Psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses : A systematic literature review

How individuals with psychosis develop and maintain resilience to suicidal experiences through psychological therapy: a qualitative study

BACKGROUND

Almost half of people with psychosis have suicidal experiences. There is limited understanding of the processes underpinning psychological resilience to psychotic and suicidal experiences especially in people who have engaged with psychological talking therapies. Hence, the current study aimed to redress this gap by examining the perspectives of clients who had recent lived-experiences of psychosis, suicidality, and psychological therapy.

METHODS

Semi-structured interviews were conducted with 35 participants who had psychosis and suicidal experiences in the three months prior to recruitment. Data were analysed using reflexive thematic analysis.

RESULTS

There were four key psychological processes that contributed to resilience: (1) gaining a sense of control by nullifying perceptions of being controlled by overwhelming emotional and psychotic experiences, and instead, acquiring confident autonomy; (2) gaining a sense of hope facilitated by experiencing mental health problems on a fluctuating continuum, translating immersive positive memories into future possibilities, and embracing meaningful personal values; (3) developing genuine self-worth based on compassionate self-understanding, and affirmation of personal qualities; and (4) finding acceptance by being able to live alongside psychotic and suicidal experiences. Specific resilience components that participants developed through psychological therapy, together with their own knowledge and observations, were identified.

CONCLUSIONS

People who live with psychotic and suicidal experiences can, and do, experience psychological change and psychological resilience in response to psychological therapy. To promote resilience, practitioners should pursue a person-based, client-directed approach; embrace acceptance; and be open to exploring different ways of working with clients' experiences of overwhelming thoughts and emotions.

Factors related to suicidal ideation of schizophrenia patients in China: a study based on decision tree and logistic regression model

This study aimed to investigate the factors associated with suicidal ideation in schizophrenia patients in China using decision tree and logistic regression models. From October 2020 to March 2022, patients with schizophrenia were chosen from Chifeng Anding Hospital and Daqing Third Hospital in Heilongjiang Province. A total of 300 patients with schizophrenia who met the inclusion criteria were investigated by questionnaire. The questionnaire covered general data, suicidal ideation, childhood trauma, social support, depressive symptoms and psychological resilience. Logistic regression analysis revealed that childhood trauma and depressive symptoms were risk factors for suicidal ideation in schizophrenia (OR = 2.330, 95%CI: 1.177 ~ 4.614; OR = 10.619, 95%CI: 5.199 ~ 21.688), while psychological resilience was a protective factor for suicidal ideation in schizophrenia (OR = 0.173, 95%CI: 0.073 ~ 0.409). The results of the decision tree model analysis demonstrated that depressive symptoms, psychological resilience and childhood trauma were influential factors for suicidal ideation in patients with schizophrenia (p < 0.05). The area under the ROC for the logistic regression model and the decision tree model were 0.868 (95% CI: 0.821 ~ 0.916) and 0.863 (95% CI: 0.814 ~ 0.912) respectively, indicating excellent accuracy of the models. Meanwhile, the logistic regression model had a sensitivity of 0.834 and a specificity of 0.743 when the Youden index was at its maximum. The decision tree model had a sensitivity of 0.768 and a specificity of 0.8. Decision trees in combination with logistic regression models are of high value in the study of factors influencing suicidal ideation in schizophrenia patients.

The relationship between time anxiety and college students' sleep quality: the mediating role of irrational procrastination and the moderating effect of physical activity

Background

Poor sleep quality has become one of the most pressing public issues among Chinese college students, with an increasing incidence rate in recent years. Although some studies showed that anxiety is related to sleep quality, the relationship between time anxiety (which is a more concrete manifestation of anxiety in the temporal dimension) and sleep quality, as well as its potential mechanisms, still requires further investigation and analysis. This study aimed to explore the relationship between time anxiety and sleep quality among college students, and to examine the mediating role of irrational procrastination and the moderating effect of physical activity.

Methodology

A cross-sectional study was conducted with 1,137 participants recruited from four universities in eastern, western, and central China. They completed a questionnaire survey on time anxiety, irrational procrastination, physical activity, and sleep quality. Data analysis was performed using SPSS 26.0 and PROCESS 3.3.

Results

Time anxiety had a significant positive impact on sleep quality (β = 0.28, t = 9.95, p < 0.001). Irrational procrastination played a mediating role between time anxiety and college students' sleep quality, the effect value was 0.05, and the intermediary effect accounted for 19.26%. Physical activity moderated the direct effect of time anxiety on college students' sleep quality (β = -0.08, t = -2.98, p < 0.01), and moderated the second half path of irrational procrastination mediation model (β = -0.06, t = -2.12, p < 0.05).

Conclusion

Higher levels of time anxiety are associated with poorer sleep quality among college students. Time anxiety not only directly affects college students' sleep quality, but also indirectly affects it through irrational procrastination. Conducting physical activities can mitigate the impact of time anxiety and irrational procrastination on college students' sleep quality.

The interplay between suicidal experiences, psychotic experiences and interpersonal relationships: a qualitative study

BACKGROUND

Suicidal thoughts, acts, plans and deaths are considerably more prevalent in people with non-affective psychosis, including schizophrenia, compared to the general population. Social isolation and interpersonal difficulties have been implicated in pathways which underpin suicidal experiences in people with severe mental health problems. However, the interactions between psychotic experiences, such as hallucinations and paranoia, suicidal experiences, and the presence, and indeed, absence of interpersonal relationships is poorly understood and insufficiently explored. The current study sought to contribute to this understanding.

METHODS

An inductive thematic analysis was conducted on transcripts of 22, individual, semi-structured interviews with adult participants who had both non-affective psychosis and recent suicidal experiences. A purposive sampling strategy was used. Trustworthiness of the analysis was assured with researcher triangulation.

RESULTS

Participants relayed both positive and negative experiences of interpersonal relationships. A novel conceptual model is presented reflecting a highly complex interplay between a range of different suicidal experiences, psychosis, and aspects of interpersonal relationships. Three themes fed into this interplay, depicting dynamics between perceptions of i. not mattering and mattering, ii. becoming disconnected from other people, and iii. constraints versus freedom associated with sharing suicidal and psychotic experiences with others.

CONCLUSION

This study revealed a detailed insight into ways in which interpersonal relationships are perceived to interact with psychotic and suicidal experiences in ways that can be both beneficial and challenging. This is important from scientific and clinical perspectives for understanding the complex pathways involved in suicidal experiences.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 .); 5th June 2017). Registration was recorded prior to participant recruitment commencing.

Visual Analysis of Psychological Resilience Research Based on Web of Science Database

Background

The importance of psychological resilience that people show in coping with stress and adversity is prominent, but few studies have used rigorous bibliometric tools to analyze the knowledge structure and distribution of psychological resilience research.

Objective

The purpose of this study was to sort out and summarize the previous studies on psychological resilience by using bibliometrics. Specifically, the time distribution of psychological resilience research was determined by publication trend, the power distribution was determined by the distribution of countries, authors, institutions and journals, the hot research spots were analyzed according to the results of keyword cluster analysis, and the research frontier was explored according to the results of burst keywords.

Methods

CiteSpace5.8.R3 was used to analyze the literatures on psychological resilience collected in Web of Science core Collection database from January 1, 2010, to June 16, 2022.

Results

A total of 8462 literatures were included after screening. Research on psychological resilience has been on the rise in recent years. The United States had made a high contribution in this field. Robert H Pietrzak, George A Bonanno, Connor KM and others were highly influential. J Pers Soc Psychol has the highest citation frequency and centrality. The research hot spots focus on five aspects: study on psychological resilience related to COVID-19 pandemic, influencing factors of psychological resilience, psychological resilience related to PTSD, study on psychological resilience of special population, and the molecular biology and genetic basis of psychological resilience. Psychological resilience related to COVID-19 pandemic was the most cutting-edge research aspect.

Conclusion

The current situation and trend of psychological resilience research were found in this study, which may be used to identify more hot issues and explore new research directions in this field.

Physical activity as a causal variable for adolescent resilience levels: A cross-lagged analysis

This study extends research on the relationship between physical activity and adolescent resilience by using cross-lagged analysis. Therefore, it used the Adolescent Resilience Rating Scale and the Physical Activity Scale to conduct a one-year longitudinal follow-up survey on 818 adolescents (50.6% boys), aged 12-17. They completed the questionnaires, providing data on physical activity and adolescent resilience. The results indicated there were significant gender differences in physical activity, but there was no significant gender difference in adolescent resilience; there was a significant positive correlation between physical activity and adolescent resilience; physical activity had a significant predictive effect on adolescent resilience. This study supports the assertion that physical activity has an important impact on adolescent resilience. It further analyzes the possible reasons for this result and contemplates the theoretical and practical significance of the findings, which provides evidence for the study of adolescents' physical and mental health and enriches the theory of resilience.

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.

Suicide resilience: A concept analysis

OBJECTIVE

Suicide resilience is gaining increasing attention from researchers because of its potential role in preventing suicide. However, it has not been clearly analyzed, and there are various meanings and terms regarding this issue. The purpose of this analysis, therefore, was to conceptualize the concept of suicide resilience.

METHODS

Walker and Avant's method of concept analysis was used to identify the antecedents, attributes, and consequences of suicide resilience. The literature was searched using PubMed, PsychINFO, Embase, Web of Science, CINAHL, CNKI, and WanFang databases with no limitation on publication date. The search included peer-reviewed journal articles and dissertations related to suicide resilience published in English or Chinese.

RESULTS

52 articles were identified to provide information for this concept analysis. Five defining attributes of suicide resilience were identified: social support, coping strategies, psychological capital, meaning in life, and sense of responsibility. Antecedents of suicide resilience were high suicide risk events, and consequences of suicide resilience were keeping vulnerable individuals stay away from or overcoming suicidality.

CONCLUSIONS

The result of the analysis provided a more clear definition of suicide resilience. The identified defining attributes, antecedents, and consequences can be further tested and used to develop potential interventions. Future research is needed and will help to advance our understanding of the scope.

Resilience Predicts Self-Stigma and Stigma Resistance in Stabilized Patients With Bipolar I Disorder

The identification of factors that prevent self-stigma and on the other hand promote stigma resistance are of importance in the long-term management of bipolar disorder. Accordingly, the aim of the current study was to investigate the association of factors deemed relevant in this context, i.e., resilience, premorbid functioning, and residual mood symptoms, with self-stigma/stigma resistance. Sixty patients diagnosed with bipolar I disorder were recruited from a specialized outpatient clinic. Self-stigma and stigma resistance were measured by the Internalized Stigma of Mental Illness (ISMI) Scale. The presence and severity of symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). Resilience and premorbid functioning were measured by the Resilience Scale (RS-25) and the Premorbid Adjustment Scale (PAS), respectively. Resilience correlated negatively with self-stigma and positively with stigma resistance and was a predictor for self-stigma/stigma resistance in multiple linear regression analysis. Residual depressive symptoms correlated positively with self-stigma and negatively with stigma resistance. There were no significant correlations between sociodemographic variables, premorbid functioning as well as residual manic symptoms and self-stigma/stigma resistance. The findings of this study implicate that resilience may be considered as an important component of self-stigma reduction interventions.