideation among community-residing older adults and to investigate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA). METHOD Of 173 older adults initially recruited into a longitudinal study on late-life suicide ideation, 109 completed the RFL-OA and measures of cognitive and physical functioning and positive and negative psychological factors at a two-year follow-up assessment. We tested a model in which RFL and MIL protect against suicide ideation, controlling for demographic and clinical factors. We also assessed the psychometric properties of the RFL-OA in community-residing older adults, investigating its internal consistency and its convergent (MIL, perceived social support, and life satisfaction), divergent (loneliness, depressive symptom severity, and suicide ideation), and discriminant validity (cognitive and physical functioning). RESULTS RFL-OA scores explained significant variance in suicide ideation, controlling for age, sex, depressive symptom severity, and loneliness. MIL explained significant unique variance in suicide ideation, controlling for these factors and RFL, and MIL significantly mediated the association between RFL and suicide ideation. Psychometric analyses indicated strong internal consistency (α = .94), convergent, divergent, and discriminant validity for the RFL-OA relative to positive and negative psychological factors and cognitive and physical functioning. CONCLUSION These findings add to a growing body of literature suggesting merit in investigating positive psychological factors together with negative factors when assessing suicide risk and planning psychological services for older adults.
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Affiliation(s)
- Marnin J Heisel
- a Departments of Psychiatry and of Epidemiology & Biostatistics , Schulich School of Medicine and Dentistry, The University of Western Ontario , London , Canada.,b Lawson Health Research Institute , London , Canada.,c Center for the Study and Prevention of Suicide , University of Rochester Medical Center , Rochester , NY , USA
| | - Eva Neufeld
- d Centre for Rural and Northern Health Research , Laurentian University , Sudbury , Canada
| | - Gordon L Flett
- e Department of Psychology , York University , Toronto , Canada
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Stanley IH, Hom MA, Rogers ML, Hagan CR, Joiner TE. Understanding suicide among older adults: a review of psychological and sociological theories of suicide. Aging Ment Health 2016; 20:113-22. [PMID: 25693646 DOI: 10.1080/13607863.2015.1012045] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions. METHOD In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults. RESULTS Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults. CONCLUSION To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory.
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Affiliation(s)
- Ian H Stanley
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Melanie A Hom
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Megan L Rogers
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Christopher R Hagan
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Thomas E Joiner
- a Department of Psychology , Florida State University , Tallahassee , FL , USA
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Huffman JC, Boehm JK, Beach SR, Beale EE, DuBois CM, Healy BC. Relationship of optimism and suicidal ideation in three groups of patients at varying levels of suicide risk. J Psychiatr Res 2016; 77:76-84. [PMID: 26994340 PMCID: PMC4841259 DOI: 10.1016/j.jpsychires.2016.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 12/12/2022]
Abstract
Optimism has been associated with reduced suicidal ideation, but there have been few studies in patients at high suicide risk. We analyzed data from three study populations (total N = 319) with elevated risk of suicide: (1) patients with a recent acute cardiovascular event, (2) patients hospitalized for heart disease who had depression or an anxiety disorder, and (3) patients psychiatrically hospitalized for suicidal ideation or following a suicide attempt. For each study we analyzed the association between optimism (measured by the Life-Orientation Test-Revised) and suicidal ideation, and then completed an exploratory random effects meta-analysis of the findings to synthesize this data. The meta-analysis of the three studies showed that higher levels of self-reported optimism were associated with a lower likelihood of suicidal ideation (odds ratio [OR] = .89, 95% confidence interval [CI] = .85-.95, z = 3.94, p < .001), independent of age, gender, and depressive symptoms. This association held when using the subscales of the Life Orientation Test-Revised scale that measured higher optimism (OR = .84, 95% CI = .76-.92, z = 3.57, p < .001) and lower pessimism (OR = .83, 95% CI = .75-.92], z = 3.61, p < .001). These results also held when suicidal ideation was analyzed as an ordinal variable. Our findings suggest that optimism may be associated with a lower risk of suicidal ideation, above and beyond the effects of depressive symptoms, for a wide range of patients with clinical conditions that place them at elevated risk for suicide.
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Affiliation(s)
- Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Julia K. Boehm
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Eleanor E. Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Brian C. Healy
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
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Marco JH, Pérez S, García-Alandete J. Meaning in Life Buffers the Association Between Risk Factors for Suicide and Hopelessness in Participants With Mental Disorders. J Clin Psychol 2016; 72:689-700. [PMID: 26990856 DOI: 10.1002/jclp.22285] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 01/14/2016] [Accepted: 02/01/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Hopelessness is a proximal risk factor of suicide. Meaning in life has been found to be a protective factor against suicidal ideation; however, the majority of studies that have explored the role of meaning in life in the context of suicidality have been conducted in nonclinical populations. The aim of this study was to investigate whether meaning in life can moderate and buffer the association between suicide risk factors and hopelessness in a clinical sample with a heightened risk of suicide. METHOD A total of 224 participants diagnosed with mental disorders completed self-report measures of suicide risk factors, hopelessness, and meaning in life. RESULTS The main result from this study was that meaning in life moderated the association between suicide risk factors and hopelessness. CONCLUSION Meaning in life is an important variable in the prevention and treatment of people at risk of suicide.
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Affiliation(s)
- José H Marco
- Universidad Católica de Valencia "San Vicente Mártir"
| | - Sandra Pérez
- Universidad Católica de Valencia "San Vicente Mártir"
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30
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Optimistic Explanatory Style and Suicide Attempt in Young Adults. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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31
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Karimli L, Ssewamala FM. Do Savings Mediate Changes in Adolescents' Future Orientation and Health-Related Outcomes? Findings From Randomized Experiment in Uganda. J Adolesc Health 2015; 57:425-32. [PMID: 26271162 PMCID: PMC4583807 DOI: 10.1016/j.jadohealth.2015.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 05/22/2015] [Accepted: 06/10/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset accumulation (in this case, by increasing family savings). METHODS Using longitudinal data from the cluster-randomized experiment, we ran generalized estimating equation models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents' future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping-to address the assumption of normal distribution. RESULTS Results indicate that participation in a matched Child Savings Account (CSA) program improved adolescents' future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents' confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched CSA program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. CONCLUSIONS Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched CSAs, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how?
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Affiliation(s)
- Leyla Karimli
- Silver School of Social Work, McSilver Institute for Poverty Policy and Research, New York, New York.
| | - Fred M. Ssewamala
- Columbia University’s International Center for Child Health and Asset Development; School of Social Work,
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Roepke AM, Seligman MEP. Depression and prospection. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 55:23-48. [PMID: 26096347 DOI: 10.1111/bjc.12087] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 04/17/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions. METHODS We integrate several literatures: Using the database PsycInfo, we retrieved empirical studies with the keywords prospection, prediction, expectation, pessimism, mental simulation, future-thinking, future-directed thinking, foresight, and/or mental time travel, in conjunction with depression, depressed, or depressive. RESULTS Three kinds of faulty prospection, taken together, could drive depression: Poor generation of possible futures, poor evaluation of possible futures, and negative beliefs about the future. Depressed mood and poor functioning, in turn, may maintain faulty prospection and feed a vicious cycle. Future-oriented treatment strategies drawn from cognitive-behavioural therapy help to fix poor prospection, and they deserve to be developed further. CONCLUSIONS Prospection-based techniques may lead to transdiagnostic treatment strategies for depression and other disorders.
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Affiliation(s)
- Ann Marie Roepke
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin E P Seligman
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pennings SM, Law KC, Green BA, Anestis MD. The Impact of Grit on the Relationship Between Hopelessness and Suicidality. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.2.130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Future orientation and health quality of life in primary care: vitality as a mediator. Qual Life Res 2014; 24:1653-9. [PMID: 25547659 DOI: 10.1007/s11136-014-0901-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Temporal perspective, including views about future goals, may influence motivational processes related to health. An adaptive sense of future orientation is linked to better health, but little research has examined potential underlying factors, such as vitality. METHOD In a sample of 101 primary care patients, we examined whether belief in the changeability of the future was related to mental and physical energization and, in turn, to health-related quality of life. Participants were working, uninsured primary care patients, who completed self-report measures of future orientation, vitality, and health-related quality of life. RESULTS Mediation models, covarying age, sex, and race/ethnicity indicated that vitality significantly mediated the association between future orientation and the outcomes of general health, mental health, social functioning, bodily pain, and role limitations due to emotional and physical reasons. Vitality exerted an indirect-only effect on the relation between future orientation and physical functioning. CONCLUSIONS Our findings suggest that adaptive beliefs about the future may promote, or allow access to, physical and mental energy and, in turn, may result in better mental and physical health functioning. Individual-level and public health interventions designed to promote future orientation and vitality may beneficially influence quality of life and well-being.
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Coping Skills Help Explain How Future-Oriented Adolescents Accrue Greater Well-Being Over Time. J Youth Adolesc 2014; 44:2028-41. [PMID: 25427783 DOI: 10.1007/s10964-014-0230-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
Adolescents who endorse greater levels of future orientation report greater well-being over time, but we do not know the mechanism by which this happens. The present longitudinal study examined whether both adaptive as well as maladaptive coping strategies might explain how future orientation leads to ill-being and well-being over time in young New Zealanders. A sample of 1,774 preadolescents and early adolescents (51.9 % female) aged 10-15 years at Time 1 completed a self-report survey three times with 1 year intervals in between. Longitudinal mediation path models were constructed to determine whether and how maladaptive and adaptive coping strategies at Time 2 functioned as mediators between future orientation at Time 1 and ill-being and well-being at Time 3. Results showed that future orientation predicted lower maladaptive coping, which in turn predicted lower substance use and self-harming behavior. All three well-being outcomes (i.e., happiness with weight, vitality, and sleep) were consistently predicted by future orientation, and all three pathways were mediated by both lower maladaptive and higher adaptive coping strategies (with the exception of happiness with weight, which was mediated only by lower maladaptive coping). The results suggest that several pathways by which future orientation leads to greater well-being occurs through an increased use of adaptive coping, a decreased use of maladaptive coping, or both.
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Positive psychological determinants of treatment adherence among primary care patients. Prim Health Care Res Dev 2014; 16:398-406. [DOI: 10.1017/s1463423614000292] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BackgroundPatient adherence to medical treatment recommendations can affect disease prognosis, and may be beneficially or deleteriously influenced by psychological factors.AimWe examined the relationships between both adaptive and maladaptive psychological factors and treatment adherence among a sample of primary care patients.MethodsOne hundred and one rural, primary care patients completed the Life Orientation Test-Revised, Trait Hope Scale, Future Orientation Scale, NEO-FFI Personality Inventory (measuring positive and negative affect), and Medical Outcomes Study General Adherence Scale.FindingsIn independent models, positive affect, optimism, hope, and future orientation were beneficially associated with treatment adherence, whereas pessimism and negative affect were negatively related to adherence. In multivariate models, only negative affect, optimism and hope remained significant and, in a comparative model, trait hope was most robustly associated with treatment adherence.ImplicationsTherapeutically, addressing negative emotions and expectancies, while simultaneously bolstering motivational and goal-directed attributes, may improve adherence to treatment regimens.
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Huffman JC, DuBois CM, Healy BC, Boehm JK, Kashdan TB, Celano CM, Denninger JW, Lyubomirsky S. Feasibility and utility of positive psychology exercises for suicidal inpatients. Gen Hosp Psychiatry 2014; 36:88-94. [PMID: 24230461 DOI: 10.1016/j.genhosppsych.2013.10.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/03/2013] [Accepted: 10/05/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective was to assess the feasibility and acceptability of nine positive psychology exercises delivered to patients hospitalized for suicidal thoughts or behaviors, and to secondarily explore the relative impact of the exercises. METHOD Participants admitted to a psychiatric unit for suicidal ideation or behavior completed daily positive psychology exercises while hospitalized. Likert-scale ratings of efficacy (optimism, hopelessness, perceived utility) and ease of completion were consolidated and compared across exercises using mixed models accounting for age, missing data and exercise order. Overall effects of exercise on efficacy and ease were also examined using mixed models. RESULTS Fifty-two (85.3%) of 61 participants completed at least one exercise, and 189/213 (88.7%) assigned exercises were completed. There were overall effects of exercise on efficacy (χ(2)=19.39; P=.013) but not ease of completion (χ(2)=11.64; P=.17), accounting for age, order and skipped exercises. Effect (Cohen's d) of exercise on both optimism and hopelessness was moderate for the majority of exercises. Exercises related to gratitude and personal strengths ranked highest. Both gratitude exercises had efficacy scores that were significantly (P=.001) greater than the lowest-ranked exercise (forgiveness). CONCLUSION In this exploratory project, positive psychology exercises delivered to suicidal inpatients were feasible and associated with short-term gains in clinically relevant outcomes.
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Affiliation(s)
- Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Christina M DuBois
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Todd B Kashdan
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John W Denninger
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Benson Henry Institute for Mind Body Medicine, BostonMA, USA
| | - Sonja Lyubomirsky
- Department of Psychology, University of California-Riverside, Riverside, CA, USA
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Gratitude and grit indirectly reduce risk of suicidal ideations by enhancing meaning in life: Evidence for a mediated moderation model. JOURNAL OF RESEARCH IN PERSONALITY 2013. [DOI: 10.1016/j.jrp.2013.04.007] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Britton PC, Bossarte RM, Thompson C, Kemp J, Conner KR. Influences on call outcomes among veteran callers to the National Veterans Crisis Line. Suicide Life Threat Behav 2013; 43:494-502. [PMID: 23611446 PMCID: PMC5064431 DOI: 10.1111/sltb.12033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/24/2013] [Indexed: 11/28/2022]
Abstract
The association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls were examined. From October 1-7, 2010, 665 veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line; 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome (a resolution or a referral) when compared to an unfavorable outcome (no resolution or referral). A multivariable logistic regression was used to identify correlates of responder-rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution, and 59% with a referral to a local health care provider. Calls from high-risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high-risk veteran callers. Responders appeared to use known risk and protective factors to determine caller risk.
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Affiliation(s)
- Peter C. Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA,Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14620, USA
| | - Robert M. Bossarte
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA,Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14620, USA
| | - Caitlin Thompson
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14620, USA,National Veterans Crisis Line, Department of Veterans Affairs, Canandaigua Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA
| | - Janet Kemp
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA,National Veterans Crisis Line, Department of Veterans Affairs, Canandaigua Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA,Office of Suicide Prevention, Department of Veterans Affairs, Central Office, 810 Vermont Ave, NW, Washington, DC 20420, USA
| | - Kenneth R. Conner
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14424, USA,Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14620, USA
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Chin J, Holden RR. Multidimensional future time perspective as moderators of the relationships between suicide motivation, preparation, and its predictors. Suicide Life Threat Behav 2013; 43:395-405. [PMID: 23590396 DOI: 10.1111/sltb.12025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
Abstract
The moderating impact of future time perspective (FTP) components on the relationships of hopelessness, depressive symptoms, and psychache with suicide motivation and preparation was investigated. In a sample of first year college students (N = 87) recruited on the basis of elevated suicide ideation and depressive symptoms, future thinking, optimism, and future connectedness attenuated the relationship of suicide motivation with depressive symptoms and hopelessness. Future thinking moderated the impact of depressive symptoms on suicide preparation. No moderating effects were found for psychache. This study demonstrates that FTP may buffer against the worst effects of salient suicide predictors among high-risk students.
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Affiliation(s)
- Jacqueline Chin
- Department of Clinical Psychology, Queen's University, Kingston, ON, Canada.
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Chang EC, Yu EA, Lee JY, Hirsch JK, Kupfermann Y, Kahle ER. An Examination of Optimism/Pessimism and Suicide Risk in Primary Care Patients: Does Belief in a Changeable Future Make a Difference? COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9505-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older. Am J Geriatr Psychiatry 2012; 20:717-23. [PMID: 22048322 PMCID: PMC3276748 DOI: 10.1097/jgp.0b013e31822ccd79] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether living alone is significantly associated with expression of suicide ideation among mood-disordered mental health patients and whether degree of family connectedness moderates the association between living alone and expression of suicide ideation. DESIGN Cross-sectional survey design. SETTING Inpatient and outpatient mental health services in Rochester, New York. PARTICIPANTS A total of 130-mood-disordered inpatients and outpatients 50 years and older. MEASUREMENTS Patients completed a demographics form, an interviewer-rated measure of current suicide ideation (Scale for Suicide Ideation), and a self-report measure of family connectedness derived from the Reasons for Living Scale-Older Adult version. RESULTS Patients who reported greater family connectedness were significantly less likely to report suicide ideation; this protective effect was strongest for those living with others (Wald χ(2)[df = 1] = 3.987, p = 0.046, OR = 0.905; 95% CI = 0.821-0.998). A significant main effect of family connectedness on suicide ideation suggested that having a stronger connection to family members decreased the likelihood of reporting suicide ideation (Wald χ(2)[df = 1] = 9.730, p = 0.002, OR = 0.852; 95% CI = 0.771-0.942). CONCLUSIONS These results suggest potential value in assessing the quality of interpersonal relationships when conducting a suicide risk assessment among depressed middle-aged and older adults.
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Hirsch JK, Chang EC, Jeglic EL. Social problem solving and suicidal behavior: ethnic differences in the moderating effects of loneliness and life stress. Arch Suicide Res 2012; 16:303-15. [PMID: 23137220 DOI: 10.1080/13811118.2013.722054] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to examine the combined moderating effects of life stress and loneliness on the association between social problem solving ability (SPS) and suicidal behaviors. We assessed SPS, suicidal behavior, loneliness, and stressful life events in a sample of 385 ethnically diverse college students. Overall, only loneliness moderated the association between SPS and suicidal behaviors. Across ethnic groups, loneliness moderated the association between SPS and suicidal behavior for Blacks, Whites, and Asians; life stress was a moderator for Hispanics. For most individuals, loneliness increases the strength of the association between poor problem-solving and suicidal behaviors. For Hispanics, life stress exacerbates this relationship. Ethnically-specific prevention strategies targeting loneliness and life stress may promote effective problem-solving, reducing suicide risk.
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Affiliation(s)
- Jameson K Hirsch
- Department of Psychology, East Tennessee State University, P.O. Box 70649, Johnson City, TN 37614 USA.
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Dervic K, Carballo JJ, Baca-Garcia E, Galfalvy HC, Mann JJ, Brent DA, Oquendo MA. Moral or religious objections to suicide may protect against suicidal behavior in bipolar disorder. J Clin Psychiatry 2011; 72:1390-6. [PMID: 21367349 PMCID: PMC3785100 DOI: 10.4088/jcp.09m05910gre] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/25/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Patients with bipolar disorder are prone to suicidal behavior, yet possible protective mechanisms are rarely studied. We investigated a possible protective role for moral or religious objections to suicide against suicidal ideation and attempts in depressed bipolar patients. METHOD A retrospective case control study of 149 depressed bipolar patients (DSM-III-R criteria) in a tertiary care university research clinic was conducted. Patients who reported religious affiliation were compared with 51 patients without religious affiliation in terms of sociodemographic and clinical characteristics and history of suicidal behavior. The primary outcome measure was the moral or religious objections to suicide subscale of the Reasons for Living Inventory (RFLI). RESULTS Religiously affiliated patients had more children and more family-oriented social networks than nonaffiliated patients. As for clinical variables, religiously affiliated patients had fewer past suicide attempts, had fewer suicides in first-degree relatives, and were older at the time of first suicide attempt than unaffiliated patients. Furthermore, patients with religious affiliation had comparatively higher scores on the moral or religious objections to suicide subscale of the RFLI, lower lifetime aggression, and less comorbid alcohol and substance abuse and childhood abuse experience. After controlling for confounders, higher aggression scores (P = .001) and lower score on the moral or religious objections to suicide subscale of the RFLI (P < .001) were significantly associated with suicidal behavior in depressed bipolar patients. Moral or religious objections to suicide mediated the effects of religious affiliation on suicidal behavior in this sample. CONCLUSIONS Higher score on the moral or religious objections to suicide subscale of the RFLI is associated with fewer suicidal acts in depressed bipolar patients. The strength of this association was comparable to that of aggression scores and suicidal behavior, and had an independent effect. A possible protective role of moral or religious objections to suicide deserves consideration in the assessment and treatment of suicidality in bipolar disorder.
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Hasler G. Can the neuroeconomics revolution revolutionize psychiatry? Neurosci Biobehav Rev 2011; 36:64-78. [PMID: 21550365 DOI: 10.1016/j.neubiorev.2011.04.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/07/2011] [Accepted: 04/19/2011] [Indexed: 01/18/2023]
Abstract
Neuroeconomics is a rapidly growing new research discipline aimed at describing the neural substrate of decision-making using incentivized decisions introduced in experimental economics. The novel combination of economic decision theory and neuroscience has the potential to better examine the interactions of social, psychological and neural factors with regard to motivational forces that may underlie psychiatric problems. Game theory will provide psychiatry with computationally principled measures of cognitive dysfunction. Given the relatively high heritability of these measures, they may contribute to improving phenotypic definitions of psychiatric conditions. The game-theoretical concepts of optimal behavior will allow description of psychopathology as deviation from optimal functioning. Neuroeconomists have successfully used normative or near-normative models to interpret the function of neurotransmitters; these models have the potential to significantly improve neurotransmitter theories of psychiatric disorders. This paper will review recent evidence from neuroeconomics and psychiatry in support of applying economic concepts such as risk/uncertainty preference, time preference and social preference to psychiatric research to improve diagnostic classification, prevention and therapy.
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Affiliation(s)
- Gregor Hasler
- Psychiatric University Hospital, University of Berne, Bolligenstrasse 111, 3000 Berne 60, Switzerland.
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Dombrovski AY, Clark L, Siegle GJ, Butters MA, Ichikawa N, Sahakian B, Szanto K. Reward/Punishment reversal learning in older suicide attempters. Am J Psychiatry 2010; 167:699-707. [PMID: 20231320 PMCID: PMC3020386 DOI: 10.1176/appi.ajp.2009.09030407] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Suicide rates are high in old age, and the contribution of cognitive risk factors remains poorly understood. Suicide may be viewed as an outcome of an altered decision process. The authors hypothesized that impairment in reward/punishment-based learning, a component of affective decision making, is associated with attempted suicide in late-life depression. They expected that suicide attempters would discount past reward/punishment history, focusing excessively on the most recent rewards and punishments. The authors further hypothesized that this impairment could be dissociated from executive abilities, such as forward planning. METHOD The authors assessed reward/punishment-based learning using the probabilistic reversal learning task in 65 individuals age 60 and older: suicide attempters, suicide ideators, nonsuicidal depressed elderly, and nondepressed comparison subjects. The authors used a reinforcement learning computational model to decompose reward/punishment processing over time. The Stockings of Cambridge test served as a control measure of executive function. RESULTS Suicide attempters but not suicide ideators showed impaired probabilistic reversal learning compared to both nonsuicidal depressed elderly and nondepressed comparison subjects, after controlling for effects of education, global cognitive function, and substance use. Model-based analyses revealed that suicide attempters discounted previous history to a higher degree relative to comparison subjects, basing their choice largely on reward/punishment received on the last trial. Groups did not differ in their performance on the Stockings of Cambridge test. CONCLUSIONS Older suicide attempters display impaired reward/punishment-based learning. The authors propose a hypothesis that older suicide attempters make overly present-focused decisions, ignoring past experiences. Modification of this "myopia for the past" may have therapeutic potential.
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Affiliation(s)
- Alexandre Y. Dombrovski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Luke Clark
- Department of Experimental Psychology, University of Cambridge (UK), Behavioural and Clinical Neuroscience Institute, University of Cambridge
| | - Greg J. Siegle
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Meryl A. Butters
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Naho Ichikawa
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Department of Psychology, University of Nagoya (Japan)
| | - Barbara Sahakian
- Department of Psychiatry, University of Cambridge (UK), Behavioural and Clinical Neuroscience Institute, University of Cambridge
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
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Seriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life. Palliat Support Care 2010; 7:393-404. [PMID: 19939302 DOI: 10.1017/s147895150999040x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients approaching the end of life not only face challenges to physical well-being but also threats to emotional and spiritual integrity. Yet, identifying appropriate, effective, and brief interventions to address those concerns has proven elusive. We developed an intervention based on life review and emotional disclosure literatures and conducted a pilot study to determine feasibility and acceptability. This article presents qualitative intervention responses. METHOD We conducted a three-armed randomized control trial to evaluate the effects of preparation and life completion discussion on health outcomes in patients with advanced serious illness. Hospice-eligible subjects were randomly assigned to one of three groups: (1) intervention (life completion discussion intervention), (2) attention control (relaxation meditation), and control (no intervention). Subjects in the intervention arm met with a facilitator three times. Session 1 focused on life story, Session 2 on forgiveness, and Session 3, on heritage and legacy. RESULTS Eighteen subjects participated in the pilot intervention interviews. Subjects from a range of socioeconomic backgrounds completed the intervention with equal facility. Results from Session 1 demonstrate narrative responses participants gave as they reconnected with previous life roles, values, and accomplishments. The second session illustrated reflections of choices one might have made differently and exploration of forgiveness offered and sought. Content from the first and second sessions laid the foundation for discussing Session 3's lessons learned and heritage and legacy. Responses are summarized to assist clinicians in anticipating life review content that may improve overall quality of life at the end of life. SIGNIFICANCE OF RESULTS Discussions of life completion may improve important health outcomes for patients at the end of life. This intervention may provide a brief, standardized, and transportable means for improving the quality of life of patients with advanced serious illness.
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Abstract
SummarySuicide is accepted as a major health problem worldwide, especially in the young and middle aged. It is, however, a significant health problem in older people as well, and those aged 65 years and over generally have the highest suicide rates compared with all other age groups. In research literature from the last decade, there has been an increased interest in disentangling the phenomenon of suicide in later life. This paper aims to critically review the literature on suicide and suicidality in later life published from 2000 to 2009. Prevalence rates as well as risk and protective factors are mapped and correlates reviewed. The association between suicidality and help-seeking behaviour is considered. Finally, potential prevention strategies are reviewed.
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van Beek W, Kerkhof A, Beekman A. Future oriented group training for suicidal patients: a randomized clinical trial. BMC Psychiatry 2009; 9:65. [PMID: 19811638 PMCID: PMC2767345 DOI: 10.1186/1471-244x-9-65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 10/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In routine psychiatric treatment most clinicians inquire about indicators of suicide risk, but once the risk is assessed not many clinicians systematically focus on suicidal thoughts. This may reflect a commonly held opinion that once the depressive or anxious symptoms are effectively treated the suicidal symptoms will wane. Consequently, many clients with suicidal thoughts do not receive systematic treatment of their suicidal thinking. There are many indications that specific attention to suicidal thinking is necessary to effectively decrease the intensity and recurrence of suicidal thinking. We therefore developed a group training for patients with suicidal thoughts that is easy to apply in clinical settings as an addition to regular treatment and that explicitly focuses on suicidal thinking. We hypothesize that such an additional training will decrease the frequency and intensity of suicidal thinking.We based the training on cognitive behavioural approaches of hopelessness, worrying, and future perspectives, given the theories of Beck, McLeod and others, concerning the lack of positive expectations characteristic for many suicidal patients. In collaboration with each participant in the training individual positive future possibilities and goals were challenged. METHODS/DESIGN We evaluate the effects of our program on suicide ideation (primary outcome measure). The study is conducted in a regular treatment setting with regular inpatients and outpatients representative for Dutch psychiatric treatment settings. The design is a RCT with two arms: TAU (Treatment as Usual) versus TAU plus the training. Follow up measurements are taken 12 months after the first assessment. DISCUSSION There is a need for research on the effectiveness of interventions in suicidology, especially RCT's. In our treatment program we combine aspects and interventions that have been proven to be useful in the treatment of suicidal thinking and behavior. TRIAL REGISTRATION ISRCTN56421759.
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Affiliation(s)
| | - Ad Kerkhof
- Vrije Universiteit, Dpt Clinical Psychology, Amsterdam; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Vrije Universiteit, Dpt Psychiatry, Amsterdam; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Hirsch JK, Duberstein PR, Unützer J. Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness. Int J Geriatr Psychiatry 2009; 24:671-9. [PMID: 19145577 PMCID: PMC2903840 DOI: 10.1002/gps.2174] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. We tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress. METHODS A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems. RESULTS Chronic medical problems are associated with suicide ideation and, as hypothesized, happiness attenuates the relationship between self-reported diseases and suicidal distress. CONCLUSIONS Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. Our results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk.
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Affiliation(s)
- Jameson K. Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA, Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry,Correspondence to: Dr J. K. Hirsch, Department of Psychology, East Tennessee State University, Department of Psychology, P.O. Box 70649. Johnson City, TN. 37614. USA.,
| | - Paul R. Duberstein
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - Jürgen Unützer
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine
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