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Kraiss J, Glaesmer H, Forkmann T, Spangenberg L, Hallensleben N, Schreiber D, Höller I. Beyond one-size-fits-all suicide prediction: Studying idiographic associations of risk factors for suicide in a psychiatric sample using ecological momentary assessment. J Psychiatr Res 2024; 178:130-138. [PMID: 39141992 DOI: 10.1016/j.jpsychires.2024.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/28/2024] [Accepted: 07/31/2024] [Indexed: 08/16/2024]
Abstract
The Interpersonal Psychological Theory of Suicide (IPTS) states that thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness are risk factors for suicidal ideation. This ecological momentary assessment (EMA) study aimed to (1) demonstrate that there is substantial between-person variability in the association between IPTS predictors and suicidal ideation, (2) identify clusters of patients for which the predictors differently predict suicidal ideation, and (3) examine whether identified clusters are characterized by specific patient characteristics. EMA data were collected ten times per day for six days in 74 psychiatric inpatients and was analyzed with dynamic structural equation modelling. Idiographic associations were obtained and clustered using k-means clustering. We found substantial between-person variability in associations between IPTS predictors and suicidal ideation. Four distinct clusters were identified and different risk factors were relevant for different clusters. In the largest cluster (n = 36), none of the IPTS predictors predicted suicidal ideation. Clusters in which associations between IPTS variables and suicidal ideation were stronger showed higher suicidal ideation, depression, and lower positive affect. These findings suggest that a one-size-fits-all model may not adequately reflect idiosyncratic processes leading to suicidal ideation. A promising avenue might be to use idiographic approaches to personalize prediction and interventions.
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Affiliation(s)
- Jannis Kraiss
- Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands.
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Nina Hallensleben
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
| | - Dajana Schreiber
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Inken Höller
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
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Gilbert P. Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well-being. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:453-471. [PMID: 38698734 DOI: 10.1111/bjc.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 05/05/2024]
Abstract
In 1993, the British Journal of Clinical Psychology published my paper titled 'Defence and safety: Their function in social behaviour and psychopathology'. The paper highlights that to understand people's sensitivity to threat, we also need to understand their ability to identify what is safe. This paper offers an update on these concepts, highlighting distinctions that were implicit but not clearly defined at the time. Hence, the paper seeks to clarify distinctions between: (i) threat detection and response, (ii) safety and safety seeking, (iii) safeness and (iv) their social and non-social functions and forms. Threat detection and response are to prevent or minimize harm (e.g., run from a predator or fire). Safety checking relates to monitoring for the absence and avoidance of threat, while safety seeking links to the destination of the defensive behaviour (e.g., running home). Safety seeking also relates to maintaining vigilance to the appearance of potential harms and doing things believed to avoid harm. Threat-defending and safety checking and seeking are regulated primarily through evolved threat processing systems that monitor the nature, presence, controllability and/or absence of threat (e.g., amygdala and sympathetic nervous system). Safeness uses different monitoring systems via different psychophysiological systems (e.g., prefrontal cortex, parasympathetic system) for the presence of internal and external resources that support threat-coping, risk-taking, resource exploration. Creating brain states that recruit safeness processing can impact how standard evidence-based therapies (e.g., exposure, distress tolerance and reappraisal) are experienced and produce long-term change.
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Affiliation(s)
- Paul Gilbert
- Centre of Compassion Research and Training, College of Health and Social Care Research Centre, University of Derby, Derby, UK
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Rainbow C, Tatnell R, Blashki G, Melvin GA. Perceived Usefulness of Self-Guided Versus Collaborative Suicide Safety Plans in Online Help-Seekers. CRISIS 2024; 45:294-300. [PMID: 38319612 DOI: 10.1027/0227-5910/a000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Suicide safety plans were originally devised to be paper-based and clinician-guided, but digital self-guided plans are now common. Aim: This study explored whether plan format (paper vs. digital), assistance (self-authored vs. collaboration), and suicide attempt history were associated with differences in suicidal ideation, suicide-related coping, and perceived usefulness. Method: An online sample of safety plan users (N = 131) completed a survey assessing suicidal ideation, suicide-related coping, and perceived usefulness of their plan. t tests compared outcomes by plan format, collaboration, and suicide attempt history. Pearson correlations explored associations between reasons for plan use, suicidal ideation, and suicide-related coping. Results: Suicidal ideation was significantly higher, and perceived usefulness significantly lower in participants with a past suicide attempt (vs. none) and in those who had collaborated to make their safety plan (vs. self-authored). Collaborators were largely health professionals. No significant differences were found between plan formats. Suicide-related coping was associated with higher perceived usefulness overall. Limitations: Our study design was cross-sectional, utilizing a largely young, female, English-speaking, online help-seeking sample. Conclusions: For clients with prior suicide attempts and higher levels of suicidal ideation, meaningful collaboration may be needed to find safety plan coping strategies that are perceived as useful.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
- Beyond Blue, Melbourne, VIC, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
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Moscardini EH, Breaux EA, Oakey-Frost DN, Tucker RP. Examining aspects of psychological flexibility within the integrated motivational-volitional model of suicidal behavior: A prospective investigation. Suicide Life Threat Behav 2024; 54:425-436. [PMID: 38345177 DOI: 10.1111/sltb.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/31/2023] [Accepted: 01/23/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND According to the integrated motivational-volitional model of suicide, feelings of entrapment are related to the emergence of suicidal ideation (SI). However, this relation can be moderated by certain protective factors. METHODS This study examined whether aspects of psychological flexibility (i.e., experiential avoidance, experiential acceptance, harnessing) moderated the relation between aspects of entrapment and SI severity in college students experiencing SI (N = 553) both cross-sectionally and when SI severity was measured 1 week later (N = 247). RESULTS At baseline, experiential acceptance, but not experiential avoidance or harnessing, significantly moderated the relation between external entrapment and SI severity and internal entrapment and SI severity. No aspects of psychological flexibility prospectively moderated relations between entrapment and SI severity. CONCLUSIONS Aspects of psychological flexibility may influence immediate vulnerability to SI severity among young adults experiencing feelings of entrapment. Implications for clinical interventions influencing changes in psychological flexibility are discussed.
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Ramos-Vera C, Calle D, Quispe-Callo G, Höller I, Forkmann T, Ordoñez-Carrasco J, Čopková R, Lichner V, Lobos-Rivera M, Calizaya-Milla YE, Saintila J. Sex differences in entrapment in a multinational sample: a network analysis perspective. Front Psychiatry 2024; 15:1321207. [PMID: 38863617 PMCID: PMC11165698 DOI: 10.3389/fpsyt.2024.1321207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/22/2024] [Indexed: 06/13/2024] Open
Abstract
Background The concept of entrapment has been highlighted as a transdiagnostic element that manifests itself in disorders such as depression, anxiety, and suicidal ideation. Although research has been conducted in different contexts independently, a comprehensive multi-country study to assess gender differences in entrapment through network analysis has not yet been carried out. The objective of this study was to evaluate the entrapment network in men and women at the multinational level. Methods A sample of 2,949 participants, ranging in age from 18 to 73 years from six countries (Germany, Iran, Spain, Slovakia, El Salvador, and Peru), was considered. They completed the entrapment scale. A network analysis was performed for both men and women to identify the connectivity between indicators and the formation of clusters and domains, in addition to the centrality assessment in both sex groups. Results The study findings revealed the presence of a third domain focused on external interpersonal entrapment in the network of men and women. However, in relation to the interconnectivity between domains, variations were evidenced in both networks, as well as in centrality, it was reported that men present a greater generalized entrapment in various aspects of life, while women tend to experience a more focused entrapment in expressions of intense emotional charge. Conclusion The multinational study identified variations in the structure of entrapment between genders, with three domains (internal, external, and external-interpersonal) and differences in the interaction of indicators and groupings, as well as discrepancies in centrality.
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Affiliation(s)
| | - Dennis Calle
- Área de Investigación, Universidad César Vallejoo, Lima, Peru
| | - Gleni Quispe-Callo
- Escuela de Psicología, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | - Inken Höller
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Psychology and Psychotherapy, Charlotte Fresenius Hochschule, Düsseldorf, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | | | - Radka Čopková
- Faculty of Economics, Technical University of Košice, Košice, Slovakia
| | - Vladimir Lichner
- Department of Social Work, Faculty of Arts, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Marlon Lobos-Rivera
- Escuela de Psicología, Universidad Tecnológica de El Salvador, San Salvador, El Salvador
| | | | - Jacksaint Saintila
- Facultad de Ciencias de la Salud, Universidad Señor de Sipán, Chiclayo, Peru
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Cramer RJ, Robertson RA, Nobles MR, Bowling J, Cacace S, Feinstein BA, Rasmussen S. Entrapment and Defeat Scales: Factor Structure Assessment and Variation by Gender and Sexual Identity among Adults in the United Kingdom. J Pers Assess 2024; 106:254-266. [PMID: 37315196 DOI: 10.1080/00223891.2023.2220400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
Entrapment and defeat are empirically-supported suicide risk factors. Their measurement is the subject of some debate, however. Also, limited work exists examining sexual and gender minority (SGM) differences in these suicide risk factors despite overall elevated rates of suicidal thoughts and behaviors (STBs) for SGM persons. The present study examined (1) entrapment and defeat differences by sexual orientation and gender identity, (2) factor structure and criterion validity of the Entrapment Scale (E-Scale) and the Defeat Scale (D-Scale), and (3) measurement invariance by sexual orientation (subsamples were too small for gender identity). A sample of 1,027 adults living in the United Kingdom completed a cross-sectional online questionnaire assessing mental health. Analysis of Variance and Kruskal-Wallis testing revealed: (1) all sexual minority (i.e., gay/lesbian, bisexual, and other SM) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to their heterosexual counterparts, and; (2) gender minority (i.e., transgender and gender diverse) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to cisgender persons. Supported by suicide theory, confirmatory factor analysis showed modest support for a two-factor E-Scale (internal and external), and a one-factor D-Scale. All entrapment and defeat scores displayed significant moderate positive correlations with suicidal ideation. E- and D-scale scores displayed high intercorrelation, tempering confidence in conclusions regarding the facture structure findings. Item threshold-level responding varied by sexual orientation for the D-Scale but not the E-Scale. Results are discussed with respect to suicide theory and measurement, public health, and clinical practice.
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Affiliation(s)
- Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | - Ryan A Robertson
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | - Matt R Nobles
- Department of Criminal Justice, University of Central Florida
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | - Sam Cacace
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde
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Chabbouh A, Charro E, Al Tekle GA, Soufia M, Hallit S. Psychometric properties of an Arabic translation of the short entrapment scale in a non-clinical sample of young adults. PSICOLOGIA-REFLEXAO E CRITICA 2024; 37:3. [PMID: 38236551 PMCID: PMC10796859 DOI: 10.1186/s41155-024-00286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Entrapment is the feeling of wanting to leave an unbearable situation but believing that there are no options to do so. An Arabic entrapment Scale will assist healthcare professionals in the region in the prevention of suicide as the tool is tailored to the specific sociocultural context, which would enhance entrapment detection. OBJECTIVE In the current study, we aim to evaluate the psychometric properties of a translated Arabic version of the Entrapment Scale Short Form (E-SF). METHODS Three hundred eighty-nine Lebanese citizens were enrolled in this cross-sectional study. RESULTS The mean age of participants was 23.03 years (SD = 2.93), 69.4% being women. To examine the factor structure of the entrapment scale, we used an exploratory-to-confirmatory factor analysis (EFA-to-CFA) strategy. EFA and CFA results indicated that the fit of the unidimensional model of the Arabic Entrapment Scale (A-ES) was generally acceptable. Composite reliability of scores was adequate in the total sample (ω = .87). All indices suggested that configural, metric, and scalar invariance was supported across genders. Entrapment was positively and significantly correlated with suicidal ideation, alcohol use disorder, psychological distress, and orthorexia nervosa, suggesting convergent and divergent validity. CONCLUSION The A-ES was found to be a valid and reliable tool to assess the degree of entrapment in Lebanese young adults. The A-ES will assist healthcare professionals in the region in the prevention of suicide as the tool is tailored to the specific sociocultural context, which would enhance entrapment detection.
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Affiliation(s)
- Alfred Chabbouh
- Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Elie Charro
- Faculty of Medical Sciences, Lebanese University, Hadat, Lebanon
| | - Georges-Alain Al Tekle
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Höller I, Spangenberg L. Study protocol for a feasibility study of microinterventions in smartphone-based assessments to reduce depressive rumination. BMJ Open 2023; 13:e076031. [PMID: 38135315 DOI: 10.1136/bmjopen-2023-076031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Depression as well as suicidal ideation and behaviours share several precipitating and maintaining factors and are subject to the influence of overlapping constructs. One of these transdiagnostic constructs is rumination. For the treatment of rumination, a variety of interventions are already available. However, not everyone with a need receives psychotherapeutic treatment. And even if they do: implementing learnt strategies alone at home can be challenging for patients. Therefore, this study aims to test the feasibility of delivering microinterventions for the reduction of rumination in a smartphone-based setting with the goal to make these interventions accessible to a larger number of people and support their use in everyday life. METHODS AND ANALYSIS The study's design is an uncontrolled-within-group design. Participants with at least mild depressive symptoms and reported rumination will be included and recruited via outpatient clinics as well as in the general population. The aim is to recruit at least N=70 participants. Participants first undergo a short telephone screening, a baseline assessment, a 7-day smartphone-based assessment including microinterventions in case participants report rumination and a postassessment. For feasibility purposes, primary outcomes relate to participants' compliance, their evaluation of the smartphone-based assessment as well as the microinterventions delivered during the assessment. As a secondary goal, clinical utility will be examined. Clinical outcomes (eg, depressive symptoms, rumination) will be measured at baseline and postassessment. ETHICS AND DISSEMINATION The ethics committee of the institute of psychology of the university of Duisburg-Essen and University of Leipzig has approved the study. Study results will be disseminated to healthcare communities, in peer-reviewed science journals and at conferences. TRIAL REGISTRATION NUMBER DRKS00031743.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology and Psychotherapy, Charlotte Fresenius Hochschule, Düsseldorf, Germany
- Department of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig, Germany
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Rasmussen S, Cramer RJ, Nascimbene L, Robertson RA, Cacace S, Bowling J. A qualitative assessment and short-term mediation analysis of defeat, entrapment, and suicide. Suicide Life Threat Behav 2023; 53:880-892. [PMID: 37571915 DOI: 10.1111/sltb.12990] [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: 01/12/2023] [Revised: 04/27/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES The Integrated Motivational-Volitional Model (IMV) of Suicide is growing in empirical support. The present study advances IMV research through two aims: (1) to qualitatively probe the subjective experiences of defeat, internal entrapment, and external entrapment, and (2) conducting a 3-month prospective mediation analysis using quantitative and qualitative metrics of defeat and entrapment. METHODS The study featured an online two-point survey separated by 3 months. Participants were 255 adults living in the United Kingdom. RESULTS Persons endorsing qualitative defeat and internal entrapment in their narratives also showed higher quantitative scores on corresponding IMV and suicide-related self-report scales. Internal entrapment mediated the effect of baseline defeat on 3-month suicidal ideation, whereas external entrapment mediated the association of baseline defeat on 3-month suicide attempt likelihood. Quantitative assessment of entrapment was more significantly associated with suicide attempts and ideation within mediation tests compared to corresponding qualitative variables. CONCLUSIONS IMV model principles are largely supported by findings. Mediation results support further consideration of entrapment and defeat within clinical practice and public health-focused suicide research. Understanding the complexity of entrapment narratives represents an important next step for conducting qualitative IMV-focused research with minoritized and high-risk suicide populations.
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Affiliation(s)
- Susan Rasmussen
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Laura Nascimbene
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Ryan A Robertson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sam Cacace
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Laghaei M, Mehrabizadeh Honarmand M, Jobson L, Abdollahpour Ranjbar H, Habibi Asgarabad M. Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms. BMC Psychiatry 2023; 23:295. [PMID: 37118697 PMCID: PMC10148382 DOI: 10.1186/s12888-023-04699-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 03/20/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Suicidal ideation is a clinical exigency heightening the risk of suicide at different levels of suicidal behavior. This study sought to explore crucial correlates of this phenomenon with a structural equation modeling approach. Accordingly, the mediating role of depressive symptoms and difficulties in emotion regulation between childhood trauma and suicidal ideation were explored. METHOD The sample consisted of 372 university students (57.3% females, M = 20.75, SD = 2.25) who completed self-report measures examining experiences of childhood trauma, depressive symptoms, difficulties in emotion regulation, and suicidal ideation. Structural equation modeling was employed, and mediation analysis was conducted. Confirmatory factor analysis was used to test the measurement model of each construct before evaluating the conceptual mediated model. RESULTS Findings indicate that depressive symptoms with difficulties in emotion regulation had the strongest association (r = 0.60, P = 0.001), then depressive symptoms and suicidal ideation (r = 0.58, P = 0.001), suicidal ideation with difficulties in emotion regulation (r = 0.45, P = 0.001) then suicidal ideation with childhood trauma (r = 0.39, P = 0.001), difficulties in emotion regulation with childhood trauma (r = 0.36 P = 0.001) and finally depressive symptoms and childhood trauma (r = 0.35, P = 0.001). Regarding indirect paths, difficulties in emotion regulation and depression function together (in a sequential path) to mediate the association between childhood trauma and suicidal ideation ( χ2(68) = 216.86, P < 0.01, CFI = 0.95, TLI = 0.93, RMSE = 0.077, CI [0.066 to 0.089], SRMR = 0.049). CONCLUSION Results demonstrate that childhood trauma, depressive symptoms, and difficulties in emotion regulation are linked to suicidal ideation, highlighting the necessity of recognizing and addressing suicidal ideation as well as the factors that contribute to suicidal ideation. Emotion regulation interventions can be effective in reducing the negative effects of childhood trauma and lowering the risk of suicide. These interventions can help in reducing depressive symptoms and improve overall mental well-being, leading to a lower risk of suicide.
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Affiliation(s)
- Marziyeh Laghaei
- Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | | | - Laura Jobson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | | | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Psychology, Norwegian University of Science and Technology, Dragvoll, 7491, Trondheim, Norway.
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
- Positive Youth Development Lab, Human Development & Family Sciences, Texas Tech University, Texas, USA.
- Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran.
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Wang S, Wei T, Zhu R, Li S, Liu X, Cai Y, Gong R. Perceived entrapment predicts first-onset suicidal ideation: A longitudinal study among medical students in China. Front Public Health 2023; 10:1049975. [PMID: 36743178 PMCID: PMC9892625 DOI: 10.3389/fpubh.2022.1049975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction The prevalence of suicidal ideation among medical students is high. Evidence indicates that feelings of entrapment are a predictor of suicidal ideation. In this study, we aimed to (1) investigate the prevalence of first-onset suicidal ideation among Chinese medical students and (2) explore the predictive effects of perceived entrapment on first-onset suicidal ideation. Methods This longitudinal study was conducted between 2018 and 2019 among 211 newly enrolled medical students in Shanghai. Using an anonymous questionnaire, we collected information on sociodemographic (sex, major, parents' income, and academic performance) and psychological (entrapment, depression, loneliness, defeat, social support, and interpersonal needs) variables as well as suicidal ideation. Participants were divided into four subgroups based on their exposure to entrapment (control, new-onset, reduced, and persistent). The primary outcome, first-onset suicidal ideation, was defined as suicidal ideation absent at baseline but present at follow-up. Results In total, 54.98% of participants (116/211) were women, and 76.78% (162/211) majored in clinical medicine. In the follow-up survey, 6.16% of participants (16/211) reported first-onset suicidal ideation, 17.54% (37/211) reported new-onset entrapment, and 12.80% (27/211) reported persistent entrapment during follow-up. Compared with the control group who reported no perceived entrapment at baseline and follow-up, participants who reported new-onset entrapment had the highest risk of new-onset suicidal ideation [odds ratio (OR) = 14.700, 95% confidence interval (CI) = 2.906-74.364; adjusted OR = 8.798; 95% CI = 1.588-48.757; multivariate OR = 8.238, 95% CI = 1.394-48.693). Conclusion New-onset entrapment can significantly predict suicidal ideation. Therefore, greater attention is needed for new-onset entrapment, such as intervention for suicidal ideation.
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Affiliation(s)
- Suping Wang
- Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Wei
- Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Zhu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sicong Li
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Liu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Cai
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Community Health Care, Hospital Development Institute Shanghai Jiao Tong University, Shanghai, China
| | - Ruijie Gong
- Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department Immunization Program, Xuhui Center for Disease Control and Prevention, Shanghai, China
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12
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Oakey-Frost DN, Harris JA, May AM, Bryan AO, Tucker RP, Bryan CJ. Internal entrapment and fearlessness about death as precipitants of suicidal thoughts and planning in the context of post-traumatic stress disorder. Suicide Life Threat Behav 2022; 52:147-158. [PMID: 34738655 DOI: 10.1111/sltb.12815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between post-traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD). METHOD The cross-sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N = 2690). RESULTS Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past-month SI, and past-month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self-rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD. CONCLUSIONS Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE.
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Affiliation(s)
| | - Julia A Harris
- College of Social and Behavioral Sciences, The University of Utah, Salt Lake City, Utah, USA
| | - Alexis M May
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - AnnaBelle O Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Roland L, Höller I, Forkmann T, Glaesmer H, Paashaus L, Schönfelder A, Teismann T, Juckel G, Rath D. Suicidal behavior in the social environment: Does exposure moderate the relationship between an individual's own suicidal ideation and behavior? Clin Psychol Psychother 2022; 29:1309-1320. [PMID: 35005811 DOI: 10.1002/cpp.2709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Suicidal behavior still cannot be sufficiently predicted. Exposure to suicidal behavior in the personal social environment is assumed to moderate the individual's transition from suicidal ideation to suicidal behavior within the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV-model). This study aimed to investigate this moderating effect in a German high-risk sample. METHODS We interviewed 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.9, SD = 14.30) admitted after attempted suicide (53%) or due to an acute suicidal crisis (47%) regarding exposure events in their social environment. Four types of exposure events were analyzed using moderation analyses: familial suicides/suicide attempts, non-familial suicides/suicide attempts. Additionally, the numbers of reported exposure events were compared between patients with and without a recent suicide attempt as well as between patients with lifetime suicide attempts and lifetime suicidal ideation. RESULTS Neither moderating effects of exposure events on the relationship between lifetime suicidal ideation and recent suicidal behavior nor group differences between suicidal ideators and suicide attempters regarding the exposure events were found. CONCLUSIONS Exposure events might have differential and possibly protective effects on suicidal behavior - depending on type and quality (intensity, personal relevance, and recency) of event - and on the outcome (suicide vs. suicide attempt).
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Affiliation(s)
- Lea Roland
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
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