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Goldstein KE, Pietrzak RH, Challman KN, Chu KW, Beck KD, Brenner LA, Interian A, Myers CE, Shafritz KM, Szeszko PR, Goodman M, Haznedar MM, Hazlett EA. Multi-modal risk factors differentiate suicide attempters from ideators in military veterans with major depressive disorder. J Affect Disord 2024:S0165-0327(24)01636-7. [PMID: 39341292 DOI: 10.1016/j.jad.2024.09.149] [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: 03/19/2024] [Revised: 09/16/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND The suicide rate for United States military veterans is 1.5× higher than that of non-veterans. To meaningfully advance suicide prevention efforts, research is needed to delineate factors that differentiate veterans with suicide attempt/s, particularly in high-risk groups, e.g., major depressive disorder (MDD), from those with suicidal ideation (no history of attempt/s). The current study aimed to identify clinical, neurocognitive, and neuroimaging variables that differentiate suicide-severity groups in veterans with MDD. METHODS Sixty-eight veterans with a DSM-5 diagnosis of MDD, including those with no ideation or suicide attempt (N = 21; MDD-SI/SA), ideation-only (N = 17; MDD + SI), and one-or-more suicide attempts (N = 30; MDD + SA; aborted, interrupted, actual attempts), participated in this study. Participants underwent a structured diagnostic interview, neurocognitive assessment, and 3 T-structural/diffusion tensor magnetic-resonance-imaging (MRI). Multinomial logistic regression models were conducted to identify variables that differentiated groups with respect to the severity of suicidal behavior. RESULTS Relative to veterans with MDD-SI/SA, those with MDD + SA had significantly higher left cingulum fractional anisotropy, decreased attentional control on emotional-Stroop, and faster response time with intact accuracy on Go/No-Go. Relative to MDD + SI, MDD + SA had higher left cingulum fractional anisotropy and faster response time with intact accuracy on Go/No-Go. LIMITATIONS Findings are based on retrospective, cross-sectional data and cannot identify causal relationships. Also, a healthy control group was not included given the study's focus on differentiating suicide profiles in MDD. CONCLUSIONS This study suggests that MRI and neurocognition differentiate veterans with MDD along the suicide-risk spectrum and could inform suicide-risk stratification and prevention efforts in veterans and other vulnerable populations.
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Affiliation(s)
- Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert H Pietrzak
- United States Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Katelyn N Challman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Kevin D Beck
- Research Service, VA New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Eastern Colorado Health Care System, Aurora, CO, USA; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Alejandro Interian
- Mental Health and Behavioral Sciences, VA New Jersey Health Care System, Lyons, NJ, USA; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Catherine E Myers
- Research Service, VA New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Keith M Shafritz
- Department of Psychology, Hofstra University, Hempstead, NY, United States of America; Institute of Behavioral Science, Feinstein Institutes of Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA; Mental Health Patient Care Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA; Mental Health Patient Care Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Health Patient Care Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, NY, USA; Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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2
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Keefner T, Minton M. Acquired Capability for Suicide: An Evolutionary Concept Analysis. Issues Ment Health Nurs 2024; 45:734-745. [PMID: 38718381 DOI: 10.1080/01612840.2024.2346594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
While virtually all suicide attempters experience ideations, not all who think about suicide will attempt or die by suicide. The ideation-to-action framework has led to new theories distinguishing suicide ideators from suicide attempters. The framework suggests that suicide progresses on a spectrum of thoughts and behaviors with different identifiers and explanations. The concept of acquired capability for suicide (ACS), conceptualized by the Interpersonal Psychological Theory of Suicide, is the first to explain the movement from ideation to action. This concept analysis of ACS is timely and relevant for greater clarification of the role ACS has in the movement from ideation to action. Rodgers' evolutionary concept analysis method is used. The six-step evolutionary method highlights the concept's attributes, antecedents, and consequences and provides a basis for further inquiry and development rather than a final definition.
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Affiliation(s)
- Tamara Keefner
- Department of Nursing, University of South Dakota, Vermillion, South Dakota, USA
| | - Mary Minton
- South Dakota State University, Brookings, South Dakota, USA
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3
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Wycoff AM, Griffin SA, Helle AC, Haney AM, Watts AL, Trull TJ. The Brief Emotion Dysregulation Scale: Development, Preliminary Validation, and Recommendations for Use. Assessment 2024; 31:335-349. [PMID: 36960725 PMCID: PMC10518026 DOI: 10.1177/10731911231161800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Emotion dysregulation is a multi-faceted, transdiagnostic construct, and its assessment is crucial for characterizing its role in the development, maintenance, and treatment of psychiatric problems. We developed the Brief Emotion Dysregulation Scale (BEDS) to capture four components of emotion dysregulation: sensitivity, lability, reactivity, and consequences. We examined factor structure and construct validity in four independent samples of college students (N = 1,485). We elected to treat consequences as a separate index of problems associated with emotion dysregulation. Exploratory and confirmatory factor analyses did not support the reactivity subscale and instead supported a well-fitting two-factor solution for sensitivity and lability. Multi-group analyses demonstrated strong factorial invariance by gender. The resulting 12-item BEDS includes sensitivity and lability subscales and a separate consequences scale to indicate associated problems. Convergent correlations suggested good construct validity. This provides preliminary support for the BEDS as a brief transdiagnostic screening tool for emotion dysregulation and associated consequences.
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4
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Kirkpatrick RH, Breton E, Biorac A, Munoz DP, Booij L. Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis. Int J Eat Disord 2024; 57:223-248. [PMID: 38041221 DOI: 10.1002/eat.24088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE This study aimed to quantify the prevalence of non-suicidal self-injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so-called prevalence, meta-analysis. METHOD Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot. RESULTS 79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta-analyses on self-injury in EDs to date. Overall prevalence of non-suicidal self-injury was 34.59% (95%CI = 30.49-38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96-30.03%), 41.98% (95%CI = 32.35-51.91%), 36.97% (95%CI = 30.69-43.46%), 21.21% (95%CI = 14.93-28.12%) and 37.65% (95%CI = 28.59-47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies. DISCUSSION Non-suicidal self-injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self-injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self-injury in people with ED, irrespective of specific diagnoses. The method of determining self-injury varied across studies and may limit this study. PUBLIC SIGNIFICANCE This study highlights the prevalence of self-injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self-injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self-injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self-injury.
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Affiliation(s)
- Ryan H Kirkpatrick
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Edith Breton
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, University of Oslo & Oslo University Hospital, Oslo, Norway
| | - Aleksandar Biorac
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated Health and Social Services Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Quebec, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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5
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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6
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Saunokonoko AJ, Mars M, Sattmann-Frese WJ. The significance of the father-daughter relationship to understanding and treating Bulimia Nervosa: a Hermeneutic Phenomenological Study. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2095721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - M. Mars
- Torrens University Australia, Pyrmont, New South Wales, Australia
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7
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Forrest LN, Grilo CM, Udo T. Suicide attempts among people with eating disorders and adverse childhood experiences: Results from a nationally representative sample of adults. Int J Eat Disord 2021; 54:326-335. [PMID: 33372308 DOI: 10.1002/eat.23457] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/06/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE People with eating disorders (EDs) have elevated rates of suicide attempts. A need exists to identify factors that help predict which people with EDs might be at greater risk for suicidal behavior. Adverse childhood experiences (ACEs) are associated with both EDs and with suicide attempts. Thus, the current study examined whether having histories of ACEs and EDs augments lifetime risk for suicide attempts. METHOD This study included 36,146 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III who completed structured diagnostic interviews and answered questions regarding ACEs and suicide attempts. Weighted means, frequencies, and cross-tabulations were computed for prevalence of ACEs and suicide attempts by ED diagnosis. Multiple logistic regression was used to compare risk of lifetime suicide attempts by ED diagnosis and ACE history. RESULTS Prevalence of ACEs among people with EDs was 54.1-67.8%. ACE history and ED diagnosis were associated with elevated odds of experiencing a lifetime suicide attempt (AORs = 4.64-6.45 and 3.20-4.06, respectively). There was no ACE history-by-ED interaction on risk of suicide attempt, regardless of forms of EDs. DISCUSSION ACEs are common among people with EDs and associated significantly with suicide attempts, but ACEs and EDs do not appear to interact to augment risk for suicide attempts. Considering ACE exposure in theoretical models of suicidal behavior in people with and without EDs and in suicide risk assessment and management with people with EDs may prove useful.
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Affiliation(s)
- Lauren N Forrest
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Albany, New York, USA
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8
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Armey MF, Brick L, Schatten HT, Nugent NR, Miller IW. Ecologically assessed affect and suicidal ideation following psychiatric inpatient hospitalization. Gen Hosp Psychiatry 2020; 63:89-96. [PMID: 30297091 PMCID: PMC6581626 DOI: 10.1016/j.genhosppsych.2018.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/18/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Michael F Armey
- Psychosocial Research Program, Butler Hospital, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America.
| | - Leslie Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Heather T Schatten
- Psychosocial Research Program, Butler Hospital, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America; Department of Pediatrics, Alpert Medical School of Brown University, United States of America; Bradley/Hasbro Children's Research Center of Rhode Island Hospital, United States of America
| | - Ivan W Miller
- Psychosocial Research Program, Butler Hospital, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
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9
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Harris CE, Carter S, Powers A, Bradley B. Impulsivity Mediates the Link between Childhood Sexual Abuse and Juvenile Incarceration among Low-Income African American Women. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2019; 30:389-409. [PMID: 34093000 PMCID: PMC8171029 DOI: 10.1080/10926771.2019.1692981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 06/12/2023]
Abstract
A history of childhood trauma has been found to have a robust influence on juvenile delinquency, and evidence suggests that childhood sexual abuse is particularly common among female youth involved in the juvenile justice system. The current study sought to investigate impulsivity as a potential mediator of the relationship between childhood sexual abuse (CSA) and juvenile incarceration amongst a community sample of low-income, urban, African American adult women. Although impulsivity has been studied among justice-involved youth, few studies have examined the influence of impulsivity within the relationship between CSA and juvenile incarceration and no known studies have explored their relationship in community populations of African American women with histories of juvenile incarceration. Results revealed that impulsivity mediated the relationship between CSA and previous juvenile incarceration. As an exploratory analysis, overall emotion dysregulation as well as other facets of emotion dysregulation did not serve as significant mediators in this relationship. These findings suggest that difficulties in impulse control may be one mechanism through which childhood sexual abuse increases risk for juvenile justice system involvement among African American women.
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Affiliation(s)
| | | | | | - Bekh Bradley
- Emory University School of Medicine and Atlanta VA Medical Center
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10
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Direct and indirect associations between perception of childhood trauma and suicidal ideation through emotion dysregulation in males who use heroin. Addict Behav 2019; 98:106011. [PMID: 31233952 DOI: 10.1016/j.addbeh.2019.05.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.
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11
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Hoyos C, Mancini V, Furlong Y, Medford N, Critchley H, Chen W. The role of dissociation and abuse among adolescents who self-harm. Aust N Z J Psychiatry 2019; 53:989-999. [PMID: 31146573 DOI: 10.1177/0004867419851869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Retrospective recall of dissociative symptoms has been found to mediate the association between childhood abuse and deliberate self-harm (DSH) in later life. To disentangle the effect of recall bias, we tested whether dissociation symptoms ascertained during an acute DSH presentation mediates this link. METHOD All participants with DSH were recruited during emergency presentation. Seventy-one individuals aged 11-17 years with overdose (OD) and/or self-injury (SI) participated in semi-structured interviews and psychiatric assessment to measure abuse and dissociation. An age- and gender-matched comparison group of 42 non-psychiatric patients admitted to the same service were also assessed. RESULTS The DSH groups reported significantly higher levels of abuse and dissociation compared to comparison group. Dissociation significantly mediated the association between abuse and DSH. Of the four dissociation subtypes, 'depersonalisation' was the primary mediator. Adolescents with chronic patterns of DSH and the 'OD + SI' self-harm type reported more severe dissociation. CONCLUSION Exposure to abuse significantly increased the risk of DSH in adolescence. This association was mediated by dissociation. Our findings suggest a possible dose-response relationship between dissociation with DSH chronicity and the 'OD + SI' self-harm type, implicating the importance of evaluating dissociation and depersonalisation symptoms as well as abuse exposure in DSH management.
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Affiliation(s)
- Carlos Hoyos
- Child and Adolescent Psychiatry, Solent NHS Trust, Southampton, UK
| | - Vincent Mancini
- Complex Attention and Hyperactivity Disorders Service (CAHDS), Department of Health, Perth, WA, Australia.,Discipline of Psychological Science, The Australian College of Applied Psychology, Sydney, NSW, Australia
| | - Yulia Furlong
- Paediatric Consultation Liaison Service, Perth Children's Hospital, Department of Health, Perth, WA, Australia
| | - Nick Medford
- Lishman Neuropsychiatry Unit, Maudsley & Bethlem Royal Hospitals, London, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Hugo Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - Wai Chen
- Complex Attention and Hyperactivity Disorders Service (CAHDS), Department of Health, Perth, WA, Australia.,Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia
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12
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The role of emotion dysregulation in the relation of childhood trauma to heroin craving in individuals with heroin dependence. Drug Alcohol Depend 2019; 195:132-139. [PMID: 30634108 DOI: 10.1016/j.drugalcdep.2018.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/02/2018] [Accepted: 12/11/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Difficulties in emotion regulation (DER) may be important in heroin craving in individuals with heroin dependence who have experienced childhood trauma (CT). However, no research has been performed on DER in the context of heroin dependence. The aim of this study was to evaluate direct and indirect relations of CT to the subscales of heroin craving (i.e., heroin thoughts and interference, intention to use heroin and control of its consumption, and resistance to thoughts and decisions to use heroin) via DER dimensions in individuals with a DSM diagnosis of heroin dependence. METHODS In a cross-sectional design, 330 males with heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). RESULTS The results revealed that CT had no direct relations to the subscales of heroin craving, but it indirectly was related to all three subscales of heroin craving via one of the DER dimensions named limited access to emotion regulation strategies (Strategies) after adjusting for demographic and clinical factors. CONCLUSIONS The findings suggest that Strategies may be related to heroin craving in individuals with heroin dependence who have CT. This proposes that treatment and prevention attempts focused on training the use of effective emotion regulation strategies may be useful to reduce heroin craving in individuals with heroin dependence who have experienced a history of CT.
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13
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Affiliation(s)
- Mercede Erfanian
- Department of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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14
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Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions. Curr Psychiatry Rep 2017. [PMID: 28624866 DOI: 10.1007/s11920-017-0806-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This paper provides an updated review of the literature on the relationship between psychological trauma exposure, other severe adverse experiences, and eating disorders. RECENT FINDINGS Trauma exposure and other severe adverse experiences (e.g., emotional abuse) in both childhood and adulthood are associated with eating disorders. The relationship between traumatic and other adverse experiences and eating disorders appears to be mediated by emotional and behavioral dysregulation, as well as by cognitive factors such as self-criticism. Biological vulnerabilities may also be relevant to this relationship. Overall, the literature is limited by predominantly cross-sectional designs. There is clear evidence of a correlational relationship between trauma exposure and other severe adverse events, and eating disorders. Both risk and maintenance factor hypotheses have been put forth; however, prospective research testing these hypotheses remains limited. Future research should use prospective designs and focus on trauma-related symptoms (rather than trauma exposure) in order to advance research on risk and maintaining factors for eating disorders and inform treatment directions.
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15
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Glenn CR, Cha CB, Kleiman EM, Nock MK. Understanding Suicide Risk within the Research Domain Criteria (RDoC) Framework: Insights, Challenges, and Future Research Considerations. Clin Psychol Sci 2017; 5:568-592. [PMID: 28670505 PMCID: PMC5487002 DOI: 10.1177/2167702616686854] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Suicide is a leading cause of death worldwide. Prior research has focused primarily on sociodemographic and psychiatric risk factors with little improvement in the prediction or prevention of suicidal behavior over time. The Research Domain Criteria (RDoC) may be an especially useful framework for advancing research in this area. This paper provides a brief and broad overview of research on suicidal behavior relating to each of the RDoC domains-highlighting the RDoC construct(s) where research has focused, construct(s) where research is lacking, and suggestions for future research directions. We also discuss major challenges for suicide research within the RDoC framework, including the intersection of RDoC domains, interaction of domains with the environment, incorporation of developmental stage, integration of distal and proximal processes, and inclusion of suicide-specific constructs. We conclude by underscoring important considerations for future research aimed at using the RDoC framework to study suicidal behavior and other forms of psychopathology.
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Affiliation(s)
- Catherine R. Glenn
- Department of Clinical and Social Sciences in Psychology, University of Rochester
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Pisetsky EM, Crow SJ, Peterson CB. An empirical test of the interpersonal theory of suicide in a heterogeneous eating disorder sample. Int J Eat Disord 2017; 50:162-165. [PMID: 27859487 PMCID: PMC5291819 DOI: 10.1002/eat.22645] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Interpersonal Theory of Suicide (IPTS) model has not been fully tested in a clinical eating disorder (ED) population. METHOD Participants (N = 114) completed questionnaires assessing suicidal ideation (SI), suicide attempts (SA), and constructs of the IPTS. Logistic regressions determined whether thwarted belongingness and perceived burdensomeness were associated with lifetime SI. Among those who endorsed lifetime SI, logistic regressions were used to determine whether elements of the acquired capability for suicide (fearlessness about death and painful and provocative events) were associated with lifetime SA. RESULTS Sixty-five participants (57.0%) had lifetime SI and 24 (21.1%) had lifetime SA. Thwarted belongingness (P < 0.001) and perceived burdensomeness (P < 0.01) were associated with lifetime SI. Painful and provocative events were associated with lifetime SA (P < 0.03). DISCUSSION The IPTS was partially supported. Targeting interpersonal variables may be important in treating and preventing suicidality. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:162-165).
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Affiliation(s)
- Emily M. Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA,The Emily Program, St. Paul, MN, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA,The Emily Program, St. Paul, MN, USA
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Howard R, Karatzias T, Power K, Mahoney A. From Childhood Trauma to Self-Harm: An Investigation of Theoretical Pathways among Female Prisoners. Clin Psychol Psychother 2016; 24:942-951. [DOI: 10.1002/cpp.2058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Ruth Howard
- Edinburgh Napier University, School of Health and Social Care; Edinburgh UK
| | - Thanos Karatzias
- Edinburgh Napier University, School of Health and Social Care; Edinburgh UK
- NHS Lothian, Rivers Centre for Traumatic Stress; Edinburgh UK
| | - Kevin Power
- NHS Tayside, Psychological Therapies Service; Dundee UK
- Stirling University, School of Natural Sciences; Stirling UK
| | - Adam Mahoney
- HMP YOI Cornton Vale, Scottish Prison Service; Stirling UK
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18
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Smith CE, Pisetsky EM, Wonderlich SA, Crosby RD, Mitchell JE, Joiner TE, Bardone-Cone A, Le Grange D, Klein MH, Crow SJ, Peterson CB. Is childhood trauma associated with lifetime suicide attempts in women with bulimia nervosa? Eat Weight Disord 2016; 21:199-204. [PMID: 26462683 PMCID: PMC4833682 DOI: 10.1007/s40519-015-0226-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the association between specific forms of childhood abuse and neglect with lifetime suicide attempts in women with bulimia nervosa (BN). METHODS Two hundred and four women aged 18-65 (mean 25.6 years, SD 9.13) with full or subclinical BN were recruited in five US Midwestern communities and specialized eating disorder clinics. Participants completed questionnaires including the Childhood Trauma Questionnaire (CTQ) and self-reported whether they had ever had a lifetime suicide attempt. Logistic regression analyses were used to predict lifetime suicide attempts from each subscale of the CTQ. RESULTS Childhood emotional, physical, and sexual abuse were significantly associated with the presence of a lifetime suicide attempt in women with BN. Childhood emotional and physical neglect were not associated with suicide attempts. CONCLUSIONS Individuals with BN who have experienced childhood emotional and sexual abuse are at increased risk of a lifetime suicide attempt. Future research is needed to understand the mechanism to address in treatment and prevention efforts. It is important for clinicians to be aware of the potential increased risk of suicide in individuals with BN with a history of childhood abuse.
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Affiliation(s)
- Christina E Smith
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
| | - Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA.
| | - Stephen A Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Ross D Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Anna Bardone-Cone
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Marjorie H Klein
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
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